Practice Economics

The Institute for Healthcare Improvement (IHI) released its Triple Aim Initiative in 2008, challenging the healthcare industry to undergo extensive systematic change, with the following goals:¹

• Reduce the per capita cost of healthcare;
• Improve the patient experience of care, including quality and satisfaction; and
• Improve the health of populations.

The first two aims are difficult enough, but the third involves engaging and empowering patients and their families to take ownership of their own health and wellness. This is much more than just understanding what your diagnoses are and which medications to take; it is about getting and staying well. Keeping patients and their families well is a goal that has eluded the healthcare industry since before Hippocrates and is an extremely challenging one for hospitalists, whose time with patients is usually limited to an acute care hospital stay.

Naturally, when one industry cannot figure out how to do something well, another industry will develop a breakthrough innovation. Enter Apple Inc., which has officially moved into the health and wellness business. Apple Health is a new app that will share multiple inputs of patient information in a cloud platform called “HealthKit.” HealthKit will allow a user to view a personalized dashboard of health and fitness metrics, which conglomerates information from a myriad of different health and wellness apps, helping them “communicate” with one another.²

The breadth and choice of health and wellness apps available to users is astounding. In a five-minute browse through the app store on my iPhone, I found the following free options to help patients track and understand their health and wellness:

• MyPlate Calorie Tracker, Calorie Counter, and Fooducate help educate and monitor caloric intake.
• iTriage, WebMD, and Mango Health Medication Manager, which can answer questions about symptoms you may be experiencing, will save a list of medications, conditions, procedures, physicians, appointments, and more, and can help you manage your medications.
• Nexercise, MapMyRun, MapMyRide, MapMyFitness, Pacer, and Health Mate track physical activity.
• Fitness Buddy and Daily Workout allow users to view daily workout options and target muscle groups for appropriate exercises.
• ShopWell allows you to scan food labels and evaluate ingredients, calories, gluten, and so on in most store-bought food products.

What Apple proposes to do with its new HealthKit is coordinate the input of these types of apps to synthesize a patient’s health and wellness onto a single platform, which can be shared with caretakers and healthcare providers as needed. The company, as only Apple can, actually declared that its app might be “the beginning of a health revolution.”

A New Day

What HealthKit offers is truly unique from a data security standpoint, which will appeal to Orwellian paranoids. Traditionally, when customers use services such as Google or Yahoo, these services use your personal identity—gathered in pieces of data such as your location and your browsing histories—and then use that data to collect, store, or sell such information on their terms. But Apple promises to help manage health and wellness data on the users’ terms. The purpose is to enable easy but secure sharing of complex health information, which can be updated by users or by other devices. Apple has coordinated with other developers to import information to HealthKit from multiple platforms and devices (such as Nike+, Withings Scale, and Fitbit Flex), acting as a central repository of personalized information.

With this technology, it’s easy to envision hospitals, clinics, pharmacies, laboratories, and even insurers integrating bilaterally with any patient information housed on HealthKit, at the discretion of the user. Mayo Clinic, Cleveland Clinic, Kaiser Permanente, Stanford, UCLA, and Mount Sinai Hospital are all rumored to be working with Apple to figure out how to exchange relevant patient information to enhance the continuity of a patient’s care. In addition to these potential collaborators, electronic health record providers Epic Systems and Allscripts are rumored to be working with Apple in some sort of partnership.^3,4

Not only will HealthKit be a secure repository of information, but it will constantly monitor all the metrics and can be programmed to send alerts to key stakeholders, such as family members or healthcare providers, when any of the metrics veer outside predetermined boundaries.⁴

This “new revolution” in healthcare and wellness should prove extremely helpful to hospitalists, who are often caught in the crosshairs of disjointed patient care delivery systems, and patients who need someone (or something) to track their health and wellness. Imagine a late afternoon admission of a patient who knows exactly what medications she is taking, who can outline several months’ history of caloric intake, physical activity, and basic vital signs, who has an accurate and updated inventory of laboratory exams from other medical centers, and who has a list of all recent physicians and appointments. Although this may seem too good to be true, such an admission may not be too far in the future.

What would be even better is if a patient’s health and wellness tracking keeps him out of the hospital altogether. After all, an Apple a day keeps the doctors away.

Dr. Scheurer is a hospitalist and chief quality officer at the Medical University of South Carolina in Charleston. She is physician editor of The Hospitalist. Email her at [email protected].

References

1. Institute for Healthcare Improvement. IHI Triple Aim Initiative. Available at: http://www.ihi.org/Engage/Initiatives/TripleAim/Pages/default.aspx. Accessed August 31, 2014.
2. Apple Inc. Healthkit information page. Available at: https://developer.apple.com/healthkit/. Accessed August 31, 2014.
3. The Advisory Board Company. Daily Briefing: Apple in talks with top hospitals to become ‘hub of health data.’ Available at: http://www.advisory.com/daily-briefing/2014/08/12/apple-in-talks-with-top-hospitals-to-become-hub-of-health-data. Accessed August 31, 2014.
4. Sullivan M. VentureBeat News. Apple announces HealthKit platform and new health app. Available at: http://venturebeat.com/2014/06/02/apple-announces-heath-kit-platform-and-health-app/. Accessed August 31, 2014.

The Institute for Healthcare Improvement (IHI) released its Triple Aim Initiative in 2008, challenging the healthcare industry to undergo extensive systematic change, with the following goals:¹

• Reduce the per capita cost of healthcare;
• Improve the patient experience of care, including quality and satisfaction; and
• Improve the health of populations.

The first two aims are difficult enough, but the third involves engaging and empowering patients and their families to take ownership of their own health and wellness. This is much more than just understanding what your diagnoses are and which medications to take; it is about getting and staying well. Keeping patients and their families well is a goal that has eluded the healthcare industry since before Hippocrates and is an extremely challenging one for hospitalists, whose time with patients is usually limited to an acute care hospital stay.

Naturally, when one industry cannot figure out how to do something well, another industry will develop a breakthrough innovation. Enter Apple Inc., which has officially moved into the health and wellness business. Apple Health is a new app that will share multiple inputs of patient information in a cloud platform called “HealthKit.” HealthKit will allow a user to view a personalized dashboard of health and fitness metrics, which conglomerates information from a myriad of different health and wellness apps, helping them “communicate” with one another.²

The breadth and choice of health and wellness apps available to users is astounding. In a five-minute browse through the app store on my iPhone, I found the following free options to help patients track and understand their health and wellness:

• MyPlate Calorie Tracker, Calorie Counter, and Fooducate help educate and monitor caloric intake.
• iTriage, WebMD, and Mango Health Medication Manager, which can answer questions about symptoms you may be experiencing, will save a list of medications, conditions, procedures, physicians, appointments, and more, and can help you manage your medications.
• Nexercise, MapMyRun, MapMyRide, MapMyFitness, Pacer, and Health Mate track physical activity.
• Fitness Buddy and Daily Workout allow users to view daily workout options and target muscle groups for appropriate exercises.
• ShopWell allows you to scan food labels and evaluate ingredients, calories, gluten, and so on in most store-bought food products.

What Apple proposes to do with its new HealthKit is coordinate the input of these types of apps to synthesize a patient’s health and wellness onto a single platform, which can be shared with caretakers and healthcare providers as needed. The company, as only Apple can, actually declared that its app might be “the beginning of a health revolution.”

A New Day

What HealthKit offers is truly unique from a data security standpoint, which will appeal to Orwellian paranoids. Traditionally, when customers use services such as Google or Yahoo, these services use your personal identity—gathered in pieces of data such as your location and your browsing histories—and then use that data to collect, store, or sell such information on their terms. But Apple promises to help manage health and wellness data on the users’ terms. The purpose is to enable easy but secure sharing of complex health information, which can be updated by users or by other devices. Apple has coordinated with other developers to import information to HealthKit from multiple platforms and devices (such as Nike+, Withings Scale, and Fitbit Flex), acting as a central repository of personalized information.

With this technology, it’s easy to envision hospitals, clinics, pharmacies, laboratories, and even insurers integrating bilaterally with any patient information housed on HealthKit, at the discretion of the user. Mayo Clinic, Cleveland Clinic, Kaiser Permanente, Stanford, UCLA, and Mount Sinai Hospital are all rumored to be working with Apple to figure out how to exchange relevant patient information to enhance the continuity of a patient’s care. In addition to these potential collaborators, electronic health record providers Epic Systems and Allscripts are rumored to be working with Apple in some sort of partnership.^3,4

Not only will HealthKit be a secure repository of information, but it will constantly monitor all the metrics and can be programmed to send alerts to key stakeholders, such as family members or healthcare providers, when any of the metrics veer outside predetermined boundaries.⁴

This “new revolution” in healthcare and wellness should prove extremely helpful to hospitalists, who are often caught in the crosshairs of disjointed patient care delivery systems, and patients who need someone (or something) to track their health and wellness. Imagine a late afternoon admission of a patient who knows exactly what medications she is taking, who can outline several months’ history of caloric intake, physical activity, and basic vital signs, who has an accurate and updated inventory of laboratory exams from other medical centers, and who has a list of all recent physicians and appointments. Although this may seem too good to be true, such an admission may not be too far in the future.

What would be even better is if a patient’s health and wellness tracking keeps him out of the hospital altogether. After all, an Apple a day keeps the doctors away.

Dr. Scheurer is a hospitalist and chief quality officer at the Medical University of South Carolina in Charleston. She is physician editor of The Hospitalist. Email her at [email protected].

References

1. Institute for Healthcare Improvement. IHI Triple Aim Initiative. Available at: http://www.ihi.org/Engage/Initiatives/TripleAim/Pages/default.aspx. Accessed August 31, 2014.
2. Apple Inc. Healthkit information page. Available at: https://developer.apple.com/healthkit/. Accessed August 31, 2014.
3. The Advisory Board Company. Daily Briefing: Apple in talks with top hospitals to become ‘hub of health data.’ Available at: http://www.advisory.com/daily-briefing/2014/08/12/apple-in-talks-with-top-hospitals-to-become-hub-of-health-data. Accessed August 31, 2014.
4. Sullivan M. VentureBeat News. Apple announces HealthKit platform and new health app. Available at: http://venturebeat.com/2014/06/02/apple-announces-heath-kit-platform-and-health-app/. Accessed August 31, 2014.

The Institute for Healthcare Improvement (IHI) released its Triple Aim Initiative in 2008, challenging the healthcare industry to undergo extensive systematic change, with the following goals:¹

• Reduce the per capita cost of healthcare;
• Improve the patient experience of care, including quality and satisfaction; and
• Improve the health of populations.

The first two aims are difficult enough, but the third involves engaging and empowering patients and their families to take ownership of their own health and wellness. This is much more than just understanding what your diagnoses are and which medications to take; it is about getting and staying well. Keeping patients and their families well is a goal that has eluded the healthcare industry since before Hippocrates and is an extremely challenging one for hospitalists, whose time with patients is usually limited to an acute care hospital stay.

Naturally, when one industry cannot figure out how to do something well, another industry will develop a breakthrough innovation. Enter Apple Inc., which has officially moved into the health and wellness business. Apple Health is a new app that will share multiple inputs of patient information in a cloud platform called “HealthKit.” HealthKit will allow a user to view a personalized dashboard of health and fitness metrics, which conglomerates information from a myriad of different health and wellness apps, helping them “communicate” with one another.²

The breadth and choice of health and wellness apps available to users is astounding. In a five-minute browse through the app store on my iPhone, I found the following free options to help patients track and understand their health and wellness:

• MyPlate Calorie Tracker, Calorie Counter, and Fooducate help educate and monitor caloric intake.
• iTriage, WebMD, and Mango Health Medication Manager, which can answer questions about symptoms you may be experiencing, will save a list of medications, conditions, procedures, physicians, appointments, and more, and can help you manage your medications.
• Nexercise, MapMyRun, MapMyRide, MapMyFitness, Pacer, and Health Mate track physical activity.
• Fitness Buddy and Daily Workout allow users to view daily workout options and target muscle groups for appropriate exercises.
• ShopWell allows you to scan food labels and evaluate ingredients, calories, gluten, and so on in most store-bought food products.

What Apple proposes to do with its new HealthKit is coordinate the input of these types of apps to synthesize a patient’s health and wellness onto a single platform, which can be shared with caretakers and healthcare providers as needed. The company, as only Apple can, actually declared that its app might be “the beginning of a health revolution.”

A New Day

What HealthKit offers is truly unique from a data security standpoint, which will appeal to Orwellian paranoids. Traditionally, when customers use services such as Google or Yahoo, these services use your personal identity—gathered in pieces of data such as your location and your browsing histories—and then use that data to collect, store, or sell such information on their terms. But Apple promises to help manage health and wellness data on the users’ terms. The purpose is to enable easy but secure sharing of complex health information, which can be updated by users or by other devices. Apple has coordinated with other developers to import information to HealthKit from multiple platforms and devices (such as Nike+, Withings Scale, and Fitbit Flex), acting as a central repository of personalized information.

With this technology, it’s easy to envision hospitals, clinics, pharmacies, laboratories, and even insurers integrating bilaterally with any patient information housed on HealthKit, at the discretion of the user. Mayo Clinic, Cleveland Clinic, Kaiser Permanente, Stanford, UCLA, and Mount Sinai Hospital are all rumored to be working with Apple to figure out how to exchange relevant patient information to enhance the continuity of a patient’s care. In addition to these potential collaborators, electronic health record providers Epic Systems and Allscripts are rumored to be working with Apple in some sort of partnership.^3,4

Not only will HealthKit be a secure repository of information, but it will constantly monitor all the metrics and can be programmed to send alerts to key stakeholders, such as family members or healthcare providers, when any of the metrics veer outside predetermined boundaries.⁴

This “new revolution” in healthcare and wellness should prove extremely helpful to hospitalists, who are often caught in the crosshairs of disjointed patient care delivery systems, and patients who need someone (or something) to track their health and wellness. Imagine a late afternoon admission of a patient who knows exactly what medications she is taking, who can outline several months’ history of caloric intake, physical activity, and basic vital signs, who has an accurate and updated inventory of laboratory exams from other medical centers, and who has a list of all recent physicians and appointments. Although this may seem too good to be true, such an admission may not be too far in the future.

What would be even better is if a patient’s health and wellness tracking keeps him out of the hospital altogether. After all, an Apple a day keeps the doctors away.

Dr. Scheurer is a hospitalist and chief quality officer at the Medical University of South Carolina in Charleston. She is physician editor of The Hospitalist. Email her at [email protected].

References

1. Institute for Healthcare Improvement. IHI Triple Aim Initiative. Available at: http://www.ihi.org/Engage/Initiatives/TripleAim/Pages/default.aspx. Accessed August 31, 2014.
2. Apple Inc. Healthkit information page. Available at: https://developer.apple.com/healthkit/. Accessed August 31, 2014.
3. The Advisory Board Company. Daily Briefing: Apple in talks with top hospitals to become ‘hub of health data.’ Available at: http://www.advisory.com/daily-briefing/2014/08/12/apple-in-talks-with-top-hospitals-to-become-hub-of-health-data. Accessed August 31, 2014.
4. Sullivan M. VentureBeat News. Apple announces HealthKit platform and new health app. Available at: http://venturebeat.com/2014/06/02/apple-announces-heath-kit-platform-and-health-app/. Accessed August 31, 2014.

“People don’t always remember what you say or even what you do, but they always remember how you made them feel.”—Maya Angelou

When SHM surveyed its members last year about why they had attended the annual meeting, the single most common response was to “be part of the hospital medicine movement.”

In the first three of my presidential columns, I talked about what that meant for the first 15 years of our specialty. HM’s rise occurred in the mid 1990s, during a time of despair in medicine, when pressures from rising costs and the new managed care industry upended the usual way of doing things, and then, around the turn of the century, amid a growing awareness that the care we had been delivering was wildly variable in quality—and often unsafe. Our field, created by members of the Baby Boomer generation, ultimately proved highly attractive to Generation X’ers, and our growth was accelerated by this new supply of young doctors. Fueled by the influx of dollars and attention brought on by the patient safety and quality movement, HM became the fastest growing medical specialty in history.

So, now we know what being part of the hospitalist movement meant before, but what does it mean today? Are the issues and drivers the same? I left my last column in 2006, with the partnership between the Institute for Healthcare Improvement (IHI), SHM, and six other key organizations to create the 5 Million Lives Campaign. It was an important year in several other ways, as what it meant to be a hospitalist began to change.

Enter the Millenials

In 2006 a new generation, the Millenials, born between 1985 and 2000, began entering medical schools across the country. This group, raised on a diet of positive reinforcement and cooperation, is characterized by confidence and a desire to work in teams. Born after the introduction of the Macintosh computer, Millenials are not just tech savvy; they have grown up in the world of social media and are digital media savvy. Even more than Gen X, Millenials strive for work-life balance. It almost seems this was a generation born and raised to be hospitalists!

Not only is their life philosophy different than the Boomers and X’ers before them, but their medical training has been unlike any before. From the moment they entered medical school, they were taught about patient quality and safety. To them, doctors aren’t the isolated pillars of strength and sole possessors of sacred knowledge that they used to be. They intuitively get that medicine is a team sport. In fact, most of the attendings on their ward rotations have been hospitalists.

Rise of Experience

In the early days of medicine, we as physicians understood that patients might not have the best experience, but that was just part of the deal, right? It’s just not supposed to be fun to be hospitalized—and sometimes you had to go through hell to get better. Those were the days of pure, unadulterated paternalism. We did things to patients to make them get better.

In the late 1970s, Irwin Press, PhD, began to study and lecture on patient satisfaction. In 1985, he joined forces with statistician Rod Ganey, PhD, to found Press Ganey Inc.¹ Patient experience as a concept began to enter the conversation of hospital administration, especially around the one-dimensional idea that better experience could contribute to the better financial health of an organization.

During the rise of the patient safety and quality movement in the late 1990s and early 2000s, our zeal to improve care led us to begin doing many things for patients. But a collateral idea began to rise in importance, too—the idea that a patient’s experience was critical to improving quality, not just a tool to attract more patients.

The entire national quality infrastructure I described in my last column (CMS, JCAHO, AHRQ, NQF) began to work on adding experience to the suite of measurements being developed. In 2006, CMS introduced the HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey. This was a set of questions designed to be used at all hospitals nationwide, a significant development, because there was now a national standard for patient experience that could be compared over time and across hospitals anywhere in the country.²

In 2007, all hospitals subject to the Inpatient Prospective Payment System—pretty much all hospitals except critical access hospitals—were required to submit their HCAHPS survey data or face up to a 2% penalty. In 2008, this experience data was released publicly for the first time.²

And, of course, the Patient Protection and Affordable Care Act of 2010 (ACA) included HCAHPS results in calculating Hospital Value-Based Purchasing payments.³

The Institute of Medicine, in laying out a vision for better healthcare in 2012, called for more involvement of patients and families.

We are even seeing organizations creating leadership positions solely focused on patient experience. The Cleveland Clinic created the first physician leadership position dedicated to patient experience in the country, appointing Bridget Duffy, MD, a hospitalist, as its first chief experience officer in 2010. In 2012, Sound Physicians became the first hospitalist company to create such a position, to which it appointed Mark Rudolph, MD. Who would have imagined this 10 years ago?

Life for hospitalists has changed dramatically from the early 1990s to the Millenials now entering our workforce. The forces guiding our work and stimulating our growth have evolved, but the overarching theme of the last twenty years has been improvement. When the medical world took a cold hard look at the care being delivered, we suddenly saw a world of opportunities for improvement.

I talked before about how the rise of the patient safety and quality movement coincided perfectly with the emergence of hospitalists. Here I told you about how patient experience emerged in prominence as we, collectively, in becoming aware of our quality deficits, gained newfound empathy for what patients were going through. This focus on patient experience again plays into our strength and the opportunity we have as a specialty.

In the December issue of The Hospitalist, the final column in this five-part series will examine how to put it all together as we move toward the future of the field. But first I’ll introduce one last factor, a problem that helped launch our field and is now the greatest threat to our success.

Dr. Kealey is SHM president and medical director of hospital specialties at HealthPartners Medical Group in St. Paul, Minn.

References

1. Press Ganey Associates, Inc. A spark ignited nearly three decades ago. Available at: http://www.pressganey.com/aboutUs/ourHistory.aspx. Accessed August 31, 2014.
2. Centers for Medicare and Medicaid Services. HCAHPS Fact Sheet. Available at: www.hcahpsonline.org. Accessed August 31, 2014.
3. American Hospital Association. Inpatient PPS. Available at: http://www.aha.org/advocacy-issues/medicare/ipps/index.shtml. Accessed August 31, 2014.

“People don’t always remember what you say or even what you do, but they always remember how you made them feel.”—Maya Angelou

When SHM surveyed its members last year about why they had attended the annual meeting, the single most common response was to “be part of the hospital medicine movement.”

In the first three of my presidential columns, I talked about what that meant for the first 15 years of our specialty. HM’s rise occurred in the mid 1990s, during a time of despair in medicine, when pressures from rising costs and the new managed care industry upended the usual way of doing things, and then, around the turn of the century, amid a growing awareness that the care we had been delivering was wildly variable in quality—and often unsafe. Our field, created by members of the Baby Boomer generation, ultimately proved highly attractive to Generation X’ers, and our growth was accelerated by this new supply of young doctors. Fueled by the influx of dollars and attention brought on by the patient safety and quality movement, HM became the fastest growing medical specialty in history.

So, now we know what being part of the hospitalist movement meant before, but what does it mean today? Are the issues and drivers the same? I left my last column in 2006, with the partnership between the Institute for Healthcare Improvement (IHI), SHM, and six other key organizations to create the 5 Million Lives Campaign. It was an important year in several other ways, as what it meant to be a hospitalist began to change.

Enter the Millenials

In 2006 a new generation, the Millenials, born between 1985 and 2000, began entering medical schools across the country. This group, raised on a diet of positive reinforcement and cooperation, is characterized by confidence and a desire to work in teams. Born after the introduction of the Macintosh computer, Millenials are not just tech savvy; they have grown up in the world of social media and are digital media savvy. Even more than Gen X, Millenials strive for work-life balance. It almost seems this was a generation born and raised to be hospitalists!

Not only is their life philosophy different than the Boomers and X’ers before them, but their medical training has been unlike any before. From the moment they entered medical school, they were taught about patient quality and safety. To them, doctors aren’t the isolated pillars of strength and sole possessors of sacred knowledge that they used to be. They intuitively get that medicine is a team sport. In fact, most of the attendings on their ward rotations have been hospitalists.

Rise of Experience

In the early days of medicine, we as physicians understood that patients might not have the best experience, but that was just part of the deal, right? It’s just not supposed to be fun to be hospitalized—and sometimes you had to go through hell to get better. Those were the days of pure, unadulterated paternalism. We did things to patients to make them get better.

In the late 1970s, Irwin Press, PhD, began to study and lecture on patient satisfaction. In 1985, he joined forces with statistician Rod Ganey, PhD, to found Press Ganey Inc.¹ Patient experience as a concept began to enter the conversation of hospital administration, especially around the one-dimensional idea that better experience could contribute to the better financial health of an organization.

During the rise of the patient safety and quality movement in the late 1990s and early 2000s, our zeal to improve care led us to begin doing many things for patients. But a collateral idea began to rise in importance, too—the idea that a patient’s experience was critical to improving quality, not just a tool to attract more patients.

The entire national quality infrastructure I described in my last column (CMS, JCAHO, AHRQ, NQF) began to work on adding experience to the suite of measurements being developed. In 2006, CMS introduced the HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey. This was a set of questions designed to be used at all hospitals nationwide, a significant development, because there was now a national standard for patient experience that could be compared over time and across hospitals anywhere in the country.²

In 2007, all hospitals subject to the Inpatient Prospective Payment System—pretty much all hospitals except critical access hospitals—were required to submit their HCAHPS survey data or face up to a 2% penalty. In 2008, this experience data was released publicly for the first time.²

And, of course, the Patient Protection and Affordable Care Act of 2010 (ACA) included HCAHPS results in calculating Hospital Value-Based Purchasing payments.³

The Institute of Medicine, in laying out a vision for better healthcare in 2012, called for more involvement of patients and families.

We are even seeing organizations creating leadership positions solely focused on patient experience. The Cleveland Clinic created the first physician leadership position dedicated to patient experience in the country, appointing Bridget Duffy, MD, a hospitalist, as its first chief experience officer in 2010. In 2012, Sound Physicians became the first hospitalist company to create such a position, to which it appointed Mark Rudolph, MD. Who would have imagined this 10 years ago?

Life for hospitalists has changed dramatically from the early 1990s to the Millenials now entering our workforce. The forces guiding our work and stimulating our growth have evolved, but the overarching theme of the last twenty years has been improvement. When the medical world took a cold hard look at the care being delivered, we suddenly saw a world of opportunities for improvement.

I talked before about how the rise of the patient safety and quality movement coincided perfectly with the emergence of hospitalists. Here I told you about how patient experience emerged in prominence as we, collectively, in becoming aware of our quality deficits, gained newfound empathy for what patients were going through. This focus on patient experience again plays into our strength and the opportunity we have as a specialty.

In the December issue of The Hospitalist, the final column in this five-part series will examine how to put it all together as we move toward the future of the field. But first I’ll introduce one last factor, a problem that helped launch our field and is now the greatest threat to our success.

Dr. Kealey is SHM president and medical director of hospital specialties at HealthPartners Medical Group in St. Paul, Minn.

References

1. Press Ganey Associates, Inc. A spark ignited nearly three decades ago. Available at: http://www.pressganey.com/aboutUs/ourHistory.aspx. Accessed August 31, 2014.
2. Centers for Medicare and Medicaid Services. HCAHPS Fact Sheet. Available at: www.hcahpsonline.org. Accessed August 31, 2014.
3. American Hospital Association. Inpatient PPS. Available at: http://www.aha.org/advocacy-issues/medicare/ipps/index.shtml. Accessed August 31, 2014.

“People don’t always remember what you say or even what you do, but they always remember how you made them feel.”—Maya Angelou

When SHM surveyed its members last year about why they had attended the annual meeting, the single most common response was to “be part of the hospital medicine movement.”

In the first three of my presidential columns, I talked about what that meant for the first 15 years of our specialty. HM’s rise occurred in the mid 1990s, during a time of despair in medicine, when pressures from rising costs and the new managed care industry upended the usual way of doing things, and then, around the turn of the century, amid a growing awareness that the care we had been delivering was wildly variable in quality—and often unsafe. Our field, created by members of the Baby Boomer generation, ultimately proved highly attractive to Generation X’ers, and our growth was accelerated by this new supply of young doctors. Fueled by the influx of dollars and attention brought on by the patient safety and quality movement, HM became the fastest growing medical specialty in history.

So, now we know what being part of the hospitalist movement meant before, but what does it mean today? Are the issues and drivers the same? I left my last column in 2006, with the partnership between the Institute for Healthcare Improvement (IHI), SHM, and six other key organizations to create the 5 Million Lives Campaign. It was an important year in several other ways, as what it meant to be a hospitalist began to change.

Enter the Millenials

In 2006 a new generation, the Millenials, born between 1985 and 2000, began entering medical schools across the country. This group, raised on a diet of positive reinforcement and cooperation, is characterized by confidence and a desire to work in teams. Born after the introduction of the Macintosh computer, Millenials are not just tech savvy; they have grown up in the world of social media and are digital media savvy. Even more than Gen X, Millenials strive for work-life balance. It almost seems this was a generation born and raised to be hospitalists!

Not only is their life philosophy different than the Boomers and X’ers before them, but their medical training has been unlike any before. From the moment they entered medical school, they were taught about patient quality and safety. To them, doctors aren’t the isolated pillars of strength and sole possessors of sacred knowledge that they used to be. They intuitively get that medicine is a team sport. In fact, most of the attendings on their ward rotations have been hospitalists.

Rise of Experience

In the early days of medicine, we as physicians understood that patients might not have the best experience, but that was just part of the deal, right? It’s just not supposed to be fun to be hospitalized—and sometimes you had to go through hell to get better. Those were the days of pure, unadulterated paternalism. We did things to patients to make them get better.

In the late 1970s, Irwin Press, PhD, began to study and lecture on patient satisfaction. In 1985, he joined forces with statistician Rod Ganey, PhD, to found Press Ganey Inc.¹ Patient experience as a concept began to enter the conversation of hospital administration, especially around the one-dimensional idea that better experience could contribute to the better financial health of an organization.

During the rise of the patient safety and quality movement in the late 1990s and early 2000s, our zeal to improve care led us to begin doing many things for patients. But a collateral idea began to rise in importance, too—the idea that a patient’s experience was critical to improving quality, not just a tool to attract more patients.

The entire national quality infrastructure I described in my last column (CMS, JCAHO, AHRQ, NQF) began to work on adding experience to the suite of measurements being developed. In 2006, CMS introduced the HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey. This was a set of questions designed to be used at all hospitals nationwide, a significant development, because there was now a national standard for patient experience that could be compared over time and across hospitals anywhere in the country.²

In 2007, all hospitals subject to the Inpatient Prospective Payment System—pretty much all hospitals except critical access hospitals—were required to submit their HCAHPS survey data or face up to a 2% penalty. In 2008, this experience data was released publicly for the first time.²

And, of course, the Patient Protection and Affordable Care Act of 2010 (ACA) included HCAHPS results in calculating Hospital Value-Based Purchasing payments.³

The Institute of Medicine, in laying out a vision for better healthcare in 2012, called for more involvement of patients and families.

We are even seeing organizations creating leadership positions solely focused on patient experience. The Cleveland Clinic created the first physician leadership position dedicated to patient experience in the country, appointing Bridget Duffy, MD, a hospitalist, as its first chief experience officer in 2010. In 2012, Sound Physicians became the first hospitalist company to create such a position, to which it appointed Mark Rudolph, MD. Who would have imagined this 10 years ago?

Life for hospitalists has changed dramatically from the early 1990s to the Millenials now entering our workforce. The forces guiding our work and stimulating our growth have evolved, but the overarching theme of the last twenty years has been improvement. When the medical world took a cold hard look at the care being delivered, we suddenly saw a world of opportunities for improvement.

I talked before about how the rise of the patient safety and quality movement coincided perfectly with the emergence of hospitalists. Here I told you about how patient experience emerged in prominence as we, collectively, in becoming aware of our quality deficits, gained newfound empathy for what patients were going through. This focus on patient experience again plays into our strength and the opportunity we have as a specialty.

In the December issue of The Hospitalist, the final column in this five-part series will examine how to put it all together as we move toward the future of the field. But first I’ll introduce one last factor, a problem that helped launch our field and is now the greatest threat to our success.

Dr. Kealey is SHM president and medical director of hospital specialties at HealthPartners Medical Group in St. Paul, Minn.

References

1. Press Ganey Associates, Inc. A spark ignited nearly three decades ago. Available at: http://www.pressganey.com/aboutUs/ourHistory.aspx. Accessed August 31, 2014.
2. Centers for Medicare and Medicaid Services. HCAHPS Fact Sheet. Available at: www.hcahpsonline.org. Accessed August 31, 2014.
3. American Hospital Association. Inpatient PPS. Available at: http://www.aha.org/advocacy-issues/medicare/ipps/index.shtml. Accessed August 31, 2014.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

EDITOR’S NOTE: First in a series of reviews of the “Hospital Medicine: Current Concepts” series by members of Team Hospitalist.

According to the Advisory Board projections of inpatient service line volume through 2017, most service lines will experience a decrease. Those that are projected to increase include neurosurgery, vascular surgery, orthopedic surgery, and general surgery. It seems clear that the need for hospital medicine to engage in the care of the surgical patient is sure to grow.

That makes the publication of this book so prescient. As one in a series titled Hospital Medicine: Current Concepts, edited by Scott Flanders, MD, MHM, and Sanjay Saint, MD, MPH, this is a valuable contribution to hospitalist leaders, policymakers, and anyone routinely caring for the peri-operative patient.

Part one focuses on systems of care. The authors articulate the essential elements of developing a consultation service, a clinic, and a co-management program. Eric Siegal, MD, FHM, authors the second chapter, clearly delineating the important differences between a co-management program and a consultation program. He provides the reader with pearls as well as potential pitfalls.

The first eight chapters of this book will have a long shelf life; they deliver sound advice on quality and practice management in the peri-operative arena. Identifying elements of a successful program, engaging key stakeholders, and managing medications are all skills a hospitalist needs and will not change anytime soon. Anyone planning to build a consultation or co-management service will be well served by the guidance in part one.

The next three parts explore the assessment and management of various risks, post-operative care, and post-operative conditions. Although written by a veritable who’s who of hospital medicine and peri-operative medicine giants, some parts of these sections fall prey to the rapidly changing world of clinical care. For example, Chapter 9 provides a great review of the history of developing cardiac risk assessment tools for the patient undergoing noncardiac surgery. The chapter also reviews strategies to mitigate risk; however, it falls short by failing to discuss the Gupta risk score, which was developed over 200,000 cases, compared with about 4,000 for the revised cardiac risk index. That omission is likely a result of publication timing. Although the chapter does not call out the recent implications of scientific misconduct related to the Dutch peri-operative beta blocker trials, the authors’ conclusions on the use of beta blockers remains appropriate and could have been more timely if it had included a recent meta-analysis omitting the Dutch data.

Similarly, Chapter 10 provides an excellent review of the etiology and burden of peri-operative pulmonary complications. Relatively recent literature that updates previous guidelines, indicating the benefits of respiratory muscle training, is included; however, the recently completed IMPROVE trial was likely published too late for inclusion in this chapter. Thus the benefits of a low tidal volume/lung protective strategy in those at intermediate to high risk could be missed. Still, the clinical foundation provided by the chapters in parts two through four fill the void most of us experienced in training—namely, not learning how to care for the peri-operative patient.

Special sections on the bariatric and neurosurgical patient will be welcomed by those of us never trained in the care of such conditions.

Key Takeaways

As hospitalists become increasingly important in the care of surgical patients, this book will provide an excellent foundation for critical peri-operative concepts and tools.

The authors include specific recommendations that will help in the management of almost every surgical patient encountered. For example, the anticoagulation and glycemic control strategies are well written, as well as easy to understand and apply.

If you are a hospitalist group leader, this is a must read that will help define quality, scope of practice, and practice management issues we all struggle with.

Dr. Fitterman is vice chair of hospital medicine in the department of medicine North Shore-LIJ Health System and assistant professor of medicine at Hofstra North Shore-LIJ School of Medicine.

EDITOR’S NOTE: First in a series of reviews of the “Hospital Medicine: Current Concepts” series by members of Team Hospitalist.

According to the Advisory Board projections of inpatient service line volume through 2017, most service lines will experience a decrease. Those that are projected to increase include neurosurgery, vascular surgery, orthopedic surgery, and general surgery. It seems clear that the need for hospital medicine to engage in the care of the surgical patient is sure to grow.

That makes the publication of this book so prescient. As one in a series titled Hospital Medicine: Current Concepts, edited by Scott Flanders, MD, MHM, and Sanjay Saint, MD, MPH, this is a valuable contribution to hospitalist leaders, policymakers, and anyone routinely caring for the peri-operative patient.

Part one focuses on systems of care. The authors articulate the essential elements of developing a consultation service, a clinic, and a co-management program. Eric Siegal, MD, FHM, authors the second chapter, clearly delineating the important differences between a co-management program and a consultation program. He provides the reader with pearls as well as potential pitfalls.

The first eight chapters of this book will have a long shelf life; they deliver sound advice on quality and practice management in the peri-operative arena. Identifying elements of a successful program, engaging key stakeholders, and managing medications are all skills a hospitalist needs and will not change anytime soon. Anyone planning to build a consultation or co-management service will be well served by the guidance in part one.

The next three parts explore the assessment and management of various risks, post-operative care, and post-operative conditions. Although written by a veritable who’s who of hospital medicine and peri-operative medicine giants, some parts of these sections fall prey to the rapidly changing world of clinical care. For example, Chapter 9 provides a great review of the history of developing cardiac risk assessment tools for the patient undergoing noncardiac surgery. The chapter also reviews strategies to mitigate risk; however, it falls short by failing to discuss the Gupta risk score, which was developed over 200,000 cases, compared with about 4,000 for the revised cardiac risk index. That omission is likely a result of publication timing. Although the chapter does not call out the recent implications of scientific misconduct related to the Dutch peri-operative beta blocker trials, the authors’ conclusions on the use of beta blockers remains appropriate and could have been more timely if it had included a recent meta-analysis omitting the Dutch data.

Similarly, Chapter 10 provides an excellent review of the etiology and burden of peri-operative pulmonary complications. Relatively recent literature that updates previous guidelines, indicating the benefits of respiratory muscle training, is included; however, the recently completed IMPROVE trial was likely published too late for inclusion in this chapter. Thus the benefits of a low tidal volume/lung protective strategy in those at intermediate to high risk could be missed. Still, the clinical foundation provided by the chapters in parts two through four fill the void most of us experienced in training—namely, not learning how to care for the peri-operative patient.

Special sections on the bariatric and neurosurgical patient will be welcomed by those of us never trained in the care of such conditions.

Key Takeaways

As hospitalists become increasingly important in the care of surgical patients, this book will provide an excellent foundation for critical peri-operative concepts and tools.

The authors include specific recommendations that will help in the management of almost every surgical patient encountered. For example, the anticoagulation and glycemic control strategies are well written, as well as easy to understand and apply.

If you are a hospitalist group leader, this is a must read that will help define quality, scope of practice, and practice management issues we all struggle with.

Dr. Fitterman is vice chair of hospital medicine in the department of medicine North Shore-LIJ Health System and assistant professor of medicine at Hofstra North Shore-LIJ School of Medicine.

EDITOR’S NOTE: First in a series of reviews of the “Hospital Medicine: Current Concepts” series by members of Team Hospitalist.

According to the Advisory Board projections of inpatient service line volume through 2017, most service lines will experience a decrease. Those that are projected to increase include neurosurgery, vascular surgery, orthopedic surgery, and general surgery. It seems clear that the need for hospital medicine to engage in the care of the surgical patient is sure to grow.

That makes the publication of this book so prescient. As one in a series titled Hospital Medicine: Current Concepts, edited by Scott Flanders, MD, MHM, and Sanjay Saint, MD, MPH, this is a valuable contribution to hospitalist leaders, policymakers, and anyone routinely caring for the peri-operative patient.

Part one focuses on systems of care. The authors articulate the essential elements of developing a consultation service, a clinic, and a co-management program. Eric Siegal, MD, FHM, authors the second chapter, clearly delineating the important differences between a co-management program and a consultation program. He provides the reader with pearls as well as potential pitfalls.

The first eight chapters of this book will have a long shelf life; they deliver sound advice on quality and practice management in the peri-operative arena. Identifying elements of a successful program, engaging key stakeholders, and managing medications are all skills a hospitalist needs and will not change anytime soon. Anyone planning to build a consultation or co-management service will be well served by the guidance in part one.

The next three parts explore the assessment and management of various risks, post-operative care, and post-operative conditions. Although written by a veritable who’s who of hospital medicine and peri-operative medicine giants, some parts of these sections fall prey to the rapidly changing world of clinical care. For example, Chapter 9 provides a great review of the history of developing cardiac risk assessment tools for the patient undergoing noncardiac surgery. The chapter also reviews strategies to mitigate risk; however, it falls short by failing to discuss the Gupta risk score, which was developed over 200,000 cases, compared with about 4,000 for the revised cardiac risk index. That omission is likely a result of publication timing. Although the chapter does not call out the recent implications of scientific misconduct related to the Dutch peri-operative beta blocker trials, the authors’ conclusions on the use of beta blockers remains appropriate and could have been more timely if it had included a recent meta-analysis omitting the Dutch data.

Similarly, Chapter 10 provides an excellent review of the etiology and burden of peri-operative pulmonary complications. Relatively recent literature that updates previous guidelines, indicating the benefits of respiratory muscle training, is included; however, the recently completed IMPROVE trial was likely published too late for inclusion in this chapter. Thus the benefits of a low tidal volume/lung protective strategy in those at intermediate to high risk could be missed. Still, the clinical foundation provided by the chapters in parts two through four fill the void most of us experienced in training—namely, not learning how to care for the peri-operative patient.

Special sections on the bariatric and neurosurgical patient will be welcomed by those of us never trained in the care of such conditions.

Key Takeaways

As hospitalists become increasingly important in the care of surgical patients, this book will provide an excellent foundation for critical peri-operative concepts and tools.

The authors include specific recommendations that will help in the management of almost every surgical patient encountered. For example, the anticoagulation and glycemic control strategies are well written, as well as easy to understand and apply.

If you are a hospitalist group leader, this is a must read that will help define quality, scope of practice, and practice management issues we all struggle with.

Dr. Fitterman is vice chair of hospital medicine in the department of medicine North Shore-LIJ Health System and assistant professor of medicine at Hofstra North Shore-LIJ School of Medicine.

Engaging patients more effectively in their own treatment is becoming a growing focus for hospitals and hospitalists. The Wall Street Journal earlier this year described how hospitals are scoring patients on their “activation”—how engaged they are likely to be in their ongoing care and recovery—with measurement tools such as the Patient Activation Measure (www.insigniahealth.com/solutions/patient-activation-measure)—in order to customize their care through special coaching or other interventions.⁴ Information Week Healthcare notes that more hospitals are putting patient experience officers in the C-suite to help them learn how to treat patients more like valued customers.⁵

One of the country’s first chief experience officers (CXOs), James Merlino, MD, CXO for Cleveland Clinic, heads a department that hosts the annual Patient Experience Summit, which was held in Cleveland in May with co-sponsorship by the Society for Hospital Medicine and the American Hospital Association. It’s one thing to talk about how important patient experience is, Dr. Merlino told Information Week Healthcare. “But it’s another to hold people accountable for it.”

Larry Beresford is a freelance writer in Alameda, Calif.

References

1. Nagasako EM, Reidhead M, Waterman B, Dunagan WC. Adding socioeconomic data to hospital readmissions calculations may produce more useful results. Health Affair. 2014;33(5):786-791.
2. Hu J, Gonsahn MD, Nerenz DR. Socioeconomic status and readmissions: Evidence from an urban teaching hospital. Health Affair. 2014;33(5):778-785.
3. Hoyer EH, Needham DM, Atanelov L, Knox B, Friedman M, Brotman DJ. Association of impaired functional status at hospital discharge and subsequent rehospitalization. J Hosp Med. 2014;9(5):277–282.
4. Landro L. How doctors rate patients. The Wall Street Journal. March 31, 2014. Available at: http://online.wsj.com/news/articles/SB10001424052702304432604579473301109907412. Accessed July 31, 2014.
5. Diana A. Hospitals elevate patient satisfaction to the C-suite. Information Week Healthcare. March 24, 2014. Available at: http://www.informationweek.com/healthcare/leadership/ hospitals-elevate-patient-satisfaction-to-the-c-suite/d/d-id/1127860. Accessed July 31, 2014.
6. The Press Association. London trust now testing seriously ill patients for HIV. Nursing Times. May 8, 2014. Available at: http://www.nursingtimes.net/confirmation?rtn=%252fbarts-to-rollout-routine-hiv-testing-for-intensive-care-patients%252f5070642.article. Accessed July 31, 2014.
7. Pallin DJ, Espinola JA, Camargo CA Jr. US population aging and demand for inpatient services. J Hosp Med. 2014;9(3):193-196.

Engaging patients more effectively in their own treatment is becoming a growing focus for hospitals and hospitalists. The Wall Street Journal earlier this year described how hospitals are scoring patients on their “activation”—how engaged they are likely to be in their ongoing care and recovery—with measurement tools such as the Patient Activation Measure (www.insigniahealth.com/solutions/patient-activation-measure)—in order to customize their care through special coaching or other interventions.⁴ Information Week Healthcare notes that more hospitals are putting patient experience officers in the C-suite to help them learn how to treat patients more like valued customers.⁵

One of the country’s first chief experience officers (CXOs), James Merlino, MD, CXO for Cleveland Clinic, heads a department that hosts the annual Patient Experience Summit, which was held in Cleveland in May with co-sponsorship by the Society for Hospital Medicine and the American Hospital Association. It’s one thing to talk about how important patient experience is, Dr. Merlino told Information Week Healthcare. “But it’s another to hold people accountable for it.”

Larry Beresford is a freelance writer in Alameda, Calif.

References

1. Nagasako EM, Reidhead M, Waterman B, Dunagan WC. Adding socioeconomic data to hospital readmissions calculations may produce more useful results. Health Affair. 2014;33(5):786-791.
2. Hu J, Gonsahn MD, Nerenz DR. Socioeconomic status and readmissions: Evidence from an urban teaching hospital. Health Affair. 2014;33(5):778-785.
3. Hoyer EH, Needham DM, Atanelov L, Knox B, Friedman M, Brotman DJ. Association of impaired functional status at hospital discharge and subsequent rehospitalization. J Hosp Med. 2014;9(5):277–282.
4. Landro L. How doctors rate patients. The Wall Street Journal. March 31, 2014. Available at: http://online.wsj.com/news/articles/SB10001424052702304432604579473301109907412. Accessed July 31, 2014.
5. Diana A. Hospitals elevate patient satisfaction to the C-suite. Information Week Healthcare. March 24, 2014. Available at: http://www.informationweek.com/healthcare/leadership/ hospitals-elevate-patient-satisfaction-to-the-c-suite/d/d-id/1127860. Accessed July 31, 2014.
6. The Press Association. London trust now testing seriously ill patients for HIV. Nursing Times. May 8, 2014. Available at: http://www.nursingtimes.net/confirmation?rtn=%252fbarts-to-rollout-routine-hiv-testing-for-intensive-care-patients%252f5070642.article. Accessed July 31, 2014.
7. Pallin DJ, Espinola JA, Camargo CA Jr. US population aging and demand for inpatient services. J Hosp Med. 2014;9(3):193-196.

Engaging patients more effectively in their own treatment is becoming a growing focus for hospitals and hospitalists. The Wall Street Journal earlier this year described how hospitals are scoring patients on their “activation”—how engaged they are likely to be in their ongoing care and recovery—with measurement tools such as the Patient Activation Measure (www.insigniahealth.com/solutions/patient-activation-measure)—in order to customize their care through special coaching or other interventions.⁴ Information Week Healthcare notes that more hospitals are putting patient experience officers in the C-suite to help them learn how to treat patients more like valued customers.⁵

One of the country’s first chief experience officers (CXOs), James Merlino, MD, CXO for Cleveland Clinic, heads a department that hosts the annual Patient Experience Summit, which was held in Cleveland in May with co-sponsorship by the Society for Hospital Medicine and the American Hospital Association. It’s one thing to talk about how important patient experience is, Dr. Merlino told Information Week Healthcare. “But it’s another to hold people accountable for it.”

Larry Beresford is a freelance writer in Alameda, Calif.

References

1. Nagasako EM, Reidhead M, Waterman B, Dunagan WC. Adding socioeconomic data to hospital readmissions calculations may produce more useful results. Health Affair. 2014;33(5):786-791.
2. Hu J, Gonsahn MD, Nerenz DR. Socioeconomic status and readmissions: Evidence from an urban teaching hospital. Health Affair. 2014;33(5):778-785.
3. Hoyer EH, Needham DM, Atanelov L, Knox B, Friedman M, Brotman DJ. Association of impaired functional status at hospital discharge and subsequent rehospitalization. J Hosp Med. 2014;9(5):277–282.
4. Landro L. How doctors rate patients. The Wall Street Journal. March 31, 2014. Available at: http://online.wsj.com/news/articles/SB10001424052702304432604579473301109907412. Accessed July 31, 2014.
5. Diana A. Hospitals elevate patient satisfaction to the C-suite. Information Week Healthcare. March 24, 2014. Available at: http://www.informationweek.com/healthcare/leadership/ hospitals-elevate-patient-satisfaction-to-the-c-suite/d/d-id/1127860. Accessed July 31, 2014.
6. The Press Association. London trust now testing seriously ill patients for HIV. Nursing Times. May 8, 2014. Available at: http://www.nursingtimes.net/confirmation?rtn=%252fbarts-to-rollout-routine-hiv-testing-for-intensive-care-patients%252f5070642.article. Accessed July 31, 2014.
7. Pallin DJ, Espinola JA, Camargo CA Jr. US population aging and demand for inpatient services. J Hosp Med. 2014;9(3):193-196.

Following a successful pilot at The Royal London Hospital in Whitechapel, the Barts Health NHS Trust of the British National Health Service has begun routinely offering the blood test for HIV infection to all critical care patients served by the trust, aiming to get more HIV cases diagnosed earlier, thereby helping to stop the virus’ spread by those who don’t know they are infected. Fifty-two percent of 899 patients on the pilot critical care unit agreed to the test, three of whom tested positive for HIV, enabling their doctors to commence treatment.⁶

Patients on critical care units are receiving blood tests already, and the HIV test was presented as just one more test, albeit one with the potential to save lives and stop HIV transmission to partners, said Barts Health NHS Trust HIV medicine consultant Chloe Orkin, MD.

“People are still dying of HIV in the UK—but only because they test too late,” Dr. Orkin says.

The new policy at the UK’s largest regional health trust is in line with guidelines recommending the introduction of universal opt-out testing for HIV in critical care departments where local prevalence of the infection exceeds two per 1,000 individuals.

Larry Beresford is a freelance writer in Alameda, Calif.

Following a successful pilot at The Royal London Hospital in Whitechapel, the Barts Health NHS Trust of the British National Health Service has begun routinely offering the blood test for HIV infection to all critical care patients served by the trust, aiming to get more HIV cases diagnosed earlier, thereby helping to stop the virus’ spread by those who don’t know they are infected. Fifty-two percent of 899 patients on the pilot critical care unit agreed to the test, three of whom tested positive for HIV, enabling their doctors to commence treatment.⁶

Patients on critical care units are receiving blood tests already, and the HIV test was presented as just one more test, albeit one with the potential to save lives and stop HIV transmission to partners, said Barts Health NHS Trust HIV medicine consultant Chloe Orkin, MD.

“People are still dying of HIV in the UK—but only because they test too late,” Dr. Orkin says.

The new policy at the UK’s largest regional health trust is in line with guidelines recommending the introduction of universal opt-out testing for HIV in critical care departments where local prevalence of the infection exceeds two per 1,000 individuals.

Larry Beresford is a freelance writer in Alameda, Calif.

Following a successful pilot at The Royal London Hospital in Whitechapel, the Barts Health NHS Trust of the British National Health Service has begun routinely offering the blood test for HIV infection to all critical care patients served by the trust, aiming to get more HIV cases diagnosed earlier, thereby helping to stop the virus’ spread by those who don’t know they are infected. Fifty-two percent of 899 patients on the pilot critical care unit agreed to the test, three of whom tested positive for HIV, enabling their doctors to commence treatment.⁶

Patients on critical care units are receiving blood tests already, and the HIV test was presented as just one more test, albeit one with the potential to save lives and stop HIV transmission to partners, said Barts Health NHS Trust HIV medicine consultant Chloe Orkin, MD.

“People are still dying of HIV in the UK—but only because they test too late,” Dr. Orkin says.

The new policy at the UK’s largest regional health trust is in line with guidelines recommending the introduction of universal opt-out testing for HIV in critical care departments where local prevalence of the infection exceeds two per 1,000 individuals.

Larry Beresford is a freelance writer in Alameda, Calif.

72%

Total growth in hospital capacity needed by the year 2050, according to an analysis in the Journal of Hospital Medicine.⁷ The estimate is based on a predicted 67% increase in the annual number of hospitalizations—assuming that other factors such as age-specific hospitalization rates and lengths of stay do not change—and derived from U.S. Census Bureau projections that by 2050 the U.S. population will increase by 41%. Total U.S. hospital capacity has steadily decreased for the past three decades.

Larry Beresford is a freelance writer in Alameda, Calif.

72%

Total growth in hospital capacity needed by the year 2050, according to an analysis in the Journal of Hospital Medicine.⁷ The estimate is based on a predicted 67% increase in the annual number of hospitalizations—assuming that other factors such as age-specific hospitalization rates and lengths of stay do not change—and derived from U.S. Census Bureau projections that by 2050 the U.S. population will increase by 41%. Total U.S. hospital capacity has steadily decreased for the past three decades.

Larry Beresford is a freelance writer in Alameda, Calif.

72%

Total growth in hospital capacity needed by the year 2050, according to an analysis in the Journal of Hospital Medicine.⁷ The estimate is based on a predicted 67% increase in the annual number of hospitalizations—assuming that other factors such as age-specific hospitalization rates and lengths of stay do not change—and derived from U.S. Census Bureau projections that by 2050 the U.S. population will increase by 41%. Total U.S. hospital capacity has steadily decreased for the past three decades.

Larry Beresford is a freelance writer in Alameda, Calif.