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HM15 Offers Hospitalist Leaders Training, Encouragement
NATIONAL HARBOR, Md.—Patient satisfaction, physician engagement, and administrator buy-in, oh my.
So went the thoughts of Jaidev Bhoopal, MD, last month at HM15. He’d been a hospitalist for about eight years, but he was named section chair about a month before he arrived at the annual meeting. His calculated first stop was the daylong practice management pre-course titled “Where the Rubber Meets the Road: Managing in the Era of Healthcare Reform.”
The timing couldn’t have been better.
“I’m starting a new role and I wanted to get input and ideas,” said Dr. Bhoopal, section chair of the hospitalist department at St. Mary’s Medical Center in Duluth, Minn. “This gives you a playbook of where you want to be and where you want to go.”
A playbook for where to go could just as well be the slogan for practice management’s role at SHM’s annual meeting. An educational track, a dedicated—and ever-popular—pre-course, and a chance to ask the field’s founding fathers their best practices were among the highlights of this spring’s four-day confab.
The need for practice management and leadership training is greater in the past few years as hospitalists have been more confounded than ever with how to best run their practices under a myriad of new rules and regulations tied to the Affordable Care Act and the digitization of healthcare. At their core, the changes are shifting hospital-based care from fee-for-service to value-based payments.
“The tipping point is really here for us,” said Win Whitcomb, MD, MHM, chief medical officer of Remedy Partners of Darien, Conn.
Dr. Whitcomb, a founder of SHM and regular columnist for The Hospitalist, said that HM group (HMG) leaders have to be well versed in how to navigate a landscape of alternative payment models to excel in the new paradigm. Particularly after the announcement earlier this year that the federal government has set a goal of tying 85% of Medicare hospital fee-for-service payments to quality or value by 2016, and that percentage could increase to 90% by 2018. The January announcement was the first time in Medicare’s history that explicit goals for alternative payment models and value-based payments were set, according to an announcement from the U.S. Department of Health and Human Services.
“Strategically, these things are essential to work into the plan of what the hospital medicine group is doing in the coming three to five years,” Dr. Whitcomb said. “Hospitalists can’t do this alone. They have to do it with teams. It’s not only teams of other professionals in the hospital and around the hospital, but it’s other physicians.”
Dr. Whitcomb said key to the new paradigm is shared financial and clinical responsibilities. He says hospitalists have to “change our thinking…to a mindset where we’re in this together.”
Part of that shared responsibility extends to the post-acute care setting, where SHM senior vice president for practice management Joseph Miller said that some 30% of HMGs are practicing. To help those practitioners, SHM and IPC Healthcare of North Hollywood, Calif., debuted the “Primer for Hospitalists on Skilled Nursing Facilities” at HM15.
The educational program, housed at SHM’s Learning Portal, has 32 lessons meant to differentiate the traditional acute-care hospital from post-acute care facilities. It is grouped in five sections and two modules, with a focus on skilled-nursing facilities (SNFs), which are the most common post-acute care settings.
“The types of resources that are available are different, and that’s not only in terms of staff, but the availability of specialists, the availability of testing capabilities,” Miller said. “If you need to work with a cardiologist for a particular patient...how do you engage them? You’re not going to be able to have them come and see that patient frequently. How do you communicate with them to get the feedback you need as the attending physician?”
Another communication hassle involves the growing number of HMGs spread over multiple sites. For Sara Shraibman, MD, an assistant program director at Syosset Hospital in Syosset, N.Y., those sites are two hospitals covered by the North Shore LIJ Medical Group.
“It’s actually a new program, so we are trying to look at our compensation, models comparing them across two hospitals…and how we manage,” she said. “Not every hospitalist will go back and forth. Some will, some won’t. Some will work nights to help cover, some won’t. It’s very interesting trying to come up with a schedule.”
The best way to address conflict at multi-site groups is communicating and focusing on shared goals, said David Weidig, MD, director of hospital medicine for Aurora Medical Group in West Allis, Wis., and a new member of Team Hospitalist.
“Make sure that no matter what conflict might be up front, that everybody is looking at the goals downstream and saying, ‘Yes, that is a goal we want to achieve. We want to have better patient safety metrics. We want to have decreased readmissions. We want to have better transitions of care,’” Dr. Weidig said. “The common goal all the way from hospital administrators all the way down to hospital physicians is going to be the key.”
Richard Quinn is a freelance writer in New Jersey.
NATIONAL HARBOR, Md.—Patient satisfaction, physician engagement, and administrator buy-in, oh my.
So went the thoughts of Jaidev Bhoopal, MD, last month at HM15. He’d been a hospitalist for about eight years, but he was named section chair about a month before he arrived at the annual meeting. His calculated first stop was the daylong practice management pre-course titled “Where the Rubber Meets the Road: Managing in the Era of Healthcare Reform.”
The timing couldn’t have been better.
“I’m starting a new role and I wanted to get input and ideas,” said Dr. Bhoopal, section chair of the hospitalist department at St. Mary’s Medical Center in Duluth, Minn. “This gives you a playbook of where you want to be and where you want to go.”
A playbook for where to go could just as well be the slogan for practice management’s role at SHM’s annual meeting. An educational track, a dedicated—and ever-popular—pre-course, and a chance to ask the field’s founding fathers their best practices were among the highlights of this spring’s four-day confab.
The need for practice management and leadership training is greater in the past few years as hospitalists have been more confounded than ever with how to best run their practices under a myriad of new rules and regulations tied to the Affordable Care Act and the digitization of healthcare. At their core, the changes are shifting hospital-based care from fee-for-service to value-based payments.
“The tipping point is really here for us,” said Win Whitcomb, MD, MHM, chief medical officer of Remedy Partners of Darien, Conn.
Dr. Whitcomb, a founder of SHM and regular columnist for The Hospitalist, said that HM group (HMG) leaders have to be well versed in how to navigate a landscape of alternative payment models to excel in the new paradigm. Particularly after the announcement earlier this year that the federal government has set a goal of tying 85% of Medicare hospital fee-for-service payments to quality or value by 2016, and that percentage could increase to 90% by 2018. The January announcement was the first time in Medicare’s history that explicit goals for alternative payment models and value-based payments were set, according to an announcement from the U.S. Department of Health and Human Services.
“Strategically, these things are essential to work into the plan of what the hospital medicine group is doing in the coming three to five years,” Dr. Whitcomb said. “Hospitalists can’t do this alone. They have to do it with teams. It’s not only teams of other professionals in the hospital and around the hospital, but it’s other physicians.”
Dr. Whitcomb said key to the new paradigm is shared financial and clinical responsibilities. He says hospitalists have to “change our thinking…to a mindset where we’re in this together.”
Part of that shared responsibility extends to the post-acute care setting, where SHM senior vice president for practice management Joseph Miller said that some 30% of HMGs are practicing. To help those practitioners, SHM and IPC Healthcare of North Hollywood, Calif., debuted the “Primer for Hospitalists on Skilled Nursing Facilities” at HM15.
The educational program, housed at SHM’s Learning Portal, has 32 lessons meant to differentiate the traditional acute-care hospital from post-acute care facilities. It is grouped in five sections and two modules, with a focus on skilled-nursing facilities (SNFs), which are the most common post-acute care settings.
“The types of resources that are available are different, and that’s not only in terms of staff, but the availability of specialists, the availability of testing capabilities,” Miller said. “If you need to work with a cardiologist for a particular patient...how do you engage them? You’re not going to be able to have them come and see that patient frequently. How do you communicate with them to get the feedback you need as the attending physician?”
Another communication hassle involves the growing number of HMGs spread over multiple sites. For Sara Shraibman, MD, an assistant program director at Syosset Hospital in Syosset, N.Y., those sites are two hospitals covered by the North Shore LIJ Medical Group.
“It’s actually a new program, so we are trying to look at our compensation, models comparing them across two hospitals…and how we manage,” she said. “Not every hospitalist will go back and forth. Some will, some won’t. Some will work nights to help cover, some won’t. It’s very interesting trying to come up with a schedule.”
The best way to address conflict at multi-site groups is communicating and focusing on shared goals, said David Weidig, MD, director of hospital medicine for Aurora Medical Group in West Allis, Wis., and a new member of Team Hospitalist.
“Make sure that no matter what conflict might be up front, that everybody is looking at the goals downstream and saying, ‘Yes, that is a goal we want to achieve. We want to have better patient safety metrics. We want to have decreased readmissions. We want to have better transitions of care,’” Dr. Weidig said. “The common goal all the way from hospital administrators all the way down to hospital physicians is going to be the key.”
Richard Quinn is a freelance writer in New Jersey.
NATIONAL HARBOR, Md.—Patient satisfaction, physician engagement, and administrator buy-in, oh my.
So went the thoughts of Jaidev Bhoopal, MD, last month at HM15. He’d been a hospitalist for about eight years, but he was named section chair about a month before he arrived at the annual meeting. His calculated first stop was the daylong practice management pre-course titled “Where the Rubber Meets the Road: Managing in the Era of Healthcare Reform.”
The timing couldn’t have been better.
“I’m starting a new role and I wanted to get input and ideas,” said Dr. Bhoopal, section chair of the hospitalist department at St. Mary’s Medical Center in Duluth, Minn. “This gives you a playbook of where you want to be and where you want to go.”
A playbook for where to go could just as well be the slogan for practice management’s role at SHM’s annual meeting. An educational track, a dedicated—and ever-popular—pre-course, and a chance to ask the field’s founding fathers their best practices were among the highlights of this spring’s four-day confab.
The need for practice management and leadership training is greater in the past few years as hospitalists have been more confounded than ever with how to best run their practices under a myriad of new rules and regulations tied to the Affordable Care Act and the digitization of healthcare. At their core, the changes are shifting hospital-based care from fee-for-service to value-based payments.
“The tipping point is really here for us,” said Win Whitcomb, MD, MHM, chief medical officer of Remedy Partners of Darien, Conn.
Dr. Whitcomb, a founder of SHM and regular columnist for The Hospitalist, said that HM group (HMG) leaders have to be well versed in how to navigate a landscape of alternative payment models to excel in the new paradigm. Particularly after the announcement earlier this year that the federal government has set a goal of tying 85% of Medicare hospital fee-for-service payments to quality or value by 2016, and that percentage could increase to 90% by 2018. The January announcement was the first time in Medicare’s history that explicit goals for alternative payment models and value-based payments were set, according to an announcement from the U.S. Department of Health and Human Services.
“Strategically, these things are essential to work into the plan of what the hospital medicine group is doing in the coming three to five years,” Dr. Whitcomb said. “Hospitalists can’t do this alone. They have to do it with teams. It’s not only teams of other professionals in the hospital and around the hospital, but it’s other physicians.”
Dr. Whitcomb said key to the new paradigm is shared financial and clinical responsibilities. He says hospitalists have to “change our thinking…to a mindset where we’re in this together.”
Part of that shared responsibility extends to the post-acute care setting, where SHM senior vice president for practice management Joseph Miller said that some 30% of HMGs are practicing. To help those practitioners, SHM and IPC Healthcare of North Hollywood, Calif., debuted the “Primer for Hospitalists on Skilled Nursing Facilities” at HM15.
The educational program, housed at SHM’s Learning Portal, has 32 lessons meant to differentiate the traditional acute-care hospital from post-acute care facilities. It is grouped in five sections and two modules, with a focus on skilled-nursing facilities (SNFs), which are the most common post-acute care settings.
“The types of resources that are available are different, and that’s not only in terms of staff, but the availability of specialists, the availability of testing capabilities,” Miller said. “If you need to work with a cardiologist for a particular patient...how do you engage them? You’re not going to be able to have them come and see that patient frequently. How do you communicate with them to get the feedback you need as the attending physician?”
Another communication hassle involves the growing number of HMGs spread over multiple sites. For Sara Shraibman, MD, an assistant program director at Syosset Hospital in Syosset, N.Y., those sites are two hospitals covered by the North Shore LIJ Medical Group.
“It’s actually a new program, so we are trying to look at our compensation, models comparing them across two hospitals…and how we manage,” she said. “Not every hospitalist will go back and forth. Some will, some won’t. Some will work nights to help cover, some won’t. It’s very interesting trying to come up with a schedule.”
The best way to address conflict at multi-site groups is communicating and focusing on shared goals, said David Weidig, MD, director of hospital medicine for Aurora Medical Group in West Allis, Wis., and a new member of Team Hospitalist.
“Make sure that no matter what conflict might be up front, that everybody is looking at the goals downstream and saying, ‘Yes, that is a goal we want to achieve. We want to have better patient safety metrics. We want to have decreased readmissions. We want to have better transitions of care,’” Dr. Weidig said. “The common goal all the way from hospital administrators all the way down to hospital physicians is going to be the key.”
Richard Quinn is a freelance writer in New Jersey.
HM15 Speakers Urge Hospitalists to Use Technology, Teamwork, Talent
NATIONAL HARBOR, Md.—In the convention business, some say an annual meeting is only as good as its keynote addresses. Those people would call HM15 a home run, because the thousands of hospitalists who made their way to just outside the nation’s capital last month were treated to a trinity of talented talkers.
First up was patient safety guru Peter Pronovost, MD, PhD, FCCM, senior vice president for patient safety and quality at Johns Hopkins Medicine in Baltimore. Maureen Bisognano, president and CEO of the Institute for Healthcare Improvement (IHI), echoed his patient-centered focus in her address. The four-day confab ended with hospitalist dean Bob Wachter, MD, MHM, reading from his new book, “The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age.”
The three came from different perspectives but ended up in the same place: Hospitalists can use technology, teamwork, and talent to be the people who make healthcare in this country safer. In fact, HM has the responsibility to do so.
“We are the only hope that the healthcare system has of improving quality and safety,” Dr. Pronovost said.
Famous for creating a five-step checklist designed to reduce the incidence of central line-associated infections, he talked about healthcare in terms of physicians telling “depressing” stories that hold change back.
“The first is that we still tell a story that harm is inevitable,” he said. “‘You’re sick, you’re old, you’re young, stuff happens.’ Second, we still tell stories that [show that] safety and quality are based on the heroism of our clinicians rather than design of safe systems. And, third, we still tell a story that ‘I am powerless to do anything about it.’
“We need some new stories.”
Reframing the discussion of healthcare into a story of preventing all harm is ambitious but doable, he added. Hospitalists need to team with others, though, because an overhauled healthcare system needs buy-in from all physicians.
“The trick of this is to have enough details that people want to join you, but don’t completely tell the story, because others have to co-create it with you,” Dr. Pronovost said. “You tell the why and the what, but the how is co-created by all of your colleagues who are working with you.”
Bisognano says hospitalists can help hospitalists achieve IHI’s Triple Aim, an initiative to simultaneously improve the patient experience and the health of populations, reducing the per capita cost of healthcare. But, like Dr. Pronovost, her argument is based on a new view of the healthcare system.
“We need not a system that says, ‘What’s the matter?’ but a system that understands deeply what matters to each patient,” Bisognano said.
That prism requires speaking a new “language,” one that uses quality of care delivered and defines it more broadly than simply mortality rates and adverse events.
“You can look at health and care, but you also can drive out unnecessary cost,” she said. “And being a former hospital CEO, I can say it was magic when a clinician could walk in and be able to talk in both languages.”
Dr. Wachter spoke of the past, present, and future of the digital age of medicine. He is as frustrated by poor electronic health record (EHR) rollouts as front-line hospitalists but notes that healthcare in the past five years has seen a digital revolution in a much shorter time period than most industries, thanks to federal incentives.
“Most fields that go digital do so over the course of 10 or 20 years, in a very organic way, with the early adopters, the rank and file, and then the laggards,” he said. “And in that kind of organic adoption curve, you see problems arise, and people begin to deal with them and understand them and mitigate them.
“What the federal intervention did was essentially turbocharge the digitization of healthcare. We’ve seen this in a very telescoped way. … It’s like we got started on a huge dose of chemo, stat.”
Moving forward, Dr. Wachter said the focus has to be on improving the use and integration of healthcare to ensure that it translates to better patient care. For example, going to digital radiology has in many ways ended the daily meetings that once were commonplace in hospital “film rooms.” In essence, the move from “analog to digital” meant people communicated less. Now, multidisciplinary rounds and other unit-based approaches are trying to recreate teamwork.
“Places are doing some pretty impressive things to try to bring teams back together in a digital environment,” Dr. Wachter said. “But, the point is, I didn’t give this any thought. I don’t know whether you did. What didn’t cross my own cognitive radar screen was that when we go digital, we will screw up the relationships, because people can now be wherever they want to be to do their work.”
Richard Quinn is a freelance writer in New Jersey.
NATIONAL HARBOR, Md.—In the convention business, some say an annual meeting is only as good as its keynote addresses. Those people would call HM15 a home run, because the thousands of hospitalists who made their way to just outside the nation’s capital last month were treated to a trinity of talented talkers.
First up was patient safety guru Peter Pronovost, MD, PhD, FCCM, senior vice president for patient safety and quality at Johns Hopkins Medicine in Baltimore. Maureen Bisognano, president and CEO of the Institute for Healthcare Improvement (IHI), echoed his patient-centered focus in her address. The four-day confab ended with hospitalist dean Bob Wachter, MD, MHM, reading from his new book, “The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age.”
The three came from different perspectives but ended up in the same place: Hospitalists can use technology, teamwork, and talent to be the people who make healthcare in this country safer. In fact, HM has the responsibility to do so.
“We are the only hope that the healthcare system has of improving quality and safety,” Dr. Pronovost said.
Famous for creating a five-step checklist designed to reduce the incidence of central line-associated infections, he talked about healthcare in terms of physicians telling “depressing” stories that hold change back.
“The first is that we still tell a story that harm is inevitable,” he said. “‘You’re sick, you’re old, you’re young, stuff happens.’ Second, we still tell stories that [show that] safety and quality are based on the heroism of our clinicians rather than design of safe systems. And, third, we still tell a story that ‘I am powerless to do anything about it.’
“We need some new stories.”
Reframing the discussion of healthcare into a story of preventing all harm is ambitious but doable, he added. Hospitalists need to team with others, though, because an overhauled healthcare system needs buy-in from all physicians.
“The trick of this is to have enough details that people want to join you, but don’t completely tell the story, because others have to co-create it with you,” Dr. Pronovost said. “You tell the why and the what, but the how is co-created by all of your colleagues who are working with you.”
Bisognano says hospitalists can help hospitalists achieve IHI’s Triple Aim, an initiative to simultaneously improve the patient experience and the health of populations, reducing the per capita cost of healthcare. But, like Dr. Pronovost, her argument is based on a new view of the healthcare system.
“We need not a system that says, ‘What’s the matter?’ but a system that understands deeply what matters to each patient,” Bisognano said.
That prism requires speaking a new “language,” one that uses quality of care delivered and defines it more broadly than simply mortality rates and adverse events.
“You can look at health and care, but you also can drive out unnecessary cost,” she said. “And being a former hospital CEO, I can say it was magic when a clinician could walk in and be able to talk in both languages.”
Dr. Wachter spoke of the past, present, and future of the digital age of medicine. He is as frustrated by poor electronic health record (EHR) rollouts as front-line hospitalists but notes that healthcare in the past five years has seen a digital revolution in a much shorter time period than most industries, thanks to federal incentives.
“Most fields that go digital do so over the course of 10 or 20 years, in a very organic way, with the early adopters, the rank and file, and then the laggards,” he said. “And in that kind of organic adoption curve, you see problems arise, and people begin to deal with them and understand them and mitigate them.
“What the federal intervention did was essentially turbocharge the digitization of healthcare. We’ve seen this in a very telescoped way. … It’s like we got started on a huge dose of chemo, stat.”
Moving forward, Dr. Wachter said the focus has to be on improving the use and integration of healthcare to ensure that it translates to better patient care. For example, going to digital radiology has in many ways ended the daily meetings that once were commonplace in hospital “film rooms.” In essence, the move from “analog to digital” meant people communicated less. Now, multidisciplinary rounds and other unit-based approaches are trying to recreate teamwork.
“Places are doing some pretty impressive things to try to bring teams back together in a digital environment,” Dr. Wachter said. “But, the point is, I didn’t give this any thought. I don’t know whether you did. What didn’t cross my own cognitive radar screen was that when we go digital, we will screw up the relationships, because people can now be wherever they want to be to do their work.”
Richard Quinn is a freelance writer in New Jersey.
NATIONAL HARBOR, Md.—In the convention business, some say an annual meeting is only as good as its keynote addresses. Those people would call HM15 a home run, because the thousands of hospitalists who made their way to just outside the nation’s capital last month were treated to a trinity of talented talkers.
First up was patient safety guru Peter Pronovost, MD, PhD, FCCM, senior vice president for patient safety and quality at Johns Hopkins Medicine in Baltimore. Maureen Bisognano, president and CEO of the Institute for Healthcare Improvement (IHI), echoed his patient-centered focus in her address. The four-day confab ended with hospitalist dean Bob Wachter, MD, MHM, reading from his new book, “The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age.”
The three came from different perspectives but ended up in the same place: Hospitalists can use technology, teamwork, and talent to be the people who make healthcare in this country safer. In fact, HM has the responsibility to do so.
“We are the only hope that the healthcare system has of improving quality and safety,” Dr. Pronovost said.
Famous for creating a five-step checklist designed to reduce the incidence of central line-associated infections, he talked about healthcare in terms of physicians telling “depressing” stories that hold change back.
“The first is that we still tell a story that harm is inevitable,” he said. “‘You’re sick, you’re old, you’re young, stuff happens.’ Second, we still tell stories that [show that] safety and quality are based on the heroism of our clinicians rather than design of safe systems. And, third, we still tell a story that ‘I am powerless to do anything about it.’
“We need some new stories.”
Reframing the discussion of healthcare into a story of preventing all harm is ambitious but doable, he added. Hospitalists need to team with others, though, because an overhauled healthcare system needs buy-in from all physicians.
“The trick of this is to have enough details that people want to join you, but don’t completely tell the story, because others have to co-create it with you,” Dr. Pronovost said. “You tell the why and the what, but the how is co-created by all of your colleagues who are working with you.”
Bisognano says hospitalists can help hospitalists achieve IHI’s Triple Aim, an initiative to simultaneously improve the patient experience and the health of populations, reducing the per capita cost of healthcare. But, like Dr. Pronovost, her argument is based on a new view of the healthcare system.
“We need not a system that says, ‘What’s the matter?’ but a system that understands deeply what matters to each patient,” Bisognano said.
That prism requires speaking a new “language,” one that uses quality of care delivered and defines it more broadly than simply mortality rates and adverse events.
“You can look at health and care, but you also can drive out unnecessary cost,” she said. “And being a former hospital CEO, I can say it was magic when a clinician could walk in and be able to talk in both languages.”
Dr. Wachter spoke of the past, present, and future of the digital age of medicine. He is as frustrated by poor electronic health record (EHR) rollouts as front-line hospitalists but notes that healthcare in the past five years has seen a digital revolution in a much shorter time period than most industries, thanks to federal incentives.
“Most fields that go digital do so over the course of 10 or 20 years, in a very organic way, with the early adopters, the rank and file, and then the laggards,” he said. “And in that kind of organic adoption curve, you see problems arise, and people begin to deal with them and understand them and mitigate them.
“What the federal intervention did was essentially turbocharge the digitization of healthcare. We’ve seen this in a very telescoped way. … It’s like we got started on a huge dose of chemo, stat.”
Moving forward, Dr. Wachter said the focus has to be on improving the use and integration of healthcare to ensure that it translates to better patient care. For example, going to digital radiology has in many ways ended the daily meetings that once were commonplace in hospital “film rooms.” In essence, the move from “analog to digital” meant people communicated less. Now, multidisciplinary rounds and other unit-based approaches are trying to recreate teamwork.
“Places are doing some pretty impressive things to try to bring teams back together in a digital environment,” Dr. Wachter said. “But, the point is, I didn’t give this any thought. I don’t know whether you did. What didn’t cross my own cognitive radar screen was that when we go digital, we will screw up the relationships, because people can now be wherever they want to be to do their work.”
Richard Quinn is a freelance writer in New Jersey.
Society of Hospital Medicine’s RIV Poster Contest Draws Best, Brightest
LISTEN NOW: David Weidig, MD, talks about best practices for multi-site hospital medicine
Excerpts from our interview with Team Hospitalist member David Weidig, MD, director of hospital medicine for Aurora Medical Group in West Allis, Wis., about best practices for multi-site hospital medicine.
[audio mp3="http://www.the-hospitalist.org/wp-content/uploads/2015/05/David-Weidig_HM15_FINAL_050215.mp3"][/audio]
Excerpts from our interview with Team Hospitalist member David Weidig, MD, director of hospital medicine for Aurora Medical Group in West Allis, Wis., about best practices for multi-site hospital medicine.
[audio mp3="http://www.the-hospitalist.org/wp-content/uploads/2015/05/David-Weidig_HM15_FINAL_050215.mp3"][/audio]
Excerpts from our interview with Team Hospitalist member David Weidig, MD, director of hospital medicine for Aurora Medical Group in West Allis, Wis., about best practices for multi-site hospital medicine.
[audio mp3="http://www.the-hospitalist.org/wp-content/uploads/2015/05/David-Weidig_HM15_FINAL_050215.mp3"][/audio]
LISTEN NOW: Win Whitcomb, MD, MHM, talks about practice management in an ever-changing healthcare landscape
SHM founder Win Whitcomb, MD, MHM, chief medical officer of Remedy Partners of Darien, Conn., talks about the annual practice management pre-course in an ever-changing healthcare landscape.
SHM founder Win Whitcomb, MD, MHM, chief medical officer of Remedy Partners of Darien, Conn., talks about the annual practice management pre-course in an ever-changing healthcare landscape.
SHM founder Win Whitcomb, MD, MHM, chief medical officer of Remedy Partners of Darien, Conn., talks about the annual practice management pre-course in an ever-changing healthcare landscape.
Multi-Site Hospitalist Leaders: HM15 Session Summary
Session: Multi-site Hospitalist Leaders: Unique Challenges/What You Should Know
HM15 Presenter/Moderator: Scott Rissmiller, MD
Summation: This standing-room-only session was the result of a popular HMX e-community, which has become an active discussion board. As hospitals and health systems continue to consolidate across the country, there has been a rapid growth of multi-hospital systems. The role of the “Chief Hospitalist,” whose job is to lead multiple hospitalist groups within these systems, is evolving. These “Chief Hospitalists” are growing in number and they, as well as their followers, face unique challenges.
These points regarding organization structure were discussed, and as you look at your own organizational structure, these questions deserve your attention:
- Purpose of your structure?
- Is your structure centralized or decentralized?
- How does your organizational structure support decision-making?
- How does the structure ensure proper communication?
- How are resources shared across geography?
- What is your administrative support structure?
- How is administrative time allocated for physician leaders?
- How do you ensure engagement from all providers?
- How does your organization structure create alignment with the healthcare system?
The following compensation issues were discussed, and can be used as a discussion outline for most groups:
- How does your compensation (comp) plan align with the goals and values of the system?
- How does your comp plan account for regional variances?
- How does the comp plan encourage teamwork and sharing of resources?
- How does comp plan account for differences in acuity, hospital size, night frequency, etc.?
- Are goals and incentives group based, site based, or individual based?
- How does the comp plan fairly reward “non-RVU” work? (teaching, committee service, etc.)
- Should all site leaders receive the same comp regardless of group size?
- Does the comp plan incorporate “minimum work standards”/social compact?
Key Points/HM Takeaways:
- Panel discussion was valuable and reassured attendees that there are multiple ways to make groups successful. One common variable of successful groups is open lines of communication at all levels.
- Physician on-boarding is critical and should be utilized to set clear expectations.
- HM Goals/expectations must be aligned with those of the hospital and health system.
- When multiple hospitals are part of a larger system, it is desirable for goals to be aligned across the health system.
- Two-way open communication is necessary for success.
- Try to take a walk in your colleague’s/stakeholder’s shoes:
- How does my hospital administrative partner see this issue?
- How does my regional director/system lead see this issue?
- How does my bedside hospitalist physician/provider see this issue?
- How would my patients view this issue?
- Issues facing different types of groups, academic vs. community and for profit vs. not for profit, are somewhat variable.
- The leadership Dyad consisting of a physician and practice management professional in partnership is an effective and well-proven management model.
Many thanks to Drs. T.J. Richardson and Dan Duzan for their input and assistance with this session summary. Dr. Richardson is a Regional Medical Director and Dr. Duzan is a Facility Medical Director, both work for TeamHealth.
Julianna Lindsey is a hospitalist and physician leader based in the Dallas-Fort Worth Metroplex. Her focus is patient safety/quality and physician leadership. She is a member of TeamHospitalist.
Session: Multi-site Hospitalist Leaders: Unique Challenges/What You Should Know
HM15 Presenter/Moderator: Scott Rissmiller, MD
Summation: This standing-room-only session was the result of a popular HMX e-community, which has become an active discussion board. As hospitals and health systems continue to consolidate across the country, there has been a rapid growth of multi-hospital systems. The role of the “Chief Hospitalist,” whose job is to lead multiple hospitalist groups within these systems, is evolving. These “Chief Hospitalists” are growing in number and they, as well as their followers, face unique challenges.
These points regarding organization structure were discussed, and as you look at your own organizational structure, these questions deserve your attention:
- Purpose of your structure?
- Is your structure centralized or decentralized?
- How does your organizational structure support decision-making?
- How does the structure ensure proper communication?
- How are resources shared across geography?
- What is your administrative support structure?
- How is administrative time allocated for physician leaders?
- How do you ensure engagement from all providers?
- How does your organization structure create alignment with the healthcare system?
The following compensation issues were discussed, and can be used as a discussion outline for most groups:
- How does your compensation (comp) plan align with the goals and values of the system?
- How does your comp plan account for regional variances?
- How does the comp plan encourage teamwork and sharing of resources?
- How does comp plan account for differences in acuity, hospital size, night frequency, etc.?
- Are goals and incentives group based, site based, or individual based?
- How does the comp plan fairly reward “non-RVU” work? (teaching, committee service, etc.)
- Should all site leaders receive the same comp regardless of group size?
- Does the comp plan incorporate “minimum work standards”/social compact?
Key Points/HM Takeaways:
- Panel discussion was valuable and reassured attendees that there are multiple ways to make groups successful. One common variable of successful groups is open lines of communication at all levels.
- Physician on-boarding is critical and should be utilized to set clear expectations.
- HM Goals/expectations must be aligned with those of the hospital and health system.
- When multiple hospitals are part of a larger system, it is desirable for goals to be aligned across the health system.
- Two-way open communication is necessary for success.
- Try to take a walk in your colleague’s/stakeholder’s shoes:
- How does my hospital administrative partner see this issue?
- How does my regional director/system lead see this issue?
- How does my bedside hospitalist physician/provider see this issue?
- How would my patients view this issue?
- Issues facing different types of groups, academic vs. community and for profit vs. not for profit, are somewhat variable.
- The leadership Dyad consisting of a physician and practice management professional in partnership is an effective and well-proven management model.
Many thanks to Drs. T.J. Richardson and Dan Duzan for their input and assistance with this session summary. Dr. Richardson is a Regional Medical Director and Dr. Duzan is a Facility Medical Director, both work for TeamHealth.
Julianna Lindsey is a hospitalist and physician leader based in the Dallas-Fort Worth Metroplex. Her focus is patient safety/quality and physician leadership. She is a member of TeamHospitalist.
Session: Multi-site Hospitalist Leaders: Unique Challenges/What You Should Know
HM15 Presenter/Moderator: Scott Rissmiller, MD
Summation: This standing-room-only session was the result of a popular HMX e-community, which has become an active discussion board. As hospitals and health systems continue to consolidate across the country, there has been a rapid growth of multi-hospital systems. The role of the “Chief Hospitalist,” whose job is to lead multiple hospitalist groups within these systems, is evolving. These “Chief Hospitalists” are growing in number and they, as well as their followers, face unique challenges.
These points regarding organization structure were discussed, and as you look at your own organizational structure, these questions deserve your attention:
- Purpose of your structure?
- Is your structure centralized or decentralized?
- How does your organizational structure support decision-making?
- How does the structure ensure proper communication?
- How are resources shared across geography?
- What is your administrative support structure?
- How is administrative time allocated for physician leaders?
- How do you ensure engagement from all providers?
- How does your organization structure create alignment with the healthcare system?
The following compensation issues were discussed, and can be used as a discussion outline for most groups:
- How does your compensation (comp) plan align with the goals and values of the system?
- How does your comp plan account for regional variances?
- How does the comp plan encourage teamwork and sharing of resources?
- How does comp plan account for differences in acuity, hospital size, night frequency, etc.?
- Are goals and incentives group based, site based, or individual based?
- How does the comp plan fairly reward “non-RVU” work? (teaching, committee service, etc.)
- Should all site leaders receive the same comp regardless of group size?
- Does the comp plan incorporate “minimum work standards”/social compact?
Key Points/HM Takeaways:
- Panel discussion was valuable and reassured attendees that there are multiple ways to make groups successful. One common variable of successful groups is open lines of communication at all levels.
- Physician on-boarding is critical and should be utilized to set clear expectations.
- HM Goals/expectations must be aligned with those of the hospital and health system.
- When multiple hospitals are part of a larger system, it is desirable for goals to be aligned across the health system.
- Two-way open communication is necessary for success.
- Try to take a walk in your colleague’s/stakeholder’s shoes:
- How does my hospital administrative partner see this issue?
- How does my regional director/system lead see this issue?
- How does my bedside hospitalist physician/provider see this issue?
- How would my patients view this issue?
- Issues facing different types of groups, academic vs. community and for profit vs. not for profit, are somewhat variable.
- The leadership Dyad consisting of a physician and practice management professional in partnership is an effective and well-proven management model.
Many thanks to Drs. T.J. Richardson and Dan Duzan for their input and assistance with this session summary. Dr. Richardson is a Regional Medical Director and Dr. Duzan is a Facility Medical Director, both work for TeamHealth.
Julianna Lindsey is a hospitalist and physician leader based in the Dallas-Fort Worth Metroplex. Her focus is patient safety/quality and physician leadership. She is a member of TeamHospitalist.
HM15 Session Analysis: The Physician-Administrator Management Dyad
Hm15 Presenters: Chuck Ainsworth, MD, MCC,; Dan Virnich, MD, MBA; Roberta Himebaugh, MBA, SFHM; Robert Hickling, MHA; Sendil Krishnan, MD
Summation: The presenters, a group of physicians and administrators for hospital medicine groups, explored three dyad models. These three models were:
- Office of the Executive, where there is one senior executive and a junior executive;
- Coordinated Co-Leadership, where each of the two co-leaders has separate direct reports; and
- Integrated Co-Leadership, where there are two co-leaders and the staff report to the co-leader team.
The discussion ensued to outline the benefit of a dyad leadership model, which can lead to growth and success in advancing the commitment to patient care. The group also emphasized the importance of providing leadership training and education to optimize the dyad leadership model. Bringing together physician and administrator dyads enables an organization to have complimentary expertise to advance hospital medicine programs into the next era.
Hm15 Presenters: Chuck Ainsworth, MD, MCC,; Dan Virnich, MD, MBA; Roberta Himebaugh, MBA, SFHM; Robert Hickling, MHA; Sendil Krishnan, MD
Summation: The presenters, a group of physicians and administrators for hospital medicine groups, explored three dyad models. These three models were:
- Office of the Executive, where there is one senior executive and a junior executive;
- Coordinated Co-Leadership, where each of the two co-leaders has separate direct reports; and
- Integrated Co-Leadership, where there are two co-leaders and the staff report to the co-leader team.
The discussion ensued to outline the benefit of a dyad leadership model, which can lead to growth and success in advancing the commitment to patient care. The group also emphasized the importance of providing leadership training and education to optimize the dyad leadership model. Bringing together physician and administrator dyads enables an organization to have complimentary expertise to advance hospital medicine programs into the next era.
Hm15 Presenters: Chuck Ainsworth, MD, MCC,; Dan Virnich, MD, MBA; Roberta Himebaugh, MBA, SFHM; Robert Hickling, MHA; Sendil Krishnan, MD
Summation: The presenters, a group of physicians and administrators for hospital medicine groups, explored three dyad models. These three models were:
- Office of the Executive, where there is one senior executive and a junior executive;
- Coordinated Co-Leadership, where each of the two co-leaders has separate direct reports; and
- Integrated Co-Leadership, where there are two co-leaders and the staff report to the co-leader team.
The discussion ensued to outline the benefit of a dyad leadership model, which can lead to growth and success in advancing the commitment to patient care. The group also emphasized the importance of providing leadership training and education to optimize the dyad leadership model. Bringing together physician and administrator dyads enables an organization to have complimentary expertise to advance hospital medicine programs into the next era.
HM15 Session Analysis: Innovative Hospitalist Staffing Models
HM15 Presenters: John Nelson, MD, MHM; Daniel Hanson, MD, FHM; Darren Thomas, MD
Summation: The presenters, from three entirely different geographic regions across the U.S., walked the audience through several different innovative hospitalist staffing models, from staffing in a multi-hospital system to integrating of advanced practice clinicians to deploying staggered staffing techniques to match the patient demand and enhance continuity of care.
Many multi-hospital systems are challenged to consider creative solutions on how to meet individual hospital staffing needs, while also creating staffing efficiencies across the system, such as cross coverage at night and back-up staffing solutions for increased patient volumes and unexpected staffing vacancies.
Examples to enhance patient continuity were presented throughout, such as pairing together a hospitalist from one week to a hospitalist from an alternate week to care for the same patients.
Similarly, the experts provided a compelling case to consider pairing hospitalist providers with patients, and referring physicians longitudinally across multiple admissions.
Key Takeaways:
1. Patients Come First - consider patient alignment, or continuity, in determing provider scheduling options.
2. Multi-hospital Systems - establish the onboarding parameters needed for providers to be successful in covering more than one hospital and how to build into your scheduling model.
3. Integrate the Care Team - ensure the roles of the integrated provider team (e.g., physicians and advanced practice clinicians) are clearly understood when developing the schedule.
4. Know Your Numbers - clearly understand the workload demands to properly balance the scheduling needs before establishing the schedule.
5. Regular Review - regularly review all of these areas and revise your schedule based on the changing landscape of demands on your hospital medicine group.
HM15 Presenters: John Nelson, MD, MHM; Daniel Hanson, MD, FHM; Darren Thomas, MD
Summation: The presenters, from three entirely different geographic regions across the U.S., walked the audience through several different innovative hospitalist staffing models, from staffing in a multi-hospital system to integrating of advanced practice clinicians to deploying staggered staffing techniques to match the patient demand and enhance continuity of care.
Many multi-hospital systems are challenged to consider creative solutions on how to meet individual hospital staffing needs, while also creating staffing efficiencies across the system, such as cross coverage at night and back-up staffing solutions for increased patient volumes and unexpected staffing vacancies.
Examples to enhance patient continuity were presented throughout, such as pairing together a hospitalist from one week to a hospitalist from an alternate week to care for the same patients.
Similarly, the experts provided a compelling case to consider pairing hospitalist providers with patients, and referring physicians longitudinally across multiple admissions.
Key Takeaways:
1. Patients Come First - consider patient alignment, or continuity, in determing provider scheduling options.
2. Multi-hospital Systems - establish the onboarding parameters needed for providers to be successful in covering more than one hospital and how to build into your scheduling model.
3. Integrate the Care Team - ensure the roles of the integrated provider team (e.g., physicians and advanced practice clinicians) are clearly understood when developing the schedule.
4. Know Your Numbers - clearly understand the workload demands to properly balance the scheduling needs before establishing the schedule.
5. Regular Review - regularly review all of these areas and revise your schedule based on the changing landscape of demands on your hospital medicine group.
HM15 Presenters: John Nelson, MD, MHM; Daniel Hanson, MD, FHM; Darren Thomas, MD
Summation: The presenters, from three entirely different geographic regions across the U.S., walked the audience through several different innovative hospitalist staffing models, from staffing in a multi-hospital system to integrating of advanced practice clinicians to deploying staggered staffing techniques to match the patient demand and enhance continuity of care.
Many multi-hospital systems are challenged to consider creative solutions on how to meet individual hospital staffing needs, while also creating staffing efficiencies across the system, such as cross coverage at night and back-up staffing solutions for increased patient volumes and unexpected staffing vacancies.
Examples to enhance patient continuity were presented throughout, such as pairing together a hospitalist from one week to a hospitalist from an alternate week to care for the same patients.
Similarly, the experts provided a compelling case to consider pairing hospitalist providers with patients, and referring physicians longitudinally across multiple admissions.
Key Takeaways:
1. Patients Come First - consider patient alignment, or continuity, in determing provider scheduling options.
2. Multi-hospital Systems - establish the onboarding parameters needed for providers to be successful in covering more than one hospital and how to build into your scheduling model.
3. Integrate the Care Team - ensure the roles of the integrated provider team (e.g., physicians and advanced practice clinicians) are clearly understood when developing the schedule.
4. Know Your Numbers - clearly understand the workload demands to properly balance the scheduling needs before establishing the schedule.
5. Regular Review - regularly review all of these areas and revise your schedule based on the changing landscape of demands on your hospital medicine group.
Palliative Care and Last-Minute Heroics
4/8/15
HM15 Presenter: Tammie Quest, MD
Summation: Heroics- a set of medical actions that attempt to prolong life with a low likelihood of success.
Palliative care- an approach of care provided to patients and families suffering from serious and/or life limiting illness; focus on physical, spiritual, psychological and social aspects of distress.
Hospice care- intense palliative care provided when the patient has terminal illness with a prognosis of 6 months or less if the disease runs its usual course.
We underutilize Palliative and Hospice care in the US. Here in the US fewer than 50% of all persons receive hospice care at EOL, of those who receive hospice care more than half receive care for less than 20 days, and 1 in 5 patients die in an ICU. Palliative Care can/should co-exist with life prolonging care following the diagnosis of serious illness.
Common therapies/interventions to be contemplated and discussed with patient at end of life: cpr, mechanical ventilation, central venous/arterial access, renal replacement therapy, surgical procedures, valve therapies, ventricular assist devices, continuous infusions, IV fluids, supplemental oxygen, artificial nutrition, antimicrobials, blood products, cancer directed therapy, antithrombotics, anticoagulation.
Practical Elements of Palliative Care: pain and symptom management, advance care planning, communication/goals of care, truth-telling, social support, spiritual support, psychological support, risk/burden assessment of treatments.
Key Points/HM Takeaways:
1-Palliative Care Bedside Talking Points-
- Cardiac arrest is the moment of death, very few people survive an attempt at reversing death
- If you are one of the few who survive to discharge, you may do well but few will survive to discharge
- Antibiotics DO improve survival, antibiotics DO NOT improve comfort
- No evidence to show that dying from pneumonia, or other infection, is painful
- Allowing natural death includes permitting the body to shut itself down through natural mechanisms, including infection
- Dialysis may extend life, but there will be progressive functional decline
2-Goals of Care define what therapies are indicated. Balance prolongation of life with illness experience.
Julianna Lindsey is a hospitalist and physician leader based in the Dallas-Fort Worth Metroplex. Her focus is patient safety/quality and physician leadership. She is a member of TeamHospitalist.
4/8/15
HM15 Presenter: Tammie Quest, MD
Summation: Heroics- a set of medical actions that attempt to prolong life with a low likelihood of success.
Palliative care- an approach of care provided to patients and families suffering from serious and/or life limiting illness; focus on physical, spiritual, psychological and social aspects of distress.
Hospice care- intense palliative care provided when the patient has terminal illness with a prognosis of 6 months or less if the disease runs its usual course.
We underutilize Palliative and Hospice care in the US. Here in the US fewer than 50% of all persons receive hospice care at EOL, of those who receive hospice care more than half receive care for less than 20 days, and 1 in 5 patients die in an ICU. Palliative Care can/should co-exist with life prolonging care following the diagnosis of serious illness.
Common therapies/interventions to be contemplated and discussed with patient at end of life: cpr, mechanical ventilation, central venous/arterial access, renal replacement therapy, surgical procedures, valve therapies, ventricular assist devices, continuous infusions, IV fluids, supplemental oxygen, artificial nutrition, antimicrobials, blood products, cancer directed therapy, antithrombotics, anticoagulation.
Practical Elements of Palliative Care: pain and symptom management, advance care planning, communication/goals of care, truth-telling, social support, spiritual support, psychological support, risk/burden assessment of treatments.
Key Points/HM Takeaways:
1-Palliative Care Bedside Talking Points-
- Cardiac arrest is the moment of death, very few people survive an attempt at reversing death
- If you are one of the few who survive to discharge, you may do well but few will survive to discharge
- Antibiotics DO improve survival, antibiotics DO NOT improve comfort
- No evidence to show that dying from pneumonia, or other infection, is painful
- Allowing natural death includes permitting the body to shut itself down through natural mechanisms, including infection
- Dialysis may extend life, but there will be progressive functional decline
2-Goals of Care define what therapies are indicated. Balance prolongation of life with illness experience.
Julianna Lindsey is a hospitalist and physician leader based in the Dallas-Fort Worth Metroplex. Her focus is patient safety/quality and physician leadership. She is a member of TeamHospitalist.
4/8/15
HM15 Presenter: Tammie Quest, MD
Summation: Heroics- a set of medical actions that attempt to prolong life with a low likelihood of success.
Palliative care- an approach of care provided to patients and families suffering from serious and/or life limiting illness; focus on physical, spiritual, psychological and social aspects of distress.
Hospice care- intense palliative care provided when the patient has terminal illness with a prognosis of 6 months or less if the disease runs its usual course.
We underutilize Palliative and Hospice care in the US. Here in the US fewer than 50% of all persons receive hospice care at EOL, of those who receive hospice care more than half receive care for less than 20 days, and 1 in 5 patients die in an ICU. Palliative Care can/should co-exist with life prolonging care following the diagnosis of serious illness.
Common therapies/interventions to be contemplated and discussed with patient at end of life: cpr, mechanical ventilation, central venous/arterial access, renal replacement therapy, surgical procedures, valve therapies, ventricular assist devices, continuous infusions, IV fluids, supplemental oxygen, artificial nutrition, antimicrobials, blood products, cancer directed therapy, antithrombotics, anticoagulation.
Practical Elements of Palliative Care: pain and symptom management, advance care planning, communication/goals of care, truth-telling, social support, spiritual support, psychological support, risk/burden assessment of treatments.
Key Points/HM Takeaways:
1-Palliative Care Bedside Talking Points-
- Cardiac arrest is the moment of death, very few people survive an attempt at reversing death
- If you are one of the few who survive to discharge, you may do well but few will survive to discharge
- Antibiotics DO improve survival, antibiotics DO NOT improve comfort
- No evidence to show that dying from pneumonia, or other infection, is painful
- Allowing natural death includes permitting the body to shut itself down through natural mechanisms, including infection
- Dialysis may extend life, but there will be progressive functional decline
2-Goals of Care define what therapies are indicated. Balance prolongation of life with illness experience.
Julianna Lindsey is a hospitalist and physician leader based in the Dallas-Fort Worth Metroplex. Her focus is patient safety/quality and physician leadership. She is a member of TeamHospitalist.
Implementing Physician Value-Based Purchasing in Your Practice: HM15 Session Analysis
HM15 Session: Putting Your Nickel Down: The What, Why, and How of Implementing Physician Value-Based Purchasing in Your Practice
Presenters: Stephen Besch, Simone Karp RPh, Patrick Torcson MD MMM SFHM, Gregory Seymann MD SFHM
Medicare is transforming itself from a “passive payer” to an “active purchaser” of high quality, efficient healthcare. As such- active participation by physicians, physician groups, and hospitals is required for payment eligibility.
At the physician/group level, hospitalists should be reporting PQRS measures. Incentive payments for PQRS ended in 2014, Medicare is now making “negative payment adjustments.” Penalties are equal to a percentage of all Medicare Part B FFS (Fee-for-Service) charges and there is a 2-year delay between reporting or performance failure and penalization.
Physician Value-Based Purchasing (P-VBP) affects all Eligible Providers (EPs) in 2015. P4P (Pay for Performance) assesses both quality and cost. Aim is for budget neutrality via “quality tiering” which rewards “high quality/low cost” practices with penalties from “low quality/high cost” practices. As of now (2015) ACPs and therapists can be penalized under P-VBP.
Key Points/HM Takeaways:
- Hospitalists should be reporting PQRS measures- penalty phase has begun
- Key PQRS Changes for 2015:
- 6 measures applicable to inpatient billing removed
- no useful inpatient measures added
- penalty avoidance requires 9 measures at 50% or higher rates, covering at least 3 of the 6 NQS (National Quality Strategy) domains- including 1 cross-cutting measure
- all 2015 PQRS data will be posted to Physician Compare website in 2016
- 3 Examples of hospitalist applicable “cross-cutting measures” are
- 47-advance care plan
- 130-documentation of current medications
- 317-preventative care: bp screening
- PQRS data must be reported with respect to MAV clusters (Measure Applicability Validation)- reporting only measure that have no MAV cluster is a safe strategy so long as one of the measures is “cross-cutting”
- Maximum P-VBP penalties automatically apply if group does not report enough PQRS data
- visit CMS website for more information
HM15 Session: Putting Your Nickel Down: The What, Why, and How of Implementing Physician Value-Based Purchasing in Your Practice
Presenters: Stephen Besch, Simone Karp RPh, Patrick Torcson MD MMM SFHM, Gregory Seymann MD SFHM
Medicare is transforming itself from a “passive payer” to an “active purchaser” of high quality, efficient healthcare. As such- active participation by physicians, physician groups, and hospitals is required for payment eligibility.
At the physician/group level, hospitalists should be reporting PQRS measures. Incentive payments for PQRS ended in 2014, Medicare is now making “negative payment adjustments.” Penalties are equal to a percentage of all Medicare Part B FFS (Fee-for-Service) charges and there is a 2-year delay between reporting or performance failure and penalization.
Physician Value-Based Purchasing (P-VBP) affects all Eligible Providers (EPs) in 2015. P4P (Pay for Performance) assesses both quality and cost. Aim is for budget neutrality via “quality tiering” which rewards “high quality/low cost” practices with penalties from “low quality/high cost” practices. As of now (2015) ACPs and therapists can be penalized under P-VBP.
Key Points/HM Takeaways:
- Hospitalists should be reporting PQRS measures- penalty phase has begun
- Key PQRS Changes for 2015:
- 6 measures applicable to inpatient billing removed
- no useful inpatient measures added
- penalty avoidance requires 9 measures at 50% or higher rates, covering at least 3 of the 6 NQS (National Quality Strategy) domains- including 1 cross-cutting measure
- all 2015 PQRS data will be posted to Physician Compare website in 2016
- 3 Examples of hospitalist applicable “cross-cutting measures” are
- 47-advance care plan
- 130-documentation of current medications
- 317-preventative care: bp screening
- PQRS data must be reported with respect to MAV clusters (Measure Applicability Validation)- reporting only measure that have no MAV cluster is a safe strategy so long as one of the measures is “cross-cutting”
- Maximum P-VBP penalties automatically apply if group does not report enough PQRS data
- visit CMS website for more information
HM15 Session: Putting Your Nickel Down: The What, Why, and How of Implementing Physician Value-Based Purchasing in Your Practice
Presenters: Stephen Besch, Simone Karp RPh, Patrick Torcson MD MMM SFHM, Gregory Seymann MD SFHM
Medicare is transforming itself from a “passive payer” to an “active purchaser” of high quality, efficient healthcare. As such- active participation by physicians, physician groups, and hospitals is required for payment eligibility.
At the physician/group level, hospitalists should be reporting PQRS measures. Incentive payments for PQRS ended in 2014, Medicare is now making “negative payment adjustments.” Penalties are equal to a percentage of all Medicare Part B FFS (Fee-for-Service) charges and there is a 2-year delay between reporting or performance failure and penalization.
Physician Value-Based Purchasing (P-VBP) affects all Eligible Providers (EPs) in 2015. P4P (Pay for Performance) assesses both quality and cost. Aim is for budget neutrality via “quality tiering” which rewards “high quality/low cost” practices with penalties from “low quality/high cost” practices. As of now (2015) ACPs and therapists can be penalized under P-VBP.
Key Points/HM Takeaways:
- Hospitalists should be reporting PQRS measures- penalty phase has begun
- Key PQRS Changes for 2015:
- 6 measures applicable to inpatient billing removed
- no useful inpatient measures added
- penalty avoidance requires 9 measures at 50% or higher rates, covering at least 3 of the 6 NQS (National Quality Strategy) domains- including 1 cross-cutting measure
- all 2015 PQRS data will be posted to Physician Compare website in 2016
- 3 Examples of hospitalist applicable “cross-cutting measures” are
- 47-advance care plan
- 130-documentation of current medications
- 317-preventative care: bp screening
- PQRS data must be reported with respect to MAV clusters (Measure Applicability Validation)- reporting only measure that have no MAV cluster is a safe strategy so long as one of the measures is “cross-cutting”
- Maximum P-VBP penalties automatically apply if group does not report enough PQRS data
- visit CMS website for more information