Career

Presenter: Jordan Messler, MD, SHFM

Summary: The main objective of this lecture was to understand the culture that often limits physician engagement. It also offered insights on how to best understand motivators for engagement, and tried to focus on strategies to improve and create an environment for physician engagement.

Despite strong evidence, there remains a refusal to confront healthcare provider’s severe quality problems. There is a high rate of failure, considering that 80% of major initiatives don’t meet their objectives. Dr. Messler pointed out that the second principle of the "Key Characteristics of an Effective Hospital Medicine Group" is an engaged hospitalist. To make this more complicated, 40% of hospitalists report inpatient census that exceed safe levels at least once a month; and 52% of hospitalists have signs of burnout.

Dr. Messler explained are intrinsic and extrinsic motivators: the culture of the group will impact the extrinsic motivation factors when it tries to encourage physician to do their work because they expected of themselves, not because some else is looking over their shoulders. Among intrinsic motivators: a sense of autonomy, mastery and purpose drives a culture of not only do the work but also improve it. Some hospitalist groups are trying to explore new approaches, including protective time for physicians to allow them to get involved in committee and QI projects.

Applying behavioral economics concepts (science of human motivation) can help HMGs design incentives among such domains as inertia (by simplifying processes), immediacy (giving bonus right after achieving goals), mental accounting (using paper checks for rewards).

HM Takeaways:

• There is lack of awareness of physician disengagement.
• Burn out is the opposite of engagement and affects patient quality.
• There are intrinsic and extrinsic factors that drives engagement.
• By creating a culture of ownership, mastery, autonomy, and rediscovery of purpose and right mix of incentives physicians can engage more.
• SHM has an Engagement Survey that can help get to know baseline motivators driving among specific groups.

Dr. Villagra is a hospitalist in Batesville, Ark., and a member of Team Hospitalist.

 

 

Presenter: Jordan Messler, MD, SHFM

Summary: The main objective of this lecture was to understand the culture that often limits physician engagement. It also offered insights on how to best understand motivators for engagement, and tried to focus on strategies to improve and create an environment for physician engagement.

Despite strong evidence, there remains a refusal to confront healthcare provider’s severe quality problems. There is a high rate of failure, considering that 80% of major initiatives don’t meet their objectives. Dr. Messler pointed out that the second principle of the "Key Characteristics of an Effective Hospital Medicine Group" is an engaged hospitalist. To make this more complicated, 40% of hospitalists report inpatient census that exceed safe levels at least once a month; and 52% of hospitalists have signs of burnout.

Dr. Messler explained are intrinsic and extrinsic motivators: the culture of the group will impact the extrinsic motivation factors when it tries to encourage physician to do their work because they expected of themselves, not because some else is looking over their shoulders. Among intrinsic motivators: a sense of autonomy, mastery and purpose drives a culture of not only do the work but also improve it. Some hospitalist groups are trying to explore new approaches, including protective time for physicians to allow them to get involved in committee and QI projects.

Applying behavioral economics concepts (science of human motivation) can help HMGs design incentives among such domains as inertia (by simplifying processes), immediacy (giving bonus right after achieving goals), mental accounting (using paper checks for rewards).

HM Takeaways:

• There is lack of awareness of physician disengagement.
• Burn out is the opposite of engagement and affects patient quality.
• There are intrinsic and extrinsic factors that drives engagement.
• By creating a culture of ownership, mastery, autonomy, and rediscovery of purpose and right mix of incentives physicians can engage more.
• SHM has an Engagement Survey that can help get to know baseline motivators driving among specific groups.

Dr. Villagra is a hospitalist in Batesville, Ark., and a member of Team Hospitalist.

 

 

Presenter: Jordan Messler, MD, SHFM

Summary: The main objective of this lecture was to understand the culture that often limits physician engagement. It also offered insights on how to best understand motivators for engagement, and tried to focus on strategies to improve and create an environment for physician engagement.

Despite strong evidence, there remains a refusal to confront healthcare provider’s severe quality problems. There is a high rate of failure, considering that 80% of major initiatives don’t meet their objectives. Dr. Messler pointed out that the second principle of the "Key Characteristics of an Effective Hospital Medicine Group" is an engaged hospitalist. To make this more complicated, 40% of hospitalists report inpatient census that exceed safe levels at least once a month; and 52% of hospitalists have signs of burnout.

Dr. Messler explained are intrinsic and extrinsic motivators: the culture of the group will impact the extrinsic motivation factors when it tries to encourage physician to do their work because they expected of themselves, not because some else is looking over their shoulders. Among intrinsic motivators: a sense of autonomy, mastery and purpose drives a culture of not only do the work but also improve it. Some hospitalist groups are trying to explore new approaches, including protective time for physicians to allow them to get involved in committee and QI projects.

Applying behavioral economics concepts (science of human motivation) can help HMGs design incentives among such domains as inertia (by simplifying processes), immediacy (giving bonus right after achieving goals), mental accounting (using paper checks for rewards).

HM Takeaways:

• There is lack of awareness of physician disengagement.
• Burn out is the opposite of engagement and affects patient quality.
• There are intrinsic and extrinsic factors that drives engagement.
• By creating a culture of ownership, mastery, autonomy, and rediscovery of purpose and right mix of incentives physicians can engage more.
• SHM has an Engagement Survey that can help get to know baseline motivators driving among specific groups.

Dr. Villagra is a hospitalist in Batesville, Ark., and a member of Team Hospitalist.

 

 

Presenter: Jim Pile, MD, Cleveland Clinic

Summary: The following three infectious diagnoses are relatively uncommon but important not to miss as they are associated with high mortality, especially when diagnosis and treatment are delayed. Remembering these key points can help you make the diagnosis:

• Bacterial meningitis: Many patients do not have the classic triad—fever, nuchal rigidity, and altered mental status—but nearly all have at least one of these signs, and most have headache. The jolt accentuation test—horizontal movement of the head causing exacerbation of the headache—is more sensitive than nuchal rigidity in these cases. Diagnosis is confirmed by lumbar puncture. It appears safe to not to perform head CT in patients

• Spinal epidural abscess: Risk factors include DM, IV drug use, hemodialysis, UTI, trauma, epidural anesthesia, trauma/surgery. Presentation is acute to indolent and usually consists of four stages: central back pain, radicular pain, neurologic deficits, paralysis; fever variable. Checking ESR can be helpful as it is elevated in most cases. MRI is imaging study of choice. Initial management includes antibiotics to coverage Staph Aureus and gram negative rods and surgery consultation.
• Necrotizing soft tissue infection: Risk factors include DM, IV drug use, trauma/surgery, ETOH, immunosuppression (Type I); muscle trauma, skin integrity deficits (Type II). Clinical suspicion is paramount. Specific clues include: pain out of proportion, anesthesia, systemic toxicity, rapid progression, bullae/crepitus, and failure to respond to antibiotics. Initial management includes initiation of B-lactam/lactamase inhibitor or carbapenem plus clindamycin and MRSA coverage, imaging and prompt surgical consultation (as delayed/inadequate surgery associated with poor prognosis.

Key Takeaway

Clinical suspicion is key to diagnosis of bacterial meningitis, spinal epidural abscesses, and necrotizing soft tissue infections, and delays in diagnosis and treatment are associated with increased mortality.TH

Presenter: Jim Pile, MD, Cleveland Clinic

Summary: The following three infectious diagnoses are relatively uncommon but important not to miss as they are associated with high mortality, especially when diagnosis and treatment are delayed. Remembering these key points can help you make the diagnosis:

• Bacterial meningitis: Many patients do not have the classic triad—fever, nuchal rigidity, and altered mental status—but nearly all have at least one of these signs, and most have headache. The jolt accentuation test—horizontal movement of the head causing exacerbation of the headache—is more sensitive than nuchal rigidity in these cases. Diagnosis is confirmed by lumbar puncture. It appears safe to not to perform head CT in patients

• Spinal epidural abscess: Risk factors include DM, IV drug use, hemodialysis, UTI, trauma, epidural anesthesia, trauma/surgery. Presentation is acute to indolent and usually consists of four stages: central back pain, radicular pain, neurologic deficits, paralysis; fever variable. Checking ESR can be helpful as it is elevated in most cases. MRI is imaging study of choice. Initial management includes antibiotics to coverage Staph Aureus and gram negative rods and surgery consultation.
• Necrotizing soft tissue infection: Risk factors include DM, IV drug use, trauma/surgery, ETOH, immunosuppression (Type I); muscle trauma, skin integrity deficits (Type II). Clinical suspicion is paramount. Specific clues include: pain out of proportion, anesthesia, systemic toxicity, rapid progression, bullae/crepitus, and failure to respond to antibiotics. Initial management includes initiation of B-lactam/lactamase inhibitor or carbapenem plus clindamycin and MRSA coverage, imaging and prompt surgical consultation (as delayed/inadequate surgery associated with poor prognosis.

Key Takeaway

Clinical suspicion is key to diagnosis of bacterial meningitis, spinal epidural abscesses, and necrotizing soft tissue infections, and delays in diagnosis and treatment are associated with increased mortality.TH

Presenter: Jim Pile, MD, Cleveland Clinic

Summary: The following three infectious diagnoses are relatively uncommon but important not to miss as they are associated with high mortality, especially when diagnosis and treatment are delayed. Remembering these key points can help you make the diagnosis:

• Bacterial meningitis: Many patients do not have the classic triad—fever, nuchal rigidity, and altered mental status—but nearly all have at least one of these signs, and most have headache. The jolt accentuation test—horizontal movement of the head causing exacerbation of the headache—is more sensitive than nuchal rigidity in these cases. Diagnosis is confirmed by lumbar puncture. It appears safe to not to perform head CT in patients

• Spinal epidural abscess: Risk factors include DM, IV drug use, hemodialysis, UTI, trauma, epidural anesthesia, trauma/surgery. Presentation is acute to indolent and usually consists of four stages: central back pain, radicular pain, neurologic deficits, paralysis; fever variable. Checking ESR can be helpful as it is elevated in most cases. MRI is imaging study of choice. Initial management includes antibiotics to coverage Staph Aureus and gram negative rods and surgery consultation.
• Necrotizing soft tissue infection: Risk factors include DM, IV drug use, trauma/surgery, ETOH, immunosuppression (Type I); muscle trauma, skin integrity deficits (Type II). Clinical suspicion is paramount. Specific clues include: pain out of proportion, anesthesia, systemic toxicity, rapid progression, bullae/crepitus, and failure to respond to antibiotics. Initial management includes initiation of B-lactam/lactamase inhibitor or carbapenem plus clindamycin and MRSA coverage, imaging and prompt surgical consultation (as delayed/inadequate surgery associated with poor prognosis.

Key Takeaway

Clinical suspicion is key to diagnosis of bacterial meningitis, spinal epidural abscesses, and necrotizing soft tissue infections, and delays in diagnosis and treatment are associated with increased mortality.TH

Presenter: Aziz Ansari, DO, FHM

Summary: With the implementation of ICD-10, correct and specific documentation to ensure proper patient diagnosis categorization has become increasingly important. Hospitalists are urged to understand the impact CDI has on quality and reimbursement.

Quality Impact: Documentation has a direct impact on quality reporting for mortality and complication rates, risk of mortality, as well as severity of illness. Documenting present on admission (POA) also directly impacts the hospital-acquired condition (HAC) classifications.

Reimbursement Impact: Documentation has a direct impact on expected length of stay, case mix index (CMI), cost reporting, and appropriate hospital reimbursement.

HM Takeaways:

• Be clear and specific.
• Document principle diagnosis and secondary diagnoses, and their associated interactions, are critically important.
• Ensure all diagnoses are a part of the discharge summary.
• Avoid saying “History of.”
• It’s OK to document “possible,” “probably,” “likely,” or “suspected.”
• Document “why” the patient has the diagnosis.
• List all differentials, and identify if ruled in or ruled out.
• Indicate acuity, even if obvious.

This presenter also reviewed common CDI opportunities in hospital medicine.

Note: This discussion was specific to the needs of the hospital patient diagnosis and billing, and not related to physician billing and CPT codes.

Presenter: Aziz Ansari, DO, FHM

Summary: With the implementation of ICD-10, correct and specific documentation to ensure proper patient diagnosis categorization has become increasingly important. Hospitalists are urged to understand the impact CDI has on quality and reimbursement.

Quality Impact: Documentation has a direct impact on quality reporting for mortality and complication rates, risk of mortality, as well as severity of illness. Documenting present on admission (POA) also directly impacts the hospital-acquired condition (HAC) classifications.

Reimbursement Impact: Documentation has a direct impact on expected length of stay, case mix index (CMI), cost reporting, and appropriate hospital reimbursement.

HM Takeaways:

• Be clear and specific.
• Document principle diagnosis and secondary diagnoses, and their associated interactions, are critically important.
• Ensure all diagnoses are a part of the discharge summary.
• Avoid saying “History of.”
• It’s OK to document “possible,” “probably,” “likely,” or “suspected.”
• Document “why” the patient has the diagnosis.
• List all differentials, and identify if ruled in or ruled out.
• Indicate acuity, even if obvious.

This presenter also reviewed common CDI opportunities in hospital medicine.

Note: This discussion was specific to the needs of the hospital patient diagnosis and billing, and not related to physician billing and CPT codes.

Presenter: Aziz Ansari, DO, FHM

Summary: With the implementation of ICD-10, correct and specific documentation to ensure proper patient diagnosis categorization has become increasingly important. Hospitalists are urged to understand the impact CDI has on quality and reimbursement.

Quality Impact: Documentation has a direct impact on quality reporting for mortality and complication rates, risk of mortality, as well as severity of illness. Documenting present on admission (POA) also directly impacts the hospital-acquired condition (HAC) classifications.

Reimbursement Impact: Documentation has a direct impact on expected length of stay, case mix index (CMI), cost reporting, and appropriate hospital reimbursement.

HM Takeaways:

• Be clear and specific.
• Document principle diagnosis and secondary diagnoses, and their associated interactions, are critically important.
• Ensure all diagnoses are a part of the discharge summary.
• Avoid saying “History of.”
• It’s OK to document “possible,” “probably,” “likely,” or “suspected.”
• Document “why” the patient has the diagnosis.
• List all differentials, and identify if ruled in or ruled out.
• Indicate acuity, even if obvious.

This presenter also reviewed common CDI opportunities in hospital medicine.

Note: This discussion was specific to the needs of the hospital patient diagnosis and billing, and not related to physician billing and CPT codes.

At #HospMed16 Plenary, the U.S. Surgeon General, Vice Admiral Vivek H. Murthy, MD, MBA, spoke to a standing-room-only crowd about how hospitalists can lead in “Bringing Health to America.”

Dr. Murthy, who previously worked as a hospitalist in Boston, spoke about how the urgency to build a foundation for health in America, where chronic illness and healthcare costs have skyrocketed, could not be any greater. Health is the key to opportunity, he said. He explored the following strategies to make America healthier:

1. Make the pursuit of healthy appealing;
2. Improve the safety of our communities;
3. Focus on the mind and spirit; and,
4. Cultivate our ability to give and receive kindness.

Specifically, hospitalists should contemplate the following questions:

• How can hospitalists leverage their leadership in the hospital to improve systems and create a culture that supports healing and health?
• How can hospitalists be a powerful of force of change both inside and outside the hospital?
• How can hospitalists inspire the next generation of physicians to safeguard the health of their community by treating and preventing illness?

Dr. Murthy challenged hospitalists to commit to strengthening the foundation of health in our country and shift our culture towards the well-being of our communities through prevention.

He left the group by saying, “In the end, the world gets better when people choose to come together to make it better.” TH

At #HospMed16 Plenary, the U.S. Surgeon General, Vice Admiral Vivek H. Murthy, MD, MBA, spoke to a standing-room-only crowd about how hospitalists can lead in “Bringing Health to America.”

Dr. Murthy, who previously worked as a hospitalist in Boston, spoke about how the urgency to build a foundation for health in America, where chronic illness and healthcare costs have skyrocketed, could not be any greater. Health is the key to opportunity, he said. He explored the following strategies to make America healthier:

1. Make the pursuit of healthy appealing;
2. Improve the safety of our communities;
3. Focus on the mind and spirit; and,
4. Cultivate our ability to give and receive kindness.

Specifically, hospitalists should contemplate the following questions:

• How can hospitalists leverage their leadership in the hospital to improve systems and create a culture that supports healing and health?
• How can hospitalists be a powerful of force of change both inside and outside the hospital?
• How can hospitalists inspire the next generation of physicians to safeguard the health of their community by treating and preventing illness?

Dr. Murthy challenged hospitalists to commit to strengthening the foundation of health in our country and shift our culture towards the well-being of our communities through prevention.

He left the group by saying, “In the end, the world gets better when people choose to come together to make it better.” TH

At #HospMed16 Plenary, the U.S. Surgeon General, Vice Admiral Vivek H. Murthy, MD, MBA, spoke to a standing-room-only crowd about how hospitalists can lead in “Bringing Health to America.”

Dr. Murthy, who previously worked as a hospitalist in Boston, spoke about how the urgency to build a foundation for health in America, where chronic illness and healthcare costs have skyrocketed, could not be any greater. Health is the key to opportunity, he said. He explored the following strategies to make America healthier:

1. Make the pursuit of healthy appealing;
2. Improve the safety of our communities;
3. Focus on the mind and spirit; and,
4. Cultivate our ability to give and receive kindness.

Specifically, hospitalists should contemplate the following questions:

• How can hospitalists leverage their leadership in the hospital to improve systems and create a culture that supports healing and health?
• How can hospitalists be a powerful of force of change both inside and outside the hospital?
• How can hospitalists inspire the next generation of physicians to safeguard the health of their community by treating and preventing illness?

Dr. Murthy challenged hospitalists to commit to strengthening the foundation of health in our country and shift our culture towards the well-being of our communities through prevention.

He left the group by saying, “In the end, the world gets better when people choose to come together to make it better.” TH

ATLANTA (Reuters) - Did you get enough sleep last night? If not, you are not alone. More than one out of three American adults do not get enough sleep, according to a study released Thursday from the U.S. Centers for Disease Control and Prevention.

"That's a big problem," says Dr. Nancy Collop, director of the Emory Sleep Center at Emory University School of Medicine in Atlanta, who is familiar with the study. "You don't function as well, your ability to pay attention is reduced, and it can have serious, long term side effects. It can change your metabolism for the worse."

At least seven hours of sleep is considered healthy for an adults aged 18 to 60, according to the American Academy of Sleep Medicine and the Sleep Research Society. The CDC analyzed data from a 2014 survey of 444,306 adults and found roughly 65% of respondents reported getting that amount of

sleep.

"Lifestyle changes such as going to bed at the same time each night; rising at the same time each morning; and turning off or removing televisions, computers, mobile devices from the bedroom, can help people get the healthy sleep they need," said Dr. Wayne Giles, director of the CDC's Division of Population Health, in a statement.

Getting less than seven hours a night is associated with an increased risk of obesity, diabetes, high blood pressure, heart disease, stroke and frequent mental distress, the study shows. Published in the CDC's Morbidity and Mortality Weekly Report, the study is the first of its kind to look at all 50 U.S. states and the District of Columbia.

The study found that among those most likely to get great sleep were married or have a job, with 67% and 65%, respectively saying they get enough. Only 56% of divorced adults said they get enough sleep, and just over half of jobless adults sleep seven hours a night regularly. Among the best sleepers were college graduates, with 72% reporting seven hours or more.

The study found geographical differences as well as ethnic disparities. Hawaiian residents get less sleep than those living in South Dakota, the study found. Non-Hispanic whites sleep better than non-Hispanic black residents, with 67% and 54%, respectively.

ATLANTA (Reuters) - Did you get enough sleep last night? If not, you are not alone. More than one out of three American adults do not get enough sleep, according to a study released Thursday from the U.S. Centers for Disease Control and Prevention.

"That's a big problem," says Dr. Nancy Collop, director of the Emory Sleep Center at Emory University School of Medicine in Atlanta, who is familiar with the study. "You don't function as well, your ability to pay attention is reduced, and it can have serious, long term side effects. It can change your metabolism for the worse."

At least seven hours of sleep is considered healthy for an adults aged 18 to 60, according to the American Academy of Sleep Medicine and the Sleep Research Society. The CDC analyzed data from a 2014 survey of 444,306 adults and found roughly 65% of respondents reported getting that amount of

sleep.

"Lifestyle changes such as going to bed at the same time each night; rising at the same time each morning; and turning off or removing televisions, computers, mobile devices from the bedroom, can help people get the healthy sleep they need," said Dr. Wayne Giles, director of the CDC's Division of Population Health, in a statement.

Getting less than seven hours a night is associated with an increased risk of obesity, diabetes, high blood pressure, heart disease, stroke and frequent mental distress, the study shows. Published in the CDC's Morbidity and Mortality Weekly Report, the study is the first of its kind to look at all 50 U.S. states and the District of Columbia.

The study found that among those most likely to get great sleep were married or have a job, with 67% and 65%, respectively saying they get enough. Only 56% of divorced adults said they get enough sleep, and just over half of jobless adults sleep seven hours a night regularly. Among the best sleepers were college graduates, with 72% reporting seven hours or more.

The study found geographical differences as well as ethnic disparities. Hawaiian residents get less sleep than those living in South Dakota, the study found. Non-Hispanic whites sleep better than non-Hispanic black residents, with 67% and 54%, respectively.

ATLANTA (Reuters) - Did you get enough sleep last night? If not, you are not alone. More than one out of three American adults do not get enough sleep, according to a study released Thursday from the U.S. Centers for Disease Control and Prevention.

"That's a big problem," says Dr. Nancy Collop, director of the Emory Sleep Center at Emory University School of Medicine in Atlanta, who is familiar with the study. "You don't function as well, your ability to pay attention is reduced, and it can have serious, long term side effects. It can change your metabolism for the worse."

At least seven hours of sleep is considered healthy for an adults aged 18 to 60, according to the American Academy of Sleep Medicine and the Sleep Research Society. The CDC analyzed data from a 2014 survey of 444,306 adults and found roughly 65% of respondents reported getting that amount of

sleep.

"Lifestyle changes such as going to bed at the same time each night; rising at the same time each morning; and turning off or removing televisions, computers, mobile devices from the bedroom, can help people get the healthy sleep they need," said Dr. Wayne Giles, director of the CDC's Division of Population Health, in a statement.

Getting less than seven hours a night is associated with an increased risk of obesity, diabetes, high blood pressure, heart disease, stroke and frequent mental distress, the study shows. Published in the CDC's Morbidity and Mortality Weekly Report, the study is the first of its kind to look at all 50 U.S. states and the District of Columbia.

The study found that among those most likely to get great sleep were married or have a job, with 67% and 65%, respectively saying they get enough. Only 56% of divorced adults said they get enough sleep, and just over half of jobless adults sleep seven hours a night regularly. Among the best sleepers were college graduates, with 72% reporting seven hours or more.

The study found geographical differences as well as ethnic disparities. Hawaiian residents get less sleep than those living in South Dakota, the study found. Non-Hispanic whites sleep better than non-Hispanic black residents, with 67% and 54%, respectively.

The demand for training in healthcare quality and patient safety, for both medical students and residents, has never been higher. The Quality and Safety Educators Academy (QSEA, sites.hospitalmedicine.org/qsea) responds to that demand by providing medical educators with the knowledge and tools to integrate quality improvement and safety concepts into their curricula.

Sponsored by the Society of Hospital Medicine (SHM) and the Alliance for Academic Internal Medicine (AAIM), QSEA 2016 is a two-and-a-half-day course designed as a faculty development program. This year, QSEA will be held at Tempe Mission Palms Hotel and Conference Center in Tempe, Ariz., from May 23 to 25.

Attendees will enjoy a hands-on, interactive learning environment with a 10-to-1 student-to-faculty ratio. Participants will develop a professional network and leave with a tool kit of educational resources and curricular tools for quality and safety education.

Think QSEA is for you? Make plans to attend now if you are:

• A program director or assistant program director interested in acquiring new curricular ideas to help meet the ACGME requirements, which require residency programs to integrate quality and safety in their curriculum
• A medical school leader or clerkship director developing quality and safety curricula for students
• A faculty member beginning a new role or expanding an existing role in quality and safety education
• A quality and safety leader who wishes to extend influence and effectiveness by learning strategies to teach and engage trainees

QSEA has sold out each of the past four years, so don’t delay. Register online at sites.hospitalmedicine.org/qsea/register.html or via phone at 800-843-3360. Questions? Email [email protected]. TH

---

Brett Radler is SHM’s communications coordinator.

The demand for training in healthcare quality and patient safety, for both medical students and residents, has never been higher. The Quality and Safety Educators Academy (QSEA, sites.hospitalmedicine.org/qsea) responds to that demand by providing medical educators with the knowledge and tools to integrate quality improvement and safety concepts into their curricula.

Sponsored by the Society of Hospital Medicine (SHM) and the Alliance for Academic Internal Medicine (AAIM), QSEA 2016 is a two-and-a-half-day course designed as a faculty development program. This year, QSEA will be held at Tempe Mission Palms Hotel and Conference Center in Tempe, Ariz., from May 23 to 25.

Attendees will enjoy a hands-on, interactive learning environment with a 10-to-1 student-to-faculty ratio. Participants will develop a professional network and leave with a tool kit of educational resources and curricular tools for quality and safety education.

Think QSEA is for you? Make plans to attend now if you are:

• A program director or assistant program director interested in acquiring new curricular ideas to help meet the ACGME requirements, which require residency programs to integrate quality and safety in their curriculum
• A medical school leader or clerkship director developing quality and safety curricula for students
• A faculty member beginning a new role or expanding an existing role in quality and safety education
• A quality and safety leader who wishes to extend influence and effectiveness by learning strategies to teach and engage trainees

QSEA has sold out each of the past four years, so don’t delay. Register online at sites.hospitalmedicine.org/qsea/register.html or via phone at 800-843-3360. Questions? Email [email protected]. TH

---

Brett Radler is SHM’s communications coordinator.

The demand for training in healthcare quality and patient safety, for both medical students and residents, has never been higher. The Quality and Safety Educators Academy (QSEA, sites.hospitalmedicine.org/qsea) responds to that demand by providing medical educators with the knowledge and tools to integrate quality improvement and safety concepts into their curricula.

Sponsored by the Society of Hospital Medicine (SHM) and the Alliance for Academic Internal Medicine (AAIM), QSEA 2016 is a two-and-a-half-day course designed as a faculty development program. This year, QSEA will be held at Tempe Mission Palms Hotel and Conference Center in Tempe, Ariz., from May 23 to 25.

Attendees will enjoy a hands-on, interactive learning environment with a 10-to-1 student-to-faculty ratio. Participants will develop a professional network and leave with a tool kit of educational resources and curricular tools for quality and safety education.

Think QSEA is for you? Make plans to attend now if you are:

• A program director or assistant program director interested in acquiring new curricular ideas to help meet the ACGME requirements, which require residency programs to integrate quality and safety in their curriculum
• A medical school leader or clerkship director developing quality and safety curricula for students
• A faculty member beginning a new role or expanding an existing role in quality and safety education
• A quality and safety leader who wishes to extend influence and effectiveness by learning strategies to teach and engage trainees

QSEA has sold out each of the past four years, so don’t delay. Register online at sites.hospitalmedicine.org/qsea/register.html or via phone at 800-843-3360. Questions? Email [email protected]. TH

---

Brett Radler is SHM’s communications coordinator.

NEW YORK (Reuters Health) - Implementation of a patient-centered medical home (PCMH) resulted in small changes in utilization patterns and modest quality improvements over a three-year period, according to a new report.

Dr. Lisa M. Kern of Weill Cornell Medical College in New York City and colleagues found more primary care visits, fewer specialist visits, fewer lab and radiologic tests, and fewer hospitalizations and rehospitalizations in the practices that adopted the PCMH.

Most changes occurred in the last year of the study, three years after PCMH implementation, they report in the Annals of Internal Medicine, online February 15.

The PCMH model "attempts to shift the medical paradigm from care for individual patients to care for populations, from care by physicians to care by a team of providers, from a focus on acute illness to an emphasis on chronic disease management, and from care at a single site to coordinated care across providers and settings," Dr. Kern and her team write. However, they add, studies looking at the effectiveness of the approach have had mixed results.

To date, most studies attempting to look at PCMH have had follow-up periods lasting just 1.5 to 2 years after implementation, the researchers note. "These changes take time, and studies with relatively short follow-up may have underestimated the effects of the intervention," they add.

The new study included 438 primary care physicians in 226 practices with more than 136,000 patients enrolled in five health plans. Insurers offered incentives of $2 to $10 per patient per month to practices that achieved level III PCMH recognition from the National Committee for Quality Assurance

(NCQA).

Twelve practices including 125 physicians volunteered for the PCMH initiative, and were assisted by two outside consulting groups. All of these practices achieved level III PCMH recognition. Among the remaining physicians, 87 doctors in 45 practices adopted electronic health records (EHR) without the

PCMH intervention, and 226 physicians in 169 practices continued using paper records.

For the eight quality measures the researchers looked at, two showed greater improvements over time in the PCMH group compared to one or both of the control groups: eye examination and hemoglobin A1c testing for patients with diabetes.

From 2008 to 2012, the PCMH group showed improvements over the paper group and the EHR group for six of seven utilization measures.

NCQA recognition was one aspect of the PCMH intervention in the new study, but this doesn't represent the entire intervention, Dr. Mark W. Friedberg of RAND Corporation and Brigham and Women's Hospital in Boston, who wrote an editorial accompanying the study, told Reuters Health.

"What they evaluated was a different way of paying practices, combined with some technical assistance, combined with some shared savings in the last year of the pilot," Dr. Friedberg explained. And this also requires defining what improving care means, he added, for example "better technical quality of care, better patient experience, better effectiveness of care, better professional satisfaction and lower burnout for people working in the practices. It's also hard to measure all of those, and most studies don't."

The new study is well done, according to Dr. Friedberg, but the challenge will be to understand how it fits in with the rest of the medical home literature, he said. "There's a lot of trials still out there and the results are still coming in, including some very large Medicare medical home pilots. I think we'll have a much better sense of what works in a year or two as those results come back."

Dr. Kern did not respond to an interview request by press time.

 

The study was funded by The Commonwealth Fund and the New York State Department of Health.

 

 

 

 

 

 

 

 

 

 

 

NEW YORK (Reuters Health) - Implementation of a patient-centered medical home (PCMH) resulted in small changes in utilization patterns and modest quality improvements over a three-year period, according to a new report.

Dr. Lisa M. Kern of Weill Cornell Medical College in New York City and colleagues found more primary care visits, fewer specialist visits, fewer lab and radiologic tests, and fewer hospitalizations and rehospitalizations in the practices that adopted the PCMH.

Most changes occurred in the last year of the study, three years after PCMH implementation, they report in the Annals of Internal Medicine, online February 15.

The PCMH model "attempts to shift the medical paradigm from care for individual patients to care for populations, from care by physicians to care by a team of providers, from a focus on acute illness to an emphasis on chronic disease management, and from care at a single site to coordinated care across providers and settings," Dr. Kern and her team write. However, they add, studies looking at the effectiveness of the approach have had mixed results.

To date, most studies attempting to look at PCMH have had follow-up periods lasting just 1.5 to 2 years after implementation, the researchers note. "These changes take time, and studies with relatively short follow-up may have underestimated the effects of the intervention," they add.

The new study included 438 primary care physicians in 226 practices with more than 136,000 patients enrolled in five health plans. Insurers offered incentives of $2 to $10 per patient per month to practices that achieved level III PCMH recognition from the National Committee for Quality Assurance

(NCQA).

Twelve practices including 125 physicians volunteered for the PCMH initiative, and were assisted by two outside consulting groups. All of these practices achieved level III PCMH recognition. Among the remaining physicians, 87 doctors in 45 practices adopted electronic health records (EHR) without the

PCMH intervention, and 226 physicians in 169 practices continued using paper records.

For the eight quality measures the researchers looked at, two showed greater improvements over time in the PCMH group compared to one or both of the control groups: eye examination and hemoglobin A1c testing for patients with diabetes.

From 2008 to 2012, the PCMH group showed improvements over the paper group and the EHR group for six of seven utilization measures.

NCQA recognition was one aspect of the PCMH intervention in the new study, but this doesn't represent the entire intervention, Dr. Mark W. Friedberg of RAND Corporation and Brigham and Women's Hospital in Boston, who wrote an editorial accompanying the study, told Reuters Health.

"What they evaluated was a different way of paying practices, combined with some technical assistance, combined with some shared savings in the last year of the pilot," Dr. Friedberg explained. And this also requires defining what improving care means, he added, for example "better technical quality of care, better patient experience, better effectiveness of care, better professional satisfaction and lower burnout for people working in the practices. It's also hard to measure all of those, and most studies don't."

The new study is well done, according to Dr. Friedberg, but the challenge will be to understand how it fits in with the rest of the medical home literature, he said. "There's a lot of trials still out there and the results are still coming in, including some very large Medicare medical home pilots. I think we'll have a much better sense of what works in a year or two as those results come back."

Dr. Kern did not respond to an interview request by press time.

 

The study was funded by The Commonwealth Fund and the New York State Department of Health.

 

 

 

 

 

 

 

 

 

 

 

NEW YORK (Reuters Health) - Implementation of a patient-centered medical home (PCMH) resulted in small changes in utilization patterns and modest quality improvements over a three-year period, according to a new report.

Dr. Lisa M. Kern of Weill Cornell Medical College in New York City and colleagues found more primary care visits, fewer specialist visits, fewer lab and radiologic tests, and fewer hospitalizations and rehospitalizations in the practices that adopted the PCMH.

Most changes occurred in the last year of the study, three years after PCMH implementation, they report in the Annals of Internal Medicine, online February 15.

The PCMH model "attempts to shift the medical paradigm from care for individual patients to care for populations, from care by physicians to care by a team of providers, from a focus on acute illness to an emphasis on chronic disease management, and from care at a single site to coordinated care across providers and settings," Dr. Kern and her team write. However, they add, studies looking at the effectiveness of the approach have had mixed results.

To date, most studies attempting to look at PCMH have had follow-up periods lasting just 1.5 to 2 years after implementation, the researchers note. "These changes take time, and studies with relatively short follow-up may have underestimated the effects of the intervention," they add.

The new study included 438 primary care physicians in 226 practices with more than 136,000 patients enrolled in five health plans. Insurers offered incentives of $2 to $10 per patient per month to practices that achieved level III PCMH recognition from the National Committee for Quality Assurance

(NCQA).

Twelve practices including 125 physicians volunteered for the PCMH initiative, and were assisted by two outside consulting groups. All of these practices achieved level III PCMH recognition. Among the remaining physicians, 87 doctors in 45 practices adopted electronic health records (EHR) without the

PCMH intervention, and 226 physicians in 169 practices continued using paper records.

For the eight quality measures the researchers looked at, two showed greater improvements over time in the PCMH group compared to one or both of the control groups: eye examination and hemoglobin A1c testing for patients with diabetes.

From 2008 to 2012, the PCMH group showed improvements over the paper group and the EHR group for six of seven utilization measures.

NCQA recognition was one aspect of the PCMH intervention in the new study, but this doesn't represent the entire intervention, Dr. Mark W. Friedberg of RAND Corporation and Brigham and Women's Hospital in Boston, who wrote an editorial accompanying the study, told Reuters Health.

"What they evaluated was a different way of paying practices, combined with some technical assistance, combined with some shared savings in the last year of the pilot," Dr. Friedberg explained. And this also requires defining what improving care means, he added, for example "better technical quality of care, better patient experience, better effectiveness of care, better professional satisfaction and lower burnout for people working in the practices. It's also hard to measure all of those, and most studies don't."

The new study is well done, according to Dr. Friedberg, but the challenge will be to understand how it fits in with the rest of the medical home literature, he said. "There's a lot of trials still out there and the results are still coming in, including some very large Medicare medical home pilots. I think we'll have a much better sense of what works in a year or two as those results come back."

Dr. Kern did not respond to an interview request by press time.

 

The study was funded by The Commonwealth Fund and the New York State Department of Health.

 

 

 

 

 

 

 

 

 

 

 

(Reuters Health) - Medicaid, the U.S. health program for the poor, pays far less for common surgical procedures in many states than does Medicare, the federal insurance plan for the elderly, according to a new study.

Some of the discounts are so steep that they may threaten access to care, the authors argue.

Medicaid is the biggest public health program in the U.S. and currently accounts for about $1 out of every $6 spent on medical care. Medicaid expenditures also represent almost half of all federal funds spent by states.

When Medicaid fees are too low relative to payments from Medicare, doctors may refuse to treat Medicaid patients, potentially making it much harder for poor people to get treatment, argue Dr. Charles Mabry of the University of Arkansas in Little Rock and colleagues in a paper released online January 13 in the Journal of the American College of Surgeons.

"Lack of proper payment can cause some Medicaid patients to have needed surgical procedures delayed," Mabry told Reuters Health by email. "Our hope was that by researching and publishing on these wide variations in payment, it would spur states to rethink the methodology for how they determine payment."

Even though the federal government picks up part of the tab for care, Medicaid payment rates as well as enrollment eligibility and covered benefits are determined by individual states.

To assess the degree of variation between Medicare and Medicaid payments for surgery, Mabry and colleagues calculated how much fees varied for some of the most common procedures done by general surgeons in nearly every state across the country.

The analysis excluded only Kansas and Tennessee.

The largest discount they found was in New Jersey, where Medicaid paid $1,011 (about 933 euros) less than Medicare for surgery to remove all or part of the small intestine.

At the other extreme, the biggest premium was in Alaska, which paid $1,382 more for insertion of a tunneled central venous port under Medicaid than Medicare would pay for the procedure.

When they looked at mastectomy, Medicaid paid $226.47 in Connecticut, 69% less than the $725.35 Medicare payment for the same procedure in the same state.

For an enterectomy, New Jersey's Medicaid payment of $332 was 75% less than the $1,343.16 payment under Medicare.

To fix a ventral hernia, Medicaid in New Hampshire pays $300, 61% less than the $762.28 Medicare payment in the state.

The analysis has several limitations, including the narrow focus on a handful of surgical procedures and the reliance on published payment schedules in each state, which may not necessarily reflect what surgeons actually get paid, the authors note. The analysis also lacked data on certain bulk payments or additional funds paid by Medicaid that might minimize the apparent discounts in some cases.

The paper didn't examine how access to care might be adversely affected by steep discounts in Medicaid payments relative to Medicare or private insurance. But, the authors conclude, it's likely some people struggle to find surgeons or experience delays in care as a direct result of low fees that motivate doctors to refuse Medicaid patients.

One woman with sickle-cell disease and Medicaid coverage is a case-in-point for Dr. Constantine Manthous, who retired from Yale University and works in private practice in New London, Connecticut.

He recalled meeting her after she had spent a decade in a wheelchair because she couldn't find a surgeon to repair her hip. She didn't receive surgery until the hip fell out of its socket, requiring constant hospitalization and morphine.

"By that time she was so ill she died of late complications from the decade delay," Manthous, who wasn't involved in the study, said by email. "You and I would have gotten the hip immediately."

 

 

 

 

 

 

 

 

 

 

 

(Reuters Health) - Medicaid, the U.S. health program for the poor, pays far less for common surgical procedures in many states than does Medicare, the federal insurance plan for the elderly, according to a new study.

Some of the discounts are so steep that they may threaten access to care, the authors argue.

Medicaid is the biggest public health program in the U.S. and currently accounts for about $1 out of every $6 spent on medical care. Medicaid expenditures also represent almost half of all federal funds spent by states.

When Medicaid fees are too low relative to payments from Medicare, doctors may refuse to treat Medicaid patients, potentially making it much harder for poor people to get treatment, argue Dr. Charles Mabry of the University of Arkansas in Little Rock and colleagues in a paper released online January 13 in the Journal of the American College of Surgeons.

"Lack of proper payment can cause some Medicaid patients to have needed surgical procedures delayed," Mabry told Reuters Health by email. "Our hope was that by researching and publishing on these wide variations in payment, it would spur states to rethink the methodology for how they determine payment."

Even though the federal government picks up part of the tab for care, Medicaid payment rates as well as enrollment eligibility and covered benefits are determined by individual states.

To assess the degree of variation between Medicare and Medicaid payments for surgery, Mabry and colleagues calculated how much fees varied for some of the most common procedures done by general surgeons in nearly every state across the country.

The analysis excluded only Kansas and Tennessee.

The largest discount they found was in New Jersey, where Medicaid paid $1,011 (about 933 euros) less than Medicare for surgery to remove all or part of the small intestine.

At the other extreme, the biggest premium was in Alaska, which paid $1,382 more for insertion of a tunneled central venous port under Medicaid than Medicare would pay for the procedure.

When they looked at mastectomy, Medicaid paid $226.47 in Connecticut, 69% less than the $725.35 Medicare payment for the same procedure in the same state.

For an enterectomy, New Jersey's Medicaid payment of $332 was 75% less than the $1,343.16 payment under Medicare.

To fix a ventral hernia, Medicaid in New Hampshire pays $300, 61% less than the $762.28 Medicare payment in the state.

The analysis has several limitations, including the narrow focus on a handful of surgical procedures and the reliance on published payment schedules in each state, which may not necessarily reflect what surgeons actually get paid, the authors note. The analysis also lacked data on certain bulk payments or additional funds paid by Medicaid that might minimize the apparent discounts in some cases.

The paper didn't examine how access to care might be adversely affected by steep discounts in Medicaid payments relative to Medicare or private insurance. But, the authors conclude, it's likely some people struggle to find surgeons or experience delays in care as a direct result of low fees that motivate doctors to refuse Medicaid patients.

One woman with sickle-cell disease and Medicaid coverage is a case-in-point for Dr. Constantine Manthous, who retired from Yale University and works in private practice in New London, Connecticut.

He recalled meeting her after she had spent a decade in a wheelchair because she couldn't find a surgeon to repair her hip. She didn't receive surgery until the hip fell out of its socket, requiring constant hospitalization and morphine.

"By that time she was so ill she died of late complications from the decade delay," Manthous, who wasn't involved in the study, said by email. "You and I would have gotten the hip immediately."

 

 

 

 

 

 

 

 

 

 

 

(Reuters Health) - Medicaid, the U.S. health program for the poor, pays far less for common surgical procedures in many states than does Medicare, the federal insurance plan for the elderly, according to a new study.

Some of the discounts are so steep that they may threaten access to care, the authors argue.

Medicaid is the biggest public health program in the U.S. and currently accounts for about $1 out of every $6 spent on medical care. Medicaid expenditures also represent almost half of all federal funds spent by states.

When Medicaid fees are too low relative to payments from Medicare, doctors may refuse to treat Medicaid patients, potentially making it much harder for poor people to get treatment, argue Dr. Charles Mabry of the University of Arkansas in Little Rock and colleagues in a paper released online January 13 in the Journal of the American College of Surgeons.

"Lack of proper payment can cause some Medicaid patients to have needed surgical procedures delayed," Mabry told Reuters Health by email. "Our hope was that by researching and publishing on these wide variations in payment, it would spur states to rethink the methodology for how they determine payment."

Even though the federal government picks up part of the tab for care, Medicaid payment rates as well as enrollment eligibility and covered benefits are determined by individual states.

To assess the degree of variation between Medicare and Medicaid payments for surgery, Mabry and colleagues calculated how much fees varied for some of the most common procedures done by general surgeons in nearly every state across the country.

The analysis excluded only Kansas and Tennessee.

The largest discount they found was in New Jersey, where Medicaid paid $1,011 (about 933 euros) less than Medicare for surgery to remove all or part of the small intestine.

At the other extreme, the biggest premium was in Alaska, which paid $1,382 more for insertion of a tunneled central venous port under Medicaid than Medicare would pay for the procedure.

When they looked at mastectomy, Medicaid paid $226.47 in Connecticut, 69% less than the $725.35 Medicare payment for the same procedure in the same state.

For an enterectomy, New Jersey's Medicaid payment of $332 was 75% less than the $1,343.16 payment under Medicare.

To fix a ventral hernia, Medicaid in New Hampshire pays $300, 61% less than the $762.28 Medicare payment in the state.

The analysis has several limitations, including the narrow focus on a handful of surgical procedures and the reliance on published payment schedules in each state, which may not necessarily reflect what surgeons actually get paid, the authors note. The analysis also lacked data on certain bulk payments or additional funds paid by Medicaid that might minimize the apparent discounts in some cases.

The paper didn't examine how access to care might be adversely affected by steep discounts in Medicaid payments relative to Medicare or private insurance. But, the authors conclude, it's likely some people struggle to find surgeons or experience delays in care as a direct result of low fees that motivate doctors to refuse Medicaid patients.

One woman with sickle-cell disease and Medicaid coverage is a case-in-point for Dr. Constantine Manthous, who retired from Yale University and works in private practice in New London, Connecticut.

He recalled meeting her after she had spent a decade in a wheelchair because she couldn't find a surgeon to repair her hip. She didn't receive surgery until the hip fell out of its socket, requiring constant hospitalization and morphine.

"By that time she was so ill she died of late complications from the decade delay," Manthous, who wasn't involved in the study, said by email. "You and I would have gotten the hip immediately."

 

 

 

 

 

 

 

 

 

 

 

Mary Kathryn Anania, MD, has been appointed as hospitalist medical director at Florida Hospital Flagler in Palm Coast. Dr. Anania previously served as a hospitalist at Florida Hospital Memorial Medical Center in Daytona Beach. As Flagler medical director, Dr. Anania will oversee 11 hospitalists.

 

 

Zeshan Anwar, MD, is the new medical director of the hospitalist group at Evangelical Community Hospital in Lewisburg, Pa. Before arriving at Evangelical as a hospitalist in 2013, Dr. Anwar served as a hospitalist at Lock Haven Hospital in Linden, Pa., where he was also chair of the quality improvement committee and a physician advisor.

Roberto de la Cruz, MD, has been appointed as chief medical officer for Parkland Health & Hospital System in Dallas. Dr. de la Cruz previously held the position of hospitalist division chief at Parkland, and he served on Parkland’s board of managers from 2011 to 2013. He also is an assistant professor of internal medicine at University of Texas Southwestern Medical Center.

 

Janet Meckley, MD, recently was awarded the Paul S. Rhoads, MD, Humanity in Medicine Award by Reid Health in Richmond, Ind. Dr. Meckley served as a hospitalist from 2009 until 2015, when she decided to return to private practice. The Rhoads award recognizes compassionate patient and family care as well as community healthcare involvement.

 

Deshini Moonesinghe, MD, is the new senior vice president and chief medical officer for the Howard Region of Community Howard Regional Health in Kokomo, Ind. Dr. Moonesinghe spearheaded the foundation of Community Howard’s hospitalist program in 2010, and she currently serves as lead hospitalist of the health system. Dr. Moonesinghe received Community Howard’s Physician of the Year Award in 2014.

Mark V. Williams, MD, MHM, recently was named to the advisory board of The Joint Commission Journal on Quality and Patient Safety. Dr. Williams is a professor and the vice chair of the Department of Internal Medicine at the University of Kentucky in Lexington. Dr. Williams founded the hospitalist program at Grady Memorial Hospital in Atlanta and the academic hospitalist programs at Emory and Northwestern universities. He is a founding editor of the Journal of Hospital Medicine and a past president of SHM.

John Zachem, DO, received the 2015 North Star Award from St. Charles Health System in Bend, Ore. Dr. Zachem led the charge in forming the first hospitalist program at St. Charles in 2006, where he has practiced since. According to the health system, the North Star Award recognizes a local physician who practices “compassionate patient care, professionalism, and a commitment to improving the lives of Central Oregonians.”

Business Deals

ApolloMed Hospitalists, a management group affiliated with the Glendale, Calif.–based Apollo Medical Holdings, Inc., has partnered with Allied Pacific of California IPA, an independent practice association based in Alhambra, Calif. Allied Pacific already manages inpatient admissions at five AHMC Healthcare hospitals in Southern California, plus two others, and ApolloMed Hospitalists will handle staffing physicians at these seven. ApolloMed Hospitalists was founded in 2001.

Sound Physicians, a private hospital medicine staffing company based in Tacoma, Wash., recently contracted to provide hospitalist services at the following institutions: Mercy Health—Fairfield Hospital in Fairfield, Ohio; Natividad Medical Center in Salinas, Calif.; Skagit Valley Hospital in Mt. Vernon, Wash.; and St. Elizabeth Youngstown Hospital in Youngstown, Ohio. Sound Physicians manages hospitalist physicians in 35 states in the U.S.

Sound Physicians is celebrating with one of its partner hospitals, OSF St. Francis Hospital in Escanaba, Mich., which was recently named one of The Leapfrog Group’s Top Hospitals in the U.S. for the fourth consecutive year. Sound Physicians manages OSF St. Francis’s hospitalist physicians and oversees more than half of the hospital’s total inpatient admissions. The Leapfrog Group’s Top Hospitals list is compiled from survey results based on Leapfrog’s quality and safety standards.

 

---

Michael O’Neal is a freelance writer in New York City.

Mary Kathryn Anania, MD, has been appointed as hospitalist medical director at Florida Hospital Flagler in Palm Coast. Dr. Anania previously served as a hospitalist at Florida Hospital Memorial Medical Center in Daytona Beach. As Flagler medical director, Dr. Anania will oversee 11 hospitalists.

 

 

Zeshan Anwar, MD, is the new medical director of the hospitalist group at Evangelical Community Hospital in Lewisburg, Pa. Before arriving at Evangelical as a hospitalist in 2013, Dr. Anwar served as a hospitalist at Lock Haven Hospital in Linden, Pa., where he was also chair of the quality improvement committee and a physician advisor.

Roberto de la Cruz, MD, has been appointed as chief medical officer for Parkland Health & Hospital System in Dallas. Dr. de la Cruz previously held the position of hospitalist division chief at Parkland, and he served on Parkland’s board of managers from 2011 to 2013. He also is an assistant professor of internal medicine at University of Texas Southwestern Medical Center.

 

Janet Meckley, MD, recently was awarded the Paul S. Rhoads, MD, Humanity in Medicine Award by Reid Health in Richmond, Ind. Dr. Meckley served as a hospitalist from 2009 until 2015, when she decided to return to private practice. The Rhoads award recognizes compassionate patient and family care as well as community healthcare involvement.

 

Deshini Moonesinghe, MD, is the new senior vice president and chief medical officer for the Howard Region of Community Howard Regional Health in Kokomo, Ind. Dr. Moonesinghe spearheaded the foundation of Community Howard’s hospitalist program in 2010, and she currently serves as lead hospitalist of the health system. Dr. Moonesinghe received Community Howard’s Physician of the Year Award in 2014.

Mark V. Williams, MD, MHM, recently was named to the advisory board of The Joint Commission Journal on Quality and Patient Safety. Dr. Williams is a professor and the vice chair of the Department of Internal Medicine at the University of Kentucky in Lexington. Dr. Williams founded the hospitalist program at Grady Memorial Hospital in Atlanta and the academic hospitalist programs at Emory and Northwestern universities. He is a founding editor of the Journal of Hospital Medicine and a past president of SHM.

John Zachem, DO, received the 2015 North Star Award from St. Charles Health System in Bend, Ore. Dr. Zachem led the charge in forming the first hospitalist program at St. Charles in 2006, where he has practiced since. According to the health system, the North Star Award recognizes a local physician who practices “compassionate patient care, professionalism, and a commitment to improving the lives of Central Oregonians.”

Business Deals

ApolloMed Hospitalists, a management group affiliated with the Glendale, Calif.–based Apollo Medical Holdings, Inc., has partnered with Allied Pacific of California IPA, an independent practice association based in Alhambra, Calif. Allied Pacific already manages inpatient admissions at five AHMC Healthcare hospitals in Southern California, plus two others, and ApolloMed Hospitalists will handle staffing physicians at these seven. ApolloMed Hospitalists was founded in 2001.

Sound Physicians, a private hospital medicine staffing company based in Tacoma, Wash., recently contracted to provide hospitalist services at the following institutions: Mercy Health—Fairfield Hospital in Fairfield, Ohio; Natividad Medical Center in Salinas, Calif.; Skagit Valley Hospital in Mt. Vernon, Wash.; and St. Elizabeth Youngstown Hospital in Youngstown, Ohio. Sound Physicians manages hospitalist physicians in 35 states in the U.S.

Sound Physicians is celebrating with one of its partner hospitals, OSF St. Francis Hospital in Escanaba, Mich., which was recently named one of The Leapfrog Group’s Top Hospitals in the U.S. for the fourth consecutive year. Sound Physicians manages OSF St. Francis’s hospitalist physicians and oversees more than half of the hospital’s total inpatient admissions. The Leapfrog Group’s Top Hospitals list is compiled from survey results based on Leapfrog’s quality and safety standards.

 

---

Michael O’Neal is a freelance writer in New York City.

Mary Kathryn Anania, MD, has been appointed as hospitalist medical director at Florida Hospital Flagler in Palm Coast. Dr. Anania previously served as a hospitalist at Florida Hospital Memorial Medical Center in Daytona Beach. As Flagler medical director, Dr. Anania will oversee 11 hospitalists.

 

 

Zeshan Anwar, MD, is the new medical director of the hospitalist group at Evangelical Community Hospital in Lewisburg, Pa. Before arriving at Evangelical as a hospitalist in 2013, Dr. Anwar served as a hospitalist at Lock Haven Hospital in Linden, Pa., where he was also chair of the quality improvement committee and a physician advisor.

Roberto de la Cruz, MD, has been appointed as chief medical officer for Parkland Health & Hospital System in Dallas. Dr. de la Cruz previously held the position of hospitalist division chief at Parkland, and he served on Parkland’s board of managers from 2011 to 2013. He also is an assistant professor of internal medicine at University of Texas Southwestern Medical Center.

 

Janet Meckley, MD, recently was awarded the Paul S. Rhoads, MD, Humanity in Medicine Award by Reid Health in Richmond, Ind. Dr. Meckley served as a hospitalist from 2009 until 2015, when she decided to return to private practice. The Rhoads award recognizes compassionate patient and family care as well as community healthcare involvement.

 

Deshini Moonesinghe, MD, is the new senior vice president and chief medical officer for the Howard Region of Community Howard Regional Health in Kokomo, Ind. Dr. Moonesinghe spearheaded the foundation of Community Howard’s hospitalist program in 2010, and she currently serves as lead hospitalist of the health system. Dr. Moonesinghe received Community Howard’s Physician of the Year Award in 2014.

Mark V. Williams, MD, MHM, recently was named to the advisory board of The Joint Commission Journal on Quality and Patient Safety. Dr. Williams is a professor and the vice chair of the Department of Internal Medicine at the University of Kentucky in Lexington. Dr. Williams founded the hospitalist program at Grady Memorial Hospital in Atlanta and the academic hospitalist programs at Emory and Northwestern universities. He is a founding editor of the Journal of Hospital Medicine and a past president of SHM.

John Zachem, DO, received the 2015 North Star Award from St. Charles Health System in Bend, Ore. Dr. Zachem led the charge in forming the first hospitalist program at St. Charles in 2006, where he has practiced since. According to the health system, the North Star Award recognizes a local physician who practices “compassionate patient care, professionalism, and a commitment to improving the lives of Central Oregonians.”

Business Deals

ApolloMed Hospitalists, a management group affiliated with the Glendale, Calif.–based Apollo Medical Holdings, Inc., has partnered with Allied Pacific of California IPA, an independent practice association based in Alhambra, Calif. Allied Pacific already manages inpatient admissions at five AHMC Healthcare hospitals in Southern California, plus two others, and ApolloMed Hospitalists will handle staffing physicians at these seven. ApolloMed Hospitalists was founded in 2001.

Sound Physicians, a private hospital medicine staffing company based in Tacoma, Wash., recently contracted to provide hospitalist services at the following institutions: Mercy Health—Fairfield Hospital in Fairfield, Ohio; Natividad Medical Center in Salinas, Calif.; Skagit Valley Hospital in Mt. Vernon, Wash.; and St. Elizabeth Youngstown Hospital in Youngstown, Ohio. Sound Physicians manages hospitalist physicians in 35 states in the U.S.

Sound Physicians is celebrating with one of its partner hospitals, OSF St. Francis Hospital in Escanaba, Mich., which was recently named one of The Leapfrog Group’s Top Hospitals in the U.S. for the fourth consecutive year. Sound Physicians manages OSF St. Francis’s hospitalist physicians and oversees more than half of the hospital’s total inpatient admissions. The Leapfrog Group’s Top Hospitals list is compiled from survey results based on Leapfrog’s quality and safety standards.

 

---

Michael O’Neal is a freelance writer in New York City.

Every American knows this well-known phrase from the Declaration of Independence, which describes the three “unalienable rights” ordained on humans by their Creator and which governments are bound to dutifully protect. But I wonder if the last unalienable right has implications for career happiness in the healthcare industry, particularly for hospitalists. With the phrase now being 240 years old, it has understandably permeated every inch of American society and affected every crevice of the American psyche. Despite having this decreed inalienable right of the pursuit of happiness, there is evidence of widespread dissatisfaction and unhappiness within our profession.

Speaking of happiness, I was listening to a 60 Minutes podcast entitled “Heroin in the Heartland.” It described a widespread affliction of heroin among mainstream middle- and upper-class suburban youths.1 During the piece, they interviewed several addicted youngsters and their parents. I was struck by the story of a young woman named Hannah; she described how and why she became addicted to heroin in her upper-middle-class high school in Columbus, Ohio. She described how heroin made her feel. On a scale of 1–10 in happiness, she said it made her feel like a “26.” She and many of her friends became addicted to the feeling of happiness that was infused into them, a feeling that could not be replicated without the use of the drug. She and her friends started their road to addiction in a quest for their unalienable right of the pursuit of happiness.

Contrast that story with the “unhappiness factor” that plagues U.S. physicians. A 2014 survey found that 54% of physicians reported at least one symptom of burnout.2 That figure was up from 46% in a 2011 survey. From 2011 to 2014, satisfaction with work-life balance dropped to 41% from 49%. Within that same time frame, burnout and dissatisfaction showed very little change in other U.S. working adults, widening the gap in dissatisfaction between physicians and non-physicians. Even after adjusting for age, sex, relationship status, and hours worked, physicians still were almost twice as likely to experience burnout than other working U.S. adults, and they only had an odds ratio of satisfaction of 0.68 (95% CI, 0.62–0.75) compared with non-physicians. In another recent (and sobering) meta-analysis, researchers found that about a third of all resident physicians report depression or depressive symptoms during their training (ranging from 21% to 43%, depending on the instrument used).3

Could it be that physicians in the U.S., in their quest for the pursuit of happiness, are looking for happiness in all the wrong ways? I read an article recently on DailyGood entitled “Does Trying to Be Happy Make Us Unhappy?”4 It describes several studies that purport that the more value people place on trying to become happy, the less happy they actually become. It turns out that in order for us to figure out if we are happy, we are forced to evaluate our current level of happiness and set that against some benchmark (usually from our own past) to analyze where we are. The mere act of doing this moves us from an experiential mode to an evaluation mode, which puts us out of touch with those things in life that can bring us joy and contentment.

Social scientists have found that when we are immersed in the present, we don’t report being happy in that moment, but we do report happiness later when reflecting on those moments. Ruminating about whether we are unhappy, depressed, burned out, or unsatisfied makes us inwardly focused and makes us lose the ability to become immersed in the present.

Scientists also have found that we tend to overestimate how external influences, such as getting a promotion or moving into a new job, will inflate our happiness and that we all adapt to new experiences and quickly return to our baseline happiness (as if the change never occurred). They’ve also found that when we pursue happiness as an individual state, we become inwardly focused and less likely to actually achieve happiness. People who are more outwardly focused on how others feel (and not how they themselves feel) are much more likely to achieve a state of sustained happiness.

 

Finally, researchers have found that happiness is more likely achieved by pursuing frequent positive emotions rather than intense positive emotions. Many of us search for single intense emotional experiences (the winning of a gold medal) in the pursuit of happiness, but researchers found that the frequency of positive emotions are much more important than the intensity of positive emotions.

So maybe, as physicians in pursuit of happiness, we are going about this pursuit all wrong, with resultant depression, dissatisfaction, and burnout. We can’t change the Declaration of Independence or the American psyche, but we can change how we perceive that pursuit.

Happiness is not a goal to be achieved but a state of mind to be savored. Immersing ourselves in our daily life, we should be outwardly focused on our colleagues and our patients. If we take this approach, there is no other profession better suited to actually achieving sustained happiness. TH

References

1. Preview: heroin in the heartland. CBS News website. Available at: www.cbsnews.com/videos/preview-heroin-in-the-heartland. Accessed Feb. 1, 2016.

2. Shanafelt TD, Hasan O, Dyrbye LN, et al. Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014. Mayo Clin Proc. 2015;90(12):1600-1613. doi:10.1016/j.maocop.2015.08.023.

3. Mata DA, Ramos MA, Bansal N. Prevalence of depression and depressive symptoms among resident physicians: a systematic review and meta-analysis. JAMA. 2015;314(22):2373-2383. doi:10.1001/jama.2015.15845.

4. Grant A. Does trying to be happy make us unhappy? DailyGood website. Available at: http://www.dailygood.org/story/1187/does-trying-to-be-happy-make-us-unhappy-adam-grant/. Accessed Feb. 1, 2016.

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Dr. Scheurer is a hospitalist and chief quality officer at the Medical University of South Carolina in Charleston. She is physician editor of The Hospitalist. Email her at [email protected].

Every American knows this well-known phrase from the Declaration of Independence, which describes the three “unalienable rights” ordained on humans by their Creator and which governments are bound to dutifully protect. But I wonder if the last unalienable right has implications for career happiness in the healthcare industry, particularly for hospitalists. With the phrase now being 240 years old, it has understandably permeated every inch of American society and affected every crevice of the American psyche. Despite having this decreed inalienable right of the pursuit of happiness, there is evidence of widespread dissatisfaction and unhappiness within our profession.

Speaking of happiness, I was listening to a 60 Minutes podcast entitled “Heroin in the Heartland.” It described a widespread affliction of heroin among mainstream middle- and upper-class suburban youths.1 During the piece, they interviewed several addicted youngsters and their parents. I was struck by the story of a young woman named Hannah; she described how and why she became addicted to heroin in her upper-middle-class high school in Columbus, Ohio. She described how heroin made her feel. On a scale of 1–10 in happiness, she said it made her feel like a “26.” She and many of her friends became addicted to the feeling of happiness that was infused into them, a feeling that could not be replicated without the use of the drug. She and her friends started their road to addiction in a quest for their unalienable right of the pursuit of happiness.

Contrast that story with the “unhappiness factor” that plagues U.S. physicians. A 2014 survey found that 54% of physicians reported at least one symptom of burnout.2 That figure was up from 46% in a 2011 survey. From 2011 to 2014, satisfaction with work-life balance dropped to 41% from 49%. Within that same time frame, burnout and dissatisfaction showed very little change in other U.S. working adults, widening the gap in dissatisfaction between physicians and non-physicians. Even after adjusting for age, sex, relationship status, and hours worked, physicians still were almost twice as likely to experience burnout than other working U.S. adults, and they only had an odds ratio of satisfaction of 0.68 (95% CI, 0.62–0.75) compared with non-physicians. In another recent (and sobering) meta-analysis, researchers found that about a third of all resident physicians report depression or depressive symptoms during their training (ranging from 21% to 43%, depending on the instrument used).3

Could it be that physicians in the U.S., in their quest for the pursuit of happiness, are looking for happiness in all the wrong ways? I read an article recently on DailyGood entitled “Does Trying to Be Happy Make Us Unhappy?”4 It describes several studies that purport that the more value people place on trying to become happy, the less happy they actually become. It turns out that in order for us to figure out if we are happy, we are forced to evaluate our current level of happiness and set that against some benchmark (usually from our own past) to analyze where we are. The mere act of doing this moves us from an experiential mode to an evaluation mode, which puts us out of touch with those things in life that can bring us joy and contentment.

Social scientists have found that when we are immersed in the present, we don’t report being happy in that moment, but we do report happiness later when reflecting on those moments. Ruminating about whether we are unhappy, depressed, burned out, or unsatisfied makes us inwardly focused and makes us lose the ability to become immersed in the present.

Scientists also have found that we tend to overestimate how external influences, such as getting a promotion or moving into a new job, will inflate our happiness and that we all adapt to new experiences and quickly return to our baseline happiness (as if the change never occurred). They’ve also found that when we pursue happiness as an individual state, we become inwardly focused and less likely to actually achieve happiness. People who are more outwardly focused on how others feel (and not how they themselves feel) are much more likely to achieve a state of sustained happiness.

 

Finally, researchers have found that happiness is more likely achieved by pursuing frequent positive emotions rather than intense positive emotions. Many of us search for single intense emotional experiences (the winning of a gold medal) in the pursuit of happiness, but researchers found that the frequency of positive emotions are much more important than the intensity of positive emotions.

So maybe, as physicians in pursuit of happiness, we are going about this pursuit all wrong, with resultant depression, dissatisfaction, and burnout. We can’t change the Declaration of Independence or the American psyche, but we can change how we perceive that pursuit.

Happiness is not a goal to be achieved but a state of mind to be savored. Immersing ourselves in our daily life, we should be outwardly focused on our colleagues and our patients. If we take this approach, there is no other profession better suited to actually achieving sustained happiness. TH

References

1. Preview: heroin in the heartland. CBS News website. Available at: www.cbsnews.com/videos/preview-heroin-in-the-heartland. Accessed Feb. 1, 2016.

2. Shanafelt TD, Hasan O, Dyrbye LN, et al. Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014. Mayo Clin Proc. 2015;90(12):1600-1613. doi:10.1016/j.maocop.2015.08.023.

3. Mata DA, Ramos MA, Bansal N. Prevalence of depression and depressive symptoms among resident physicians: a systematic review and meta-analysis. JAMA. 2015;314(22):2373-2383. doi:10.1001/jama.2015.15845.

4. Grant A. Does trying to be happy make us unhappy? DailyGood website. Available at: http://www.dailygood.org/story/1187/does-trying-to-be-happy-make-us-unhappy-adam-grant/. Accessed Feb. 1, 2016.

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Dr. Scheurer is a hospitalist and chief quality officer at the Medical University of South Carolina in Charleston. She is physician editor of The Hospitalist. Email her at [email protected].

Every American knows this well-known phrase from the Declaration of Independence, which describes the three “unalienable rights” ordained on humans by their Creator and which governments are bound to dutifully protect. But I wonder if the last unalienable right has implications for career happiness in the healthcare industry, particularly for hospitalists. With the phrase now being 240 years old, it has understandably permeated every inch of American society and affected every crevice of the American psyche. Despite having this decreed inalienable right of the pursuit of happiness, there is evidence of widespread dissatisfaction and unhappiness within our profession.

Speaking of happiness, I was listening to a 60 Minutes podcast entitled “Heroin in the Heartland.” It described a widespread affliction of heroin among mainstream middle- and upper-class suburban youths.1 During the piece, they interviewed several addicted youngsters and their parents. I was struck by the story of a young woman named Hannah; she described how and why she became addicted to heroin in her upper-middle-class high school in Columbus, Ohio. She described how heroin made her feel. On a scale of 1–10 in happiness, she said it made her feel like a “26.” She and many of her friends became addicted to the feeling of happiness that was infused into them, a feeling that could not be replicated without the use of the drug. She and her friends started their road to addiction in a quest for their unalienable right of the pursuit of happiness.

Contrast that story with the “unhappiness factor” that plagues U.S. physicians. A 2014 survey found that 54% of physicians reported at least one symptom of burnout.2 That figure was up from 46% in a 2011 survey. From 2011 to 2014, satisfaction with work-life balance dropped to 41% from 49%. Within that same time frame, burnout and dissatisfaction showed very little change in other U.S. working adults, widening the gap in dissatisfaction between physicians and non-physicians. Even after adjusting for age, sex, relationship status, and hours worked, physicians still were almost twice as likely to experience burnout than other working U.S. adults, and they only had an odds ratio of satisfaction of 0.68 (95% CI, 0.62–0.75) compared with non-physicians. In another recent (and sobering) meta-analysis, researchers found that about a third of all resident physicians report depression or depressive symptoms during their training (ranging from 21% to 43%, depending on the instrument used).3

Could it be that physicians in the U.S., in their quest for the pursuit of happiness, are looking for happiness in all the wrong ways? I read an article recently on DailyGood entitled “Does Trying to Be Happy Make Us Unhappy?”4 It describes several studies that purport that the more value people place on trying to become happy, the less happy they actually become. It turns out that in order for us to figure out if we are happy, we are forced to evaluate our current level of happiness and set that against some benchmark (usually from our own past) to analyze where we are. The mere act of doing this moves us from an experiential mode to an evaluation mode, which puts us out of touch with those things in life that can bring us joy and contentment.

Social scientists have found that when we are immersed in the present, we don’t report being happy in that moment, but we do report happiness later when reflecting on those moments. Ruminating about whether we are unhappy, depressed, burned out, or unsatisfied makes us inwardly focused and makes us lose the ability to become immersed in the present.

Scientists also have found that we tend to overestimate how external influences, such as getting a promotion or moving into a new job, will inflate our happiness and that we all adapt to new experiences and quickly return to our baseline happiness (as if the change never occurred). They’ve also found that when we pursue happiness as an individual state, we become inwardly focused and less likely to actually achieve happiness. People who are more outwardly focused on how others feel (and not how they themselves feel) are much more likely to achieve a state of sustained happiness.

 

Finally, researchers have found that happiness is more likely achieved by pursuing frequent positive emotions rather than intense positive emotions. Many of us search for single intense emotional experiences (the winning of a gold medal) in the pursuit of happiness, but researchers found that the frequency of positive emotions are much more important than the intensity of positive emotions.

So maybe, as physicians in pursuit of happiness, we are going about this pursuit all wrong, with resultant depression, dissatisfaction, and burnout. We can’t change the Declaration of Independence or the American psyche, but we can change how we perceive that pursuit.

Happiness is not a goal to be achieved but a state of mind to be savored. Immersing ourselves in our daily life, we should be outwardly focused on our colleagues and our patients. If we take this approach, there is no other profession better suited to actually achieving sustained happiness. TH

References

1. Preview: heroin in the heartland. CBS News website. Available at: www.cbsnews.com/videos/preview-heroin-in-the-heartland. Accessed Feb. 1, 2016.

2. Shanafelt TD, Hasan O, Dyrbye LN, et al. Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014. Mayo Clin Proc. 2015;90(12):1600-1613. doi:10.1016/j.maocop.2015.08.023.

3. Mata DA, Ramos MA, Bansal N. Prevalence of depression and depressive symptoms among resident physicians: a systematic review and meta-analysis. JAMA. 2015;314(22):2373-2383. doi:10.1001/jama.2015.15845.

4. Grant A. Does trying to be happy make us unhappy? DailyGood website. Available at: http://www.dailygood.org/story/1187/does-trying-to-be-happy-make-us-unhappy-adam-grant/. Accessed Feb. 1, 2016.

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Dr. Scheurer is a hospitalist and chief quality officer at the Medical University of South Carolina in Charleston. She is physician editor of The Hospitalist. Email her at [email protected].