Richard Quinn

Lean thinking teaches you that change and improvement do not come down from leadership, but rather develop up from front-line workers. Group leaders need to continue seeing patients to truly understand the processes and problems inherent in clinical work.

It took a while for James J. O’Callaghan, MD, FAAP, FHM, to settle on a career path. First, he pursued the life of a chemical engineer. Then, in his third year at Rensselaer Polytechnic Institute in Troy, N.Y., he realized the kind of job he would be getting into was not quite for him. His then-girlfriend was a pre-med student, and it wasn’t long until he switched majors.

Hospital medicine drew his interest during residency, when he spent a monthlong rotation with a small group of physicians at a community hospital in Cleveland.

“Their days consisted of rounding on pediatric inpatients, examining normal newborns, completing pediatric consults in the ED, and performing minor procedures on the floor,” he says. “To me, it seemed the perfect job.”

Dr. O’Callaghan married an adult-medicine hospitalist and moved to Seattle, but he could not find a good fit in a hospitalist practice. He did private practice for two years, and in 2004, he landed a position in pediatric hospital medicine.

“I quickly changed career paths,” he says.

Dr. O’Callaghan is now a regional pediatric hospitalist at Evergreen Hospital in Kirkland, Wash., and a medical hospitalist at Seattle Children’s Hospital. He is a clinical assistant professor at the University of Washington and one of nine new Team Hospitalist members, The Hospitalist’s volunteer editorial advisory group.

As the section head for pediatrics at Evergreen, Dr. O’Callaghan spends most of his time seeing patients. However, he has in recent years developed a keen interest in quality improvement (QI). He’s the lead pediatric hospitalist on two clinical pathways at Seattle Children’s and has been an active member of SHM’s Hospital Quality and Patient Safety Committee since 2012.

“I want to continue to expand on this QI work,” he says, “with the goal of developing into a formal QI role at either, or both, hospitals.”

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

Answer: I like the fact that the work I am doing as a hospitalist can have both an immediate impact on a single patient and a prolonged impact on multiple patients. I can admit a child with community-acquired pneumonia and, through my treatment, prevent serious sequelae from developing. However, I can also develop an evidenced-based, community-acquired pneumonia pathway and, potentially, affect the care of hundreds of children. There is immediate gratification in treating today’s patient and delayed gratification knowing that you are helping many of tomorrow’s patients.

Q: What do you dislike?

A: One of the hardest parts of a career in HM is trying to effect culture change. Hospital systems are typically large, complex organizations with their own culture. In order to successfully produce sustainable, long-term improvement, you must change this culture. You can perform a robust search of the literature to produce a brilliant clinical-care path, but unless you can affect behavior, your work and effort may not last. It can be frustrating to think you have the answer to a clinical problem only to see your effort fail because you could not change culture.

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

A: In the early years, much of the conversation in HM was centered on the viability of a career in HM. Could one make a sustainable career in HM? Would hospitals and health systems continue to support physicians in HM? The biggest change I have seen is that we are no longer having those conversations. Now, the conversations are focused on determining which areas of medicine will be owned by HM: First it was QI work, then patient safety, and now resource utilization and cost containment. We are no longer spending time and energy worrying about the future of HM, but rather now our efforts are focused on the present work of HM. As a sustainable career, HM is here to stay.

Q: For group leaders, why is it important for you to continue seeing patients?

A: In my QI work, I have studied Lean thinking and methodology. Lean thinking teaches you that change and improvement do not come down from leadership, but rather develop up from front-line workers. Group leaders need to continue seeing patients to truly understand the processes and problems inherent in clinical work. Effective solutions must come from those actually doing the work, rather than from those managing the work from above.

Q: What does it mean to you to be elected a Fellow in Hospital Medicine?

A: It meant that I had committed fully to a career in hospital medicine. I use the FHM designation proudly in all my communications, as a signal to others of my commitment and dedication to hospital medicine. Someday, I hope to earn the designation of SFHM, as a validation and recognition of my contributions to the field of pediatric hospital medicine.

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

A: After family, it is important for me to maintain a healthy lifestyle and stay in shape. I am able to commute to Seattle Children’s Hospital by bicycle and I try to run two to three times a week. I squeeze in half-marathons and marathons, along with century [100 miles] and double-century bicycle rides each year.

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

A: I would love to be a stay-at-home father for my boys and also devote the time and energy into pursuing a career in trail running.

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

A: I recently read Jim Collins’ “Good to Great” as part of a management training course at Seattle Children’s Hospital. This easy-to-read, highly entertaining book clearly demonstrates the culture changes that need to occur for companies to move from good to great. As a field, hospital medicine, with its focus on QI work and patient safety, is now in the midst of trying to become “great.”

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

A: As many as possible. My wife and I own two iPhones, two iPads, and a MacBook Air, which she thinks we share but, in actuality, is mine. We are hoping to purchase a Mac desktop, and then we will have fully given over to the dark side.

Richard Quinn is a freelance writer in New Jersey.

Lean thinking teaches you that change and improvement do not come down from leadership, but rather develop up from front-line workers. Group leaders need to continue seeing patients to truly understand the processes and problems inherent in clinical work.

It took a while for James J. O’Callaghan, MD, FAAP, FHM, to settle on a career path. First, he pursued the life of a chemical engineer. Then, in his third year at Rensselaer Polytechnic Institute in Troy, N.Y., he realized the kind of job he would be getting into was not quite for him. His then-girlfriend was a pre-med student, and it wasn’t long until he switched majors.

Hospital medicine drew his interest during residency, when he spent a monthlong rotation with a small group of physicians at a community hospital in Cleveland.

“Their days consisted of rounding on pediatric inpatients, examining normal newborns, completing pediatric consults in the ED, and performing minor procedures on the floor,” he says. “To me, it seemed the perfect job.”

Dr. O’Callaghan married an adult-medicine hospitalist and moved to Seattle, but he could not find a good fit in a hospitalist practice. He did private practice for two years, and in 2004, he landed a position in pediatric hospital medicine.

“I quickly changed career paths,” he says.

Dr. O’Callaghan is now a regional pediatric hospitalist at Evergreen Hospital in Kirkland, Wash., and a medical hospitalist at Seattle Children’s Hospital. He is a clinical assistant professor at the University of Washington and one of nine new Team Hospitalist members, The Hospitalist’s volunteer editorial advisory group.

As the section head for pediatrics at Evergreen, Dr. O’Callaghan spends most of his time seeing patients. However, he has in recent years developed a keen interest in quality improvement (QI). He’s the lead pediatric hospitalist on two clinical pathways at Seattle Children’s and has been an active member of SHM’s Hospital Quality and Patient Safety Committee since 2012.

“I want to continue to expand on this QI work,” he says, “with the goal of developing into a formal QI role at either, or both, hospitals.”

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

Answer: I like the fact that the work I am doing as a hospitalist can have both an immediate impact on a single patient and a prolonged impact on multiple patients. I can admit a child with community-acquired pneumonia and, through my treatment, prevent serious sequelae from developing. However, I can also develop an evidenced-based, community-acquired pneumonia pathway and, potentially, affect the care of hundreds of children. There is immediate gratification in treating today’s patient and delayed gratification knowing that you are helping many of tomorrow’s patients.

Q: What do you dislike?

A: One of the hardest parts of a career in HM is trying to effect culture change. Hospital systems are typically large, complex organizations with their own culture. In order to successfully produce sustainable, long-term improvement, you must change this culture. You can perform a robust search of the literature to produce a brilliant clinical-care path, but unless you can affect behavior, your work and effort may not last. It can be frustrating to think you have the answer to a clinical problem only to see your effort fail because you could not change culture.

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

A: In the early years, much of the conversation in HM was centered on the viability of a career in HM. Could one make a sustainable career in HM? Would hospitals and health systems continue to support physicians in HM? The biggest change I have seen is that we are no longer having those conversations. Now, the conversations are focused on determining which areas of medicine will be owned by HM: First it was QI work, then patient safety, and now resource utilization and cost containment. We are no longer spending time and energy worrying about the future of HM, but rather now our efforts are focused on the present work of HM. As a sustainable career, HM is here to stay.

Q: For group leaders, why is it important for you to continue seeing patients?

A: In my QI work, I have studied Lean thinking and methodology. Lean thinking teaches you that change and improvement do not come down from leadership, but rather develop up from front-line workers. Group leaders need to continue seeing patients to truly understand the processes and problems inherent in clinical work. Effective solutions must come from those actually doing the work, rather than from those managing the work from above.

Q: What does it mean to you to be elected a Fellow in Hospital Medicine?

A: It meant that I had committed fully to a career in hospital medicine. I use the FHM designation proudly in all my communications, as a signal to others of my commitment and dedication to hospital medicine. Someday, I hope to earn the designation of SFHM, as a validation and recognition of my contributions to the field of pediatric hospital medicine.

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

A: After family, it is important for me to maintain a healthy lifestyle and stay in shape. I am able to commute to Seattle Children’s Hospital by bicycle and I try to run two to three times a week. I squeeze in half-marathons and marathons, along with century [100 miles] and double-century bicycle rides each year.

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

A: I would love to be a stay-at-home father for my boys and also devote the time and energy into pursuing a career in trail running.

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

A: I recently read Jim Collins’ “Good to Great” as part of a management training course at Seattle Children’s Hospital. This easy-to-read, highly entertaining book clearly demonstrates the culture changes that need to occur for companies to move from good to great. As a field, hospital medicine, with its focus on QI work and patient safety, is now in the midst of trying to become “great.”

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

A: As many as possible. My wife and I own two iPhones, two iPads, and a MacBook Air, which she thinks we share but, in actuality, is mine. We are hoping to purchase a Mac desktop, and then we will have fully given over to the dark side.

Richard Quinn is a freelance writer in New Jersey.

Lean thinking teaches you that change and improvement do not come down from leadership, but rather develop up from front-line workers. Group leaders need to continue seeing patients to truly understand the processes and problems inherent in clinical work.

It took a while for James J. O’Callaghan, MD, FAAP, FHM, to settle on a career path. First, he pursued the life of a chemical engineer. Then, in his third year at Rensselaer Polytechnic Institute in Troy, N.Y., he realized the kind of job he would be getting into was not quite for him. His then-girlfriend was a pre-med student, and it wasn’t long until he switched majors.

Hospital medicine drew his interest during residency, when he spent a monthlong rotation with a small group of physicians at a community hospital in Cleveland.

“Their days consisted of rounding on pediatric inpatients, examining normal newborns, completing pediatric consults in the ED, and performing minor procedures on the floor,” he says. “To me, it seemed the perfect job.”

Dr. O’Callaghan married an adult-medicine hospitalist and moved to Seattle, but he could not find a good fit in a hospitalist practice. He did private practice for two years, and in 2004, he landed a position in pediatric hospital medicine.

“I quickly changed career paths,” he says.

Dr. O’Callaghan is now a regional pediatric hospitalist at Evergreen Hospital in Kirkland, Wash., and a medical hospitalist at Seattle Children’s Hospital. He is a clinical assistant professor at the University of Washington and one of nine new Team Hospitalist members, The Hospitalist’s volunteer editorial advisory group.

As the section head for pediatrics at Evergreen, Dr. O’Callaghan spends most of his time seeing patients. However, he has in recent years developed a keen interest in quality improvement (QI). He’s the lead pediatric hospitalist on two clinical pathways at Seattle Children’s and has been an active member of SHM’s Hospital Quality and Patient Safety Committee since 2012.

“I want to continue to expand on this QI work,” he says, “with the goal of developing into a formal QI role at either, or both, hospitals.”

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

Answer: I like the fact that the work I am doing as a hospitalist can have both an immediate impact on a single patient and a prolonged impact on multiple patients. I can admit a child with community-acquired pneumonia and, through my treatment, prevent serious sequelae from developing. However, I can also develop an evidenced-based, community-acquired pneumonia pathway and, potentially, affect the care of hundreds of children. There is immediate gratification in treating today’s patient and delayed gratification knowing that you are helping many of tomorrow’s patients.

Q: What do you dislike?

A: One of the hardest parts of a career in HM is trying to effect culture change. Hospital systems are typically large, complex organizations with their own culture. In order to successfully produce sustainable, long-term improvement, you must change this culture. You can perform a robust search of the literature to produce a brilliant clinical-care path, but unless you can affect behavior, your work and effort may not last. It can be frustrating to think you have the answer to a clinical problem only to see your effort fail because you could not change culture.

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

A: In the early years, much of the conversation in HM was centered on the viability of a career in HM. Could one make a sustainable career in HM? Would hospitals and health systems continue to support physicians in HM? The biggest change I have seen is that we are no longer having those conversations. Now, the conversations are focused on determining which areas of medicine will be owned by HM: First it was QI work, then patient safety, and now resource utilization and cost containment. We are no longer spending time and energy worrying about the future of HM, but rather now our efforts are focused on the present work of HM. As a sustainable career, HM is here to stay.

Q: For group leaders, why is it important for you to continue seeing patients?

A: In my QI work, I have studied Lean thinking and methodology. Lean thinking teaches you that change and improvement do not come down from leadership, but rather develop up from front-line workers. Group leaders need to continue seeing patients to truly understand the processes and problems inherent in clinical work. Effective solutions must come from those actually doing the work, rather than from those managing the work from above.

Q: What does it mean to you to be elected a Fellow in Hospital Medicine?

A: It meant that I had committed fully to a career in hospital medicine. I use the FHM designation proudly in all my communications, as a signal to others of my commitment and dedication to hospital medicine. Someday, I hope to earn the designation of SFHM, as a validation and recognition of my contributions to the field of pediatric hospital medicine.

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

A: After family, it is important for me to maintain a healthy lifestyle and stay in shape. I am able to commute to Seattle Children’s Hospital by bicycle and I try to run two to three times a week. I squeeze in half-marathons and marathons, along with century [100 miles] and double-century bicycle rides each year.

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

A: I would love to be a stay-at-home father for my boys and also devote the time and energy into pursuing a career in trail running.

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

A: I recently read Jim Collins’ “Good to Great” as part of a management training course at Seattle Children’s Hospital. This easy-to-read, highly entertaining book clearly demonstrates the culture changes that need to occur for companies to move from good to great. As a field, hospital medicine, with its focus on QI work and patient safety, is now in the midst of trying to become “great.”

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

A: As many as possible. My wife and I own two iPhones, two iPads, and a MacBook Air, which she thinks we share but, in actuality, is mine. We are hoping to purchase a Mac desktop, and then we will have fully given over to the dark side.

Richard Quinn is a freelance writer in New Jersey.

New research suggests use of the designation "observation status" for admitted hospital patients varies in clinical practice, despite rigid criteria the Centers for Medicare & Medicaid Services (CMS) uses to define the term.

CMS defines observation status as "well-defined sets of specific, clinically appropriate services." In most cases, the status applies to inpatient stays of less than 24 hours. Longer than 48 hours is dubbed "rare and exceptional" by the federal agency.

But in the report, “Hospitalized But Not Admitted: Characteristics of Patients With ‘Observation Status’ at an Academic Medical Center," lead author and hospitalist Ann Sheehy, MD, MS, of Wisconsin School of Medicine and Public Health in Madison found that patients' mean length of stay (LOS) in observation was 33.3 hours, but it was longer than 48 hours in 16.5% of cases. Dr. Sheehy adds that 1,141 distinct observation diagnosis codes were used for observation stays during the study period, which ran from July 1, 2010, to Dec. 31, 2011.

"What CMS has as a definition for observation status is clearly not what's happening in clinical practice, based on the length of stay and the wide variety of diagnosis codes," Dr. Sheehy says. "We had over 1,000 diagnosis codes for something CMS says is well-defined."

The issue is of particular note to hospital medicine groups as observation status disproportionately affects the general-medicine population, Dr. Sheehy says. Just over 52% of all observation stays in the study were adult general-medicine patients.

The paper adds that while the cost per encounter for observation care was less than that for inpatient care, the average reimbursement for observation care failed to cover it. The net loss per encounter for an observation stay was $331, compared with a net gain of $2,163 for an inpatient stay.

"We don't want to have hospitals operating on a huge profit margin," Dr. Sheehy says, but "you can't have hospitals delivering care at a loss consistently and have them stay solvent. It's just not going to work."

Visit our website for more information on observation status rules.

New research suggests use of the designation "observation status" for admitted hospital patients varies in clinical practice, despite rigid criteria the Centers for Medicare & Medicaid Services (CMS) uses to define the term.

CMS defines observation status as "well-defined sets of specific, clinically appropriate services." In most cases, the status applies to inpatient stays of less than 24 hours. Longer than 48 hours is dubbed "rare and exceptional" by the federal agency.

But in the report, “Hospitalized But Not Admitted: Characteristics of Patients With ‘Observation Status’ at an Academic Medical Center," lead author and hospitalist Ann Sheehy, MD, MS, of Wisconsin School of Medicine and Public Health in Madison found that patients' mean length of stay (LOS) in observation was 33.3 hours, but it was longer than 48 hours in 16.5% of cases. Dr. Sheehy adds that 1,141 distinct observation diagnosis codes were used for observation stays during the study period, which ran from July 1, 2010, to Dec. 31, 2011.

"What CMS has as a definition for observation status is clearly not what's happening in clinical practice, based on the length of stay and the wide variety of diagnosis codes," Dr. Sheehy says. "We had over 1,000 diagnosis codes for something CMS says is well-defined."

The issue is of particular note to hospital medicine groups as observation status disproportionately affects the general-medicine population, Dr. Sheehy says. Just over 52% of all observation stays in the study were adult general-medicine patients.

The paper adds that while the cost per encounter for observation care was less than that for inpatient care, the average reimbursement for observation care failed to cover it. The net loss per encounter for an observation stay was $331, compared with a net gain of $2,163 for an inpatient stay.

"We don't want to have hospitals operating on a huge profit margin," Dr. Sheehy says, but "you can't have hospitals delivering care at a loss consistently and have them stay solvent. It's just not going to work."

Visit our website for more information on observation status rules.

New research suggests use of the designation "observation status" for admitted hospital patients varies in clinical practice, despite rigid criteria the Centers for Medicare & Medicaid Services (CMS) uses to define the term.

CMS defines observation status as "well-defined sets of specific, clinically appropriate services." In most cases, the status applies to inpatient stays of less than 24 hours. Longer than 48 hours is dubbed "rare and exceptional" by the federal agency.

But in the report, “Hospitalized But Not Admitted: Characteristics of Patients With ‘Observation Status’ at an Academic Medical Center," lead author and hospitalist Ann Sheehy, MD, MS, of Wisconsin School of Medicine and Public Health in Madison found that patients' mean length of stay (LOS) in observation was 33.3 hours, but it was longer than 48 hours in 16.5% of cases. Dr. Sheehy adds that 1,141 distinct observation diagnosis codes were used for observation stays during the study period, which ran from July 1, 2010, to Dec. 31, 2011.

"What CMS has as a definition for observation status is clearly not what's happening in clinical practice, based on the length of stay and the wide variety of diagnosis codes," Dr. Sheehy says. "We had over 1,000 diagnosis codes for something CMS says is well-defined."

The issue is of particular note to hospital medicine groups as observation status disproportionately affects the general-medicine population, Dr. Sheehy says. Just over 52% of all observation stays in the study were adult general-medicine patients.

The paper adds that while the cost per encounter for observation care was less than that for inpatient care, the average reimbursement for observation care failed to cover it. The net loss per encounter for an observation stay was $331, compared with a net gain of $2,163 for an inpatient stay.

"We don't want to have hospitals operating on a huge profit margin," Dr. Sheehy says, but "you can't have hospitals delivering care at a loss consistently and have them stay solvent. It's just not going to work."

Visit our website for more information on observation status rules.

A new report that shows double-digit gains in hospitals’ electronic health information exchanges with other providers is a boon to healthcare, says one of SHM’s leading health information technology experts.

Published last month at HealthAffairs.org, “Hospital Electronic Health Information Exchange Grew Substantially in 2008-2012,” found that nearly 6 in 10 hospitals actively exchanged electronic health information with providers and hospitals outside of their own organization in 2012, a 41% jump since 2008.

Kendall Rogers, MD, FACP, SFHM, chief of the division of hospital medicine at the University of New Mexico Health Sciences Center in Albuquerque, says in an email to The Hospitalist that the growth is a good thing.

“Obviously, flow of information is never a bad thing for hospital medicine,” writes Dr. Rogers, chair of SHM’s Information Technology Executive Committee. “I think we have made more progress getting information back out to providers in the community, [and] helping with a safer transition (though we still have a long way to go), but we still lack significantly [in] getting info from providers or other hospitals on admission.”

The report notes that while more information has flowed among hospitals and providers, exchanges of clinical-care summaries and medication lists remain limited. The authors suggest that “new and ongoing policy initiatives and payment reforms may accelerate” the process.

Dr. Rogers adds that making systems more user-friendly may also encourage meaningful participation. “We have a health information exchange here in New Mexico that includes most hospitals”; however, he writes, “it is cumbersome and not routinely used, but definitely a step in the right direction.”

Visit our website for more information on health information technology.

A new report that shows double-digit gains in hospitals’ electronic health information exchanges with other providers is a boon to healthcare, says one of SHM’s leading health information technology experts.

Published last month at HealthAffairs.org, “Hospital Electronic Health Information Exchange Grew Substantially in 2008-2012,” found that nearly 6 in 10 hospitals actively exchanged electronic health information with providers and hospitals outside of their own organization in 2012, a 41% jump since 2008.

Kendall Rogers, MD, FACP, SFHM, chief of the division of hospital medicine at the University of New Mexico Health Sciences Center in Albuquerque, says in an email to The Hospitalist that the growth is a good thing.

“Obviously, flow of information is never a bad thing for hospital medicine,” writes Dr. Rogers, chair of SHM’s Information Technology Executive Committee. “I think we have made more progress getting information back out to providers in the community, [and] helping with a safer transition (though we still have a long way to go), but we still lack significantly [in] getting info from providers or other hospitals on admission.”

The report notes that while more information has flowed among hospitals and providers, exchanges of clinical-care summaries and medication lists remain limited. The authors suggest that “new and ongoing policy initiatives and payment reforms may accelerate” the process.

Dr. Rogers adds that making systems more user-friendly may also encourage meaningful participation. “We have a health information exchange here in New Mexico that includes most hospitals”; however, he writes, “it is cumbersome and not routinely used, but definitely a step in the right direction.”

Visit our website for more information on health information technology.

A new report that shows double-digit gains in hospitals’ electronic health information exchanges with other providers is a boon to healthcare, says one of SHM’s leading health information technology experts.

Published last month at HealthAffairs.org, “Hospital Electronic Health Information Exchange Grew Substantially in 2008-2012,” found that nearly 6 in 10 hospitals actively exchanged electronic health information with providers and hospitals outside of their own organization in 2012, a 41% jump since 2008.

Kendall Rogers, MD, FACP, SFHM, chief of the division of hospital medicine at the University of New Mexico Health Sciences Center in Albuquerque, says in an email to The Hospitalist that the growth is a good thing.

“Obviously, flow of information is never a bad thing for hospital medicine,” writes Dr. Rogers, chair of SHM’s Information Technology Executive Committee. “I think we have made more progress getting information back out to providers in the community, [and] helping with a safer transition (though we still have a long way to go), but we still lack significantly [in] getting info from providers or other hospitals on admission.”

The report notes that while more information has flowed among hospitals and providers, exchanges of clinical-care summaries and medication lists remain limited. The authors suggest that “new and ongoing policy initiatives and payment reforms may accelerate” the process.

Dr. Rogers adds that making systems more user-friendly may also encourage meaningful participation. “We have a health information exchange here in New Mexico that includes most hospitals”; however, he writes, “it is cumbersome and not routinely used, but definitely a step in the right direction.”

Visit our website for more information on health information technology.

On May 12, 113 hospitalists descended on Capitol Hill for “Hospitalists on the Hill 2013,” the public-advocacy highlight of SHM’s annual meeting. Hospitalists from all parts of the country engaged with congressional representatives in a daylong series of meet-and-greets that may seem to some people useless in the face of political obstinacy in Washington. But the trip worked.

Josh Boswell, SHM’s senior manager of government relations, reports many Hill Day objectives were achieved:

• The number of legislators co-sponsoring a bill regarding the “three-day observation rule” more than tripled in the House of Representatives and doubled in the Senate. SHM officials note that the added support has come from both political parties.
• A Congressional Budget Office (CBO) review of the bill has been formally requested by those legislators.
• A congressman from Washington state asked for—and received—a letter of support for a proposed measure, the Improved Health Care at a Lower Cost Act of 2013 (H.R. 1487).
• Multiple reports of continued dialogue between congressional staffers and SHM members nationwide. When planning the advocacy day, SHM officials noted that one of the most valuable results is creating relationships at the local level.

Observation Legislation

One of the three talking points hospitalists took into their legislative meetings was solving the dilemmas surrounding observation status. Currently, time spent on observation status does not count toward the required three consecutive overnights an inpatient needs to qualify for Medicare benefits at a skilled nursing facility (SNF).

Hospitalists have been pushing to change that rule, in large part by supporting the Improving Access to Medicare Coverage Act of 2013 (H.R. 1179, S. 569), sponsored by Rep. Joe Courtney (D-Conn.), Rep. Tom Latham (R-Iowa), and Sen. Sherrod Brown (D-Ohio).¹ In addition to the status reclassification, the proposal would establish a 90-day appeal period for those who have been denied the benefit.

The issue is important to hospitalists because of the penalties hospitals face for readmissions—and also in part because hospitalists increasingly are providing care at SNFs and other post-acute-care facilities. SHM says that after the Hill visits—and the ensuing follow-up communications—the number of co-sponsors in the House jumped to 70 from 22. The Senate version doubled its list of co-sponsors.

And, perhaps more important, a CBO analysis has been requested for the observation bills. That review, known as a CBO score, weighs the financial impacts of proposed laws and is considered a necessary precursor to successfully passing any legislation.

All in all, SHM was pleased with the progress on the observation-status bill and will continue to push for its passage, whether it is in this congressional session or the next.

“Rep. Courtney’s bill is now getting significant traction,” Boswell says. “Hospitalists should be proud to know this is in no small part due to their advocacy efforts.”

Political Networking

Hospitalist David Ramenofsky, MD, who works at Northwest Hospital and Medical Center in Seattle, wasn’t sure how much traction he was going to be able to generate at his first Hill Day. SHM had arranged meetings with the offices of three local politicians: Rep. Jim McDermott (D-Wash.), Sen. Patty Murray (D-Wash.), and Sen. Maria Cantwell (D-Wash.).

Dr. Ramenofsky sat with two of McDermott’s staffers, one of whom sounded knowledgeable and enthused about health-care-policy issues. Although the congressman couldn’t sit in on the meeting, he knew Dr. Ramenofsky’s name and took the time to say hello.

“It was really interesting to me that these staffers wanted to hear what I had to say and learn about my experience,” Dr. Ramenofsky adds. “My views may affect how they work with their bosses to make policy changes. It was surprising to me how much my opinions mattered to them.”

After the meeting and another briefing SHM arranged with another local hospitalist, McDermott reached out to SHM. He asked for support for his proposed bill to expand protections from anti-kickback laws and regulations, to provide safe harbor protection for gainsharing, and other incentive-payment systems.

SHM responded in July with a letter of support that thanked the congressman for his efforts.²

“We look forward to working with you,” the letter ended.

Dr. Ramenofsky says he’s proud his efforts led to a working relationship between his professional society and his local legislator. He says he’s looking forward to participating in future Hill Day activities and acting as a local liaison for SHM.

He laments that he has not received much post-meeting feedback from his discussions with the senators’ offices, but says he understands how busy politicians are. And a 1-for-3 showing is pretty good, given his status as a political novice.

“Given overall public perception of Congress, I’m amazed that my visits caused one of three offices to engage in further policy discussions with SHM,” he says. “I’m encouraged to remain engaged in political activities through SHM.”

Richard Quinn is a freelance writer in New Jersey.

References

1. Society of Hospital Medicine. Letter to Congress members. Society of Hospital Medicine website. Available at: http://www.hospitalmedicine.org/AM/Template.cfm?Section=Letters_to_Congress_and_ Regulatory_Agencies&Template=/CM/ContentDisplay.cfm&ContentID=33169. Accessed July 15, 2013.
2. Society of Hospital Medicine. Letter to Congressman Jim McDermott. Society of Hospital Medicine website. Available at: http://www.hospitalmedicine.org/AM/Template.cfm?Section=Letters_to_Congress_and_Regulatory_Agencies&Template=/CM/ContentDisplay.cfm&ContentID=34169. Accessed July 15, 2013.

On May 12, 113 hospitalists descended on Capitol Hill for “Hospitalists on the Hill 2013,” the public-advocacy highlight of SHM’s annual meeting. Hospitalists from all parts of the country engaged with congressional representatives in a daylong series of meet-and-greets that may seem to some people useless in the face of political obstinacy in Washington. But the trip worked.

Josh Boswell, SHM’s senior manager of government relations, reports many Hill Day objectives were achieved:

• The number of legislators co-sponsoring a bill regarding the “three-day observation rule” more than tripled in the House of Representatives and doubled in the Senate. SHM officials note that the added support has come from both political parties.
• A Congressional Budget Office (CBO) review of the bill has been formally requested by those legislators.
• A congressman from Washington state asked for—and received—a letter of support for a proposed measure, the Improved Health Care at a Lower Cost Act of 2013 (H.R. 1487).
• Multiple reports of continued dialogue between congressional staffers and SHM members nationwide. When planning the advocacy day, SHM officials noted that one of the most valuable results is creating relationships at the local level.

Observation Legislation

One of the three talking points hospitalists took into their legislative meetings was solving the dilemmas surrounding observation status. Currently, time spent on observation status does not count toward the required three consecutive overnights an inpatient needs to qualify for Medicare benefits at a skilled nursing facility (SNF).

Hospitalists have been pushing to change that rule, in large part by supporting the Improving Access to Medicare Coverage Act of 2013 (H.R. 1179, S. 569), sponsored by Rep. Joe Courtney (D-Conn.), Rep. Tom Latham (R-Iowa), and Sen. Sherrod Brown (D-Ohio).¹ In addition to the status reclassification, the proposal would establish a 90-day appeal period for those who have been denied the benefit.

The issue is important to hospitalists because of the penalties hospitals face for readmissions—and also in part because hospitalists increasingly are providing care at SNFs and other post-acute-care facilities. SHM says that after the Hill visits—and the ensuing follow-up communications—the number of co-sponsors in the House jumped to 70 from 22. The Senate version doubled its list of co-sponsors.

And, perhaps more important, a CBO analysis has been requested for the observation bills. That review, known as a CBO score, weighs the financial impacts of proposed laws and is considered a necessary precursor to successfully passing any legislation.

All in all, SHM was pleased with the progress on the observation-status bill and will continue to push for its passage, whether it is in this congressional session or the next.

“Rep. Courtney’s bill is now getting significant traction,” Boswell says. “Hospitalists should be proud to know this is in no small part due to their advocacy efforts.”

Political Networking

Hospitalist David Ramenofsky, MD, who works at Northwest Hospital and Medical Center in Seattle, wasn’t sure how much traction he was going to be able to generate at his first Hill Day. SHM had arranged meetings with the offices of three local politicians: Rep. Jim McDermott (D-Wash.), Sen. Patty Murray (D-Wash.), and Sen. Maria Cantwell (D-Wash.).

Dr. Ramenofsky sat with two of McDermott’s staffers, one of whom sounded knowledgeable and enthused about health-care-policy issues. Although the congressman couldn’t sit in on the meeting, he knew Dr. Ramenofsky’s name and took the time to say hello.

“It was really interesting to me that these staffers wanted to hear what I had to say and learn about my experience,” Dr. Ramenofsky adds. “My views may affect how they work with their bosses to make policy changes. It was surprising to me how much my opinions mattered to them.”

After the meeting and another briefing SHM arranged with another local hospitalist, McDermott reached out to SHM. He asked for support for his proposed bill to expand protections from anti-kickback laws and regulations, to provide safe harbor protection for gainsharing, and other incentive-payment systems.

SHM responded in July with a letter of support that thanked the congressman for his efforts.²

“We look forward to working with you,” the letter ended.

Dr. Ramenofsky says he’s proud his efforts led to a working relationship between his professional society and his local legislator. He says he’s looking forward to participating in future Hill Day activities and acting as a local liaison for SHM.

He laments that he has not received much post-meeting feedback from his discussions with the senators’ offices, but says he understands how busy politicians are. And a 1-for-3 showing is pretty good, given his status as a political novice.

“Given overall public perception of Congress, I’m amazed that my visits caused one of three offices to engage in further policy discussions with SHM,” he says. “I’m encouraged to remain engaged in political activities through SHM.”

Richard Quinn is a freelance writer in New Jersey.

References

1. Society of Hospital Medicine. Letter to Congress members. Society of Hospital Medicine website. Available at: http://www.hospitalmedicine.org/AM/Template.cfm?Section=Letters_to_Congress_and_ Regulatory_Agencies&Template=/CM/ContentDisplay.cfm&ContentID=33169. Accessed July 15, 2013.
2. Society of Hospital Medicine. Letter to Congressman Jim McDermott. Society of Hospital Medicine website. Available at: http://www.hospitalmedicine.org/AM/Template.cfm?Section=Letters_to_Congress_and_Regulatory_Agencies&Template=/CM/ContentDisplay.cfm&ContentID=34169. Accessed July 15, 2013.

On May 12, 113 hospitalists descended on Capitol Hill for “Hospitalists on the Hill 2013,” the public-advocacy highlight of SHM’s annual meeting. Hospitalists from all parts of the country engaged with congressional representatives in a daylong series of meet-and-greets that may seem to some people useless in the face of political obstinacy in Washington. But the trip worked.

Josh Boswell, SHM’s senior manager of government relations, reports many Hill Day objectives were achieved:

• The number of legislators co-sponsoring a bill regarding the “three-day observation rule” more than tripled in the House of Representatives and doubled in the Senate. SHM officials note that the added support has come from both political parties.
• A Congressional Budget Office (CBO) review of the bill has been formally requested by those legislators.
• A congressman from Washington state asked for—and received—a letter of support for a proposed measure, the Improved Health Care at a Lower Cost Act of 2013 (H.R. 1487).
• Multiple reports of continued dialogue between congressional staffers and SHM members nationwide. When planning the advocacy day, SHM officials noted that one of the most valuable results is creating relationships at the local level.

Observation Legislation

One of the three talking points hospitalists took into their legislative meetings was solving the dilemmas surrounding observation status. Currently, time spent on observation status does not count toward the required three consecutive overnights an inpatient needs to qualify for Medicare benefits at a skilled nursing facility (SNF).

Hospitalists have been pushing to change that rule, in large part by supporting the Improving Access to Medicare Coverage Act of 2013 (H.R. 1179, S. 569), sponsored by Rep. Joe Courtney (D-Conn.), Rep. Tom Latham (R-Iowa), and Sen. Sherrod Brown (D-Ohio).¹ In addition to the status reclassification, the proposal would establish a 90-day appeal period for those who have been denied the benefit.

The issue is important to hospitalists because of the penalties hospitals face for readmissions—and also in part because hospitalists increasingly are providing care at SNFs and other post-acute-care facilities. SHM says that after the Hill visits—and the ensuing follow-up communications—the number of co-sponsors in the House jumped to 70 from 22. The Senate version doubled its list of co-sponsors.

And, perhaps more important, a CBO analysis has been requested for the observation bills. That review, known as a CBO score, weighs the financial impacts of proposed laws and is considered a necessary precursor to successfully passing any legislation.

All in all, SHM was pleased with the progress on the observation-status bill and will continue to push for its passage, whether it is in this congressional session or the next.

“Rep. Courtney’s bill is now getting significant traction,” Boswell says. “Hospitalists should be proud to know this is in no small part due to their advocacy efforts.”

Political Networking

Hospitalist David Ramenofsky, MD, who works at Northwest Hospital and Medical Center in Seattle, wasn’t sure how much traction he was going to be able to generate at his first Hill Day. SHM had arranged meetings with the offices of three local politicians: Rep. Jim McDermott (D-Wash.), Sen. Patty Murray (D-Wash.), and Sen. Maria Cantwell (D-Wash.).

Dr. Ramenofsky sat with two of McDermott’s staffers, one of whom sounded knowledgeable and enthused about health-care-policy issues. Although the congressman couldn’t sit in on the meeting, he knew Dr. Ramenofsky’s name and took the time to say hello.

“It was really interesting to me that these staffers wanted to hear what I had to say and learn about my experience,” Dr. Ramenofsky adds. “My views may affect how they work with their bosses to make policy changes. It was surprising to me how much my opinions mattered to them.”

After the meeting and another briefing SHM arranged with another local hospitalist, McDermott reached out to SHM. He asked for support for his proposed bill to expand protections from anti-kickback laws and regulations, to provide safe harbor protection for gainsharing, and other incentive-payment systems.

SHM responded in July with a letter of support that thanked the congressman for his efforts.²

“We look forward to working with you,” the letter ended.

Dr. Ramenofsky says he’s proud his efforts led to a working relationship between his professional society and his local legislator. He says he’s looking forward to participating in future Hill Day activities and acting as a local liaison for SHM.

He laments that he has not received much post-meeting feedback from his discussions with the senators’ offices, but says he understands how busy politicians are. And a 1-for-3 showing is pretty good, given his status as a political novice.

“Given overall public perception of Congress, I’m amazed that my visits caused one of three offices to engage in further policy discussions with SHM,” he says. “I’m encouraged to remain engaged in political activities through SHM.”

Richard Quinn is a freelance writer in New Jersey.

References

1. Society of Hospital Medicine. Letter to Congress members. Society of Hospital Medicine website. Available at: http://www.hospitalmedicine.org/AM/Template.cfm?Section=Letters_to_Congress_and_ Regulatory_Agencies&Template=/CM/ContentDisplay.cfm&ContentID=33169. Accessed July 15, 2013.
2. Society of Hospital Medicine. Letter to Congressman Jim McDermott. Society of Hospital Medicine website. Available at: http://www.hospitalmedicine.org/AM/Template.cfm?Section=Letters_to_Congress_and_Regulatory_Agencies&Template=/CM/ContentDisplay.cfm&ContentID=34169. Accessed July 15, 2013.

It is very rewarding to me to be able to come into a hospital and put processes in place, then actually see the risk-adjusted mortality rates improve. One of my teams’ biggest wins was taking over an HM program in a hospital with a mortality rate of 4, and seeing that mortality rate cut literally in half within six months.

Growing up on a farm in rural Kentucky could have led to a career in the family business for Julianna Lindsey, MD, MBA, FHM. Except she knew at an early age that she wanted to be a doctor.

“My family physician was very influential on my decision to become a physician,” she says. “[He] mentored and encouraged me from a young age; it was very powerful for me.”

Dr. Lindsey earned bachelor’s degrees in biomedical science from the University of South Alabama and biochemistry from Western Kentucky University. She graduated from the University of Kentucky College of Medicine and completed her internal-medicine residency at the University of Kentucky. In 2011, she earned her master’s in business administration from the University of Tennessee.

Immediately following residency, she worked for the Veterans Affairs Medical Center in Lexington, Ky., as an ED physician. In 2002, she latched on to a career in HM when she and her husband, a gastroenterologist, relocated to Knoxville, Tenn. She recently launched a startup company, Synergy Surgicalists, with two orthopedic surgeons, and also provides process-improvement and leadership-development consulting.

She says she was told early in her career to know your goals and stay focused.

“That has been the guiding light for me throughout my career,” says Dr. Lindsey, one of nine new Team Hospitalist members, The Hospitalist’s volunteer editorial advisory group. “My goal is to make medical care better and safer for hospitalized patients. We increasingly need to figure out how to do that with fewer and fewer resources. Regardless, we can never move backward on delivering better and safer care to patients.”

Question: How did you decide to become a hospitalist?

Answer: I have always been drawn to the practice of acute-care medicine. I enjoy taking care of patients and their families in their times of need. From the purely diagnostic standpoint, I very much enjoy the critical decision-making required in the diagnosis and treatment of the acutely ill patient.

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

A: I enjoy the opportunity to “dig in” and positively affect processes and patient outcomes throughout hospitals.

Q: What do you dislike most?

A: Fighting the “scope creep” that is continually pushing on us as hospitalists. Hospitalists are constantly being asked to admit patients whose problems are outside the scope of our practice as medically trained physicians. A few examples of this include acute surgical abdomens, intracranial hemorrhages, and blunt-trauma cases.

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

A: The explosion of hospitalist programs throughout the country. Hospitalists programs are now even being built by payors and long-term-care facilities.

Q: For group leaders, why is it important for you to continue seeing patients?

A: In order to improve upon a process, you must know the process; to truly know the process, you must live the process. If you are not at the bedside delivering care to patients, there will be a disconnect between you, as a leader, and your physicians, who are at the bedside delivering care.

Q: What are your interests outside of patient care?

A: I believe the success—or failure—of a hospital, physician group, corporation, etc. is directly related to leadership. I enjoy leadership development because I see that as “mission critical” to the success of delivering better and safer patient care in any health-care system. As physicians, most of us never receive meaningful leadership training, yet are expected to come out of residency ready to lead. I enjoy providing physicians the tools to lead effectively. It makes the careers of physician leaders more fulfilling, as well as the careers of those physicians who are “following.”

Q: What is your biggest professional challenge?

A: Continuing to provide better and safer patient care with diminishing resources.

Q: What is your biggest professional reward?

A: Making a difference in the lives of patients. It is very rewarding to me to be able to come into a hospital and put processes in place, then actually see the risk-adjusted mortality rates improve. One of my teams’ biggest wins was taking over an HM program in a hospital with a mortality rate of 4, and seeing that mortality rate cut literally in half within six months.

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

A: My husband and children are the most important aspect of my life. My husband is a gastroenterologist; we have been married for 13 years. We have two healthy, happy kiddos ages 8 and 10.

Q: What’s next professionally? Where do you see yourself in 10 years?

A: I am partnering with two orthopedic surgeons in a startup company, Synergy Surgicalists. Our company mirrors the hospitalist model utilizing general and orthopedic surgeons. It’s very exciting to have the opportunity to bring value to hospitals and patients on a larger scale. Also, for the immediate future, I have accepted the role of interim executive medical director for hospital medicine for University of Texas Southwestern and Parkland hospitals. We are completely restructuring those programs in preparation for moving into two beautiful new (and very large) hospitals. I’m very excited about working with a truly excellent group of physicians and leaders while we are recruiting a permanent executive director and expanding our ranks.

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

A: I cannot imagine not being a physician. I suppose if pressed, I imagine I would have landed somewhere in the financial industry. I am also a musician, but have a hard time seeing myself employed in that industry.

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

A: “Widow Walk” by Gerard LaSalle. He is a physician author who pens a beautiful story. It’s just an enjoyable read of American historical fiction set in the Pacific Northwest.

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

A: Sadly, I interface with 11 (11!) different Apple products in any given week. (Even sadder: I just came into an iPod Shuffle, so I’m up to 12 … )

Q: What’s next in your Netflix queue?

A: “Fringe,” Season 2, Episode 19.

Richard Quinn is a freelance writer in New Jersey.

It is very rewarding to me to be able to come into a hospital and put processes in place, then actually see the risk-adjusted mortality rates improve. One of my teams’ biggest wins was taking over an HM program in a hospital with a mortality rate of 4, and seeing that mortality rate cut literally in half within six months.

Growing up on a farm in rural Kentucky could have led to a career in the family business for Julianna Lindsey, MD, MBA, FHM. Except she knew at an early age that she wanted to be a doctor.

“My family physician was very influential on my decision to become a physician,” she says. “[He] mentored and encouraged me from a young age; it was very powerful for me.”

Dr. Lindsey earned bachelor’s degrees in biomedical science from the University of South Alabama and biochemistry from Western Kentucky University. She graduated from the University of Kentucky College of Medicine and completed her internal-medicine residency at the University of Kentucky. In 2011, she earned her master’s in business administration from the University of Tennessee.

Immediately following residency, she worked for the Veterans Affairs Medical Center in Lexington, Ky., as an ED physician. In 2002, she latched on to a career in HM when she and her husband, a gastroenterologist, relocated to Knoxville, Tenn. She recently launched a startup company, Synergy Surgicalists, with two orthopedic surgeons, and also provides process-improvement and leadership-development consulting.

She says she was told early in her career to know your goals and stay focused.

“That has been the guiding light for me throughout my career,” says Dr. Lindsey, one of nine new Team Hospitalist members, The Hospitalist’s volunteer editorial advisory group. “My goal is to make medical care better and safer for hospitalized patients. We increasingly need to figure out how to do that with fewer and fewer resources. Regardless, we can never move backward on delivering better and safer care to patients.”

Question: How did you decide to become a hospitalist?

Answer: I have always been drawn to the practice of acute-care medicine. I enjoy taking care of patients and their families in their times of need. From the purely diagnostic standpoint, I very much enjoy the critical decision-making required in the diagnosis and treatment of the acutely ill patient.

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

A: I enjoy the opportunity to “dig in” and positively affect processes and patient outcomes throughout hospitals.

Q: What do you dislike most?

A: Fighting the “scope creep” that is continually pushing on us as hospitalists. Hospitalists are constantly being asked to admit patients whose problems are outside the scope of our practice as medically trained physicians. A few examples of this include acute surgical abdomens, intracranial hemorrhages, and blunt-trauma cases.

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

A: The explosion of hospitalist programs throughout the country. Hospitalists programs are now even being built by payors and long-term-care facilities.

Q: For group leaders, why is it important for you to continue seeing patients?

A: In order to improve upon a process, you must know the process; to truly know the process, you must live the process. If you are not at the bedside delivering care to patients, there will be a disconnect between you, as a leader, and your physicians, who are at the bedside delivering care.

Q: What are your interests outside of patient care?

A: I believe the success—or failure—of a hospital, physician group, corporation, etc. is directly related to leadership. I enjoy leadership development because I see that as “mission critical” to the success of delivering better and safer patient care in any health-care system. As physicians, most of us never receive meaningful leadership training, yet are expected to come out of residency ready to lead. I enjoy providing physicians the tools to lead effectively. It makes the careers of physician leaders more fulfilling, as well as the careers of those physicians who are “following.”

Q: What is your biggest professional challenge?

A: Continuing to provide better and safer patient care with diminishing resources.

Q: What is your biggest professional reward?

A: Making a difference in the lives of patients. It is very rewarding to me to be able to come into a hospital and put processes in place, then actually see the risk-adjusted mortality rates improve. One of my teams’ biggest wins was taking over an HM program in a hospital with a mortality rate of 4, and seeing that mortality rate cut literally in half within six months.

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

A: My husband and children are the most important aspect of my life. My husband is a gastroenterologist; we have been married for 13 years. We have two healthy, happy kiddos ages 8 and 10.

Q: What’s next professionally? Where do you see yourself in 10 years?

A: I am partnering with two orthopedic surgeons in a startup company, Synergy Surgicalists. Our company mirrors the hospitalist model utilizing general and orthopedic surgeons. It’s very exciting to have the opportunity to bring value to hospitals and patients on a larger scale. Also, for the immediate future, I have accepted the role of interim executive medical director for hospital medicine for University of Texas Southwestern and Parkland hospitals. We are completely restructuring those programs in preparation for moving into two beautiful new (and very large) hospitals. I’m very excited about working with a truly excellent group of physicians and leaders while we are recruiting a permanent executive director and expanding our ranks.

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

A: I cannot imagine not being a physician. I suppose if pressed, I imagine I would have landed somewhere in the financial industry. I am also a musician, but have a hard time seeing myself employed in that industry.

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

A: “Widow Walk” by Gerard LaSalle. He is a physician author who pens a beautiful story. It’s just an enjoyable read of American historical fiction set in the Pacific Northwest.

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

A: Sadly, I interface with 11 (11!) different Apple products in any given week. (Even sadder: I just came into an iPod Shuffle, so I’m up to 12 … )

Q: What’s next in your Netflix queue?

A: “Fringe,” Season 2, Episode 19.

Richard Quinn is a freelance writer in New Jersey.

It is very rewarding to me to be able to come into a hospital and put processes in place, then actually see the risk-adjusted mortality rates improve. One of my teams’ biggest wins was taking over an HM program in a hospital with a mortality rate of 4, and seeing that mortality rate cut literally in half within six months.

Growing up on a farm in rural Kentucky could have led to a career in the family business for Julianna Lindsey, MD, MBA, FHM. Except she knew at an early age that she wanted to be a doctor.

“My family physician was very influential on my decision to become a physician,” she says. “[He] mentored and encouraged me from a young age; it was very powerful for me.”

Dr. Lindsey earned bachelor’s degrees in biomedical science from the University of South Alabama and biochemistry from Western Kentucky University. She graduated from the University of Kentucky College of Medicine and completed her internal-medicine residency at the University of Kentucky. In 2011, she earned her master’s in business administration from the University of Tennessee.

Immediately following residency, she worked for the Veterans Affairs Medical Center in Lexington, Ky., as an ED physician. In 2002, she latched on to a career in HM when she and her husband, a gastroenterologist, relocated to Knoxville, Tenn. She recently launched a startup company, Synergy Surgicalists, with two orthopedic surgeons, and also provides process-improvement and leadership-development consulting.

She says she was told early in her career to know your goals and stay focused.

“That has been the guiding light for me throughout my career,” says Dr. Lindsey, one of nine new Team Hospitalist members, The Hospitalist’s volunteer editorial advisory group. “My goal is to make medical care better and safer for hospitalized patients. We increasingly need to figure out how to do that with fewer and fewer resources. Regardless, we can never move backward on delivering better and safer care to patients.”

Question: How did you decide to become a hospitalist?

Answer: I have always been drawn to the practice of acute-care medicine. I enjoy taking care of patients and their families in their times of need. From the purely diagnostic standpoint, I very much enjoy the critical decision-making required in the diagnosis and treatment of the acutely ill patient.

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

A: I enjoy the opportunity to “dig in” and positively affect processes and patient outcomes throughout hospitals.

Q: What do you dislike most?

A: Fighting the “scope creep” that is continually pushing on us as hospitalists. Hospitalists are constantly being asked to admit patients whose problems are outside the scope of our practice as medically trained physicians. A few examples of this include acute surgical abdomens, intracranial hemorrhages, and blunt-trauma cases.

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

A: The explosion of hospitalist programs throughout the country. Hospitalists programs are now even being built by payors and long-term-care facilities.

Q: For group leaders, why is it important for you to continue seeing patients?

A: In order to improve upon a process, you must know the process; to truly know the process, you must live the process. If you are not at the bedside delivering care to patients, there will be a disconnect between you, as a leader, and your physicians, who are at the bedside delivering care.

Q: What are your interests outside of patient care?

A: I believe the success—or failure—of a hospital, physician group, corporation, etc. is directly related to leadership. I enjoy leadership development because I see that as “mission critical” to the success of delivering better and safer patient care in any health-care system. As physicians, most of us never receive meaningful leadership training, yet are expected to come out of residency ready to lead. I enjoy providing physicians the tools to lead effectively. It makes the careers of physician leaders more fulfilling, as well as the careers of those physicians who are “following.”

Q: What is your biggest professional challenge?

A: Continuing to provide better and safer patient care with diminishing resources.

Q: What is your biggest professional reward?

A: Making a difference in the lives of patients. It is very rewarding to me to be able to come into a hospital and put processes in place, then actually see the risk-adjusted mortality rates improve. One of my teams’ biggest wins was taking over an HM program in a hospital with a mortality rate of 4, and seeing that mortality rate cut literally in half within six months.

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

A: My husband and children are the most important aspect of my life. My husband is a gastroenterologist; we have been married for 13 years. We have two healthy, happy kiddos ages 8 and 10.

Q: What’s next professionally? Where do you see yourself in 10 years?

A: I am partnering with two orthopedic surgeons in a startup company, Synergy Surgicalists. Our company mirrors the hospitalist model utilizing general and orthopedic surgeons. It’s very exciting to have the opportunity to bring value to hospitals and patients on a larger scale. Also, for the immediate future, I have accepted the role of interim executive medical director for hospital medicine for University of Texas Southwestern and Parkland hospitals. We are completely restructuring those programs in preparation for moving into two beautiful new (and very large) hospitals. I’m very excited about working with a truly excellent group of physicians and leaders while we are recruiting a permanent executive director and expanding our ranks.

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

A: I cannot imagine not being a physician. I suppose if pressed, I imagine I would have landed somewhere in the financial industry. I am also a musician, but have a hard time seeing myself employed in that industry.

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

A: “Widow Walk” by Gerard LaSalle. He is a physician author who pens a beautiful story. It’s just an enjoyable read of American historical fiction set in the Pacific Northwest.

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

A: Sadly, I interface with 11 (11!) different Apple products in any given week. (Even sadder: I just came into an iPod Shuffle, so I’m up to 12 … )

Q: What’s next in your Netflix queue?

A: “Fringe,” Season 2, Episode 19.

Richard Quinn is a freelance writer in New Jersey.

A new study that showed no long-term decrease in patient outcomes after landmark 2003 reforms could portend good news for the latest duty-hour regulations implemented in 2011.

The Journal of General Internal Medicine report, “Teaching Hospital Five-Year Mortality Trends in the Wake of Duty Hour Reforms,” found that the 2003 changes were associated with “no significant change in mortality in the early years after implementation, and with a trend toward improved mortality among medical patients in the fourth and fifth years.” One of the authors says it’s not evident whether the improved outcomes are because of the reforms.

“We don’t think it’s an effect of work-hour reforms itself, but more likely a marker that teaching hospitals are staying ahead of the curve in general,” says Patrick Romano, MD, MPH, FACP, FAAP, a professor of medicine and pediatrics at the University of California at Davis School of Medicine in Sacramento.

Dr. Romano, who along with colleagues has been studying duty-hour reforms for years, says the new research shows that teaching hospitals were able to adapt over the long term to staffing rules. Researchers are now curious how health care will adapt to the more restrictive 2011 changes promulgated by the Accreditation Council for Graduate Medical Education (ACGME), which mostly limits first-year residents to a maximum 16-hour shift and older residents to 24 hours.

“Even though there were more handoffs [caused by the 2003 reforms], even though there were more opportunities for error due to handoffs, teaching hospitals were able to update,” Dr. Romano says. “Maybe that’s optimistic for 2011.

“Is the glass half full or half empty?”

Visit our website for more information on duty hours.

A new study that showed no long-term decrease in patient outcomes after landmark 2003 reforms could portend good news for the latest duty-hour regulations implemented in 2011.

The Journal of General Internal Medicine report, “Teaching Hospital Five-Year Mortality Trends in the Wake of Duty Hour Reforms,” found that the 2003 changes were associated with “no significant change in mortality in the early years after implementation, and with a trend toward improved mortality among medical patients in the fourth and fifth years.” One of the authors says it’s not evident whether the improved outcomes are because of the reforms.

“We don’t think it’s an effect of work-hour reforms itself, but more likely a marker that teaching hospitals are staying ahead of the curve in general,” says Patrick Romano, MD, MPH, FACP, FAAP, a professor of medicine and pediatrics at the University of California at Davis School of Medicine in Sacramento.

Dr. Romano, who along with colleagues has been studying duty-hour reforms for years, says the new research shows that teaching hospitals were able to adapt over the long term to staffing rules. Researchers are now curious how health care will adapt to the more restrictive 2011 changes promulgated by the Accreditation Council for Graduate Medical Education (ACGME), which mostly limits first-year residents to a maximum 16-hour shift and older residents to 24 hours.

“Even though there were more handoffs [caused by the 2003 reforms], even though there were more opportunities for error due to handoffs, teaching hospitals were able to update,” Dr. Romano says. “Maybe that’s optimistic for 2011.

“Is the glass half full or half empty?”

Visit our website for more information on duty hours.

A new study that showed no long-term decrease in patient outcomes after landmark 2003 reforms could portend good news for the latest duty-hour regulations implemented in 2011.

The Journal of General Internal Medicine report, “Teaching Hospital Five-Year Mortality Trends in the Wake of Duty Hour Reforms,” found that the 2003 changes were associated with “no significant change in mortality in the early years after implementation, and with a trend toward improved mortality among medical patients in the fourth and fifth years.” One of the authors says it’s not evident whether the improved outcomes are because of the reforms.

“We don’t think it’s an effect of work-hour reforms itself, but more likely a marker that teaching hospitals are staying ahead of the curve in general,” says Patrick Romano, MD, MPH, FACP, FAAP, a professor of medicine and pediatrics at the University of California at Davis School of Medicine in Sacramento.

Dr. Romano, who along with colleagues has been studying duty-hour reforms for years, says the new research shows that teaching hospitals were able to adapt over the long term to staffing rules. Researchers are now curious how health care will adapt to the more restrictive 2011 changes promulgated by the Accreditation Council for Graduate Medical Education (ACGME), which mostly limits first-year residents to a maximum 16-hour shift and older residents to 24 hours.

“Even though there were more handoffs [caused by the 2003 reforms], even though there were more opportunities for error due to handoffs, teaching hospitals were able to update,” Dr. Romano says. “Maybe that’s optimistic for 2011.

“Is the glass half full or half empty?”

Visit our website for more information on duty hours.

A recent report about medication management for hospitalized patients with psychiatric comorbidities shows that collaboration between hospitalists and specialists is key to improving the care of these patients.

The paper, "Challenges in Pharmacologic Management of the Hospitalized Patient with Psychiatric Comorbidity," suggests that "when making complex psychopharmacologic decisions," hospitalists should collaborate with pharmacists and psychiatrists. The study aims to help hospitalists make informed decisions when considering whether to continue home psychotropic medication in medically ill patients.

Martha Ward, MD, assistant professor in the department of psychiatry and behavioral sciences at Emory University School of Medicine in Atlanta and lead author of the study, says hospitalists are rightly focused on the acute problem in front of them, and they sometimes do not have time to address chronic, nonemergent issues, such as a psychiatric comorbidity.

"It's a mindset," Dr. Ward says. "At times when you're focused minute to minute on an emergent issue, it can be difficult to look at the chronic issues that don't come to the forefront."

Dr. Ward says it's important for hospitalists to never "reflexively discontinue" medications for patients with mental illness. Instead, she suggests weighing the risks and benefits of how existing medications would interact with new treatments.

Working with pharmacists, psychiatrists, or even tapping online resources that provide information about drug interactions is a good first step, she adds. Otherwise, physicians risk introducing complicating factors, such as potential adverse events related to psychiatric decompensation or psychotropic drug withdrawal.

Over the long term, Dr. Ward says, hospitalists should be educated in psychiatry, starting in medical school and in residency. "I'm somewhat biased," adds Dr. Ward, who is trained in both internal medicine and psychiatry. "I think internal-medicine doctors could benefit greatly from additional training. I think that's one of the biggest deficiencies in our curriculum."

Visit our website for more information about hospital medicine and psychiatry.

A recent report about medication management for hospitalized patients with psychiatric comorbidities shows that collaboration between hospitalists and specialists is key to improving the care of these patients.

The paper, "Challenges in Pharmacologic Management of the Hospitalized Patient with Psychiatric Comorbidity," suggests that "when making complex psychopharmacologic decisions," hospitalists should collaborate with pharmacists and psychiatrists. The study aims to help hospitalists make informed decisions when considering whether to continue home psychotropic medication in medically ill patients.

Martha Ward, MD, assistant professor in the department of psychiatry and behavioral sciences at Emory University School of Medicine in Atlanta and lead author of the study, says hospitalists are rightly focused on the acute problem in front of them, and they sometimes do not have time to address chronic, nonemergent issues, such as a psychiatric comorbidity.

"It's a mindset," Dr. Ward says. "At times when you're focused minute to minute on an emergent issue, it can be difficult to look at the chronic issues that don't come to the forefront."

Dr. Ward says it's important for hospitalists to never "reflexively discontinue" medications for patients with mental illness. Instead, she suggests weighing the risks and benefits of how existing medications would interact with new treatments.

Working with pharmacists, psychiatrists, or even tapping online resources that provide information about drug interactions is a good first step, she adds. Otherwise, physicians risk introducing complicating factors, such as potential adverse events related to psychiatric decompensation or psychotropic drug withdrawal.

Over the long term, Dr. Ward says, hospitalists should be educated in psychiatry, starting in medical school and in residency. "I'm somewhat biased," adds Dr. Ward, who is trained in both internal medicine and psychiatry. "I think internal-medicine doctors could benefit greatly from additional training. I think that's one of the biggest deficiencies in our curriculum."

Visit our website for more information about hospital medicine and psychiatry.

A recent report about medication management for hospitalized patients with psychiatric comorbidities shows that collaboration between hospitalists and specialists is key to improving the care of these patients.

The paper, "Challenges in Pharmacologic Management of the Hospitalized Patient with Psychiatric Comorbidity," suggests that "when making complex psychopharmacologic decisions," hospitalists should collaborate with pharmacists and psychiatrists. The study aims to help hospitalists make informed decisions when considering whether to continue home psychotropic medication in medically ill patients.

Martha Ward, MD, assistant professor in the department of psychiatry and behavioral sciences at Emory University School of Medicine in Atlanta and lead author of the study, says hospitalists are rightly focused on the acute problem in front of them, and they sometimes do not have time to address chronic, nonemergent issues, such as a psychiatric comorbidity.

"It's a mindset," Dr. Ward says. "At times when you're focused minute to minute on an emergent issue, it can be difficult to look at the chronic issues that don't come to the forefront."

Dr. Ward says it's important for hospitalists to never "reflexively discontinue" medications for patients with mental illness. Instead, she suggests weighing the risks and benefits of how existing medications would interact with new treatments.

Working with pharmacists, psychiatrists, or even tapping online resources that provide information about drug interactions is a good first step, she adds. Otherwise, physicians risk introducing complicating factors, such as potential adverse events related to psychiatric decompensation or psychotropic drug withdrawal.

Over the long term, Dr. Ward says, hospitalists should be educated in psychiatry, starting in medical school and in residency. "I'm somewhat biased," adds Dr. Ward, who is trained in both internal medicine and psychiatry. "I think internal-medicine doctors could benefit greatly from additional training. I think that's one of the biggest deficiencies in our curriculum."

Visit our website for more information about hospital medicine and psychiatry.

Bryan Weiss, MBA, likes to say he’s “passionate” about HM. The twist? He isn’t even a practicing physician. Nevertheless, he’s been involved in medicine for 25 years, having worked with hospitals, health plans, and multispecialty groups before joining IPC: The Hospitalist Company in 2003. During his first few years working in the field, he realized the specialty had a bright future.

“I enjoy working with the hospitalists and assisting them to become the cornerstone of the hospitals they work in,” says Weiss, managing director of the consulting services practice at Irving, Texas-based MedSynergies. “Creating the open communications among the hospital administration, emergency room, nursing, case management, consultants, and PCPs—as well as moving the specialty forward with actionable, balanced scorecards—is the most satisfying component.”

Weiss previously was president of the hospitalist division at Hospital Physician Partners of Hollywood, Fla., and COO of inpatient services at Dallas-based EmCare. He graduated with a bachelor’s degree in business administration from California State University and earned his master’s degree from California Lutheran University.

He is one of nine new Team Hospitalist members, The Hospitalist’s volunteer group of editorial advisors. He sees challenges ahead for hospitalists, administrators, and the health-care system, but he also has faith the specialty will be up to the task.

“I think the incredibly rapid growth of the specialty is huge,” he says. “The acceptance of the specialty has gone from needing to explain what a hospitalist is to insurance companies and hospitals and other physicians to [knowing] the value of a hospitalist program and how disadvantaged a hospital is without a program.”

I want to make sure the hospitalist team truly operates as a team and not a bunch of physicians who happen to work in the same hospital. The bottom line is it is about the patient experience and how hospitalists will be pivotal as health care moves to more risk-based and population health.

Question: As a nonphysician, explain your role in the health-care system and HM.

Answer: I want to make sure the hospitalist team truly operates as a team and not a bunch of physicians who happen to work in the same hospital. The bottom line is it is about the patient experience and how hospitalists will be pivotal as health care moves to more risk-based and population health.

Q: What is your biggest professional challenge?

A: Ensuring the alignment of the goals of the hospital and the hospitalists are translated to measurable outcomes is probably the biggest challenge in the current state of health care.

Q: What is your biggest professional reward?

A: The number of hospital administrators who value my contribution and commitment to making the hospitalist program at their facilities the best they can become.

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

A: My family time and the balance of work and life have become the most important as I have matured professionally.

Q: What’s next professionally?

A: I am doing my ideal professional position.

Q: If you had to do it all over again, what career would you be doing right now?

A: If I wasn’t an executive in healthcare, I would have probably been a lawyer since I contemplated law school over my MBA.

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

A: New Orleans Saints quarterback Drew Brees’ book, “Coming Back Stronger.” As an avid sports fan, I appreciate what this athlete experienced personally and professionally, and still was able to pick himself back up from situations that many of us would have struggled to overcome. He is one of the biggest class acts in sports and the book just solidified that opinion. We can apply what he says to our own lives and make ourselves better in what we do as leaders.

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

A: I am constantly on my iPad and use iTunes regularly during my weekly travels. My cellphone is an Android, so only two Apple products, but I use Apple countless times a week.

Richard Quinn is a freelance author in New Jersey.

Bryan Weiss, MBA, likes to say he’s “passionate” about HM. The twist? He isn’t even a practicing physician. Nevertheless, he’s been involved in medicine for 25 years, having worked with hospitals, health plans, and multispecialty groups before joining IPC: The Hospitalist Company in 2003. During his first few years working in the field, he realized the specialty had a bright future.

“I enjoy working with the hospitalists and assisting them to become the cornerstone of the hospitals they work in,” says Weiss, managing director of the consulting services practice at Irving, Texas-based MedSynergies. “Creating the open communications among the hospital administration, emergency room, nursing, case management, consultants, and PCPs—as well as moving the specialty forward with actionable, balanced scorecards—is the most satisfying component.”

Weiss previously was president of the hospitalist division at Hospital Physician Partners of Hollywood, Fla., and COO of inpatient services at Dallas-based EmCare. He graduated with a bachelor’s degree in business administration from California State University and earned his master’s degree from California Lutheran University.

He is one of nine new Team Hospitalist members, The Hospitalist’s volunteer group of editorial advisors. He sees challenges ahead for hospitalists, administrators, and the health-care system, but he also has faith the specialty will be up to the task.

“I think the incredibly rapid growth of the specialty is huge,” he says. “The acceptance of the specialty has gone from needing to explain what a hospitalist is to insurance companies and hospitals and other physicians to [knowing] the value of a hospitalist program and how disadvantaged a hospital is without a program.”

I want to make sure the hospitalist team truly operates as a team and not a bunch of physicians who happen to work in the same hospital. The bottom line is it is about the patient experience and how hospitalists will be pivotal as health care moves to more risk-based and population health.

Question: As a nonphysician, explain your role in the health-care system and HM.

Answer: I want to make sure the hospitalist team truly operates as a team and not a bunch of physicians who happen to work in the same hospital. The bottom line is it is about the patient experience and how hospitalists will be pivotal as health care moves to more risk-based and population health.

Q: What is your biggest professional challenge?

A: Ensuring the alignment of the goals of the hospital and the hospitalists are translated to measurable outcomes is probably the biggest challenge in the current state of health care.

Q: What is your biggest professional reward?

A: The number of hospital administrators who value my contribution and commitment to making the hospitalist program at their facilities the best they can become.

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

A: My family time and the balance of work and life have become the most important as I have matured professionally.

Q: What’s next professionally?

A: I am doing my ideal professional position.

Q: If you had to do it all over again, what career would you be doing right now?

A: If I wasn’t an executive in healthcare, I would have probably been a lawyer since I contemplated law school over my MBA.

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

A: New Orleans Saints quarterback Drew Brees’ book, “Coming Back Stronger.” As an avid sports fan, I appreciate what this athlete experienced personally and professionally, and still was able to pick himself back up from situations that many of us would have struggled to overcome. He is one of the biggest class acts in sports and the book just solidified that opinion. We can apply what he says to our own lives and make ourselves better in what we do as leaders.

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

A: I am constantly on my iPad and use iTunes regularly during my weekly travels. My cellphone is an Android, so only two Apple products, but I use Apple countless times a week.

Richard Quinn is a freelance author in New Jersey.

Bryan Weiss, MBA, likes to say he’s “passionate” about HM. The twist? He isn’t even a practicing physician. Nevertheless, he’s been involved in medicine for 25 years, having worked with hospitals, health plans, and multispecialty groups before joining IPC: The Hospitalist Company in 2003. During his first few years working in the field, he realized the specialty had a bright future.

“I enjoy working with the hospitalists and assisting them to become the cornerstone of the hospitals they work in,” says Weiss, managing director of the consulting services practice at Irving, Texas-based MedSynergies. “Creating the open communications among the hospital administration, emergency room, nursing, case management, consultants, and PCPs—as well as moving the specialty forward with actionable, balanced scorecards—is the most satisfying component.”

Weiss previously was president of the hospitalist division at Hospital Physician Partners of Hollywood, Fla., and COO of inpatient services at Dallas-based EmCare. He graduated with a bachelor’s degree in business administration from California State University and earned his master’s degree from California Lutheran University.

He is one of nine new Team Hospitalist members, The Hospitalist’s volunteer group of editorial advisors. He sees challenges ahead for hospitalists, administrators, and the health-care system, but he also has faith the specialty will be up to the task.

“I think the incredibly rapid growth of the specialty is huge,” he says. “The acceptance of the specialty has gone from needing to explain what a hospitalist is to insurance companies and hospitals and other physicians to [knowing] the value of a hospitalist program and how disadvantaged a hospital is without a program.”

I want to make sure the hospitalist team truly operates as a team and not a bunch of physicians who happen to work in the same hospital. The bottom line is it is about the patient experience and how hospitalists will be pivotal as health care moves to more risk-based and population health.

Question: As a nonphysician, explain your role in the health-care system and HM.

Answer: I want to make sure the hospitalist team truly operates as a team and not a bunch of physicians who happen to work in the same hospital. The bottom line is it is about the patient experience and how hospitalists will be pivotal as health care moves to more risk-based and population health.

Q: What is your biggest professional challenge?

A: Ensuring the alignment of the goals of the hospital and the hospitalists are translated to measurable outcomes is probably the biggest challenge in the current state of health care.

Q: What is your biggest professional reward?

A: The number of hospital administrators who value my contribution and commitment to making the hospitalist program at their facilities the best they can become.

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

A: My family time and the balance of work and life have become the most important as I have matured professionally.

Q: What’s next professionally?

A: I am doing my ideal professional position.

Q: If you had to do it all over again, what career would you be doing right now?

A: If I wasn’t an executive in healthcare, I would have probably been a lawyer since I contemplated law school over my MBA.

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

A: New Orleans Saints quarterback Drew Brees’ book, “Coming Back Stronger.” As an avid sports fan, I appreciate what this athlete experienced personally and professionally, and still was able to pick himself back up from situations that many of us would have struggled to overcome. He is one of the biggest class acts in sports and the book just solidified that opinion. We can apply what he says to our own lives and make ourselves better in what we do as leaders.

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

A: I am constantly on my iPad and use iTunes regularly during my weekly travels. My cellphone is an Android, so only two Apple products, but I use Apple countless times a week.

Richard Quinn is a freelance author in New Jersey.

A new report that shows ever-growing Medicare spending for chronically ill patients in the last two years of life can serve as a reminder for hospitalists to properly gauge patients’ wishes for end-of-life care, one of the authors says.

The brief from the Dartmouth Atlas Project [PDF] shows that from 2007 to 2010, average spending per patient in the last two years of life increased 15.2% to $69,947, and average spending in the last six months of life rose 13.4% to $36,392.

During the same three-year period, patients in their last six months of life were less likely to be hospitalized and logged more time in hospice care—21 days versus 18.3 days—reflecting the wishes of most patients to spend their last days in a homelike environment, the report notes. Accordingly, chronically ill Medicare patients were less likely to die in the hospital by the end of the study period.

David Goodman, MD, MS, co-principal investigator for Dartmouth Atlas of Health Care, says the growing use of hospice care and decreased hospitalization stays “aligns more closely with patients’ preferences.”

“The focus really needs to be on better diagnosis of patients’ preferences to reduce what has been well-documented as overutilization from the patient’s perspective,” Dr. Goodman says.

While costs and trends vary widely among regions and health-care systems, Dr. Goodman attributes the differences to local supplies of hospital beds and practice styles. For example, in regions with more beds, patients are more likely to spend time in the hospital near the end of life, he says. “There is definitely a national trend away from hospital care near the end of life,” he adds. “But that rate of change varies a lot from place to place. It’s helpful for hospitalists to understand where they fit on the spectrum.”

Visit our website for more information on end of life care.

A new report that shows ever-growing Medicare spending for chronically ill patients in the last two years of life can serve as a reminder for hospitalists to properly gauge patients’ wishes for end-of-life care, one of the authors says.

The brief from the Dartmouth Atlas Project [PDF] shows that from 2007 to 2010, average spending per patient in the last two years of life increased 15.2% to $69,947, and average spending in the last six months of life rose 13.4% to $36,392.

During the same three-year period, patients in their last six months of life were less likely to be hospitalized and logged more time in hospice care—21 days versus 18.3 days—reflecting the wishes of most patients to spend their last days in a homelike environment, the report notes. Accordingly, chronically ill Medicare patients were less likely to die in the hospital by the end of the study period.

David Goodman, MD, MS, co-principal investigator for Dartmouth Atlas of Health Care, says the growing use of hospice care and decreased hospitalization stays “aligns more closely with patients’ preferences.”

“The focus really needs to be on better diagnosis of patients’ preferences to reduce what has been well-documented as overutilization from the patient’s perspective,” Dr. Goodman says.

While costs and trends vary widely among regions and health-care systems, Dr. Goodman attributes the differences to local supplies of hospital beds and practice styles. For example, in regions with more beds, patients are more likely to spend time in the hospital near the end of life, he says. “There is definitely a national trend away from hospital care near the end of life,” he adds. “But that rate of change varies a lot from place to place. It’s helpful for hospitalists to understand where they fit on the spectrum.”

Visit our website for more information on end of life care.

A new report that shows ever-growing Medicare spending for chronically ill patients in the last two years of life can serve as a reminder for hospitalists to properly gauge patients’ wishes for end-of-life care, one of the authors says.

The brief from the Dartmouth Atlas Project [PDF] shows that from 2007 to 2010, average spending per patient in the last two years of life increased 15.2% to $69,947, and average spending in the last six months of life rose 13.4% to $36,392.

During the same three-year period, patients in their last six months of life were less likely to be hospitalized and logged more time in hospice care—21 days versus 18.3 days—reflecting the wishes of most patients to spend their last days in a homelike environment, the report notes. Accordingly, chronically ill Medicare patients were less likely to die in the hospital by the end of the study period.

David Goodman, MD, MS, co-principal investigator for Dartmouth Atlas of Health Care, says the growing use of hospice care and decreased hospitalization stays “aligns more closely with patients’ preferences.”

“The focus really needs to be on better diagnosis of patients’ preferences to reduce what has been well-documented as overutilization from the patient’s perspective,” Dr. Goodman says.

While costs and trends vary widely among regions and health-care systems, Dr. Goodman attributes the differences to local supplies of hospital beds and practice styles. For example, in regions with more beds, patients are more likely to spend time in the hospital near the end of life, he says. “There is definitely a national trend away from hospital care near the end of life,” he adds. “But that rate of change varies a lot from place to place. It’s helpful for hospitalists to understand where they fit on the spectrum.”

Visit our website for more information on end of life care.

An author of a new report that looks at the quality and safety implications of electronic health records (EHRs) wants physicians to view the efficacy of the system as an extension of the patient-care-delivery process.

"In medicine, we have an obligation to report errors," says co-author Kevin Baumlin, MD, FACEP, associate medical information officer at Mount Sinai Medical Center in New York. "When those errors may or may not have to do with an EHR, we have an obligation to get better. It's about patient care, right?"

The paper highlights the potential health and safety issues due to a lack of industrywide technology standards, alert fatigue, and communication problems. Although the report focuses on ED doctors, Dr. Baumlin notes that what's good for that specialty is good for hospitalists, as physicians work together on countless care transitions, both physically and electronically.

To that end, the report issues recommendations to improve the safety of ED information systems, including:

• Appoint a “clinician champion” to act as a liaison between doctors;




• Have vendors and hospital leadership form a multidisciplinary performance-improvement group;




• Set up an ongoing review process to monitor patient concerns in a timely manner;




• Measure and share lessons learned; and




• Remove “hold harmless” and “learned intermediary” clauses from vendor software contracts that can prevent the sharing of information that could help solve future problems.

Dr. Baumlin says the purpose of the paper isn't to paint EHR vendors as unhelpful, but to point out that healthcare as an industry has to promote more collaboration among vendors, physicians, and hospital leaders. To that end, the American College of Emergency Physicians has been holding talks with vendors about bridging information gaps and eliminating hurdles to communication.

“We're just trying to create a forum where everyone can talk and be heard,” Dr. Baumlin says. “We're not looking back. We're going forward.”

Visit our website for more information on health information technology.

An author of a new report that looks at the quality and safety implications of electronic health records (EHRs) wants physicians to view the efficacy of the system as an extension of the patient-care-delivery process.

"In medicine, we have an obligation to report errors," says co-author Kevin Baumlin, MD, FACEP, associate medical information officer at Mount Sinai Medical Center in New York. "When those errors may or may not have to do with an EHR, we have an obligation to get better. It's about patient care, right?"

The paper highlights the potential health and safety issues due to a lack of industrywide technology standards, alert fatigue, and communication problems. Although the report focuses on ED doctors, Dr. Baumlin notes that what's good for that specialty is good for hospitalists, as physicians work together on countless care transitions, both physically and electronically.

To that end, the report issues recommendations to improve the safety of ED information systems, including:

• Appoint a “clinician champion” to act as a liaison between doctors;




• Have vendors and hospital leadership form a multidisciplinary performance-improvement group;




• Set up an ongoing review process to monitor patient concerns in a timely manner;




• Measure and share lessons learned; and




• Remove “hold harmless” and “learned intermediary” clauses from vendor software contracts that can prevent the sharing of information that could help solve future problems.

Dr. Baumlin says the purpose of the paper isn't to paint EHR vendors as unhelpful, but to point out that healthcare as an industry has to promote more collaboration among vendors, physicians, and hospital leaders. To that end, the American College of Emergency Physicians has been holding talks with vendors about bridging information gaps and eliminating hurdles to communication.

“We're just trying to create a forum where everyone can talk and be heard,” Dr. Baumlin says. “We're not looking back. We're going forward.”

Visit our website for more information on health information technology.

An author of a new report that looks at the quality and safety implications of electronic health records (EHRs) wants physicians to view the efficacy of the system as an extension of the patient-care-delivery process.

"In medicine, we have an obligation to report errors," says co-author Kevin Baumlin, MD, FACEP, associate medical information officer at Mount Sinai Medical Center in New York. "When those errors may or may not have to do with an EHR, we have an obligation to get better. It's about patient care, right?"

The paper highlights the potential health and safety issues due to a lack of industrywide technology standards, alert fatigue, and communication problems. Although the report focuses on ED doctors, Dr. Baumlin notes that what's good for that specialty is good for hospitalists, as physicians work together on countless care transitions, both physically and electronically.

To that end, the report issues recommendations to improve the safety of ED information systems, including:

• Appoint a “clinician champion” to act as a liaison between doctors;




• Have vendors and hospital leadership form a multidisciplinary performance-improvement group;




• Set up an ongoing review process to monitor patient concerns in a timely manner;




• Measure and share lessons learned; and




• Remove “hold harmless” and “learned intermediary” clauses from vendor software contracts that can prevent the sharing of information that could help solve future problems.

Dr. Baumlin says the purpose of the paper isn't to paint EHR vendors as unhelpful, but to point out that healthcare as an industry has to promote more collaboration among vendors, physicians, and hospital leaders. To that end, the American College of Emergency Physicians has been holding talks with vendors about bridging information gaps and eliminating hurdles to communication.

“We're just trying to create a forum where everyone can talk and be heard,” Dr. Baumlin says. “We're not looking back. We're going forward.”

Visit our website for more information on health information technology.