Career

A lawsuit recently levied against a hospital accused of discharging a homeless patient to city streets serves as a reminder that physicians need to look beyond a patient's immediate health concerns when considering care transitions, one hospitalist says.

As reported in the Los Angeles Times, Glendale Adventist Medical Center in Glendale, Calif., has agreed to pay $700,000 in civil penalties to settle a lawsuit brought against it by the Los Angeles City Attorney. A hospital spokesperson said the medical center denies the charges but has agreed to pay the fine to avoid the cost of fighting the allegations.

"We have to be able to recognize that just writing a discharge order is not meeting any of our patients' needs," says Gregory Misky, MD, hospitalist and associate professor of medicine at the University of Colorado (UC) Hospital in Denver. "It's hard to expect we can fix their COPD or manage their diabetes when there are all these layers of social and behavioral health needs."

Dr. Misky says he gradually became interested in issues affecting indigent patients while researching ways to help patients transition from hospital to home.

"Some patients are dealing with financial issues," he says. "Some have acute family crises they're dealing with. Some have homelessness issues or housing issues. All those things interfere with their health and ability to prioritize health needs over these other things."

One of Dr. Misky's current research projects involves performing qualitative interviews with patients who are readmitted within 30 days to learn what challenges they dealt with after being discharged.

As for "patient dumping," Dr. Misky says that, in his experience, hospitals typically do the opposite: hospitalize patients for indefinite periods of time when they seem to have no family to turn to, for example, or are dealing with cognitive issues.

Here are Dr. Misky's tips for providing better discharges:

• Be aware: Not all patients are equal. It's important to realize patients may not recuperate from pneumonia if they are living on the street;
• Rely on case managers: Hospitalists at the UC Hospital perform discharge rounds with a team that includes a case manager, who is usually a registered nurse or social worker. Let the case manager know about your patients’ needs; and
• Form partnerships: Learn about how you can match up your patients with resources for homeless people available in your community.

A lawsuit recently levied against a hospital accused of discharging a homeless patient to city streets serves as a reminder that physicians need to look beyond a patient's immediate health concerns when considering care transitions, one hospitalist says.

As reported in the Los Angeles Times, Glendale Adventist Medical Center in Glendale, Calif., has agreed to pay $700,000 in civil penalties to settle a lawsuit brought against it by the Los Angeles City Attorney. A hospital spokesperson said the medical center denies the charges but has agreed to pay the fine to avoid the cost of fighting the allegations.

"We have to be able to recognize that just writing a discharge order is not meeting any of our patients' needs," says Gregory Misky, MD, hospitalist and associate professor of medicine at the University of Colorado (UC) Hospital in Denver. "It's hard to expect we can fix their COPD or manage their diabetes when there are all these layers of social and behavioral health needs."

Dr. Misky says he gradually became interested in issues affecting indigent patients while researching ways to help patients transition from hospital to home.

"Some patients are dealing with financial issues," he says. "Some have acute family crises they're dealing with. Some have homelessness issues or housing issues. All those things interfere with their health and ability to prioritize health needs over these other things."

One of Dr. Misky's current research projects involves performing qualitative interviews with patients who are readmitted within 30 days to learn what challenges they dealt with after being discharged.

As for "patient dumping," Dr. Misky says that, in his experience, hospitals typically do the opposite: hospitalize patients for indefinite periods of time when they seem to have no family to turn to, for example, or are dealing with cognitive issues.

Here are Dr. Misky's tips for providing better discharges:

• Be aware: Not all patients are equal. It's important to realize patients may not recuperate from pneumonia if they are living on the street;
• Rely on case managers: Hospitalists at the UC Hospital perform discharge rounds with a team that includes a case manager, who is usually a registered nurse or social worker. Let the case manager know about your patients’ needs; and
• Form partnerships: Learn about how you can match up your patients with resources for homeless people available in your community.

A lawsuit recently levied against a hospital accused of discharging a homeless patient to city streets serves as a reminder that physicians need to look beyond a patient's immediate health concerns when considering care transitions, one hospitalist says.

As reported in the Los Angeles Times, Glendale Adventist Medical Center in Glendale, Calif., has agreed to pay $700,000 in civil penalties to settle a lawsuit brought against it by the Los Angeles City Attorney. A hospital spokesperson said the medical center denies the charges but has agreed to pay the fine to avoid the cost of fighting the allegations.

"We have to be able to recognize that just writing a discharge order is not meeting any of our patients' needs," says Gregory Misky, MD, hospitalist and associate professor of medicine at the University of Colorado (UC) Hospital in Denver. "It's hard to expect we can fix their COPD or manage their diabetes when there are all these layers of social and behavioral health needs."

Dr. Misky says he gradually became interested in issues affecting indigent patients while researching ways to help patients transition from hospital to home.

"Some patients are dealing with financial issues," he says. "Some have acute family crises they're dealing with. Some have homelessness issues or housing issues. All those things interfere with their health and ability to prioritize health needs over these other things."

One of Dr. Misky's current research projects involves performing qualitative interviews with patients who are readmitted within 30 days to learn what challenges they dealt with after being discharged.

As for "patient dumping," Dr. Misky says that, in his experience, hospitals typically do the opposite: hospitalize patients for indefinite periods of time when they seem to have no family to turn to, for example, or are dealing with cognitive issues.

Here are Dr. Misky's tips for providing better discharges:

• Be aware: Not all patients are equal. It's important to realize patients may not recuperate from pneumonia if they are living on the street;
• Rely on case managers: Hospitalists at the UC Hospital perform discharge rounds with a team that includes a case manager, who is usually a registered nurse or social worker. Let the case manager know about your patients’ needs; and
• Form partnerships: Learn about how you can match up your patients with resources for homeless people available in your community.

News that healthcare spending's growth rate slowed in 2013 but is expected to pick up in the next decade isn't all rosy for hospitalists, says a member of SHM's Public Policy Committee.

Committee member Bradley Flansbaum, DO, MPH, SFHM, says he expects the amount of funding going to hospitalists to decrease in the coming years as healthcare reform focuses on keeping patients out of the hospital.

"The slice that's going to be dedicated to inpatient medicine in hospitals is going to shrink," says Dr. Flansbaum, a hospitalist at Lenox Hill Hospital in New York City. "From a hospitalist standpoint, I don't think it's kick back, flip open the beer lid, and turn the game on. Things are really going to change."

A report in this month's Health Affairs shows that spending growth in 2013 fell to 3.6%, down from 7.2% annually on average between 1990 and 2008. The decreased rate is attributed to a "sluggish economic recovery, the effects of sequestration, and continued increases in private health insurance cost-sharing requirements," according to the report.

However, the combination of money being pumped into healthcare reform and a growing economy is projected to push up spending by 5.6% this year and 6% annually each year from 2015 to 2023, according to the report. How much of that money will flow into HM depends, in part, on how well the specialty improves patient care and hospital bottom lines, Dr. Flansbaum says. "And teasing out that effect is tough," he says. "Mainly, is it that we're ordering less tests or are the prices going down or neither, and [are] other forces contributing to efficiency gains? Those are very different variables."

News that healthcare spending's growth rate slowed in 2013 but is expected to pick up in the next decade isn't all rosy for hospitalists, says a member of SHM's Public Policy Committee.

Committee member Bradley Flansbaum, DO, MPH, SFHM, says he expects the amount of funding going to hospitalists to decrease in the coming years as healthcare reform focuses on keeping patients out of the hospital.

"The slice that's going to be dedicated to inpatient medicine in hospitals is going to shrink," says Dr. Flansbaum, a hospitalist at Lenox Hill Hospital in New York City. "From a hospitalist standpoint, I don't think it's kick back, flip open the beer lid, and turn the game on. Things are really going to change."

A report in this month's Health Affairs shows that spending growth in 2013 fell to 3.6%, down from 7.2% annually on average between 1990 and 2008. The decreased rate is attributed to a "sluggish economic recovery, the effects of sequestration, and continued increases in private health insurance cost-sharing requirements," according to the report.

However, the combination of money being pumped into healthcare reform and a growing economy is projected to push up spending by 5.6% this year and 6% annually each year from 2015 to 2023, according to the report. How much of that money will flow into HM depends, in part, on how well the specialty improves patient care and hospital bottom lines, Dr. Flansbaum says. "And teasing out that effect is tough," he says. "Mainly, is it that we're ordering less tests or are the prices going down or neither, and [are] other forces contributing to efficiency gains? Those are very different variables."

News that healthcare spending's growth rate slowed in 2013 but is expected to pick up in the next decade isn't all rosy for hospitalists, says a member of SHM's Public Policy Committee.

Committee member Bradley Flansbaum, DO, MPH, SFHM, says he expects the amount of funding going to hospitalists to decrease in the coming years as healthcare reform focuses on keeping patients out of the hospital.

"The slice that's going to be dedicated to inpatient medicine in hospitals is going to shrink," says Dr. Flansbaum, a hospitalist at Lenox Hill Hospital in New York City. "From a hospitalist standpoint, I don't think it's kick back, flip open the beer lid, and turn the game on. Things are really going to change."

A report in this month's Health Affairs shows that spending growth in 2013 fell to 3.6%, down from 7.2% annually on average between 1990 and 2008. The decreased rate is attributed to a "sluggish economic recovery, the effects of sequestration, and continued increases in private health insurance cost-sharing requirements," according to the report.

However, the combination of money being pumped into healthcare reform and a growing economy is projected to push up spending by 5.6% this year and 6% annually each year from 2015 to 2023, according to the report. How much of that money will flow into HM depends, in part, on how well the specialty improves patient care and hospital bottom lines, Dr. Flansbaum says. "And teasing out that effect is tough," he says. "Mainly, is it that we're ordering less tests or are the prices going down or neither, and [are] other forces contributing to efficiency gains? Those are very different variables."

One of the toughest jobs of group management is teasing out the trends that will define HM in the future. In the past few years, hospitalist leaders have tried to forecast whether the growth in compensation would slow or even recede. Instead, median compensation nationwide climbed 17.7% between 2010 and 2014, telling

Dr. Landis that a specialty barely 20 years old still has room to grow.

“There’s a lot at stake here,” he says. “Our patients’ lives are at stake. A lot of our country’s resources are going into healthcare, and the hospital is a very expensive place to receive care, so we want to be delivering the best value.

“We’ve got to do a better job, The information [in the report] is there to help hospital medicine groups and hospitalists.”

IPC’s Taylor adds that trying to understand trends begins with noticing shifts before they become industry standards. He’s tracking two of those right now.

“We’re now seeing hospital stipends starting to be examined by the hospitals,” he says, noting that healthcare executives are asking if this is “a rational amount of money to be paying to support a program?

“We’re [also] starting to see a reversal in the trend of hospitals employing their own hospitalists, which gained quite a bit of steam about five years ago, but it seemed to start running out of steam. Now, from what we are seeing in the marketplace, it appears to be tipping back the other way, particularly with hospitals that have done the math, and they’re beginning to outsource.”

Whether those early warning signs become full-blown trends or not, Taylor says the best management approach is to measure as much information as possible moving forward. Having the SOHM’s baseline every other year is another piece of that information pie.

“It’s interesting data, but I think it’s going to be more interesting to me to see how that data looks three to four years from now, [to understand] if the trends we see or we believe we see beginning, continue,” he adds. “It will be interesting to see the impact of those two forces on the data.”—RQ

One of the toughest jobs of group management is teasing out the trends that will define HM in the future. In the past few years, hospitalist leaders have tried to forecast whether the growth in compensation would slow or even recede. Instead, median compensation nationwide climbed 17.7% between 2010 and 2014, telling

Dr. Landis that a specialty barely 20 years old still has room to grow.

“There’s a lot at stake here,” he says. “Our patients’ lives are at stake. A lot of our country’s resources are going into healthcare, and the hospital is a very expensive place to receive care, so we want to be delivering the best value.

“We’ve got to do a better job, The information [in the report] is there to help hospital medicine groups and hospitalists.”

IPC’s Taylor adds that trying to understand trends begins with noticing shifts before they become industry standards. He’s tracking two of those right now.

“We’re now seeing hospital stipends starting to be examined by the hospitals,” he says, noting that healthcare executives are asking if this is “a rational amount of money to be paying to support a program?

“We’re [also] starting to see a reversal in the trend of hospitals employing their own hospitalists, which gained quite a bit of steam about five years ago, but it seemed to start running out of steam. Now, from what we are seeing in the marketplace, it appears to be tipping back the other way, particularly with hospitals that have done the math, and they’re beginning to outsource.”

Whether those early warning signs become full-blown trends or not, Taylor says the best management approach is to measure as much information as possible moving forward. Having the SOHM’s baseline every other year is another piece of that information pie.

“It’s interesting data, but I think it’s going to be more interesting to me to see how that data looks three to four years from now, [to understand] if the trends we see or we believe we see beginning, continue,” he adds. “It will be interesting to see the impact of those two forces on the data.”—RQ

One of the toughest jobs of group management is teasing out the trends that will define HM in the future. In the past few years, hospitalist leaders have tried to forecast whether the growth in compensation would slow or even recede. Instead, median compensation nationwide climbed 17.7% between 2010 and 2014, telling

Dr. Landis that a specialty barely 20 years old still has room to grow.

“There’s a lot at stake here,” he says. “Our patients’ lives are at stake. A lot of our country’s resources are going into healthcare, and the hospital is a very expensive place to receive care, so we want to be delivering the best value.

“We’ve got to do a better job, The information [in the report] is there to help hospital medicine groups and hospitalists.”

IPC’s Taylor adds that trying to understand trends begins with noticing shifts before they become industry standards. He’s tracking two of those right now.

“We’re now seeing hospital stipends starting to be examined by the hospitals,” he says, noting that healthcare executives are asking if this is “a rational amount of money to be paying to support a program?

“We’re [also] starting to see a reversal in the trend of hospitals employing their own hospitalists, which gained quite a bit of steam about five years ago, but it seemed to start running out of steam. Now, from what we are seeing in the marketplace, it appears to be tipping back the other way, particularly with hospitals that have done the math, and they’re beginning to outsource.”

Whether those early warning signs become full-blown trends or not, Taylor says the best management approach is to measure as much information as possible moving forward. Having the SOHM’s baseline every other year is another piece of that information pie.

“It’s interesting data, but I think it’s going to be more interesting to me to see how that data looks three to four years from now, [to understand] if the trends we see or we believe we see beginning, continue,” he adds. “It will be interesting to see the impact of those two forces on the data.”—RQ

Annual median compensation for adult hospitalists in the U.S. rose 8% to a record high $252,996 in 2013, according to SHM's newly released 2014 State of Hospital Medicine (SOHM) report.

Hospitalists in the South region continue to earn the most, with a median compensation of $258,020—essentially static with $258,793 reported in 2012—according to data from the Medical Group Management Association Physician Compensation and Production Survey: 2014 Report Based on 2013 Data. The MGMA compensation and productivity data are wrapped into the biennial SOHM, whose 2014 edition debuted last week.

The largest compensation jump was for hospitalists in the West region, who logged an 11.8% gain in annual median compensation to $249,894 for 2013, up from $223,574 reported in 2012. Hospitalists in the Midwest saw a 10% increase, up to $261,868 from $237,987. Practitioners in the East had both the smallest increase, 4.8%, and the lowest median compensation, $238,676 in 2013, which is up slightly from $227,656. Part of the compensation push is tied to upward pressure on productivity. Nationwide, median relative value units (RVUs) ticked up 3.3% to 4,297 in 2013 from 4,159 in the 2012 report.

Median collection-to-work RVUs rose 6.8% to 51.5 from 48.21. Production (10.5%) and performance (6.6%) in 2013 were also slightly larger portions of mean compensation than in 2012, figures many industry experts expect will increase in the future. The 2014 SOHM report also notes that academic/university hospitalists typically receive more in base pay, while hospitalists in private practice receive less.

"It is the very best survey, quantity and quality, of hospital medicine [HM] groups," says William "Tex" Landis, MD, FHM, medical director of WellSpan Hospitalists in York, Pa., and a member and former chair of SHM's Practice Analysis Committee. "And so it becomes the best source of information to make important decisions about resourcing and operating hospital medicine groups."

Beyond analyzing hospitalists' median compensation, the SOHM report delves into scheduling, productivity, staffing, a breakdown of payment allocations, practice models, and dozens of other topics that HM group leaders find useful. In all, 499 groups representing some 6,300 providers were included in the survey. TH

SHM will also be hosting a free webinar Oct. 14 to discuss the specifics of the report.

Visit our website for more information about SHM's 2014 State of Hospital Medicine.

 

 

 

 

Annual median compensation for adult hospitalists in the U.S. rose 8% to a record high $252,996 in 2013, according to SHM's newly released 2014 State of Hospital Medicine (SOHM) report.

Hospitalists in the South region continue to earn the most, with a median compensation of $258,020—essentially static with $258,793 reported in 2012—according to data from the Medical Group Management Association Physician Compensation and Production Survey: 2014 Report Based on 2013 Data. The MGMA compensation and productivity data are wrapped into the biennial SOHM, whose 2014 edition debuted last week.

The largest compensation jump was for hospitalists in the West region, who logged an 11.8% gain in annual median compensation to $249,894 for 2013, up from $223,574 reported in 2012. Hospitalists in the Midwest saw a 10% increase, up to $261,868 from $237,987. Practitioners in the East had both the smallest increase, 4.8%, and the lowest median compensation, $238,676 in 2013, which is up slightly from $227,656. Part of the compensation push is tied to upward pressure on productivity. Nationwide, median relative value units (RVUs) ticked up 3.3% to 4,297 in 2013 from 4,159 in the 2012 report.

Median collection-to-work RVUs rose 6.8% to 51.5 from 48.21. Production (10.5%) and performance (6.6%) in 2013 were also slightly larger portions of mean compensation than in 2012, figures many industry experts expect will increase in the future. The 2014 SOHM report also notes that academic/university hospitalists typically receive more in base pay, while hospitalists in private practice receive less.

"It is the very best survey, quantity and quality, of hospital medicine [HM] groups," says William "Tex" Landis, MD, FHM, medical director of WellSpan Hospitalists in York, Pa., and a member and former chair of SHM's Practice Analysis Committee. "And so it becomes the best source of information to make important decisions about resourcing and operating hospital medicine groups."

Beyond analyzing hospitalists' median compensation, the SOHM report delves into scheduling, productivity, staffing, a breakdown of payment allocations, practice models, and dozens of other topics that HM group leaders find useful. In all, 499 groups representing some 6,300 providers were included in the survey. TH

SHM will also be hosting a free webinar Oct. 14 to discuss the specifics of the report.

Visit our website for more information about SHM's 2014 State of Hospital Medicine.

 

 

 

 

Annual median compensation for adult hospitalists in the U.S. rose 8% to a record high $252,996 in 2013, according to SHM's newly released 2014 State of Hospital Medicine (SOHM) report.

Hospitalists in the South region continue to earn the most, with a median compensation of $258,020—essentially static with $258,793 reported in 2012—according to data from the Medical Group Management Association Physician Compensation and Production Survey: 2014 Report Based on 2013 Data. The MGMA compensation and productivity data are wrapped into the biennial SOHM, whose 2014 edition debuted last week.

The largest compensation jump was for hospitalists in the West region, who logged an 11.8% gain in annual median compensation to $249,894 for 2013, up from $223,574 reported in 2012. Hospitalists in the Midwest saw a 10% increase, up to $261,868 from $237,987. Practitioners in the East had both the smallest increase, 4.8%, and the lowest median compensation, $238,676 in 2013, which is up slightly from $227,656. Part of the compensation push is tied to upward pressure on productivity. Nationwide, median relative value units (RVUs) ticked up 3.3% to 4,297 in 2013 from 4,159 in the 2012 report.

Median collection-to-work RVUs rose 6.8% to 51.5 from 48.21. Production (10.5%) and performance (6.6%) in 2013 were also slightly larger portions of mean compensation than in 2012, figures many industry experts expect will increase in the future. The 2014 SOHM report also notes that academic/university hospitalists typically receive more in base pay, while hospitalists in private practice receive less.

"It is the very best survey, quantity and quality, of hospital medicine [HM] groups," says William "Tex" Landis, MD, FHM, medical director of WellSpan Hospitalists in York, Pa., and a member and former chair of SHM's Practice Analysis Committee. "And so it becomes the best source of information to make important decisions about resourcing and operating hospital medicine groups."

Beyond analyzing hospitalists' median compensation, the SOHM report delves into scheduling, productivity, staffing, a breakdown of payment allocations, practice models, and dozens of other topics that HM group leaders find useful. In all, 499 groups representing some 6,300 providers were included in the survey. TH

SHM will also be hosting a free webinar Oct. 14 to discuss the specifics of the report.

Visit our website for more information about SHM's 2014 State of Hospital Medicine.

 

 

 

 

How well is your patient eating?

How often you ask this question could improve your hospital's readmission and length-of-stay rates, says Melissa Parkhurst, MD, FHM, medical director of hospital medicine and nutrition support at the University of Kansas Hospital in Kansas City.

A recent report from the Alliance to Advance Patient Nutrition [PDF]—a partnership of four organizations, including SHM, organized to improve nutrition screening and intervention among hospitalized patients—notes that about one in three patients admitted to a hospital meets the criteria for being malnourished. If left untreated, two-thirds of these patients will become more malnourished in the hospital.

"Often patients aren't eating because of testing or because their appetites are depressed because they're ill and not feeling well," says Dr. Parkhurst, an Alliance representative. "Sometimes their medications can alter their tastes, make them nauseated, or give them diarrhea."

Released last month, the findings are included in the partnership's first progress report. It describes the group's efforts in raising awareness about hospital nutrition, such as through info booths at medical meetings and via an online resource center on SHM's Center for Hospital Innovation & Improvement website.

Dr. Parkhurst points to studies that show inpatient malnutrition can lead to higher costs and more complications, as well as make patients more prone to surgical site infections, pressure ulcers, and falls.

"Malnourished patients are more apt to come back to the hospitals and to come in with complications," she says. "That is something we all should be concerned about as clinicians and at the hospital-administration level as well."

Here are Dr. Parkhurst's tips for improving nutrition among your patients:

• Ensure that every patient is getting a nutritional assessment upon admission and that staff is available to follow up with the results;
• Incorporate nutrition into the daily scope of patient care, for example, regularly ask staff whether your patients are eating or not;
• Include information about nutrition in the discharge plan and educate the patient’s family about nutritional interventions; and
• Work with hospital leadership to see how policies and procedures compare with the patient-care models put forth by the Alliance and note areas for improvement.

TH

Visit our website for more information about the importance of inpatient nutrition.

 

How well is your patient eating?

How often you ask this question could improve your hospital's readmission and length-of-stay rates, says Melissa Parkhurst, MD, FHM, medical director of hospital medicine and nutrition support at the University of Kansas Hospital in Kansas City.

A recent report from the Alliance to Advance Patient Nutrition [PDF]—a partnership of four organizations, including SHM, organized to improve nutrition screening and intervention among hospitalized patients—notes that about one in three patients admitted to a hospital meets the criteria for being malnourished. If left untreated, two-thirds of these patients will become more malnourished in the hospital.

"Often patients aren't eating because of testing or because their appetites are depressed because they're ill and not feeling well," says Dr. Parkhurst, an Alliance representative. "Sometimes their medications can alter their tastes, make them nauseated, or give them diarrhea."

Released last month, the findings are included in the partnership's first progress report. It describes the group's efforts in raising awareness about hospital nutrition, such as through info booths at medical meetings and via an online resource center on SHM's Center for Hospital Innovation & Improvement website.

Dr. Parkhurst points to studies that show inpatient malnutrition can lead to higher costs and more complications, as well as make patients more prone to surgical site infections, pressure ulcers, and falls.

"Malnourished patients are more apt to come back to the hospitals and to come in with complications," she says. "That is something we all should be concerned about as clinicians and at the hospital-administration level as well."

Here are Dr. Parkhurst's tips for improving nutrition among your patients:

• Ensure that every patient is getting a nutritional assessment upon admission and that staff is available to follow up with the results;
• Incorporate nutrition into the daily scope of patient care, for example, regularly ask staff whether your patients are eating or not;
• Include information about nutrition in the discharge plan and educate the patient’s family about nutritional interventions; and
• Work with hospital leadership to see how policies and procedures compare with the patient-care models put forth by the Alliance and note areas for improvement.

TH

Visit our website for more information about the importance of inpatient nutrition.

 

How well is your patient eating?

How often you ask this question could improve your hospital's readmission and length-of-stay rates, says Melissa Parkhurst, MD, FHM, medical director of hospital medicine and nutrition support at the University of Kansas Hospital in Kansas City.

A recent report from the Alliance to Advance Patient Nutrition [PDF]—a partnership of four organizations, including SHM, organized to improve nutrition screening and intervention among hospitalized patients—notes that about one in three patients admitted to a hospital meets the criteria for being malnourished. If left untreated, two-thirds of these patients will become more malnourished in the hospital.

"Often patients aren't eating because of testing or because their appetites are depressed because they're ill and not feeling well," says Dr. Parkhurst, an Alliance representative. "Sometimes their medications can alter their tastes, make them nauseated, or give them diarrhea."

Released last month, the findings are included in the partnership's first progress report. It describes the group's efforts in raising awareness about hospital nutrition, such as through info booths at medical meetings and via an online resource center on SHM's Center for Hospital Innovation & Improvement website.

Dr. Parkhurst points to studies that show inpatient malnutrition can lead to higher costs and more complications, as well as make patients more prone to surgical site infections, pressure ulcers, and falls.

"Malnourished patients are more apt to come back to the hospitals and to come in with complications," she says. "That is something we all should be concerned about as clinicians and at the hospital-administration level as well."

Here are Dr. Parkhurst's tips for improving nutrition among your patients:

• Ensure that every patient is getting a nutritional assessment upon admission and that staff is available to follow up with the results;
• Incorporate nutrition into the daily scope of patient care, for example, regularly ask staff whether your patients are eating or not;
• Include information about nutrition in the discharge plan and educate the patient’s family about nutritional interventions; and
• Work with hospital leadership to see how policies and procedures compare with the patient-care models put forth by the Alliance and note areas for improvement.

TH

Visit our website for more information about the importance of inpatient nutrition.

 

Summary

Physicians suffer from “arrested development,” said Dr. Chiang, a hospitalist and chief of inpatient services at Boston Children’s Hospital, during a PHM2014 workshop on the basics of negotiation. Dr. Chiang was referring to the fact that in several professional realms, including negotiation, most physicians have not had the traditional experience of interviewing and negotiating for jobs after high school or college.

An understanding of several negotiation concepts can help the negotiator achieve an agreeable solution. Awareness of values and limits prior to the actual discussion or negotiation will increase the chance of a successful negotiation. Examples of some of these concepts are:

1. Best alternative to a negotiation agreement (BATNA). This is the course of action if negotiations fail. The negotiator should not accept a worse resolution than the BATNA.
2. Reservation value (RV). This is the lowest value a negotiator will accept in a deal.
3. Zone of possible agreement (ZOPA). This is the intellectual zone between two parties in a negotiation where an agreement can be reached.

The twin tasks of negotiation are a) learning about the true ZOPA in advance and b) determining how to influence the other person’s perception of this zone.

There are several negotiation methods and strategies of influence that can be used to support your position or goals. For example, status quo bias is very common. Addressing the specific reason a person is not willing to change from the status quo enables progress.

While it is important to advocate for one’s position, fairness is an important variable in reaching an agreement. Fairness often is not universally defined. Communication is essential in understanding each group’s position.

Summary

Physicians suffer from “arrested development,” said Dr. Chiang, a hospitalist and chief of inpatient services at Boston Children’s Hospital, during a PHM2014 workshop on the basics of negotiation. Dr. Chiang was referring to the fact that in several professional realms, including negotiation, most physicians have not had the traditional experience of interviewing and negotiating for jobs after high school or college.

An understanding of several negotiation concepts can help the negotiator achieve an agreeable solution. Awareness of values and limits prior to the actual discussion or negotiation will increase the chance of a successful negotiation. Examples of some of these concepts are:

1. Best alternative to a negotiation agreement (BATNA). This is the course of action if negotiations fail. The negotiator should not accept a worse resolution than the BATNA.
2. Reservation value (RV). This is the lowest value a negotiator will accept in a deal.
3. Zone of possible agreement (ZOPA). This is the intellectual zone between two parties in a negotiation where an agreement can be reached.

The twin tasks of negotiation are a) learning about the true ZOPA in advance and b) determining how to influence the other person’s perception of this zone.

There are several negotiation methods and strategies of influence that can be used to support your position or goals. For example, status quo bias is very common. Addressing the specific reason a person is not willing to change from the status quo enables progress.

While it is important to advocate for one’s position, fairness is an important variable in reaching an agreement. Fairness often is not universally defined. Communication is essential in understanding each group’s position.

Summary

Physicians suffer from “arrested development,” said Dr. Chiang, a hospitalist and chief of inpatient services at Boston Children’s Hospital, during a PHM2014 workshop on the basics of negotiation. Dr. Chiang was referring to the fact that in several professional realms, including negotiation, most physicians have not had the traditional experience of interviewing and negotiating for jobs after high school or college.

An understanding of several negotiation concepts can help the negotiator achieve an agreeable solution. Awareness of values and limits prior to the actual discussion or negotiation will increase the chance of a successful negotiation. Examples of some of these concepts are:

1. Best alternative to a negotiation agreement (BATNA). This is the course of action if negotiations fail. The negotiator should not accept a worse resolution than the BATNA.
2. Reservation value (RV). This is the lowest value a negotiator will accept in a deal.
3. Zone of possible agreement (ZOPA). This is the intellectual zone between two parties in a negotiation where an agreement can be reached.

The twin tasks of negotiation are a) learning about the true ZOPA in advance and b) determining how to influence the other person’s perception of this zone.

There are several negotiation methods and strategies of influence that can be used to support your position or goals. For example, status quo bias is very common. Addressing the specific reason a person is not willing to change from the status quo enables progress.

While it is important to advocate for one’s position, fairness is an important variable in reaching an agreement. Fairness often is not universally defined. Communication is essential in understanding each group’s position.

Chad Whelan, MD, FHM, began his new role as chief medical officer at Loyola University Health System in Chicago on June 1. Dr. Whelan previously worked as director of the hospital medicine division at Loyola before serving as associate chief medical officer at the University of Chicago Medical Center.

Matthew Dunn, MD, is the 2014 Nathan Avery Physician of the Year at Flagstaff (Ariz.) Medical Center (FMC). Dr. Dunn has worked at FMC as an adult hospitalist since 2011 and a pediatric hospitalist since July 2012 when FMC launched its pediatric hospitalist program. Dr. Dunn is known for his emphasis on patient- and family-centered care as well as interdisciplinary teamwork.

Barbara Michael, MD, and Jim K. Hudson III, MD, were recently honored as two of the Knoxville, Tenn.-based TeamHealth’s 2014 Medical Directors of the Year. Dr. Michael, the hospital medicine honoree, is hospitalist medical director at St. Francis Hospital in Charleston, W.Va. Dr. Hudson, the specialty hospitalist honoree, is medical director of orthopedic surgery at Baptist Memorial Hospital in Memphis, Tenn.

Murthy Madduri, MD, has been named the new hospitalist medical director at CaroMont Regional Medical Center in Gastonia, N.C. Dr. Madduri has been a practicing hospitalist since 1996 and a hospitalist medical director at various institutions since 2000.

Brian Pate, MD, is the new chair of the pediatrics department at the University of Kansas School of Medicine in Wichita. Prior to his current position, Dr. Pate served as pediatric hospitalist division director and vice president of inpatient services at Children’s Mercy Hospital in Kansas City, Mo.

Chad Whelan, MD, FHM, began his new role as chief medical officer at Loyola University Health System in Chicago on June 1. Dr. Whelan previously worked as director of the hospital medicine division at Loyola before serving as associate chief medical officer at the University of Chicago Medical Center.

Matthew Dunn, MD, is the 2014 Nathan Avery Physician of the Year at Flagstaff (Ariz.) Medical Center (FMC). Dr. Dunn has worked at FMC as an adult hospitalist since 2011 and a pediatric hospitalist since July 2012 when FMC launched its pediatric hospitalist program. Dr. Dunn is known for his emphasis on patient- and family-centered care as well as interdisciplinary teamwork.

Barbara Michael, MD, and Jim K. Hudson III, MD, were recently honored as two of the Knoxville, Tenn.-based TeamHealth’s 2014 Medical Directors of the Year. Dr. Michael, the hospital medicine honoree, is hospitalist medical director at St. Francis Hospital in Charleston, W.Va. Dr. Hudson, the specialty hospitalist honoree, is medical director of orthopedic surgery at Baptist Memorial Hospital in Memphis, Tenn.

Murthy Madduri, MD, has been named the new hospitalist medical director at CaroMont Regional Medical Center in Gastonia, N.C. Dr. Madduri has been a practicing hospitalist since 1996 and a hospitalist medical director at various institutions since 2000.

Brian Pate, MD, is the new chair of the pediatrics department at the University of Kansas School of Medicine in Wichita. Prior to his current position, Dr. Pate served as pediatric hospitalist division director and vice president of inpatient services at Children’s Mercy Hospital in Kansas City, Mo.

Chad Whelan, MD, FHM, began his new role as chief medical officer at Loyola University Health System in Chicago on June 1. Dr. Whelan previously worked as director of the hospital medicine division at Loyola before serving as associate chief medical officer at the University of Chicago Medical Center.

Matthew Dunn, MD, is the 2014 Nathan Avery Physician of the Year at Flagstaff (Ariz.) Medical Center (FMC). Dr. Dunn has worked at FMC as an adult hospitalist since 2011 and a pediatric hospitalist since July 2012 when FMC launched its pediatric hospitalist program. Dr. Dunn is known for his emphasis on patient- and family-centered care as well as interdisciplinary teamwork.

Barbara Michael, MD, and Jim K. Hudson III, MD, were recently honored as two of the Knoxville, Tenn.-based TeamHealth’s 2014 Medical Directors of the Year. Dr. Michael, the hospital medicine honoree, is hospitalist medical director at St. Francis Hospital in Charleston, W.Va. Dr. Hudson, the specialty hospitalist honoree, is medical director of orthopedic surgery at Baptist Memorial Hospital in Memphis, Tenn.

Murthy Madduri, MD, has been named the new hospitalist medical director at CaroMont Regional Medical Center in Gastonia, N.C. Dr. Madduri has been a practicing hospitalist since 1996 and a hospitalist medical director at various institutions since 2000.

Brian Pate, MD, is the new chair of the pediatrics department at the University of Kansas School of Medicine in Wichita. Prior to his current position, Dr. Pate served as pediatric hospitalist division director and vice president of inpatient services at Children’s Mercy Hospital in Kansas City, Mo.

Controlling glycemic levels and diabetes in hospitalized patients is one of the biggest ongoing challenges hospitalists face. Now, hospitalists can help their hospitals come up with system-wide improvements to address glycemic control.

SHM’s Glycemic Control Mentored Implementation (GCMI) Program gives hospitalists the tools they need to make system-level changes in their hospital and pairs them with a mentor to help make it happen.

SHM is accepting applications for the 2014 GCMI program, but act soon. Applications are due September 30. For more information, visit www.hospitalmedicine.org/gcmi.

Controlling glycemic levels and diabetes in hospitalized patients is one of the biggest ongoing challenges hospitalists face. Now, hospitalists can help their hospitals come up with system-wide improvements to address glycemic control.

SHM’s Glycemic Control Mentored Implementation (GCMI) Program gives hospitalists the tools they need to make system-level changes in their hospital and pairs them with a mentor to help make it happen.

SHM is accepting applications for the 2014 GCMI program, but act soon. Applications are due September 30. For more information, visit www.hospitalmedicine.org/gcmi.

Controlling glycemic levels and diabetes in hospitalized patients is one of the biggest ongoing challenges hospitalists face. Now, hospitalists can help their hospitals come up with system-wide improvements to address glycemic control.

SHM’s Glycemic Control Mentored Implementation (GCMI) Program gives hospitalists the tools they need to make system-level changes in their hospital and pairs them with a mentor to help make it happen.

SHM is accepting applications for the 2014 GCMI program, but act soon. Applications are due September 30. For more information, visit www.hospitalmedicine.org/gcmi.

Surrounded by the bucolic grounds of the Disney Yacht and Beach Club Resort in Lake Buena Vista, Fla., more than 800 pediatric hospitalists gathered in July for Pediatric Hospital Medicine 2014 (PHM14). Preceded by the Society for Pediatric Sedation’s pre-course, PHM14 began in earnest with a warm welcome from Doug Carlson, MD, FAAP, chief of pediatric hospital medicine programs at St. Louis (Mo.) Children’s Hospital and chair of the PHM14 organizing committee.

The first day of the conference started with Patrick Conway, MD, MSc, FAAP, MHM, chief medical officer for the Centers for Medicare and Medicaid Services (CMS), who gave an update of ongoing reforms in the U.S. health delivery system, with a focus on pediatrics. With three years of experience as CMS’ top doc, Dr. Conway related the difficulties of going from an unsustainable fee-for-service system to a people-centered, outcomes-driven system.

“Pediatrics,” Dr. Conway said, “is a leader in patient and family engagement and population health.” This practice, he added, means that the six goals of the CMS Quality Strategy align well with ongoing efforts in PHM.

Despite the difficulties of instituting change in a system that handles $3 billion daily, Dr. Conway, formerly a pediatric hospitalist at Cincinnati Children’s Hospital, said he’s witnessed many signs of improvement in the CMS landscape. Preliminary data from 2012-2014, he said, have shown a 9% reduction in hospital-acquired conditions across all measures, and overall hospital utilization is “dropping like a rock.”

While “having a foot in the boat and a foot on the dock” has been difficult, the transition, through its alphabet soup of innovation programs, is now beginning to pay off. Giving providers a pathway through the changing landscape of risk, Dr. Conway said, is an ongoing priority.

Wrapping up the first day, three healthcare system CEOs took the stage to answer questions from the audience, with Mark Shen, MD, SFHM, president of Dell Children’s Medical Center of Central Texas in Austin, Texas, posing questions like a seasoned talk show host. Panel members included David J. Bailey, MD, MBA, president and CEO of the Nemours Foundation; Steve Narang, MD, MHCM, FAAP, CEO of Banner Good Samaritan Medical Center in Phoenix, Ariz.; and Jeff Sperring, MD, FAAP, president and CEO of Riley Hospital for Children at Indiana University Health in Indianapolis.

Questions were wide-ranging.

Q: How did you become a CEO?

“All I had to do was keep on saying ‘yes,’” Dr. Bailey said.

Q: What are you doing as a CEO to move from a fee-for-service system to a population-based system?

“We are still living in two different worlds. …It depends on ACO penetration, whether quality or volume will be the driver over the next three to five years,” Dr. Narang said.

Q: If PHM fellowship becomes a requirement, will your hospital fund them?

“It’s hard to define what we do, but we know there are core competencies. I don’t think we’re going to be at a point where certification will limit being a hospitalist anytime soon,” Dr. Shen said.

Q: What are the three most important things, from a CEO perspective, that a hospitalist should know?

“Know where your organization wants to go,” Dr. Sperring said.

The next day kicked off with an inspiring call to action by Steve Meuthing, MD, vice president for safety at Cincinnati Children’s Hospital Medical Center. He called on pediatric hospitalists to eliminate all serious harm from children’s hospitals in the U.S. As a part of the Children’s Hospitals’ Solutions for Patient Safety (SPS) network, an organization accounting for 25% of all children hospitalized in the U.S., Dr. Meuthing related the need to employ high reliability theory, along with operational and cultural changes, to improve reliability in patient safety.

 

“If you don’t standardize, the rest is just chaos,” he said. “We have to make it easy to do these things.”

Dr. Meuthing said improving process reliability is key to reducing adverse outcomes, and high reliability organizations have utilized this approach to reduce serious harm events across the 81 SPS hospitals. While prevention of patient harm is the goal, an additional benefit is cost savings. He estimated $27 million of cost savings was realized within SPS network hospitals in 2012-2013.

Oral abstract and conundrum presentations, concurrent with 23 sessions across nine tracks, kept attendees busy. Topics ranged from a PHM circumcision service to decreasing overuse of continuous pulse oximetry. The day’s talks wrapped up with the respective presidents of the meeting’s co-sponsors—the American Academy of Pediatrics, the American Pediatrics Association, and SHM—sharing their organizations’ visions of PHM’s future in a town hall format.

The second full day began with an update of the Joint Council of Pediatric Hospital Medicine’s efforts to further advance PHM as a field. The process of submitting a petition to the American Board of Pediatrics was reviewed, as were the current status and time course of the move toward Accreditation Council for Graduate Medical Education certification.

After lunch, the highly anticipated “Top Articles” session was presented by Robert Dudas, MD, medical director of the pediatric hospitalist program at Johns Hopkins Bayview Medical Center in Baltimore, and Karen Wilson, MD, MPH, section head for pediatric hospital medicine at Children’s Hospital Colorado in Aurora. The presenters reviewed literature from the past year on topics ranging from nebulized hypertonic saline for bronchiolitis to antibiotic prophylaxis in vesicoureteral reflux.

The final day commenced with a talk by Alberto Puig, MD, PhD, FACP, associate director of undergraduate education at Massachusetts General Hospital in Boston, whose experiences as an internist provided insight regarding the history of the physical examination, from the aphorisms of Hippocrates to the family-centered bedside rounding of today.

---

Dr. Chang is associate clinical professor of medicine and pediatrics at the University of California at San Diego School of Medicine and a hospitalist at both UCSD Medical Center and Rady Children’s Hospital. He is pediatric editor of The Hospitalist.

Dr. O’Callaghan is a clinical assistant professor of pediatrics at the University of Washington and a member of Team Hospitalist.

Dr. Hale is a past member of Team Hospitalist and a pediatric hospitalist at the Floating Hospital for Children at Tufts Medical Center in Boston.

Dr. Pressel is a pediatric hospitalist and inpatient medical director at Nemours/Alfred I. duPont Hospital for Children in Wilmington, Del., and a member of Team Hospitalist.

Surrounded by the bucolic grounds of the Disney Yacht and Beach Club Resort in Lake Buena Vista, Fla., more than 800 pediatric hospitalists gathered in July for Pediatric Hospital Medicine 2014 (PHM14). Preceded by the Society for Pediatric Sedation’s pre-course, PHM14 began in earnest with a warm welcome from Doug Carlson, MD, FAAP, chief of pediatric hospital medicine programs at St. Louis (Mo.) Children’s Hospital and chair of the PHM14 organizing committee.

The first day of the conference started with Patrick Conway, MD, MSc, FAAP, MHM, chief medical officer for the Centers for Medicare and Medicaid Services (CMS), who gave an update of ongoing reforms in the U.S. health delivery system, with a focus on pediatrics. With three years of experience as CMS’ top doc, Dr. Conway related the difficulties of going from an unsustainable fee-for-service system to a people-centered, outcomes-driven system.

“Pediatrics,” Dr. Conway said, “is a leader in patient and family engagement and population health.” This practice, he added, means that the six goals of the CMS Quality Strategy align well with ongoing efforts in PHM.

Despite the difficulties of instituting change in a system that handles $3 billion daily, Dr. Conway, formerly a pediatric hospitalist at Cincinnati Children’s Hospital, said he’s witnessed many signs of improvement in the CMS landscape. Preliminary data from 2012-2014, he said, have shown a 9% reduction in hospital-acquired conditions across all measures, and overall hospital utilization is “dropping like a rock.”

While “having a foot in the boat and a foot on the dock” has been difficult, the transition, through its alphabet soup of innovation programs, is now beginning to pay off. Giving providers a pathway through the changing landscape of risk, Dr. Conway said, is an ongoing priority.

Wrapping up the first day, three healthcare system CEOs took the stage to answer questions from the audience, with Mark Shen, MD, SFHM, president of Dell Children’s Medical Center of Central Texas in Austin, Texas, posing questions like a seasoned talk show host. Panel members included David J. Bailey, MD, MBA, president and CEO of the Nemours Foundation; Steve Narang, MD, MHCM, FAAP, CEO of Banner Good Samaritan Medical Center in Phoenix, Ariz.; and Jeff Sperring, MD, FAAP, president and CEO of Riley Hospital for Children at Indiana University Health in Indianapolis.

Questions were wide-ranging.

Q: How did you become a CEO?

“All I had to do was keep on saying ‘yes,’” Dr. Bailey said.

Q: What are you doing as a CEO to move from a fee-for-service system to a population-based system?

“We are still living in two different worlds. …It depends on ACO penetration, whether quality or volume will be the driver over the next three to five years,” Dr. Narang said.

Q: If PHM fellowship becomes a requirement, will your hospital fund them?

“It’s hard to define what we do, but we know there are core competencies. I don’t think we’re going to be at a point where certification will limit being a hospitalist anytime soon,” Dr. Shen said.

Q: What are the three most important things, from a CEO perspective, that a hospitalist should know?

“Know where your organization wants to go,” Dr. Sperring said.

The next day kicked off with an inspiring call to action by Steve Meuthing, MD, vice president for safety at Cincinnati Children’s Hospital Medical Center. He called on pediatric hospitalists to eliminate all serious harm from children’s hospitals in the U.S. As a part of the Children’s Hospitals’ Solutions for Patient Safety (SPS) network, an organization accounting for 25% of all children hospitalized in the U.S., Dr. Meuthing related the need to employ high reliability theory, along with operational and cultural changes, to improve reliability in patient safety.

 

“If you don’t standardize, the rest is just chaos,” he said. “We have to make it easy to do these things.”

Dr. Meuthing said improving process reliability is key to reducing adverse outcomes, and high reliability organizations have utilized this approach to reduce serious harm events across the 81 SPS hospitals. While prevention of patient harm is the goal, an additional benefit is cost savings. He estimated $27 million of cost savings was realized within SPS network hospitals in 2012-2013.

Oral abstract and conundrum presentations, concurrent with 23 sessions across nine tracks, kept attendees busy. Topics ranged from a PHM circumcision service to decreasing overuse of continuous pulse oximetry. The day’s talks wrapped up with the respective presidents of the meeting’s co-sponsors—the American Academy of Pediatrics, the American Pediatrics Association, and SHM—sharing their organizations’ visions of PHM’s future in a town hall format.

The second full day began with an update of the Joint Council of Pediatric Hospital Medicine’s efforts to further advance PHM as a field. The process of submitting a petition to the American Board of Pediatrics was reviewed, as were the current status and time course of the move toward Accreditation Council for Graduate Medical Education certification.

After lunch, the highly anticipated “Top Articles” session was presented by Robert Dudas, MD, medical director of the pediatric hospitalist program at Johns Hopkins Bayview Medical Center in Baltimore, and Karen Wilson, MD, MPH, section head for pediatric hospital medicine at Children’s Hospital Colorado in Aurora. The presenters reviewed literature from the past year on topics ranging from nebulized hypertonic saline for bronchiolitis to antibiotic prophylaxis in vesicoureteral reflux.

The final day commenced with a talk by Alberto Puig, MD, PhD, FACP, associate director of undergraduate education at Massachusetts General Hospital in Boston, whose experiences as an internist provided insight regarding the history of the physical examination, from the aphorisms of Hippocrates to the family-centered bedside rounding of today.

---

Dr. Chang is associate clinical professor of medicine and pediatrics at the University of California at San Diego School of Medicine and a hospitalist at both UCSD Medical Center and Rady Children’s Hospital. He is pediatric editor of The Hospitalist.

Dr. O’Callaghan is a clinical assistant professor of pediatrics at the University of Washington and a member of Team Hospitalist.

Dr. Hale is a past member of Team Hospitalist and a pediatric hospitalist at the Floating Hospital for Children at Tufts Medical Center in Boston.

Dr. Pressel is a pediatric hospitalist and inpatient medical director at Nemours/Alfred I. duPont Hospital for Children in Wilmington, Del., and a member of Team Hospitalist.

Surrounded by the bucolic grounds of the Disney Yacht and Beach Club Resort in Lake Buena Vista, Fla., more than 800 pediatric hospitalists gathered in July for Pediatric Hospital Medicine 2014 (PHM14). Preceded by the Society for Pediatric Sedation’s pre-course, PHM14 began in earnest with a warm welcome from Doug Carlson, MD, FAAP, chief of pediatric hospital medicine programs at St. Louis (Mo.) Children’s Hospital and chair of the PHM14 organizing committee.

The first day of the conference started with Patrick Conway, MD, MSc, FAAP, MHM, chief medical officer for the Centers for Medicare and Medicaid Services (CMS), who gave an update of ongoing reforms in the U.S. health delivery system, with a focus on pediatrics. With three years of experience as CMS’ top doc, Dr. Conway related the difficulties of going from an unsustainable fee-for-service system to a people-centered, outcomes-driven system.

“Pediatrics,” Dr. Conway said, “is a leader in patient and family engagement and population health.” This practice, he added, means that the six goals of the CMS Quality Strategy align well with ongoing efforts in PHM.

Despite the difficulties of instituting change in a system that handles $3 billion daily, Dr. Conway, formerly a pediatric hospitalist at Cincinnati Children’s Hospital, said he’s witnessed many signs of improvement in the CMS landscape. Preliminary data from 2012-2014, he said, have shown a 9% reduction in hospital-acquired conditions across all measures, and overall hospital utilization is “dropping like a rock.”

While “having a foot in the boat and a foot on the dock” has been difficult, the transition, through its alphabet soup of innovation programs, is now beginning to pay off. Giving providers a pathway through the changing landscape of risk, Dr. Conway said, is an ongoing priority.

Wrapping up the first day, three healthcare system CEOs took the stage to answer questions from the audience, with Mark Shen, MD, SFHM, president of Dell Children’s Medical Center of Central Texas in Austin, Texas, posing questions like a seasoned talk show host. Panel members included David J. Bailey, MD, MBA, president and CEO of the Nemours Foundation; Steve Narang, MD, MHCM, FAAP, CEO of Banner Good Samaritan Medical Center in Phoenix, Ariz.; and Jeff Sperring, MD, FAAP, president and CEO of Riley Hospital for Children at Indiana University Health in Indianapolis.

Questions were wide-ranging.

Q: How did you become a CEO?

“All I had to do was keep on saying ‘yes,’” Dr. Bailey said.

Q: What are you doing as a CEO to move from a fee-for-service system to a population-based system?

“We are still living in two different worlds. …It depends on ACO penetration, whether quality or volume will be the driver over the next three to five years,” Dr. Narang said.

Q: If PHM fellowship becomes a requirement, will your hospital fund them?

“It’s hard to define what we do, but we know there are core competencies. I don’t think we’re going to be at a point where certification will limit being a hospitalist anytime soon,” Dr. Shen said.

Q: What are the three most important things, from a CEO perspective, that a hospitalist should know?

“Know where your organization wants to go,” Dr. Sperring said.

The next day kicked off with an inspiring call to action by Steve Meuthing, MD, vice president for safety at Cincinnati Children’s Hospital Medical Center. He called on pediatric hospitalists to eliminate all serious harm from children’s hospitals in the U.S. As a part of the Children’s Hospitals’ Solutions for Patient Safety (SPS) network, an organization accounting for 25% of all children hospitalized in the U.S., Dr. Meuthing related the need to employ high reliability theory, along with operational and cultural changes, to improve reliability in patient safety.

 

“If you don’t standardize, the rest is just chaos,” he said. “We have to make it easy to do these things.”

Dr. Meuthing said improving process reliability is key to reducing adverse outcomes, and high reliability organizations have utilized this approach to reduce serious harm events across the 81 SPS hospitals. While prevention of patient harm is the goal, an additional benefit is cost savings. He estimated $27 million of cost savings was realized within SPS network hospitals in 2012-2013.

Oral abstract and conundrum presentations, concurrent with 23 sessions across nine tracks, kept attendees busy. Topics ranged from a PHM circumcision service to decreasing overuse of continuous pulse oximetry. The day’s talks wrapped up with the respective presidents of the meeting’s co-sponsors—the American Academy of Pediatrics, the American Pediatrics Association, and SHM—sharing their organizations’ visions of PHM’s future in a town hall format.

The second full day began with an update of the Joint Council of Pediatric Hospital Medicine’s efforts to further advance PHM as a field. The process of submitting a petition to the American Board of Pediatrics was reviewed, as were the current status and time course of the move toward Accreditation Council for Graduate Medical Education certification.

After lunch, the highly anticipated “Top Articles” session was presented by Robert Dudas, MD, medical director of the pediatric hospitalist program at Johns Hopkins Bayview Medical Center in Baltimore, and Karen Wilson, MD, MPH, section head for pediatric hospital medicine at Children’s Hospital Colorado in Aurora. The presenters reviewed literature from the past year on topics ranging from nebulized hypertonic saline for bronchiolitis to antibiotic prophylaxis in vesicoureteral reflux.

The final day commenced with a talk by Alberto Puig, MD, PhD, FACP, associate director of undergraduate education at Massachusetts General Hospital in Boston, whose experiences as an internist provided insight regarding the history of the physical examination, from the aphorisms of Hippocrates to the family-centered bedside rounding of today.

---

Dr. Chang is associate clinical professor of medicine and pediatrics at the University of California at San Diego School of Medicine and a hospitalist at both UCSD Medical Center and Rady Children’s Hospital. He is pediatric editor of The Hospitalist.

Dr. O’Callaghan is a clinical assistant professor of pediatrics at the University of Washington and a member of Team Hospitalist.

Dr. Hale is a past member of Team Hospitalist and a pediatric hospitalist at the Floating Hospital for Children at Tufts Medical Center in Boston.

Dr. Pressel is a pediatric hospitalist and inpatient medical director at Nemours/Alfred I. duPont Hospital for Children in Wilmington, Del., and a member of Team Hospitalist.

In the September issue of The Hospitalist, we look at SHM’s award-winning quality improvement (QI) programs in our cover story, “Mentored Implementation.” Dr. Mark Williams, professor of medicine at the University of Kentucky and principal investigator for SHM’s Project BOOST, outlines what mentored implementation really means and explains how site visits became a central feature. Dr. Gregory Maynard, director of the UC San Diego Center for Innovation and Improvement Science and senior vice president of SHM’s Center for Hospital Innovation and Improvement, talks about how mentored implementation of QI programs works. Also featured in this issue, we recap key sessions from the 2014 Pediatric Hospital Medicine conference held last month, and launch into part one of our two-part series on using electronic health record systems to reduce readmissions. This issue also features a write-up on The Hospitalist’s latest editorial award: an APEX Grand Award for Magazines, Journals, and Tabloids!

Click here to listen to the September highlights Podcast.

In the September issue of The Hospitalist, we look at SHM’s award-winning quality improvement (QI) programs in our cover story, “Mentored Implementation.” Dr. Mark Williams, professor of medicine at the University of Kentucky and principal investigator for SHM’s Project BOOST, outlines what mentored implementation really means and explains how site visits became a central feature. Dr. Gregory Maynard, director of the UC San Diego Center for Innovation and Improvement Science and senior vice president of SHM’s Center for Hospital Innovation and Improvement, talks about how mentored implementation of QI programs works. Also featured in this issue, we recap key sessions from the 2014 Pediatric Hospital Medicine conference held last month, and launch into part one of our two-part series on using electronic health record systems to reduce readmissions. This issue also features a write-up on The Hospitalist’s latest editorial award: an APEX Grand Award for Magazines, Journals, and Tabloids!

Click here to listen to the September highlights Podcast.

In the September issue of The Hospitalist, we look at SHM’s award-winning quality improvement (QI) programs in our cover story, “Mentored Implementation.” Dr. Mark Williams, professor of medicine at the University of Kentucky and principal investigator for SHM’s Project BOOST, outlines what mentored implementation really means and explains how site visits became a central feature. Dr. Gregory Maynard, director of the UC San Diego Center for Innovation and Improvement Science and senior vice president of SHM’s Center for Hospital Innovation and Improvement, talks about how mentored implementation of QI programs works. Also featured in this issue, we recap key sessions from the 2014 Pediatric Hospital Medicine conference held last month, and launch into part one of our two-part series on using electronic health record systems to reduce readmissions. This issue also features a write-up on The Hospitalist’s latest editorial award: an APEX Grand Award for Magazines, Journals, and Tabloids!

Click here to listen to the September highlights Podcast.