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The Society of Hospital Medicine (SHM) is supporting a Congressional push to tweak which admissions factors are taken into consideration in the federal Hospital Readmissions Reduction Program.

Hospitalist and SHM President Burke Kealey, MD, SFHM, says that the Establishing Beneficiary Equity in the Hospital Readmission Program Act (H.R. 4188) would help "level the playing field."

Sponsored by U.S. Representative James Renacci (R-Ohio), the proposal seeks to "exclude from the program admissions related to transplants, end-stage renal disease, burns, trauma, psychosis, or substance abuse." It also would require the U.S. Department of Health & Human Services (HHS) "in applying requirements for the excess readmission ratio to provide for a risk adjustment" that would take into account the percentage of inpatients eligible for both Medicare and Medicaid to avoid unfairly penalizing hospitals that treat the most vulnerable populations.

"We feel that some hospitals may be being unfairly handled in this program," Dr. Kealey says. "Those are the hospitals that are having to deal with more complex populations or lower-SES [socioeconomic status] populations. Those are the hospitalists that actually need the most resources to help prevent readmissions, and they end up losing in this whole equation."

In a letter to Rep. Renacci outlining SHM's support for the bill, Dr. Kealey notes that the current readmissions reduction program "needs fine-tuning to better account for preventable readmission."

Dr. Kealey also says he believes attempts by HHS to address readmissions are well-intentioned. However, as the program is implemented, he wants the government to be flexible in dealing with hospitals, particularly those dealing with complex populations or large groups of low-SES patients.

"We feel [these are] valuable programs, and in general, they help move the country in the right direction," Dr. Kealey says. "But they certainly need to be open and available to be modified and changed to fit conditions better."

SHM's program to reduce hospital readmissions, Project BOOST, is accepting applications to its 2014 cohort through August 30. TH

Visit our website for more information on hospital readmissions penalties.

The Society of Hospital Medicine (SHM) is supporting a Congressional push to tweak which admissions factors are taken into consideration in the federal Hospital Readmissions Reduction Program.

Hospitalist and SHM President Burke Kealey, MD, SFHM, says that the Establishing Beneficiary Equity in the Hospital Readmission Program Act (H.R. 4188) would help "level the playing field."

Sponsored by U.S. Representative James Renacci (R-Ohio), the proposal seeks to "exclude from the program admissions related to transplants, end-stage renal disease, burns, trauma, psychosis, or substance abuse." It also would require the U.S. Department of Health & Human Services (HHS) "in applying requirements for the excess readmission ratio to provide for a risk adjustment" that would take into account the percentage of inpatients eligible for both Medicare and Medicaid to avoid unfairly penalizing hospitals that treat the most vulnerable populations.

"We feel that some hospitals may be being unfairly handled in this program," Dr. Kealey says. "Those are the hospitals that are having to deal with more complex populations or lower-SES [socioeconomic status] populations. Those are the hospitalists that actually need the most resources to help prevent readmissions, and they end up losing in this whole equation."

In a letter to Rep. Renacci outlining SHM's support for the bill, Dr. Kealey notes that the current readmissions reduction program "needs fine-tuning to better account for preventable readmission."

Dr. Kealey also says he believes attempts by HHS to address readmissions are well-intentioned. However, as the program is implemented, he wants the government to be flexible in dealing with hospitals, particularly those dealing with complex populations or large groups of low-SES patients.

"We feel [these are] valuable programs, and in general, they help move the country in the right direction," Dr. Kealey says. "But they certainly need to be open and available to be modified and changed to fit conditions better."

SHM's program to reduce hospital readmissions, Project BOOST, is accepting applications to its 2014 cohort through August 30. TH

Visit our website for more information on hospital readmissions penalties.

The Society of Hospital Medicine (SHM) is supporting a Congressional push to tweak which admissions factors are taken into consideration in the federal Hospital Readmissions Reduction Program.

Hospitalist and SHM President Burke Kealey, MD, SFHM, says that the Establishing Beneficiary Equity in the Hospital Readmission Program Act (H.R. 4188) would help "level the playing field."

Sponsored by U.S. Representative James Renacci (R-Ohio), the proposal seeks to "exclude from the program admissions related to transplants, end-stage renal disease, burns, trauma, psychosis, or substance abuse." It also would require the U.S. Department of Health & Human Services (HHS) "in applying requirements for the excess readmission ratio to provide for a risk adjustment" that would take into account the percentage of inpatients eligible for both Medicare and Medicaid to avoid unfairly penalizing hospitals that treat the most vulnerable populations.

"We feel that some hospitals may be being unfairly handled in this program," Dr. Kealey says. "Those are the hospitals that are having to deal with more complex populations or lower-SES [socioeconomic status] populations. Those are the hospitalists that actually need the most resources to help prevent readmissions, and they end up losing in this whole equation."

In a letter to Rep. Renacci outlining SHM's support for the bill, Dr. Kealey notes that the current readmissions reduction program "needs fine-tuning to better account for preventable readmission."

Dr. Kealey also says he believes attempts by HHS to address readmissions are well-intentioned. However, as the program is implemented, he wants the government to be flexible in dealing with hospitals, particularly those dealing with complex populations or large groups of low-SES patients.

"We feel [these are] valuable programs, and in general, they help move the country in the right direction," Dr. Kealey says. "But they certainly need to be open and available to be modified and changed to fit conditions better."

SHM's program to reduce hospital readmissions, Project BOOST, is accepting applications to its 2014 cohort through August 30. TH

Visit our website for more information on hospital readmissions penalties.

A new report that shows efforts to prevent central-line-associated bloodstream infections (CLABSIs) saved the government at least $640 million over nearly 20 years is an example of how effective prevention campaigns can be, a veteran hospitalist says.

"The major idea of this report was to show us that complications like bloodstream infections are preventable," says Ketino Kobaidze MD, PhD, FHM, assistant professor of medicine and associate site director of the division of hospital medicine at the Emory University School of Medicine in Atlanta. "When you prevent these things, you can locate other things. That's what the major message is to any kind of healthcare provider."

Published in the June issue of Health Affairs, the report examines the results of CDC programs from 1990 to 2008 to prevent CLABSIs in critical care units and how prevention helped the Centers for Medicaid & Medicare Services (CMS) reduce the amount of reimbursement paid to hospitals for treating such infections.

The authors reported that from 1990 to 2008, between 40,556 and 75,067 CLABSIs were avoided in Medicare and Medicaid patients treated in critical care units. This resulted in:

• Net savings ranging from $640 million to $1.8 billion;

• Net savings per case ranging from $15,780 to $24,391; and

• Per dollar rate of return on CDC investments between $3.88 and $23.85.

"Now, you're basically expected for it to not happen at all," says Dr. Kobaidze, referring to a rule implemented by CMS in 2008 that ended reimbursements to hospitals for treating CLABSIs that weren't present upon admission.

With that rule, CMS included 10 categories of hospital-acquired conditions (HACs) for the payment provision rule, including stage III and IV pressure ulcers and falls that occur while the patient is in the hospital. The rule was updated in 2013 to include HACs related to surgical site infection with cardiac implantable electronic devices and iatrogenic pneumothorax with venous catheterization. TH 

Visit our website for more information on bloodstream infection prevention.

A new report that shows efforts to prevent central-line-associated bloodstream infections (CLABSIs) saved the government at least $640 million over nearly 20 years is an example of how effective prevention campaigns can be, a veteran hospitalist says.

"The major idea of this report was to show us that complications like bloodstream infections are preventable," says Ketino Kobaidze MD, PhD, FHM, assistant professor of medicine and associate site director of the division of hospital medicine at the Emory University School of Medicine in Atlanta. "When you prevent these things, you can locate other things. That's what the major message is to any kind of healthcare provider."

Published in the June issue of Health Affairs, the report examines the results of CDC programs from 1990 to 2008 to prevent CLABSIs in critical care units and how prevention helped the Centers for Medicaid & Medicare Services (CMS) reduce the amount of reimbursement paid to hospitals for treating such infections.

The authors reported that from 1990 to 2008, between 40,556 and 75,067 CLABSIs were avoided in Medicare and Medicaid patients treated in critical care units. This resulted in:

• Net savings ranging from $640 million to $1.8 billion;

• Net savings per case ranging from $15,780 to $24,391; and

• Per dollar rate of return on CDC investments between $3.88 and $23.85.

"Now, you're basically expected for it to not happen at all," says Dr. Kobaidze, referring to a rule implemented by CMS in 2008 that ended reimbursements to hospitals for treating CLABSIs that weren't present upon admission.

With that rule, CMS included 10 categories of hospital-acquired conditions (HACs) for the payment provision rule, including stage III and IV pressure ulcers and falls that occur while the patient is in the hospital. The rule was updated in 2013 to include HACs related to surgical site infection with cardiac implantable electronic devices and iatrogenic pneumothorax with venous catheterization. TH 

Visit our website for more information on bloodstream infection prevention.

A new report that shows efforts to prevent central-line-associated bloodstream infections (CLABSIs) saved the government at least $640 million over nearly 20 years is an example of how effective prevention campaigns can be, a veteran hospitalist says.

"The major idea of this report was to show us that complications like bloodstream infections are preventable," says Ketino Kobaidze MD, PhD, FHM, assistant professor of medicine and associate site director of the division of hospital medicine at the Emory University School of Medicine in Atlanta. "When you prevent these things, you can locate other things. That's what the major message is to any kind of healthcare provider."

Published in the June issue of Health Affairs, the report examines the results of CDC programs from 1990 to 2008 to prevent CLABSIs in critical care units and how prevention helped the Centers for Medicaid & Medicare Services (CMS) reduce the amount of reimbursement paid to hospitals for treating such infections.

The authors reported that from 1990 to 2008, between 40,556 and 75,067 CLABSIs were avoided in Medicare and Medicaid patients treated in critical care units. This resulted in:

• Net savings ranging from $640 million to $1.8 billion;

• Net savings per case ranging from $15,780 to $24,391; and

• Per dollar rate of return on CDC investments between $3.88 and $23.85.

"Now, you're basically expected for it to not happen at all," says Dr. Kobaidze, referring to a rule implemented by CMS in 2008 that ended reimbursements to hospitals for treating CLABSIs that weren't present upon admission.

With that rule, CMS included 10 categories of hospital-acquired conditions (HACs) for the payment provision rule, including stage III and IV pressure ulcers and falls that occur while the patient is in the hospital. The rule was updated in 2013 to include HACs related to surgical site infection with cardiac implantable electronic devices and iatrogenic pneumothorax with venous catheterization. TH 

Visit our website for more information on bloodstream infection prevention.

More than 70% of people who responded to a survey at The-Hospitalist.org had a negative opinion about how local and national quality initiatives (QI) have impacted their ability to care for hospitalized patients.

Survey respondents were asked to gauge the effectiveness of core measures, Physician Quality Reporting System (PQRS) reporting, and clinical reminders. A combined 38% of respondents said that QI measures produced little benefit for their patients or rarely addressed patients' acute issues. Another 21% of respondents labeled QI measures as "distractions," and 12% said QI measures affected their productivity.

Only 28% of respondents thought that QI have improved inpatient care, just 2% more than those who found "little benefit" to them (26%), indicating that 54% of respondents were nearly evenly split on whether QI measures directly benefit patients.

Felix Aguirre, MD, FHM, vice president of medical affairs for IPC: The Hospitalist Company and a member of SHM's Performance Measurement and Reporting Committee (PMRC), says while certain core measures, such as PQRS reporting, may not address the specific needs of all hospital patients, it does not make them unsuccessful.

"I think measures do improve care, even if it's not for my patients, [then] for the global population of patients," Dr. Aguirre says. "We're not moving the needle quickly by treating my patients; we're moving the needle slowly, but surely, by treating all patients."

PMRC chair Gregory B. Seymann, MD, SFHM, clinical professor and chief of the division of hospital medicine at University of California San Diego Health Sciences, says the variety of QI measures included in the survey may explain the difference in opinions.

"There are multiple different practice arrangements among the general population of hospitalists and thus many different ways an individual respondent might interact with the measures," Dr. Seymann says. TH

Visit our website for more information on quality initiatives.

More than 70% of people who responded to a survey at The-Hospitalist.org had a negative opinion about how local and national quality initiatives (QI) have impacted their ability to care for hospitalized patients.

Survey respondents were asked to gauge the effectiveness of core measures, Physician Quality Reporting System (PQRS) reporting, and clinical reminders. A combined 38% of respondents said that QI measures produced little benefit for their patients or rarely addressed patients' acute issues. Another 21% of respondents labeled QI measures as "distractions," and 12% said QI measures affected their productivity.

Only 28% of respondents thought that QI have improved inpatient care, just 2% more than those who found "little benefit" to them (26%), indicating that 54% of respondents were nearly evenly split on whether QI measures directly benefit patients.

Felix Aguirre, MD, FHM, vice president of medical affairs for IPC: The Hospitalist Company and a member of SHM's Performance Measurement and Reporting Committee (PMRC), says while certain core measures, such as PQRS reporting, may not address the specific needs of all hospital patients, it does not make them unsuccessful.

"I think measures do improve care, even if it's not for my patients, [then] for the global population of patients," Dr. Aguirre says. "We're not moving the needle quickly by treating my patients; we're moving the needle slowly, but surely, by treating all patients."

PMRC chair Gregory B. Seymann, MD, SFHM, clinical professor and chief of the division of hospital medicine at University of California San Diego Health Sciences, says the variety of QI measures included in the survey may explain the difference in opinions.

"There are multiple different practice arrangements among the general population of hospitalists and thus many different ways an individual respondent might interact with the measures," Dr. Seymann says. TH

Visit our website for more information on quality initiatives.

More than 70% of people who responded to a survey at The-Hospitalist.org had a negative opinion about how local and national quality initiatives (QI) have impacted their ability to care for hospitalized patients.

Survey respondents were asked to gauge the effectiveness of core measures, Physician Quality Reporting System (PQRS) reporting, and clinical reminders. A combined 38% of respondents said that QI measures produced little benefit for their patients or rarely addressed patients' acute issues. Another 21% of respondents labeled QI measures as "distractions," and 12% said QI measures affected their productivity.

Only 28% of respondents thought that QI have improved inpatient care, just 2% more than those who found "little benefit" to them (26%), indicating that 54% of respondents were nearly evenly split on whether QI measures directly benefit patients.

Felix Aguirre, MD, FHM, vice president of medical affairs for IPC: The Hospitalist Company and a member of SHM's Performance Measurement and Reporting Committee (PMRC), says while certain core measures, such as PQRS reporting, may not address the specific needs of all hospital patients, it does not make them unsuccessful.

"I think measures do improve care, even if it's not for my patients, [then] for the global population of patients," Dr. Aguirre says. "We're not moving the needle quickly by treating my patients; we're moving the needle slowly, but surely, by treating all patients."

PMRC chair Gregory B. Seymann, MD, SFHM, clinical professor and chief of the division of hospital medicine at University of California San Diego Health Sciences, says the variety of QI measures included in the survey may explain the difference in opinions.

"There are multiple different practice arrangements among the general population of hospitalists and thus many different ways an individual respondent might interact with the measures," Dr. Seymann says. TH

Visit our website for more information on quality initiatives.

Clinical question: Does the risk of pneumonia vary for different inhaled agents?

Background: Inhaled corticosteroids (ICS) are known to increase the risk of pneumonia in COPD patients; duration, dosage, and various agents, especially fluticasone and budesonide, were investigated.

Study design: Nested, case-control analysis.

Setting: Quebec health insurance database for new users with COPD, 1990–2005, with follow-up through 2007.

Synopsis: Investigators analyzed 163,514 patients, including 20,344 patients with serious pneumonia; current use of ICS was associated with a 69% increase in the rate of serious pneumonia (RR 1.69; 95% CI 1.63-1.75). The increased risk was sustained with long-term use but declined gradually to zero at six months after stopping ICS. The risk of serious pneumonia was higher with fluticasone (RR 2.01; 95% CI 1.93-2.10) than budesonide (RR 1.17; 95% CI 1.09-1.26).

Bottom line: Fluticasone was associated with an increased risk of pneumonia in COPD patients, consistent with earlier clinical trials, but the risk with budesonide was much lower.

Citation: Suissa S, Patenaude V, Lapi F, Ernst P. Inhaled corticosteroids in COPD and the risk of serious pneumonia. Thorax. 2013;68(11):1029-1036.

Clinical question: Does the risk of pneumonia vary for different inhaled agents?

Background: Inhaled corticosteroids (ICS) are known to increase the risk of pneumonia in COPD patients; duration, dosage, and various agents, especially fluticasone and budesonide, were investigated.

Study design: Nested, case-control analysis.

Setting: Quebec health insurance database for new users with COPD, 1990–2005, with follow-up through 2007.

Synopsis: Investigators analyzed 163,514 patients, including 20,344 patients with serious pneumonia; current use of ICS was associated with a 69% increase in the rate of serious pneumonia (RR 1.69; 95% CI 1.63-1.75). The increased risk was sustained with long-term use but declined gradually to zero at six months after stopping ICS. The risk of serious pneumonia was higher with fluticasone (RR 2.01; 95% CI 1.93-2.10) than budesonide (RR 1.17; 95% CI 1.09-1.26).

Bottom line: Fluticasone was associated with an increased risk of pneumonia in COPD patients, consistent with earlier clinical trials, but the risk with budesonide was much lower.

Citation: Suissa S, Patenaude V, Lapi F, Ernst P. Inhaled corticosteroids in COPD and the risk of serious pneumonia. Thorax. 2013;68(11):1029-1036.

Clinical question: Does the risk of pneumonia vary for different inhaled agents?

Background: Inhaled corticosteroids (ICS) are known to increase the risk of pneumonia in COPD patients; duration, dosage, and various agents, especially fluticasone and budesonide, were investigated.

Study design: Nested, case-control analysis.

Setting: Quebec health insurance database for new users with COPD, 1990–2005, with follow-up through 2007.

Synopsis: Investigators analyzed 163,514 patients, including 20,344 patients with serious pneumonia; current use of ICS was associated with a 69% increase in the rate of serious pneumonia (RR 1.69; 95% CI 1.63-1.75). The increased risk was sustained with long-term use but declined gradually to zero at six months after stopping ICS. The risk of serious pneumonia was higher with fluticasone (RR 2.01; 95% CI 1.93-2.10) than budesonide (RR 1.17; 95% CI 1.09-1.26).

Bottom line: Fluticasone was associated with an increased risk of pneumonia in COPD patients, consistent with earlier clinical trials, but the risk with budesonide was much lower.

Citation: Suissa S, Patenaude V, Lapi F, Ernst P. Inhaled corticosteroids in COPD and the risk of serious pneumonia. Thorax. 2013;68(11):1029-1036.

Highlights from The Hospitalist this month include hospitalist reactions to the once-again delayed implementation of the coding classification system ICD-10. Robert Tennant, senior policy advisor at Medical Group Management Association, shares his organization’s perspective on the postponement. Dr. Amy Boutwell, a hospitalist at Newton-Wellesley Hospital and president of Collaborative Healthcare Strategies, discusses Medicare’s new hospital discharge rules and the opportunity they hold for hospitalists. Elsewhere in this issue, we have an update on SHM’s Leadership Academy scheduled for November 3–6 in Honolulu, Hawaii, and the latest in clinical research, including a review of best practices for end-of-life care and when to suspect Kawasaki disease in infants.

Click here to listen to the July highlights Podcast.

Highlights from The Hospitalist this month include hospitalist reactions to the once-again delayed implementation of the coding classification system ICD-10. Robert Tennant, senior policy advisor at Medical Group Management Association, shares his organization’s perspective on the postponement. Dr. Amy Boutwell, a hospitalist at Newton-Wellesley Hospital and president of Collaborative Healthcare Strategies, discusses Medicare’s new hospital discharge rules and the opportunity they hold for hospitalists. Elsewhere in this issue, we have an update on SHM’s Leadership Academy scheduled for November 3–6 in Honolulu, Hawaii, and the latest in clinical research, including a review of best practices for end-of-life care and when to suspect Kawasaki disease in infants.

Click here to listen to the July highlights Podcast.

Highlights from The Hospitalist this month include hospitalist reactions to the once-again delayed implementation of the coding classification system ICD-10. Robert Tennant, senior policy advisor at Medical Group Management Association, shares his organization’s perspective on the postponement. Dr. Amy Boutwell, a hospitalist at Newton-Wellesley Hospital and president of Collaborative Healthcare Strategies, discusses Medicare’s new hospital discharge rules and the opportunity they hold for hospitalists. Elsewhere in this issue, we have an update on SHM’s Leadership Academy scheduled for November 3–6 in Honolulu, Hawaii, and the latest in clinical research, including a review of best practices for end-of-life care and when to suspect Kawasaki disease in infants.

Click here to listen to the July highlights Podcast.

Dr. Kosaraju

Michael Campbell, MD, has been named one of the 2013 Physicians of the Year at Lake Health community health system in Lake County, Ohio. Dr. Campbell is a hospitalist who is board certified in family practice. He has been with Lake Health since 2011.

Nitish Kosaraju, MD, and Jocelyn Hendricks, DO, both received the 2013 Hospitalist of the Year award for an acute care practice from IPC The Hospitalist Company, based in North Hollywood, Calif. Dr. Kosaraju is a practice group leader for IPC in Houston and has been an IPC hospitalist since 2010. Dr. Hendricks is a practice group leader in Tucson, Ariz., and has been part of IPC since 2004.

Pedram Taher, MD, received IPC’s 2013 Hospitalist of the Year award for a post-acute care practice. Dr. Taher has worked for IPC since 2009 and is a practice group leader in the San Francisco Bay area.

Tammy Hilliard, FNP-C, earned IPC’s 2013 Hospitalist of the Year award for a non-physician provider. Hilliard has been with IPC since 2009 and now serves as a nurse practitioner and practice group representative in Phoenix, Ariz.

Jeffrey Harris, MD, received IPC’s 2013 Newcomer Clinician of the Year award. Dr. Harris is a neuro-hospitalist in San Antonio, Texas, and joined IPC in January 2013.

Corbi Milligan, MD, was featured in Murfreesboro Magazine for her exemplary leadership as the EmCare hospitalist site medical director for TriStar StoneCrest Medical Center in Smyrna, Tenn. Dr. Milligan oversees 10 hospitalists in her role and has been with TriStar StoneCrest since 2004.

Business Moves

St. Anthony’s Memorial Hospital in Effingham, Ill., has announced a brand new hospitalist program. The 146-bed acute care center will staff two full-time hospitalists.

Laurens County Memorial Hospital (LCMH) in Clinton, S.C., has partnered with the hospitalist program at Greenville Health System (GHS) in Greenville, S.C., to provide 24-hour hospitalist services. GHS’s lead hospitalist, Kevin Gilroy, MD, will oversee the new program at LCMH. GHS is a public, nonprofit healthcare system comprising seven regional medical centers, including LCMH, as well as numerous post-acute care facilities and offices.

The hospitalist program at Erlanger Health System in Chattanooga, Tenn., will now be managed by MDP Management, a Chattanooga-based physician management company. Erlanger’s hospitalist program has 18 full-time physicians at the nonprofit, level-one trauma center.

IPC The Hospitalist Company has acquired the post-acute hospitalist practice CAP Medical Group, PLLC, in New Hartford, N.Y. CAP Medical Group has served the Oneida County area of upstate New York since 2007. IPC oversees hospitalist services in over 400 hospitals and 1,100 post-acute care practices across the country.

Dr. Kosaraju

Michael Campbell, MD, has been named one of the 2013 Physicians of the Year at Lake Health community health system in Lake County, Ohio. Dr. Campbell is a hospitalist who is board certified in family practice. He has been with Lake Health since 2011.

Nitish Kosaraju, MD, and Jocelyn Hendricks, DO, both received the 2013 Hospitalist of the Year award for an acute care practice from IPC The Hospitalist Company, based in North Hollywood, Calif. Dr. Kosaraju is a practice group leader for IPC in Houston and has been an IPC hospitalist since 2010. Dr. Hendricks is a practice group leader in Tucson, Ariz., and has been part of IPC since 2004.

Pedram Taher, MD, received IPC’s 2013 Hospitalist of the Year award for a post-acute care practice. Dr. Taher has worked for IPC since 2009 and is a practice group leader in the San Francisco Bay area.

Tammy Hilliard, FNP-C, earned IPC’s 2013 Hospitalist of the Year award for a non-physician provider. Hilliard has been with IPC since 2009 and now serves as a nurse practitioner and practice group representative in Phoenix, Ariz.

Jeffrey Harris, MD, received IPC’s 2013 Newcomer Clinician of the Year award. Dr. Harris is a neuro-hospitalist in San Antonio, Texas, and joined IPC in January 2013.

Corbi Milligan, MD, was featured in Murfreesboro Magazine for her exemplary leadership as the EmCare hospitalist site medical director for TriStar StoneCrest Medical Center in Smyrna, Tenn. Dr. Milligan oversees 10 hospitalists in her role and has been with TriStar StoneCrest since 2004.

Business Moves

St. Anthony’s Memorial Hospital in Effingham, Ill., has announced a brand new hospitalist program. The 146-bed acute care center will staff two full-time hospitalists.

Laurens County Memorial Hospital (LCMH) in Clinton, S.C., has partnered with the hospitalist program at Greenville Health System (GHS) in Greenville, S.C., to provide 24-hour hospitalist services. GHS’s lead hospitalist, Kevin Gilroy, MD, will oversee the new program at LCMH. GHS is a public, nonprofit healthcare system comprising seven regional medical centers, including LCMH, as well as numerous post-acute care facilities and offices.

The hospitalist program at Erlanger Health System in Chattanooga, Tenn., will now be managed by MDP Management, a Chattanooga-based physician management company. Erlanger’s hospitalist program has 18 full-time physicians at the nonprofit, level-one trauma center.

IPC The Hospitalist Company has acquired the post-acute hospitalist practice CAP Medical Group, PLLC, in New Hartford, N.Y. CAP Medical Group has served the Oneida County area of upstate New York since 2007. IPC oversees hospitalist services in over 400 hospitals and 1,100 post-acute care practices across the country.

Dr. Kosaraju

Michael Campbell, MD, has been named one of the 2013 Physicians of the Year at Lake Health community health system in Lake County, Ohio. Dr. Campbell is a hospitalist who is board certified in family practice. He has been with Lake Health since 2011.

Nitish Kosaraju, MD, and Jocelyn Hendricks, DO, both received the 2013 Hospitalist of the Year award for an acute care practice from IPC The Hospitalist Company, based in North Hollywood, Calif. Dr. Kosaraju is a practice group leader for IPC in Houston and has been an IPC hospitalist since 2010. Dr. Hendricks is a practice group leader in Tucson, Ariz., and has been part of IPC since 2004.

Pedram Taher, MD, received IPC’s 2013 Hospitalist of the Year award for a post-acute care practice. Dr. Taher has worked for IPC since 2009 and is a practice group leader in the San Francisco Bay area.

Tammy Hilliard, FNP-C, earned IPC’s 2013 Hospitalist of the Year award for a non-physician provider. Hilliard has been with IPC since 2009 and now serves as a nurse practitioner and practice group representative in Phoenix, Ariz.

Jeffrey Harris, MD, received IPC’s 2013 Newcomer Clinician of the Year award. Dr. Harris is a neuro-hospitalist in San Antonio, Texas, and joined IPC in January 2013.

Corbi Milligan, MD, was featured in Murfreesboro Magazine for her exemplary leadership as the EmCare hospitalist site medical director for TriStar StoneCrest Medical Center in Smyrna, Tenn. Dr. Milligan oversees 10 hospitalists in her role and has been with TriStar StoneCrest since 2004.

Business Moves

St. Anthony’s Memorial Hospital in Effingham, Ill., has announced a brand new hospitalist program. The 146-bed acute care center will staff two full-time hospitalists.

Laurens County Memorial Hospital (LCMH) in Clinton, S.C., has partnered with the hospitalist program at Greenville Health System (GHS) in Greenville, S.C., to provide 24-hour hospitalist services. GHS’s lead hospitalist, Kevin Gilroy, MD, will oversee the new program at LCMH. GHS is a public, nonprofit healthcare system comprising seven regional medical centers, including LCMH, as well as numerous post-acute care facilities and offices.

The hospitalist program at Erlanger Health System in Chattanooga, Tenn., will now be managed by MDP Management, a Chattanooga-based physician management company. Erlanger’s hospitalist program has 18 full-time physicians at the nonprofit, level-one trauma center.

IPC The Hospitalist Company has acquired the post-acute hospitalist practice CAP Medical Group, PLLC, in New Hartford, N.Y. CAP Medical Group has served the Oneida County area of upstate New York since 2007. IPC oversees hospitalist services in over 400 hospitals and 1,100 post-acute care practices across the country.

In a recent visit to Capitol Hill, Ann Sheehy, MD, MS, FHM, gave Congressional lawmakers the hospitalist perspective on how such Medicare policies as the two-midnight rule, patient observation status, and Recovery Audit Contractor (RAC) program impact patient care, physicians, and hospitals.

These issues are "so important and I am passionate about [them]," says Dr. Sheehy, a physician at the University of Wisconsin School of Medicine and Public Health (UW) in Madison who addressed the House Committee on Ways and Means' Subcommittee on Health on May 20. "I saw what was happening to patients, and it just did not make any sense at all."

Under the Centers for Medicare & Medicaid Service's two-midnight rule, most patients who stay in the hospital fewer than two days must be considered outpatients or under observation.

Observation status leaves them on the hook for the costs of any chronic condition medications they receive in the hospital, and patients under observation, or considered to be outpatients, are not eligible for skilled nursing facility (SNF) care coverage.

"Because of our clinical work and extensive experience in the hospital setting, hospitalists have a firsthand view of what observation care looks like to patients, physicians, and hospitals," Dr. Sheehy told the committee in her testimony [PDF].

SHM actively supports the Improving Access to Medicare Coverage Act (H.R. 1179), bipartisan legislation sponsored by Rep. Joe Courtney (D-Conn.), aimed at ensuring Medicare beneficiaries classified under observation are considered inpatient for the purposes of accessing SNF care.

Dr. Sheehy also addressed problems with Medicare's RAC program, telling Congress that "RAC auditors are paid exclusively on contingency as a percent of the Medicare dollars they recover for the federal government on cases audited," according to her testimony. "Unfortunately, these contingency incentives favor aggressive auditing, without transparency, accountability, or repercussions for cases that should never have been audited." She added "hospitals spend an enormous amount of resources on determining patient status, and then preparing cases for audit and appeal, for very little benefit."

At the Congressional hearing, Dr. Sheehy used her experience at UW and findings based on two studies about observation status in hospitals she and colleagues published last year in JAMA Internal Medicine to build a backstory around the issues.

In one of her studies, Dr. Sheehy and colleagues found that nearly half of UW patients would have been assigned observation status rather than inpatient under the two-midnight rule based on their hospital arrival time.

Additionally, Dr. Sheehy told Congress that RAC audits of 299 patient charts at UW found that 21% had improper payments. The hospital appealed 58 of the 63 audit decisions and had won each of them as of May 14.

Dr. Sheehy hopes her testimony will lead to meaningful changes.

"Our understanding is that [Ways and Means committee members] were going to draft legislation out of the hearing, and we hope we have comprehensively addressed [patient] observation and the auditing programs that enforce it," Dr. Sheehy says. "Hopefully, we provided the backstory and evidence for a comprehensive bill everyone can get behind."

For SHM, Dr. Sheehy's testimony demonstrates that hospitalists are taking leadership roles when it comes to critical issues that impact patients, physicians, and hospitals.

"The hearing shows the strength of hospital medicine as a specialty and a movement in healthcare: hospitalists and SHM are not standing on the sidelines when it comes to flawed Medicare policies such as the two-midnight rule and observation care in general," says SHM president Burke Kealey, MD, SFHM, medical director of hospital specialties at HealthPartners Medical Group in St. Paul, Minn.

"These policy discussions are critical to the care our patients receive," Dr. Kealey adds. "Congress is clearly interested in and listening to the hospitalist perspective. Dr. Sheehy represented the nation's 44,000 hospitalists with the expertise, confidence, and compassion that are hallmarks of the specialty." Th

Visit our website for more information on Medicare's two-midnight rule.

In a recent visit to Capitol Hill, Ann Sheehy, MD, MS, FHM, gave Congressional lawmakers the hospitalist perspective on how such Medicare policies as the two-midnight rule, patient observation status, and Recovery Audit Contractor (RAC) program impact patient care, physicians, and hospitals.

These issues are "so important and I am passionate about [them]," says Dr. Sheehy, a physician at the University of Wisconsin School of Medicine and Public Health (UW) in Madison who addressed the House Committee on Ways and Means' Subcommittee on Health on May 20. "I saw what was happening to patients, and it just did not make any sense at all."

Under the Centers for Medicare & Medicaid Service's two-midnight rule, most patients who stay in the hospital fewer than two days must be considered outpatients or under observation.

Observation status leaves them on the hook for the costs of any chronic condition medications they receive in the hospital, and patients under observation, or considered to be outpatients, are not eligible for skilled nursing facility (SNF) care coverage.

"Because of our clinical work and extensive experience in the hospital setting, hospitalists have a firsthand view of what observation care looks like to patients, physicians, and hospitals," Dr. Sheehy told the committee in her testimony [PDF].

SHM actively supports the Improving Access to Medicare Coverage Act (H.R. 1179), bipartisan legislation sponsored by Rep. Joe Courtney (D-Conn.), aimed at ensuring Medicare beneficiaries classified under observation are considered inpatient for the purposes of accessing SNF care.

Dr. Sheehy also addressed problems with Medicare's RAC program, telling Congress that "RAC auditors are paid exclusively on contingency as a percent of the Medicare dollars they recover for the federal government on cases audited," according to her testimony. "Unfortunately, these contingency incentives favor aggressive auditing, without transparency, accountability, or repercussions for cases that should never have been audited." She added "hospitals spend an enormous amount of resources on determining patient status, and then preparing cases for audit and appeal, for very little benefit."

At the Congressional hearing, Dr. Sheehy used her experience at UW and findings based on two studies about observation status in hospitals she and colleagues published last year in JAMA Internal Medicine to build a backstory around the issues.

In one of her studies, Dr. Sheehy and colleagues found that nearly half of UW patients would have been assigned observation status rather than inpatient under the two-midnight rule based on their hospital arrival time.

Additionally, Dr. Sheehy told Congress that RAC audits of 299 patient charts at UW found that 21% had improper payments. The hospital appealed 58 of the 63 audit decisions and had won each of them as of May 14.

Dr. Sheehy hopes her testimony will lead to meaningful changes.

"Our understanding is that [Ways and Means committee members] were going to draft legislation out of the hearing, and we hope we have comprehensively addressed [patient] observation and the auditing programs that enforce it," Dr. Sheehy says. "Hopefully, we provided the backstory and evidence for a comprehensive bill everyone can get behind."

For SHM, Dr. Sheehy's testimony demonstrates that hospitalists are taking leadership roles when it comes to critical issues that impact patients, physicians, and hospitals.

"The hearing shows the strength of hospital medicine as a specialty and a movement in healthcare: hospitalists and SHM are not standing on the sidelines when it comes to flawed Medicare policies such as the two-midnight rule and observation care in general," says SHM president Burke Kealey, MD, SFHM, medical director of hospital specialties at HealthPartners Medical Group in St. Paul, Minn.

"These policy discussions are critical to the care our patients receive," Dr. Kealey adds. "Congress is clearly interested in and listening to the hospitalist perspective. Dr. Sheehy represented the nation's 44,000 hospitalists with the expertise, confidence, and compassion that are hallmarks of the specialty." Th

Visit our website for more information on Medicare's two-midnight rule.

In a recent visit to Capitol Hill, Ann Sheehy, MD, MS, FHM, gave Congressional lawmakers the hospitalist perspective on how such Medicare policies as the two-midnight rule, patient observation status, and Recovery Audit Contractor (RAC) program impact patient care, physicians, and hospitals.

These issues are "so important and I am passionate about [them]," says Dr. Sheehy, a physician at the University of Wisconsin School of Medicine and Public Health (UW) in Madison who addressed the House Committee on Ways and Means' Subcommittee on Health on May 20. "I saw what was happening to patients, and it just did not make any sense at all."

Under the Centers for Medicare & Medicaid Service's two-midnight rule, most patients who stay in the hospital fewer than two days must be considered outpatients or under observation.

Observation status leaves them on the hook for the costs of any chronic condition medications they receive in the hospital, and patients under observation, or considered to be outpatients, are not eligible for skilled nursing facility (SNF) care coverage.

"Because of our clinical work and extensive experience in the hospital setting, hospitalists have a firsthand view of what observation care looks like to patients, physicians, and hospitals," Dr. Sheehy told the committee in her testimony [PDF].

SHM actively supports the Improving Access to Medicare Coverage Act (H.R. 1179), bipartisan legislation sponsored by Rep. Joe Courtney (D-Conn.), aimed at ensuring Medicare beneficiaries classified under observation are considered inpatient for the purposes of accessing SNF care.

Dr. Sheehy also addressed problems with Medicare's RAC program, telling Congress that "RAC auditors are paid exclusively on contingency as a percent of the Medicare dollars they recover for the federal government on cases audited," according to her testimony. "Unfortunately, these contingency incentives favor aggressive auditing, without transparency, accountability, or repercussions for cases that should never have been audited." She added "hospitals spend an enormous amount of resources on determining patient status, and then preparing cases for audit and appeal, for very little benefit."

At the Congressional hearing, Dr. Sheehy used her experience at UW and findings based on two studies about observation status in hospitals she and colleagues published last year in JAMA Internal Medicine to build a backstory around the issues.

In one of her studies, Dr. Sheehy and colleagues found that nearly half of UW patients would have been assigned observation status rather than inpatient under the two-midnight rule based on their hospital arrival time.

Additionally, Dr. Sheehy told Congress that RAC audits of 299 patient charts at UW found that 21% had improper payments. The hospital appealed 58 of the 63 audit decisions and had won each of them as of May 14.

Dr. Sheehy hopes her testimony will lead to meaningful changes.

"Our understanding is that [Ways and Means committee members] were going to draft legislation out of the hearing, and we hope we have comprehensively addressed [patient] observation and the auditing programs that enforce it," Dr. Sheehy says. "Hopefully, we provided the backstory and evidence for a comprehensive bill everyone can get behind."

For SHM, Dr. Sheehy's testimony demonstrates that hospitalists are taking leadership roles when it comes to critical issues that impact patients, physicians, and hospitals.

"The hearing shows the strength of hospital medicine as a specialty and a movement in healthcare: hospitalists and SHM are not standing on the sidelines when it comes to flawed Medicare policies such as the two-midnight rule and observation care in general," says SHM president Burke Kealey, MD, SFHM, medical director of hospital specialties at HealthPartners Medical Group in St. Paul, Minn.

"These policy discussions are critical to the care our patients receive," Dr. Kealey adds. "Congress is clearly interested in and listening to the hospitalist perspective. Dr. Sheehy represented the nation's 44,000 hospitalists with the expertise, confidence, and compassion that are hallmarks of the specialty." Th

Visit our website for more information on Medicare's two-midnight rule.

A recent rule change that allows registered dietitians (RDs) to independently order therapeutic diets for inpatients should free up hospitalists to focus on other, potentially more pressing issues, says a hospitalist. In the past, therapeutic diets could only be prescribed by a physician.

Issued by the Centers for Medicare & Medicaid Services, the revised rule enables RDs to "operate at the top of their license," says hospitalist Melissa Parkhurst, MD, FHM, medical director of the Nutrition Support Service at the University of Kansas Hospital in Kansas City, who says she's in favor of the change.

Dr. Parkhurst is hopeful that the rule will spur conversations on what RDs and others—non-physician practitioners and physician assistants, for example—can do to continue to free up physicians for other duties.

"Any time you can allow the different disciplines to work directly with patients to help in that hospital stay, you are not only hopefully bettering the care of the patient, but you're helping the primary attending physicians as well," Dr. Parkhurst says. "The idea was not only to hopefully improve the timeliness of getting nutrition intervention started with patients but also to … allow everybody to do what they're good at."

Closing the malnutrition gap in hospitals also was the topic of a recent blog post on "The Hospital Leader" by Dr. Karim Godamunne, MD, MBA, SFHM

Together with SHM and the Alliance to Advance Patient Nutrition, Dr. Parkhurst has advocated on behalf of better collaboration to address the nutritional needs of hospitalized patients. She sees allowing other care providers to do more independent work as part of the overall reform movement that is changing healthcare delivery.

"The days of all aspects of the patients care being dictated and initially coming from the primary attending—those days have been changing and going away,” she adds. “This is just another piece of that puzzle."  TH

Visit our website for more information about inpatient nutrition.

A recent rule change that allows registered dietitians (RDs) to independently order therapeutic diets for inpatients should free up hospitalists to focus on other, potentially more pressing issues, says a hospitalist. In the past, therapeutic diets could only be prescribed by a physician.

Issued by the Centers for Medicare & Medicaid Services, the revised rule enables RDs to "operate at the top of their license," says hospitalist Melissa Parkhurst, MD, FHM, medical director of the Nutrition Support Service at the University of Kansas Hospital in Kansas City, who says she's in favor of the change.

Dr. Parkhurst is hopeful that the rule will spur conversations on what RDs and others—non-physician practitioners and physician assistants, for example—can do to continue to free up physicians for other duties.

"Any time you can allow the different disciplines to work directly with patients to help in that hospital stay, you are not only hopefully bettering the care of the patient, but you're helping the primary attending physicians as well," Dr. Parkhurst says. "The idea was not only to hopefully improve the timeliness of getting nutrition intervention started with patients but also to … allow everybody to do what they're good at."

Closing the malnutrition gap in hospitals also was the topic of a recent blog post on "The Hospital Leader" by Dr. Karim Godamunne, MD, MBA, SFHM

Together with SHM and the Alliance to Advance Patient Nutrition, Dr. Parkhurst has advocated on behalf of better collaboration to address the nutritional needs of hospitalized patients. She sees allowing other care providers to do more independent work as part of the overall reform movement that is changing healthcare delivery.

"The days of all aspects of the patients care being dictated and initially coming from the primary attending—those days have been changing and going away,” she adds. “This is just another piece of that puzzle."  TH

Visit our website for more information about inpatient nutrition.

A recent rule change that allows registered dietitians (RDs) to independently order therapeutic diets for inpatients should free up hospitalists to focus on other, potentially more pressing issues, says a hospitalist. In the past, therapeutic diets could only be prescribed by a physician.

Issued by the Centers for Medicare & Medicaid Services, the revised rule enables RDs to "operate at the top of their license," says hospitalist Melissa Parkhurst, MD, FHM, medical director of the Nutrition Support Service at the University of Kansas Hospital in Kansas City, who says she's in favor of the change.

Dr. Parkhurst is hopeful that the rule will spur conversations on what RDs and others—non-physician practitioners and physician assistants, for example—can do to continue to free up physicians for other duties.

"Any time you can allow the different disciplines to work directly with patients to help in that hospital stay, you are not only hopefully bettering the care of the patient, but you're helping the primary attending physicians as well," Dr. Parkhurst says. "The idea was not only to hopefully improve the timeliness of getting nutrition intervention started with patients but also to … allow everybody to do what they're good at."

Closing the malnutrition gap in hospitals also was the topic of a recent blog post on "The Hospital Leader" by Dr. Karim Godamunne, MD, MBA, SFHM

Together with SHM and the Alliance to Advance Patient Nutrition, Dr. Parkhurst has advocated on behalf of better collaboration to address the nutritional needs of hospitalized patients. She sees allowing other care providers to do more independent work as part of the overall reform movement that is changing healthcare delivery.

"The days of all aspects of the patients care being dictated and initially coming from the primary attending—those days have been changing and going away,” she adds. “This is just another piece of that puzzle."  TH

Visit our website for more information about inpatient nutrition.

Click on the 5-minute video below...

Click on the 5-minute video below...

Click on the 5-minute video below...

Hospitalist Ateev Mehrotra, MD, MPH, garnered an audience in Congress last month with his speech on telemedicine that called on lawmakers to take a deliberate approach to the healthcare strategy.

Dr. Mehrotra, a staff physician at Beth Israel Deaconess Medical Center in Boston and a policy analyst for RAND Corporation in Santa Monica, Calif., testified before a health subcommittee of the Energy & Commerce Committee[PDF]. He urged politicians to understand that telemedicine has immense potential but needs to be implemented deliberately to ensure that it provides quality care, improves access to those who need it most, and is used in the most cost-efficient manner.

He spoke with The Hospitalist after testifying:

Question: What do you hope the committee took away from your speech?

Answer: Go in with [your] eyes wide open. Experience tells us this is going to work in some ways and is not going to work in some ways. I think some people are naive and think telemedicine is perfect.

Q: Overutilization is a fear of yours. Tell me why.

A: For every great and remarkable intervention we have introduced in medicine, there has been this potential concern. I gave the example of cardiac catheterization, [which] has saved tens of thousands of lives probably. I can cite many other examples from MRIs to CTs [computed tomography] to robot-assisted surgery, etc., where that overuse issue is very significant. Economists believe [new technologies] are one of the greatest drivers of increased healthcare spending in the United States. With that as background, one shouldn’t be surprised that telemedicine would face the same issues.

Q: With a national push for telemedicine, is that overall a good thing?

A: Maybe I’m just too much of a doctor, but I think about this very much like I think about a drug. You have positive benefits, and you’ve got side effects. You need to be aware of the side effects … it doesn’t mean in many cases you don’t prescribe the drug because the drug is helping overall. If you take that same framework to telemedicine, I would say I’m overall very enthusiastic about the multitude of benefits … but not all telemedicine is the same. TH

Visit our website for more information on telemedicine and hospitalists.

Hospitalist Ateev Mehrotra, MD, MPH, garnered an audience in Congress last month with his speech on telemedicine that called on lawmakers to take a deliberate approach to the healthcare strategy.

Dr. Mehrotra, a staff physician at Beth Israel Deaconess Medical Center in Boston and a policy analyst for RAND Corporation in Santa Monica, Calif., testified before a health subcommittee of the Energy & Commerce Committee[PDF]. He urged politicians to understand that telemedicine has immense potential but needs to be implemented deliberately to ensure that it provides quality care, improves access to those who need it most, and is used in the most cost-efficient manner.

He spoke with The Hospitalist after testifying:

Question: What do you hope the committee took away from your speech?

Answer: Go in with [your] eyes wide open. Experience tells us this is going to work in some ways and is not going to work in some ways. I think some people are naive and think telemedicine is perfect.

Q: Overutilization is a fear of yours. Tell me why.

A: For every great and remarkable intervention we have introduced in medicine, there has been this potential concern. I gave the example of cardiac catheterization, [which] has saved tens of thousands of lives probably. I can cite many other examples from MRIs to CTs [computed tomography] to robot-assisted surgery, etc., where that overuse issue is very significant. Economists believe [new technologies] are one of the greatest drivers of increased healthcare spending in the United States. With that as background, one shouldn’t be surprised that telemedicine would face the same issues.

Q: With a national push for telemedicine, is that overall a good thing?

A: Maybe I’m just too much of a doctor, but I think about this very much like I think about a drug. You have positive benefits, and you’ve got side effects. You need to be aware of the side effects … it doesn’t mean in many cases you don’t prescribe the drug because the drug is helping overall. If you take that same framework to telemedicine, I would say I’m overall very enthusiastic about the multitude of benefits … but not all telemedicine is the same. TH

Visit our website for more information on telemedicine and hospitalists.

Hospitalist Ateev Mehrotra, MD, MPH, garnered an audience in Congress last month with his speech on telemedicine that called on lawmakers to take a deliberate approach to the healthcare strategy.

Dr. Mehrotra, a staff physician at Beth Israel Deaconess Medical Center in Boston and a policy analyst for RAND Corporation in Santa Monica, Calif., testified before a health subcommittee of the Energy & Commerce Committee[PDF]. He urged politicians to understand that telemedicine has immense potential but needs to be implemented deliberately to ensure that it provides quality care, improves access to those who need it most, and is used in the most cost-efficient manner.

He spoke with The Hospitalist after testifying:

Question: What do you hope the committee took away from your speech?

Answer: Go in with [your] eyes wide open. Experience tells us this is going to work in some ways and is not going to work in some ways. I think some people are naive and think telemedicine is perfect.

Q: Overutilization is a fear of yours. Tell me why.

A: For every great and remarkable intervention we have introduced in medicine, there has been this potential concern. I gave the example of cardiac catheterization, [which] has saved tens of thousands of lives probably. I can cite many other examples from MRIs to CTs [computed tomography] to robot-assisted surgery, etc., where that overuse issue is very significant. Economists believe [new technologies] are one of the greatest drivers of increased healthcare spending in the United States. With that as background, one shouldn’t be surprised that telemedicine would face the same issues.

Q: With a national push for telemedicine, is that overall a good thing?

A: Maybe I’m just too much of a doctor, but I think about this very much like I think about a drug. You have positive benefits, and you’ve got side effects. You need to be aware of the side effects … it doesn’t mean in many cases you don’t prescribe the drug because the drug is helping overall. If you take that same framework to telemedicine, I would say I’m overall very enthusiastic about the multitude of benefits … but not all telemedicine is the same. TH

Visit our website for more information on telemedicine and hospitalists.