Career

NATIONAL HARBOR, Md.—Hospitalists' growing attention to the "post-acute-care space" is driven in part by high rates of 30-day readmissions for patients who get discharged to skilled nursing facilities (SNF)—1 in 4 Medicare patients, according to government estimates. The rate is 1 in 3 for heart-failure patients.

But post-acute care also is "a great place to change your career trajectory and have an immediate impact on the quality of care," Jerome Wilborn, MD, national medical director for post acute services for IPC The Hospitalist Company, said Sunday at HM13.

Dr. Wilborn made that transition and now is part of an IPC medical group in Ann Arbor, Mich., that works with 85 long-term-care facilities. “A lot of our post-acute providers do very well on professional billing,” he noted.

Hospitalists may be able to divide their practices between the acute and post-acute worlds, especially for facilities in close proximity. However, Dr. Wilborn noted that IPC prefers dedicated post-acute providers.

Watch a 2-minute video clip of Bob Wachter's HM13 keynote address

Hospitalists entering the post-acute world need to understand that these patients generally are very sick, although without access to the plethora of medical monitoring equipment that hospitalists take for granted. And sick patients need in-person medical attention, Dr. Wilborn said. Another key to success is regular, scheduled presence to develop institutional bonding with the facility, its staff and its culture. IPC physicians, especially if they take on the role of facility medical director, are expected to visit the facility at least three times a week.

SHM established a post-acute care task force and is surveying its members on their involvement and interest in this realm. For information or to participate in the survey, email SHM senior vice president Joseph Miller.

NATIONAL HARBOR, Md.—Hospitalists' growing attention to the "post-acute-care space" is driven in part by high rates of 30-day readmissions for patients who get discharged to skilled nursing facilities (SNF)—1 in 4 Medicare patients, according to government estimates. The rate is 1 in 3 for heart-failure patients.

But post-acute care also is "a great place to change your career trajectory and have an immediate impact on the quality of care," Jerome Wilborn, MD, national medical director for post acute services for IPC The Hospitalist Company, said Sunday at HM13.

Dr. Wilborn made that transition and now is part of an IPC medical group in Ann Arbor, Mich., that works with 85 long-term-care facilities. “A lot of our post-acute providers do very well on professional billing,” he noted.

Hospitalists may be able to divide their practices between the acute and post-acute worlds, especially for facilities in close proximity. However, Dr. Wilborn noted that IPC prefers dedicated post-acute providers.

Watch a 2-minute video clip of Bob Wachter's HM13 keynote address

Hospitalists entering the post-acute world need to understand that these patients generally are very sick, although without access to the plethora of medical monitoring equipment that hospitalists take for granted. And sick patients need in-person medical attention, Dr. Wilborn said. Another key to success is regular, scheduled presence to develop institutional bonding with the facility, its staff and its culture. IPC physicians, especially if they take on the role of facility medical director, are expected to visit the facility at least three times a week.

SHM established a post-acute care task force and is surveying its members on their involvement and interest in this realm. For information or to participate in the survey, email SHM senior vice president Joseph Miller.

NATIONAL HARBOR, Md.—Hospitalists' growing attention to the "post-acute-care space" is driven in part by high rates of 30-day readmissions for patients who get discharged to skilled nursing facilities (SNF)—1 in 4 Medicare patients, according to government estimates. The rate is 1 in 3 for heart-failure patients.

But post-acute care also is "a great place to change your career trajectory and have an immediate impact on the quality of care," Jerome Wilborn, MD, national medical director for post acute services for IPC The Hospitalist Company, said Sunday at HM13.

Dr. Wilborn made that transition and now is part of an IPC medical group in Ann Arbor, Mich., that works with 85 long-term-care facilities. “A lot of our post-acute providers do very well on professional billing,” he noted.

Hospitalists may be able to divide their practices between the acute and post-acute worlds, especially for facilities in close proximity. However, Dr. Wilborn noted that IPC prefers dedicated post-acute providers.

Watch a 2-minute video clip of Bob Wachter's HM13 keynote address

Hospitalists entering the post-acute world need to understand that these patients generally are very sick, although without access to the plethora of medical monitoring equipment that hospitalists take for granted. And sick patients need in-person medical attention, Dr. Wilborn said. Another key to success is regular, scheduled presence to develop institutional bonding with the facility, its staff and its culture. IPC physicians, especially if they take on the role of facility medical director, are expected to visit the facility at least three times a week.

SHM established a post-acute care task force and is surveying its members on their involvement and interest in this realm. For information or to participate in the survey, email SHM senior vice president Joseph Miller.

NATIONAL HARBOR, MD–New SHM president Eric Howell, MD, SFHM, set a concrete goal for his one-year term he began yesterday at HM13: double the society's number of student and housestaff members from 500 to 1,000.

He then immediately recruited the first member of the 2014 class: his younger sister.

Lesley Sutherland, a third-year medical student at the University of Maryland in College Park, Md., had been debating whether to go into family medicine versus internal medicine. That decision seems a moot point now, after her big brother pulled her onstage and inducted her into SHM before a packed ballroom at the Gaylord National Resort & Convention Center.

"For our specialty to be just as powerful, and just as important, and thrive just as much in the next 16 years as it has in the past 16 years, we are going to need high-quality recruits and a lot of them," said Dr. Howell, chief of hospital medicine at Johns Hopkins Bayview Medical Center in Baltimore, Md. "I know exactly where we're going to get them."

Check out today's HM13 video exclusive: Channeling Osler, Pioneer in Bedside Exams

Dr. Howell said recruiting medical students and housestaff—an initiative he calls the "Challenge of 2014"—is important to the future of hospital medicine. The marketing pitch to those would-be hospitalists is as simple as touting the work-life balance that has helped to boost the specialty's ranks to some 40,000 practitioners, and imparting the sense of pride and ownership that hospitalists take in their institutions.

"If you consider the hospital the house, then we are house owners and not renters," he added. "We're not waiting for two weeks to rotate off service and go to our real research job. We’re not coming in early in the morning and leaving for our actual office. We live in that professional house and we want to make the best house we can." TH

NATIONAL HARBOR, MD–New SHM president Eric Howell, MD, SFHM, set a concrete goal for his one-year term he began yesterday at HM13: double the society's number of student and housestaff members from 500 to 1,000.

He then immediately recruited the first member of the 2014 class: his younger sister.

Lesley Sutherland, a third-year medical student at the University of Maryland in College Park, Md., had been debating whether to go into family medicine versus internal medicine. That decision seems a moot point now, after her big brother pulled her onstage and inducted her into SHM before a packed ballroom at the Gaylord National Resort & Convention Center.

"For our specialty to be just as powerful, and just as important, and thrive just as much in the next 16 years as it has in the past 16 years, we are going to need high-quality recruits and a lot of them," said Dr. Howell, chief of hospital medicine at Johns Hopkins Bayview Medical Center in Baltimore, Md. "I know exactly where we're going to get them."

Check out today's HM13 video exclusive: Channeling Osler, Pioneer in Bedside Exams

Dr. Howell said recruiting medical students and housestaff—an initiative he calls the "Challenge of 2014"—is important to the future of hospital medicine. The marketing pitch to those would-be hospitalists is as simple as touting the work-life balance that has helped to boost the specialty's ranks to some 40,000 practitioners, and imparting the sense of pride and ownership that hospitalists take in their institutions.

"If you consider the hospital the house, then we are house owners and not renters," he added. "We're not waiting for two weeks to rotate off service and go to our real research job. We’re not coming in early in the morning and leaving for our actual office. We live in that professional house and we want to make the best house we can." TH

NATIONAL HARBOR, MD–New SHM president Eric Howell, MD, SFHM, set a concrete goal for his one-year term he began yesterday at HM13: double the society's number of student and housestaff members from 500 to 1,000.

He then immediately recruited the first member of the 2014 class: his younger sister.

Lesley Sutherland, a third-year medical student at the University of Maryland in College Park, Md., had been debating whether to go into family medicine versus internal medicine. That decision seems a moot point now, after her big brother pulled her onstage and inducted her into SHM before a packed ballroom at the Gaylord National Resort & Convention Center.

"For our specialty to be just as powerful, and just as important, and thrive just as much in the next 16 years as it has in the past 16 years, we are going to need high-quality recruits and a lot of them," said Dr. Howell, chief of hospital medicine at Johns Hopkins Bayview Medical Center in Baltimore, Md. "I know exactly where we're going to get them."

Check out today's HM13 video exclusive: Channeling Osler, Pioneer in Bedside Exams

Dr. Howell said recruiting medical students and housestaff—an initiative he calls the "Challenge of 2014"—is important to the future of hospital medicine. The marketing pitch to those would-be hospitalists is as simple as touting the work-life balance that has helped to boost the specialty's ranks to some 40,000 practitioners, and imparting the sense of pride and ownership that hospitalists take in their institutions.

"If you consider the hospital the house, then we are house owners and not renters," he added. "We're not waiting for two weeks to rotate off service and go to our real research job. We’re not coming in early in the morning and leaving for our actual office. We live in that professional house and we want to make the best house we can." TH

NATIONAL HARBOR, MD—As fast as the annual Research, Innovation, and Clinical Vignette competition is growing, research abstracts focused on technology applications for quality improvement and patient safety are growing nearly as quickly.

One good example on display Saturday during the HM13 oral presentations was research that documented Internet use by re-hospitalized patients from S. Ryan Greysen, MD, MHS, MA, of the Division of Hospital Medicine at the University of California at San Francisco. Dr. Greysen and colleagues found that two-thirds of re-hospitalized patients had Internet access at home and half had looked up health information within the past year, but most did not use the Internet to communicate with PCPs, or to manage medical appointments or prescriptions—three core tasks in helping to avoid readmissions.

One patient told the researchers he went home with a nebulizer but could not recall instructions given in the hospital for its use. “But he used YouTube to find an instructional video,” Dr. Greysen said. “We need to tailor online patient resources to focus on post-discharge tasks.”

HM13 VIDEO EXCLUSIVE: Hospitalists practice physical exam skills, learn to teach them better

More than 800 abstracts were submitted and nearly 600 were accepted for HM13. And technology applications for improving hospital care are more popular than ever, said Eduard Vasilevskis, MD, hospitalist at Vanderbilt University in Nashville, Tenn., and co-chair of SHM’s research abstracts judging committee. “What’s increasingly apparent is that people are trying to harness the electronic health record (EHR) for research,” Dr. Vasilevskis added.

HM13 Research, Innovations, and Clinical Vignettes Competition WINNERS

RESEARCH: "Comparison of Palliative Care Consultation Services in California Hospitals Between 2007 and 2011”

By Steven Pantilat, MD, David O’Riordan, PhD, University of California at San Francisco

INNOVATIONS: “SEPTRIS: Improving Sepsis Recognition and Management Through a Mobile Educational Game”

By Lisa Shieh, Eileen Pummer, J. Tsui, B. Tobin, J. Leung, M. Strehlow, W. Daines, P. Maggio, K. Hooper, Stanford Hospital, Stanford, Calif.

ADULT VIGNETTE: “Something Fishy in Dixie”

By Leslie Anne Cassidy, Sarah Lofgren, MD, Praneetha Thulasi, MD, Laurence Beer, MD, Daniel Dressler, MD, MSc, Emory University School of Medicine, Atlanta

PEDIATRIC VIGNETTE: "You Can’t Handle the Truth: Another Cause of Headache with Neurologic Deficits”

By Richard Bloomfield, MD, Eric Edwards, MD, University of North Carolina School of Medicine, Chapel Hill, N.C.

NATIONAL HARBOR, MD—As fast as the annual Research, Innovation, and Clinical Vignette competition is growing, research abstracts focused on technology applications for quality improvement and patient safety are growing nearly as quickly.

One good example on display Saturday during the HM13 oral presentations was research that documented Internet use by re-hospitalized patients from S. Ryan Greysen, MD, MHS, MA, of the Division of Hospital Medicine at the University of California at San Francisco. Dr. Greysen and colleagues found that two-thirds of re-hospitalized patients had Internet access at home and half had looked up health information within the past year, but most did not use the Internet to communicate with PCPs, or to manage medical appointments or prescriptions—three core tasks in helping to avoid readmissions.

One patient told the researchers he went home with a nebulizer but could not recall instructions given in the hospital for its use. “But he used YouTube to find an instructional video,” Dr. Greysen said. “We need to tailor online patient resources to focus on post-discharge tasks.”

HM13 VIDEO EXCLUSIVE: Hospitalists practice physical exam skills, learn to teach them better

More than 800 abstracts were submitted and nearly 600 were accepted for HM13. And technology applications for improving hospital care are more popular than ever, said Eduard Vasilevskis, MD, hospitalist at Vanderbilt University in Nashville, Tenn., and co-chair of SHM’s research abstracts judging committee. “What’s increasingly apparent is that people are trying to harness the electronic health record (EHR) for research,” Dr. Vasilevskis added.

HM13 Research, Innovations, and Clinical Vignettes Competition WINNERS

RESEARCH: "Comparison of Palliative Care Consultation Services in California Hospitals Between 2007 and 2011”

By Steven Pantilat, MD, David O’Riordan, PhD, University of California at San Francisco

INNOVATIONS: “SEPTRIS: Improving Sepsis Recognition and Management Through a Mobile Educational Game”

By Lisa Shieh, Eileen Pummer, J. Tsui, B. Tobin, J. Leung, M. Strehlow, W. Daines, P. Maggio, K. Hooper, Stanford Hospital, Stanford, Calif.

ADULT VIGNETTE: “Something Fishy in Dixie”

By Leslie Anne Cassidy, Sarah Lofgren, MD, Praneetha Thulasi, MD, Laurence Beer, MD, Daniel Dressler, MD, MSc, Emory University School of Medicine, Atlanta

PEDIATRIC VIGNETTE: "You Can’t Handle the Truth: Another Cause of Headache with Neurologic Deficits”

By Richard Bloomfield, MD, Eric Edwards, MD, University of North Carolina School of Medicine, Chapel Hill, N.C.

NATIONAL HARBOR, MD—As fast as the annual Research, Innovation, and Clinical Vignette competition is growing, research abstracts focused on technology applications for quality improvement and patient safety are growing nearly as quickly.

One good example on display Saturday during the HM13 oral presentations was research that documented Internet use by re-hospitalized patients from S. Ryan Greysen, MD, MHS, MA, of the Division of Hospital Medicine at the University of California at San Francisco. Dr. Greysen and colleagues found that two-thirds of re-hospitalized patients had Internet access at home and half had looked up health information within the past year, but most did not use the Internet to communicate with PCPs, or to manage medical appointments or prescriptions—three core tasks in helping to avoid readmissions.

One patient told the researchers he went home with a nebulizer but could not recall instructions given in the hospital for its use. “But he used YouTube to find an instructional video,” Dr. Greysen said. “We need to tailor online patient resources to focus on post-discharge tasks.”

HM13 VIDEO EXCLUSIVE: Hospitalists practice physical exam skills, learn to teach them better

More than 800 abstracts were submitted and nearly 600 were accepted for HM13. And technology applications for improving hospital care are more popular than ever, said Eduard Vasilevskis, MD, hospitalist at Vanderbilt University in Nashville, Tenn., and co-chair of SHM’s research abstracts judging committee. “What’s increasingly apparent is that people are trying to harness the electronic health record (EHR) for research,” Dr. Vasilevskis added.

HM13 Research, Innovations, and Clinical Vignettes Competition WINNERS

RESEARCH: "Comparison of Palliative Care Consultation Services in California Hospitals Between 2007 and 2011”

By Steven Pantilat, MD, David O’Riordan, PhD, University of California at San Francisco

INNOVATIONS: “SEPTRIS: Improving Sepsis Recognition and Management Through a Mobile Educational Game”

By Lisa Shieh, Eileen Pummer, J. Tsui, B. Tobin, J. Leung, M. Strehlow, W. Daines, P. Maggio, K. Hooper, Stanford Hospital, Stanford, Calif.

ADULT VIGNETTE: “Something Fishy in Dixie”

By Leslie Anne Cassidy, Sarah Lofgren, MD, Praneetha Thulasi, MD, Laurence Beer, MD, Daniel Dressler, MD, MSc, Emory University School of Medicine, Atlanta

PEDIATRIC VIGNETTE: "You Can’t Handle the Truth: Another Cause of Headache with Neurologic Deficits”

By Richard Bloomfield, MD, Eric Edwards, MD, University of North Carolina School of Medicine, Chapel Hill, N.C.

NATIONAL HARBOR, MD—David Feinberg, MD, MBA, president of UCLA Health System in Los Angeles, set a lofty goal for hospitalists in his keynote address yesterday at HM13: get it right, all the time.

Dr. Feinberg’s health system is in the 99th percentile for patient satisfaction, which means that roughly 85 out of every 100 patients served is pretty happy with their experience. But while that’s good enough to be among the nation’s best, it’s still short of where health care needs to be, he said.

“It means that we’re the cream of the crap,” Dr. Feinberg told a packed room of hospitalists at the Gaylord National Resort & Convention Center here. “Of the last 100 people we took care of, 15 of them—and, by definition, those 15 people are someone’s mom, someone’s brother, someone’s coworker—would not refer us to a friend, or rate us a nine or 10. So, I think while we’ve really moved the needle, we’re really not done until we get it right with every patient, every time.”

Check out today's HM13 video exclusive: Gordon Guyatt, MD: The guru of evidence-based medicine

Dr. Feinberg, a national leader on patient-centric care who said he still spends hours each day talking to patients, urged hospitalists to put the patient first in all decisions. In an address that bounced between motivational speech and stand-up comedy, he told hospitalists to push patient-centeredness on both a systems level and in individual interactions. That will increase patient satisfaction, he said.

“The push back I hear is, ‘Some of this stuff is unpreventable,’” Dr. Feinberg added. “Well, maybe it’s unpreventable the way we’re doing it now. But, maybe we need to think differently. Maybe it is unpreventable, but if this decreases the prevalence, or makes it better, than, to me, it’s important to do.”

NATIONAL HARBOR, MD—David Feinberg, MD, MBA, president of UCLA Health System in Los Angeles, set a lofty goal for hospitalists in his keynote address yesterday at HM13: get it right, all the time.

Dr. Feinberg’s health system is in the 99th percentile for patient satisfaction, which means that roughly 85 out of every 100 patients served is pretty happy with their experience. But while that’s good enough to be among the nation’s best, it’s still short of where health care needs to be, he said.

“It means that we’re the cream of the crap,” Dr. Feinberg told a packed room of hospitalists at the Gaylord National Resort & Convention Center here. “Of the last 100 people we took care of, 15 of them—and, by definition, those 15 people are someone’s mom, someone’s brother, someone’s coworker—would not refer us to a friend, or rate us a nine or 10. So, I think while we’ve really moved the needle, we’re really not done until we get it right with every patient, every time.”

Check out today's HM13 video exclusive: Gordon Guyatt, MD: The guru of evidence-based medicine

Dr. Feinberg, a national leader on patient-centric care who said he still spends hours each day talking to patients, urged hospitalists to put the patient first in all decisions. In an address that bounced between motivational speech and stand-up comedy, he told hospitalists to push patient-centeredness on both a systems level and in individual interactions. That will increase patient satisfaction, he said.

“The push back I hear is, ‘Some of this stuff is unpreventable,’” Dr. Feinberg added. “Well, maybe it’s unpreventable the way we’re doing it now. But, maybe we need to think differently. Maybe it is unpreventable, but if this decreases the prevalence, or makes it better, than, to me, it’s important to do.”

NATIONAL HARBOR, MD—David Feinberg, MD, MBA, president of UCLA Health System in Los Angeles, set a lofty goal for hospitalists in his keynote address yesterday at HM13: get it right, all the time.

Dr. Feinberg’s health system is in the 99th percentile for patient satisfaction, which means that roughly 85 out of every 100 patients served is pretty happy with their experience. But while that’s good enough to be among the nation’s best, it’s still short of where health care needs to be, he said.

“It means that we’re the cream of the crap,” Dr. Feinberg told a packed room of hospitalists at the Gaylord National Resort & Convention Center here. “Of the last 100 people we took care of, 15 of them—and, by definition, those 15 people are someone’s mom, someone’s brother, someone’s coworker—would not refer us to a friend, or rate us a nine or 10. So, I think while we’ve really moved the needle, we’re really not done until we get it right with every patient, every time.”

Check out today's HM13 video exclusive: Gordon Guyatt, MD: The guru of evidence-based medicine

Dr. Feinberg, a national leader on patient-centric care who said he still spends hours each day talking to patients, urged hospitalists to put the patient first in all decisions. In an address that bounced between motivational speech and stand-up comedy, he told hospitalists to push patient-centeredness on both a systems level and in individual interactions. That will increase patient satisfaction, he said.

“The push back I hear is, ‘Some of this stuff is unpreventable,’” Dr. Feinberg added. “Well, maybe it’s unpreventable the way we’re doing it now. But, maybe we need to think differently. Maybe it is unpreventable, but if this decreases the prevalence, or makes it better, than, to me, it’s important to do.”

NATIONAL HARBOR, MD—Avoiding unnecessary hospital readmissions may be the most touted benefit of improving care for discharged patients, but better care can also limit patients’ potential to experience adverse effects after leaving the hospital.

“There’s a lot more to care transitions than readmissions,” said hospitalist Jeffrey Greenwald, MD, SFHM, faculty member of the inpatient clinician educator service at Massachusetts General Hospital in Boston during a session on lessons from SHM’s Project BOOST yesterday at HM13. “We’re trying to improve transitions to reduce adverse effects” from ineffective or unsuccessful hospital discharges and transitions of care, he said.

But, Dr. Greenwald acknowledged that the federal Hospital Readmissions Reduction Program and reimbursement penalties, which began last October, has increased attention on the quality of transitional care by U.S. hospitals and their hospitalists.

Check out today's HM13 video exclusive: Gordon Guyatt, MD: The guru of evidence-based medicine

About two-thirds of U.S. hospitals now experience automatic deductions of up to 1% of their Medicare reimbursement for high readmissions rates, based on experience with three diagnoses posted between 2008 and 2011. By fiscal year 2015, penalties will rise to 3% of hospitals’ Medicare reimbursement for a longer list of diagnoses, but those penalties will reflect the readmissions that hospitals experience today, said co-presenter Mark Williams, MD, FACP, MHM, chief of hospital medicine at Northwestern University in Chicago and a Project BOOST principal investigator.

SHM launched Project BOOST in 2007, and 160 hospitals have participated to date. Another national cohort is planned for this fall, with a July 31 application deadline. Preliminary results from pilot intervention units at 11 of the first 30 BOOST hospitals showed reductions in readmission rates from 14.7% to 12.7%, Dr. Williams reported.

A more recent BOOST collaborative with BlueCross BlueShield of Illinois and 27 hospitals in that state suggests a 25% decrease in readmissions on the BOOST intervention units. The “special sauce” in these achievements, Dr. Williams said, is the involvement of the expert BOOST mentors to help hold the site accountable.

NATIONAL HARBOR, MD—Avoiding unnecessary hospital readmissions may be the most touted benefit of improving care for discharged patients, but better care can also limit patients’ potential to experience adverse effects after leaving the hospital.

“There’s a lot more to care transitions than readmissions,” said hospitalist Jeffrey Greenwald, MD, SFHM, faculty member of the inpatient clinician educator service at Massachusetts General Hospital in Boston during a session on lessons from SHM’s Project BOOST yesterday at HM13. “We’re trying to improve transitions to reduce adverse effects” from ineffective or unsuccessful hospital discharges and transitions of care, he said.

But, Dr. Greenwald acknowledged that the federal Hospital Readmissions Reduction Program and reimbursement penalties, which began last October, has increased attention on the quality of transitional care by U.S. hospitals and their hospitalists.

Check out today's HM13 video exclusive: Gordon Guyatt, MD: The guru of evidence-based medicine

About two-thirds of U.S. hospitals now experience automatic deductions of up to 1% of their Medicare reimbursement for high readmissions rates, based on experience with three diagnoses posted between 2008 and 2011. By fiscal year 2015, penalties will rise to 3% of hospitals’ Medicare reimbursement for a longer list of diagnoses, but those penalties will reflect the readmissions that hospitals experience today, said co-presenter Mark Williams, MD, FACP, MHM, chief of hospital medicine at Northwestern University in Chicago and a Project BOOST principal investigator.

SHM launched Project BOOST in 2007, and 160 hospitals have participated to date. Another national cohort is planned for this fall, with a July 31 application deadline. Preliminary results from pilot intervention units at 11 of the first 30 BOOST hospitals showed reductions in readmission rates from 14.7% to 12.7%, Dr. Williams reported.

A more recent BOOST collaborative with BlueCross BlueShield of Illinois and 27 hospitals in that state suggests a 25% decrease in readmissions on the BOOST intervention units. The “special sauce” in these achievements, Dr. Williams said, is the involvement of the expert BOOST mentors to help hold the site accountable.

NATIONAL HARBOR, MD—Avoiding unnecessary hospital readmissions may be the most touted benefit of improving care for discharged patients, but better care can also limit patients’ potential to experience adverse effects after leaving the hospital.

“There’s a lot more to care transitions than readmissions,” said hospitalist Jeffrey Greenwald, MD, SFHM, faculty member of the inpatient clinician educator service at Massachusetts General Hospital in Boston during a session on lessons from SHM’s Project BOOST yesterday at HM13. “We’re trying to improve transitions to reduce adverse effects” from ineffective or unsuccessful hospital discharges and transitions of care, he said.

But, Dr. Greenwald acknowledged that the federal Hospital Readmissions Reduction Program and reimbursement penalties, which began last October, has increased attention on the quality of transitional care by U.S. hospitals and their hospitalists.

Check out today's HM13 video exclusive: Gordon Guyatt, MD: The guru of evidence-based medicine

About two-thirds of U.S. hospitals now experience automatic deductions of up to 1% of their Medicare reimbursement for high readmissions rates, based on experience with three diagnoses posted between 2008 and 2011. By fiscal year 2015, penalties will rise to 3% of hospitals’ Medicare reimbursement for a longer list of diagnoses, but those penalties will reflect the readmissions that hospitals experience today, said co-presenter Mark Williams, MD, FACP, MHM, chief of hospital medicine at Northwestern University in Chicago and a Project BOOST principal investigator.

SHM launched Project BOOST in 2007, and 160 hospitals have participated to date. Another national cohort is planned for this fall, with a July 31 application deadline. Preliminary results from pilot intervention units at 11 of the first 30 BOOST hospitals showed reductions in readmission rates from 14.7% to 12.7%, Dr. Williams reported.

A more recent BOOST collaborative with BlueCross BlueShield of Illinois and 27 hospitals in that state suggests a 25% decrease in readmissions on the BOOST intervention units. The “special sauce” in these achievements, Dr. Williams said, is the involvement of the expert BOOST mentors to help hold the site accountable.

NATIONAL HARBOR, MD—HM13 officially kicks off this morning, but the four-day confab already is well under way.

SHM's annual meeting began yesterday with eight day-long pre-courses. Today's schedule includes keynote addresses from hospitalist Patrick Conway, MD, MSc, FAAP, SFHM, chief medical officer of the Centers for Medicaid & Medicare Services (CMS); and patient-centerdness guru David Feinberg, MD, MBA, president of UCLA Health System in Los Angeles.

The meeting expects to attract 2,500 hospitalists and includes nearly 100 breakout sessions, the popular Research, Innovations, and Clinical Vignettes (RIV) poster competition, and induction of the latest class of fellows, senior fellows, and masters. New SHM president Eric Howell, MD, SFHM, will offer Saturday’s keynote address, and true to annual meeting tradition, HM pioneer Bob Wachter, MD, MHM, will wrap up this year's conference with a keynote focusing on quality and patient safety.

If that sounds like a blitzkrieg of social, business, and educational activities, well, that's exactly what lures attendees like Ibe Mbanu, MD, MBA, MPH, medical director of the adult hospitalist department at Bon Secours St. Mary's Hospital in Richmond, Va.

"The landscape in health care is rapidly evolving at a frantic pace," Dr. Mbanu says. "I essentially came here to get a condensed source of information on how to manage the changes that are coming through the pipeline, and how to effectively run my department."

Hospitalist Roman Cortez, MD, who helps run Inpatient Medical Service in Kailua, Hawaii, is at his second annual meeting. Last year was his first and he enjoyed it so much, he brought his business partners this year. And after just a few hours yesterday, he already was glad they made the 4,800-mile trek.

"This is definitely my priority conference every year," Dr. Cortez adds. "If I can only go to one conference, this is the one I will go to from now on."

NATIONAL HARBOR, MD—HM13 officially kicks off this morning, but the four-day confab already is well under way.

SHM's annual meeting began yesterday with eight day-long pre-courses. Today's schedule includes keynote addresses from hospitalist Patrick Conway, MD, MSc, FAAP, SFHM, chief medical officer of the Centers for Medicaid & Medicare Services (CMS); and patient-centerdness guru David Feinberg, MD, MBA, president of UCLA Health System in Los Angeles.

The meeting expects to attract 2,500 hospitalists and includes nearly 100 breakout sessions, the popular Research, Innovations, and Clinical Vignettes (RIV) poster competition, and induction of the latest class of fellows, senior fellows, and masters. New SHM president Eric Howell, MD, SFHM, will offer Saturday’s keynote address, and true to annual meeting tradition, HM pioneer Bob Wachter, MD, MHM, will wrap up this year's conference with a keynote focusing on quality and patient safety.

If that sounds like a blitzkrieg of social, business, and educational activities, well, that's exactly what lures attendees like Ibe Mbanu, MD, MBA, MPH, medical director of the adult hospitalist department at Bon Secours St. Mary's Hospital in Richmond, Va.

"The landscape in health care is rapidly evolving at a frantic pace," Dr. Mbanu says. "I essentially came here to get a condensed source of information on how to manage the changes that are coming through the pipeline, and how to effectively run my department."

Hospitalist Roman Cortez, MD, who helps run Inpatient Medical Service in Kailua, Hawaii, is at his second annual meeting. Last year was his first and he enjoyed it so much, he brought his business partners this year. And after just a few hours yesterday, he already was glad they made the 4,800-mile trek.

"This is definitely my priority conference every year," Dr. Cortez adds. "If I can only go to one conference, this is the one I will go to from now on."

NATIONAL HARBOR, MD—HM13 officially kicks off this morning, but the four-day confab already is well under way.

SHM's annual meeting began yesterday with eight day-long pre-courses. Today's schedule includes keynote addresses from hospitalist Patrick Conway, MD, MSc, FAAP, SFHM, chief medical officer of the Centers for Medicaid & Medicare Services (CMS); and patient-centerdness guru David Feinberg, MD, MBA, president of UCLA Health System in Los Angeles.

The meeting expects to attract 2,500 hospitalists and includes nearly 100 breakout sessions, the popular Research, Innovations, and Clinical Vignettes (RIV) poster competition, and induction of the latest class of fellows, senior fellows, and masters. New SHM president Eric Howell, MD, SFHM, will offer Saturday’s keynote address, and true to annual meeting tradition, HM pioneer Bob Wachter, MD, MHM, will wrap up this year's conference with a keynote focusing on quality and patient safety.

If that sounds like a blitzkrieg of social, business, and educational activities, well, that's exactly what lures attendees like Ibe Mbanu, MD, MBA, MPH, medical director of the adult hospitalist department at Bon Secours St. Mary's Hospital in Richmond, Va.

"The landscape in health care is rapidly evolving at a frantic pace," Dr. Mbanu says. "I essentially came here to get a condensed source of information on how to manage the changes that are coming through the pipeline, and how to effectively run my department."

Hospitalist Roman Cortez, MD, who helps run Inpatient Medical Service in Kailua, Hawaii, is at his second annual meeting. Last year was his first and he enjoyed it so much, he brought his business partners this year. And after just a few hours yesterday, he already was glad they made the 4,800-mile trek.

"This is definitely my priority conference every year," Dr. Cortez adds. "If I can only go to one conference, this is the one I will go to from now on."

Tanya Boldenow, MD, a hospitalist at St. Joseph Mercy Hospital in Ann Arbor, Mich., attended yesterday’s HM13 Quality Improvement pre-course because she had been inspired by SHM’s participation in the ABIM Foundation’s Choosing Wisely campaign that identifies common treatments worth questioning by physicians and patients.

“I feel that I got some quality training in residency and have some support for it at the hospital, but for taking that next step to actually implement a project, it was important for me to have additional training and tools,” Dr. Boldenow said. SHM’s five recommended treatments to question “were things that I had a sense we ought to be looking at,” she added, but they weren’t being actively pursued at her hospital.

The full-day pre-course offered a review of QI principles and techniques. Participants then planned how concepts could be applied to a project targeting one of the SHM recommendations.

Dr. Boldenow chose the practice of avoiding or removing unnecessary urinary catheters, with a focus on preventing catheter-related urinary tract infections. Her group discussed baseline data to collect and analyze, where and how to pilot an initiative in the hospital, how to mobilize electronic health records, and what might persuade other professionals to change their habits.“It’s important to keep our eyes on the prize,” noted faculty member Ian Jenkins, MD, a hospitalist at the University of California at San Diego. “What are we trying to reduce; catheters or catheter-related complications?”

Dr. Boldenow sent an email to her department head a month ago proposing such a project. “I got funding from the residency program to come to the pre-course,” she said, “with the idea that I’d go back and make a presentation to our core faculty—and initiate a quality project.”

Tanya Boldenow, MD, a hospitalist at St. Joseph Mercy Hospital in Ann Arbor, Mich., attended yesterday’s HM13 Quality Improvement pre-course because she had been inspired by SHM’s participation in the ABIM Foundation’s Choosing Wisely campaign that identifies common treatments worth questioning by physicians and patients.

“I feel that I got some quality training in residency and have some support for it at the hospital, but for taking that next step to actually implement a project, it was important for me to have additional training and tools,” Dr. Boldenow said. SHM’s five recommended treatments to question “were things that I had a sense we ought to be looking at,” she added, but they weren’t being actively pursued at her hospital.

The full-day pre-course offered a review of QI principles and techniques. Participants then planned how concepts could be applied to a project targeting one of the SHM recommendations.

Dr. Boldenow chose the practice of avoiding or removing unnecessary urinary catheters, with a focus on preventing catheter-related urinary tract infections. Her group discussed baseline data to collect and analyze, where and how to pilot an initiative in the hospital, how to mobilize electronic health records, and what might persuade other professionals to change their habits.“It’s important to keep our eyes on the prize,” noted faculty member Ian Jenkins, MD, a hospitalist at the University of California at San Diego. “What are we trying to reduce; catheters or catheter-related complications?”

Dr. Boldenow sent an email to her department head a month ago proposing such a project. “I got funding from the residency program to come to the pre-course,” she said, “with the idea that I’d go back and make a presentation to our core faculty—and initiate a quality project.”

Tanya Boldenow, MD, a hospitalist at St. Joseph Mercy Hospital in Ann Arbor, Mich., attended yesterday’s HM13 Quality Improvement pre-course because she had been inspired by SHM’s participation in the ABIM Foundation’s Choosing Wisely campaign that identifies common treatments worth questioning by physicians and patients.

“I feel that I got some quality training in residency and have some support for it at the hospital, but for taking that next step to actually implement a project, it was important for me to have additional training and tools,” Dr. Boldenow said. SHM’s five recommended treatments to question “were things that I had a sense we ought to be looking at,” she added, but they weren’t being actively pursued at her hospital.

The full-day pre-course offered a review of QI principles and techniques. Participants then planned how concepts could be applied to a project targeting one of the SHM recommendations.

Dr. Boldenow chose the practice of avoiding or removing unnecessary urinary catheters, with a focus on preventing catheter-related urinary tract infections. Her group discussed baseline data to collect and analyze, where and how to pilot an initiative in the hospital, how to mobilize electronic health records, and what might persuade other professionals to change their habits.“It’s important to keep our eyes on the prize,” noted faculty member Ian Jenkins, MD, a hospitalist at the University of California at San Diego. “What are we trying to reduce; catheters or catheter-related complications?”

Dr. Boldenow sent an email to her department head a month ago proposing such a project. “I got funding from the residency program to come to the pre-course,” she said, “with the idea that I’d go back and make a presentation to our core faculty—and initiate a quality project.”

SHM board member Eric Siegal, MD, SFHM, wasn't surprised by the findings in a new report in the Journal of General Internal Medicine that found medical interns spent just 12% of their time in direct patient care and a whopping 40% of their time using computers.

"There certainly are advantages to electronic health records (EHRs), but one of the clear consequences is that it's impossible to function in the hospital without spending a lot of time in front of a computer screen. EHRs have turned physicians into secretaries," says Dr. Siegal, medical director of critical-care medicine at Aurora St. Luke's Medical Center in Milwaukee. "Work that we used to hand off to a unit clerk or to somebody else to do has now dropped into our laps."

Dr. Siegal and two of the authors of "In the Wake of the 2003 and 2011 Duty Hours Regulations, How do Internal Medicine Interns Spend Their Time?" agree that the growing EHR presence means that hospitalists and other internists spend a significant amount of time on data input and management, potentially at the cost of other activities. The observational study, which tracked general medicine inpatient ward rotations at Johns Hopkins School of Medicine and the University of Maryland, both in Baltimore, found that interns spent 64% of their time in indirect patient care, 15% in educational activities, and 9% in miscellaneous activities.

"We've created the perfect system to give us these results," says John Hopkins hospitalist and senior author Leonard Feldman, MD, FACP, FAAP, SFHM. "We need to place a value judgment as a medical community on whether these results are what we want our training programs to look like."

Dr. Feldman says EHRs need to be more efficient than current iterations, which focus more on data collection.

"I have been remarkably unimpressed with how many EMRs organize data and how surprisingly difficult it is for us to efficiently glean and prioritize information that we need to make decisions," Dr. Siegal adds.

Study lead author Lauren Block, MD, also of Johns Hopkins, says increased efficiency with EHRs is just one pathway to more direct patient care. Another is focusing on improving how physicians interact with the patients. She says teaching medical interns how to make the most of the time they have with patients—including digital interactions—is the next step toward improving the patient experience.

"It's not just the quantity of time, it's the quality of time," Dr. Block says. "Medical education has to find a way to address that and make sure that all the various modes of communication we use with patients are done well, and done in a manner that's safe, respects patients’ privacy, and meets patient needs."

Visit our website for more information on time hospitalists spend on EHR.

SHM board member Eric Siegal, MD, SFHM, wasn't surprised by the findings in a new report in the Journal of General Internal Medicine that found medical interns spent just 12% of their time in direct patient care and a whopping 40% of their time using computers.

"There certainly are advantages to electronic health records (EHRs), but one of the clear consequences is that it's impossible to function in the hospital without spending a lot of time in front of a computer screen. EHRs have turned physicians into secretaries," says Dr. Siegal, medical director of critical-care medicine at Aurora St. Luke's Medical Center in Milwaukee. "Work that we used to hand off to a unit clerk or to somebody else to do has now dropped into our laps."

Dr. Siegal and two of the authors of "In the Wake of the 2003 and 2011 Duty Hours Regulations, How do Internal Medicine Interns Spend Their Time?" agree that the growing EHR presence means that hospitalists and other internists spend a significant amount of time on data input and management, potentially at the cost of other activities. The observational study, which tracked general medicine inpatient ward rotations at Johns Hopkins School of Medicine and the University of Maryland, both in Baltimore, found that interns spent 64% of their time in indirect patient care, 15% in educational activities, and 9% in miscellaneous activities.

"We've created the perfect system to give us these results," says John Hopkins hospitalist and senior author Leonard Feldman, MD, FACP, FAAP, SFHM. "We need to place a value judgment as a medical community on whether these results are what we want our training programs to look like."

Dr. Feldman says EHRs need to be more efficient than current iterations, which focus more on data collection.

"I have been remarkably unimpressed with how many EMRs organize data and how surprisingly difficult it is for us to efficiently glean and prioritize information that we need to make decisions," Dr. Siegal adds.

Study lead author Lauren Block, MD, also of Johns Hopkins, says increased efficiency with EHRs is just one pathway to more direct patient care. Another is focusing on improving how physicians interact with the patients. She says teaching medical interns how to make the most of the time they have with patients—including digital interactions—is the next step toward improving the patient experience.

"It's not just the quantity of time, it's the quality of time," Dr. Block says. "Medical education has to find a way to address that and make sure that all the various modes of communication we use with patients are done well, and done in a manner that's safe, respects patients’ privacy, and meets patient needs."

Visit our website for more information on time hospitalists spend on EHR.

SHM board member Eric Siegal, MD, SFHM, wasn't surprised by the findings in a new report in the Journal of General Internal Medicine that found medical interns spent just 12% of their time in direct patient care and a whopping 40% of their time using computers.

"There certainly are advantages to electronic health records (EHRs), but one of the clear consequences is that it's impossible to function in the hospital without spending a lot of time in front of a computer screen. EHRs have turned physicians into secretaries," says Dr. Siegal, medical director of critical-care medicine at Aurora St. Luke's Medical Center in Milwaukee. "Work that we used to hand off to a unit clerk or to somebody else to do has now dropped into our laps."

Dr. Siegal and two of the authors of "In the Wake of the 2003 and 2011 Duty Hours Regulations, How do Internal Medicine Interns Spend Their Time?" agree that the growing EHR presence means that hospitalists and other internists spend a significant amount of time on data input and management, potentially at the cost of other activities. The observational study, which tracked general medicine inpatient ward rotations at Johns Hopkins School of Medicine and the University of Maryland, both in Baltimore, found that interns spent 64% of their time in indirect patient care, 15% in educational activities, and 9% in miscellaneous activities.

"We've created the perfect system to give us these results," says John Hopkins hospitalist and senior author Leonard Feldman, MD, FACP, FAAP, SFHM. "We need to place a value judgment as a medical community on whether these results are what we want our training programs to look like."

Dr. Feldman says EHRs need to be more efficient than current iterations, which focus more on data collection.

"I have been remarkably unimpressed with how many EMRs organize data and how surprisingly difficult it is for us to efficiently glean and prioritize information that we need to make decisions," Dr. Siegal adds.

Study lead author Lauren Block, MD, also of Johns Hopkins, says increased efficiency with EHRs is just one pathway to more direct patient care. Another is focusing on improving how physicians interact with the patients. She says teaching medical interns how to make the most of the time they have with patients—including digital interactions—is the next step toward improving the patient experience.

"It's not just the quantity of time, it's the quality of time," Dr. Block says. "Medical education has to find a way to address that and make sure that all the various modes of communication we use with patients are done well, and done in a manner that's safe, respects patients’ privacy, and meets patient needs."

Visit our website for more information on time hospitalists spend on EHR.

Hospitalists and ED physicians belong to two of the largest U.S. medical specialties and increasingly they are the only physicians seen by some hospitalized patients. Comanagement between the specialties is increasing in some hospitals, and in others, they might be the only physicians in the building after hours. They share similar workspaces, schedules, and responsibility for decisions about the most expensive care in medicine.

And yet there is not enough collaboration between the two specialties beyond brief phone encounters at handoff, says hospitalist Alpesh Amin, MD, MPA, MACP, SFHM, executive director of the hospitalist program at the University of California at Irvine. Dr. Amin coauthored a recent review highlighting opportunities for closer HM-ED collaboration with Charles Pollack Jr., MD, MA, FACEP, FAAEM, FAHA, who chairs the emergency department at Pennsylvania Hospital in Philadelphia.

A good place to start is for the two groups to simply sit down together regularly to discuss matters of common interest, perhaps monthly or quarterly, Dr. Amin says.

"Talk about clinical pathway development for common hospital diagnoses and how to improve admission processes," he adds. "There may be a role for the hospitalist in the emergency department when the patient gets handed off for hospital admission."

Collaboration also can improve patient flow and reduce ED diversion, shorten boarding times in the ED, and enhance quality and patient safety, Dr. Amin adds. "It's about how to optimize patient care for the benefit of the patient and the hospital," he says.

Visit our website for more information on hospitalists in the ED.

Hospitalists and ED physicians belong to two of the largest U.S. medical specialties and increasingly they are the only physicians seen by some hospitalized patients. Comanagement between the specialties is increasing in some hospitals, and in others, they might be the only physicians in the building after hours. They share similar workspaces, schedules, and responsibility for decisions about the most expensive care in medicine.

And yet there is not enough collaboration between the two specialties beyond brief phone encounters at handoff, says hospitalist Alpesh Amin, MD, MPA, MACP, SFHM, executive director of the hospitalist program at the University of California at Irvine. Dr. Amin coauthored a recent review highlighting opportunities for closer HM-ED collaboration with Charles Pollack Jr., MD, MA, FACEP, FAAEM, FAHA, who chairs the emergency department at Pennsylvania Hospital in Philadelphia.

A good place to start is for the two groups to simply sit down together regularly to discuss matters of common interest, perhaps monthly or quarterly, Dr. Amin says.

"Talk about clinical pathway development for common hospital diagnoses and how to improve admission processes," he adds. "There may be a role for the hospitalist in the emergency department when the patient gets handed off for hospital admission."

Collaboration also can improve patient flow and reduce ED diversion, shorten boarding times in the ED, and enhance quality and patient safety, Dr. Amin adds. "It's about how to optimize patient care for the benefit of the patient and the hospital," he says.

Visit our website for more information on hospitalists in the ED.

Hospitalists and ED physicians belong to two of the largest U.S. medical specialties and increasingly they are the only physicians seen by some hospitalized patients. Comanagement between the specialties is increasing in some hospitals, and in others, they might be the only physicians in the building after hours. They share similar workspaces, schedules, and responsibility for decisions about the most expensive care in medicine.

And yet there is not enough collaboration between the two specialties beyond brief phone encounters at handoff, says hospitalist Alpesh Amin, MD, MPA, MACP, SFHM, executive director of the hospitalist program at the University of California at Irvine. Dr. Amin coauthored a recent review highlighting opportunities for closer HM-ED collaboration with Charles Pollack Jr., MD, MA, FACEP, FAAEM, FAHA, who chairs the emergency department at Pennsylvania Hospital in Philadelphia.

A good place to start is for the two groups to simply sit down together regularly to discuss matters of common interest, perhaps monthly or quarterly, Dr. Amin says.

"Talk about clinical pathway development for common hospital diagnoses and how to improve admission processes," he adds. "There may be a role for the hospitalist in the emergency department when the patient gets handed off for hospital admission."

Collaboration also can improve patient flow and reduce ED diversion, shorten boarding times in the ED, and enhance quality and patient safety, Dr. Amin adds. "It's about how to optimize patient care for the benefit of the patient and the hospital," he says.

Visit our website for more information on hospitalists in the ED.

Click here to listen to Dr. Agarwal-Antal

Click here to listen to Dr. Agarwal-Antal

Click here to listen to Dr. Agarwal-Antal