Richard Quinn

A surgical hospitalist program that's been shown to improve clinical outcomes and reduce inpatient length of stay (LOS) in a non-trauma setting is replicable across the country, says the author of a recent study.

Published in the Journal of the American College of Surgeons, the study reports that a team of surgeons dedicated solely to acute-care surgeries at Sutter Medical Center in Sacramento, Calif., decreased patients' LOS (6.5 days to 5.7 days, P<0.0016), hospital costs ($12,009 to $8306, P<0.0001), and overall complications (21% to 12%, P<0.0001).

Readmissions also "showed a downward trend" but not enough to be statistically significant. The retrospective review looked at the five-year period from 2007 to 2011, which represented the year before the service was initiated and the subsequent four years in which it was practiced.

"By decreasing variation, we improved outcomes and we improved efficiencies," says study author Leon Owens, MD, FACS, president and chief executive officer of the Sacramento-based Surgical Affiliates Management Group, which provided the surgical coverage for Sutter Medical Center. "So we wound up saving money and taking better care of patients. We succeeded because of the uniformity of how we approached the problems and because our team of surgeons is dedicated to doing these surgeries. They do not additionally need to do an elective surgery or deal with other distractions at their office."

Dr. Owens says he believes a well-managed team of acute-care surgeons can improve patient care at any institution that chooses to institute a similar program. "It's not only the brilliance of our doctors but the methodology," he adds. "Our doctors are bright and good, but if you get group-oriented, team-willing, competent surgeons, I believe this is reproducible. We believe this is going to be a common practice across the country. It's just a matter of time to get there." TH

Visit our website for more information on surgical hospitalists.

A surgical hospitalist program that's been shown to improve clinical outcomes and reduce inpatient length of stay (LOS) in a non-trauma setting is replicable across the country, says the author of a recent study.

Published in the Journal of the American College of Surgeons, the study reports that a team of surgeons dedicated solely to acute-care surgeries at Sutter Medical Center in Sacramento, Calif., decreased patients' LOS (6.5 days to 5.7 days, P<0.0016), hospital costs ($12,009 to $8306, P<0.0001), and overall complications (21% to 12%, P<0.0001).

Readmissions also "showed a downward trend" but not enough to be statistically significant. The retrospective review looked at the five-year period from 2007 to 2011, which represented the year before the service was initiated and the subsequent four years in which it was practiced.

"By decreasing variation, we improved outcomes and we improved efficiencies," says study author Leon Owens, MD, FACS, president and chief executive officer of the Sacramento-based Surgical Affiliates Management Group, which provided the surgical coverage for Sutter Medical Center. "So we wound up saving money and taking better care of patients. We succeeded because of the uniformity of how we approached the problems and because our team of surgeons is dedicated to doing these surgeries. They do not additionally need to do an elective surgery or deal with other distractions at their office."

Dr. Owens says he believes a well-managed team of acute-care surgeons can improve patient care at any institution that chooses to institute a similar program. "It's not only the brilliance of our doctors but the methodology," he adds. "Our doctors are bright and good, but if you get group-oriented, team-willing, competent surgeons, I believe this is reproducible. We believe this is going to be a common practice across the country. It's just a matter of time to get there." TH

Visit our website for more information on surgical hospitalists.

A surgical hospitalist program that's been shown to improve clinical outcomes and reduce inpatient length of stay (LOS) in a non-trauma setting is replicable across the country, says the author of a recent study.

Published in the Journal of the American College of Surgeons, the study reports that a team of surgeons dedicated solely to acute-care surgeries at Sutter Medical Center in Sacramento, Calif., decreased patients' LOS (6.5 days to 5.7 days, P<0.0016), hospital costs ($12,009 to $8306, P<0.0001), and overall complications (21% to 12%, P<0.0001).

Readmissions also "showed a downward trend" but not enough to be statistically significant. The retrospective review looked at the five-year period from 2007 to 2011, which represented the year before the service was initiated and the subsequent four years in which it was practiced.

"By decreasing variation, we improved outcomes and we improved efficiencies," says study author Leon Owens, MD, FACS, president and chief executive officer of the Sacramento-based Surgical Affiliates Management Group, which provided the surgical coverage for Sutter Medical Center. "So we wound up saving money and taking better care of patients. We succeeded because of the uniformity of how we approached the problems and because our team of surgeons is dedicated to doing these surgeries. They do not additionally need to do an elective surgery or deal with other distractions at their office."

Dr. Owens says he believes a well-managed team of acute-care surgeons can improve patient care at any institution that chooses to institute a similar program. "It's not only the brilliance of our doctors but the methodology," he adds. "Our doctors are bright and good, but if you get group-oriented, team-willing, competent surgeons, I believe this is reproducible. We believe this is going to be a common practice across the country. It's just a matter of time to get there." TH

Visit our website for more information on surgical hospitalists.

A hospitalist and SHM Public Policy Committee member is hopeful that SHM's recently released position paper recommending changes to the way the "observation status" designation is used for admitted hospital patients will help improve patient care.

The increasing use of the Centers for Medicare & Medicaid Services' (CMS) patient observation status designation—which grew 88% from 2006 to 2012—has frustrated hospitalists. Under the rule, patients are ineligible for skilled-nursing facility (SNF) care, may not claim insurance coverage for some medications, and may face uncertain cost-sharing and other financial liabilities for their hospitalization.

SHM outlined its concerns about the policy and suggested solutions in the report titled "The Observation Status Problem: Impact and Recommendations for Change."

CMS has attempted to address the issue by creating the "two-midnight rule." The report notes, however, that amid confusion on the application of the "two-midnight rule," Medicare auditing and enforcement have been pushed back several times, most recently to March 31, 2015.

"We still are unclear about what patient vulnerability is under this," says SHM Public Policy Committee member Ann Sheehy, MD, MS, FHM, a hospitalist at the University of Wisconsin School of Medicine and Public Health in Madison, who testified before Congress last May on observation status and other Medicare policies.

"We know that patients can't get SNF coverage when they're under observation," Dr. Sheehy says. "We know that patients are subject to unlimited co-pays when they're under observation, as opposed to when they're hospitalized as inpatients under Medicare Part A, which has a one-time deductible."

The SHM white paper outlines both short- and long-term fixes to the policy. In the near term, SHM recommends:

• Educating providers and patients on the purpose of observation status and raising confidence in when and how it should be applied;

• Changing SNF coverage rules to ensure patients’ eligibility; and

• Reforming the Medicare Recovery Audit Contractor program to improve RAC performance and reduce unintended pressures on admission decisions.

In the long term, the report suggests creating modifiers for diagnosis-related group (DRG) payments to assign to patients needing lower-acuity services, as well as crafting a list of DRGs to assign to patients needing short periods of inpatient care.

"The policy overall is very frustrating," Dr. Sheehy adds. "We hope that any rule change that comes out will address the core problems of observation so that patients can get the care they need with fair and appropriate insurance coverage." TH

Visit our website for more information about patient observation status.

A hospitalist and SHM Public Policy Committee member is hopeful that SHM's recently released position paper recommending changes to the way the "observation status" designation is used for admitted hospital patients will help improve patient care.

The increasing use of the Centers for Medicare & Medicaid Services' (CMS) patient observation status designation—which grew 88% from 2006 to 2012—has frustrated hospitalists. Under the rule, patients are ineligible for skilled-nursing facility (SNF) care, may not claim insurance coverage for some medications, and may face uncertain cost-sharing and other financial liabilities for their hospitalization.

SHM outlined its concerns about the policy and suggested solutions in the report titled "The Observation Status Problem: Impact and Recommendations for Change."

CMS has attempted to address the issue by creating the "two-midnight rule." The report notes, however, that amid confusion on the application of the "two-midnight rule," Medicare auditing and enforcement have been pushed back several times, most recently to March 31, 2015.

"We still are unclear about what patient vulnerability is under this," says SHM Public Policy Committee member Ann Sheehy, MD, MS, FHM, a hospitalist at the University of Wisconsin School of Medicine and Public Health in Madison, who testified before Congress last May on observation status and other Medicare policies.

"We know that patients can't get SNF coverage when they're under observation," Dr. Sheehy says. "We know that patients are subject to unlimited co-pays when they're under observation, as opposed to when they're hospitalized as inpatients under Medicare Part A, which has a one-time deductible."

The SHM white paper outlines both short- and long-term fixes to the policy. In the near term, SHM recommends:

• Educating providers and patients on the purpose of observation status and raising confidence in when and how it should be applied;

• Changing SNF coverage rules to ensure patients’ eligibility; and

• Reforming the Medicare Recovery Audit Contractor program to improve RAC performance and reduce unintended pressures on admission decisions.

In the long term, the report suggests creating modifiers for diagnosis-related group (DRG) payments to assign to patients needing lower-acuity services, as well as crafting a list of DRGs to assign to patients needing short periods of inpatient care.

"The policy overall is very frustrating," Dr. Sheehy adds. "We hope that any rule change that comes out will address the core problems of observation so that patients can get the care they need with fair and appropriate insurance coverage." TH

Visit our website for more information about patient observation status.

A hospitalist and SHM Public Policy Committee member is hopeful that SHM's recently released position paper recommending changes to the way the "observation status" designation is used for admitted hospital patients will help improve patient care.

The increasing use of the Centers for Medicare & Medicaid Services' (CMS) patient observation status designation—which grew 88% from 2006 to 2012—has frustrated hospitalists. Under the rule, patients are ineligible for skilled-nursing facility (SNF) care, may not claim insurance coverage for some medications, and may face uncertain cost-sharing and other financial liabilities for their hospitalization.

SHM outlined its concerns about the policy and suggested solutions in the report titled "The Observation Status Problem: Impact and Recommendations for Change."

CMS has attempted to address the issue by creating the "two-midnight rule." The report notes, however, that amid confusion on the application of the "two-midnight rule," Medicare auditing and enforcement have been pushed back several times, most recently to March 31, 2015.

"We still are unclear about what patient vulnerability is under this," says SHM Public Policy Committee member Ann Sheehy, MD, MS, FHM, a hospitalist at the University of Wisconsin School of Medicine and Public Health in Madison, who testified before Congress last May on observation status and other Medicare policies.

"We know that patients can't get SNF coverage when they're under observation," Dr. Sheehy says. "We know that patients are subject to unlimited co-pays when they're under observation, as opposed to when they're hospitalized as inpatients under Medicare Part A, which has a one-time deductible."

The SHM white paper outlines both short- and long-term fixes to the policy. In the near term, SHM recommends:

• Educating providers and patients on the purpose of observation status and raising confidence in when and how it should be applied;

• Changing SNF coverage rules to ensure patients’ eligibility; and

• Reforming the Medicare Recovery Audit Contractor program to improve RAC performance and reduce unintended pressures on admission decisions.

In the long term, the report suggests creating modifiers for diagnosis-related group (DRG) payments to assign to patients needing lower-acuity services, as well as crafting a list of DRGs to assign to patients needing short periods of inpatient care.

"The policy overall is very frustrating," Dr. Sheehy adds. "We hope that any rule change that comes out will address the core problems of observation so that patients can get the care they need with fair and appropriate insurance coverage." TH

Visit our website for more information about patient observation status.

Dr. Fedderson

Growing up in America’s heartland, Julie Fedderson, MD, realized at an early age that something wasn’t right with the U.S. healthcare system. Her grandmother, a “headstrong” immigrant from the Czech Republic, died of colon cancer when Dr. Fedderson was young, and that experience—watching a loved one “reduced to tears” trying to navigate a complicated and impersonal healthcare system in rural Nebraska—made her realize “how important having dedicated physicians is.”

“It may sound naïve, but I really wanted to help people,” says Dr. Fedderson, who grew up and went to high school in a small town two hours from an urban center. She eventually attended college in what she saw as the big city—Lincoln, Nebraska. After attending the University of Nebraska, Dr. Fedderson went to medical school at the University of Nebraska Medical School (UNMC) in Omaha. She did her residency at Baylor College of Medicine in Houston, then returned to Nebraska.

Since 2003, she has worked as a hospitalist and is currently an assistant professor in the department of internal medicine at the UNMC. Her story, practicing as a “traditional” internist for several years before making the switch to HM, is similar to many in hospital medicine.

“I wanted to make an impact on the seamless transition of in-house care to outpatient care,” says one of the newest members of Team Hospitalist, the volunteer editorial advisory board of The Hospitalist. “The two are so intricately intertwined, yet so siloed, and many times the patient—who is the least capable of navigating our complex systems—is the one who is left with the responsibility to do it. I wanted to improve that.”

Dr. Fedderson

Dr. Fedderson is working toward her master’s degree from the University of Colorado’s Executive MBA Program. She is the resident supervisor for UNMC’s Physicians Midtown Clinic, serves as the Nebraska Medical Center’s enterprise chief quality and outcomes officer, and is on the board of directors of Nebraska Health Partners. She is also a member of the department of internal medicine’s executive committee.

Question: What do you like most about working as a hospitalist?

Answer: The ability to implement rapid change of process in a controlled environment.

Q: What do you dislike most?

A: The regulatory ties placed on hospitals that may not be quality oriented [and] the difficulty of handling the outpatient care of uninsured or underinsured patients.

Q: What’s the best advice you ever received?

A: For life: Shut up and listen. From one of my attendings during my residency: Piss, pus, and hostility all must come out eventually.

Q: What’s the biggest change you’ve seen in hospital medicine in your career?

A: The shift to technology as a basis of care. When done well, it is phenomenal. When done without appropriate thought, it can be disastrous for patients and providers alike.

Q: Why is it important for you, as a hospitalist group leader, to continue seeing patients?

A: How do you implement change if you have no skin in the game? I stay current and see patients to see the system work firsthand and to provide innovative—but practical—solutions.

Q: Outside of patient care, what are your career interests?

A: I am currently our new chief quality and outcomes officer at The Nebraska Medical Center Enterprise. I am also involved as a physician champion for our electronic health record [EHR] implementation and in clinical documentation improvement at all levels.

Q: What is your biggest professional challenge?

A: There are a lot of daunting things coming from entities that don’t necessarily have a patient’s best interests at heart. Keeping sane doing the “regulatory” quality while still providing good quality care is a challenge. Sometimes it feels like a game—but obviously a game with serious consequences.

Q: What is your biggest professional reward?

A: Frankly, [it is] when one of my colleagues relates to me a success story with a new process or plan. I hear so many of my medical friends so dissatisfied with healthcare’s trajectory—they’re burned out, telling their kids to not go into medicine. When I see someone get that spark back for their career and their reason for choosing it, that makes me feel fantastic.

Q: When you aren’t working, what is important to you?

A: I have two boys, and they hung the moon. We hang out as much as possible. I am also into physical fitness, so I try to run, do yoga, and hike as much as I can.

Q: Where do you see yourself in 10 years?

A: I would like to continue to be a chief quality officer, potentially for an entire healthcare system.

Q: If you weren’t a doctor, what would you be doing right now?

A: Writing romance novels.

Q: What’s the best book you’ve read recently? Why?

A: “Mountains Beyond Mountains” by Tracy Kidder. It’s about Dr. Paul Farmer’s work in Haiti. Really exemplifies that one person can change lives.

Q: How many Apple products (phones, iPods, tablets, iTunes, etc.) do you interface with in a given week?

A: I’ve been infiltrated with Apples. My iPhone seldom leaves my hand. I use an iPad for notes and to chart. I run three miles a day with my iPod. I own two Macs.

Q: What’s next in your Netflix queue?

A: I have a six- and a seven-year-old, so anything with animation. Last great movie I saw was “Silver Linings Playbook.”

Richard Quinn is a freelance writer in New Jersey.

Dr. Fedderson

Growing up in America’s heartland, Julie Fedderson, MD, realized at an early age that something wasn’t right with the U.S. healthcare system. Her grandmother, a “headstrong” immigrant from the Czech Republic, died of colon cancer when Dr. Fedderson was young, and that experience—watching a loved one “reduced to tears” trying to navigate a complicated and impersonal healthcare system in rural Nebraska—made her realize “how important having dedicated physicians is.”

“It may sound naïve, but I really wanted to help people,” says Dr. Fedderson, who grew up and went to high school in a small town two hours from an urban center. She eventually attended college in what she saw as the big city—Lincoln, Nebraska. After attending the University of Nebraska, Dr. Fedderson went to medical school at the University of Nebraska Medical School (UNMC) in Omaha. She did her residency at Baylor College of Medicine in Houston, then returned to Nebraska.

Since 2003, she has worked as a hospitalist and is currently an assistant professor in the department of internal medicine at the UNMC. Her story, practicing as a “traditional” internist for several years before making the switch to HM, is similar to many in hospital medicine.

“I wanted to make an impact on the seamless transition of in-house care to outpatient care,” says one of the newest members of Team Hospitalist, the volunteer editorial advisory board of The Hospitalist. “The two are so intricately intertwined, yet so siloed, and many times the patient—who is the least capable of navigating our complex systems—is the one who is left with the responsibility to do it. I wanted to improve that.”

Dr. Fedderson

Dr. Fedderson is working toward her master’s degree from the University of Colorado’s Executive MBA Program. She is the resident supervisor for UNMC’s Physicians Midtown Clinic, serves as the Nebraska Medical Center’s enterprise chief quality and outcomes officer, and is on the board of directors of Nebraska Health Partners. She is also a member of the department of internal medicine’s executive committee.

Question: What do you like most about working as a hospitalist?

Answer: The ability to implement rapid change of process in a controlled environment.

Q: What do you dislike most?

A: The regulatory ties placed on hospitals that may not be quality oriented [and] the difficulty of handling the outpatient care of uninsured or underinsured patients.

Q: What’s the best advice you ever received?

A: For life: Shut up and listen. From one of my attendings during my residency: Piss, pus, and hostility all must come out eventually.

Q: What’s the biggest change you’ve seen in hospital medicine in your career?

A: The shift to technology as a basis of care. When done well, it is phenomenal. When done without appropriate thought, it can be disastrous for patients and providers alike.

Q: Why is it important for you, as a hospitalist group leader, to continue seeing patients?

A: How do you implement change if you have no skin in the game? I stay current and see patients to see the system work firsthand and to provide innovative—but practical—solutions.

Q: Outside of patient care, what are your career interests?

A: I am currently our new chief quality and outcomes officer at The Nebraska Medical Center Enterprise. I am also involved as a physician champion for our electronic health record [EHR] implementation and in clinical documentation improvement at all levels.

Q: What is your biggest professional challenge?

A: There are a lot of daunting things coming from entities that don’t necessarily have a patient’s best interests at heart. Keeping sane doing the “regulatory” quality while still providing good quality care is a challenge. Sometimes it feels like a game—but obviously a game with serious consequences.

Q: What is your biggest professional reward?

A: Frankly, [it is] when one of my colleagues relates to me a success story with a new process or plan. I hear so many of my medical friends so dissatisfied with healthcare’s trajectory—they’re burned out, telling their kids to not go into medicine. When I see someone get that spark back for their career and their reason for choosing it, that makes me feel fantastic.

Q: When you aren’t working, what is important to you?

A: I have two boys, and they hung the moon. We hang out as much as possible. I am also into physical fitness, so I try to run, do yoga, and hike as much as I can.

Q: Where do you see yourself in 10 years?

A: I would like to continue to be a chief quality officer, potentially for an entire healthcare system.

Q: If you weren’t a doctor, what would you be doing right now?

A: Writing romance novels.

Q: What’s the best book you’ve read recently? Why?

A: “Mountains Beyond Mountains” by Tracy Kidder. It’s about Dr. Paul Farmer’s work in Haiti. Really exemplifies that one person can change lives.

Q: How many Apple products (phones, iPods, tablets, iTunes, etc.) do you interface with in a given week?

A: I’ve been infiltrated with Apples. My iPhone seldom leaves my hand. I use an iPad for notes and to chart. I run three miles a day with my iPod. I own two Macs.

Q: What’s next in your Netflix queue?

A: I have a six- and a seven-year-old, so anything with animation. Last great movie I saw was “Silver Linings Playbook.”

Richard Quinn is a freelance writer in New Jersey.

Dr. Fedderson

Growing up in America’s heartland, Julie Fedderson, MD, realized at an early age that something wasn’t right with the U.S. healthcare system. Her grandmother, a “headstrong” immigrant from the Czech Republic, died of colon cancer when Dr. Fedderson was young, and that experience—watching a loved one “reduced to tears” trying to navigate a complicated and impersonal healthcare system in rural Nebraska—made her realize “how important having dedicated physicians is.”

“It may sound naïve, but I really wanted to help people,” says Dr. Fedderson, who grew up and went to high school in a small town two hours from an urban center. She eventually attended college in what she saw as the big city—Lincoln, Nebraska. After attending the University of Nebraska, Dr. Fedderson went to medical school at the University of Nebraska Medical School (UNMC) in Omaha. She did her residency at Baylor College of Medicine in Houston, then returned to Nebraska.

Since 2003, she has worked as a hospitalist and is currently an assistant professor in the department of internal medicine at the UNMC. Her story, practicing as a “traditional” internist for several years before making the switch to HM, is similar to many in hospital medicine.

“I wanted to make an impact on the seamless transition of in-house care to outpatient care,” says one of the newest members of Team Hospitalist, the volunteer editorial advisory board of The Hospitalist. “The two are so intricately intertwined, yet so siloed, and many times the patient—who is the least capable of navigating our complex systems—is the one who is left with the responsibility to do it. I wanted to improve that.”

Dr. Fedderson

Dr. Fedderson is working toward her master’s degree from the University of Colorado’s Executive MBA Program. She is the resident supervisor for UNMC’s Physicians Midtown Clinic, serves as the Nebraska Medical Center’s enterprise chief quality and outcomes officer, and is on the board of directors of Nebraska Health Partners. She is also a member of the department of internal medicine’s executive committee.

Question: What do you like most about working as a hospitalist?

Answer: The ability to implement rapid change of process in a controlled environment.

Q: What do you dislike most?

A: The regulatory ties placed on hospitals that may not be quality oriented [and] the difficulty of handling the outpatient care of uninsured or underinsured patients.

Q: What’s the best advice you ever received?

A: For life: Shut up and listen. From one of my attendings during my residency: Piss, pus, and hostility all must come out eventually.

Q: What’s the biggest change you’ve seen in hospital medicine in your career?

A: The shift to technology as a basis of care. When done well, it is phenomenal. When done without appropriate thought, it can be disastrous for patients and providers alike.

Q: Why is it important for you, as a hospitalist group leader, to continue seeing patients?

A: How do you implement change if you have no skin in the game? I stay current and see patients to see the system work firsthand and to provide innovative—but practical—solutions.

Q: Outside of patient care, what are your career interests?

A: I am currently our new chief quality and outcomes officer at The Nebraska Medical Center Enterprise. I am also involved as a physician champion for our electronic health record [EHR] implementation and in clinical documentation improvement at all levels.

Q: What is your biggest professional challenge?

A: There are a lot of daunting things coming from entities that don’t necessarily have a patient’s best interests at heart. Keeping sane doing the “regulatory” quality while still providing good quality care is a challenge. Sometimes it feels like a game—but obviously a game with serious consequences.

Q: What is your biggest professional reward?

A: Frankly, [it is] when one of my colleagues relates to me a success story with a new process or plan. I hear so many of my medical friends so dissatisfied with healthcare’s trajectory—they’re burned out, telling their kids to not go into medicine. When I see someone get that spark back for their career and their reason for choosing it, that makes me feel fantastic.

Q: When you aren’t working, what is important to you?

A: I have two boys, and they hung the moon. We hang out as much as possible. I am also into physical fitness, so I try to run, do yoga, and hike as much as I can.

Q: Where do you see yourself in 10 years?

A: I would like to continue to be a chief quality officer, potentially for an entire healthcare system.

Q: If you weren’t a doctor, what would you be doing right now?

A: Writing romance novels.

Q: What’s the best book you’ve read recently? Why?

A: “Mountains Beyond Mountains” by Tracy Kidder. It’s about Dr. Paul Farmer’s work in Haiti. Really exemplifies that one person can change lives.

Q: How many Apple products (phones, iPods, tablets, iTunes, etc.) do you interface with in a given week?

A: I’ve been infiltrated with Apples. My iPhone seldom leaves my hand. I use an iPad for notes and to chart. I run three miles a day with my iPod. I own two Macs.

Q: What’s next in your Netflix queue?

A: I have a six- and a seven-year-old, so anything with animation. Last great movie I saw was “Silver Linings Playbook.”

Richard Quinn is a freelance writer in New Jersey.

In March 2012, physicians and staff of the hospital medicine division at the University of California San Francisco (UCSF) kicked off a high-value care (HVC) program to more efficiently tie quality care delivery to healthcare costs. Early results suggest the plan is working, and the lead author of a recent paper believes other HM groups could use the program as a guide to implement similar plans in their own practices.

"There are a lot of idiosyncrasies between different programs and different medical centers, particularly when it comes to cost," says Christopher Moriates, MD, co-chair of the UCSF division's high-value care committee. "Many of the things we're identifying are indeed transplantable…but not all of them."

Published online this month in the Journal of Hospital Medicine, authors identify six ongoing HVC projects that have shown encouraging data in promoting improved healthcare value and clinician engagement. The projects are designed to:

• Reduce unnecessary nebulizer use;
• Curb overuse and inappropriate use of gastric stress ulcer prophylaxis;
• Encourage better blood utilization stewardship;
• Improve the use of telemetry;
• Scale back on inappropriate, repeat inpatient echocardiograms; and
• Reduce the number of ionized calcium labs.

To date, the nebulizer program has dropped usage rates by more than 50% on a high-acuity medical floor. Along with merely identifying waste-reduction and cost-savings plans, the program spells out goals for each initiative, strategies for reaching those goals, and next steps.

"We're not just creating these pilot programs and asking people to do more," Dr. Moriates says. "We're really thinking through these interventions as complete packages. We're really baking it into our culture. As we address what people actually do and change the systems around and change the way we think about things, it becomes standard practice and thus more likely to be sustainable." TH

Visit our website for more information on cost-effective, value-based patient care.

In March 2012, physicians and staff of the hospital medicine division at the University of California San Francisco (UCSF) kicked off a high-value care (HVC) program to more efficiently tie quality care delivery to healthcare costs. Early results suggest the plan is working, and the lead author of a recent paper believes other HM groups could use the program as a guide to implement similar plans in their own practices.

"There are a lot of idiosyncrasies between different programs and different medical centers, particularly when it comes to cost," says Christopher Moriates, MD, co-chair of the UCSF division's high-value care committee. "Many of the things we're identifying are indeed transplantable…but not all of them."

Published online this month in the Journal of Hospital Medicine, authors identify six ongoing HVC projects that have shown encouraging data in promoting improved healthcare value and clinician engagement. The projects are designed to:

• Reduce unnecessary nebulizer use;
• Curb overuse and inappropriate use of gastric stress ulcer prophylaxis;
• Encourage better blood utilization stewardship;
• Improve the use of telemetry;
• Scale back on inappropriate, repeat inpatient echocardiograms; and
• Reduce the number of ionized calcium labs.

To date, the nebulizer program has dropped usage rates by more than 50% on a high-acuity medical floor. Along with merely identifying waste-reduction and cost-savings plans, the program spells out goals for each initiative, strategies for reaching those goals, and next steps.

"We're not just creating these pilot programs and asking people to do more," Dr. Moriates says. "We're really thinking through these interventions as complete packages. We're really baking it into our culture. As we address what people actually do and change the systems around and change the way we think about things, it becomes standard practice and thus more likely to be sustainable." TH

Visit our website for more information on cost-effective, value-based patient care.

In March 2012, physicians and staff of the hospital medicine division at the University of California San Francisco (UCSF) kicked off a high-value care (HVC) program to more efficiently tie quality care delivery to healthcare costs. Early results suggest the plan is working, and the lead author of a recent paper believes other HM groups could use the program as a guide to implement similar plans in their own practices.

"There are a lot of idiosyncrasies between different programs and different medical centers, particularly when it comes to cost," says Christopher Moriates, MD, co-chair of the UCSF division's high-value care committee. "Many of the things we're identifying are indeed transplantable…but not all of them."

Published online this month in the Journal of Hospital Medicine, authors identify six ongoing HVC projects that have shown encouraging data in promoting improved healthcare value and clinician engagement. The projects are designed to:

• Reduce unnecessary nebulizer use;
• Curb overuse and inappropriate use of gastric stress ulcer prophylaxis;
• Encourage better blood utilization stewardship;
• Improve the use of telemetry;
• Scale back on inappropriate, repeat inpatient echocardiograms; and
• Reduce the number of ionized calcium labs.

To date, the nebulizer program has dropped usage rates by more than 50% on a high-acuity medical floor. Along with merely identifying waste-reduction and cost-savings plans, the program spells out goals for each initiative, strategies for reaching those goals, and next steps.

"We're not just creating these pilot programs and asking people to do more," Dr. Moriates says. "We're really thinking through these interventions as complete packages. We're really baking it into our culture. As we address what people actually do and change the systems around and change the way we think about things, it becomes standard practice and thus more likely to be sustainable." TH

Visit our website for more information on cost-effective, value-based patient care.

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

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

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

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

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

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

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

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

Visit our website for more information on hospital readmissions penalties.

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

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

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

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

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

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

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

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

Visit our website for more information on hospital readmissions penalties.

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

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

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

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

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

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

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

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

Visit our website for more information on hospital readmissions penalties.

Klaus Suehler, MD, FHM, grew up in Germany and studied in Munich but dreamed of one day becoming the next Marcus Welby, MD. So he trained in Minnesota and has now worked for the same physician group for nearly two decades.

“Like many of us, I had some romantic ideas of being a doctor, running around with my black bag, figuring out a patient’s diagnosis that everyone else had missed,” says Dr. Suehler, one of the newest members of Team Hospitalist, the volunteer editorial advisory group for The Hospitalist. “As I was more seriously contemplating medicine, hospital medicine [presented] an intellectual challenge, the opportunity of applying science outside of a lab, and to be of service and to develop relationships with one’s patients.”

Dr. Suehler says internal medicine appealed to him because it was, and still is, “somewhat of an art” and affords him professional freedom. In 1994, straight out of residency, he joined Midwest Internal Medicine in Coon Rapids, Minn., an internal medicine group that, at the time, was breaking ground by dedicating physicians to hospital-based positions.

“The time was right. … Being at the hospital was kind of a continuation of residency anyhow. Some of my friends at my teaching hospital were starting a hospitalist service as well, and the whole concept appealed to me,” he says. “After juggling outpatient clinic and my weeks at the hospital for about five to six years, I finally became a full-time hospitalist.”

Since 2000, he has worked only as a hospitalist with Midwest Internal Medicine, serving as the hospitalist group’s leader for eight of those years.

Question: What do you like most about working as a hospitalist?

Answer: I like the challenging cases and the opportunity to collaborate with other specialists and the staff on the wards. We always learn from each other within our hospitalist group, as we are taking care of each other’s patients. There is ample opportunity to informally discuss complex patients and their treatment.

Q: What do you dislike most?

A: Overly busy call nights. I must say, though, at least at our hospital we have the opportunity to close our service for admissions, if we feel the workload would no longer be safe.

Q: What’s the best advice you ever received?

A: There was no single advice that I can recall related to my HM practice. What really helped very much was the ongoing input and advice that I received through formal leadership training, which I received during the time as the leader of our group. It helped me to be more grounded, resilient, and effective, both as a professional and a person.

Q: What’s the biggest change you’ve seen in HM in your career?

A: The field has essentially become its own specialty. There is an increased focus on the operational part of taking care of patients in the hospital, as well as the transitions, which goes beyond the medical aspects of patient care for, let’s say, patients presenting with congestive heart failure.

Q: Why is it important for group leaders to continue seeing patients?

A: It adds credibility to their leadership. There is nothing like shouldering new responsibilities or high workloads together with your partners.

Q: Outside of patient care, what about your job interests you the most?

A: Quality and patient safety are of great interest for me. Our hospitalist group consists of about 25 hospitalists, but there are about 200 hospitalists within our health system. I participate in a steering committee within the larger system to improve medication reconciliation.

I also continue to be interested in leadership. Especially in the years to come, with all the upcoming changes in the delivery of care, performance measures, and modes of reimbursement, there will be an increased need for physician leaders.

Q: What is your biggest professional challenge?

A: It is a good sign that I have to think for a while to come up with an answer. It probably is taking care of patients with narcotic addictions or difficult personalities. Every given week there are probably one or two such patients on the service. It is challenging to do these patients justice and to provide the appropriate medical care.

Q: What is your biggest professional reward?

A: The respect of my physician colleagues, the nursing staff, and the gratitude of my patients and their families. One of my most moving experiences was when a former patient of mine walked over to my table in a Chinese restaurant and said: “Thank you for saving my life!”

Q: You were one of the first hospitalists designated Fellow in Hospital Medicine. What does that mean to you?

A: It gave me some formal recognition for the years of service I have put into HM, both in patient care and leadership, as well as for my level of experience.

Q: When you aren’t working, what is important to you?

A: The relationships with the people around me (marriage, family, friendship). In terms of what I do, it is traveling, exercising, reading, and being appreciative of the moment.

Q: Where do you see yourself in 10 years?

A: I want to continue to work as a hospitalist. I am looking into leadership opportunities. I can see shifting my focus more toward leadership or consulting roles again within the next 10 years.

Q: If you weren’t a doctor, what would you be doing right now?

A: I think I would be a lawyer. I know there is a perceived friction between these professions, but there are some common themes, such as providing expert advice or professional help in times of need.

Q: What’s the best book you’ve read recently?

A: The Angel’s Game by Carlos Ruiz Zafon. It is an incredibly captivating story, with a marvelous imagery of old Barcelona before the Spanish Civil War.

Q: How many Apple products do you interface with in a given week?

A: Two: iPhone and iPad.

Richard Quinn is a freelance writer in New Jersey.

Klaus Suehler, MD, FHM, grew up in Germany and studied in Munich but dreamed of one day becoming the next Marcus Welby, MD. So he trained in Minnesota and has now worked for the same physician group for nearly two decades.

“Like many of us, I had some romantic ideas of being a doctor, running around with my black bag, figuring out a patient’s diagnosis that everyone else had missed,” says Dr. Suehler, one of the newest members of Team Hospitalist, the volunteer editorial advisory group for The Hospitalist. “As I was more seriously contemplating medicine, hospital medicine [presented] an intellectual challenge, the opportunity of applying science outside of a lab, and to be of service and to develop relationships with one’s patients.”

Dr. Suehler says internal medicine appealed to him because it was, and still is, “somewhat of an art” and affords him professional freedom. In 1994, straight out of residency, he joined Midwest Internal Medicine in Coon Rapids, Minn., an internal medicine group that, at the time, was breaking ground by dedicating physicians to hospital-based positions.

“The time was right. … Being at the hospital was kind of a continuation of residency anyhow. Some of my friends at my teaching hospital were starting a hospitalist service as well, and the whole concept appealed to me,” he says. “After juggling outpatient clinic and my weeks at the hospital for about five to six years, I finally became a full-time hospitalist.”

Since 2000, he has worked only as a hospitalist with Midwest Internal Medicine, serving as the hospitalist group’s leader for eight of those years.

Question: What do you like most about working as a hospitalist?

Answer: I like the challenging cases and the opportunity to collaborate with other specialists and the staff on the wards. We always learn from each other within our hospitalist group, as we are taking care of each other’s patients. There is ample opportunity to informally discuss complex patients and their treatment.

Q: What do you dislike most?

A: Overly busy call nights. I must say, though, at least at our hospital we have the opportunity to close our service for admissions, if we feel the workload would no longer be safe.

Q: What’s the best advice you ever received?

A: There was no single advice that I can recall related to my HM practice. What really helped very much was the ongoing input and advice that I received through formal leadership training, which I received during the time as the leader of our group. It helped me to be more grounded, resilient, and effective, both as a professional and a person.

Q: What’s the biggest change you’ve seen in HM in your career?

A: The field has essentially become its own specialty. There is an increased focus on the operational part of taking care of patients in the hospital, as well as the transitions, which goes beyond the medical aspects of patient care for, let’s say, patients presenting with congestive heart failure.

Q: Why is it important for group leaders to continue seeing patients?

A: It adds credibility to their leadership. There is nothing like shouldering new responsibilities or high workloads together with your partners.

Q: Outside of patient care, what about your job interests you the most?

A: Quality and patient safety are of great interest for me. Our hospitalist group consists of about 25 hospitalists, but there are about 200 hospitalists within our health system. I participate in a steering committee within the larger system to improve medication reconciliation.

I also continue to be interested in leadership. Especially in the years to come, with all the upcoming changes in the delivery of care, performance measures, and modes of reimbursement, there will be an increased need for physician leaders.

Q: What is your biggest professional challenge?

A: It is a good sign that I have to think for a while to come up with an answer. It probably is taking care of patients with narcotic addictions or difficult personalities. Every given week there are probably one or two such patients on the service. It is challenging to do these patients justice and to provide the appropriate medical care.

Q: What is your biggest professional reward?

A: The respect of my physician colleagues, the nursing staff, and the gratitude of my patients and their families. One of my most moving experiences was when a former patient of mine walked over to my table in a Chinese restaurant and said: “Thank you for saving my life!”

Q: You were one of the first hospitalists designated Fellow in Hospital Medicine. What does that mean to you?

A: It gave me some formal recognition for the years of service I have put into HM, both in patient care and leadership, as well as for my level of experience.

Q: When you aren’t working, what is important to you?

A: The relationships with the people around me (marriage, family, friendship). In terms of what I do, it is traveling, exercising, reading, and being appreciative of the moment.

Q: Where do you see yourself in 10 years?

A: I want to continue to work as a hospitalist. I am looking into leadership opportunities. I can see shifting my focus more toward leadership or consulting roles again within the next 10 years.

Q: If you weren’t a doctor, what would you be doing right now?

A: I think I would be a lawyer. I know there is a perceived friction between these professions, but there are some common themes, such as providing expert advice or professional help in times of need.

Q: What’s the best book you’ve read recently?

A: The Angel’s Game by Carlos Ruiz Zafon. It is an incredibly captivating story, with a marvelous imagery of old Barcelona before the Spanish Civil War.

Q: How many Apple products do you interface with in a given week?

A: Two: iPhone and iPad.

Richard Quinn is a freelance writer in New Jersey.

Klaus Suehler, MD, FHM, grew up in Germany and studied in Munich but dreamed of one day becoming the next Marcus Welby, MD. So he trained in Minnesota and has now worked for the same physician group for nearly two decades.

“Like many of us, I had some romantic ideas of being a doctor, running around with my black bag, figuring out a patient’s diagnosis that everyone else had missed,” says Dr. Suehler, one of the newest members of Team Hospitalist, the volunteer editorial advisory group for The Hospitalist. “As I was more seriously contemplating medicine, hospital medicine [presented] an intellectual challenge, the opportunity of applying science outside of a lab, and to be of service and to develop relationships with one’s patients.”

Dr. Suehler says internal medicine appealed to him because it was, and still is, “somewhat of an art” and affords him professional freedom. In 1994, straight out of residency, he joined Midwest Internal Medicine in Coon Rapids, Minn., an internal medicine group that, at the time, was breaking ground by dedicating physicians to hospital-based positions.

“The time was right. … Being at the hospital was kind of a continuation of residency anyhow. Some of my friends at my teaching hospital were starting a hospitalist service as well, and the whole concept appealed to me,” he says. “After juggling outpatient clinic and my weeks at the hospital for about five to six years, I finally became a full-time hospitalist.”

Since 2000, he has worked only as a hospitalist with Midwest Internal Medicine, serving as the hospitalist group’s leader for eight of those years.

Question: What do you like most about working as a hospitalist?

Answer: I like the challenging cases and the opportunity to collaborate with other specialists and the staff on the wards. We always learn from each other within our hospitalist group, as we are taking care of each other’s patients. There is ample opportunity to informally discuss complex patients and their treatment.

Q: What do you dislike most?

A: Overly busy call nights. I must say, though, at least at our hospital we have the opportunity to close our service for admissions, if we feel the workload would no longer be safe.

Q: What’s the best advice you ever received?

A: There was no single advice that I can recall related to my HM practice. What really helped very much was the ongoing input and advice that I received through formal leadership training, which I received during the time as the leader of our group. It helped me to be more grounded, resilient, and effective, both as a professional and a person.

Q: What’s the biggest change you’ve seen in HM in your career?

A: The field has essentially become its own specialty. There is an increased focus on the operational part of taking care of patients in the hospital, as well as the transitions, which goes beyond the medical aspects of patient care for, let’s say, patients presenting with congestive heart failure.

Q: Why is it important for group leaders to continue seeing patients?

A: It adds credibility to their leadership. There is nothing like shouldering new responsibilities or high workloads together with your partners.

Q: Outside of patient care, what about your job interests you the most?

A: Quality and patient safety are of great interest for me. Our hospitalist group consists of about 25 hospitalists, but there are about 200 hospitalists within our health system. I participate in a steering committee within the larger system to improve medication reconciliation.

I also continue to be interested in leadership. Especially in the years to come, with all the upcoming changes in the delivery of care, performance measures, and modes of reimbursement, there will be an increased need for physician leaders.

Q: What is your biggest professional challenge?

A: It is a good sign that I have to think for a while to come up with an answer. It probably is taking care of patients with narcotic addictions or difficult personalities. Every given week there are probably one or two such patients on the service. It is challenging to do these patients justice and to provide the appropriate medical care.

Q: What is your biggest professional reward?

A: The respect of my physician colleagues, the nursing staff, and the gratitude of my patients and their families. One of my most moving experiences was when a former patient of mine walked over to my table in a Chinese restaurant and said: “Thank you for saving my life!”

Q: You were one of the first hospitalists designated Fellow in Hospital Medicine. What does that mean to you?

A: It gave me some formal recognition for the years of service I have put into HM, both in patient care and leadership, as well as for my level of experience.

Q: When you aren’t working, what is important to you?

A: The relationships with the people around me (marriage, family, friendship). In terms of what I do, it is traveling, exercising, reading, and being appreciative of the moment.

Q: Where do you see yourself in 10 years?

A: I want to continue to work as a hospitalist. I am looking into leadership opportunities. I can see shifting my focus more toward leadership or consulting roles again within the next 10 years.

Q: If you weren’t a doctor, what would you be doing right now?

A: I think I would be a lawyer. I know there is a perceived friction between these professions, but there are some common themes, such as providing expert advice or professional help in times of need.

Q: What’s the best book you’ve read recently?

A: The Angel’s Game by Carlos Ruiz Zafon. It is an incredibly captivating story, with a marvelous imagery of old Barcelona before the Spanish Civil War.

Q: How many Apple products do you interface with in a given week?

A: Two: iPhone and iPad.

Richard Quinn is a freelance writer in New Jersey.

Dr. Lenchus

Congress has once again delayed implementation of draconian Medicare cuts tied to the sustainable growth rate (SGR) formula. It was the 17th temporary patch applied to the ailing physician reimbursement program, so the decision caused little surprise.

But with the same legislation—the Protecting Access to Medicare Act of 2014—being used to delay the long-awaited debut of ICD-10, many hospitalists and physicians couldn’t help but wonder whether billing and coding would now be as much of a political football as the SGR fix.¹

The upshot: It doesn’t seem that way.

“I think it’s two separate issues,” says Phyllis “PJ” Floyd, RN, BSN, MBA, NE-BC, CCA, director of health information services and clinical documentation improvement at Medical University of South Carolina (MUSC) in Charleston, S.C. “The fact that it was all in one bill, I don’t know that it was well thought out as much as it was, ‘Let’s put the ICD-10 in here at the same time.’

“It was just a few sentences, and then it wasn’t even brought up in the discussion on the floor.”

Four policy wonks interviewed by The Hospitalist concurred that while tying the ICD-10 delay to the SGR issue was an unexpected and frustrating development, the coding system likely will be implemented in the relative short term. Meanwhile, a long-term resolution of the SGR dilemma remains much more elusive.

“For about 12 hours, I felt relief about the ICD-10 [being delayed], and then I just realized, it’s still coming, presumably,” says John Nelson, MD, MHM, a co-founder and past president of SHM and medical director of the hospitalist practice at Overlake Hospital Medical Center in Bellevue, Wash. “[It’s] like a patient who needs surgery and finds out it’s canceled for the day and he’ll have it tomorrow. Well, that’s good for right now, but [he] still has to face this eventually.”

“Doc-Pay” Fix Near?

Congress’ recent decision to delay both an SGR fix and the ICD-10 are troubling to some hospitalists and others for different reasons.

The SGR extension through this year’s end means that physicians do not face a 24% cut to physician payments under Medicare. SHM has long lobbied against temporary patches to the SGR, repeatedly backing legislation that would once and for all scrap the formula and replace it with something sustainable.

The SGR formula was first crafted in 1997, but the now often-delayed cuts were a byproduct of the federal sequester that was included in the Budget Control Act of 2011. At the time, the massive reduction to Medicare payments was tied to political brinksmanship over the country’s debt ceiling. The cuts were implemented as a doomsday scenario that was never likely to actually happen, but despite negotiations over the past three years, no long-term compromise can be found. Paying for the reform remains the main stumbling block.

“I think, this year, Congress was as close as it’s been in a long time to enacting a serious fix, aided by the agreement of major professional societies like the American College of Physicians and American College of Surgeons,” says David Howard, PhD, an associate professor in the department of health policy and management at the Rollins School of Public Health at Emory University in Atlanta. “They were all on board with this solution. ... Who knows, maybe if the economic situation continues to improve [and] tax revenues continue to go up...that will create a more favorable environment for compromise.”

Dr. Howard adds that while Congress might be close to a solution in theory, agreement on how to offset the roughly $100 billion in costs “is just very difficult.” That is why the healthcare professor is pessimistic that a long-term fix is truly at hand.

“The places where Congress might have looked for savings to offset the cost of the doc fix, such as hospital reimbursement rates or payment rates to Medicare Advantage plans—those are exactly the areas that the Affordable Care Act is targeting to pay for insurance expansion,” Dr. Howard adds. “So those areas of savings are not going to be available to offset the cost of the doc fix.”

ICD-10 Delays “Unfair”

Dr. Lenchus

The medical coding conundrum presents a different set of issues. The delay in transitioning healthcare providers from the ICD-9 medical coding classification system to the more complicated ICD-10 means the upgraded system is now against an Oct. 1, 2015, deadline. This comes after the Centers for Medicare & Medicaid Services (CMS) already pushed back the original implementation date for ICD-10 by one year.

SHM Public Policy Committee member Joshua Lenchus, DO, RPh, FACP, SFHM, says he thinks most doctors are content with the delay, particularly in light of some estimates that show that only about 20% of physicians “have actually initiated the ICD-10 transition.” But he also notes that it’s unfair to the health systems that have prepared for ICD-10.

“ICD-9 has a little more than 14,000 diagnostic codes and nearly 4,000 procedural codes. That is to be contrasted to ICD-10, which has more than 68,000 diagnostic codes ... and over 72,000 procedural codes,” Dr. Lenchus says. “So, it is not surprising that many take solace in the delay.”

Dr. Nelson says the level of frustration for hospitalists is growing; however, the level of disruption for hospitals and health systems is reaching a boiling point.

“Of course, in some places, hospitalists may be the physician lead on ICD-10 efforts, so [they are] very much wrapped up in the problem of ‘What do we do now?’”

The answer, at least to the Coalition for ICD-10, a group of medical/technology trade groups, is to fight to ensure that the delays go no further. In an April letter to CMS Administrator Marilyn Tavenner, the coalition made that case, noting that in 2012, “CMS estimated the cost to the healthcare industry of a one-year delay to be as much as $6.6 billion, or approximately 30% of the $22 billion that CMS estimated had been invested or budgeted for ICD-10 implementation.”²

The letter went on to explain that the disruption and cost will grow each time the ICD-10 deadline is pushed.

“Furthermore, as CMS stated in 2012, implementation costs will continue to increase considerably with every year of a delay,” according to the letter. “The lost opportunity costs of failing to move to a more effective code set also continue to climb every year.”

Stay Engaged, Switch Gears

One of Floyd’s biggest concerns is that the ICD-10 implementation delays will affect physician engagement. The hospitalist groups at MUSC began training for ICD-10 in January 2013; however, the preparation and training were geared toward a 2014 implementation.

“You have to switch gears a little bit,” she says. “What we plan to do now is begin to do heavy auditing, and then from those audits we can give real-time feedback on what we’re doing well and what we’re not doing well. So I think that will be a method for engagement.”

She urges hospitalists, practice leaders, and informatics professionals to discuss ICD-10 not as a theoretical application, but as one tied to reimbursement that will have major impact in the years ahead. To that end, the American Health Information Management Association highlights the fact that the new coding system will result in higher-quality data that can improve performance measures, provide “increased sensitivity” to reimbursement methodologies, and help with stronger public health surveillance.³

“A lot of physicians see this as a hospital issue, and I think that’s why they shy away,” Floyd says. “Now there are some physicians who are interested in how well the hospital does, but the other piece is that it does affect things like [reduced] risk of mortality [and] comparison of data worldwide—those are things that we just have to continue to reiterate … and give them real examples.”

Richard Quinn is a freelance writer in New Jersey.

References

1. Govtrack. H.R. 4302: Protecting Access to Medicare Act of 2014. https://www.govtrack.us/congress/bills/113/hr4302. Accessed June 5, 2014.
2. Coalition for ICD. Letter to CMS Administrator Tavenner, April 11, 2014. http://coalitionforicd10.wordpress.com/2014/03/26/letter-from-the-coalition-for-icd-10. Accessed June 5, 2014.
3. American Health Information Management Association. ICD-10-CM/PCS Transition: Planning and Preparation Checklist. http://journal.ahima.org/wp-content/uploads/ICD10-checklist.pdf. Accessed June 5, 2014.

Dr. Lenchus

Congress has once again delayed implementation of draconian Medicare cuts tied to the sustainable growth rate (SGR) formula. It was the 17th temporary patch applied to the ailing physician reimbursement program, so the decision caused little surprise.

But with the same legislation—the Protecting Access to Medicare Act of 2014—being used to delay the long-awaited debut of ICD-10, many hospitalists and physicians couldn’t help but wonder whether billing and coding would now be as much of a political football as the SGR fix.¹

The upshot: It doesn’t seem that way.

“I think it’s two separate issues,” says Phyllis “PJ” Floyd, RN, BSN, MBA, NE-BC, CCA, director of health information services and clinical documentation improvement at Medical University of South Carolina (MUSC) in Charleston, S.C. “The fact that it was all in one bill, I don’t know that it was well thought out as much as it was, ‘Let’s put the ICD-10 in here at the same time.’

“It was just a few sentences, and then it wasn’t even brought up in the discussion on the floor.”

Four policy wonks interviewed by The Hospitalist concurred that while tying the ICD-10 delay to the SGR issue was an unexpected and frustrating development, the coding system likely will be implemented in the relative short term. Meanwhile, a long-term resolution of the SGR dilemma remains much more elusive.

“For about 12 hours, I felt relief about the ICD-10 [being delayed], and then I just realized, it’s still coming, presumably,” says John Nelson, MD, MHM, a co-founder and past president of SHM and medical director of the hospitalist practice at Overlake Hospital Medical Center in Bellevue, Wash. “[It’s] like a patient who needs surgery and finds out it’s canceled for the day and he’ll have it tomorrow. Well, that’s good for right now, but [he] still has to face this eventually.”

“Doc-Pay” Fix Near?

Congress’ recent decision to delay both an SGR fix and the ICD-10 are troubling to some hospitalists and others for different reasons.

The SGR extension through this year’s end means that physicians do not face a 24% cut to physician payments under Medicare. SHM has long lobbied against temporary patches to the SGR, repeatedly backing legislation that would once and for all scrap the formula and replace it with something sustainable.

The SGR formula was first crafted in 1997, but the now often-delayed cuts were a byproduct of the federal sequester that was included in the Budget Control Act of 2011. At the time, the massive reduction to Medicare payments was tied to political brinksmanship over the country’s debt ceiling. The cuts were implemented as a doomsday scenario that was never likely to actually happen, but despite negotiations over the past three years, no long-term compromise can be found. Paying for the reform remains the main stumbling block.

“I think, this year, Congress was as close as it’s been in a long time to enacting a serious fix, aided by the agreement of major professional societies like the American College of Physicians and American College of Surgeons,” says David Howard, PhD, an associate professor in the department of health policy and management at the Rollins School of Public Health at Emory University in Atlanta. “They were all on board with this solution. ... Who knows, maybe if the economic situation continues to improve [and] tax revenues continue to go up...that will create a more favorable environment for compromise.”

Dr. Howard adds that while Congress might be close to a solution in theory, agreement on how to offset the roughly $100 billion in costs “is just very difficult.” That is why the healthcare professor is pessimistic that a long-term fix is truly at hand.

“The places where Congress might have looked for savings to offset the cost of the doc fix, such as hospital reimbursement rates or payment rates to Medicare Advantage plans—those are exactly the areas that the Affordable Care Act is targeting to pay for insurance expansion,” Dr. Howard adds. “So those areas of savings are not going to be available to offset the cost of the doc fix.”

ICD-10 Delays “Unfair”

Dr. Lenchus

The medical coding conundrum presents a different set of issues. The delay in transitioning healthcare providers from the ICD-9 medical coding classification system to the more complicated ICD-10 means the upgraded system is now against an Oct. 1, 2015, deadline. This comes after the Centers for Medicare & Medicaid Services (CMS) already pushed back the original implementation date for ICD-10 by one year.

SHM Public Policy Committee member Joshua Lenchus, DO, RPh, FACP, SFHM, says he thinks most doctors are content with the delay, particularly in light of some estimates that show that only about 20% of physicians “have actually initiated the ICD-10 transition.” But he also notes that it’s unfair to the health systems that have prepared for ICD-10.

“ICD-9 has a little more than 14,000 diagnostic codes and nearly 4,000 procedural codes. That is to be contrasted to ICD-10, which has more than 68,000 diagnostic codes ... and over 72,000 procedural codes,” Dr. Lenchus says. “So, it is not surprising that many take solace in the delay.”

Dr. Nelson says the level of frustration for hospitalists is growing; however, the level of disruption for hospitals and health systems is reaching a boiling point.

“Of course, in some places, hospitalists may be the physician lead on ICD-10 efforts, so [they are] very much wrapped up in the problem of ‘What do we do now?’”

The answer, at least to the Coalition for ICD-10, a group of medical/technology trade groups, is to fight to ensure that the delays go no further. In an April letter to CMS Administrator Marilyn Tavenner, the coalition made that case, noting that in 2012, “CMS estimated the cost to the healthcare industry of a one-year delay to be as much as $6.6 billion, or approximately 30% of the $22 billion that CMS estimated had been invested or budgeted for ICD-10 implementation.”²

The letter went on to explain that the disruption and cost will grow each time the ICD-10 deadline is pushed.

“Furthermore, as CMS stated in 2012, implementation costs will continue to increase considerably with every year of a delay,” according to the letter. “The lost opportunity costs of failing to move to a more effective code set also continue to climb every year.”

Stay Engaged, Switch Gears

One of Floyd’s biggest concerns is that the ICD-10 implementation delays will affect physician engagement. The hospitalist groups at MUSC began training for ICD-10 in January 2013; however, the preparation and training were geared toward a 2014 implementation.

“You have to switch gears a little bit,” she says. “What we plan to do now is begin to do heavy auditing, and then from those audits we can give real-time feedback on what we’re doing well and what we’re not doing well. So I think that will be a method for engagement.”

She urges hospitalists, practice leaders, and informatics professionals to discuss ICD-10 not as a theoretical application, but as one tied to reimbursement that will have major impact in the years ahead. To that end, the American Health Information Management Association highlights the fact that the new coding system will result in higher-quality data that can improve performance measures, provide “increased sensitivity” to reimbursement methodologies, and help with stronger public health surveillance.³

“A lot of physicians see this as a hospital issue, and I think that’s why they shy away,” Floyd says. “Now there are some physicians who are interested in how well the hospital does, but the other piece is that it does affect things like [reduced] risk of mortality [and] comparison of data worldwide—those are things that we just have to continue to reiterate … and give them real examples.”

Richard Quinn is a freelance writer in New Jersey.

References

1. Govtrack. H.R. 4302: Protecting Access to Medicare Act of 2014. https://www.govtrack.us/congress/bills/113/hr4302. Accessed June 5, 2014.
2. Coalition for ICD. Letter to CMS Administrator Tavenner, April 11, 2014. http://coalitionforicd10.wordpress.com/2014/03/26/letter-from-the-coalition-for-icd-10. Accessed June 5, 2014.
3. American Health Information Management Association. ICD-10-CM/PCS Transition: Planning and Preparation Checklist. http://journal.ahima.org/wp-content/uploads/ICD10-checklist.pdf. Accessed June 5, 2014.

Dr. Lenchus

Congress has once again delayed implementation of draconian Medicare cuts tied to the sustainable growth rate (SGR) formula. It was the 17th temporary patch applied to the ailing physician reimbursement program, so the decision caused little surprise.

But with the same legislation—the Protecting Access to Medicare Act of 2014—being used to delay the long-awaited debut of ICD-10, many hospitalists and physicians couldn’t help but wonder whether billing and coding would now be as much of a political football as the SGR fix.¹

The upshot: It doesn’t seem that way.

“I think it’s two separate issues,” says Phyllis “PJ” Floyd, RN, BSN, MBA, NE-BC, CCA, director of health information services and clinical documentation improvement at Medical University of South Carolina (MUSC) in Charleston, S.C. “The fact that it was all in one bill, I don’t know that it was well thought out as much as it was, ‘Let’s put the ICD-10 in here at the same time.’

“It was just a few sentences, and then it wasn’t even brought up in the discussion on the floor.”

Four policy wonks interviewed by The Hospitalist concurred that while tying the ICD-10 delay to the SGR issue was an unexpected and frustrating development, the coding system likely will be implemented in the relative short term. Meanwhile, a long-term resolution of the SGR dilemma remains much more elusive.

“For about 12 hours, I felt relief about the ICD-10 [being delayed], and then I just realized, it’s still coming, presumably,” says John Nelson, MD, MHM, a co-founder and past president of SHM and medical director of the hospitalist practice at Overlake Hospital Medical Center in Bellevue, Wash. “[It’s] like a patient who needs surgery and finds out it’s canceled for the day and he’ll have it tomorrow. Well, that’s good for right now, but [he] still has to face this eventually.”

“Doc-Pay” Fix Near?

Congress’ recent decision to delay both an SGR fix and the ICD-10 are troubling to some hospitalists and others for different reasons.

The SGR extension through this year’s end means that physicians do not face a 24% cut to physician payments under Medicare. SHM has long lobbied against temporary patches to the SGR, repeatedly backing legislation that would once and for all scrap the formula and replace it with something sustainable.

The SGR formula was first crafted in 1997, but the now often-delayed cuts were a byproduct of the federal sequester that was included in the Budget Control Act of 2011. At the time, the massive reduction to Medicare payments was tied to political brinksmanship over the country’s debt ceiling. The cuts were implemented as a doomsday scenario that was never likely to actually happen, but despite negotiations over the past three years, no long-term compromise can be found. Paying for the reform remains the main stumbling block.

“I think, this year, Congress was as close as it’s been in a long time to enacting a serious fix, aided by the agreement of major professional societies like the American College of Physicians and American College of Surgeons,” says David Howard, PhD, an associate professor in the department of health policy and management at the Rollins School of Public Health at Emory University in Atlanta. “They were all on board with this solution. ... Who knows, maybe if the economic situation continues to improve [and] tax revenues continue to go up...that will create a more favorable environment for compromise.”

Dr. Howard adds that while Congress might be close to a solution in theory, agreement on how to offset the roughly $100 billion in costs “is just very difficult.” That is why the healthcare professor is pessimistic that a long-term fix is truly at hand.

“The places where Congress might have looked for savings to offset the cost of the doc fix, such as hospital reimbursement rates or payment rates to Medicare Advantage plans—those are exactly the areas that the Affordable Care Act is targeting to pay for insurance expansion,” Dr. Howard adds. “So those areas of savings are not going to be available to offset the cost of the doc fix.”

ICD-10 Delays “Unfair”

Dr. Lenchus

The medical coding conundrum presents a different set of issues. The delay in transitioning healthcare providers from the ICD-9 medical coding classification system to the more complicated ICD-10 means the upgraded system is now against an Oct. 1, 2015, deadline. This comes after the Centers for Medicare & Medicaid Services (CMS) already pushed back the original implementation date for ICD-10 by one year.

SHM Public Policy Committee member Joshua Lenchus, DO, RPh, FACP, SFHM, says he thinks most doctors are content with the delay, particularly in light of some estimates that show that only about 20% of physicians “have actually initiated the ICD-10 transition.” But he also notes that it’s unfair to the health systems that have prepared for ICD-10.

“ICD-9 has a little more than 14,000 diagnostic codes and nearly 4,000 procedural codes. That is to be contrasted to ICD-10, which has more than 68,000 diagnostic codes ... and over 72,000 procedural codes,” Dr. Lenchus says. “So, it is not surprising that many take solace in the delay.”

Dr. Nelson says the level of frustration for hospitalists is growing; however, the level of disruption for hospitals and health systems is reaching a boiling point.

“Of course, in some places, hospitalists may be the physician lead on ICD-10 efforts, so [they are] very much wrapped up in the problem of ‘What do we do now?’”

The answer, at least to the Coalition for ICD-10, a group of medical/technology trade groups, is to fight to ensure that the delays go no further. In an April letter to CMS Administrator Marilyn Tavenner, the coalition made that case, noting that in 2012, “CMS estimated the cost to the healthcare industry of a one-year delay to be as much as $6.6 billion, or approximately 30% of the $22 billion that CMS estimated had been invested or budgeted for ICD-10 implementation.”²

The letter went on to explain that the disruption and cost will grow each time the ICD-10 deadline is pushed.

“Furthermore, as CMS stated in 2012, implementation costs will continue to increase considerably with every year of a delay,” according to the letter. “The lost opportunity costs of failing to move to a more effective code set also continue to climb every year.”

Stay Engaged, Switch Gears

One of Floyd’s biggest concerns is that the ICD-10 implementation delays will affect physician engagement. The hospitalist groups at MUSC began training for ICD-10 in January 2013; however, the preparation and training were geared toward a 2014 implementation.

“You have to switch gears a little bit,” she says. “What we plan to do now is begin to do heavy auditing, and then from those audits we can give real-time feedback on what we’re doing well and what we’re not doing well. So I think that will be a method for engagement.”

She urges hospitalists, practice leaders, and informatics professionals to discuss ICD-10 not as a theoretical application, but as one tied to reimbursement that will have major impact in the years ahead. To that end, the American Health Information Management Association highlights the fact that the new coding system will result in higher-quality data that can improve performance measures, provide “increased sensitivity” to reimbursement methodologies, and help with stronger public health surveillance.³

“A lot of physicians see this as a hospital issue, and I think that’s why they shy away,” Floyd says. “Now there are some physicians who are interested in how well the hospital does, but the other piece is that it does affect things like [reduced] risk of mortality [and] comparison of data worldwide—those are things that we just have to continue to reiterate … and give them real examples.”

Richard Quinn is a freelance writer in New Jersey.

References

1. Govtrack. H.R. 4302: Protecting Access to Medicare Act of 2014. https://www.govtrack.us/congress/bills/113/hr4302. Accessed June 5, 2014.
2. Coalition for ICD. Letter to CMS Administrator Tavenner, April 11, 2014. http://coalitionforicd10.wordpress.com/2014/03/26/letter-from-the-coalition-for-icd-10. Accessed June 5, 2014.
3. American Health Information Management Association. ICD-10-CM/PCS Transition: Planning and Preparation Checklist. http://journal.ahima.org/wp-content/uploads/ICD10-checklist.pdf. Accessed June 5, 2014.

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

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

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

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

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

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

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

Visit our website for more information about inpatient nutrition.

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

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

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

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

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

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

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

Visit our website for more information about inpatient nutrition.

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

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

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

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

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

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

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

Visit our website for more information about inpatient nutrition.

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

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

He spoke with The Hospitalist after testifying:

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

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

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

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

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

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

Visit our website for more information on telemedicine and hospitalists.

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

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

He spoke with The Hospitalist after testifying:

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

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

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

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

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

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

Visit our website for more information on telemedicine and hospitalists.

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

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

He spoke with The Hospitalist after testifying:

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

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

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

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

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

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

Visit our website for more information on telemedicine and hospitalists.

Click here to listen to more of our interview with Dr. Mourad

Click here to listen to more of our interview with Dr. Mourad

Click here to listen to more of our interview with Dr. Mourad