Career

The National Commission on Certification of Physician Assistants (NCCPA), the organization responsible for credentialing PAs, recently announced an opportunity for certified physician assistants (PA-C) to obtain a Certificate of Added Qualifications (CAQ) in Hospital Medicine. An examination for this voluntary credential will be given for the first time in September 2014.

In the meantime, eligible PAs can register for the process and start gathering the prerequisites, which include 3,000 hours of work in hospital medicine, 150 credits of HM-relevant continuing medical education, and a supervising physician’s sign-off on their ability to perform 10 procedures and patient care requirements derived from SHM’s core competencies (http://www.hospitalmedicine.org/Content/NavigationMenu/Education/CoreCurriculum/Core_Competencies.htm).

NCCPA, which estimates that 3,000 PAs currently work in hospital medicine, certifies PAs in general medical knowledge and experience and has implemented five specialized CAQs.

Zachary Hartsell, PA-C, who has 12 years of experience and directs PA services at Wake Forest Baptist Medical Center in Winston-Salem, N.C., is one of the question writers for the upcoming CAQ-HM exam. “I also look forward to taking the exam,” he says. “As a hospitalist PA, this is one way to show my hospital-based skills and expertise.”

Hartsell expects the qualification to become an important consideration in hiring PAs for jobs in hospital settings.

“As an administrator, it represents to me that this person has specific skills,” he says. But he emphasizes that the new voluntary qualification should not be viewed as locking PAs into a single setting or specialization. “Our certifying exam as PAs is based on general medicine, and PAs have to keep up general medicine skills to pass that exam every six years,” he notes.

For information about the HM CAQ, visit www.nccpa.net/HospitalMedicine.

Larry Beresford is a freelance writer in San Francisco, Calif.

References

1. Chang W, Maynard G, Clay B. Implementation of a computerized COPD inpatient pathway and transition pathway [abstract]. J Hosp Med. 2013;8 Suppl 1:709.
2. Schmitt S, McQuillen DP, Nahass R, et al. Infectious diseases specialty intervention is associated with decreased mortality and lower healthcare costs [published online ahead of print September 25, 2013]. Clin Infect Dis.
3. Torio CM, Andrews RM. National inpatient hospital costs: the most expensive conditions by payer, 2011. Healthcare Cost and Utilization Project Statistical Brief #160. Available at: http://www.hcup-us.ahrq.gov/reports/statbriefs/sb160.jsp. Accessed October 26, 2013.
4. Herman B. Top 20 most expensive inpatient conditions. Becker’s Hospital Review. Oct. 9, 2013. Available at: http://www.beckershospitalreview.com/racs-/-icd-9-/-icd-10/top-20-most-expensive-inpatient-conditions.html. Accessed October 26, 2013.

The National Commission on Certification of Physician Assistants (NCCPA), the organization responsible for credentialing PAs, recently announced an opportunity for certified physician assistants (PA-C) to obtain a Certificate of Added Qualifications (CAQ) in Hospital Medicine. An examination for this voluntary credential will be given for the first time in September 2014.

In the meantime, eligible PAs can register for the process and start gathering the prerequisites, which include 3,000 hours of work in hospital medicine, 150 credits of HM-relevant continuing medical education, and a supervising physician’s sign-off on their ability to perform 10 procedures and patient care requirements derived from SHM’s core competencies (http://www.hospitalmedicine.org/Content/NavigationMenu/Education/CoreCurriculum/Core_Competencies.htm).

NCCPA, which estimates that 3,000 PAs currently work in hospital medicine, certifies PAs in general medical knowledge and experience and has implemented five specialized CAQs.

Zachary Hartsell, PA-C, who has 12 years of experience and directs PA services at Wake Forest Baptist Medical Center in Winston-Salem, N.C., is one of the question writers for the upcoming CAQ-HM exam. “I also look forward to taking the exam,” he says. “As a hospitalist PA, this is one way to show my hospital-based skills and expertise.”

Hartsell expects the qualification to become an important consideration in hiring PAs for jobs in hospital settings.

“As an administrator, it represents to me that this person has specific skills,” he says. But he emphasizes that the new voluntary qualification should not be viewed as locking PAs into a single setting or specialization. “Our certifying exam as PAs is based on general medicine, and PAs have to keep up general medicine skills to pass that exam every six years,” he notes.

For information about the HM CAQ, visit www.nccpa.net/HospitalMedicine.

Larry Beresford is a freelance writer in San Francisco, Calif.

References

1. Chang W, Maynard G, Clay B. Implementation of a computerized COPD inpatient pathway and transition pathway [abstract]. J Hosp Med. 2013;8 Suppl 1:709.
2. Schmitt S, McQuillen DP, Nahass R, et al. Infectious diseases specialty intervention is associated with decreased mortality and lower healthcare costs [published online ahead of print September 25, 2013]. Clin Infect Dis.
3. Torio CM, Andrews RM. National inpatient hospital costs: the most expensive conditions by payer, 2011. Healthcare Cost and Utilization Project Statistical Brief #160. Available at: http://www.hcup-us.ahrq.gov/reports/statbriefs/sb160.jsp. Accessed October 26, 2013.
4. Herman B. Top 20 most expensive inpatient conditions. Becker’s Hospital Review. Oct. 9, 2013. Available at: http://www.beckershospitalreview.com/racs-/-icd-9-/-icd-10/top-20-most-expensive-inpatient-conditions.html. Accessed October 26, 2013.

The National Commission on Certification of Physician Assistants (NCCPA), the organization responsible for credentialing PAs, recently announced an opportunity for certified physician assistants (PA-C) to obtain a Certificate of Added Qualifications (CAQ) in Hospital Medicine. An examination for this voluntary credential will be given for the first time in September 2014.

In the meantime, eligible PAs can register for the process and start gathering the prerequisites, which include 3,000 hours of work in hospital medicine, 150 credits of HM-relevant continuing medical education, and a supervising physician’s sign-off on their ability to perform 10 procedures and patient care requirements derived from SHM’s core competencies (http://www.hospitalmedicine.org/Content/NavigationMenu/Education/CoreCurriculum/Core_Competencies.htm).

NCCPA, which estimates that 3,000 PAs currently work in hospital medicine, certifies PAs in general medical knowledge and experience and has implemented five specialized CAQs.

Zachary Hartsell, PA-C, who has 12 years of experience and directs PA services at Wake Forest Baptist Medical Center in Winston-Salem, N.C., is one of the question writers for the upcoming CAQ-HM exam. “I also look forward to taking the exam,” he says. “As a hospitalist PA, this is one way to show my hospital-based skills and expertise.”

Hartsell expects the qualification to become an important consideration in hiring PAs for jobs in hospital settings.

“As an administrator, it represents to me that this person has specific skills,” he says. But he emphasizes that the new voluntary qualification should not be viewed as locking PAs into a single setting or specialization. “Our certifying exam as PAs is based on general medicine, and PAs have to keep up general medicine skills to pass that exam every six years,” he notes.

For information about the HM CAQ, visit www.nccpa.net/HospitalMedicine.

Larry Beresford is a freelance writer in San Francisco, Calif.

References

1. Chang W, Maynard G, Clay B. Implementation of a computerized COPD inpatient pathway and transition pathway [abstract]. J Hosp Med. 2013;8 Suppl 1:709.
2. Schmitt S, McQuillen DP, Nahass R, et al. Infectious diseases specialty intervention is associated with decreased mortality and lower healthcare costs [published online ahead of print September 25, 2013]. Clin Infect Dis.
3. Torio CM, Andrews RM. National inpatient hospital costs: the most expensive conditions by payer, 2011. Healthcare Cost and Utilization Project Statistical Brief #160. Available at: http://www.hcup-us.ahrq.gov/reports/statbriefs/sb160.jsp. Accessed October 26, 2013.
4. Herman B. Top 20 most expensive inpatient conditions. Becker’s Hospital Review. Oct. 9, 2013. Available at: http://www.beckershospitalreview.com/racs-/-icd-9-/-icd-10/top-20-most-expensive-inpatient-conditions.html. Accessed October 26, 2013.

This legislation would authorize Medicare to provide coverage for voluntary advance care consultations every five years or at changes in the patient’s health, health-related condition, or care setting.

Although inevitable, death is often difficult to conceptualize and even more sensitive to discuss. For hospitalists and other care providers, conversations about the end of life with families and caregivers can be fraught with emotion. The fact that something is uncomfortable does not mean it is not useful or valuable, however. Patients must be able to vocalize their end-of-life wishes and should feel confident that the healthcare system is able to respond.

To help with this effort, the Society of Hospital Medicine is supporting legislation that would encourage voluntary end-of-life conversations between patients and their healthcare providers. Sponsored by U.S. Rep. Earl Blumenauer (D-Ore.), the Personalize Your Care Act of 2013 (H.R. 1173) would make Medicare reimbursement available for advance-care planning consultations, establish grants for state-level physician orders for life-sustaining treatment (POLST) programs, and require that advance directives be honored across state lines.

Hospitalists are integral team leaders for coordinating care and, as such, are often highly involved in end-of-life care for patients. They are at the front lines of these conversations, often tasked to plan end-of-life care and then carry out those plans. Many of their patients are acutely ill and need to face these critical decisions, often in real time.

End-of-life planning, like many other cognitive medical services, is not adequately reimbursed under current Medicare payment policy. This legislation would authorize Medicare to provide coverage for voluntary advance care consultations every five years or following changes in health, health-related condition, or care setting of the patient.

SHM is strongly supportive of adequate reimbursement for the counseling these patients require in planning their end-of-life care. The bill would make these conversations a practicable addition to the care and counseling workflow for healthcare providers and would ensure that they could occur at reasonable intervals and at significant changes in health or life events. These conversations would help ensure that patient wishes are respected at the end of life and prevent the use of unwanted treatments or interventions.

As the healthcare system works toward being more coordinated and more patient-centered, voluntary advance care planning is essential. Patients often see multiple providers at the end of their lives and—particularly as questions arise—it is imperative that providers have access to the most up-to-date advance care plans. H.R. 1173 works to address this gap by moving toward electronic health record display of advance directives and POLST.

Hospitalists may be eligible for reimbursement for these consultations, particularly in cases where these discussions did not occur in the outpatient setting. SHM is actively working with Rep. Blumenauer to ensure that all providers in a position to have these important conversations would be appropriately reimbursed. Patients need to have an active mechanism to ensure that their wishes are appropriately followed; this legislation would give them better access to these important and difficult conversations.

Joshua Lapps is SHM’s government relations specialist.

This legislation would authorize Medicare to provide coverage for voluntary advance care consultations every five years or at changes in the patient’s health, health-related condition, or care setting.

Although inevitable, death is often difficult to conceptualize and even more sensitive to discuss. For hospitalists and other care providers, conversations about the end of life with families and caregivers can be fraught with emotion. The fact that something is uncomfortable does not mean it is not useful or valuable, however. Patients must be able to vocalize their end-of-life wishes and should feel confident that the healthcare system is able to respond.

To help with this effort, the Society of Hospital Medicine is supporting legislation that would encourage voluntary end-of-life conversations between patients and their healthcare providers. Sponsored by U.S. Rep. Earl Blumenauer (D-Ore.), the Personalize Your Care Act of 2013 (H.R. 1173) would make Medicare reimbursement available for advance-care planning consultations, establish grants for state-level physician orders for life-sustaining treatment (POLST) programs, and require that advance directives be honored across state lines.

Hospitalists are integral team leaders for coordinating care and, as such, are often highly involved in end-of-life care for patients. They are at the front lines of these conversations, often tasked to plan end-of-life care and then carry out those plans. Many of their patients are acutely ill and need to face these critical decisions, often in real time.

End-of-life planning, like many other cognitive medical services, is not adequately reimbursed under current Medicare payment policy. This legislation would authorize Medicare to provide coverage for voluntary advance care consultations every five years or following changes in health, health-related condition, or care setting of the patient.

SHM is strongly supportive of adequate reimbursement for the counseling these patients require in planning their end-of-life care. The bill would make these conversations a practicable addition to the care and counseling workflow for healthcare providers and would ensure that they could occur at reasonable intervals and at significant changes in health or life events. These conversations would help ensure that patient wishes are respected at the end of life and prevent the use of unwanted treatments or interventions.

As the healthcare system works toward being more coordinated and more patient-centered, voluntary advance care planning is essential. Patients often see multiple providers at the end of their lives and—particularly as questions arise—it is imperative that providers have access to the most up-to-date advance care plans. H.R. 1173 works to address this gap by moving toward electronic health record display of advance directives and POLST.

Hospitalists may be eligible for reimbursement for these consultations, particularly in cases where these discussions did not occur in the outpatient setting. SHM is actively working with Rep. Blumenauer to ensure that all providers in a position to have these important conversations would be appropriately reimbursed. Patients need to have an active mechanism to ensure that their wishes are appropriately followed; this legislation would give them better access to these important and difficult conversations.

Joshua Lapps is SHM’s government relations specialist.

This legislation would authorize Medicare to provide coverage for voluntary advance care consultations every five years or at changes in the patient’s health, health-related condition, or care setting.

Although inevitable, death is often difficult to conceptualize and even more sensitive to discuss. For hospitalists and other care providers, conversations about the end of life with families and caregivers can be fraught with emotion. The fact that something is uncomfortable does not mean it is not useful or valuable, however. Patients must be able to vocalize their end-of-life wishes and should feel confident that the healthcare system is able to respond.

To help with this effort, the Society of Hospital Medicine is supporting legislation that would encourage voluntary end-of-life conversations between patients and their healthcare providers. Sponsored by U.S. Rep. Earl Blumenauer (D-Ore.), the Personalize Your Care Act of 2013 (H.R. 1173) would make Medicare reimbursement available for advance-care planning consultations, establish grants for state-level physician orders for life-sustaining treatment (POLST) programs, and require that advance directives be honored across state lines.

Hospitalists are integral team leaders for coordinating care and, as such, are often highly involved in end-of-life care for patients. They are at the front lines of these conversations, often tasked to plan end-of-life care and then carry out those plans. Many of their patients are acutely ill and need to face these critical decisions, often in real time.

End-of-life planning, like many other cognitive medical services, is not adequately reimbursed under current Medicare payment policy. This legislation would authorize Medicare to provide coverage for voluntary advance care consultations every five years or following changes in health, health-related condition, or care setting of the patient.

SHM is strongly supportive of adequate reimbursement for the counseling these patients require in planning their end-of-life care. The bill would make these conversations a practicable addition to the care and counseling workflow for healthcare providers and would ensure that they could occur at reasonable intervals and at significant changes in health or life events. These conversations would help ensure that patient wishes are respected at the end of life and prevent the use of unwanted treatments or interventions.

As the healthcare system works toward being more coordinated and more patient-centered, voluntary advance care planning is essential. Patients often see multiple providers at the end of their lives and—particularly as questions arise—it is imperative that providers have access to the most up-to-date advance care plans. H.R. 1173 works to address this gap by moving toward electronic health record display of advance directives and POLST.

Hospitalists may be eligible for reimbursement for these consultations, particularly in cases where these discussions did not occur in the outpatient setting. SHM is actively working with Rep. Blumenauer to ensure that all providers in a position to have these important conversations would be appropriately reimbursed. Patients need to have an active mechanism to ensure that their wishes are appropriately followed; this legislation would give them better access to these important and difficult conversations.

Joshua Lapps is SHM’s government relations specialist.

Beth Papetti

Having nocturnist coverage in your practice is a coveted position to be in for many hospital medicine providers. Rick Washington, MD, medical director for WellStar Kennestone Hospital in Marietta, Ga., says that “not only does it make it easier to recruit and retain daytime physicians when you have nocturnists as a part of your program, but they also serve a very valuable role in the continuity of the program throughout the nighttime hours, providing a stable admitting presence in the emergency department at all times.”

According to the 2012 State of Hospital Medicine Report, nearly half of all hospital medicine groups (HMGs) serving adults only incorporate nocturnists into their programs. Nocturnists are most common in HMGs employed by universities or medical schools (67%) and hospitals/integrated delivery systems (50%). The prevalence among management company-employed groups is much lower (25%), and no data was available for multispecialty groups or private hospitalist-only groups (see Figure 1).

As could be expected, the prevalence of nocturnists increases dramatically as the number of total FTEs of the practice increases. As the number of patients on a service, and thus the number of FTEs, grows, so does the expectation to provide on-site night coverage.

The percentage of compensation paid as base salary also has an impact; in general, the higher the percentage of compensation in base salary, the more likely that practice is to have nocturnists. Typically, night shifts tend to be less productive from a billable encounter perspective, so having a base rate of pay tends to be an essential factor in successfully maintaining nocturnists.

click for large version

However, surprisingly, in the 63% of groups that reported paying a nocturnist differential, the clinicians earned only a median of 15% more in total compensation than their non-nocturnist counterparts. Perhaps this has to do with other factors that programs are utilizing in order to entice and retain nocturnists, which includes the possibility of doing fewer shifts or shorter shifts than their colleagues. In fact, 49% of respondent groups reported implementing a nocturnist schedule differential, most commonly in the range of one to 20% fewer shifts than non-nocturnist hospitalists in the same practice.

Other practices implement a schedule differential by shortening the length of nocturnist shifts, instead of reducing the number of shifts worked.

“For me, the key to doing this long term has been the ability to have an eight-hour shift rather than 12 hours,” says Dr. Nancy Maignan, who soon will celebrate five years as a nocturnist at WellStar Kennestone Hospital. “Another factor is flexibility with our schedule. We do not work 7-on/7-off. My schedule is dependent on my family’s schedule…this allows me to attend field trips and be off for most of their [her kids] school break.”

Although she points out that a supportive family is crucial, a supportive HMG is key. I would encourage groups thinking of implementing a nocturnist role to think carefully about how to make the job one that hospitalists can successfully do for a long time, rather than just trying to attract people to the role by making it financially lucrative.

Beth Papetti is assistant vice president of WellStar Medical Group in Marrietta, Ga. She is a member of SHM’s Practice Analysis Committee.

Beth Papetti

Having nocturnist coverage in your practice is a coveted position to be in for many hospital medicine providers. Rick Washington, MD, medical director for WellStar Kennestone Hospital in Marietta, Ga., says that “not only does it make it easier to recruit and retain daytime physicians when you have nocturnists as a part of your program, but they also serve a very valuable role in the continuity of the program throughout the nighttime hours, providing a stable admitting presence in the emergency department at all times.”

According to the 2012 State of Hospital Medicine Report, nearly half of all hospital medicine groups (HMGs) serving adults only incorporate nocturnists into their programs. Nocturnists are most common in HMGs employed by universities or medical schools (67%) and hospitals/integrated delivery systems (50%). The prevalence among management company-employed groups is much lower (25%), and no data was available for multispecialty groups or private hospitalist-only groups (see Figure 1).

As could be expected, the prevalence of nocturnists increases dramatically as the number of total FTEs of the practice increases. As the number of patients on a service, and thus the number of FTEs, grows, so does the expectation to provide on-site night coverage.

The percentage of compensation paid as base salary also has an impact; in general, the higher the percentage of compensation in base salary, the more likely that practice is to have nocturnists. Typically, night shifts tend to be less productive from a billable encounter perspective, so having a base rate of pay tends to be an essential factor in successfully maintaining nocturnists.

click for large version

However, surprisingly, in the 63% of groups that reported paying a nocturnist differential, the clinicians earned only a median of 15% more in total compensation than their non-nocturnist counterparts. Perhaps this has to do with other factors that programs are utilizing in order to entice and retain nocturnists, which includes the possibility of doing fewer shifts or shorter shifts than their colleagues. In fact, 49% of respondent groups reported implementing a nocturnist schedule differential, most commonly in the range of one to 20% fewer shifts than non-nocturnist hospitalists in the same practice.

Other practices implement a schedule differential by shortening the length of nocturnist shifts, instead of reducing the number of shifts worked.

“For me, the key to doing this long term has been the ability to have an eight-hour shift rather than 12 hours,” says Dr. Nancy Maignan, who soon will celebrate five years as a nocturnist at WellStar Kennestone Hospital. “Another factor is flexibility with our schedule. We do not work 7-on/7-off. My schedule is dependent on my family’s schedule…this allows me to attend field trips and be off for most of their [her kids] school break.”

Although she points out that a supportive family is crucial, a supportive HMG is key. I would encourage groups thinking of implementing a nocturnist role to think carefully about how to make the job one that hospitalists can successfully do for a long time, rather than just trying to attract people to the role by making it financially lucrative.

Beth Papetti is assistant vice president of WellStar Medical Group in Marrietta, Ga. She is a member of SHM’s Practice Analysis Committee.

Beth Papetti

Having nocturnist coverage in your practice is a coveted position to be in for many hospital medicine providers. Rick Washington, MD, medical director for WellStar Kennestone Hospital in Marietta, Ga., says that “not only does it make it easier to recruit and retain daytime physicians when you have nocturnists as a part of your program, but they also serve a very valuable role in the continuity of the program throughout the nighttime hours, providing a stable admitting presence in the emergency department at all times.”

According to the 2012 State of Hospital Medicine Report, nearly half of all hospital medicine groups (HMGs) serving adults only incorporate nocturnists into their programs. Nocturnists are most common in HMGs employed by universities or medical schools (67%) and hospitals/integrated delivery systems (50%). The prevalence among management company-employed groups is much lower (25%), and no data was available for multispecialty groups or private hospitalist-only groups (see Figure 1).

As could be expected, the prevalence of nocturnists increases dramatically as the number of total FTEs of the practice increases. As the number of patients on a service, and thus the number of FTEs, grows, so does the expectation to provide on-site night coverage.

The percentage of compensation paid as base salary also has an impact; in general, the higher the percentage of compensation in base salary, the more likely that practice is to have nocturnists. Typically, night shifts tend to be less productive from a billable encounter perspective, so having a base rate of pay tends to be an essential factor in successfully maintaining nocturnists.

click for large version

However, surprisingly, in the 63% of groups that reported paying a nocturnist differential, the clinicians earned only a median of 15% more in total compensation than their non-nocturnist counterparts. Perhaps this has to do with other factors that programs are utilizing in order to entice and retain nocturnists, which includes the possibility of doing fewer shifts or shorter shifts than their colleagues. In fact, 49% of respondent groups reported implementing a nocturnist schedule differential, most commonly in the range of one to 20% fewer shifts than non-nocturnist hospitalists in the same practice.

Other practices implement a schedule differential by shortening the length of nocturnist shifts, instead of reducing the number of shifts worked.

“For me, the key to doing this long term has been the ability to have an eight-hour shift rather than 12 hours,” says Dr. Nancy Maignan, who soon will celebrate five years as a nocturnist at WellStar Kennestone Hospital. “Another factor is flexibility with our schedule. We do not work 7-on/7-off. My schedule is dependent on my family’s schedule…this allows me to attend field trips and be off for most of their [her kids] school break.”

Although she points out that a supportive family is crucial, a supportive HMG is key. I would encourage groups thinking of implementing a nocturnist role to think carefully about how to make the job one that hospitalists can successfully do for a long time, rather than just trying to attract people to the role by making it financially lucrative.

Beth Papetti is assistant vice president of WellStar Medical Group in Marrietta, Ga. She is a member of SHM’s Practice Analysis Committee.

HMX in 3 Minutes or Less

More than 2,500 hospitalists have logged into HMX to share their experiences and ask questions on a wide variety of topics, from HM group practice management to clinical details about glycemic control.

New communities are being added regularly, so be sure to set up your account, sign up for customizable e-mail notifications, and check back regularly to follow your favorite discussions.

Have a question or idea for other hospitalists? Share it today.

Here’s how to get started. All you need are your SHM login credentials.

1. Go to www.hmxchange.org.
2. In the top right-hand corner, click the link that reads, “Login to see members only content.”
3. Enter your SHM login credentials and click login.
4. Now you’re logged in. On the right-hand side, you will find a box with a list of the various communities. Click on the community you would like to view and/or post in.
5. Click the “Discussions” tab and, on the right, click the square button that says “+ Post New Message.”
6. Compose your message with subject and body (and you can include an attachment if you want).
7. Click “Send.”

Hospitalists can now follow their favorite discussions on the go with the Member Centric app for HMX.

1. Go to your preferred app store and download “MemberCentric.”
2. Search for “Society of Hospital Medicine” in the list of organizations.
3. Log in with your SHM/HMX username and password.
4. Get access to your discussions, contacts, private message inbox, and events calendar.

HMX in 3 Minutes or Less

More than 2,500 hospitalists have logged into HMX to share their experiences and ask questions on a wide variety of topics, from HM group practice management to clinical details about glycemic control.

New communities are being added regularly, so be sure to set up your account, sign up for customizable e-mail notifications, and check back regularly to follow your favorite discussions.

Have a question or idea for other hospitalists? Share it today.

Here’s how to get started. All you need are your SHM login credentials.

1. Go to www.hmxchange.org.
2. In the top right-hand corner, click the link that reads, “Login to see members only content.”
3. Enter your SHM login credentials and click login.
4. Now you’re logged in. On the right-hand side, you will find a box with a list of the various communities. Click on the community you would like to view and/or post in.
5. Click the “Discussions” tab and, on the right, click the square button that says “+ Post New Message.”
6. Compose your message with subject and body (and you can include an attachment if you want).
7. Click “Send.”

Hospitalists can now follow their favorite discussions on the go with the Member Centric app for HMX.

1. Go to your preferred app store and download “MemberCentric.”
2. Search for “Society of Hospital Medicine” in the list of organizations.
3. Log in with your SHM/HMX username and password.
4. Get access to your discussions, contacts, private message inbox, and events calendar.

HMX in 3 Minutes or Less

More than 2,500 hospitalists have logged into HMX to share their experiences and ask questions on a wide variety of topics, from HM group practice management to clinical details about glycemic control.

New communities are being added regularly, so be sure to set up your account, sign up for customizable e-mail notifications, and check back regularly to follow your favorite discussions.

Have a question or idea for other hospitalists? Share it today.

Here’s how to get started. All you need are your SHM login credentials.

1. Go to www.hmxchange.org.
2. In the top right-hand corner, click the link that reads, “Login to see members only content.”
3. Enter your SHM login credentials and click login.
4. Now you’re logged in. On the right-hand side, you will find a box with a list of the various communities. Click on the community you would like to view and/or post in.
5. Click the “Discussions” tab and, on the right, click the square button that says “+ Post New Message.”
6. Compose your message with subject and body (and you can include an attachment if you want).
7. Click “Send.”

Hospitalists can now follow their favorite discussions on the go with the Member Centric app for HMX.

1. Go to your preferred app store and download “MemberCentric.”
2. Search for “Society of Hospital Medicine” in the list of organizations.
3. Log in with your SHM/HMX username and password.
4. Get access to your discussions, contacts, private message inbox, and events calendar.

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SHM asked leaders of the Hospital-Based Quality Improvement in Stroke Prevention for Patients with Atrial Fibrillation (AF) Project, Hiren Shah, MD, MBA, SFHM, and Andrew Masica, MD, SFHM, to provide an overview of the program.

“AF is a disease state that is highly prevalent, and the numbers are rising yearly. We also know that it is one of the most common inpatient diagnoses,” Dr. Shah says. “However, when you look at the quality of care provided to our AF patients, it is quite variable and has implications for other hospital performance metrics such as 30-day readmission rates. This makes AF a high-impact target for inpatient quality improvement initiatives.”

Dr. Shah is assistant professor of medicine at Northwestern University’s Feinberg School of Medicine and medical director at Northwestern Memorial Hospital in Chicago. Dr. Masica is vice president of clinical effectiveness at Baylor Health Care System in Dallas.

The implementation guide for SHM’s AF project will be available later in December at www.hospitalmedicine.org/afib.

Question: What is the scope of your project?

Dr. Masica

Dr. Masica: That is a question we wrestled with. Numerous care processes related to AF are amenable to inpatient quality improvement. We chose to focus our efforts on stroke prevention in AF and the development of a toolkit to help hospital-based practitioners to assess stroke and bleeding risk consistently and, if indicated, to initiate antithrombotic therapy.

Dr. Shah: Along those lines, we know that at least 25% of AF-related strokes are potentially preventable with adherence to evidence-based care; however, current data indicate that only 50% to 60% of patients with AF who are eligible to receive antithrombotic therapy are on active stroke prophylaxis.

Q: Why do you think there are such large gaps in stroke prophylaxis for AF patients?

Dr. Masica: The prophylaxis decision requires the clinician to do an anticoagulation net-benefit and risk assessment, and although there are validated tools to do this type of assessment, use of these tools hasn’t yet become hardwired into daily hospital practice. Empiric clinical assessments often overestimate the bleed risk and underestimate stroke risk, so the ultimate result can be underuse of antithrombotic therapy.

“Ideally, we would like to start anticoagulation during the hospital stay or on discharge, if indicated, but even if we clearly communicate a patient’s stroke and bleed risk to the PCP on discharge, we can help ensure that this issue will be addressed on outpatient follow-up.”

–Dr. Shah

Dr. Shah: Another barrier is that in many hospitals, there are not reminders in place in our workflow for this assessment to happen at all. Hospitalists may think that the anticoagulation decision is an outpatient issue, better addressed by their primary care doctor, so it is sometimes even intentionally bypassed. Another barrier is that it takes time to discuss a patient’s values and preferences in the anticoagulation decision.

Q: But isn’t stroke prevention in AF more of an outpatient issue?

Dr. Shah: We think the hospital is a great place to start this evaluation and to make the anticoagulation decision. Of course, we should discuss these issues with the primary care doctor. Ideally, we would like to start anticoagulation during the hospital stay or on discharge, if indicated, but even if we clearly communicate a patient’s stroke and bleed risk to the PCP on discharge, we can help ensure that this issue will be addressed on outpatient follow-up.

Q: What specific tools for stroke and bleed risk are you referring to?

Dr. Shah: The CHADS2 scoring system is a well-validated tool for estimating the risk of stroke in AF patients, one that most clinicians may be aware of. The CHA2DS2-VASc is a slightly more refined scoring system. When it comes to bleeding, however, fewer clinicians are aware of the HAS-BLED bleeding risk assessment method.

Dr. Masica: The scoring systems represent a consistent, reproducible approach by which to evaluate inpatients with AF. Of course, there is some discretion for other patient-specific factors (e.g. fall risk) that are not captured in the scoring systems, but they are good starting points in the decision-making process. Finally and most importantly, although it is often overlooked, shared decision-making should take place with the patients, because their values in facing the risk of stroke versus bleeding often tip the balance one way or the other.

Q: How will the project help hospitals in this process?

Dr. Shah: We have written a QI Implementation Guide for hospitals with tools intended to improve the care of patients with AF in the hospital setting. This book will be similar to SHM’s VTE Prevention Implementation Guide, published a few years ago. We also will have an upcoming AF QI resource room within the SHM website. Additionally, similar to VTE, there are likely to be future mentored implementation projects where we will be working directly with hospitals and coaching them in this initiative.

Dr. Masica: We also have given a recent SHM-sponsored webinar that outlines some content of the guide. It can be accessed on the SHM website. This webinar reviews how to start a QI project in AF, assess your current state of care, build an interdisciplinary team, use validated tools, and deploy interventions to help make the stroke risk assessment and prophylaxis decision. I would note that the intended audience for these tools is broad and includes frontline hospitalists, QI directors, CMOs, and COOs, as well as nursing leadership, NPs, PAs, pharmacists, and other care providers.

Q: Does healthcare reform impact your efforts in this area?

Dr. Shah: Value-based purchasing, preventing readmissions, accountable care organizations, and bundled payments are all aspects of reform that will involve this therapeutic area, as their scope will impact the quality of care we deliver, how our cost structures are, and how we improve fragmentation of care across care transitions.

Dr. Masica: In addition, market forces, healthcare legislation, conceptual shifts regarding the need for systematic approaches to healthcare improvement, and new rules that may impact hospital reimbursement will continue to make AF an important healthcare quality issue. Thus, we think the discussion around delivering patient-centered care in AF is really just beginning.

Brendon Shank is SHM’s associate vice president of communications.

SHM asked leaders of the Hospital-Based Quality Improvement in Stroke Prevention for Patients with Atrial Fibrillation (AF) Project, Hiren Shah, MD, MBA, SFHM, and Andrew Masica, MD, SFHM, to provide an overview of the program.

“AF is a disease state that is highly prevalent, and the numbers are rising yearly. We also know that it is one of the most common inpatient diagnoses,” Dr. Shah says. “However, when you look at the quality of care provided to our AF patients, it is quite variable and has implications for other hospital performance metrics such as 30-day readmission rates. This makes AF a high-impact target for inpatient quality improvement initiatives.”

Dr. Shah is assistant professor of medicine at Northwestern University’s Feinberg School of Medicine and medical director at Northwestern Memorial Hospital in Chicago. Dr. Masica is vice president of clinical effectiveness at Baylor Health Care System in Dallas.

The implementation guide for SHM’s AF project will be available later in December at www.hospitalmedicine.org/afib.

Question: What is the scope of your project?

Dr. Masica

Dr. Masica: That is a question we wrestled with. Numerous care processes related to AF are amenable to inpatient quality improvement. We chose to focus our efforts on stroke prevention in AF and the development of a toolkit to help hospital-based practitioners to assess stroke and bleeding risk consistently and, if indicated, to initiate antithrombotic therapy.

Dr. Shah: Along those lines, we know that at least 25% of AF-related strokes are potentially preventable with adherence to evidence-based care; however, current data indicate that only 50% to 60% of patients with AF who are eligible to receive antithrombotic therapy are on active stroke prophylaxis.

Q: Why do you think there are such large gaps in stroke prophylaxis for AF patients?

Dr. Masica: The prophylaxis decision requires the clinician to do an anticoagulation net-benefit and risk assessment, and although there are validated tools to do this type of assessment, use of these tools hasn’t yet become hardwired into daily hospital practice. Empiric clinical assessments often overestimate the bleed risk and underestimate stroke risk, so the ultimate result can be underuse of antithrombotic therapy.

“Ideally, we would like to start anticoagulation during the hospital stay or on discharge, if indicated, but even if we clearly communicate a patient’s stroke and bleed risk to the PCP on discharge, we can help ensure that this issue will be addressed on outpatient follow-up.”

–Dr. Shah

Dr. Shah: Another barrier is that in many hospitals, there are not reminders in place in our workflow for this assessment to happen at all. Hospitalists may think that the anticoagulation decision is an outpatient issue, better addressed by their primary care doctor, so it is sometimes even intentionally bypassed. Another barrier is that it takes time to discuss a patient’s values and preferences in the anticoagulation decision.

Q: But isn’t stroke prevention in AF more of an outpatient issue?

Dr. Shah: We think the hospital is a great place to start this evaluation and to make the anticoagulation decision. Of course, we should discuss these issues with the primary care doctor. Ideally, we would like to start anticoagulation during the hospital stay or on discharge, if indicated, but even if we clearly communicate a patient’s stroke and bleed risk to the PCP on discharge, we can help ensure that this issue will be addressed on outpatient follow-up.

Q: What specific tools for stroke and bleed risk are you referring to?

Dr. Shah: The CHADS2 scoring system is a well-validated tool for estimating the risk of stroke in AF patients, one that most clinicians may be aware of. The CHA2DS2-VASc is a slightly more refined scoring system. When it comes to bleeding, however, fewer clinicians are aware of the HAS-BLED bleeding risk assessment method.

Dr. Masica: The scoring systems represent a consistent, reproducible approach by which to evaluate inpatients with AF. Of course, there is some discretion for other patient-specific factors (e.g. fall risk) that are not captured in the scoring systems, but they are good starting points in the decision-making process. Finally and most importantly, although it is often overlooked, shared decision-making should take place with the patients, because their values in facing the risk of stroke versus bleeding often tip the balance one way or the other.

Q: How will the project help hospitals in this process?

Dr. Shah: We have written a QI Implementation Guide for hospitals with tools intended to improve the care of patients with AF in the hospital setting. This book will be similar to SHM’s VTE Prevention Implementation Guide, published a few years ago. We also will have an upcoming AF QI resource room within the SHM website. Additionally, similar to VTE, there are likely to be future mentored implementation projects where we will be working directly with hospitals and coaching them in this initiative.

Dr. Masica: We also have given a recent SHM-sponsored webinar that outlines some content of the guide. It can be accessed on the SHM website. This webinar reviews how to start a QI project in AF, assess your current state of care, build an interdisciplinary team, use validated tools, and deploy interventions to help make the stroke risk assessment and prophylaxis decision. I would note that the intended audience for these tools is broad and includes frontline hospitalists, QI directors, CMOs, and COOs, as well as nursing leadership, NPs, PAs, pharmacists, and other care providers.

Q: Does healthcare reform impact your efforts in this area?

Dr. Shah: Value-based purchasing, preventing readmissions, accountable care organizations, and bundled payments are all aspects of reform that will involve this therapeutic area, as their scope will impact the quality of care we deliver, how our cost structures are, and how we improve fragmentation of care across care transitions.

Dr. Masica: In addition, market forces, healthcare legislation, conceptual shifts regarding the need for systematic approaches to healthcare improvement, and new rules that may impact hospital reimbursement will continue to make AF an important healthcare quality issue. Thus, we think the discussion around delivering patient-centered care in AF is really just beginning.

Brendon Shank is SHM’s associate vice president of communications.

SHM asked leaders of the Hospital-Based Quality Improvement in Stroke Prevention for Patients with Atrial Fibrillation (AF) Project, Hiren Shah, MD, MBA, SFHM, and Andrew Masica, MD, SFHM, to provide an overview of the program.

“AF is a disease state that is highly prevalent, and the numbers are rising yearly. We also know that it is one of the most common inpatient diagnoses,” Dr. Shah says. “However, when you look at the quality of care provided to our AF patients, it is quite variable and has implications for other hospital performance metrics such as 30-day readmission rates. This makes AF a high-impact target for inpatient quality improvement initiatives.”

Dr. Shah is assistant professor of medicine at Northwestern University’s Feinberg School of Medicine and medical director at Northwestern Memorial Hospital in Chicago. Dr. Masica is vice president of clinical effectiveness at Baylor Health Care System in Dallas.

The implementation guide for SHM’s AF project will be available later in December at www.hospitalmedicine.org/afib.

Question: What is the scope of your project?

Dr. Masica

Dr. Masica: That is a question we wrestled with. Numerous care processes related to AF are amenable to inpatient quality improvement. We chose to focus our efforts on stroke prevention in AF and the development of a toolkit to help hospital-based practitioners to assess stroke and bleeding risk consistently and, if indicated, to initiate antithrombotic therapy.

Dr. Shah: Along those lines, we know that at least 25% of AF-related strokes are potentially preventable with adherence to evidence-based care; however, current data indicate that only 50% to 60% of patients with AF who are eligible to receive antithrombotic therapy are on active stroke prophylaxis.

Q: Why do you think there are such large gaps in stroke prophylaxis for AF patients?

Dr. Masica: The prophylaxis decision requires the clinician to do an anticoagulation net-benefit and risk assessment, and although there are validated tools to do this type of assessment, use of these tools hasn’t yet become hardwired into daily hospital practice. Empiric clinical assessments often overestimate the bleed risk and underestimate stroke risk, so the ultimate result can be underuse of antithrombotic therapy.

“Ideally, we would like to start anticoagulation during the hospital stay or on discharge, if indicated, but even if we clearly communicate a patient’s stroke and bleed risk to the PCP on discharge, we can help ensure that this issue will be addressed on outpatient follow-up.”

–Dr. Shah

Dr. Shah: Another barrier is that in many hospitals, there are not reminders in place in our workflow for this assessment to happen at all. Hospitalists may think that the anticoagulation decision is an outpatient issue, better addressed by their primary care doctor, so it is sometimes even intentionally bypassed. Another barrier is that it takes time to discuss a patient’s values and preferences in the anticoagulation decision.

Q: But isn’t stroke prevention in AF more of an outpatient issue?

Dr. Shah: We think the hospital is a great place to start this evaluation and to make the anticoagulation decision. Of course, we should discuss these issues with the primary care doctor. Ideally, we would like to start anticoagulation during the hospital stay or on discharge, if indicated, but even if we clearly communicate a patient’s stroke and bleed risk to the PCP on discharge, we can help ensure that this issue will be addressed on outpatient follow-up.

Q: What specific tools for stroke and bleed risk are you referring to?

Dr. Shah: The CHADS2 scoring system is a well-validated tool for estimating the risk of stroke in AF patients, one that most clinicians may be aware of. The CHA2DS2-VASc is a slightly more refined scoring system. When it comes to bleeding, however, fewer clinicians are aware of the HAS-BLED bleeding risk assessment method.

Dr. Masica: The scoring systems represent a consistent, reproducible approach by which to evaluate inpatients with AF. Of course, there is some discretion for other patient-specific factors (e.g. fall risk) that are not captured in the scoring systems, but they are good starting points in the decision-making process. Finally and most importantly, although it is often overlooked, shared decision-making should take place with the patients, because their values in facing the risk of stroke versus bleeding often tip the balance one way or the other.

Q: How will the project help hospitals in this process?

Dr. Shah: We have written a QI Implementation Guide for hospitals with tools intended to improve the care of patients with AF in the hospital setting. This book will be similar to SHM’s VTE Prevention Implementation Guide, published a few years ago. We also will have an upcoming AF QI resource room within the SHM website. Additionally, similar to VTE, there are likely to be future mentored implementation projects where we will be working directly with hospitals and coaching them in this initiative.

Dr. Masica: We also have given a recent SHM-sponsored webinar that outlines some content of the guide. It can be accessed on the SHM website. This webinar reviews how to start a QI project in AF, assess your current state of care, build an interdisciplinary team, use validated tools, and deploy interventions to help make the stroke risk assessment and prophylaxis decision. I would note that the intended audience for these tools is broad and includes frontline hospitalists, QI directors, CMOs, and COOs, as well as nursing leadership, NPs, PAs, pharmacists, and other care providers.

Q: Does healthcare reform impact your efforts in this area?

Dr. Shah: Value-based purchasing, preventing readmissions, accountable care organizations, and bundled payments are all aspects of reform that will involve this therapeutic area, as their scope will impact the quality of care we deliver, how our cost structures are, and how we improve fragmentation of care across care transitions.

Dr. Masica: In addition, market forces, healthcare legislation, conceptual shifts regarding the need for systematic approaches to healthcare improvement, and new rules that may impact hospital reimbursement will continue to make AF an important healthcare quality issue. Thus, we think the discussion around delivering patient-centered care in AF is really just beginning.

Brendon Shank is SHM’s associate vice president of communications.

President Obama has nominated 37-year-old Boston hospitalist Vivek Murthy, MD, MBA, as surgeon general of the United States. Dr. Murthy has worked since 2006 as a hospitalist and assistant professor of medicine at Harvard Medical School and Brigham and Women’s Hospital in Boston. He is co-founder and president of Doctors for America, a Washington, D.C.-based group of 16,000 physicians and medical students that advocates for access to affordable, high quality health care and has been a strong supporter of the Affordable Care Act.

If confirmed by the U.S. Senate, Dr. Murthy would replace acting surgeon general Boris Lushniak. The surgeon general serves a four-year term. “We share a belief that access to quality health care is a basic human right,” Brigham president Dr. Betsy Nabel said in a statement about Dr. Murthy. “I am confident that he will be a passionate advocate and that he will have an extraordinary impact as our nation’s surgeon general.”

Dr. Murthy studied at Harvard, received his medical degree at Yale School of Medicine, and earned an MBA from Yale School of Management. In 2011, he was appointed to serve as a member of the Advisory Group on Prevention, Health Promotion, and Integrative and Public Health. He was co-founder and is chairman of the board of TrialNetworks, formerly known as Epernicus, since 2007. He co-founded VISIONS Worldwide in 1995, a non-profit organization focused on HIV/AIDS education in India and the United States, where he served as president from 1995 to 2000 and chairman of the board from 2000 to 2003.

Daniel Virnich, MD, MBA, has been named TeamHealth Hospital Medicine’s new chief medical officer. Dr. Virnich previously served as the company’s western region medical director. He currently serves on SHM’s Practice Management Committee and SHM’s Patient Experience Task Force. TeamHealth, based in Knoxville, Tenn., provides private hospitalist services in 47 states.

Dean Dalili, MD, FHM, is the new vice president of medical affairs at Hollywood, Fla.-based Hospital Physician Partners (HPP), a private hospitalist management company with services in more than 20 states. Dr. Dalili previously served as HPP medical director and regional medical director. He was recognized in 2012 and this year as one of HPP’s outstanding medical directors in the hospital medicine division for his operational and leadership excellence.

David Roe is the new executive director of IPC The Hospitalist Company’s Northeast Tenn./Southwest Virginia region, where he will oversee operations at both acute and post-acute care facilities throughout the region. Roe previously served as executive director of THS Physician Partners, a multi-specialty physician group based in Charleston, W.Va.

Robert Mickelsen, MD, has been appointed system medical director for Lovelace Hospitalist Services in Albuquerque, N.M. The programs at Lovelace’s three hospital facilities are all managed by Hospital Physician Partners (HPP), and Dr. Mickelsen will be charged with overseeing operations at all three hospitals. Dr. Mickelsen comes to his new role from Gerald Champion Regional Medical Center in Alamogordo, N.M., where he served as hospitalist medical director.

Francisco Loya, MD, MSc, has been named chief medical officer for EmCare Hospital Medicine. Dr. Loya earned his medical degree at the University of Texas Southwestern Medical School in Dallas and completed his internal medicine residency at Brigham and Women’s Hospital in Boston. He earned his master of science degree in healthcare management from Harvard School of Public Health in Boston. After earning his master’s degree, Dr. Loya created a software tool (CMORx) that uses deductive algorithms to fill the gaps in medical records, which he will bring with him to EmCare. Based in Dallas, EmCare provides hospitalist and other services to more than 500 hospitals nationwide.

Business Moves

ECI Healthcare Partners, based in Traverse City, Mich., will now provide hospitalist services to O’Bleness Memorial Hospital in Athens, Ohio. O’Bleness Memorial has been serving the neighborhoods in and around Athens since 1921. ECI Healthcare Partners provides hospitalist and emergency medicine services to hospitals in more than 30 states.

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

President Obama has nominated 37-year-old Boston hospitalist Vivek Murthy, MD, MBA, as surgeon general of the United States. Dr. Murthy has worked since 2006 as a hospitalist and assistant professor of medicine at Harvard Medical School and Brigham and Women’s Hospital in Boston. He is co-founder and president of Doctors for America, a Washington, D.C.-based group of 16,000 physicians and medical students that advocates for access to affordable, high quality health care and has been a strong supporter of the Affordable Care Act.

If confirmed by the U.S. Senate, Dr. Murthy would replace acting surgeon general Boris Lushniak. The surgeon general serves a four-year term. “We share a belief that access to quality health care is a basic human right,” Brigham president Dr. Betsy Nabel said in a statement about Dr. Murthy. “I am confident that he will be a passionate advocate and that he will have an extraordinary impact as our nation’s surgeon general.”

Dr. Murthy studied at Harvard, received his medical degree at Yale School of Medicine, and earned an MBA from Yale School of Management. In 2011, he was appointed to serve as a member of the Advisory Group on Prevention, Health Promotion, and Integrative and Public Health. He was co-founder and is chairman of the board of TrialNetworks, formerly known as Epernicus, since 2007. He co-founded VISIONS Worldwide in 1995, a non-profit organization focused on HIV/AIDS education in India and the United States, where he served as president from 1995 to 2000 and chairman of the board from 2000 to 2003.

Daniel Virnich, MD, MBA, has been named TeamHealth Hospital Medicine’s new chief medical officer. Dr. Virnich previously served as the company’s western region medical director. He currently serves on SHM’s Practice Management Committee and SHM’s Patient Experience Task Force. TeamHealth, based in Knoxville, Tenn., provides private hospitalist services in 47 states.

Dean Dalili, MD, FHM, is the new vice president of medical affairs at Hollywood, Fla.-based Hospital Physician Partners (HPP), a private hospitalist management company with services in more than 20 states. Dr. Dalili previously served as HPP medical director and regional medical director. He was recognized in 2012 and this year as one of HPP’s outstanding medical directors in the hospital medicine division for his operational and leadership excellence.

David Roe is the new executive director of IPC The Hospitalist Company’s Northeast Tenn./Southwest Virginia region, where he will oversee operations at both acute and post-acute care facilities throughout the region. Roe previously served as executive director of THS Physician Partners, a multi-specialty physician group based in Charleston, W.Va.

Robert Mickelsen, MD, has been appointed system medical director for Lovelace Hospitalist Services in Albuquerque, N.M. The programs at Lovelace’s three hospital facilities are all managed by Hospital Physician Partners (HPP), and Dr. Mickelsen will be charged with overseeing operations at all three hospitals. Dr. Mickelsen comes to his new role from Gerald Champion Regional Medical Center in Alamogordo, N.M., where he served as hospitalist medical director.

Francisco Loya, MD, MSc, has been named chief medical officer for EmCare Hospital Medicine. Dr. Loya earned his medical degree at the University of Texas Southwestern Medical School in Dallas and completed his internal medicine residency at Brigham and Women’s Hospital in Boston. He earned his master of science degree in healthcare management from Harvard School of Public Health in Boston. After earning his master’s degree, Dr. Loya created a software tool (CMORx) that uses deductive algorithms to fill the gaps in medical records, which he will bring with him to EmCare. Based in Dallas, EmCare provides hospitalist and other services to more than 500 hospitals nationwide.

Business Moves

ECI Healthcare Partners, based in Traverse City, Mich., will now provide hospitalist services to O’Bleness Memorial Hospital in Athens, Ohio. O’Bleness Memorial has been serving the neighborhoods in and around Athens since 1921. ECI Healthcare Partners provides hospitalist and emergency medicine services to hospitals in more than 30 states.

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

President Obama has nominated 37-year-old Boston hospitalist Vivek Murthy, MD, MBA, as surgeon general of the United States. Dr. Murthy has worked since 2006 as a hospitalist and assistant professor of medicine at Harvard Medical School and Brigham and Women’s Hospital in Boston. He is co-founder and president of Doctors for America, a Washington, D.C.-based group of 16,000 physicians and medical students that advocates for access to affordable, high quality health care and has been a strong supporter of the Affordable Care Act.

If confirmed by the U.S. Senate, Dr. Murthy would replace acting surgeon general Boris Lushniak. The surgeon general serves a four-year term. “We share a belief that access to quality health care is a basic human right,” Brigham president Dr. Betsy Nabel said in a statement about Dr. Murthy. “I am confident that he will be a passionate advocate and that he will have an extraordinary impact as our nation’s surgeon general.”

Dr. Murthy studied at Harvard, received his medical degree at Yale School of Medicine, and earned an MBA from Yale School of Management. In 2011, he was appointed to serve as a member of the Advisory Group on Prevention, Health Promotion, and Integrative and Public Health. He was co-founder and is chairman of the board of TrialNetworks, formerly known as Epernicus, since 2007. He co-founded VISIONS Worldwide in 1995, a non-profit organization focused on HIV/AIDS education in India and the United States, where he served as president from 1995 to 2000 and chairman of the board from 2000 to 2003.

Daniel Virnich, MD, MBA, has been named TeamHealth Hospital Medicine’s new chief medical officer. Dr. Virnich previously served as the company’s western region medical director. He currently serves on SHM’s Practice Management Committee and SHM’s Patient Experience Task Force. TeamHealth, based in Knoxville, Tenn., provides private hospitalist services in 47 states.

Dean Dalili, MD, FHM, is the new vice president of medical affairs at Hollywood, Fla.-based Hospital Physician Partners (HPP), a private hospitalist management company with services in more than 20 states. Dr. Dalili previously served as HPP medical director and regional medical director. He was recognized in 2012 and this year as one of HPP’s outstanding medical directors in the hospital medicine division for his operational and leadership excellence.

David Roe is the new executive director of IPC The Hospitalist Company’s Northeast Tenn./Southwest Virginia region, where he will oversee operations at both acute and post-acute care facilities throughout the region. Roe previously served as executive director of THS Physician Partners, a multi-specialty physician group based in Charleston, W.Va.

Robert Mickelsen, MD, has been appointed system medical director for Lovelace Hospitalist Services in Albuquerque, N.M. The programs at Lovelace’s three hospital facilities are all managed by Hospital Physician Partners (HPP), and Dr. Mickelsen will be charged with overseeing operations at all three hospitals. Dr. Mickelsen comes to his new role from Gerald Champion Regional Medical Center in Alamogordo, N.M., where he served as hospitalist medical director.

Francisco Loya, MD, MSc, has been named chief medical officer for EmCare Hospital Medicine. Dr. Loya earned his medical degree at the University of Texas Southwestern Medical School in Dallas and completed his internal medicine residency at Brigham and Women’s Hospital in Boston. He earned his master of science degree in healthcare management from Harvard School of Public Health in Boston. After earning his master’s degree, Dr. Loya created a software tool (CMORx) that uses deductive algorithms to fill the gaps in medical records, which he will bring with him to EmCare. Based in Dallas, EmCare provides hospitalist and other services to more than 500 hospitals nationwide.

Business Moves

ECI Healthcare Partners, based in Traverse City, Mich., will now provide hospitalist services to O’Bleness Memorial Hospital in Athens, Ohio. O’Bleness Memorial has been serving the neighborhoods in and around Athens since 1921. ECI Healthcare Partners provides hospitalist and emergency medicine services to hospitals in more than 30 states.

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

Dr. Bekanich

Dr. Bekanich

After nine years in practice as a hospitalist in community and academic settings, Leonard Noronha, MD, applied for and in July 2012 became the inaugural, full-year, full-time fellow in hospice and palliative medicine (HPM) at the University of New Mexico in Albuquerque, one of approximately 200 such positions nationwide. The fellowship training qualifies him to sit for HPM subspecialty medical board certification.

Dr. Noronha says he was casually acquainted with the concept of palliative care from residency but didn’t know “when to ask for a palliative care consultation or what they offered.”

“I also had a sense that discussions about feeding tubes, for example, could happen better and easier than they typically did,” he says.

His interest piqued as he learned more about palliative care at hospitalist meetings.

“I grew more excited about it and came to realize that it is something I’d find rewarding and enjoyable, if I could get good at it,” Dr. Noronha says. “Over time, I found more satisfaction in palliative care encounters with patients—and became less comfortable with what I perceived as occasionally inappropriate and excessive testing and treatment [for some hospitalized patients who weren’t offered palliative care].”

Palliative care is a medical specialty that focuses on comfort, relief of symptoms, and clarifying patients’ treatment goals. It is commonly provided as an interdisciplinary consultation service in hospitals. Advocates say it can be offered concurrently with other medical therapies for any seriously ill patient, particularly when there are physical, psychosocial, or spiritual complications, and it is not limited to patients approaching death.

Experienced clinicians say palliative care maximizes quality of life and empowers patients and their families to make treatment decisions more in line with their hopes and values. They also say palliative care gives an emotional lift to providers, while reducing hospital expenditures. Some also suggest that palliative care is an additional tool for enhancing care transitions, potentially affecting readmission rates.

For Dr. Noronha, the one-year fellowship required a significant cut in pay, but he was prepared for the financial hardship.

“It was a great decision for me,” he says. “Some of my colleagues had encouraged me to think about using the experiential pathway to HPM board certification, but I knew I’d do better in the structured environment of a fellowship.

“There have been times when I’ve been outside of my comfort zone, sometimes feeling like the least experienced person in the room. But I knew the fellowship would help—and it did.”

He says the training gives him a better appreciation for things like illness trajectories, the nuances of goal clarification, and the benefit of an extra set of eyes and ears to assess the patient.

After completing his fellowship, Dr. Noronha became UNM’s second full-time palliative medicine faculty. He encourages hospitalists to talk to the palliative care service at their institutions and request consultations for complex, seriously ill patients who might benefit.

As for his new career path, he says that often he is asked if palliative care is depressing. “Some of these situations can be tragic, but I find the work very rewarding,” he says.

Service Models

In some settings, palliative care is incorporated into the hospitalist service. Hospitalists are scheduled for palliative care shifts or have palliative care visits incorporated into daily rounds. Such blended positions could be a recruiting incentive for some physicians who want to do both.

In other settings, palliative care is a separate service. Consultations are ordered as needed by hospitalists and other physicians.

Advocates like Marianne Novelli, MD, FHM, FACP, say hospitalists play a pivotal role in providing the basics of palliative care for seriously ill, hospitalized patients.

“Palliative care is part and parcel of what we do as hospitalists with the people we serve—who by definition are very sick, even to get into the hospital,” says Dr. Novelli, formerly the chief of the division of hospital medicine at Kaiser Permanente in Denver, Colo. She rotated off that leadership position in 2011 and has since divided her time between hospital medicine and palliative care shifts in the hospital, although she now does palliative care exclusively.

Initially, she watched palliative care consults and asked for mentorship from the palliative care team. Although it took time to get used to the advisory role of the consultant, and to working with a team, she eventually became board certified in HPM.

“Palliative care is incredibly intense but richly rewarding work,” she says. “The patients you see are never simple. It allows us to practice the type of medicine we originally set out to do, with people at the most vulnerable times in their lives.”

Workforce, Fellowship, Board Certification

In October 2012, 3,356 physicians passed the hospice and palliative medicine subspecialty board exams offered by the American Board of Medical Specialties and 10 of its constituent specialty boards, with the lion’s share of them certified by the American Board of Internal Medicine. That more than doubled the number of physicians earning the HPM credential since its inception in 2008.

Even with the surge in palliative care training, workforce studies suggest the U.S. is woefully short of credentialed palliative care physicians. And many think hospitalists can help fill that void.

The Center to Advance Palliative Care (CAPC, www.capc.org) counts 1,400 hospital-based palliative care programs in the U.S., while the Centers for Medicare & Medicaid Services (CMS) recognizes about 3,500 Medicare-certified hospice programs. A 2010 estimate by Dale Lupu and the American Academy of Hospice and Palliative Medicine (AAHPM), however, suggested a need for between 4,487 and 10,810 palliative care physician FTEs just to staff existing programs at appropriate levels—without considering growth for the field or its spread into outpatient settings.¹

In the past, mid-career physicians had an experiential pathway to the HPM board exam, based on hours worked with a hospice or palliative care team, but physicians now must complete an HPM fellowship of at least one year in order to sit for the boards. And, according to AAHPM, only 234 HPM fellowship positions are offered nationwide by 85 approved fellowship programs.

Dr. Bekanich

A one-year fellowship is a big commitment for an established hospitalist, according to Stephen Bekanich, MD, co-director of Seton Palliative Care at Seton Healthcare, an 11-hospital system in Austin, Texas. A former hospitalist, Dr. Bekanich says that in his region a fellow stipend is about $70,000, whereas typical hospitalist compensation is in the mid- to upper-$200,000s.

AAHPM is exploring other approaches to expanding the workforce with mid-career physicians. One approach, authored by Timothy Quill, MD, and Amy Abernethy, MD, the past and current AAHPM board presidents, is to develop a two-tiered system in which palliative medicine specialists teach basic palliative care techniques and approaches to primary care physicians, hospitalists, and such specialists as oncologists.² The article also suggested equipping clinicians with the tools to recognize when more specialized help is needed.

“As in any medical discipline, some core elements of palliative care, such as aligning treatment with a patient’s goals and basic symptom management, should be routine aspects of care delivered by any practitioner,” Drs. Quill and Abernethy wrote. “Other skills are more complex and take years of training to learn and apply, such as negotiating a difficult family meeting, addressing veiled existential distress, and managing refractory symptoms.”

Dr. Bekanich is trying the two-tiered approach at Seton Healthcare. At facilities with no palliative care service, he is transplanting palliative-trained nurse practitioners in hospital medicine groups.

“This model is locked into our budget for fiscal year 2014,” Dr. Bekanich says. “We’ll train folks, starting with hospitalists and primary care physicians.”

The training will start with a pair of three-hour sessions on palliative care techniques for hospitalists and PCPs, followed by homework assignments. “Then we’ll meet again in three months to do some role plays,” he says.

Two final rounds of training will focus on skills, philosophy, values, and practice.

Palliative care is incredibly intense but richly rewarding work. The patients you see are never simple. It allows us to practice the type of medicine we originally set out to do, with people at the most vulnerable times in their lives.

—Marianne Novelli, MD, FHM, FACP, former chief of the division of hospital medicine, Kaiser Permanente, Denver, Colo.

On-the-Job Training

David Weissman, MD, FACP, a palliative care specialist in Milwaukee, Wis., and consultant to the CAPC, recommends hospitalists do what they can to improve their knowledge and skills. “There are a lot of opportunities for palliative care training out there,” he says.

HM conferences often include palliative care content. AAHPM and CAPC offer annual conferences that immerse participants in content, with opportunities to mingle with palliative care colleagues. AAHPM also offers specific content through its “Unipac” series of nine self-study training modules (www.aahpm.org/resources/default/unipac-4th-edition.html.)

Dr. Weissman

On the job, Dr. Weissman says hospitalists should ask for consults for patients with complex needs. Also pay attention to how the service works and what it recommends. Taking a couple of days to round with the palliative care service could be very educational. It may be possible to take a part-time position with the team, providing weekend or vacation coverage. Hospitalists can participate on planning or advisory committees for palliative care in their hospitals or on quality improvement projects.

“If there isn’t a palliative care service, advocate for developing one,” he says.

Local hospice programs, especially those with inpatient hospice facilities that need daily physician coverage, might have part-time staff positions, which could be a great moonlighting opportunity for hospitalists and a way to learn a lot very quickly.

“I can tell the difference between physicians who have spent time working in a hospice, where you can learn about caring for people at the end of life because most of the patients are so sick, and those who have not,” says Porter Storey, MD, FACP, AAHPM’s executive vice president and a practicing palliative care physician in Colorado. “You can learn how to use the medications to get someone comfortable quickly and how to talk to families in crisis. It can be some of the most rewarding work you can possibly do—especially when you have the time and training to do it well for some of the most challenging of patients and families.”

Dr. Storey recommends that hospitalists join AAHPM, use its professional materials, attend its annual meetings, and, if they feel a calling, consider fellowship training as the next big step.

“Palliative care programs are growing in number and size but are chronically understaffed,” says Steven Pantilat, MD, SFHM, hospitalist and director of the Palliative Care Program at the University of California at San Francisco. “This creates a great opportunity for hospitalists. I have heard of places that were having trouble recruiting palliative care physicians but were willing to sponsor a hospitalist to go and do a fellowship, supplementing their salary as an incentive—and a reasonable one—for a hospitalist interested in making a career move.”

He says that palliative care, like hospital medicine, has been a significant value-add in many hospitals and health systems. More importantly, it correlates to positive patient outcomes (see “Research Highlights Palliative Care Contributions,”).

Dr. Pantilat

“What’s new is how it connects to current issues like improved care transitions and readmissions reduction,” Dr. Pantilat says.

Advocates say palliative care helps to match medical services to patient preferences, thereby improving patient satisfaction scores, especially for those who aren’t likely to achieve good outcomes. Dr. Pantilat says it puts plans in place for patients to get the right services for the post-discharge period and for responding to anticipated problems like chest pain.

“It’s not just how to get patients out of the hospital as quickly as possible,” he says, “but to do that with a plan that sets them up to succeed at home.”

Larry Beresford is a freelance writer in San Francisco.

References

1. Lupu D. American Academy of Hospice and Palliative Medicine Workforce Task Force. Estimate of current hospice and palliative medicine physician workforce shortage. J Pain Symptom Manage. 2010;40(6):899-911.
2. Quill TE, Abernethy AP. Generalist plus specialist palliative care—creating a more sustainable model. N Engl J Med. 2013;368(13):1173-1175.
3. Morrison RS, Penrod JD, Cassel JB, et al. Palliative Care Leadership Centers' Outcomes Group. Cost savings associated with US hospital palliative care consultation programs. Arch Intern Med. 2008;168(16):1783-1790.
4. Penrod JD, Deb P, Dellenbaugh C, et al. Hospital-based palliative care consultation: effects on hospital cost. J Palliat Med. 2010;13(8):973-979.
5. Gelfman LP, Meier DE, Morrison RS. Does palliative care improve quality? A survey of bereaved family members. J Pain Symptom Manage. 2008;36(1):22-28.
6. Temel JS, Greer JA, Muzikansky A, et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med. 2010;363(8):733-742.
7. Irwin KE, Greer JA, Khatib J, Temel JS, Pirl WF. Early palliative care and metastatic non-small cell lung cancer: potential mechanisms of prolonged survival. Chron Respir Dis. 2013;10(1):35-47.
8. Von Roenn JN, Temel J. The integration of palliative care and oncology: the evidence. Oncology. 2011;25(13):1258-1260,1262,1264-1265.
9. Yoong J, Park ER, Greer JA, etc. Early palliative care in advanced lung cancer: a qualitative study. JAMA Intern Med. 2013;173(4):283-290.
10. Enguidanos S, Vesper E, Lorenz K. 30-day readmissions among seriously ill older adults. J Palliat Med. 2012;15(12):1356-1361.
11. Eti S, O’Mahony S, McHugh M, Guilbe R, Blank A, Selwyn P. Outcomes of the acute palliative care unit in an academic medical center [published online ahead of print May 10, 2013]. Am J Hosp Palliat Care. PMID: 23666616.
12. Smith AK, Thai JN, Bakitas MA, et al. The diverse landscape of palliative care clinics. J Palliat Med. 2013;16(6):661-668.

Dr. Bekanich

Dr. Bekanich

After nine years in practice as a hospitalist in community and academic settings, Leonard Noronha, MD, applied for and in July 2012 became the inaugural, full-year, full-time fellow in hospice and palliative medicine (HPM) at the University of New Mexico in Albuquerque, one of approximately 200 such positions nationwide. The fellowship training qualifies him to sit for HPM subspecialty medical board certification.

Dr. Noronha says he was casually acquainted with the concept of palliative care from residency but didn’t know “when to ask for a palliative care consultation or what they offered.”

“I also had a sense that discussions about feeding tubes, for example, could happen better and easier than they typically did,” he says.

His interest piqued as he learned more about palliative care at hospitalist meetings.

“I grew more excited about it and came to realize that it is something I’d find rewarding and enjoyable, if I could get good at it,” Dr. Noronha says. “Over time, I found more satisfaction in palliative care encounters with patients—and became less comfortable with what I perceived as occasionally inappropriate and excessive testing and treatment [for some hospitalized patients who weren’t offered palliative care].”

Palliative care is a medical specialty that focuses on comfort, relief of symptoms, and clarifying patients’ treatment goals. It is commonly provided as an interdisciplinary consultation service in hospitals. Advocates say it can be offered concurrently with other medical therapies for any seriously ill patient, particularly when there are physical, psychosocial, or spiritual complications, and it is not limited to patients approaching death.

Experienced clinicians say palliative care maximizes quality of life and empowers patients and their families to make treatment decisions more in line with their hopes and values. They also say palliative care gives an emotional lift to providers, while reducing hospital expenditures. Some also suggest that palliative care is an additional tool for enhancing care transitions, potentially affecting readmission rates.

For Dr. Noronha, the one-year fellowship required a significant cut in pay, but he was prepared for the financial hardship.

“It was a great decision for me,” he says. “Some of my colleagues had encouraged me to think about using the experiential pathway to HPM board certification, but I knew I’d do better in the structured environment of a fellowship.

“There have been times when I’ve been outside of my comfort zone, sometimes feeling like the least experienced person in the room. But I knew the fellowship would help—and it did.”

He says the training gives him a better appreciation for things like illness trajectories, the nuances of goal clarification, and the benefit of an extra set of eyes and ears to assess the patient.

After completing his fellowship, Dr. Noronha became UNM’s second full-time palliative medicine faculty. He encourages hospitalists to talk to the palliative care service at their institutions and request consultations for complex, seriously ill patients who might benefit.

As for his new career path, he says that often he is asked if palliative care is depressing. “Some of these situations can be tragic, but I find the work very rewarding,” he says.

Service Models

In some settings, palliative care is incorporated into the hospitalist service. Hospitalists are scheduled for palliative care shifts or have palliative care visits incorporated into daily rounds. Such blended positions could be a recruiting incentive for some physicians who want to do both.

In other settings, palliative care is a separate service. Consultations are ordered as needed by hospitalists and other physicians.

Advocates like Marianne Novelli, MD, FHM, FACP, say hospitalists play a pivotal role in providing the basics of palliative care for seriously ill, hospitalized patients.

“Palliative care is part and parcel of what we do as hospitalists with the people we serve—who by definition are very sick, even to get into the hospital,” says Dr. Novelli, formerly the chief of the division of hospital medicine at Kaiser Permanente in Denver, Colo. She rotated off that leadership position in 2011 and has since divided her time between hospital medicine and palliative care shifts in the hospital, although she now does palliative care exclusively.

Initially, she watched palliative care consults and asked for mentorship from the palliative care team. Although it took time to get used to the advisory role of the consultant, and to working with a team, she eventually became board certified in HPM.

“Palliative care is incredibly intense but richly rewarding work,” she says. “The patients you see are never simple. It allows us to practice the type of medicine we originally set out to do, with people at the most vulnerable times in their lives.”

Workforce, Fellowship, Board Certification

In October 2012, 3,356 physicians passed the hospice and palliative medicine subspecialty board exams offered by the American Board of Medical Specialties and 10 of its constituent specialty boards, with the lion’s share of them certified by the American Board of Internal Medicine. That more than doubled the number of physicians earning the HPM credential since its inception in 2008.

Even with the surge in palliative care training, workforce studies suggest the U.S. is woefully short of credentialed palliative care physicians. And many think hospitalists can help fill that void.

The Center to Advance Palliative Care (CAPC, www.capc.org) counts 1,400 hospital-based palliative care programs in the U.S., while the Centers for Medicare & Medicaid Services (CMS) recognizes about 3,500 Medicare-certified hospice programs. A 2010 estimate by Dale Lupu and the American Academy of Hospice and Palliative Medicine (AAHPM), however, suggested a need for between 4,487 and 10,810 palliative care physician FTEs just to staff existing programs at appropriate levels—without considering growth for the field or its spread into outpatient settings.¹

In the past, mid-career physicians had an experiential pathway to the HPM board exam, based on hours worked with a hospice or palliative care team, but physicians now must complete an HPM fellowship of at least one year in order to sit for the boards. And, according to AAHPM, only 234 HPM fellowship positions are offered nationwide by 85 approved fellowship programs.

Dr. Bekanich

A one-year fellowship is a big commitment for an established hospitalist, according to Stephen Bekanich, MD, co-director of Seton Palliative Care at Seton Healthcare, an 11-hospital system in Austin, Texas. A former hospitalist, Dr. Bekanich says that in his region a fellow stipend is about $70,000, whereas typical hospitalist compensation is in the mid- to upper-$200,000s.

AAHPM is exploring other approaches to expanding the workforce with mid-career physicians. One approach, authored by Timothy Quill, MD, and Amy Abernethy, MD, the past and current AAHPM board presidents, is to develop a two-tiered system in which palliative medicine specialists teach basic palliative care techniques and approaches to primary care physicians, hospitalists, and such specialists as oncologists.² The article also suggested equipping clinicians with the tools to recognize when more specialized help is needed.

“As in any medical discipline, some core elements of palliative care, such as aligning treatment with a patient’s goals and basic symptom management, should be routine aspects of care delivered by any practitioner,” Drs. Quill and Abernethy wrote. “Other skills are more complex and take years of training to learn and apply, such as negotiating a difficult family meeting, addressing veiled existential distress, and managing refractory symptoms.”

Dr. Bekanich is trying the two-tiered approach at Seton Healthcare. At facilities with no palliative care service, he is transplanting palliative-trained nurse practitioners in hospital medicine groups.

“This model is locked into our budget for fiscal year 2014,” Dr. Bekanich says. “We’ll train folks, starting with hospitalists and primary care physicians.”

The training will start with a pair of three-hour sessions on palliative care techniques for hospitalists and PCPs, followed by homework assignments. “Then we’ll meet again in three months to do some role plays,” he says.

Two final rounds of training will focus on skills, philosophy, values, and practice.

Palliative care is incredibly intense but richly rewarding work. The patients you see are never simple. It allows us to practice the type of medicine we originally set out to do, with people at the most vulnerable times in their lives.

—Marianne Novelli, MD, FHM, FACP, former chief of the division of hospital medicine, Kaiser Permanente, Denver, Colo.

On-the-Job Training

David Weissman, MD, FACP, a palliative care specialist in Milwaukee, Wis., and consultant to the CAPC, recommends hospitalists do what they can to improve their knowledge and skills. “There are a lot of opportunities for palliative care training out there,” he says.

HM conferences often include palliative care content. AAHPM and CAPC offer annual conferences that immerse participants in content, with opportunities to mingle with palliative care colleagues. AAHPM also offers specific content through its “Unipac” series of nine self-study training modules (www.aahpm.org/resources/default/unipac-4th-edition.html.)

Dr. Weissman

On the job, Dr. Weissman says hospitalists should ask for consults for patients with complex needs. Also pay attention to how the service works and what it recommends. Taking a couple of days to round with the palliative care service could be very educational. It may be possible to take a part-time position with the team, providing weekend or vacation coverage. Hospitalists can participate on planning or advisory committees for palliative care in their hospitals or on quality improvement projects.

“If there isn’t a palliative care service, advocate for developing one,” he says.

Local hospice programs, especially those with inpatient hospice facilities that need daily physician coverage, might have part-time staff positions, which could be a great moonlighting opportunity for hospitalists and a way to learn a lot very quickly.

“I can tell the difference between physicians who have spent time working in a hospice, where you can learn about caring for people at the end of life because most of the patients are so sick, and those who have not,” says Porter Storey, MD, FACP, AAHPM’s executive vice president and a practicing palliative care physician in Colorado. “You can learn how to use the medications to get someone comfortable quickly and how to talk to families in crisis. It can be some of the most rewarding work you can possibly do—especially when you have the time and training to do it well for some of the most challenging of patients and families.”

Dr. Storey recommends that hospitalists join AAHPM, use its professional materials, attend its annual meetings, and, if they feel a calling, consider fellowship training as the next big step.

“Palliative care programs are growing in number and size but are chronically understaffed,” says Steven Pantilat, MD, SFHM, hospitalist and director of the Palliative Care Program at the University of California at San Francisco. “This creates a great opportunity for hospitalists. I have heard of places that were having trouble recruiting palliative care physicians but were willing to sponsor a hospitalist to go and do a fellowship, supplementing their salary as an incentive—and a reasonable one—for a hospitalist interested in making a career move.”

He says that palliative care, like hospital medicine, has been a significant value-add in many hospitals and health systems. More importantly, it correlates to positive patient outcomes (see “Research Highlights Palliative Care Contributions,”).

Dr. Pantilat

“What’s new is how it connects to current issues like improved care transitions and readmissions reduction,” Dr. Pantilat says.

Advocates say palliative care helps to match medical services to patient preferences, thereby improving patient satisfaction scores, especially for those who aren’t likely to achieve good outcomes. Dr. Pantilat says it puts plans in place for patients to get the right services for the post-discharge period and for responding to anticipated problems like chest pain.

“It’s not just how to get patients out of the hospital as quickly as possible,” he says, “but to do that with a plan that sets them up to succeed at home.”

Larry Beresford is a freelance writer in San Francisco.

References

1. Lupu D. American Academy of Hospice and Palliative Medicine Workforce Task Force. Estimate of current hospice and palliative medicine physician workforce shortage. J Pain Symptom Manage. 2010;40(6):899-911.
2. Quill TE, Abernethy AP. Generalist plus specialist palliative care—creating a more sustainable model. N Engl J Med. 2013;368(13):1173-1175.
3. Morrison RS, Penrod JD, Cassel JB, et al. Palliative Care Leadership Centers' Outcomes Group. Cost savings associated with US hospital palliative care consultation programs. Arch Intern Med. 2008;168(16):1783-1790.
4. Penrod JD, Deb P, Dellenbaugh C, et al. Hospital-based palliative care consultation: effects on hospital cost. J Palliat Med. 2010;13(8):973-979.
5. Gelfman LP, Meier DE, Morrison RS. Does palliative care improve quality? A survey of bereaved family members. J Pain Symptom Manage. 2008;36(1):22-28.
6. Temel JS, Greer JA, Muzikansky A, et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med. 2010;363(8):733-742.
7. Irwin KE, Greer JA, Khatib J, Temel JS, Pirl WF. Early palliative care and metastatic non-small cell lung cancer: potential mechanisms of prolonged survival. Chron Respir Dis. 2013;10(1):35-47.
8. Von Roenn JN, Temel J. The integration of palliative care and oncology: the evidence. Oncology. 2011;25(13):1258-1260,1262,1264-1265.
9. Yoong J, Park ER, Greer JA, etc. Early palliative care in advanced lung cancer: a qualitative study. JAMA Intern Med. 2013;173(4):283-290.
10. Enguidanos S, Vesper E, Lorenz K. 30-day readmissions among seriously ill older adults. J Palliat Med. 2012;15(12):1356-1361.
11. Eti S, O’Mahony S, McHugh M, Guilbe R, Blank A, Selwyn P. Outcomes of the acute palliative care unit in an academic medical center [published online ahead of print May 10, 2013]. Am J Hosp Palliat Care. PMID: 23666616.
12. Smith AK, Thai JN, Bakitas MA, et al. The diverse landscape of palliative care clinics. J Palliat Med. 2013;16(6):661-668.

Dr. Bekanich

Dr. Bekanich

After nine years in practice as a hospitalist in community and academic settings, Leonard Noronha, MD, applied for and in July 2012 became the inaugural, full-year, full-time fellow in hospice and palliative medicine (HPM) at the University of New Mexico in Albuquerque, one of approximately 200 such positions nationwide. The fellowship training qualifies him to sit for HPM subspecialty medical board certification.

Dr. Noronha says he was casually acquainted with the concept of palliative care from residency but didn’t know “when to ask for a palliative care consultation or what they offered.”

“I also had a sense that discussions about feeding tubes, for example, could happen better and easier than they typically did,” he says.

His interest piqued as he learned more about palliative care at hospitalist meetings.

“I grew more excited about it and came to realize that it is something I’d find rewarding and enjoyable, if I could get good at it,” Dr. Noronha says. “Over time, I found more satisfaction in palliative care encounters with patients—and became less comfortable with what I perceived as occasionally inappropriate and excessive testing and treatment [for some hospitalized patients who weren’t offered palliative care].”

Palliative care is a medical specialty that focuses on comfort, relief of symptoms, and clarifying patients’ treatment goals. It is commonly provided as an interdisciplinary consultation service in hospitals. Advocates say it can be offered concurrently with other medical therapies for any seriously ill patient, particularly when there are physical, psychosocial, or spiritual complications, and it is not limited to patients approaching death.

Experienced clinicians say palliative care maximizes quality of life and empowers patients and their families to make treatment decisions more in line with their hopes and values. They also say palliative care gives an emotional lift to providers, while reducing hospital expenditures. Some also suggest that palliative care is an additional tool for enhancing care transitions, potentially affecting readmission rates.

For Dr. Noronha, the one-year fellowship required a significant cut in pay, but he was prepared for the financial hardship.

“It was a great decision for me,” he says. “Some of my colleagues had encouraged me to think about using the experiential pathway to HPM board certification, but I knew I’d do better in the structured environment of a fellowship.

“There have been times when I’ve been outside of my comfort zone, sometimes feeling like the least experienced person in the room. But I knew the fellowship would help—and it did.”

He says the training gives him a better appreciation for things like illness trajectories, the nuances of goal clarification, and the benefit of an extra set of eyes and ears to assess the patient.

After completing his fellowship, Dr. Noronha became UNM’s second full-time palliative medicine faculty. He encourages hospitalists to talk to the palliative care service at their institutions and request consultations for complex, seriously ill patients who might benefit.

As for his new career path, he says that often he is asked if palliative care is depressing. “Some of these situations can be tragic, but I find the work very rewarding,” he says.

Service Models

In some settings, palliative care is incorporated into the hospitalist service. Hospitalists are scheduled for palliative care shifts or have palliative care visits incorporated into daily rounds. Such blended positions could be a recruiting incentive for some physicians who want to do both.

In other settings, palliative care is a separate service. Consultations are ordered as needed by hospitalists and other physicians.

Advocates like Marianne Novelli, MD, FHM, FACP, say hospitalists play a pivotal role in providing the basics of palliative care for seriously ill, hospitalized patients.

“Palliative care is part and parcel of what we do as hospitalists with the people we serve—who by definition are very sick, even to get into the hospital,” says Dr. Novelli, formerly the chief of the division of hospital medicine at Kaiser Permanente in Denver, Colo. She rotated off that leadership position in 2011 and has since divided her time between hospital medicine and palliative care shifts in the hospital, although she now does palliative care exclusively.

Initially, she watched palliative care consults and asked for mentorship from the palliative care team. Although it took time to get used to the advisory role of the consultant, and to working with a team, she eventually became board certified in HPM.

“Palliative care is incredibly intense but richly rewarding work,” she says. “The patients you see are never simple. It allows us to practice the type of medicine we originally set out to do, with people at the most vulnerable times in their lives.”

Workforce, Fellowship, Board Certification

In October 2012, 3,356 physicians passed the hospice and palliative medicine subspecialty board exams offered by the American Board of Medical Specialties and 10 of its constituent specialty boards, with the lion’s share of them certified by the American Board of Internal Medicine. That more than doubled the number of physicians earning the HPM credential since its inception in 2008.

Even with the surge in palliative care training, workforce studies suggest the U.S. is woefully short of credentialed palliative care physicians. And many think hospitalists can help fill that void.

The Center to Advance Palliative Care (CAPC, www.capc.org) counts 1,400 hospital-based palliative care programs in the U.S., while the Centers for Medicare & Medicaid Services (CMS) recognizes about 3,500 Medicare-certified hospice programs. A 2010 estimate by Dale Lupu and the American Academy of Hospice and Palliative Medicine (AAHPM), however, suggested a need for between 4,487 and 10,810 palliative care physician FTEs just to staff existing programs at appropriate levels—without considering growth for the field or its spread into outpatient settings.¹

In the past, mid-career physicians had an experiential pathway to the HPM board exam, based on hours worked with a hospice or palliative care team, but physicians now must complete an HPM fellowship of at least one year in order to sit for the boards. And, according to AAHPM, only 234 HPM fellowship positions are offered nationwide by 85 approved fellowship programs.

Dr. Bekanich

A one-year fellowship is a big commitment for an established hospitalist, according to Stephen Bekanich, MD, co-director of Seton Palliative Care at Seton Healthcare, an 11-hospital system in Austin, Texas. A former hospitalist, Dr. Bekanich says that in his region a fellow stipend is about $70,000, whereas typical hospitalist compensation is in the mid- to upper-$200,000s.

AAHPM is exploring other approaches to expanding the workforce with mid-career physicians. One approach, authored by Timothy Quill, MD, and Amy Abernethy, MD, the past and current AAHPM board presidents, is to develop a two-tiered system in which palliative medicine specialists teach basic palliative care techniques and approaches to primary care physicians, hospitalists, and such specialists as oncologists.² The article also suggested equipping clinicians with the tools to recognize when more specialized help is needed.

“As in any medical discipline, some core elements of palliative care, such as aligning treatment with a patient’s goals and basic symptom management, should be routine aspects of care delivered by any practitioner,” Drs. Quill and Abernethy wrote. “Other skills are more complex and take years of training to learn and apply, such as negotiating a difficult family meeting, addressing veiled existential distress, and managing refractory symptoms.”

Dr. Bekanich is trying the two-tiered approach at Seton Healthcare. At facilities with no palliative care service, he is transplanting palliative-trained nurse practitioners in hospital medicine groups.

“This model is locked into our budget for fiscal year 2014,” Dr. Bekanich says. “We’ll train folks, starting with hospitalists and primary care physicians.”

The training will start with a pair of three-hour sessions on palliative care techniques for hospitalists and PCPs, followed by homework assignments. “Then we’ll meet again in three months to do some role plays,” he says.

Two final rounds of training will focus on skills, philosophy, values, and practice.

Palliative care is incredibly intense but richly rewarding work. The patients you see are never simple. It allows us to practice the type of medicine we originally set out to do, with people at the most vulnerable times in their lives.

—Marianne Novelli, MD, FHM, FACP, former chief of the division of hospital medicine, Kaiser Permanente, Denver, Colo.

On-the-Job Training

David Weissman, MD, FACP, a palliative care specialist in Milwaukee, Wis., and consultant to the CAPC, recommends hospitalists do what they can to improve their knowledge and skills. “There are a lot of opportunities for palliative care training out there,” he says.

HM conferences often include palliative care content. AAHPM and CAPC offer annual conferences that immerse participants in content, with opportunities to mingle with palliative care colleagues. AAHPM also offers specific content through its “Unipac” series of nine self-study training modules (www.aahpm.org/resources/default/unipac-4th-edition.html.)

Dr. Weissman

On the job, Dr. Weissman says hospitalists should ask for consults for patients with complex needs. Also pay attention to how the service works and what it recommends. Taking a couple of days to round with the palliative care service could be very educational. It may be possible to take a part-time position with the team, providing weekend or vacation coverage. Hospitalists can participate on planning or advisory committees for palliative care in their hospitals or on quality improvement projects.

“If there isn’t a palliative care service, advocate for developing one,” he says.

Local hospice programs, especially those with inpatient hospice facilities that need daily physician coverage, might have part-time staff positions, which could be a great moonlighting opportunity for hospitalists and a way to learn a lot very quickly.

“I can tell the difference between physicians who have spent time working in a hospice, where you can learn about caring for people at the end of life because most of the patients are so sick, and those who have not,” says Porter Storey, MD, FACP, AAHPM’s executive vice president and a practicing palliative care physician in Colorado. “You can learn how to use the medications to get someone comfortable quickly and how to talk to families in crisis. It can be some of the most rewarding work you can possibly do—especially when you have the time and training to do it well for some of the most challenging of patients and families.”

Dr. Storey recommends that hospitalists join AAHPM, use its professional materials, attend its annual meetings, and, if they feel a calling, consider fellowship training as the next big step.

“Palliative care programs are growing in number and size but are chronically understaffed,” says Steven Pantilat, MD, SFHM, hospitalist and director of the Palliative Care Program at the University of California at San Francisco. “This creates a great opportunity for hospitalists. I have heard of places that were having trouble recruiting palliative care physicians but were willing to sponsor a hospitalist to go and do a fellowship, supplementing their salary as an incentive—and a reasonable one—for a hospitalist interested in making a career move.”

He says that palliative care, like hospital medicine, has been a significant value-add in many hospitals and health systems. More importantly, it correlates to positive patient outcomes (see “Research Highlights Palliative Care Contributions,”).

Dr. Pantilat

“What’s new is how it connects to current issues like improved care transitions and readmissions reduction,” Dr. Pantilat says.

Advocates say palliative care helps to match medical services to patient preferences, thereby improving patient satisfaction scores, especially for those who aren’t likely to achieve good outcomes. Dr. Pantilat says it puts plans in place for patients to get the right services for the post-discharge period and for responding to anticipated problems like chest pain.

“It’s not just how to get patients out of the hospital as quickly as possible,” he says, “but to do that with a plan that sets them up to succeed at home.”

Larry Beresford is a freelance writer in San Francisco.

References

1. Lupu D. American Academy of Hospice and Palliative Medicine Workforce Task Force. Estimate of current hospice and palliative medicine physician workforce shortage. J Pain Symptom Manage. 2010;40(6):899-911.
2. Quill TE, Abernethy AP. Generalist plus specialist palliative care—creating a more sustainable model. N Engl J Med. 2013;368(13):1173-1175.
3. Morrison RS, Penrod JD, Cassel JB, et al. Palliative Care Leadership Centers' Outcomes Group. Cost savings associated with US hospital palliative care consultation programs. Arch Intern Med. 2008;168(16):1783-1790.
4. Penrod JD, Deb P, Dellenbaugh C, et al. Hospital-based palliative care consultation: effects on hospital cost. J Palliat Med. 2010;13(8):973-979.
5. Gelfman LP, Meier DE, Morrison RS. Does palliative care improve quality? A survey of bereaved family members. J Pain Symptom Manage. 2008;36(1):22-28.
6. Temel JS, Greer JA, Muzikansky A, et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med. 2010;363(8):733-742.
7. Irwin KE, Greer JA, Khatib J, Temel JS, Pirl WF. Early palliative care and metastatic non-small cell lung cancer: potential mechanisms of prolonged survival. Chron Respir Dis. 2013;10(1):35-47.
8. Von Roenn JN, Temel J. The integration of palliative care and oncology: the evidence. Oncology. 2011;25(13):1258-1260,1262,1264-1265.
9. Yoong J, Park ER, Greer JA, etc. Early palliative care in advanced lung cancer: a qualitative study. JAMA Intern Med. 2013;173(4):283-290.
10. Enguidanos S, Vesper E, Lorenz K. 30-day readmissions among seriously ill older adults. J Palliat Med. 2012;15(12):1356-1361.
11. Eti S, O’Mahony S, McHugh M, Guilbe R, Blank A, Selwyn P. Outcomes of the acute palliative care unit in an academic medical center [published online ahead of print May 10, 2013]. Am J Hosp Palliat Care. PMID: 23666616.
12. Smith AK, Thai JN, Bakitas MA, et al. The diverse landscape of palliative care clinics. J Palliat Med. 2013;16(6):661-668.

A British study that bills itself as the first to assess the impact of pre-delivery hospital admission on the incidence of VTE in pregnant women should serve as a clarion call to hospitalists, says a hospital physician and OB/GYN specialist.

Rob Olson, MD, FACOG, founding president of the Society of OB/GYN Hospitalists, says the report confirms empirically what most agree anecdotally: pregnant patients are at increased risk for VTE upon admission to the hospital, and those at highest risk should receive prophylaxis.

Published earlier this month in the British Medical Journal, the open-access report [PDF] found that hospital admissions during pregnancy were associated with a 17-fold increase in the risk of VTE. The risk remained sixfold higher for pregnant women 28 days after discharge, the report noted.

"This really quantifies it in a way I haven't seen before," says Dr. Olson, who practices in Bellingham, Wash. He says internal-medicine hospitalists should keep VTE prophylaxis front-of-mind for pregnant inpatients who during their hospital stay will likely experience a significant amount of bed rest. In those cases, he urges hospitalists to consult an obstetrician or an OB/GYN hospitalist, and consider use of compression devices or low-dose heparin.

"The more we understand the magnitude of the risks, the more we can mitigate against it," Dr. Olson adds. "The problem that you’re dealing with is something that doesn’t happen very often. Internists may see a bunch of pregnant patients and not have any problems. We want every pregnant admission to be a safe admission."

Visit our website for more information on OB/GYN hospitalists.

A British study that bills itself as the first to assess the impact of pre-delivery hospital admission on the incidence of VTE in pregnant women should serve as a clarion call to hospitalists, says a hospital physician and OB/GYN specialist.

Rob Olson, MD, FACOG, founding president of the Society of OB/GYN Hospitalists, says the report confirms empirically what most agree anecdotally: pregnant patients are at increased risk for VTE upon admission to the hospital, and those at highest risk should receive prophylaxis.

Published earlier this month in the British Medical Journal, the open-access report [PDF] found that hospital admissions during pregnancy were associated with a 17-fold increase in the risk of VTE. The risk remained sixfold higher for pregnant women 28 days after discharge, the report noted.

"This really quantifies it in a way I haven't seen before," says Dr. Olson, who practices in Bellingham, Wash. He says internal-medicine hospitalists should keep VTE prophylaxis front-of-mind for pregnant inpatients who during their hospital stay will likely experience a significant amount of bed rest. In those cases, he urges hospitalists to consult an obstetrician or an OB/GYN hospitalist, and consider use of compression devices or low-dose heparin.

"The more we understand the magnitude of the risks, the more we can mitigate against it," Dr. Olson adds. "The problem that you’re dealing with is something that doesn’t happen very often. Internists may see a bunch of pregnant patients and not have any problems. We want every pregnant admission to be a safe admission."

Visit our website for more information on OB/GYN hospitalists.

A British study that bills itself as the first to assess the impact of pre-delivery hospital admission on the incidence of VTE in pregnant women should serve as a clarion call to hospitalists, says a hospital physician and OB/GYN specialist.

Rob Olson, MD, FACOG, founding president of the Society of OB/GYN Hospitalists, says the report confirms empirically what most agree anecdotally: pregnant patients are at increased risk for VTE upon admission to the hospital, and those at highest risk should receive prophylaxis.

Published earlier this month in the British Medical Journal, the open-access report [PDF] found that hospital admissions during pregnancy were associated with a 17-fold increase in the risk of VTE. The risk remained sixfold higher for pregnant women 28 days after discharge, the report noted.

"This really quantifies it in a way I haven't seen before," says Dr. Olson, who practices in Bellingham, Wash. He says internal-medicine hospitalists should keep VTE prophylaxis front-of-mind for pregnant inpatients who during their hospital stay will likely experience a significant amount of bed rest. In those cases, he urges hospitalists to consult an obstetrician or an OB/GYN hospitalist, and consider use of compression devices or low-dose heparin.

"The more we understand the magnitude of the risks, the more we can mitigate against it," Dr. Olson adds. "The problem that you’re dealing with is something that doesn’t happen very often. Internists may see a bunch of pregnant patients and not have any problems. We want every pregnant admission to be a safe admission."

Visit our website for more information on OB/GYN hospitalists.

Next October, when COPD is added to the list of diagnoses for which hospital readmissions penalties are calculated, hospitalists will need to pay closer attention to comorbidities, home environments, socio-economic status, and other factors that can contribute to COPD readmissions.

This was a central theme at a recent conference on COPD and hospital readmissions sponsored by the COPD Foundation in Washington, D.C. The meeting brought together pulmonologists, policy makers, healthcare quality-improvement experts, and representatives from four national, patient-care transitions programs: the Care Transitions Program of the University of Colorado School of Medicine in Denver; Project RED (Re-Engineered Discharge) at Boston University Medical Center; the Transitional Care Model of the University of Pennsylvania in Philadelphia; and SHM's Project BOOST.

"This summit reinforces what has already been said, that there needs to be a comprehensive approach to COPD patients, not just managing the disease," said one of the conference’s key speakers, Mark Williams, MD, MHM, professor and chief of the division of hospital medicine at Northwestern University Feinberg School of Medicine in Chicago and principal investigator of Project BOOST. "Similar to heart failure, there needs to be support for the patient at home."

COPD is the third-leading cause of death in the U.S., with an estimated 15 million diagnosed patients and many more undiagnosed. One-fifth of hospitalized COPD patients are readmitted within 30 days, according to data from the Agency for Healthcare Research and Quality [PDF]. Many simultaneously present with heart disease, pneumonia, diabetes, or other comorbidities, and 62% of hospitalized COPD patients are readmitted for a condition other than COPD, says Brian Carlin, MD, senior staff physician at Allegheny General Hospital in Pittsburgh, Pa.

Preventing readmissions underscores the need for a patient-centered approach, says conference co-chair Jerry Krishnan, MD, PhD, professor of medicine and public health associate vice president for population health sciences at the University of Illinois Hospital and Health System in Chicago. "There's a tremendous amount of interest among physicians about the quality of care and health outcomes for these patients and conflicting evidence about what actually works," Dr. Krishnan says. "What works in one setting is unlikely to work in another setting."

Other physicians at the conference discussed ways hospitalists could help reduce COPD-related readmissions. Guidelines for non-pharmacologic interventions emphasize access to smoking cessation programs, immunizations for influenza, and pulmonary rehabilitation, says Byron Thomashow, MD, clinical professor of medicine at Columbia University Medical Center in New York City. "I also encourage all of my patients to exercise," he says.

Visit our website for more information on patient care and COPD.

Next October, when COPD is added to the list of diagnoses for which hospital readmissions penalties are calculated, hospitalists will need to pay closer attention to comorbidities, home environments, socio-economic status, and other factors that can contribute to COPD readmissions.

This was a central theme at a recent conference on COPD and hospital readmissions sponsored by the COPD Foundation in Washington, D.C. The meeting brought together pulmonologists, policy makers, healthcare quality-improvement experts, and representatives from four national, patient-care transitions programs: the Care Transitions Program of the University of Colorado School of Medicine in Denver; Project RED (Re-Engineered Discharge) at Boston University Medical Center; the Transitional Care Model of the University of Pennsylvania in Philadelphia; and SHM's Project BOOST.

"This summit reinforces what has already been said, that there needs to be a comprehensive approach to COPD patients, not just managing the disease," said one of the conference’s key speakers, Mark Williams, MD, MHM, professor and chief of the division of hospital medicine at Northwestern University Feinberg School of Medicine in Chicago and principal investigator of Project BOOST. "Similar to heart failure, there needs to be support for the patient at home."

COPD is the third-leading cause of death in the U.S., with an estimated 15 million diagnosed patients and many more undiagnosed. One-fifth of hospitalized COPD patients are readmitted within 30 days, according to data from the Agency for Healthcare Research and Quality [PDF]. Many simultaneously present with heart disease, pneumonia, diabetes, or other comorbidities, and 62% of hospitalized COPD patients are readmitted for a condition other than COPD, says Brian Carlin, MD, senior staff physician at Allegheny General Hospital in Pittsburgh, Pa.

Preventing readmissions underscores the need for a patient-centered approach, says conference co-chair Jerry Krishnan, MD, PhD, professor of medicine and public health associate vice president for population health sciences at the University of Illinois Hospital and Health System in Chicago. "There's a tremendous amount of interest among physicians about the quality of care and health outcomes for these patients and conflicting evidence about what actually works," Dr. Krishnan says. "What works in one setting is unlikely to work in another setting."

Other physicians at the conference discussed ways hospitalists could help reduce COPD-related readmissions. Guidelines for non-pharmacologic interventions emphasize access to smoking cessation programs, immunizations for influenza, and pulmonary rehabilitation, says Byron Thomashow, MD, clinical professor of medicine at Columbia University Medical Center in New York City. "I also encourage all of my patients to exercise," he says.

Visit our website for more information on patient care and COPD.

Next October, when COPD is added to the list of diagnoses for which hospital readmissions penalties are calculated, hospitalists will need to pay closer attention to comorbidities, home environments, socio-economic status, and other factors that can contribute to COPD readmissions.

This was a central theme at a recent conference on COPD and hospital readmissions sponsored by the COPD Foundation in Washington, D.C. The meeting brought together pulmonologists, policy makers, healthcare quality-improvement experts, and representatives from four national, patient-care transitions programs: the Care Transitions Program of the University of Colorado School of Medicine in Denver; Project RED (Re-Engineered Discharge) at Boston University Medical Center; the Transitional Care Model of the University of Pennsylvania in Philadelphia; and SHM's Project BOOST.

"This summit reinforces what has already been said, that there needs to be a comprehensive approach to COPD patients, not just managing the disease," said one of the conference’s key speakers, Mark Williams, MD, MHM, professor and chief of the division of hospital medicine at Northwestern University Feinberg School of Medicine in Chicago and principal investigator of Project BOOST. "Similar to heart failure, there needs to be support for the patient at home."

COPD is the third-leading cause of death in the U.S., with an estimated 15 million diagnosed patients and many more undiagnosed. One-fifth of hospitalized COPD patients are readmitted within 30 days, according to data from the Agency for Healthcare Research and Quality [PDF]. Many simultaneously present with heart disease, pneumonia, diabetes, or other comorbidities, and 62% of hospitalized COPD patients are readmitted for a condition other than COPD, says Brian Carlin, MD, senior staff physician at Allegheny General Hospital in Pittsburgh, Pa.

Preventing readmissions underscores the need for a patient-centered approach, says conference co-chair Jerry Krishnan, MD, PhD, professor of medicine and public health associate vice president for population health sciences at the University of Illinois Hospital and Health System in Chicago. "There's a tremendous amount of interest among physicians about the quality of care and health outcomes for these patients and conflicting evidence about what actually works," Dr. Krishnan says. "What works in one setting is unlikely to work in another setting."

Other physicians at the conference discussed ways hospitalists could help reduce COPD-related readmissions. Guidelines for non-pharmacologic interventions emphasize access to smoking cessation programs, immunizations for influenza, and pulmonary rehabilitation, says Byron Thomashow, MD, clinical professor of medicine at Columbia University Medical Center in New York City. "I also encourage all of my patients to exercise," he says.

Visit our website for more information on patient care and COPD.