Richard Quinn

Red Rock Canyon

So, you’re going to Las Vegas for HM14 and looking for a guide to all the fun things to do on the Las Vegas Strip, right?

Wrong, says local hospitalist Zubin Damania, MD, founder of Turntable Health (www.turntablehealth.com) in Las Vegas, who might be better known for his comedic alter ego, ZDoggMD (www.zdoggmd.com).

“When I have friends in town, I tell them not to go to the Strip and to come hang out with me downtown or in the suburbs of Vegas—where the real fun is to be had,” Dr. Damania says. “But I doubt I can tell that to 2,000 rabid hospitalists looking to relive ‘The Hangover 3.’”

To be sure, many of the attendees at the annual meeting will be staying at the meeting’s base of operations at Mandalay Bay Resort and Casino on Las Vegas Boulevard. And many won’t venture farther than they can walk.

And, while that’s not the worst idea, don’t be fooled. Las Vegas Boulevard isn’t technically in Las Vegas; it’s actually an unincorporated area of Clark County. That hasn’t stopped the desert destination from becoming a global destination. According to Las Vegas officials, 14 of the 20 largest hotels in the world are in the city, which offers more hotel rooms than any place else on Earth.

The Strip offers a bounty of world-class restaurants, clubs, and entertainment to augment the schedules of those inclined to dabble with its slot machines, table games, and sports betting. And, if you want the top-down view, try the observation tower at the Stratosphere, which, at 1,149 feet, is the tallest freestanding structure west of the Mississippi River.

But Dr. Damania doesn’t want to recommend what you can find in Frommer’s description of the famed Strip. He wants to give you the hidden Las Vegas, known locally as Downtown.

“It is the [more] authentic part of Vegas,” he says, adding that while a rental car helps to reach some places, nearly everything is accessible by taxi or bus.

For example, did you know Sin City has a Chinatown? It’s along Spring Mountain Road, about four miles north of Mandalay Bay, and includes

several enclosed shopping malls. Restaurants Dr. Damania would recommend there include Raku, which specializes in Japanese food, and Kabuto, which feeds him “the best sushi” he’s ever had.

Red Rock Canyon

In between are mom-and-pop eateries of Chinese, Vietnamese, Thai, and Indonesian food. If Mexican cuisine is more your flavor, try La Comida in Downtown, and make sure to order a margarita.

While gambling and grub are hallmarks of both the Strip and Downtown, Dr. Damania also urges friends to hit Red Rock Canyon National Conservation Area for hiking and a view of natural Nevada (www.redrockcanyonlv.org) and take a tour of the mammoth Zappos (www.zapposinsights.com/tours/zappos-tour-experience) headquarters about eight miles north of HM14’s hotel. “That is a fun tour.

To see how the Millennial Generation is changing the workplace and what kind of lessons we can learn for hospital medicine in our own workplace, which I think is way too uptight,” he says.

Speaking of which, that’s the last recommendation Dr. Damania has for every hospitalist in town for the meeting: Come visit his clinic, Turntable Health. It’s an open invite to the thousands of attendees.

If you don’t believe that, just e-mail him at [email protected] to set up a tour—or ask for a restaurant recommendation.

–Richard Quinn

Red Rock Canyon

So, you’re going to Las Vegas for HM14 and looking for a guide to all the fun things to do on the Las Vegas Strip, right?

Wrong, says local hospitalist Zubin Damania, MD, founder of Turntable Health (www.turntablehealth.com) in Las Vegas, who might be better known for his comedic alter ego, ZDoggMD (www.zdoggmd.com).

“When I have friends in town, I tell them not to go to the Strip and to come hang out with me downtown or in the suburbs of Vegas—where the real fun is to be had,” Dr. Damania says. “But I doubt I can tell that to 2,000 rabid hospitalists looking to relive ‘The Hangover 3.’”

To be sure, many of the attendees at the annual meeting will be staying at the meeting’s base of operations at Mandalay Bay Resort and Casino on Las Vegas Boulevard. And many won’t venture farther than they can walk.

And, while that’s not the worst idea, don’t be fooled. Las Vegas Boulevard isn’t technically in Las Vegas; it’s actually an unincorporated area of Clark County. That hasn’t stopped the desert destination from becoming a global destination. According to Las Vegas officials, 14 of the 20 largest hotels in the world are in the city, which offers more hotel rooms than any place else on Earth.

The Strip offers a bounty of world-class restaurants, clubs, and entertainment to augment the schedules of those inclined to dabble with its slot machines, table games, and sports betting. And, if you want the top-down view, try the observation tower at the Stratosphere, which, at 1,149 feet, is the tallest freestanding structure west of the Mississippi River.

But Dr. Damania doesn’t want to recommend what you can find in Frommer’s description of the famed Strip. He wants to give you the hidden Las Vegas, known locally as Downtown.

“It is the [more] authentic part of Vegas,” he says, adding that while a rental car helps to reach some places, nearly everything is accessible by taxi or bus.

For example, did you know Sin City has a Chinatown? It’s along Spring Mountain Road, about four miles north of Mandalay Bay, and includes

several enclosed shopping malls. Restaurants Dr. Damania would recommend there include Raku, which specializes in Japanese food, and Kabuto, which feeds him “the best sushi” he’s ever had.

Red Rock Canyon

In between are mom-and-pop eateries of Chinese, Vietnamese, Thai, and Indonesian food. If Mexican cuisine is more your flavor, try La Comida in Downtown, and make sure to order a margarita.

While gambling and grub are hallmarks of both the Strip and Downtown, Dr. Damania also urges friends to hit Red Rock Canyon National Conservation Area for hiking and a view of natural Nevada (www.redrockcanyonlv.org) and take a tour of the mammoth Zappos (www.zapposinsights.com/tours/zappos-tour-experience) headquarters about eight miles north of HM14’s hotel. “That is a fun tour.

To see how the Millennial Generation is changing the workplace and what kind of lessons we can learn for hospital medicine in our own workplace, which I think is way too uptight,” he says.

Speaking of which, that’s the last recommendation Dr. Damania has for every hospitalist in town for the meeting: Come visit his clinic, Turntable Health. It’s an open invite to the thousands of attendees.

If you don’t believe that, just e-mail him at [email protected] to set up a tour—or ask for a restaurant recommendation.

–Richard Quinn

Red Rock Canyon

So, you’re going to Las Vegas for HM14 and looking for a guide to all the fun things to do on the Las Vegas Strip, right?

Wrong, says local hospitalist Zubin Damania, MD, founder of Turntable Health (www.turntablehealth.com) in Las Vegas, who might be better known for his comedic alter ego, ZDoggMD (www.zdoggmd.com).

“When I have friends in town, I tell them not to go to the Strip and to come hang out with me downtown or in the suburbs of Vegas—where the real fun is to be had,” Dr. Damania says. “But I doubt I can tell that to 2,000 rabid hospitalists looking to relive ‘The Hangover 3.’”

To be sure, many of the attendees at the annual meeting will be staying at the meeting’s base of operations at Mandalay Bay Resort and Casino on Las Vegas Boulevard. And many won’t venture farther than they can walk.

And, while that’s not the worst idea, don’t be fooled. Las Vegas Boulevard isn’t technically in Las Vegas; it’s actually an unincorporated area of Clark County. That hasn’t stopped the desert destination from becoming a global destination. According to Las Vegas officials, 14 of the 20 largest hotels in the world are in the city, which offers more hotel rooms than any place else on Earth.

The Strip offers a bounty of world-class restaurants, clubs, and entertainment to augment the schedules of those inclined to dabble with its slot machines, table games, and sports betting. And, if you want the top-down view, try the observation tower at the Stratosphere, which, at 1,149 feet, is the tallest freestanding structure west of the Mississippi River.

But Dr. Damania doesn’t want to recommend what you can find in Frommer’s description of the famed Strip. He wants to give you the hidden Las Vegas, known locally as Downtown.

“It is the [more] authentic part of Vegas,” he says, adding that while a rental car helps to reach some places, nearly everything is accessible by taxi or bus.

For example, did you know Sin City has a Chinatown? It’s along Spring Mountain Road, about four miles north of Mandalay Bay, and includes

several enclosed shopping malls. Restaurants Dr. Damania would recommend there include Raku, which specializes in Japanese food, and Kabuto, which feeds him “the best sushi” he’s ever had.

Red Rock Canyon

In between are mom-and-pop eateries of Chinese, Vietnamese, Thai, and Indonesian food. If Mexican cuisine is more your flavor, try La Comida in Downtown, and make sure to order a margarita.

While gambling and grub are hallmarks of both the Strip and Downtown, Dr. Damania also urges friends to hit Red Rock Canyon National Conservation Area for hiking and a view of natural Nevada (www.redrockcanyonlv.org) and take a tour of the mammoth Zappos (www.zapposinsights.com/tours/zappos-tour-experience) headquarters about eight miles north of HM14’s hotel. “That is a fun tour.

To see how the Millennial Generation is changing the workplace and what kind of lessons we can learn for hospital medicine in our own workplace, which I think is way too uptight,” he says.

Speaking of which, that’s the last recommendation Dr. Damania has for every hospitalist in town for the meeting: Come visit his clinic, Turntable Health. It’s an open invite to the thousands of attendees.

If you don’t believe that, just e-mail him at [email protected] to set up a tour—or ask for a restaurant recommendation.

–Richard Quinn

SHM’s annual meeting offers something new each year. For HM14, a timely new track dubbed “Bending the Cost Curve” will focus on hospitalists’ role in improving cost effectiveness for the healthcare system as a whole.

“The value equation has always been something that’s near and dear to us,” says HM14 course director Daniel Brotman, MD, SFHM. “What’s different now is that cost shifting to the outpatient setting is something that is now being recognized as a potential unintended consequence of rushing through hospitalizations. And as we’re moving into the accountable-care world, making sure that the cost shifting does not occur…is really important.

“That means that hospitalists need to own the care transition.”

“ The educational component particularly the practice management track—is increasingly important in this era of rapid change. I don’t think any hospitalist anywhere in the country can afford to put his or her head in the sand and pretend it’s business as usual. ”

–Leslie Flores, MHA, a partner in Nelson Flores Hospital Medicine Consultants, a member of SHM’s Practice Analysis Committee, and co-director for the practice management pre-course

The debut offerings don’t stop there. Three new pre-courses are on this year’s agenda: “Cardiology: What Hospitalists Need to Know as Front-Line Providers,” “Efficient High-Value Evidence-Based Medicine for the Practicing Hospitalist,” and “NP/PA Playbook for Hospital Medicine.”

“As a pre-course director, I think the educational aspect is what sets the tone for the whole meeting,” says Leslie Flores, MHA, a partner in Nelson Flores Hospital Medicine Consultants, a member of SHM’s Practice Analysis Committee, and co-director for the practice management pre-course, “Where the Rubber Meets the Road: Managing in the Era of Healthcare Reform. “People come looking to improve their clinical skills and their hospitalist groups.”

Pre-courses are critical to the meeting’s educational offerings. In that vein, HM14 is keeping pace with generational reform in care delivery and payment methodologies.

“The educational component—particularly the practice management track—is increasingly important in this era of rapid change,” Flores adds. “I don’t think any hospitalist anywhere in the country can afford to put his or her head in the sand and pretend it’s business as usual.”

To that end, another new feature at HM14 is a panel discussion titled, “Obamacare Is Here: What Does It Mean for You and Your Hospital?” The participants are a who’s who of the specialty’s thought leaders: Centers for Medicare & Medicaid Services chief medical officer Patrick Conway, MD, MSc, FAAP, SFHM; executive director and CEO of the Medical University of South Carolina and former SHM president Patrick Cawley, MD, MHM, FACP; veteran healthcare executive Patrick Courneya, MD; and American Enterprise Institute resident fellow Scott Gottlieb, MD.

“The SHM annual meeting is pretty much the only place a hospitalist can go to learn about these changes,” Flores says, “and how to cope with them from a hospitalist’s perspective.”

Richard Quinn is a freelance writer in New Jersey.

SHM’s annual meeting offers something new each year. For HM14, a timely new track dubbed “Bending the Cost Curve” will focus on hospitalists’ role in improving cost effectiveness for the healthcare system as a whole.

“The value equation has always been something that’s near and dear to us,” says HM14 course director Daniel Brotman, MD, SFHM. “What’s different now is that cost shifting to the outpatient setting is something that is now being recognized as a potential unintended consequence of rushing through hospitalizations. And as we’re moving into the accountable-care world, making sure that the cost shifting does not occur…is really important.

“That means that hospitalists need to own the care transition.”

“ The educational component particularly the practice management track—is increasingly important in this era of rapid change. I don’t think any hospitalist anywhere in the country can afford to put his or her head in the sand and pretend it’s business as usual. ”

–Leslie Flores, MHA, a partner in Nelson Flores Hospital Medicine Consultants, a member of SHM’s Practice Analysis Committee, and co-director for the practice management pre-course

The debut offerings don’t stop there. Three new pre-courses are on this year’s agenda: “Cardiology: What Hospitalists Need to Know as Front-Line Providers,” “Efficient High-Value Evidence-Based Medicine for the Practicing Hospitalist,” and “NP/PA Playbook for Hospital Medicine.”

“As a pre-course director, I think the educational aspect is what sets the tone for the whole meeting,” says Leslie Flores, MHA, a partner in Nelson Flores Hospital Medicine Consultants, a member of SHM’s Practice Analysis Committee, and co-director for the practice management pre-course, “Where the Rubber Meets the Road: Managing in the Era of Healthcare Reform. “People come looking to improve their clinical skills and their hospitalist groups.”

Pre-courses are critical to the meeting’s educational offerings. In that vein, HM14 is keeping pace with generational reform in care delivery and payment methodologies.

“The educational component—particularly the practice management track—is increasingly important in this era of rapid change,” Flores adds. “I don’t think any hospitalist anywhere in the country can afford to put his or her head in the sand and pretend it’s business as usual.”

To that end, another new feature at HM14 is a panel discussion titled, “Obamacare Is Here: What Does It Mean for You and Your Hospital?” The participants are a who’s who of the specialty’s thought leaders: Centers for Medicare & Medicaid Services chief medical officer Patrick Conway, MD, MSc, FAAP, SFHM; executive director and CEO of the Medical University of South Carolina and former SHM president Patrick Cawley, MD, MHM, FACP; veteran healthcare executive Patrick Courneya, MD; and American Enterprise Institute resident fellow Scott Gottlieb, MD.

“The SHM annual meeting is pretty much the only place a hospitalist can go to learn about these changes,” Flores says, “and how to cope with them from a hospitalist’s perspective.”

Richard Quinn is a freelance writer in New Jersey.

SHM’s annual meeting offers something new each year. For HM14, a timely new track dubbed “Bending the Cost Curve” will focus on hospitalists’ role in improving cost effectiveness for the healthcare system as a whole.

“The value equation has always been something that’s near and dear to us,” says HM14 course director Daniel Brotman, MD, SFHM. “What’s different now is that cost shifting to the outpatient setting is something that is now being recognized as a potential unintended consequence of rushing through hospitalizations. And as we’re moving into the accountable-care world, making sure that the cost shifting does not occur…is really important.

“That means that hospitalists need to own the care transition.”

“ The educational component particularly the practice management track—is increasingly important in this era of rapid change. I don’t think any hospitalist anywhere in the country can afford to put his or her head in the sand and pretend it’s business as usual. ”

–Leslie Flores, MHA, a partner in Nelson Flores Hospital Medicine Consultants, a member of SHM’s Practice Analysis Committee, and co-director for the practice management pre-course

The debut offerings don’t stop there. Three new pre-courses are on this year’s agenda: “Cardiology: What Hospitalists Need to Know as Front-Line Providers,” “Efficient High-Value Evidence-Based Medicine for the Practicing Hospitalist,” and “NP/PA Playbook for Hospital Medicine.”

“As a pre-course director, I think the educational aspect is what sets the tone for the whole meeting,” says Leslie Flores, MHA, a partner in Nelson Flores Hospital Medicine Consultants, a member of SHM’s Practice Analysis Committee, and co-director for the practice management pre-course, “Where the Rubber Meets the Road: Managing in the Era of Healthcare Reform. “People come looking to improve their clinical skills and their hospitalist groups.”

Pre-courses are critical to the meeting’s educational offerings. In that vein, HM14 is keeping pace with generational reform in care delivery and payment methodologies.

“The educational component—particularly the practice management track—is increasingly important in this era of rapid change,” Flores adds. “I don’t think any hospitalist anywhere in the country can afford to put his or her head in the sand and pretend it’s business as usual.”

To that end, another new feature at HM14 is a panel discussion titled, “Obamacare Is Here: What Does It Mean for You and Your Hospital?” The participants are a who’s who of the specialty’s thought leaders: Centers for Medicare & Medicaid Services chief medical officer Patrick Conway, MD, MSc, FAAP, SFHM; executive director and CEO of the Medical University of South Carolina and former SHM president Patrick Cawley, MD, MHM, FACP; veteran healthcare executive Patrick Courneya, MD; and American Enterprise Institute resident fellow Scott Gottlieb, MD.

“The SHM annual meeting is pretty much the only place a hospitalist can go to learn about these changes,” Flores says, “and how to cope with them from a hospitalist’s perspective.”

Richard Quinn is a freelance writer in New Jersey.

Dr. Wachter

Bob Wachter, MD, MHM, the dean of hospital medicine, is pretty much the first to do anything in the field. First, he helped name it. Then, he helped it stand out. Now, he’s the first to give The Hospitalist a Twitter interview, a fitting nod to his technological prowess and knowledge of what’s what in the field. On stage at HM14 next month in Las Vegas, Dr. Wachter will give his 10th annual closing address, appropriately titled “10 Years of Wachter Keynotes: And Now for Something Completely Different.”

“I don’t know if he’s going to dress in something Vegas-esque,” says HM14 course director Daniel Brotman, MD, FACP, SFHM. “Who knows?”

QUESTION: How do you get excited for these end-of-meeting addresses year after year after year after—well, more than a few years now?

ANSWER: I build 1 big new tlk a yr:mtg gives me chnce 2 do so, takng some risks w/ frndly crowd. Speakng to >1K #hospitalists:how could tht get old?

Q: What is your talk-building process? As the veritable father of the field, how do you decide what you want to impart?

A: I try to pick one big topic/yr: doc of the future, changes in pt safety, how IT is transformng HC. Which one? Tickles my fancy, emergng trend.

Q: And what’s most important for this year, as the winds of the ACA, Obamacare exchanges, and pay for performance blow stronger?

A: Still musing. The uber-trends–the ones that’ll have legs ovr decades–are push to population health, wiring of HC system, and cost pressures.

Q: Those are terms HM docs didn’t learn in med school. How do they adjust to this new world of costs and wiring and population, oh my?

A: Remember, we’re 1 of th key disruptv inovatns of th pst 20 yrs. If we stop changng, we’ll be lapped by thos who fix probms. & we’ll deserv it.

Q: What changes do you see coming in the next year as the morass of ACA, ACO, VBP becomes more and more important?

A: ACA: fix the website. ACOs: hosps/med grps/insurrs scramblng to forge partnerships. VBP: move frm process 2 outcomes, new efficiency measurs & the fix of the SGR will entail some new, creative quality measures 4 docs: you’ll get your money but some will be at risk based on quality.

Q: You seem like an optimist on HM’s ability lead this change. What, specifically, makes u c the specialty as uniquely suited to the challenge?

A: HM is the 1st specialty 2 brand itself as being about both pt care AND systems improvement. Ths allows us 2 welcome change & lead the charge.

Q: What do you say to docs who say they’re so busy with pt care that systems change is a back burner issue for them?

A: I feel their pain; burnout & change fatigue r real. But I dont see a choice: we need 2 fix systems to ultimatly allow us 2 do our work, & well.

Q: Does systems change make the job any easier for HM docs, in addition to improving efficiency? How so?

A: Devil’s truly in the details, 2 simplistc 2 say it always does. Systems need 2 balance needs of pts, org, & wrkrs. Hard 2 always improv all 3.

Q: Last question: will this year’s talk have Vegas flair (shimmering outfits, hairpieces, or dancers) to entertain your fans?

A: Not quite that, but something in that genre... we’ll have to leave it at that. I figure for my 10th anniversary, what the hell. It’s Vegas.

–Richard Quinn

Dr. Wachter

Bob Wachter, MD, MHM, the dean of hospital medicine, is pretty much the first to do anything in the field. First, he helped name it. Then, he helped it stand out. Now, he’s the first to give The Hospitalist a Twitter interview, a fitting nod to his technological prowess and knowledge of what’s what in the field. On stage at HM14 next month in Las Vegas, Dr. Wachter will give his 10th annual closing address, appropriately titled “10 Years of Wachter Keynotes: And Now for Something Completely Different.”

“I don’t know if he’s going to dress in something Vegas-esque,” says HM14 course director Daniel Brotman, MD, FACP, SFHM. “Who knows?”

QUESTION: How do you get excited for these end-of-meeting addresses year after year after year after—well, more than a few years now?

ANSWER: I build 1 big new tlk a yr:mtg gives me chnce 2 do so, takng some risks w/ frndly crowd. Speakng to >1K #hospitalists:how could tht get old?

Q: What is your talk-building process? As the veritable father of the field, how do you decide what you want to impart?

A: I try to pick one big topic/yr: doc of the future, changes in pt safety, how IT is transformng HC. Which one? Tickles my fancy, emergng trend.

Q: And what’s most important for this year, as the winds of the ACA, Obamacare exchanges, and pay for performance blow stronger?

A: Still musing. The uber-trends–the ones that’ll have legs ovr decades–are push to population health, wiring of HC system, and cost pressures.

Q: Those are terms HM docs didn’t learn in med school. How do they adjust to this new world of costs and wiring and population, oh my?

A: Remember, we’re 1 of th key disruptv inovatns of th pst 20 yrs. If we stop changng, we’ll be lapped by thos who fix probms. & we’ll deserv it.

Q: What changes do you see coming in the next year as the morass of ACA, ACO, VBP becomes more and more important?

A: ACA: fix the website. ACOs: hosps/med grps/insurrs scramblng to forge partnerships. VBP: move frm process 2 outcomes, new efficiency measurs & the fix of the SGR will entail some new, creative quality measures 4 docs: you’ll get your money but some will be at risk based on quality.

Q: You seem like an optimist on HM’s ability lead this change. What, specifically, makes u c the specialty as uniquely suited to the challenge?

A: HM is the 1st specialty 2 brand itself as being about both pt care AND systems improvement. Ths allows us 2 welcome change & lead the charge.

Q: What do you say to docs who say they’re so busy with pt care that systems change is a back burner issue for them?

A: I feel their pain; burnout & change fatigue r real. But I dont see a choice: we need 2 fix systems to ultimatly allow us 2 do our work, & well.

Q: Does systems change make the job any easier for HM docs, in addition to improving efficiency? How so?

A: Devil’s truly in the details, 2 simplistc 2 say it always does. Systems need 2 balance needs of pts, org, & wrkrs. Hard 2 always improv all 3.

Q: Last question: will this year’s talk have Vegas flair (shimmering outfits, hairpieces, or dancers) to entertain your fans?

A: Not quite that, but something in that genre... we’ll have to leave it at that. I figure for my 10th anniversary, what the hell. It’s Vegas.

–Richard Quinn

Dr. Wachter

Bob Wachter, MD, MHM, the dean of hospital medicine, is pretty much the first to do anything in the field. First, he helped name it. Then, he helped it stand out. Now, he’s the first to give The Hospitalist a Twitter interview, a fitting nod to his technological prowess and knowledge of what’s what in the field. On stage at HM14 next month in Las Vegas, Dr. Wachter will give his 10th annual closing address, appropriately titled “10 Years of Wachter Keynotes: And Now for Something Completely Different.”

“I don’t know if he’s going to dress in something Vegas-esque,” says HM14 course director Daniel Brotman, MD, FACP, SFHM. “Who knows?”

QUESTION: How do you get excited for these end-of-meeting addresses year after year after year after—well, more than a few years now?

ANSWER: I build 1 big new tlk a yr:mtg gives me chnce 2 do so, takng some risks w/ frndly crowd. Speakng to >1K #hospitalists:how could tht get old?

Q: What is your talk-building process? As the veritable father of the field, how do you decide what you want to impart?

A: I try to pick one big topic/yr: doc of the future, changes in pt safety, how IT is transformng HC. Which one? Tickles my fancy, emergng trend.

Q: And what’s most important for this year, as the winds of the ACA, Obamacare exchanges, and pay for performance blow stronger?

A: Still musing. The uber-trends–the ones that’ll have legs ovr decades–are push to population health, wiring of HC system, and cost pressures.

Q: Those are terms HM docs didn’t learn in med school. How do they adjust to this new world of costs and wiring and population, oh my?

A: Remember, we’re 1 of th key disruptv inovatns of th pst 20 yrs. If we stop changng, we’ll be lapped by thos who fix probms. & we’ll deserv it.

Q: What changes do you see coming in the next year as the morass of ACA, ACO, VBP becomes more and more important?

A: ACA: fix the website. ACOs: hosps/med grps/insurrs scramblng to forge partnerships. VBP: move frm process 2 outcomes, new efficiency measurs & the fix of the SGR will entail some new, creative quality measures 4 docs: you’ll get your money but some will be at risk based on quality.

Q: You seem like an optimist on HM’s ability lead this change. What, specifically, makes u c the specialty as uniquely suited to the challenge?

A: HM is the 1st specialty 2 brand itself as being about both pt care AND systems improvement. Ths allows us 2 welcome change & lead the charge.

Q: What do you say to docs who say they’re so busy with pt care that systems change is a back burner issue for them?

A: I feel their pain; burnout & change fatigue r real. But I dont see a choice: we need 2 fix systems to ultimatly allow us 2 do our work, & well.

Q: Does systems change make the job any easier for HM docs, in addition to improving efficiency? How so?

A: Devil’s truly in the details, 2 simplistc 2 say it always does. Systems need 2 balance needs of pts, org, & wrkrs. Hard 2 always improv all 3.

Q: Last question: will this year’s talk have Vegas flair (shimmering outfits, hairpieces, or dancers) to entertain your fans?

A: Not quite that, but something in that genre... we’ll have to leave it at that. I figure for my 10th anniversary, what the hell. It’s Vegas.

–Richard Quinn

Mix the insights of a policy wonk and the accent of Sean Connery, and you have Ian Morrison, PhD, one of the keynote speakers at SHM’s annual meeting this spring.

A native of Scotland, Dr. Morrison is a well-known author, consultant, and futurist who often lectures on where healthcare is headed in this country. Appropriately, his address is titled, “The Future of the Healthcare Marketplace: Playing the New Game.”

A second-time annual meeting speaker, who last addressed HM attendees in 2008, Dr. Morrison is a founding partner in Strategic Health Perspectives (SHP), a forecasting service for the healthcare industry that includes joint venture partners Harris Interactive and the Harvard School of Public Health’s Department of Health Policy and Management. Dr. Morrison is also president emeritus of the Institute for the Future (IFTF).

Dr. Morrison spoke at length with The Hospitalist about his speech next month in Las Vegas.

Question: What do you want a room full of hospitalists to know about what they should be doing?

Answer: What I’ve been urging groups to think about is to take the longer view. I think we all get caught up in the disaster of the moment, and it’s amplified by the ideological divide over healthcare and the politicization and partisanship over it. But I think what we’ve got to do is think about the one-, three-, and five-year time horizon, about the pace of change and what we’re trying to do here. Don’t conflate the future into a blur of simultaneous change. Some of these things are going to take time.

Q: How do you rise above that fray that is “the blur of simultaneous events?”

A: If you take the longer view, there are some things that are happening, no matter what, that will not be undone by even the politics of Washington, D.C. That is the massive consolidation in the delivery system—the fact that doctors are increasingly employed by hospital systems in the main. Now, this has always been true of hospitalists, but it’s increasingly true of cardiologists and everybody else. And those trends I don’t think are going to abate. The other “megatrend” that I think is over a longer time horizon is the increasing focus on reimbursement reform to reward quality and value, particularly on a population health basis. That, I think, has so much momentum that it’s unlikely to be undone. I urge people to think about the Wright Brothers as a metaphor, rather than the Indianapolis 500; let’s just get this sucker off the ground before we declare that flying is a bad idea.

Q: How do you tailor that message to hospitalists?

A: In this new environment, hospitalists are seen as one of the specialties that have got it, in terms of patient safety, quality, and care coordination. In my rattling around the country, I see hospitalists playing a pretty critical role in things like care transitions and readmission redesign. They are trying to limit readmissions to hospitals where there are certainly financial incentives, and increasing senior management’s attention on that question. So I think hospitalists are in the center of all of those kinds of discussions, at the ground level.

“In this new environment, hospitalists are seen as one of the specialties that have got it, in terms of patient safety, quality, and care coordination. In my rattling around the country, I see hospitalists playing a pretty critical role in things like care transitions and readmission redesign. ”

–Dr. Morrison

Q: Being at the eye of a storm isn’t always the best place to be. How do hospitalists navigate this landscape, both to address patient care challenges and to deal with the shift that’s going to take place over the next five to 10 years, regardless of how fumbled anything is politically?

A: The specialty may transform itself into more of a hospital-based care management specialty. In other words, just simply discharging patients and saying “My job is over” doesn’t seem to me to be the future of this particular discipline. I think they are going to be the hospital-based voice for redesigning care processes across the continuum of care. And they may find themselves reaching out, maybe not physically, but electronically and digitally, to patients as they leave the hospital and migrate back into their homes and into their other settings, like skilled nursing facilities and home care and long-term care. They’re having a more involved role in care coordination after the patient is gone, not necessarily on a routine basis, looking and seeing how they’re doing, but designing care processes across that system of care and monitoring their effectiveness.

Q: How does the healthcare system view hospital medicine?

A: Well, certainly among hospital CEOs and leaders, and I’m not just talking about ones that have medical training, I think they see [HM] as a critical asset. Hospitalists are actually in the vanguard of this transformation effect; they’re not the victims of it.

Richard Quinn is a freelance author in New Jersey.

Mix the insights of a policy wonk and the accent of Sean Connery, and you have Ian Morrison, PhD, one of the keynote speakers at SHM’s annual meeting this spring.

A native of Scotland, Dr. Morrison is a well-known author, consultant, and futurist who often lectures on where healthcare is headed in this country. Appropriately, his address is titled, “The Future of the Healthcare Marketplace: Playing the New Game.”

A second-time annual meeting speaker, who last addressed HM attendees in 2008, Dr. Morrison is a founding partner in Strategic Health Perspectives (SHP), a forecasting service for the healthcare industry that includes joint venture partners Harris Interactive and the Harvard School of Public Health’s Department of Health Policy and Management. Dr. Morrison is also president emeritus of the Institute for the Future (IFTF).

Dr. Morrison spoke at length with The Hospitalist about his speech next month in Las Vegas.

Question: What do you want a room full of hospitalists to know about what they should be doing?

Answer: What I’ve been urging groups to think about is to take the longer view. I think we all get caught up in the disaster of the moment, and it’s amplified by the ideological divide over healthcare and the politicization and partisanship over it. But I think what we’ve got to do is think about the one-, three-, and five-year time horizon, about the pace of change and what we’re trying to do here. Don’t conflate the future into a blur of simultaneous change. Some of these things are going to take time.

Q: How do you rise above that fray that is “the blur of simultaneous events?”

A: If you take the longer view, there are some things that are happening, no matter what, that will not be undone by even the politics of Washington, D.C. That is the massive consolidation in the delivery system—the fact that doctors are increasingly employed by hospital systems in the main. Now, this has always been true of hospitalists, but it’s increasingly true of cardiologists and everybody else. And those trends I don’t think are going to abate. The other “megatrend” that I think is over a longer time horizon is the increasing focus on reimbursement reform to reward quality and value, particularly on a population health basis. That, I think, has so much momentum that it’s unlikely to be undone. I urge people to think about the Wright Brothers as a metaphor, rather than the Indianapolis 500; let’s just get this sucker off the ground before we declare that flying is a bad idea.

Q: How do you tailor that message to hospitalists?

A: In this new environment, hospitalists are seen as one of the specialties that have got it, in terms of patient safety, quality, and care coordination. In my rattling around the country, I see hospitalists playing a pretty critical role in things like care transitions and readmission redesign. They are trying to limit readmissions to hospitals where there are certainly financial incentives, and increasing senior management’s attention on that question. So I think hospitalists are in the center of all of those kinds of discussions, at the ground level.

“In this new environment, hospitalists are seen as one of the specialties that have got it, in terms of patient safety, quality, and care coordination. In my rattling around the country, I see hospitalists playing a pretty critical role in things like care transitions and readmission redesign. ”

–Dr. Morrison

Q: Being at the eye of a storm isn’t always the best place to be. How do hospitalists navigate this landscape, both to address patient care challenges and to deal with the shift that’s going to take place over the next five to 10 years, regardless of how fumbled anything is politically?

A: The specialty may transform itself into more of a hospital-based care management specialty. In other words, just simply discharging patients and saying “My job is over” doesn’t seem to me to be the future of this particular discipline. I think they are going to be the hospital-based voice for redesigning care processes across the continuum of care. And they may find themselves reaching out, maybe not physically, but electronically and digitally, to patients as they leave the hospital and migrate back into their homes and into their other settings, like skilled nursing facilities and home care and long-term care. They’re having a more involved role in care coordination after the patient is gone, not necessarily on a routine basis, looking and seeing how they’re doing, but designing care processes across that system of care and monitoring their effectiveness.

Q: How does the healthcare system view hospital medicine?

A: Well, certainly among hospital CEOs and leaders, and I’m not just talking about ones that have medical training, I think they see [HM] as a critical asset. Hospitalists are actually in the vanguard of this transformation effect; they’re not the victims of it.

Richard Quinn is a freelance author in New Jersey.

Mix the insights of a policy wonk and the accent of Sean Connery, and you have Ian Morrison, PhD, one of the keynote speakers at SHM’s annual meeting this spring.

A native of Scotland, Dr. Morrison is a well-known author, consultant, and futurist who often lectures on where healthcare is headed in this country. Appropriately, his address is titled, “The Future of the Healthcare Marketplace: Playing the New Game.”

A second-time annual meeting speaker, who last addressed HM attendees in 2008, Dr. Morrison is a founding partner in Strategic Health Perspectives (SHP), a forecasting service for the healthcare industry that includes joint venture partners Harris Interactive and the Harvard School of Public Health’s Department of Health Policy and Management. Dr. Morrison is also president emeritus of the Institute for the Future (IFTF).

Dr. Morrison spoke at length with The Hospitalist about his speech next month in Las Vegas.

Question: What do you want a room full of hospitalists to know about what they should be doing?

Answer: What I’ve been urging groups to think about is to take the longer view. I think we all get caught up in the disaster of the moment, and it’s amplified by the ideological divide over healthcare and the politicization and partisanship over it. But I think what we’ve got to do is think about the one-, three-, and five-year time horizon, about the pace of change and what we’re trying to do here. Don’t conflate the future into a blur of simultaneous change. Some of these things are going to take time.

Q: How do you rise above that fray that is “the blur of simultaneous events?”

A: If you take the longer view, there are some things that are happening, no matter what, that will not be undone by even the politics of Washington, D.C. That is the massive consolidation in the delivery system—the fact that doctors are increasingly employed by hospital systems in the main. Now, this has always been true of hospitalists, but it’s increasingly true of cardiologists and everybody else. And those trends I don’t think are going to abate. The other “megatrend” that I think is over a longer time horizon is the increasing focus on reimbursement reform to reward quality and value, particularly on a population health basis. That, I think, has so much momentum that it’s unlikely to be undone. I urge people to think about the Wright Brothers as a metaphor, rather than the Indianapolis 500; let’s just get this sucker off the ground before we declare that flying is a bad idea.

Q: How do you tailor that message to hospitalists?

A: In this new environment, hospitalists are seen as one of the specialties that have got it, in terms of patient safety, quality, and care coordination. In my rattling around the country, I see hospitalists playing a pretty critical role in things like care transitions and readmission redesign. They are trying to limit readmissions to hospitals where there are certainly financial incentives, and increasing senior management’s attention on that question. So I think hospitalists are in the center of all of those kinds of discussions, at the ground level.

“In this new environment, hospitalists are seen as one of the specialties that have got it, in terms of patient safety, quality, and care coordination. In my rattling around the country, I see hospitalists playing a pretty critical role in things like care transitions and readmission redesign. ”

–Dr. Morrison

Q: Being at the eye of a storm isn’t always the best place to be. How do hospitalists navigate this landscape, both to address patient care challenges and to deal with the shift that’s going to take place over the next five to 10 years, regardless of how fumbled anything is politically?

A: The specialty may transform itself into more of a hospital-based care management specialty. In other words, just simply discharging patients and saying “My job is over” doesn’t seem to me to be the future of this particular discipline. I think they are going to be the hospital-based voice for redesigning care processes across the continuum of care. And they may find themselves reaching out, maybe not physically, but electronically and digitally, to patients as they leave the hospital and migrate back into their homes and into their other settings, like skilled nursing facilities and home care and long-term care. They’re having a more involved role in care coordination after the patient is gone, not necessarily on a routine basis, looking and seeing how they’re doing, but designing care processes across that system of care and monitoring their effectiveness.

Q: How does the healthcare system view hospital medicine?

A: Well, certainly among hospital CEOs and leaders, and I’m not just talking about ones that have medical training, I think they see [HM] as a critical asset. Hospitalists are actually in the vanguard of this transformation effect; they’re not the victims of it.

Richard Quinn is a freelance author in New Jersey.

Mandalay Bay Resort and Casino

HM14 is expected to be the largest annual meeting yet, with nearly 3,000 projected attendees. The four-day meeting, March 24-27, has three new continuing medical courses (see “Debut,” on p. 16), a new “Bending the Cost Curve” track, and a panel discussion of Obamacare populated by four national thought leaders.

The meeting also serves up a bevy of perennial favorites: breakout sessions, practice management strategies, awards ceremonies, special interest forums, the popular Research, Innovation, and Clinical Vignette (RIV) poster competition, and a trio of keynote addresses.

For HM14 course director Daniel Brotman, MD, FACP, SFHM, and assistant course director Efren Manjarrez, MD, SFHM, crafting the convention is as much about taking a step back as it is about immersing oneself in the specialty.

“To really be able to take a step back and think about how we fit into that big picture may make you feel small and insignificant in the same way that thinking about the cosmos might,” says Dr. Brotman, director of the hospitalist program at Johns Hopkins Hospital in Baltimore. “But it certainly makes me feel like I’m part of a bigger goal and a grand vision for where we need to go as a medical society, as a field, and as practitioners in a world that needs change.”

SHM President Eric Howell, MD, SFHM, chief of hospital medicine at Johns Hopkins Bayview Medical Center in Baltimore, couldn’t agree more.

“Like many physicians, we’re busy doing our job day in and day out,” he says. “We lose [sight of] the fact that we’re privileged and lucky to be in a specialty that’s growing and makes the world a better place.”

For Darren Swenson, MD, a regional medical advisor for IPC The Hospitalist Co. in Las Vegas, who founded SHM’s society chapter there about a decade ago, the meeting is a chance to view his specialty from the proverbial 30,000 feet and to get policy updates and clinical information while reconnecting with old friends and colleagues. In recent years, he has had to choose between SHM’s annual event and the yearly meeting of the American College of Physician Executives.

This year, he’s doing both. And Dr. Swenson notes that the allure of SHM’s convention is not just the detail of each of its offerings. It’s all of them.

“It’s essential, because what you’re getting is those thought leaders, as well as the academics, as well as real life business education—all in one area,” Dr. Swenson says. “And when you’re able to choose your tracks to identify those programs that are of interest to you at that point in your career, it makes it very attractive.”

Richard Quinn is a freelance writer in New Jersey.

Mandalay Bay Resort and Casino

HM14 is expected to be the largest annual meeting yet, with nearly 3,000 projected attendees. The four-day meeting, March 24-27, has three new continuing medical courses (see “Debut,” on p. 16), a new “Bending the Cost Curve” track, and a panel discussion of Obamacare populated by four national thought leaders.

The meeting also serves up a bevy of perennial favorites: breakout sessions, practice management strategies, awards ceremonies, special interest forums, the popular Research, Innovation, and Clinical Vignette (RIV) poster competition, and a trio of keynote addresses.

For HM14 course director Daniel Brotman, MD, FACP, SFHM, and assistant course director Efren Manjarrez, MD, SFHM, crafting the convention is as much about taking a step back as it is about immersing oneself in the specialty.

“To really be able to take a step back and think about how we fit into that big picture may make you feel small and insignificant in the same way that thinking about the cosmos might,” says Dr. Brotman, director of the hospitalist program at Johns Hopkins Hospital in Baltimore. “But it certainly makes me feel like I’m part of a bigger goal and a grand vision for where we need to go as a medical society, as a field, and as practitioners in a world that needs change.”

SHM President Eric Howell, MD, SFHM, chief of hospital medicine at Johns Hopkins Bayview Medical Center in Baltimore, couldn’t agree more.

“Like many physicians, we’re busy doing our job day in and day out,” he says. “We lose [sight of] the fact that we’re privileged and lucky to be in a specialty that’s growing and makes the world a better place.”

For Darren Swenson, MD, a regional medical advisor for IPC The Hospitalist Co. in Las Vegas, who founded SHM’s society chapter there about a decade ago, the meeting is a chance to view his specialty from the proverbial 30,000 feet and to get policy updates and clinical information while reconnecting with old friends and colleagues. In recent years, he has had to choose between SHM’s annual event and the yearly meeting of the American College of Physician Executives.

This year, he’s doing both. And Dr. Swenson notes that the allure of SHM’s convention is not just the detail of each of its offerings. It’s all of them.

“It’s essential, because what you’re getting is those thought leaders, as well as the academics, as well as real life business education—all in one area,” Dr. Swenson says. “And when you’re able to choose your tracks to identify those programs that are of interest to you at that point in your career, it makes it very attractive.”

Richard Quinn is a freelance writer in New Jersey.

Mandalay Bay Resort and Casino

HM14 is expected to be the largest annual meeting yet, with nearly 3,000 projected attendees. The four-day meeting, March 24-27, has three new continuing medical courses (see “Debut,” on p. 16), a new “Bending the Cost Curve” track, and a panel discussion of Obamacare populated by four national thought leaders.

The meeting also serves up a bevy of perennial favorites: breakout sessions, practice management strategies, awards ceremonies, special interest forums, the popular Research, Innovation, and Clinical Vignette (RIV) poster competition, and a trio of keynote addresses.

For HM14 course director Daniel Brotman, MD, FACP, SFHM, and assistant course director Efren Manjarrez, MD, SFHM, crafting the convention is as much about taking a step back as it is about immersing oneself in the specialty.

“To really be able to take a step back and think about how we fit into that big picture may make you feel small and insignificant in the same way that thinking about the cosmos might,” says Dr. Brotman, director of the hospitalist program at Johns Hopkins Hospital in Baltimore. “But it certainly makes me feel like I’m part of a bigger goal and a grand vision for where we need to go as a medical society, as a field, and as practitioners in a world that needs change.”

SHM President Eric Howell, MD, SFHM, chief of hospital medicine at Johns Hopkins Bayview Medical Center in Baltimore, couldn’t agree more.

“Like many physicians, we’re busy doing our job day in and day out,” he says. “We lose [sight of] the fact that we’re privileged and lucky to be in a specialty that’s growing and makes the world a better place.”

For Darren Swenson, MD, a regional medical advisor for IPC The Hospitalist Co. in Las Vegas, who founded SHM’s society chapter there about a decade ago, the meeting is a chance to view his specialty from the proverbial 30,000 feet and to get policy updates and clinical information while reconnecting with old friends and colleagues. In recent years, he has had to choose between SHM’s annual event and the yearly meeting of the American College of Physician Executives.

This year, he’s doing both. And Dr. Swenson notes that the allure of SHM’s convention is not just the detail of each of its offerings. It’s all of them.

“It’s essential, because what you’re getting is those thought leaders, as well as the academics, as well as real life business education—all in one area,” Dr. Swenson says. “And when you’re able to choose your tracks to identify those programs that are of interest to you at that point in your career, it makes it very attractive.”

Richard Quinn is a freelance writer in New Jersey.

Hospitalists needn't worry much about federal data released this month that shows healthcare employment figures dropping for the first time in a decade. A recent report from the Bureau of Labor Statistics reflects the loss of 6,000 jobs in healthcare last December, and employment gains falling to 17,000 per month on average in 2013 compared with 27,000 per month in 2012.

"The overall decline in healthcare spending and employment will have a small effect on hospitalist growth," says Anupam Jena, MD, PhD, assistant professor of healthcare policy and medicine at Harvard Medical School, and an internist at Massachusetts General Hospital, both in Boston. "It certainly is true that the demand for hospital care has decreased over the last two decades and will continue to decrease as hospitals and providers become more incentivized to keep patients out of the hospital. But this effect is offset by the fact that hospitalists continue to account for larger and larger shares of all inpatient care in the U.S."

Dr. Jena says the fact that healthcare companies lost 6,000 positions last December—the first monthly loss since July 2003, according to CNN—isn't surprising, as it comes on the heels of a report from the Centers for Medicare and Medicaid Services that the rate of increases in healthcare spending has slowed over the past four years as well.

Dr. Jena says that, while healthcare reform under the Affordable Care Act may "trim the fat" by reducing the amount of lower-value health services and the number of providers that perform them, HM is still a budding field. As long as the specialty continues to demonstrate value via cost savings and reduced length of stay, that scenario isn’t likely to change, he adds.

"Although healthcare reforms will probably reduce hospitalizations, I expect the demand for hospitalists to continue to grow," Dr. Jena says. "There are still 30% of hospitalizations in the U.S. that are not covered by hospitalists, which means there is room to grow."

Visit our website for more information on healthcare economics.

Hospitalists needn't worry much about federal data released this month that shows healthcare employment figures dropping for the first time in a decade. A recent report from the Bureau of Labor Statistics reflects the loss of 6,000 jobs in healthcare last December, and employment gains falling to 17,000 per month on average in 2013 compared with 27,000 per month in 2012.

"The overall decline in healthcare spending and employment will have a small effect on hospitalist growth," says Anupam Jena, MD, PhD, assistant professor of healthcare policy and medicine at Harvard Medical School, and an internist at Massachusetts General Hospital, both in Boston. "It certainly is true that the demand for hospital care has decreased over the last two decades and will continue to decrease as hospitals and providers become more incentivized to keep patients out of the hospital. But this effect is offset by the fact that hospitalists continue to account for larger and larger shares of all inpatient care in the U.S."

Dr. Jena says the fact that healthcare companies lost 6,000 positions last December—the first monthly loss since July 2003, according to CNN—isn't surprising, as it comes on the heels of a report from the Centers for Medicare and Medicaid Services that the rate of increases in healthcare spending has slowed over the past four years as well.

Dr. Jena says that, while healthcare reform under the Affordable Care Act may "trim the fat" by reducing the amount of lower-value health services and the number of providers that perform them, HM is still a budding field. As long as the specialty continues to demonstrate value via cost savings and reduced length of stay, that scenario isn’t likely to change, he adds.

"Although healthcare reforms will probably reduce hospitalizations, I expect the demand for hospitalists to continue to grow," Dr. Jena says. "There are still 30% of hospitalizations in the U.S. that are not covered by hospitalists, which means there is room to grow."

Visit our website for more information on healthcare economics.

Hospitalists needn't worry much about federal data released this month that shows healthcare employment figures dropping for the first time in a decade. A recent report from the Bureau of Labor Statistics reflects the loss of 6,000 jobs in healthcare last December, and employment gains falling to 17,000 per month on average in 2013 compared with 27,000 per month in 2012.

"The overall decline in healthcare spending and employment will have a small effect on hospitalist growth," says Anupam Jena, MD, PhD, assistant professor of healthcare policy and medicine at Harvard Medical School, and an internist at Massachusetts General Hospital, both in Boston. "It certainly is true that the demand for hospital care has decreased over the last two decades and will continue to decrease as hospitals and providers become more incentivized to keep patients out of the hospital. But this effect is offset by the fact that hospitalists continue to account for larger and larger shares of all inpatient care in the U.S."

Dr. Jena says the fact that healthcare companies lost 6,000 positions last December—the first monthly loss since July 2003, according to CNN—isn't surprising, as it comes on the heels of a report from the Centers for Medicare and Medicaid Services that the rate of increases in healthcare spending has slowed over the past four years as well.

Dr. Jena says that, while healthcare reform under the Affordable Care Act may "trim the fat" by reducing the amount of lower-value health services and the number of providers that perform them, HM is still a budding field. As long as the specialty continues to demonstrate value via cost savings and reduced length of stay, that scenario isn’t likely to change, he adds.

"Although healthcare reforms will probably reduce hospitalizations, I expect the demand for hospitalists to continue to grow," Dr. Jena says. "There are still 30% of hospitalizations in the U.S. that are not covered by hospitalists, which means there is room to grow."

Visit our website for more information on healthcare economics.

Although the bungled rollout of health exchange websites has dominated healthcare-related headlines in the last months of 2013, hospitalist leaders say the policy landscape for 2014 features bigger issues.

To set the table, The Hospitalist reached out to four hospitalists who keep a close eye on the policy sphere. Those interviewed agree that the continued shift from fee-for-service to pay-for-performance will dominate policy discussions. In tow with that are the expected quality improvements the payment model is supposed to beget.

“Pay-for-performance and quality measures will be major issues for hospitalists moving forward,” says SHM Public Policy Committee member Joshua Lenchus, DO, RPh, FACP, SFHM. “But, I am not very optimistic that these processes will lead to their desired outcomes. At the end of the day, personal patient responsibility will need to be accounted for if a real change in healthcare outcomes is to be recognized.”

Other pressing policy issues the panel will pay attention to this year include:

1. Value-Based Purchasing

Further refinement and development of just how physician value-based purchasing will be implemented. More specifically, Josh Boswell, SHM’s senior manager of government relations, is watching to see how that will be incorporated into a possible long-term fix for the sustainable growth rate (SGR) formula.

“As the costs associated with noncompliance increase, hospitals will increasingly look to hospitalists to drive better performance,” says former SHM Public Policy Committee member Eric Siegal, MD, SFHM, director, Aurora Critical Care Service, St Luke’s Medical Center, Milwaukee, and clinical associate professor of medicine, University of Wisconsin School of Medicine and Public Health. “The good news: This is job security for many hospitalists. The bad news: Increasing amounts of human capital will be dedicated to meeting Medicare’s mandates, irrespective of whether this represents the most productive or effective use of those resources.”

2. ACOs

Continued monitoring of accountable-care organizations (ACOs) as the first waves of data emerge on claims and performance. Along with managing health populations, expect consolidation of healthcare systems from nearly 700 to what some experts think could be as few as 50 to 70 mega-providers.

3. Observation Status

The rollout of the new two-midnight rule, which the Centers for Medicare & Medicaid Services (CMS) recently changed to allow physicians to admit a patient if they reasonably expect and document in the medical record that a beneficiary will need to stay in the hospital for more than two midnights. Such admissions will be presumed to be appropriate for Medicare Part A payment. CMS cited concerns about the growing trend of longer observation stays to support this change. Connected with this issue is SHM’s continued backing of the Improving Access to Medicare Coverage Act of 2013 (H.R. 1179, S. 569), which would solve the conundrum of “observation status” time not counting toward the required three consecutive overnights an inpatient needs to qualify for Medicare benefits at a skilled nursing facility.

Forward Moving

SHM Public Policy Committee chair Ron Greeno, MD, FCCP, MHM, says that while insurance reform is one of the three legs of the Affordable Care Act, hospitalists need to be focused just as vigilantly on expanding healthcare access for more patients and reforming the delivery system.

“That’s where we’re supposedly going to get the resources to do these other things,” says Dr. Greeno, chief medical officer for Cogent HMG of Brentwood, Tenn. “Hospitalists are right in the middle of those discussions—and they should be.”

Whether you are for or against the changes produced by the Affordable Care Act, Dr. Siegal says the system “just became a lot less stable.”

“The tacit, quid pro quo had been that lost revenue from Medicare would, at least in part, [be] offset when 30-plus million Americans with newly minted insurance plans became paying healthcare consumers,” Dr. Siegal adds. “With this delicate balance suddenly jeopardized, my guess is that many health systems will circle their wagons until they know which way the wind will blow.”

All told, the healthcare landscape remains one that is pockmarked by generational reform that will require deft hands to navigate. But those who are still fighting reform and its expanded access provision might be missing the larger point.

“You could repeal the Affordable Care Act today, which is not going to happen obviously, but it wouldn’t change the fact that these emerging alternative payment methodologies are still going to occur,” Dr. Siegal says. “It’s beyond Medicare. The private payors are doing it. Physician groups and hospitals and other integrated healthcare organizations are gearing up to take those payments ... because staying in fee-for-service is untenable.”

Richard Quinn is a freelance writer in New Jersey.

Although the bungled rollout of health exchange websites has dominated healthcare-related headlines in the last months of 2013, hospitalist leaders say the policy landscape for 2014 features bigger issues.

To set the table, The Hospitalist reached out to four hospitalists who keep a close eye on the policy sphere. Those interviewed agree that the continued shift from fee-for-service to pay-for-performance will dominate policy discussions. In tow with that are the expected quality improvements the payment model is supposed to beget.

“Pay-for-performance and quality measures will be major issues for hospitalists moving forward,” says SHM Public Policy Committee member Joshua Lenchus, DO, RPh, FACP, SFHM. “But, I am not very optimistic that these processes will lead to their desired outcomes. At the end of the day, personal patient responsibility will need to be accounted for if a real change in healthcare outcomes is to be recognized.”

Other pressing policy issues the panel will pay attention to this year include:

1. Value-Based Purchasing

Further refinement and development of just how physician value-based purchasing will be implemented. More specifically, Josh Boswell, SHM’s senior manager of government relations, is watching to see how that will be incorporated into a possible long-term fix for the sustainable growth rate (SGR) formula.

“As the costs associated with noncompliance increase, hospitals will increasingly look to hospitalists to drive better performance,” says former SHM Public Policy Committee member Eric Siegal, MD, SFHM, director, Aurora Critical Care Service, St Luke’s Medical Center, Milwaukee, and clinical associate professor of medicine, University of Wisconsin School of Medicine and Public Health. “The good news: This is job security for many hospitalists. The bad news: Increasing amounts of human capital will be dedicated to meeting Medicare’s mandates, irrespective of whether this represents the most productive or effective use of those resources.”

2. ACOs

Continued monitoring of accountable-care organizations (ACOs) as the first waves of data emerge on claims and performance. Along with managing health populations, expect consolidation of healthcare systems from nearly 700 to what some experts think could be as few as 50 to 70 mega-providers.

3. Observation Status

The rollout of the new two-midnight rule, which the Centers for Medicare & Medicaid Services (CMS) recently changed to allow physicians to admit a patient if they reasonably expect and document in the medical record that a beneficiary will need to stay in the hospital for more than two midnights. Such admissions will be presumed to be appropriate for Medicare Part A payment. CMS cited concerns about the growing trend of longer observation stays to support this change. Connected with this issue is SHM’s continued backing of the Improving Access to Medicare Coverage Act of 2013 (H.R. 1179, S. 569), which would solve the conundrum of “observation status” time not counting toward the required three consecutive overnights an inpatient needs to qualify for Medicare benefits at a skilled nursing facility.

Forward Moving

SHM Public Policy Committee chair Ron Greeno, MD, FCCP, MHM, says that while insurance reform is one of the three legs of the Affordable Care Act, hospitalists need to be focused just as vigilantly on expanding healthcare access for more patients and reforming the delivery system.

“That’s where we’re supposedly going to get the resources to do these other things,” says Dr. Greeno, chief medical officer for Cogent HMG of Brentwood, Tenn. “Hospitalists are right in the middle of those discussions—and they should be.”

Whether you are for or against the changes produced by the Affordable Care Act, Dr. Siegal says the system “just became a lot less stable.”

“The tacit, quid pro quo had been that lost revenue from Medicare would, at least in part, [be] offset when 30-plus million Americans with newly minted insurance plans became paying healthcare consumers,” Dr. Siegal adds. “With this delicate balance suddenly jeopardized, my guess is that many health systems will circle their wagons until they know which way the wind will blow.”

All told, the healthcare landscape remains one that is pockmarked by generational reform that will require deft hands to navigate. But those who are still fighting reform and its expanded access provision might be missing the larger point.

“You could repeal the Affordable Care Act today, which is not going to happen obviously, but it wouldn’t change the fact that these emerging alternative payment methodologies are still going to occur,” Dr. Siegal says. “It’s beyond Medicare. The private payors are doing it. Physician groups and hospitals and other integrated healthcare organizations are gearing up to take those payments ... because staying in fee-for-service is untenable.”

Richard Quinn is a freelance writer in New Jersey.

Although the bungled rollout of health exchange websites has dominated healthcare-related headlines in the last months of 2013, hospitalist leaders say the policy landscape for 2014 features bigger issues.

To set the table, The Hospitalist reached out to four hospitalists who keep a close eye on the policy sphere. Those interviewed agree that the continued shift from fee-for-service to pay-for-performance will dominate policy discussions. In tow with that are the expected quality improvements the payment model is supposed to beget.

“Pay-for-performance and quality measures will be major issues for hospitalists moving forward,” says SHM Public Policy Committee member Joshua Lenchus, DO, RPh, FACP, SFHM. “But, I am not very optimistic that these processes will lead to their desired outcomes. At the end of the day, personal patient responsibility will need to be accounted for if a real change in healthcare outcomes is to be recognized.”

Other pressing policy issues the panel will pay attention to this year include:

1. Value-Based Purchasing

Further refinement and development of just how physician value-based purchasing will be implemented. More specifically, Josh Boswell, SHM’s senior manager of government relations, is watching to see how that will be incorporated into a possible long-term fix for the sustainable growth rate (SGR) formula.

“As the costs associated with noncompliance increase, hospitals will increasingly look to hospitalists to drive better performance,” says former SHM Public Policy Committee member Eric Siegal, MD, SFHM, director, Aurora Critical Care Service, St Luke’s Medical Center, Milwaukee, and clinical associate professor of medicine, University of Wisconsin School of Medicine and Public Health. “The good news: This is job security for many hospitalists. The bad news: Increasing amounts of human capital will be dedicated to meeting Medicare’s mandates, irrespective of whether this represents the most productive or effective use of those resources.”

2. ACOs

Continued monitoring of accountable-care organizations (ACOs) as the first waves of data emerge on claims and performance. Along with managing health populations, expect consolidation of healthcare systems from nearly 700 to what some experts think could be as few as 50 to 70 mega-providers.

3. Observation Status

The rollout of the new two-midnight rule, which the Centers for Medicare & Medicaid Services (CMS) recently changed to allow physicians to admit a patient if they reasonably expect and document in the medical record that a beneficiary will need to stay in the hospital for more than two midnights. Such admissions will be presumed to be appropriate for Medicare Part A payment. CMS cited concerns about the growing trend of longer observation stays to support this change. Connected with this issue is SHM’s continued backing of the Improving Access to Medicare Coverage Act of 2013 (H.R. 1179, S. 569), which would solve the conundrum of “observation status” time not counting toward the required three consecutive overnights an inpatient needs to qualify for Medicare benefits at a skilled nursing facility.

Forward Moving

SHM Public Policy Committee chair Ron Greeno, MD, FCCP, MHM, says that while insurance reform is one of the three legs of the Affordable Care Act, hospitalists need to be focused just as vigilantly on expanding healthcare access for more patients and reforming the delivery system.

“That’s where we’re supposedly going to get the resources to do these other things,” says Dr. Greeno, chief medical officer for Cogent HMG of Brentwood, Tenn. “Hospitalists are right in the middle of those discussions—and they should be.”

Whether you are for or against the changes produced by the Affordable Care Act, Dr. Siegal says the system “just became a lot less stable.”

“The tacit, quid pro quo had been that lost revenue from Medicare would, at least in part, [be] offset when 30-plus million Americans with newly minted insurance plans became paying healthcare consumers,” Dr. Siegal adds. “With this delicate balance suddenly jeopardized, my guess is that many health systems will circle their wagons until they know which way the wind will blow.”

All told, the healthcare landscape remains one that is pockmarked by generational reform that will require deft hands to navigate. But those who are still fighting reform and its expanded access provision might be missing the larger point.

“You could repeal the Affordable Care Act today, which is not going to happen obviously, but it wouldn’t change the fact that these emerging alternative payment methodologies are still going to occur,” Dr. Siegal says. “It’s beyond Medicare. The private payors are doing it. Physician groups and hospitals and other integrated healthcare organizations are gearing up to take those payments ... because staying in fee-for-service is untenable.”

Richard Quinn is a freelance writer in New Jersey.

Hospitalists shouldn't get too excited over the recent decision by the Centers for Medicare & Medicaid Services (CMS) that allows specialty society-run clinical data registries to submit their own quality metrics under the Physician Quality Reporting System (PQRS).

CMS earlier this month agreed to let specialist medical societies draw up their own quality measures, but to qualify, societies must have a certified clinical data registry. SHM’s Public Policy Committee (PPC) and Performance Measurement and Reporting Committee (PMRC) consistently provide feedback to CMS on the current PQRS quality measures and is reviewing the potential value of a clinical data registry for SHM members in the future.

PPC and Team Hospitalist member Joshua Lenchus, DO, RPh, FACP, SFHM, says he and other hospitalist leaders will discuss CMS' decision, but he wonders whether the reporting system's average payment adjustment for foreseeable program years and hospitalist interest is high enough to make establishing a data registry worthwhile. “The question begs,” Dr. Lenchus says, “is the benefit worth the effort?”

The 2014 Medicare physician fee schedule [PDF] reported that 26,515 medical practices with 266,521 eligible professionals participated in PQRS in 2011—or about 27% of eligible providers. SHM has encouraged its members to participate since the system's inception in 2007 to both take advantage of incentive payments that were available and to prepare for upcoming penalties for failure to report. Starting in 2015 and based on 2013 performance, there will be a penalty for not reporting PQRS quality measures.

Dr. Lenchus says PPC members will continue to monitor and advocate for quality metrics that are more in line with daily hospitalist duties. Similarly, SHM's Performance Measurement and Reporting Committee (PMRC) has been working to identify and ensure measures applicable to HM are included in PQRS.

"The committee is deeply concerned about the limited number of PQRS measures broadly applicable to hospitalists, and we are working to change this disparity," wrote Greg Seymann, MD, SFHM, chief of the division of hospital medicine at the University of California at San Diego and chair of SHM’s PMRC, and Josh Boswell, SHM’s senior manager of government relations in The Hospitalist last month.

Dr. Lenchus adds that while SHM and other societies can weigh in on the measures, CMS remains the final arbiter.

"Groups will submit whatever metrics they would like to be assessed against and those metrics will not be taken carte blanche, but rather will require CMS approval," he says.

Visit our website for more information about PQRS.

Hospitalists shouldn't get too excited over the recent decision by the Centers for Medicare & Medicaid Services (CMS) that allows specialty society-run clinical data registries to submit their own quality metrics under the Physician Quality Reporting System (PQRS).

CMS earlier this month agreed to let specialist medical societies draw up their own quality measures, but to qualify, societies must have a certified clinical data registry. SHM’s Public Policy Committee (PPC) and Performance Measurement and Reporting Committee (PMRC) consistently provide feedback to CMS on the current PQRS quality measures and is reviewing the potential value of a clinical data registry for SHM members in the future.

PPC and Team Hospitalist member Joshua Lenchus, DO, RPh, FACP, SFHM, says he and other hospitalist leaders will discuss CMS' decision, but he wonders whether the reporting system's average payment adjustment for foreseeable program years and hospitalist interest is high enough to make establishing a data registry worthwhile. “The question begs,” Dr. Lenchus says, “is the benefit worth the effort?”

The 2014 Medicare physician fee schedule [PDF] reported that 26,515 medical practices with 266,521 eligible professionals participated in PQRS in 2011—or about 27% of eligible providers. SHM has encouraged its members to participate since the system's inception in 2007 to both take advantage of incentive payments that were available and to prepare for upcoming penalties for failure to report. Starting in 2015 and based on 2013 performance, there will be a penalty for not reporting PQRS quality measures.

Dr. Lenchus says PPC members will continue to monitor and advocate for quality metrics that are more in line with daily hospitalist duties. Similarly, SHM's Performance Measurement and Reporting Committee (PMRC) has been working to identify and ensure measures applicable to HM are included in PQRS.

"The committee is deeply concerned about the limited number of PQRS measures broadly applicable to hospitalists, and we are working to change this disparity," wrote Greg Seymann, MD, SFHM, chief of the division of hospital medicine at the University of California at San Diego and chair of SHM’s PMRC, and Josh Boswell, SHM’s senior manager of government relations in The Hospitalist last month.

Dr. Lenchus adds that while SHM and other societies can weigh in on the measures, CMS remains the final arbiter.

"Groups will submit whatever metrics they would like to be assessed against and those metrics will not be taken carte blanche, but rather will require CMS approval," he says.

Visit our website for more information about PQRS.

Hospitalists shouldn't get too excited over the recent decision by the Centers for Medicare & Medicaid Services (CMS) that allows specialty society-run clinical data registries to submit their own quality metrics under the Physician Quality Reporting System (PQRS).

CMS earlier this month agreed to let specialist medical societies draw up their own quality measures, but to qualify, societies must have a certified clinical data registry. SHM’s Public Policy Committee (PPC) and Performance Measurement and Reporting Committee (PMRC) consistently provide feedback to CMS on the current PQRS quality measures and is reviewing the potential value of a clinical data registry for SHM members in the future.

PPC and Team Hospitalist member Joshua Lenchus, DO, RPh, FACP, SFHM, says he and other hospitalist leaders will discuss CMS' decision, but he wonders whether the reporting system's average payment adjustment for foreseeable program years and hospitalist interest is high enough to make establishing a data registry worthwhile. “The question begs,” Dr. Lenchus says, “is the benefit worth the effort?”

The 2014 Medicare physician fee schedule [PDF] reported that 26,515 medical practices with 266,521 eligible professionals participated in PQRS in 2011—or about 27% of eligible providers. SHM has encouraged its members to participate since the system's inception in 2007 to both take advantage of incentive payments that were available and to prepare for upcoming penalties for failure to report. Starting in 2015 and based on 2013 performance, there will be a penalty for not reporting PQRS quality measures.

Dr. Lenchus says PPC members will continue to monitor and advocate for quality metrics that are more in line with daily hospitalist duties. Similarly, SHM's Performance Measurement and Reporting Committee (PMRC) has been working to identify and ensure measures applicable to HM are included in PQRS.

"The committee is deeply concerned about the limited number of PQRS measures broadly applicable to hospitalists, and we are working to change this disparity," wrote Greg Seymann, MD, SFHM, chief of the division of hospital medicine at the University of California at San Diego and chair of SHM’s PMRC, and Josh Boswell, SHM’s senior manager of government relations in The Hospitalist last month.

Dr. Lenchus adds that while SHM and other societies can weigh in on the measures, CMS remains the final arbiter.

"Groups will submit whatever metrics they would like to be assessed against and those metrics will not be taken carte blanche, but rather will require CMS approval," he says.

Visit our website for more information about PQRS.

The environment that breeds the formation of accountable care organizations (ACOs) includes large integrated hospital systems, primary care physicians (PCPs) practicing in large groups, and a greater fraction of hospital risk sharing, according to a Health Affairs report (http://content.healthaffairs.org/content/32/10/1781.abstract).

In other words, institutions and areas that have begun embracing risk-based or population-based payment models are more likely to spur the formation of ACOs, which have similar risk-reward payment structures.

For hospitalists, knowing the conditions that help foster ACOs may be an important first step in pushing for development and continued growth, says Ron Greeno, MD, FCCP, MHM, SHM Public Policy Committee chair and chief medical officer of Cogent HMG in Brentwood, Tenn.

It’s a shift in mindset for sure, says the report’s lead author.

“The traditional model is pretty much fill your beds with high-paying patients. An ACO is really a different kind of concept,” says David Auerbach, MS, PhD, of Boston-based RAND Corporation. “A hospital that doesn’t have any experience thinking in a different way is going to find it hard to accommodate the ACO payment model. But hospitals that do…probably have staff that have thought about this and already started to move down the path to thinking about ways to reduce their costs.”

Regional Variance

Dr. Auerbach, a policy researcher and affiliate faculty member at Pardee RAND Graduate School, says further work needs to be done to identify “key regional factors” that induce certain physicians and hospitals to launch ACOs. His paper, “Accountable Care Organization Formation Is Associated with Integrated Systems but Not High Medical Spending,” found wide disparities in ACO formation; the model is popular in the Northeast and Midwest regions but scarcely found in the Northwest.

The authors reviewed 32 Medicare Pioneer ACOs, 116 Medicare Shared Savings Program ACOs, and 77 private-market entities very similar to ACOs. The study’s multiple-regression analysis found that in the 31 regions with at least 20% of Medicare fee-for-service beneficiaries in an ACO, more than half of hospitals had a joint venture with doctors or physician groups and were affiliated with a health system. In so-called “low-ACO areas,” that percentage hovered around 30% to 40%.

And while much of the policy discussion focuses on whether ACOs can rein in healthcare spending in some of the markets where care costs the most, the study reported “no strong pattern in the relationship between ACO penetration and Medicare spending or spending growth.”

Uncertain Upside

Dr. Auerbach says that while the results of his paper did not surprise him, he hopes hospitalists and others use them educationally.

“We might think about there being demand from people in other areas that might say, ‘I want to be a part of that too. Why aren’t there any ACOs that I can be in?’” he adds. “And so a study like this says, ‘Here are some of the things that seem to be important.’ If there’s not this kind of infrastructure in your area, as a policy maker, you could go and say, ‘Let’s try and give a boost to some of these factors or proxies for these things.’”

Part of that review would include looking at those areas that saw higher rates of physician-institution consolidation and figuring out what the motivations were. Typically, the impetus of forming larger groups is partly explained by a desire to negotiate with insurers and get better deals, Dr. Auerbach says. But with more coordinated care comes a more efficient system that can offset those lower rates.

“I think right now most policymakers are not sure if the upside is better than the downside,” he adds. “I think the answer, personally, is not to try to break up providers and do a lot of anti-trust activity. We need to understand whether, and how much, integrated groups are able to use market power to charge higher prices. And, if they do, there may be other ways to combat that problem while keeping the groups intact.”

Rethinking Reimbursement

Dr. Greeno says growing pains are inevitable along the way, particularly because the move to the ACO payment model is a seismic shift for a healthcare industry that has traditionally been based on a fee-for-service model.

“How we pay for healthcare in this country is going to be completely flipped on its head,” he says. “Part of the goal, of course, is better outcomes for patients. But it’s also cost efficiency. In the meantime, the entire system for 100 years has been paying for production.”

Dr. Greeno compares it to the shift that was the managed-care movement. Moving forward, the shift will create winners and losers and most likely will result in massive consolidation of healthcare organizations—from nearly 700 today to what Dr. Greeno believes may be 50 to 70 mega-providers.

“It’s basically what happened when HMOs started paying capitated payments to physician groups,” he says. “The groups then had X amount of dollars to care for their patient population, and if they couldn’t make that work, they went out of business or were acquired by more successful groups. If they could make it work, then they survived. It’s the exact same thing. It’s not quite as dramatic, as it is not going to happen overnight, but that’s where it’s heading.

“And instead of occurring in pockets around the country like in Southern California and Minneapolis, it’s going to be nationwide, and the world’s largest insurance company, which is Medicare, is driving it.”

Dr. Auerbach notes that while the disruption already has caused some groups to drop out of the ACO programs, he does not see that as a precursor to more organizations turning away from the program, particularly as it is among the key planks of the general healthcare reform movement.

“It is part of a larger wave that really is changing the way we do healthcare,” he says. “I think that as [ACOs] grow...people are going to say that this is becoming something like the dominant form of delivering healthcare.”

Richard Quinn is a freelance writer in New Jersey.

The environment that breeds the formation of accountable care organizations (ACOs) includes large integrated hospital systems, primary care physicians (PCPs) practicing in large groups, and a greater fraction of hospital risk sharing, according to a Health Affairs report (http://content.healthaffairs.org/content/32/10/1781.abstract).

In other words, institutions and areas that have begun embracing risk-based or population-based payment models are more likely to spur the formation of ACOs, which have similar risk-reward payment structures.

For hospitalists, knowing the conditions that help foster ACOs may be an important first step in pushing for development and continued growth, says Ron Greeno, MD, FCCP, MHM, SHM Public Policy Committee chair and chief medical officer of Cogent HMG in Brentwood, Tenn.

It’s a shift in mindset for sure, says the report’s lead author.

“The traditional model is pretty much fill your beds with high-paying patients. An ACO is really a different kind of concept,” says David Auerbach, MS, PhD, of Boston-based RAND Corporation. “A hospital that doesn’t have any experience thinking in a different way is going to find it hard to accommodate the ACO payment model. But hospitals that do…probably have staff that have thought about this and already started to move down the path to thinking about ways to reduce their costs.”

Regional Variance

Dr. Auerbach, a policy researcher and affiliate faculty member at Pardee RAND Graduate School, says further work needs to be done to identify “key regional factors” that induce certain physicians and hospitals to launch ACOs. His paper, “Accountable Care Organization Formation Is Associated with Integrated Systems but Not High Medical Spending,” found wide disparities in ACO formation; the model is popular in the Northeast and Midwest regions but scarcely found in the Northwest.

The authors reviewed 32 Medicare Pioneer ACOs, 116 Medicare Shared Savings Program ACOs, and 77 private-market entities very similar to ACOs. The study’s multiple-regression analysis found that in the 31 regions with at least 20% of Medicare fee-for-service beneficiaries in an ACO, more than half of hospitals had a joint venture with doctors or physician groups and were affiliated with a health system. In so-called “low-ACO areas,” that percentage hovered around 30% to 40%.

And while much of the policy discussion focuses on whether ACOs can rein in healthcare spending in some of the markets where care costs the most, the study reported “no strong pattern in the relationship between ACO penetration and Medicare spending or spending growth.”

Uncertain Upside

Dr. Auerbach says that while the results of his paper did not surprise him, he hopes hospitalists and others use them educationally.

“We might think about there being demand from people in other areas that might say, ‘I want to be a part of that too. Why aren’t there any ACOs that I can be in?’” he adds. “And so a study like this says, ‘Here are some of the things that seem to be important.’ If there’s not this kind of infrastructure in your area, as a policy maker, you could go and say, ‘Let’s try and give a boost to some of these factors or proxies for these things.’”

Part of that review would include looking at those areas that saw higher rates of physician-institution consolidation and figuring out what the motivations were. Typically, the impetus of forming larger groups is partly explained by a desire to negotiate with insurers and get better deals, Dr. Auerbach says. But with more coordinated care comes a more efficient system that can offset those lower rates.

“I think right now most policymakers are not sure if the upside is better than the downside,” he adds. “I think the answer, personally, is not to try to break up providers and do a lot of anti-trust activity. We need to understand whether, and how much, integrated groups are able to use market power to charge higher prices. And, if they do, there may be other ways to combat that problem while keeping the groups intact.”

Rethinking Reimbursement

Dr. Greeno says growing pains are inevitable along the way, particularly because the move to the ACO payment model is a seismic shift for a healthcare industry that has traditionally been based on a fee-for-service model.

“How we pay for healthcare in this country is going to be completely flipped on its head,” he says. “Part of the goal, of course, is better outcomes for patients. But it’s also cost efficiency. In the meantime, the entire system for 100 years has been paying for production.”

Dr. Greeno compares it to the shift that was the managed-care movement. Moving forward, the shift will create winners and losers and most likely will result in massive consolidation of healthcare organizations—from nearly 700 today to what Dr. Greeno believes may be 50 to 70 mega-providers.

“It’s basically what happened when HMOs started paying capitated payments to physician groups,” he says. “The groups then had X amount of dollars to care for their patient population, and if they couldn’t make that work, they went out of business or were acquired by more successful groups. If they could make it work, then they survived. It’s the exact same thing. It’s not quite as dramatic, as it is not going to happen overnight, but that’s where it’s heading.

“And instead of occurring in pockets around the country like in Southern California and Minneapolis, it’s going to be nationwide, and the world’s largest insurance company, which is Medicare, is driving it.”

Dr. Auerbach notes that while the disruption already has caused some groups to drop out of the ACO programs, he does not see that as a precursor to more organizations turning away from the program, particularly as it is among the key planks of the general healthcare reform movement.

“It is part of a larger wave that really is changing the way we do healthcare,” he says. “I think that as [ACOs] grow...people are going to say that this is becoming something like the dominant form of delivering healthcare.”

Richard Quinn is a freelance writer in New Jersey.

The environment that breeds the formation of accountable care organizations (ACOs) includes large integrated hospital systems, primary care physicians (PCPs) practicing in large groups, and a greater fraction of hospital risk sharing, according to a Health Affairs report (http://content.healthaffairs.org/content/32/10/1781.abstract).

In other words, institutions and areas that have begun embracing risk-based or population-based payment models are more likely to spur the formation of ACOs, which have similar risk-reward payment structures.

For hospitalists, knowing the conditions that help foster ACOs may be an important first step in pushing for development and continued growth, says Ron Greeno, MD, FCCP, MHM, SHM Public Policy Committee chair and chief medical officer of Cogent HMG in Brentwood, Tenn.

It’s a shift in mindset for sure, says the report’s lead author.

“The traditional model is pretty much fill your beds with high-paying patients. An ACO is really a different kind of concept,” says David Auerbach, MS, PhD, of Boston-based RAND Corporation. “A hospital that doesn’t have any experience thinking in a different way is going to find it hard to accommodate the ACO payment model. But hospitals that do…probably have staff that have thought about this and already started to move down the path to thinking about ways to reduce their costs.”

Regional Variance

Dr. Auerbach, a policy researcher and affiliate faculty member at Pardee RAND Graduate School, says further work needs to be done to identify “key regional factors” that induce certain physicians and hospitals to launch ACOs. His paper, “Accountable Care Organization Formation Is Associated with Integrated Systems but Not High Medical Spending,” found wide disparities in ACO formation; the model is popular in the Northeast and Midwest regions but scarcely found in the Northwest.

The authors reviewed 32 Medicare Pioneer ACOs, 116 Medicare Shared Savings Program ACOs, and 77 private-market entities very similar to ACOs. The study’s multiple-regression analysis found that in the 31 regions with at least 20% of Medicare fee-for-service beneficiaries in an ACO, more than half of hospitals had a joint venture with doctors or physician groups and were affiliated with a health system. In so-called “low-ACO areas,” that percentage hovered around 30% to 40%.

And while much of the policy discussion focuses on whether ACOs can rein in healthcare spending in some of the markets where care costs the most, the study reported “no strong pattern in the relationship between ACO penetration and Medicare spending or spending growth.”

Uncertain Upside

Dr. Auerbach says that while the results of his paper did not surprise him, he hopes hospitalists and others use them educationally.

“We might think about there being demand from people in other areas that might say, ‘I want to be a part of that too. Why aren’t there any ACOs that I can be in?’” he adds. “And so a study like this says, ‘Here are some of the things that seem to be important.’ If there’s not this kind of infrastructure in your area, as a policy maker, you could go and say, ‘Let’s try and give a boost to some of these factors or proxies for these things.’”

Part of that review would include looking at those areas that saw higher rates of physician-institution consolidation and figuring out what the motivations were. Typically, the impetus of forming larger groups is partly explained by a desire to negotiate with insurers and get better deals, Dr. Auerbach says. But with more coordinated care comes a more efficient system that can offset those lower rates.

“I think right now most policymakers are not sure if the upside is better than the downside,” he adds. “I think the answer, personally, is not to try to break up providers and do a lot of anti-trust activity. We need to understand whether, and how much, integrated groups are able to use market power to charge higher prices. And, if they do, there may be other ways to combat that problem while keeping the groups intact.”

Rethinking Reimbursement

Dr. Greeno says growing pains are inevitable along the way, particularly because the move to the ACO payment model is a seismic shift for a healthcare industry that has traditionally been based on a fee-for-service model.

“How we pay for healthcare in this country is going to be completely flipped on its head,” he says. “Part of the goal, of course, is better outcomes for patients. But it’s also cost efficiency. In the meantime, the entire system for 100 years has been paying for production.”

Dr. Greeno compares it to the shift that was the managed-care movement. Moving forward, the shift will create winners and losers and most likely will result in massive consolidation of healthcare organizations—from nearly 700 today to what Dr. Greeno believes may be 50 to 70 mega-providers.

“It’s basically what happened when HMOs started paying capitated payments to physician groups,” he says. “The groups then had X amount of dollars to care for their patient population, and if they couldn’t make that work, they went out of business or were acquired by more successful groups. If they could make it work, then they survived. It’s the exact same thing. It’s not quite as dramatic, as it is not going to happen overnight, but that’s where it’s heading.

“And instead of occurring in pockets around the country like in Southern California and Minneapolis, it’s going to be nationwide, and the world’s largest insurance company, which is Medicare, is driving it.”

Dr. Auerbach notes that while the disruption already has caused some groups to drop out of the ACO programs, he does not see that as a precursor to more organizations turning away from the program, particularly as it is among the key planks of the general healthcare reform movement.

“It is part of a larger wave that really is changing the way we do healthcare,” he says. “I think that as [ACOs] grow...people are going to say that this is becoming something like the dominant form of delivering healthcare.”

Richard Quinn is a freelance writer in New Jersey.

He doesn’t own a single Apple product. He hasn’t had a chance but can’t wait to watch “Zero Dark Thirty,” the docudrama that details the black ops mission to kill Osama bin Laden. And he doesn’t know what he’d do if he wasn’t a hospitalist.

A well-rounded hospitalist, that is.

Anand Kartha, MD, MS, is as engaged as hospital-based physicians come, working in the academic, research, community, and Veterans Affairs settings.

He studied at the University of Bombay in his native India, completing a four-year residency there before working as a resident and chief resident at the University of Pittsburgh Medical Center Mercy. He went on to complete a general medicine fellowship at Boston University and, in 2005, earned a Master of Science in Health Services Research at Boston University.

Currently, he is an academic hospitalist at the Boston VA and associate chief of general internal medicine. He is an assistant professor of medicine at Boston University School of Medicine and a lecturer in medicine at Harvard Medical School.

Dr. Kartha has been published a half dozen times and presented scientific abstract posters at HM12 in San Diego, HM10 in Washington, D.C., and HM09 in Chicago. He’s on the patient safety, systems redesign, professional standards, and peer review committees at the VA Boston Healthcare System. In 2007, he received the David Littmann Award for Excellence in Patient Care and Education from VA Boston and, in 2011, received the Robert Dawson Evans Faculty Special Recognition Teaching Award from Boston University.

“I spend about 15% to 20% of my time in research and 20% of my time in education, both focused on quality and patient safety,” says Dr. Kartha, one of nine new members of Team Hospitalist, the volunteer editorial advisory group for The Hospitalist. “For example, I am part of a national study to look at the quality of inpatient medicine care in the VA. I started and run a curriculum/rotation for medicine residents on quality and safety. I have held a number of leadership roles, like associate chief of medicine for quality and performance. I also enjoy working with system engineers on a number of QI projects.”

Working as a team and teaching residents and students are both very rewarding. As an academic hospitalist, I have flexible work hours that give me time to pursue both clinical and other opportunities too.

–Dr. Kartha

Question: Why did you choose a career in medicine?

A: Peer pressure; an interest in biology; desire to make a direct difference in people’s lives.

Q: When did you decide to become a hospitalist?

A: About 10 years ago. My research, clinical, and educational goals all overlapped in the inpatient arena and it was a natural progression.

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

A: Working as a team and teaching residents and students are both very rewarding. As an academic hospitalist, I have flexible work hours that give me time to pursue both clinical and other opportunities too.

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

A: Don’t be the first to adopt a new treatment, but don’t be the last.

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

A: Explosive growth. I never anticipated it would get to be so big, so fast.

Q: What is your biggest professional challenge?

A: Finding adequate mentorship and statistical support to do research and publish papers.

Q: What is your biggest professional reward?

A: Seeing my patients get better, watching my students get excited by medicine, and the success of my mentees.

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

A: Like most people, my family and health.

Q: What’s next professionally?

A: I have considered academic and medical industry leadership roles, but I see myself probably spending more time formally in inpatient clinical education.

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

A: I couldn’t do anything else. No skills, no interest—and I love what I do.

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

A: “Sweet Tooth” by Ian McEwan. Pure entertainment.

Richard Quinn is a freelance writer in New Jersey.

He doesn’t own a single Apple product. He hasn’t had a chance but can’t wait to watch “Zero Dark Thirty,” the docudrama that details the black ops mission to kill Osama bin Laden. And he doesn’t know what he’d do if he wasn’t a hospitalist.

A well-rounded hospitalist, that is.

Anand Kartha, MD, MS, is as engaged as hospital-based physicians come, working in the academic, research, community, and Veterans Affairs settings.

He studied at the University of Bombay in his native India, completing a four-year residency there before working as a resident and chief resident at the University of Pittsburgh Medical Center Mercy. He went on to complete a general medicine fellowship at Boston University and, in 2005, earned a Master of Science in Health Services Research at Boston University.

Currently, he is an academic hospitalist at the Boston VA and associate chief of general internal medicine. He is an assistant professor of medicine at Boston University School of Medicine and a lecturer in medicine at Harvard Medical School.

Dr. Kartha has been published a half dozen times and presented scientific abstract posters at HM12 in San Diego, HM10 in Washington, D.C., and HM09 in Chicago. He’s on the patient safety, systems redesign, professional standards, and peer review committees at the VA Boston Healthcare System. In 2007, he received the David Littmann Award for Excellence in Patient Care and Education from VA Boston and, in 2011, received the Robert Dawson Evans Faculty Special Recognition Teaching Award from Boston University.

“I spend about 15% to 20% of my time in research and 20% of my time in education, both focused on quality and patient safety,” says Dr. Kartha, one of nine new members of Team Hospitalist, the volunteer editorial advisory group for The Hospitalist. “For example, I am part of a national study to look at the quality of inpatient medicine care in the VA. I started and run a curriculum/rotation for medicine residents on quality and safety. I have held a number of leadership roles, like associate chief of medicine for quality and performance. I also enjoy working with system engineers on a number of QI projects.”

Working as a team and teaching residents and students are both very rewarding. As an academic hospitalist, I have flexible work hours that give me time to pursue both clinical and other opportunities too.

–Dr. Kartha

Question: Why did you choose a career in medicine?

A: Peer pressure; an interest in biology; desire to make a direct difference in people’s lives.

Q: When did you decide to become a hospitalist?

A: About 10 years ago. My research, clinical, and educational goals all overlapped in the inpatient arena and it was a natural progression.

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

A: Working as a team and teaching residents and students are both very rewarding. As an academic hospitalist, I have flexible work hours that give me time to pursue both clinical and other opportunities too.

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

A: Don’t be the first to adopt a new treatment, but don’t be the last.

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

A: Explosive growth. I never anticipated it would get to be so big, so fast.

Q: What is your biggest professional challenge?

A: Finding adequate mentorship and statistical support to do research and publish papers.

Q: What is your biggest professional reward?

A: Seeing my patients get better, watching my students get excited by medicine, and the success of my mentees.

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

A: Like most people, my family and health.

Q: What’s next professionally?

A: I have considered academic and medical industry leadership roles, but I see myself probably spending more time formally in inpatient clinical education.

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

A: I couldn’t do anything else. No skills, no interest—and I love what I do.

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

A: “Sweet Tooth” by Ian McEwan. Pure entertainment.

Richard Quinn is a freelance writer in New Jersey.

He doesn’t own a single Apple product. He hasn’t had a chance but can’t wait to watch “Zero Dark Thirty,” the docudrama that details the black ops mission to kill Osama bin Laden. And he doesn’t know what he’d do if he wasn’t a hospitalist.

A well-rounded hospitalist, that is.

Anand Kartha, MD, MS, is as engaged as hospital-based physicians come, working in the academic, research, community, and Veterans Affairs settings.

He studied at the University of Bombay in his native India, completing a four-year residency there before working as a resident and chief resident at the University of Pittsburgh Medical Center Mercy. He went on to complete a general medicine fellowship at Boston University and, in 2005, earned a Master of Science in Health Services Research at Boston University.

Currently, he is an academic hospitalist at the Boston VA and associate chief of general internal medicine. He is an assistant professor of medicine at Boston University School of Medicine and a lecturer in medicine at Harvard Medical School.

Dr. Kartha has been published a half dozen times and presented scientific abstract posters at HM12 in San Diego, HM10 in Washington, D.C., and HM09 in Chicago. He’s on the patient safety, systems redesign, professional standards, and peer review committees at the VA Boston Healthcare System. In 2007, he received the David Littmann Award for Excellence in Patient Care and Education from VA Boston and, in 2011, received the Robert Dawson Evans Faculty Special Recognition Teaching Award from Boston University.

“I spend about 15% to 20% of my time in research and 20% of my time in education, both focused on quality and patient safety,” says Dr. Kartha, one of nine new members of Team Hospitalist, the volunteer editorial advisory group for The Hospitalist. “For example, I am part of a national study to look at the quality of inpatient medicine care in the VA. I started and run a curriculum/rotation for medicine residents on quality and safety. I have held a number of leadership roles, like associate chief of medicine for quality and performance. I also enjoy working with system engineers on a number of QI projects.”

Working as a team and teaching residents and students are both very rewarding. As an academic hospitalist, I have flexible work hours that give me time to pursue both clinical and other opportunities too.

–Dr. Kartha

Question: Why did you choose a career in medicine?

A: Peer pressure; an interest in biology; desire to make a direct difference in people’s lives.

Q: When did you decide to become a hospitalist?

A: About 10 years ago. My research, clinical, and educational goals all overlapped in the inpatient arena and it was a natural progression.

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

A: Working as a team and teaching residents and students are both very rewarding. As an academic hospitalist, I have flexible work hours that give me time to pursue both clinical and other opportunities too.

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

A: Don’t be the first to adopt a new treatment, but don’t be the last.

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

A: Explosive growth. I never anticipated it would get to be so big, so fast.

Q: What is your biggest professional challenge?

A: Finding adequate mentorship and statistical support to do research and publish papers.

Q: What is your biggest professional reward?

A: Seeing my patients get better, watching my students get excited by medicine, and the success of my mentees.

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

A: Like most people, my family and health.

Q: What’s next professionally?

A: I have considered academic and medical industry leadership roles, but I see myself probably spending more time formally in inpatient clinical education.

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

A: I couldn’t do anything else. No skills, no interest—and I love what I do.

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

A: “Sweet Tooth” by Ian McEwan. Pure entertainment.

Richard Quinn is a freelance writer in New Jersey.