Richard Quinn

The Improving Access to Medicare Coverage Act isn’t the only legislative proposal on hospitalists’ radar right now. Republican members of the U.S. House of Representatives recently revised their plan to replace the sustainable growth rate (SGR) formula used to determine physician payments. A bill has not been introduced, but Beltway buzz hints one could be forthcoming this year.

“Fixing the flawed SGR physician payment is a top priority for the Committees on Energy and Commerce and Ways and Means,” GOP legislators said in an open letter to the “provider community.”²

The letter requested feedback from physicians and other stakeholders by April 15.

Any proposed fix would look to end the series of time-stamped delays that continue to delay a pending 27% cut to physician payments under Medicare. The latest delay was approved earlier this year, meaning that the new deadline for the SGR cut to be implemented is Dec. 31.

The SGR formula was created in 1997, but the pending cuts tied to the federal sequester were included in the Budget Control Act of 2011. At the time, the massive reduction to Medicare payments was tied to political brinksmanship over the country’s debt ceiling. But the cut also was considered a Draconian penalty that was never likely to actually happen.

---

Richard Quinn is a freelance writer in New Jersey.

References

1. SHM. Letter to Congress members. SHM website. Available at: http://www.hospitalmedicine.org/AM/Template.cfm?Section=Letters_to_Congress_and_Regulatory_Agencies&Template=/CM/ContentDisplay.cfm&ContentID=33169. Accessed May 3, 2013.
2. U.S. House of Representatives' Committee on Ways and Means, Energy and Commerce Committee, Health Subcommittee. Second draft of sustainable growth rate (SGR) repeal and reform proposal—request for feedback letter. U.S. House of Representatives' Committee on Ways and Means website. Available at: http://waysandmeans.house.gov/uploadedfiles/sgr_joint_release_document.pdf. Accessed May 3, 2013.

The Improving Access to Medicare Coverage Act isn’t the only legislative proposal on hospitalists’ radar right now. Republican members of the U.S. House of Representatives recently revised their plan to replace the sustainable growth rate (SGR) formula used to determine physician payments. A bill has not been introduced, but Beltway buzz hints one could be forthcoming this year.

“Fixing the flawed SGR physician payment is a top priority for the Committees on Energy and Commerce and Ways and Means,” GOP legislators said in an open letter to the “provider community.”²

The letter requested feedback from physicians and other stakeholders by April 15.

Any proposed fix would look to end the series of time-stamped delays that continue to delay a pending 27% cut to physician payments under Medicare. The latest delay was approved earlier this year, meaning that the new deadline for the SGR cut to be implemented is Dec. 31.

The SGR formula was created in 1997, but the pending cuts tied to the federal sequester were included in the Budget Control Act of 2011. At the time, the massive reduction to Medicare payments was tied to political brinksmanship over the country’s debt ceiling. But the cut also was considered a Draconian penalty that was never likely to actually happen.

---

Richard Quinn is a freelance writer in New Jersey.

References

1. SHM. Letter to Congress members. SHM website. Available at: http://www.hospitalmedicine.org/AM/Template.cfm?Section=Letters_to_Congress_and_Regulatory_Agencies&Template=/CM/ContentDisplay.cfm&ContentID=33169. Accessed May 3, 2013.
2. U.S. House of Representatives' Committee on Ways and Means, Energy and Commerce Committee, Health Subcommittee. Second draft of sustainable growth rate (SGR) repeal and reform proposal—request for feedback letter. U.S. House of Representatives' Committee on Ways and Means website. Available at: http://waysandmeans.house.gov/uploadedfiles/sgr_joint_release_document.pdf. Accessed May 3, 2013.

The Improving Access to Medicare Coverage Act isn’t the only legislative proposal on hospitalists’ radar right now. Republican members of the U.S. House of Representatives recently revised their plan to replace the sustainable growth rate (SGR) formula used to determine physician payments. A bill has not been introduced, but Beltway buzz hints one could be forthcoming this year.

“Fixing the flawed SGR physician payment is a top priority for the Committees on Energy and Commerce and Ways and Means,” GOP legislators said in an open letter to the “provider community.”²

The letter requested feedback from physicians and other stakeholders by April 15.

Any proposed fix would look to end the series of time-stamped delays that continue to delay a pending 27% cut to physician payments under Medicare. The latest delay was approved earlier this year, meaning that the new deadline for the SGR cut to be implemented is Dec. 31.

The SGR formula was created in 1997, but the pending cuts tied to the federal sequester were included in the Budget Control Act of 2011. At the time, the massive reduction to Medicare payments was tied to political brinksmanship over the country’s debt ceiling. But the cut also was considered a Draconian penalty that was never likely to actually happen.

---

Richard Quinn is a freelance writer in New Jersey.

References

1. SHM. Letter to Congress members. SHM website. Available at: http://www.hospitalmedicine.org/AM/Template.cfm?Section=Letters_to_Congress_and_Regulatory_Agencies&Template=/CM/ContentDisplay.cfm&ContentID=33169. Accessed May 3, 2013.
2. U.S. House of Representatives' Committee on Ways and Means, Energy and Commerce Committee, Health Subcommittee. Second draft of sustainable growth rate (SGR) repeal and reform proposal—request for feedback letter. U.S. House of Representatives' Committee on Ways and Means website. Available at: http://waysandmeans.house.gov/uploadedfiles/sgr_joint_release_document.pdf. Accessed May 3, 2013.

Hospitalists are pushing hard for a change to a Medicare rule requiring beneficiaries to accumulate at least three consecutive days of inpatient treatment at a hospital (not counting day of discharge) before it will cover care in a skilled nursing facility (SNF).

The issue was one of the talking points during last month’s Hospitalists on the Hill, SHM’s annual daylong advocacy campaign that this year coincided with the annual meeting in the nation’s capital. The issue gained attention from hospitalists and others in recent years, in part because of penalties hospitals face for readmissions—and also in part because hospitalists increasingly are providing care at SNFs and other post-acute-care facilities.

The spotlight is brighter now because a group of legislators is trying to identify Medicare beneficiaries previously given “observation status” as inpatients. The Improving Access to Medicare Coverage Act (H.R. 1179 and S. 569) also would establish a 90-day appeal period for those who have been denied the benefit.

SHM senior vice president Joe Miller says hospitalists used HM13 and the Hospitalists on the Hill advocacy day to discuss the issues and the proposed legislation with members of Congress, their staffs, and federal officials. He urges members to continue lobbying for changes. Although the topic might not have the resonance and impact of a fix to the sustainable growth rate (SGR), Miller says, “anybody that deals with admitting or discharging a patient will recognize the importance of this issue.”

The issue, according to Toby Edelman, a senior policy attorney for the Center for Medicare Advocacy in Washington, D.C, is that Medicare mandates that its program enrollees have at least three days of inpatient treatment before it will pay for SNF care. Medicare also covers the costs of post-acute care in other settings but does not require three days of inpatient treatment before doing so. The construct can be confusing to patients who spend time in a hospital but don’t realize that some or all of their stay is spent in “observation status,” meaning none of that time counts toward Medicare’s three-day threshold for reimbursement.

“Most people can’t believe you could be in a hospital bed for a week and then be told as you leave, ‘By the way, bring your checkbook to the nursing home because you weren’t an inpatient here and so now Medicare won’t pay for your stay in the nursing home,’” Edelman says. “This has been an issue for us for quite a while because the consequence for beneficiaries of being in observation is that people have to pay out of pocket for their nursing home care, and that cost is typically hundreds of dollars a day.”

The particular dilemma for hospitalists is managing transitions of care. Hospitalist Karim Godamunne, MD, MBA, SFHM, chief medical officer of North Fulton Hospital in Roswell, Ga., says hospitalists don’t want financial burdens to dictate care decisions, but they are caught in the middle of decisions that could saddle patients with uncovered costs.

He also worries that the issue will only grow in coming years as baby boomers put more pressure on the health-care system. “We have an aging population,” he adds. “This is not going to go away.”

That is one reason SHM is supporting the Improving Access to Medicare Coverage Act. SHM supported the bill when it was first introduced in March and it has been rapidly gaining cosponsors in recent weeks. This uptick in Congressional interest may be partly a response to the efforts of hospitalists during their time on the Hill. SHM staff and hospitalists are continuing their push now as society officials say hospitalists, who often handle both discharges from the hospital and care provided at SNFs, are in a position to lead discussions on how to sensibly fix the problem.

 

To that end, a recent SHM letter to the bill’s sponsors casts the issue as one of fiscal responsibility.¹ Medicare not covering beneficiaries’ observation days cost patients out-of-pocket money and could cost hospitals in the long run.

“Patients who are admitted with observation status often choose to return home rather than paying out of pocket for a SNF stay,” SHM’s letter reads. “The resultant lack of appropriate post-acute SNF care can result in additional problems such as dehydration, falls, and many other avoidable complications. These complications can not only lead to otherwise preventable readmissions but also increase costs to Medicare for the treatment of conditions that were not present at the time of the original hospital stay.”

Given the debate on observation, Miller says, adopting the bill into law should be a no-brainer. The biggest sticking point likely is the perceived added cost to Medicare. Still, to streamline care and remove an added hurdle to coordinated care, Dr. Godamunne believes the bill should be embraced. He also says that many private insurers look to Medicare decisions to determine their own coverage approaches.

Basically, if Medicare changes its rules, that will carry a lot of weight in the private insurance world.

“This creates a lot of situations for the provider and the family,” Dr. Godamunne says. “You have to make a difficult decision, to try to help the family. You’re trying to provide good care, but on the other hand, there are rules and regulations and bylaws you work under. They don’t align that well, in this case.”

---

Richard Quinn is a freelance writer in New Jersey.

References

1. SHM. Letter to Congress members. SHM website. Available at: http://www.hospitalmedicine.org/AM/Template.cfm?Section=Letters_to_Congress_and_Regulatory_Agencies&Template=/CM/ContentDisplay.cfm&ContentID=33169. Accessed May 3, 2013.

 

Hospitalists are pushing hard for a change to a Medicare rule requiring beneficiaries to accumulate at least three consecutive days of inpatient treatment at a hospital (not counting day of discharge) before it will cover care in a skilled nursing facility (SNF).

The issue was one of the talking points during last month’s Hospitalists on the Hill, SHM’s annual daylong advocacy campaign that this year coincided with the annual meeting in the nation’s capital. The issue gained attention from hospitalists and others in recent years, in part because of penalties hospitals face for readmissions—and also in part because hospitalists increasingly are providing care at SNFs and other post-acute-care facilities.

The spotlight is brighter now because a group of legislators is trying to identify Medicare beneficiaries previously given “observation status” as inpatients. The Improving Access to Medicare Coverage Act (H.R. 1179 and S. 569) also would establish a 90-day appeal period for those who have been denied the benefit.

SHM senior vice president Joe Miller says hospitalists used HM13 and the Hospitalists on the Hill advocacy day to discuss the issues and the proposed legislation with members of Congress, their staffs, and federal officials. He urges members to continue lobbying for changes. Although the topic might not have the resonance and impact of a fix to the sustainable growth rate (SGR), Miller says, “anybody that deals with admitting or discharging a patient will recognize the importance of this issue.”

The issue, according to Toby Edelman, a senior policy attorney for the Center for Medicare Advocacy in Washington, D.C, is that Medicare mandates that its program enrollees have at least three days of inpatient treatment before it will pay for SNF care. Medicare also covers the costs of post-acute care in other settings but does not require three days of inpatient treatment before doing so. The construct can be confusing to patients who spend time in a hospital but don’t realize that some or all of their stay is spent in “observation status,” meaning none of that time counts toward Medicare’s three-day threshold for reimbursement.

“Most people can’t believe you could be in a hospital bed for a week and then be told as you leave, ‘By the way, bring your checkbook to the nursing home because you weren’t an inpatient here and so now Medicare won’t pay for your stay in the nursing home,’” Edelman says. “This has been an issue for us for quite a while because the consequence for beneficiaries of being in observation is that people have to pay out of pocket for their nursing home care, and that cost is typically hundreds of dollars a day.”

The particular dilemma for hospitalists is managing transitions of care. Hospitalist Karim Godamunne, MD, MBA, SFHM, chief medical officer of North Fulton Hospital in Roswell, Ga., says hospitalists don’t want financial burdens to dictate care decisions, but they are caught in the middle of decisions that could saddle patients with uncovered costs.

He also worries that the issue will only grow in coming years as baby boomers put more pressure on the health-care system. “We have an aging population,” he adds. “This is not going to go away.”

That is one reason SHM is supporting the Improving Access to Medicare Coverage Act. SHM supported the bill when it was first introduced in March and it has been rapidly gaining cosponsors in recent weeks. This uptick in Congressional interest may be partly a response to the efforts of hospitalists during their time on the Hill. SHM staff and hospitalists are continuing their push now as society officials say hospitalists, who often handle both discharges from the hospital and care provided at SNFs, are in a position to lead discussions on how to sensibly fix the problem.

 

To that end, a recent SHM letter to the bill’s sponsors casts the issue as one of fiscal responsibility.¹ Medicare not covering beneficiaries’ observation days cost patients out-of-pocket money and could cost hospitals in the long run.

“Patients who are admitted with observation status often choose to return home rather than paying out of pocket for a SNF stay,” SHM’s letter reads. “The resultant lack of appropriate post-acute SNF care can result in additional problems such as dehydration, falls, and many other avoidable complications. These complications can not only lead to otherwise preventable readmissions but also increase costs to Medicare for the treatment of conditions that were not present at the time of the original hospital stay.”

Given the debate on observation, Miller says, adopting the bill into law should be a no-brainer. The biggest sticking point likely is the perceived added cost to Medicare. Still, to streamline care and remove an added hurdle to coordinated care, Dr. Godamunne believes the bill should be embraced. He also says that many private insurers look to Medicare decisions to determine their own coverage approaches.

Basically, if Medicare changes its rules, that will carry a lot of weight in the private insurance world.

“This creates a lot of situations for the provider and the family,” Dr. Godamunne says. “You have to make a difficult decision, to try to help the family. You’re trying to provide good care, but on the other hand, there are rules and regulations and bylaws you work under. They don’t align that well, in this case.”

---

Richard Quinn is a freelance writer in New Jersey.

References

1. SHM. Letter to Congress members. SHM website. Available at: http://www.hospitalmedicine.org/AM/Template.cfm?Section=Letters_to_Congress_and_Regulatory_Agencies&Template=/CM/ContentDisplay.cfm&ContentID=33169. Accessed May 3, 2013.

 

Hospitalists are pushing hard for a change to a Medicare rule requiring beneficiaries to accumulate at least three consecutive days of inpatient treatment at a hospital (not counting day of discharge) before it will cover care in a skilled nursing facility (SNF).

The issue was one of the talking points during last month’s Hospitalists on the Hill, SHM’s annual daylong advocacy campaign that this year coincided with the annual meeting in the nation’s capital. The issue gained attention from hospitalists and others in recent years, in part because of penalties hospitals face for readmissions—and also in part because hospitalists increasingly are providing care at SNFs and other post-acute-care facilities.

The spotlight is brighter now because a group of legislators is trying to identify Medicare beneficiaries previously given “observation status” as inpatients. The Improving Access to Medicare Coverage Act (H.R. 1179 and S. 569) also would establish a 90-day appeal period for those who have been denied the benefit.

SHM senior vice president Joe Miller says hospitalists used HM13 and the Hospitalists on the Hill advocacy day to discuss the issues and the proposed legislation with members of Congress, their staffs, and federal officials. He urges members to continue lobbying for changes. Although the topic might not have the resonance and impact of a fix to the sustainable growth rate (SGR), Miller says, “anybody that deals with admitting or discharging a patient will recognize the importance of this issue.”

The issue, according to Toby Edelman, a senior policy attorney for the Center for Medicare Advocacy in Washington, D.C, is that Medicare mandates that its program enrollees have at least three days of inpatient treatment before it will pay for SNF care. Medicare also covers the costs of post-acute care in other settings but does not require three days of inpatient treatment before doing so. The construct can be confusing to patients who spend time in a hospital but don’t realize that some or all of their stay is spent in “observation status,” meaning none of that time counts toward Medicare’s three-day threshold for reimbursement.

“Most people can’t believe you could be in a hospital bed for a week and then be told as you leave, ‘By the way, bring your checkbook to the nursing home because you weren’t an inpatient here and so now Medicare won’t pay for your stay in the nursing home,’” Edelman says. “This has been an issue for us for quite a while because the consequence for beneficiaries of being in observation is that people have to pay out of pocket for their nursing home care, and that cost is typically hundreds of dollars a day.”

The particular dilemma for hospitalists is managing transitions of care. Hospitalist Karim Godamunne, MD, MBA, SFHM, chief medical officer of North Fulton Hospital in Roswell, Ga., says hospitalists don’t want financial burdens to dictate care decisions, but they are caught in the middle of decisions that could saddle patients with uncovered costs.

He also worries that the issue will only grow in coming years as baby boomers put more pressure on the health-care system. “We have an aging population,” he adds. “This is not going to go away.”

That is one reason SHM is supporting the Improving Access to Medicare Coverage Act. SHM supported the bill when it was first introduced in March and it has been rapidly gaining cosponsors in recent weeks. This uptick in Congressional interest may be partly a response to the efforts of hospitalists during their time on the Hill. SHM staff and hospitalists are continuing their push now as society officials say hospitalists, who often handle both discharges from the hospital and care provided at SNFs, are in a position to lead discussions on how to sensibly fix the problem.

 

To that end, a recent SHM letter to the bill’s sponsors casts the issue as one of fiscal responsibility.¹ Medicare not covering beneficiaries’ observation days cost patients out-of-pocket money and could cost hospitals in the long run.

“Patients who are admitted with observation status often choose to return home rather than paying out of pocket for a SNF stay,” SHM’s letter reads. “The resultant lack of appropriate post-acute SNF care can result in additional problems such as dehydration, falls, and many other avoidable complications. These complications can not only lead to otherwise preventable readmissions but also increase costs to Medicare for the treatment of conditions that were not present at the time of the original hospital stay.”

Given the debate on observation, Miller says, adopting the bill into law should be a no-brainer. The biggest sticking point likely is the perceived added cost to Medicare. Still, to streamline care and remove an added hurdle to coordinated care, Dr. Godamunne believes the bill should be embraced. He also says that many private insurers look to Medicare decisions to determine their own coverage approaches.

Basically, if Medicare changes its rules, that will carry a lot of weight in the private insurance world.

“This creates a lot of situations for the provider and the family,” Dr. Godamunne says. “You have to make a difficult decision, to try to help the family. You’re trying to provide good care, but on the other hand, there are rules and regulations and bylaws you work under. They don’t align that well, in this case.”

---

Richard Quinn is a freelance writer in New Jersey.

References

1. SHM. Letter to Congress members. SHM website. Available at: http://www.hospitalmedicine.org/AM/Template.cfm?Section=Letters_to_Congress_and_Regulatory_Agencies&Template=/CM/ContentDisplay.cfm&ContentID=33169. Accessed May 3, 2013.

 

Ibe Mbanu, MD, MBA, MPH, became medical director of the adult hospitalist department at Bon Secours St. Mary’s Hospital in Richmond, Va., about six months ago. Since then, he’s been besieged by a torrent of reform-based challenges he says make his job exponentially more difficult than that of medical directors just a few years ago.

Accountable-care organizations (ACOs), value-based purchasing, and discussions about bundled payments for episodic care are changing rapidly, and as a new administrator in a group with 24 hospitalists and three nonphysician providers (NPPs), he felt he needed to attend his first SHM annual meeting to keep up.

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

Managing a practice is a challenge, and many of the more than 2,700 attendees at HM13 said the four-day confab’s focus on the topic was a major draw. From a rebooted continuing medical education (CME) pre-course appropriately named “What Keeps You Awake at Night? Hot Topics in Hospitalist Practice Management” to dozens of breakout sessions on the topic, it’s clear that successful practice management is a concern for many hospitalists.

“Before, the drivers were pretty clear,” Dr. Mbanu says. “Volume, productivity. Now we’re switching more toward a business model that’s changing from volume to value. Trying to adapt to that change is pretty challenging.

“Now it’s critical to really understand the environment.”

Comanagement Conundrum

One particularly hot topic this year was the trend of hospitalists taking on more comanagement responsibilities for patients previously managed by other specialties, including neurology, surgery, and others. Frank Volpicelli, MD, a first-year hospitalist and instructor at New York University (NYU) Langone Medical Center in New York, was one of three members of his HM group that attended the “Perioperative Medicine: Medical Consultation and Co-Management” pre-course. This summer, his group is going to establish a presence in the preoperative clinic.

“We hope very strongly that we can prevent some complications, identify patients that we should be following when they come into the hospital, and help the surgeons out,” he says. “No. 1, keep them in the [operating room] more, and No. 2, get in front of some of the complications that they are less comfortable managing.”

Ralph Velazquez, MD, senior vice president of care management for OSF Healthcare System in Peoria, Ill., isn’t so sure comanagement of more and more patients is the best practice-management model moving forward. For example, as physician compensation is tied more to how much their care costs to deliver, a hospitalist comanaging a surgical patient’s elective knee replacement could be financially penalized for the cost of that person’s stay, despite having nothing to do with the most expensive portion of the bill.

“You have a financial model that says do more billings, but as you start developing analytics … you may see there is no difference between the model that’s doing more billing, in terms of improving quality, and the one that is doing less,” Dr. Velazquez says. “So if you’re getting the same amount of quality, and the only thing you’re doing is generating more cost by doing more billing, you need to reevaluate your strategy.”

He believes some patients benefit from comanagement, but HM groups have to be diligent in seeking them out.

“We look for simple solutions and one-size-fits-all,” he adds. “Comanagement in complex patients—definitely there’s a need for that. Comanagement in noncomplex patients, elective patients—there’s no need for that. It’s just additional cost. I don’t think it’s going to produce any value.”

 

Startup Academy

John Colombo, MD, FACP, a 30-year veteran of internal medicine who moved to HM a few years ago when one of the hospitals he worked at asked him to launch a hospitalist group, thinks bundled payments might alleviate that value conundrum. Then again, he’s not quite sure. That’s why attended his first annual meeting.

“I found it difficult starting a new program from scratch,” says Dr. Colombo, of Crozer Keystone Health System in Drexel Hill, Pa. “Even with the materials available, there’s not a lot of ‘how to do it’ out there. There’s no ‘Starting Hospitals for Dummies’ book.”

Dr. Colombo spent much of his meeting focused on recruiting, compensation, bonus structures, and scheduling concerns. He said all are important in the hospital-heavy metropolitan Philadelphia region where he works. Plus, with departures and retirements at other programs in his health system, Dr. Colombo went from no HM experience three years ago to being in charge of four HM programs.

“The biggest thing is, I wanted to make sure I hadn’t stepped in something that I shouldn’t have already,” he adds. “There’s many different ways to do things. So I’ve learned a few different ways. I found value.”

Demonstrate Value

Another way to discover value in running a practice is looking at the business side of the house, says Denice Cora-Bramble, MD, MBA, chief medical officer and executive vice president of Ambulatory & Community Health Services at the Children’s National Medical Center in Washington, D.C.

Dr. Bramble says many hospitalists need to understand that while clinical care is what brought them to medicine, their future paychecks depend on recognizing how to provide that care in a way that demonstrates business value.

“When you finish residency, if you have not intentionally sought out those courses or those seminars, you need to recognize that as a blind spot,” she says. “You need to fill that toolkit as it relates to the business side of medicine.

“You don’t necessarily have to know all the answers, but you need to know the right questions to ask,” she says.

Dr. Bramble adds that hospitalist leaders should take advantage of certificate programs, leadership courses, basic budgeting classes, or anything that gives them added education about the economics of healthcare.

“It all comes down to demonstrating your outcomes, demonstrating the value that you bring to that institution,” she says. “And with health-care reform, I think hospitalists are uniquely positioned to be able to partner with other areas of the hospital to look at this value-based approach.”

Gary Gammon, MD, FHM, the newly named medical director of the Hospitalist Service at FirstHealth Moore Regional Hospital in Pinehurst, N.C., is doing his part to demonstrate value to his administrators. While his group does multidisciplinary rounds on patients, one of his questions for the pre-course faculty was to make sure that system of rounding is an evidence-based practice. He’s also looking for ways to establish more hegemony to his practice to ensure the rounds are effective, regardless of which physicians and others are participating.

The feedback he received was that most people view multidisciplinary rounds as a best practice. Now, Dr. Gammon can feel more authoritative that he and his 32 hospitalists and 12 extenders are practicing HM the way it should be practiced.

“I wanted to hear just what I heard, which is the leaders in the community feel that it’s helping, feel that it’s the right thing to do, feel that there’s objective data,” he says. “This is the stuff that makes me say, ‘OK, I’ve got the same problems everybody else has.’”

 

---

Richard Quinn is a freelance writer in New Jersey.

Ibe Mbanu, MD, MBA, MPH, became medical director of the adult hospitalist department at Bon Secours St. Mary’s Hospital in Richmond, Va., about six months ago. Since then, he’s been besieged by a torrent of reform-based challenges he says make his job exponentially more difficult than that of medical directors just a few years ago.

Accountable-care organizations (ACOs), value-based purchasing, and discussions about bundled payments for episodic care are changing rapidly, and as a new administrator in a group with 24 hospitalists and three nonphysician providers (NPPs), he felt he needed to attend his first SHM annual meeting to keep up.

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

Managing a practice is a challenge, and many of the more than 2,700 attendees at HM13 said the four-day confab’s focus on the topic was a major draw. From a rebooted continuing medical education (CME) pre-course appropriately named “What Keeps You Awake at Night? Hot Topics in Hospitalist Practice Management” to dozens of breakout sessions on the topic, it’s clear that successful practice management is a concern for many hospitalists.

“Before, the drivers were pretty clear,” Dr. Mbanu says. “Volume, productivity. Now we’re switching more toward a business model that’s changing from volume to value. Trying to adapt to that change is pretty challenging.

“Now it’s critical to really understand the environment.”

Comanagement Conundrum

One particularly hot topic this year was the trend of hospitalists taking on more comanagement responsibilities for patients previously managed by other specialties, including neurology, surgery, and others. Frank Volpicelli, MD, a first-year hospitalist and instructor at New York University (NYU) Langone Medical Center in New York, was one of three members of his HM group that attended the “Perioperative Medicine: Medical Consultation and Co-Management” pre-course. This summer, his group is going to establish a presence in the preoperative clinic.

“We hope very strongly that we can prevent some complications, identify patients that we should be following when they come into the hospital, and help the surgeons out,” he says. “No. 1, keep them in the [operating room] more, and No. 2, get in front of some of the complications that they are less comfortable managing.”

Ralph Velazquez, MD, senior vice president of care management for OSF Healthcare System in Peoria, Ill., isn’t so sure comanagement of more and more patients is the best practice-management model moving forward. For example, as physician compensation is tied more to how much their care costs to deliver, a hospitalist comanaging a surgical patient’s elective knee replacement could be financially penalized for the cost of that person’s stay, despite having nothing to do with the most expensive portion of the bill.

“You have a financial model that says do more billings, but as you start developing analytics … you may see there is no difference between the model that’s doing more billing, in terms of improving quality, and the one that is doing less,” Dr. Velazquez says. “So if you’re getting the same amount of quality, and the only thing you’re doing is generating more cost by doing more billing, you need to reevaluate your strategy.”

He believes some patients benefit from comanagement, but HM groups have to be diligent in seeking them out.

“We look for simple solutions and one-size-fits-all,” he adds. “Comanagement in complex patients—definitely there’s a need for that. Comanagement in noncomplex patients, elective patients—there’s no need for that. It’s just additional cost. I don’t think it’s going to produce any value.”

 

Startup Academy

John Colombo, MD, FACP, a 30-year veteran of internal medicine who moved to HM a few years ago when one of the hospitals he worked at asked him to launch a hospitalist group, thinks bundled payments might alleviate that value conundrum. Then again, he’s not quite sure. That’s why attended his first annual meeting.

“I found it difficult starting a new program from scratch,” says Dr. Colombo, of Crozer Keystone Health System in Drexel Hill, Pa. “Even with the materials available, there’s not a lot of ‘how to do it’ out there. There’s no ‘Starting Hospitals for Dummies’ book.”

Dr. Colombo spent much of his meeting focused on recruiting, compensation, bonus structures, and scheduling concerns. He said all are important in the hospital-heavy metropolitan Philadelphia region where he works. Plus, with departures and retirements at other programs in his health system, Dr. Colombo went from no HM experience three years ago to being in charge of four HM programs.

“The biggest thing is, I wanted to make sure I hadn’t stepped in something that I shouldn’t have already,” he adds. “There’s many different ways to do things. So I’ve learned a few different ways. I found value.”

Demonstrate Value

Another way to discover value in running a practice is looking at the business side of the house, says Denice Cora-Bramble, MD, MBA, chief medical officer and executive vice president of Ambulatory & Community Health Services at the Children’s National Medical Center in Washington, D.C.

Dr. Bramble says many hospitalists need to understand that while clinical care is what brought them to medicine, their future paychecks depend on recognizing how to provide that care in a way that demonstrates business value.

“When you finish residency, if you have not intentionally sought out those courses or those seminars, you need to recognize that as a blind spot,” she says. “You need to fill that toolkit as it relates to the business side of medicine.

“You don’t necessarily have to know all the answers, but you need to know the right questions to ask,” she says.

Dr. Bramble adds that hospitalist leaders should take advantage of certificate programs, leadership courses, basic budgeting classes, or anything that gives them added education about the economics of healthcare.

“It all comes down to demonstrating your outcomes, demonstrating the value that you bring to that institution,” she says. “And with health-care reform, I think hospitalists are uniquely positioned to be able to partner with other areas of the hospital to look at this value-based approach.”

Gary Gammon, MD, FHM, the newly named medical director of the Hospitalist Service at FirstHealth Moore Regional Hospital in Pinehurst, N.C., is doing his part to demonstrate value to his administrators. While his group does multidisciplinary rounds on patients, one of his questions for the pre-course faculty was to make sure that system of rounding is an evidence-based practice. He’s also looking for ways to establish more hegemony to his practice to ensure the rounds are effective, regardless of which physicians and others are participating.

The feedback he received was that most people view multidisciplinary rounds as a best practice. Now, Dr. Gammon can feel more authoritative that he and his 32 hospitalists and 12 extenders are practicing HM the way it should be practiced.

“I wanted to hear just what I heard, which is the leaders in the community feel that it’s helping, feel that it’s the right thing to do, feel that there’s objective data,” he says. “This is the stuff that makes me say, ‘OK, I’ve got the same problems everybody else has.’”

 

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Richard Quinn is a freelance writer in New Jersey.

Ibe Mbanu, MD, MBA, MPH, became medical director of the adult hospitalist department at Bon Secours St. Mary’s Hospital in Richmond, Va., about six months ago. Since then, he’s been besieged by a torrent of reform-based challenges he says make his job exponentially more difficult than that of medical directors just a few years ago.

Accountable-care organizations (ACOs), value-based purchasing, and discussions about bundled payments for episodic care are changing rapidly, and as a new administrator in a group with 24 hospitalists and three nonphysician providers (NPPs), he felt he needed to attend his first SHM annual meeting to keep up.

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

Managing a practice is a challenge, and many of the more than 2,700 attendees at HM13 said the four-day confab’s focus on the topic was a major draw. From a rebooted continuing medical education (CME) pre-course appropriately named “What Keeps You Awake at Night? Hot Topics in Hospitalist Practice Management” to dozens of breakout sessions on the topic, it’s clear that successful practice management is a concern for many hospitalists.

“Before, the drivers were pretty clear,” Dr. Mbanu says. “Volume, productivity. Now we’re switching more toward a business model that’s changing from volume to value. Trying to adapt to that change is pretty challenging.

“Now it’s critical to really understand the environment.”

Comanagement Conundrum

One particularly hot topic this year was the trend of hospitalists taking on more comanagement responsibilities for patients previously managed by other specialties, including neurology, surgery, and others. Frank Volpicelli, MD, a first-year hospitalist and instructor at New York University (NYU) Langone Medical Center in New York, was one of three members of his HM group that attended the “Perioperative Medicine: Medical Consultation and Co-Management” pre-course. This summer, his group is going to establish a presence in the preoperative clinic.

“We hope very strongly that we can prevent some complications, identify patients that we should be following when they come into the hospital, and help the surgeons out,” he says. “No. 1, keep them in the [operating room] more, and No. 2, get in front of some of the complications that they are less comfortable managing.”

Ralph Velazquez, MD, senior vice president of care management for OSF Healthcare System in Peoria, Ill., isn’t so sure comanagement of more and more patients is the best practice-management model moving forward. For example, as physician compensation is tied more to how much their care costs to deliver, a hospitalist comanaging a surgical patient’s elective knee replacement could be financially penalized for the cost of that person’s stay, despite having nothing to do with the most expensive portion of the bill.

“You have a financial model that says do more billings, but as you start developing analytics … you may see there is no difference between the model that’s doing more billing, in terms of improving quality, and the one that is doing less,” Dr. Velazquez says. “So if you’re getting the same amount of quality, and the only thing you’re doing is generating more cost by doing more billing, you need to reevaluate your strategy.”

He believes some patients benefit from comanagement, but HM groups have to be diligent in seeking them out.

“We look for simple solutions and one-size-fits-all,” he adds. “Comanagement in complex patients—definitely there’s a need for that. Comanagement in noncomplex patients, elective patients—there’s no need for that. It’s just additional cost. I don’t think it’s going to produce any value.”

 

Startup Academy

John Colombo, MD, FACP, a 30-year veteran of internal medicine who moved to HM a few years ago when one of the hospitals he worked at asked him to launch a hospitalist group, thinks bundled payments might alleviate that value conundrum. Then again, he’s not quite sure. That’s why attended his first annual meeting.

“I found it difficult starting a new program from scratch,” says Dr. Colombo, of Crozer Keystone Health System in Drexel Hill, Pa. “Even with the materials available, there’s not a lot of ‘how to do it’ out there. There’s no ‘Starting Hospitals for Dummies’ book.”

Dr. Colombo spent much of his meeting focused on recruiting, compensation, bonus structures, and scheduling concerns. He said all are important in the hospital-heavy metropolitan Philadelphia region where he works. Plus, with departures and retirements at other programs in his health system, Dr. Colombo went from no HM experience three years ago to being in charge of four HM programs.

“The biggest thing is, I wanted to make sure I hadn’t stepped in something that I shouldn’t have already,” he adds. “There’s many different ways to do things. So I’ve learned a few different ways. I found value.”

Demonstrate Value

Another way to discover value in running a practice is looking at the business side of the house, says Denice Cora-Bramble, MD, MBA, chief medical officer and executive vice president of Ambulatory & Community Health Services at the Children’s National Medical Center in Washington, D.C.

Dr. Bramble says many hospitalists need to understand that while clinical care is what brought them to medicine, their future paychecks depend on recognizing how to provide that care in a way that demonstrates business value.

“When you finish residency, if you have not intentionally sought out those courses or those seminars, you need to recognize that as a blind spot,” she says. “You need to fill that toolkit as it relates to the business side of medicine.

“You don’t necessarily have to know all the answers, but you need to know the right questions to ask,” she says.

Dr. Bramble adds that hospitalist leaders should take advantage of certificate programs, leadership courses, basic budgeting classes, or anything that gives them added education about the economics of healthcare.

“It all comes down to demonstrating your outcomes, demonstrating the value that you bring to that institution,” she says. “And with health-care reform, I think hospitalists are uniquely positioned to be able to partner with other areas of the hospital to look at this value-based approach.”

Gary Gammon, MD, FHM, the newly named medical director of the Hospitalist Service at FirstHealth Moore Regional Hospital in Pinehurst, N.C., is doing his part to demonstrate value to his administrators. While his group does multidisciplinary rounds on patients, one of his questions for the pre-course faculty was to make sure that system of rounding is an evidence-based practice. He’s also looking for ways to establish more hegemony to his practice to ensure the rounds are effective, regardless of which physicians and others are participating.

The feedback he received was that most people view multidisciplinary rounds as a best practice. Now, Dr. Gammon can feel more authoritative that he and his 32 hospitalists and 12 extenders are practicing HM the way it should be practiced.

“I wanted to hear just what I heard, which is the leaders in the community feel that it’s helping, feel that it’s the right thing to do, feel that there’s objective data,” he says. “This is the stuff that makes me say, ‘OK, I’ve got the same problems everybody else has.’”

 

---

Richard Quinn is a freelance writer in New Jersey.

To some HM13 attendees, the keynote speakers might have seemed to be talking about different things.

Patrick Conway, MD, MSc, FAAP, SFHM, chief medical officer and director of the Center for Clinical Standards and Quality at the Centers for Medicare & Medicaid Services (CMS), hinted at promising results from the first accountable-care organizations (ACOs) and noted a meaningful reduction in 30-day readmission rates for the first time in years.

David Feinberg, MD, MBA, president of UCLA Health System in Los Angeles, told hospitalists that unless they’re getting patient care right every time, they’re not getting it right enough. And nothing would make him happier than seeing fewer hospitalists at SHM’s annual meeting—because that would mean fewer hospitalized patients.

HM pioneer Bob Wachter, MD, MHM, said it’s time for hospitalists to link their quality-improvement (QI) efforts and safety acumen to projects focused on cutting costs and reducing waste in the health-care system.

So while each made their points in a different way, each plenary speaker left many meeting-goers with a similar thought: Hospitalists are positioned at the nexus of big-picture reform and day-to-day implementation. So if hospitalists as a specialty continue to embrace teamwork, evidence-based practice, quality, safety, and a sense that the patient comes first, they will cement themselves as leaders in the next iteration of health-care delivery.

“There is enormous change going on in the healthcare system,” says SHM CEO Larry Wellikson. “And we are right in the middle of this. We are essential. If we are bad, we are going to sink it. And if we’re great, we are going to take it to another level.”

Needle Movement

Dr. Conway said some of that progress already is evident. He disclosed that initial findings from the first data sets coming from the first ACOs are showing promising results, though he can’t go into detail until the information is publicly released. However, he did boast that after decades of Medicare readmission rates hovering around 19%, data from late 2012 and early 2013 show that figure has dropped to below 18%.

“That is a 1.5% to 2% shift in readmissions nationally,” he said. “It is a credit to the work you and others are doing in the field. That’s hundreds of thousands of Medicare beneficiaries that are not readmitted every year, that stay home healthy. … It’s a tremendous example of moving a national needle.”

He dismissed those who attribute the initial readmission progress solely to penalties instituted on readmissions, though he acknowledged that CMS is using both carrots and sticks to push change.

“It’s a combination of interventions,” he said.

And all of those initiatives must be aimed jointly at improving the patient experience, said Dr. Feinberg, a child psychiatrist by training whose mantra is “patient-centeredness.” Dr. Feinberg’s reputation is that of a physician-administrator who puts patients first. For example, even though his health system (www.uclahealth.org) is in the 99th percentile for patient satisfaction, he is unhappy. That’s because the top ranking means roughly 85 out of every 100 patients served are pretty happy with their experience.

 

“It means that we’re the cream of the crap,” he said. “Of the last 100 people we took care of, 15 of them—and, by definition, those 15 people are someone’s mom, someone’s brother, someone’s coworker—would not refer us to a friend, or rate us a 9 or 10. So, I think, while we’ve really moved the needle, we’re really not done until we get it right with every patient, every time.”

He added that those who argue against difficult or time-consuming innovations and improvements that better patient care are arguing against the moral high ground of how they would want a family member to be treated in the hospital.

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

Dr. Feinberg, who took over as UCLA Health System’s president in 2011, says he still spends several hours every day talking to patients. For those who say there’s not enough time to stay connected to patients and that all the time spent making sure patients are happy takes away from other activities, he says they’re forgetting what brought them into medicine in the first place: healing. He blames the delivery system for stifling what he believes is a provider’s desire to help people.

“We haven’t allowed the culture to come out,” he said. “I think it’s there.”

Dr. Wachter has a similar faith in the hospitalist culture—although his is based in the pluripotent nature of the specialty. Hospitalists have worked hard to be viewed as “generalists, able to solve all kinds of problems,” and that means the specialty is poised to adapt and thrive.

“We will morph into what is needed,” said Dr. Wachter, a past president of SHM whose titles include chief of the division of hospital medicine at the University of California at San Francisco and chair of the American Board of Internal Medicine. “That will be all sorts of things: comanagement, dealing with the residency limits in teaching hospitals, systems improvement, cost reductions, transitions, working in skilled nursing facilities, all the specialty hospitalists.

“We will fill new niches,” he said.

What Dr. Wachter does not want to see is that the field grows “fat and happy,” as it is now firmly entrenched in the U.S. health-care delivery system. In fact, he urged hospitalists to welcome change, particularly initiatives that improve quality and safety, reduce costs and waste, and, ultimately, improve the patient experience.

But he cautioned against conceptually separating QI and cost reduction. Instead, they should be viewed as equally meaningful parts of his oft-quoted value equation, which, viewed from the health-care consumer’s point of view, is quality divided by cost.

“You can’t survive and thrive in a world with the kinds of pressures that we have to improve performance if you do business the same old way,” he added. “It’s no longer possible to achieve the things you need to achieve handling these as single projects. You need to transform the way you think about care.”

---

Richard Quinn is a freelance writer in New Jersey.

To some HM13 attendees, the keynote speakers might have seemed to be talking about different things.

Patrick Conway, MD, MSc, FAAP, SFHM, chief medical officer and director of the Center for Clinical Standards and Quality at the Centers for Medicare & Medicaid Services (CMS), hinted at promising results from the first accountable-care organizations (ACOs) and noted a meaningful reduction in 30-day readmission rates for the first time in years.

David Feinberg, MD, MBA, president of UCLA Health System in Los Angeles, told hospitalists that unless they’re getting patient care right every time, they’re not getting it right enough. And nothing would make him happier than seeing fewer hospitalists at SHM’s annual meeting—because that would mean fewer hospitalized patients.

HM pioneer Bob Wachter, MD, MHM, said it’s time for hospitalists to link their quality-improvement (QI) efforts and safety acumen to projects focused on cutting costs and reducing waste in the health-care system.

So while each made their points in a different way, each plenary speaker left many meeting-goers with a similar thought: Hospitalists are positioned at the nexus of big-picture reform and day-to-day implementation. So if hospitalists as a specialty continue to embrace teamwork, evidence-based practice, quality, safety, and a sense that the patient comes first, they will cement themselves as leaders in the next iteration of health-care delivery.

“There is enormous change going on in the healthcare system,” says SHM CEO Larry Wellikson. “And we are right in the middle of this. We are essential. If we are bad, we are going to sink it. And if we’re great, we are going to take it to another level.”

Needle Movement

Dr. Conway said some of that progress already is evident. He disclosed that initial findings from the first data sets coming from the first ACOs are showing promising results, though he can’t go into detail until the information is publicly released. However, he did boast that after decades of Medicare readmission rates hovering around 19%, data from late 2012 and early 2013 show that figure has dropped to below 18%.

“That is a 1.5% to 2% shift in readmissions nationally,” he said. “It is a credit to the work you and others are doing in the field. That’s hundreds of thousands of Medicare beneficiaries that are not readmitted every year, that stay home healthy. … It’s a tremendous example of moving a national needle.”

He dismissed those who attribute the initial readmission progress solely to penalties instituted on readmissions, though he acknowledged that CMS is using both carrots and sticks to push change.

“It’s a combination of interventions,” he said.

And all of those initiatives must be aimed jointly at improving the patient experience, said Dr. Feinberg, a child psychiatrist by training whose mantra is “patient-centeredness.” Dr. Feinberg’s reputation is that of a physician-administrator who puts patients first. For example, even though his health system (www.uclahealth.org) is in the 99th percentile for patient satisfaction, he is unhappy. That’s because the top ranking means roughly 85 out of every 100 patients served are pretty happy with their experience.

 

“It means that we’re the cream of the crap,” he said. “Of the last 100 people we took care of, 15 of them—and, by definition, those 15 people are someone’s mom, someone’s brother, someone’s coworker—would not refer us to a friend, or rate us a 9 or 10. So, I think, while we’ve really moved the needle, we’re really not done until we get it right with every patient, every time.”

He added that those who argue against difficult or time-consuming innovations and improvements that better patient care are arguing against the moral high ground of how they would want a family member to be treated in the hospital.

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

Dr. Feinberg, who took over as UCLA Health System’s president in 2011, says he still spends several hours every day talking to patients. For those who say there’s not enough time to stay connected to patients and that all the time spent making sure patients are happy takes away from other activities, he says they’re forgetting what brought them into medicine in the first place: healing. He blames the delivery system for stifling what he believes is a provider’s desire to help people.

“We haven’t allowed the culture to come out,” he said. “I think it’s there.”

Dr. Wachter has a similar faith in the hospitalist culture—although his is based in the pluripotent nature of the specialty. Hospitalists have worked hard to be viewed as “generalists, able to solve all kinds of problems,” and that means the specialty is poised to adapt and thrive.

“We will morph into what is needed,” said Dr. Wachter, a past president of SHM whose titles include chief of the division of hospital medicine at the University of California at San Francisco and chair of the American Board of Internal Medicine. “That will be all sorts of things: comanagement, dealing with the residency limits in teaching hospitals, systems improvement, cost reductions, transitions, working in skilled nursing facilities, all the specialty hospitalists.

“We will fill new niches,” he said.

What Dr. Wachter does not want to see is that the field grows “fat and happy,” as it is now firmly entrenched in the U.S. health-care delivery system. In fact, he urged hospitalists to welcome change, particularly initiatives that improve quality and safety, reduce costs and waste, and, ultimately, improve the patient experience.

But he cautioned against conceptually separating QI and cost reduction. Instead, they should be viewed as equally meaningful parts of his oft-quoted value equation, which, viewed from the health-care consumer’s point of view, is quality divided by cost.

“You can’t survive and thrive in a world with the kinds of pressures that we have to improve performance if you do business the same old way,” he added. “It’s no longer possible to achieve the things you need to achieve handling these as single projects. You need to transform the way you think about care.”

---

Richard Quinn is a freelance writer in New Jersey.

To some HM13 attendees, the keynote speakers might have seemed to be talking about different things.

Patrick Conway, MD, MSc, FAAP, SFHM, chief medical officer and director of the Center for Clinical Standards and Quality at the Centers for Medicare & Medicaid Services (CMS), hinted at promising results from the first accountable-care organizations (ACOs) and noted a meaningful reduction in 30-day readmission rates for the first time in years.

David Feinberg, MD, MBA, president of UCLA Health System in Los Angeles, told hospitalists that unless they’re getting patient care right every time, they’re not getting it right enough. And nothing would make him happier than seeing fewer hospitalists at SHM’s annual meeting—because that would mean fewer hospitalized patients.

HM pioneer Bob Wachter, MD, MHM, said it’s time for hospitalists to link their quality-improvement (QI) efforts and safety acumen to projects focused on cutting costs and reducing waste in the health-care system.

So while each made their points in a different way, each plenary speaker left many meeting-goers with a similar thought: Hospitalists are positioned at the nexus of big-picture reform and day-to-day implementation. So if hospitalists as a specialty continue to embrace teamwork, evidence-based practice, quality, safety, and a sense that the patient comes first, they will cement themselves as leaders in the next iteration of health-care delivery.

“There is enormous change going on in the healthcare system,” says SHM CEO Larry Wellikson. “And we are right in the middle of this. We are essential. If we are bad, we are going to sink it. And if we’re great, we are going to take it to another level.”

Needle Movement

Dr. Conway said some of that progress already is evident. He disclosed that initial findings from the first data sets coming from the first ACOs are showing promising results, though he can’t go into detail until the information is publicly released. However, he did boast that after decades of Medicare readmission rates hovering around 19%, data from late 2012 and early 2013 show that figure has dropped to below 18%.

“That is a 1.5% to 2% shift in readmissions nationally,” he said. “It is a credit to the work you and others are doing in the field. That’s hundreds of thousands of Medicare beneficiaries that are not readmitted every year, that stay home healthy. … It’s a tremendous example of moving a national needle.”

He dismissed those who attribute the initial readmission progress solely to penalties instituted on readmissions, though he acknowledged that CMS is using both carrots and sticks to push change.

“It’s a combination of interventions,” he said.

And all of those initiatives must be aimed jointly at improving the patient experience, said Dr. Feinberg, a child psychiatrist by training whose mantra is “patient-centeredness.” Dr. Feinberg’s reputation is that of a physician-administrator who puts patients first. For example, even though his health system (www.uclahealth.org) is in the 99th percentile for patient satisfaction, he is unhappy. That’s because the top ranking means roughly 85 out of every 100 patients served are pretty happy with their experience.

 

“It means that we’re the cream of the crap,” he said. “Of the last 100 people we took care of, 15 of them—and, by definition, those 15 people are someone’s mom, someone’s brother, someone’s coworker—would not refer us to a friend, or rate us a 9 or 10. So, I think, while we’ve really moved the needle, we’re really not done until we get it right with every patient, every time.”

He added that those who argue against difficult or time-consuming innovations and improvements that better patient care are arguing against the moral high ground of how they would want a family member to be treated in the hospital.

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

Dr. Feinberg, who took over as UCLA Health System’s president in 2011, says he still spends several hours every day talking to patients. For those who say there’s not enough time to stay connected to patients and that all the time spent making sure patients are happy takes away from other activities, he says they’re forgetting what brought them into medicine in the first place: healing. He blames the delivery system for stifling what he believes is a provider’s desire to help people.

“We haven’t allowed the culture to come out,” he said. “I think it’s there.”

Dr. Wachter has a similar faith in the hospitalist culture—although his is based in the pluripotent nature of the specialty. Hospitalists have worked hard to be viewed as “generalists, able to solve all kinds of problems,” and that means the specialty is poised to adapt and thrive.

“We will morph into what is needed,” said Dr. Wachter, a past president of SHM whose titles include chief of the division of hospital medicine at the University of California at San Francisco and chair of the American Board of Internal Medicine. “That will be all sorts of things: comanagement, dealing with the residency limits in teaching hospitals, systems improvement, cost reductions, transitions, working in skilled nursing facilities, all the specialty hospitalists.

“We will fill new niches,” he said.

What Dr. Wachter does not want to see is that the field grows “fat and happy,” as it is now firmly entrenched in the U.S. health-care delivery system. In fact, he urged hospitalists to welcome change, particularly initiatives that improve quality and safety, reduce costs and waste, and, ultimately, improve the patient experience.

But he cautioned against conceptually separating QI and cost reduction. Instead, they should be viewed as equally meaningful parts of his oft-quoted value equation, which, viewed from the health-care consumer’s point of view, is quality divided by cost.

“You can’t survive and thrive in a world with the kinds of pressures that we have to improve performance if you do business the same old way,” he added. “It’s no longer possible to achieve the things you need to achieve handling these as single projects. You need to transform the way you think about care.”

---

Richard Quinn is a freelance writer in New Jersey.

A veritable perfect storm of relationships brought hospitalist Jairy Hunter, MD, MBA, SFHM, to “Hospitalists on the Hill 2013,” a daylong advocacy affair that preceded HM13 last month.

First, Dr. Hunter was born and bred—and now lives—in South Carolina, a close-knit state where leaders across industries tend to run in the same circles, or at least have relatives who do. Second, Dr. Hunter’s father, Jairy Hunter Jr., is the longtime president of Charleston Southern University, where Sen. Tim Scott (R-S.C.) earned his undergraduate degree when it was still called Baptist College at Charleston. And three, Dr. Hunter is associate executive medical director of one of the state’s flagship health-care institutions, Medical University of South Carolina in Charleston.

So it was that SHM set Dr. Hunter up in meetings with the offices of Scott, Sen. Lindsey Graham (R-S.C.), and Rep. Jim Clyburn (D-S.C.), and—for the day at least—made Dr. Hunter the voice of hospital medicine.

“It was a little bit demystifying of an experience to be able to know there’s actually people you can talk to and you can develop a relationship with,” says Dr. Hunter, who also serves on Team Hospitalist. “I thought that was very rewarding.”

The connections made by Dr. Hunter are the point of the annual trek made by SHM leaders and members to lobby legislators and federal staffers “on the way policies affect your practice and your patients,” SHM says on its website (www.hospitalmedicine.org/advocacy). This year’s volunteer effort was by far the largest ever, says Public Policy Committee chair Ron Greeno, MD, FCCP, MHM. More than 150 hospitalists participated in training, 113 hospitalists visited Capitol Hill, and scores more had to be turned away. All told, hospitalists held 409 individual meetings with legislators and staff members.

“Quite frankly, if we’d have had the budget, we could have had another 100 to 150 people come,” Dr. Greeno says. “That’s how many people wanted to go.”

Dr. Greeno attributes the interest to two factors. One, having the annual meeting at the Gaylord National Resort & Convention Center, just outside Washington, D.C, makes the Hill trip a natural extension. Two, the current landscape of health-care reform has motivated many physicians to become more involved than they might otherwise be. One challenge of having so many first-timers making this year’s trip was making sure they were properly prepared. To hone the message, SHM gave the group a few hours of education by former legislative staffer Stephanie Vance of Advocacy Associates, a communications firm that helps organizations, such as medical societies, tailor their message to policymakers. Vance told hospitalists a personal visit with a constituent often becomes the most influential type of advocacy.

“That’s why it was easy to make an initial connection, because these staffers are from where I’m from, friends with people that I’m friends with,” Dr. Hunter says.

Unique Approach

SHM CEO Larry Wellikson, MD, SFHM, says the society tries to differentiate itself from other organizations through its grassroots approach to advocacy. More important, the society refrains from giving a long list of legislative requests that are self-serving.

“We’re someone they want to talk to because we’re not coming there to just say, ‘Here’s a power play for hospitalists,’” Dr. Wellikson says. “We come and try to provide solutions.”

To that end, this year’s lobbying effort was targeted to topics important both to HM and the health-care system:

• Repealing the sustainable growth rate (SGR) formula for Medicare payments, specifically via the proposed Medicare Physician Payment Innovation Act of 2013 (H.R. 574);
• Solving the quagmire of observation status time not counting toward the required three consecutive overnights as an inpatient needed to qualify for Medicare benefits at a skilled nursing facility, by supporting the Improving Access to Medicare Coverage Act of 2013 (H.R. 1179, S. 569); and
• Getting the federal government to commit to providing $434 million in funding for the Agency for Healthcare Research and Quality (AHRQ) in fiscal 2014.

 

“The message that we’re sending resonated with the people we met with on both sides of the aisle,” Dr. Greeno says. “The SGR, for instance, they know there needs to be a fix. We want to serve as a resource for them as they start to figure out the answer to the question: What are we going to replace it with?

“What we want to do is make everybody on the Hill understand that we can be relied upon as a resource when they’re looking for solutions,” he says.

Focused on Follow-Up

And that’s where rank-and-filers, such as Dr. Hunter, have to take charge. So for his Hill Day visits, he tried to stand out. Everyone he met with got a lapel pin in the shape of a South Carolina state flag, which has become a popular fashion statement in recent years. And Scott also got a pin from Charleston Southern University, his alma mater. The gestures were small, but they served as icebreakers and reminders that Dr. Hunter and the people he met are bound by service to the residents of the Palmetto State.

Dr. Hunter also hopes the small token will be that little extra that makes him memorable enough that the next time a Congressional staffer has an SGR question, they’ll ask him and not a doctor from another specialty.

“I’m interested to see how much feedback I get back from them,” he says. “I can feed them all day long, but I don’t want to be that crazy guy bugging them. If they respond back to me, I can hopefully make more inroads.”

He certainly would if Dr. Greeno gets his way. Moving forward, SHM hopes to be able to rely more on local advocates pushing for reform than just a once-a-year major event and formal positions drafted by SHM’s staffers or the Public Policy Committee. Dr. Greeno says the physicians who participated in this year’s Hill trip are likely to find they will be asked to be the first cohort of a grassroots initiative meant to deliver the society’s message more routinely.

“These are not easy things to change because there are not easy solutions,” Dr. Greeno adds. “If you have just one meeting on the Hill, you’ll have no impact at all. You have to follow up. You have to do it consistently. And you have to have a consistent message. And we will.”

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Richard Quinn is a freelance writer in New Jersey.

A veritable perfect storm of relationships brought hospitalist Jairy Hunter, MD, MBA, SFHM, to “Hospitalists on the Hill 2013,” a daylong advocacy affair that preceded HM13 last month.

First, Dr. Hunter was born and bred—and now lives—in South Carolina, a close-knit state where leaders across industries tend to run in the same circles, or at least have relatives who do. Second, Dr. Hunter’s father, Jairy Hunter Jr., is the longtime president of Charleston Southern University, where Sen. Tim Scott (R-S.C.) earned his undergraduate degree when it was still called Baptist College at Charleston. And three, Dr. Hunter is associate executive medical director of one of the state’s flagship health-care institutions, Medical University of South Carolina in Charleston.

So it was that SHM set Dr. Hunter up in meetings with the offices of Scott, Sen. Lindsey Graham (R-S.C.), and Rep. Jim Clyburn (D-S.C.), and—for the day at least—made Dr. Hunter the voice of hospital medicine.

“It was a little bit demystifying of an experience to be able to know there’s actually people you can talk to and you can develop a relationship with,” says Dr. Hunter, who also serves on Team Hospitalist. “I thought that was very rewarding.”

The connections made by Dr. Hunter are the point of the annual trek made by SHM leaders and members to lobby legislators and federal staffers “on the way policies affect your practice and your patients,” SHM says on its website (www.hospitalmedicine.org/advocacy). This year’s volunteer effort was by far the largest ever, says Public Policy Committee chair Ron Greeno, MD, FCCP, MHM. More than 150 hospitalists participated in training, 113 hospitalists visited Capitol Hill, and scores more had to be turned away. All told, hospitalists held 409 individual meetings with legislators and staff members.

“Quite frankly, if we’d have had the budget, we could have had another 100 to 150 people come,” Dr. Greeno says. “That’s how many people wanted to go.”

Dr. Greeno attributes the interest to two factors. One, having the annual meeting at the Gaylord National Resort & Convention Center, just outside Washington, D.C, makes the Hill trip a natural extension. Two, the current landscape of health-care reform has motivated many physicians to become more involved than they might otherwise be. One challenge of having so many first-timers making this year’s trip was making sure they were properly prepared. To hone the message, SHM gave the group a few hours of education by former legislative staffer Stephanie Vance of Advocacy Associates, a communications firm that helps organizations, such as medical societies, tailor their message to policymakers. Vance told hospitalists a personal visit with a constituent often becomes the most influential type of advocacy.

“That’s why it was easy to make an initial connection, because these staffers are from where I’m from, friends with people that I’m friends with,” Dr. Hunter says.

Unique Approach

SHM CEO Larry Wellikson, MD, SFHM, says the society tries to differentiate itself from other organizations through its grassroots approach to advocacy. More important, the society refrains from giving a long list of legislative requests that are self-serving.

“We’re someone they want to talk to because we’re not coming there to just say, ‘Here’s a power play for hospitalists,’” Dr. Wellikson says. “We come and try to provide solutions.”

To that end, this year’s lobbying effort was targeted to topics important both to HM and the health-care system:

• Repealing the sustainable growth rate (SGR) formula for Medicare payments, specifically via the proposed Medicare Physician Payment Innovation Act of 2013 (H.R. 574);
• Solving the quagmire of observation status time not counting toward the required three consecutive overnights as an inpatient needed to qualify for Medicare benefits at a skilled nursing facility, by supporting the Improving Access to Medicare Coverage Act of 2013 (H.R. 1179, S. 569); and
• Getting the federal government to commit to providing $434 million in funding for the Agency for Healthcare Research and Quality (AHRQ) in fiscal 2014.

 

“The message that we’re sending resonated with the people we met with on both sides of the aisle,” Dr. Greeno says. “The SGR, for instance, they know there needs to be a fix. We want to serve as a resource for them as they start to figure out the answer to the question: What are we going to replace it with?

“What we want to do is make everybody on the Hill understand that we can be relied upon as a resource when they’re looking for solutions,” he says.

Focused on Follow-Up

And that’s where rank-and-filers, such as Dr. Hunter, have to take charge. So for his Hill Day visits, he tried to stand out. Everyone he met with got a lapel pin in the shape of a South Carolina state flag, which has become a popular fashion statement in recent years. And Scott also got a pin from Charleston Southern University, his alma mater. The gestures were small, but they served as icebreakers and reminders that Dr. Hunter and the people he met are bound by service to the residents of the Palmetto State.

Dr. Hunter also hopes the small token will be that little extra that makes him memorable enough that the next time a Congressional staffer has an SGR question, they’ll ask him and not a doctor from another specialty.

“I’m interested to see how much feedback I get back from them,” he says. “I can feed them all day long, but I don’t want to be that crazy guy bugging them. If they respond back to me, I can hopefully make more inroads.”

He certainly would if Dr. Greeno gets his way. Moving forward, SHM hopes to be able to rely more on local advocates pushing for reform than just a once-a-year major event and formal positions drafted by SHM’s staffers or the Public Policy Committee. Dr. Greeno says the physicians who participated in this year’s Hill trip are likely to find they will be asked to be the first cohort of a grassroots initiative meant to deliver the society’s message more routinely.

“These are not easy things to change because there are not easy solutions,” Dr. Greeno adds. “If you have just one meeting on the Hill, you’ll have no impact at all. You have to follow up. You have to do it consistently. And you have to have a consistent message. And we will.”

---

Richard Quinn is a freelance writer in New Jersey.

A veritable perfect storm of relationships brought hospitalist Jairy Hunter, MD, MBA, SFHM, to “Hospitalists on the Hill 2013,” a daylong advocacy affair that preceded HM13 last month.

First, Dr. Hunter was born and bred—and now lives—in South Carolina, a close-knit state where leaders across industries tend to run in the same circles, or at least have relatives who do. Second, Dr. Hunter’s father, Jairy Hunter Jr., is the longtime president of Charleston Southern University, where Sen. Tim Scott (R-S.C.) earned his undergraduate degree when it was still called Baptist College at Charleston. And three, Dr. Hunter is associate executive medical director of one of the state’s flagship health-care institutions, Medical University of South Carolina in Charleston.

So it was that SHM set Dr. Hunter up in meetings with the offices of Scott, Sen. Lindsey Graham (R-S.C.), and Rep. Jim Clyburn (D-S.C.), and—for the day at least—made Dr. Hunter the voice of hospital medicine.

“It was a little bit demystifying of an experience to be able to know there’s actually people you can talk to and you can develop a relationship with,” says Dr. Hunter, who also serves on Team Hospitalist. “I thought that was very rewarding.”

The connections made by Dr. Hunter are the point of the annual trek made by SHM leaders and members to lobby legislators and federal staffers “on the way policies affect your practice and your patients,” SHM says on its website (www.hospitalmedicine.org/advocacy). This year’s volunteer effort was by far the largest ever, says Public Policy Committee chair Ron Greeno, MD, FCCP, MHM. More than 150 hospitalists participated in training, 113 hospitalists visited Capitol Hill, and scores more had to be turned away. All told, hospitalists held 409 individual meetings with legislators and staff members.

“Quite frankly, if we’d have had the budget, we could have had another 100 to 150 people come,” Dr. Greeno says. “That’s how many people wanted to go.”

Dr. Greeno attributes the interest to two factors. One, having the annual meeting at the Gaylord National Resort & Convention Center, just outside Washington, D.C, makes the Hill trip a natural extension. Two, the current landscape of health-care reform has motivated many physicians to become more involved than they might otherwise be. One challenge of having so many first-timers making this year’s trip was making sure they were properly prepared. To hone the message, SHM gave the group a few hours of education by former legislative staffer Stephanie Vance of Advocacy Associates, a communications firm that helps organizations, such as medical societies, tailor their message to policymakers. Vance told hospitalists a personal visit with a constituent often becomes the most influential type of advocacy.

“That’s why it was easy to make an initial connection, because these staffers are from where I’m from, friends with people that I’m friends with,” Dr. Hunter says.

Unique Approach

SHM CEO Larry Wellikson, MD, SFHM, says the society tries to differentiate itself from other organizations through its grassroots approach to advocacy. More important, the society refrains from giving a long list of legislative requests that are self-serving.

“We’re someone they want to talk to because we’re not coming there to just say, ‘Here’s a power play for hospitalists,’” Dr. Wellikson says. “We come and try to provide solutions.”

To that end, this year’s lobbying effort was targeted to topics important both to HM and the health-care system:

• Repealing the sustainable growth rate (SGR) formula for Medicare payments, specifically via the proposed Medicare Physician Payment Innovation Act of 2013 (H.R. 574);
• Solving the quagmire of observation status time not counting toward the required three consecutive overnights as an inpatient needed to qualify for Medicare benefits at a skilled nursing facility, by supporting the Improving Access to Medicare Coverage Act of 2013 (H.R. 1179, S. 569); and
• Getting the federal government to commit to providing $434 million in funding for the Agency for Healthcare Research and Quality (AHRQ) in fiscal 2014.

 

“The message that we’re sending resonated with the people we met with on both sides of the aisle,” Dr. Greeno says. “The SGR, for instance, they know there needs to be a fix. We want to serve as a resource for them as they start to figure out the answer to the question: What are we going to replace it with?

“What we want to do is make everybody on the Hill understand that we can be relied upon as a resource when they’re looking for solutions,” he says.

Focused on Follow-Up

And that’s where rank-and-filers, such as Dr. Hunter, have to take charge. So for his Hill Day visits, he tried to stand out. Everyone he met with got a lapel pin in the shape of a South Carolina state flag, which has become a popular fashion statement in recent years. And Scott also got a pin from Charleston Southern University, his alma mater. The gestures were small, but they served as icebreakers and reminders that Dr. Hunter and the people he met are bound by service to the residents of the Palmetto State.

Dr. Hunter also hopes the small token will be that little extra that makes him memorable enough that the next time a Congressional staffer has an SGR question, they’ll ask him and not a doctor from another specialty.

“I’m interested to see how much feedback I get back from them,” he says. “I can feed them all day long, but I don’t want to be that crazy guy bugging them. If they respond back to me, I can hopefully make more inroads.”

He certainly would if Dr. Greeno gets his way. Moving forward, SHM hopes to be able to rely more on local advocates pushing for reform than just a once-a-year major event and formal positions drafted by SHM’s staffers or the Public Policy Committee. Dr. Greeno says the physicians who participated in this year’s Hill trip are likely to find they will be asked to be the first cohort of a grassroots initiative meant to deliver the society’s message more routinely.

“These are not easy things to change because there are not easy solutions,” Dr. Greeno adds. “If you have just one meeting on the Hill, you’ll have no impact at all. You have to follow up. You have to do it consistently. And you have to have a consistent message. And we will.”

---

Richard Quinn is a freelance writer in New Jersey.

Hospitalist Roman Cortez, MD, who helps run Inpatient Medical Service in Kailua, Hawaii, is up for recertification of his internal-medicine boards in 2015. So after attending—and loving—his first SHM annual meeting last year in San Diego, he couldn’t think of a better place to earn credits for the American Board of Internal Medicine (ABIM) Maintenance of Certification (MOC) than HM13 in National Harbor, Md.

“It’s more motivational to sit through a seminar than to do it on your own, obviously,” Dr. Cortez says. “It’s like going to the gym. Nobody wants to work out at home, but if you go to the gym, you’re more motivated because you look around and your peers are working out. It’s the same thing with your mind.”

Working on one’s mind and career development is a major aim of SHMa’s annual meeting. From credit-worthy CME pre-courses to the daylong MOC class to the newest class of Fellows, Senior Fellows, and Masters of Hospital Medicine, clinicians like Dr. Cortez can use the yearly gathering as a chance to benchmark their professional progress.

Dr. Cortez, one of three partners who launched their HM group about five years ago, says having tutors, a regimented curricula via the pre-course, and a packed room of like-minded physicians helps hospitalists who are looking for one-stop shopping rather than working on Practice Improvement Modules (PIMs) in a room at their hospital or at home while balancing domestic duties.

“It seems like SHM has streamlined it for us,” Dr. Cortez says.

Ethan Cumbler, MD, FACP, of the University of Colorado at Denver believes the MOC courses are working. Dr. Cumbler is faculty for the pre-course and says there has been a noticeable uptick in how comfortable physicians at the meeting are with quality-improvement (QI) terminology and concepts.

“I think that over the years, the audiences that we’re seeing are savvier as to the process,” he adds. “I remember the first year that the quality-improvement module went out, people were shocked.

“I see clear differences between now and where we were three, four years ago,” he says.

Moving forward, Dr. Cumbler believes that ABIM and the people who help compile PIMs and test questions have to continue to evolve with physicians.

“What we have to figure out how to do as teachers of the Maintenance of Certification modules is how to make this engaging, interesting, and relevant,” he says. And “the people who are writing these questions have to take those same considerations into account. If you are teaching things which are relevant and important, then smart people will learn them.”

New Recruits, New Paths

Larry Spratling, MD, chief medical officer at Banner Baywood Medical Center in Mesa, Ariz., expects to see even more changes to the career trajectory of hospitalists. A pulmonary-disease specialist by training, he believes that as the payment systems are reformed to reward the quality of treatment, many more hospitalists will find their careers outside the walls of institutions.

Theoretically, improved outcomes that reduce readmissions would equate to fewer overall patients, potentially requiring fewer hospitalists in the future. The recent proliferation of hospitalists in long-term acute-care hospitals (LTACs), rehabilitation centers, skilled-nursing facilities (SNFs), and other facilities likely will continue that trend, as HM practitioners adapt to the needs of what Dr. Spratling calls “hospital space in a new system.” Dr. Spratling goes as far as to wonder if the specialty’s skill set might even presage a new name, perhaps something like acute-care medical specialists.

 

“The acute-care management skills that they have in the hospital, we can use them in these other sites of care,” he adds. “They aren’t just limited to the hospital anymore.”

Another angle of career development is career inception, so newly minted by SHM president Eric Howell, MD, SFHM. In fact, Dr. Howell made recruitment of the next generation of hospitalists and HM leaders a major plank of his one-year term. Of the society’s 12,000 members, just 500 are medical students and house staff members. He’d like to triple that figure by HM14.

He believes that the same professional and personal factors that have swelled the specialty’s ranks to some 40,000 practitioners will appeal to younger physicians. On the clinical side, that includes a focus on QI at a time when health care is being pushed to be better and a chance to be a leader in the hospital of the future. On a positive note, Dr. Howell, chief of hospital medicine at Johns Hopkins Bayview Medical Center in Baltimore, says hospitalists continue to see their compensation rise along with good work-life balance.

“For our specialty to be just as powerful, and just as important, and thrive just as much in the next 16 years as it has in the past 16 years, we are going to need high-quality recruits—and a lot of them,” Dr. Howell says.

---

Richard Quinn is a freelance writer in New Jersey.

Hospitalist Roman Cortez, MD, who helps run Inpatient Medical Service in Kailua, Hawaii, is up for recertification of his internal-medicine boards in 2015. So after attending—and loving—his first SHM annual meeting last year in San Diego, he couldn’t think of a better place to earn credits for the American Board of Internal Medicine (ABIM) Maintenance of Certification (MOC) than HM13 in National Harbor, Md.

“It’s more motivational to sit through a seminar than to do it on your own, obviously,” Dr. Cortez says. “It’s like going to the gym. Nobody wants to work out at home, but if you go to the gym, you’re more motivated because you look around and your peers are working out. It’s the same thing with your mind.”

Working on one’s mind and career development is a major aim of SHMa’s annual meeting. From credit-worthy CME pre-courses to the daylong MOC class to the newest class of Fellows, Senior Fellows, and Masters of Hospital Medicine, clinicians like Dr. Cortez can use the yearly gathering as a chance to benchmark their professional progress.

Dr. Cortez, one of three partners who launched their HM group about five years ago, says having tutors, a regimented curricula via the pre-course, and a packed room of like-minded physicians helps hospitalists who are looking for one-stop shopping rather than working on Practice Improvement Modules (PIMs) in a room at their hospital or at home while balancing domestic duties.

“It seems like SHM has streamlined it for us,” Dr. Cortez says.

Ethan Cumbler, MD, FACP, of the University of Colorado at Denver believes the MOC courses are working. Dr. Cumbler is faculty for the pre-course and says there has been a noticeable uptick in how comfortable physicians at the meeting are with quality-improvement (QI) terminology and concepts.

“I think that over the years, the audiences that we’re seeing are savvier as to the process,” he adds. “I remember the first year that the quality-improvement module went out, people were shocked.

“I see clear differences between now and where we were three, four years ago,” he says.

Moving forward, Dr. Cumbler believes that ABIM and the people who help compile PIMs and test questions have to continue to evolve with physicians.

“What we have to figure out how to do as teachers of the Maintenance of Certification modules is how to make this engaging, interesting, and relevant,” he says. And “the people who are writing these questions have to take those same considerations into account. If you are teaching things which are relevant and important, then smart people will learn them.”

New Recruits, New Paths

Larry Spratling, MD, chief medical officer at Banner Baywood Medical Center in Mesa, Ariz., expects to see even more changes to the career trajectory of hospitalists. A pulmonary-disease specialist by training, he believes that as the payment systems are reformed to reward the quality of treatment, many more hospitalists will find their careers outside the walls of institutions.

Theoretically, improved outcomes that reduce readmissions would equate to fewer overall patients, potentially requiring fewer hospitalists in the future. The recent proliferation of hospitalists in long-term acute-care hospitals (LTACs), rehabilitation centers, skilled-nursing facilities (SNFs), and other facilities likely will continue that trend, as HM practitioners adapt to the needs of what Dr. Spratling calls “hospital space in a new system.” Dr. Spratling goes as far as to wonder if the specialty’s skill set might even presage a new name, perhaps something like acute-care medical specialists.

 

“The acute-care management skills that they have in the hospital, we can use them in these other sites of care,” he adds. “They aren’t just limited to the hospital anymore.”

Another angle of career development is career inception, so newly minted by SHM president Eric Howell, MD, SFHM. In fact, Dr. Howell made recruitment of the next generation of hospitalists and HM leaders a major plank of his one-year term. Of the society’s 12,000 members, just 500 are medical students and house staff members. He’d like to triple that figure by HM14.

He believes that the same professional and personal factors that have swelled the specialty’s ranks to some 40,000 practitioners will appeal to younger physicians. On the clinical side, that includes a focus on QI at a time when health care is being pushed to be better and a chance to be a leader in the hospital of the future. On a positive note, Dr. Howell, chief of hospital medicine at Johns Hopkins Bayview Medical Center in Baltimore, says hospitalists continue to see their compensation rise along with good work-life balance.

“For our specialty to be just as powerful, and just as important, and thrive just as much in the next 16 years as it has in the past 16 years, we are going to need high-quality recruits—and a lot of them,” Dr. Howell says.

---

Richard Quinn is a freelance writer in New Jersey.

Hospitalist Roman Cortez, MD, who helps run Inpatient Medical Service in Kailua, Hawaii, is up for recertification of his internal-medicine boards in 2015. So after attending—and loving—his first SHM annual meeting last year in San Diego, he couldn’t think of a better place to earn credits for the American Board of Internal Medicine (ABIM) Maintenance of Certification (MOC) than HM13 in National Harbor, Md.

“It’s more motivational to sit through a seminar than to do it on your own, obviously,” Dr. Cortez says. “It’s like going to the gym. Nobody wants to work out at home, but if you go to the gym, you’re more motivated because you look around and your peers are working out. It’s the same thing with your mind.”

Working on one’s mind and career development is a major aim of SHMa’s annual meeting. From credit-worthy CME pre-courses to the daylong MOC class to the newest class of Fellows, Senior Fellows, and Masters of Hospital Medicine, clinicians like Dr. Cortez can use the yearly gathering as a chance to benchmark their professional progress.

Dr. Cortez, one of three partners who launched their HM group about five years ago, says having tutors, a regimented curricula via the pre-course, and a packed room of like-minded physicians helps hospitalists who are looking for one-stop shopping rather than working on Practice Improvement Modules (PIMs) in a room at their hospital or at home while balancing domestic duties.

“It seems like SHM has streamlined it for us,” Dr. Cortez says.

Ethan Cumbler, MD, FACP, of the University of Colorado at Denver believes the MOC courses are working. Dr. Cumbler is faculty for the pre-course and says there has been a noticeable uptick in how comfortable physicians at the meeting are with quality-improvement (QI) terminology and concepts.

“I think that over the years, the audiences that we’re seeing are savvier as to the process,” he adds. “I remember the first year that the quality-improvement module went out, people were shocked.

“I see clear differences between now and where we were three, four years ago,” he says.

Moving forward, Dr. Cumbler believes that ABIM and the people who help compile PIMs and test questions have to continue to evolve with physicians.

“What we have to figure out how to do as teachers of the Maintenance of Certification modules is how to make this engaging, interesting, and relevant,” he says. And “the people who are writing these questions have to take those same considerations into account. If you are teaching things which are relevant and important, then smart people will learn them.”

New Recruits, New Paths

Larry Spratling, MD, chief medical officer at Banner Baywood Medical Center in Mesa, Ariz., expects to see even more changes to the career trajectory of hospitalists. A pulmonary-disease specialist by training, he believes that as the payment systems are reformed to reward the quality of treatment, many more hospitalists will find their careers outside the walls of institutions.

Theoretically, improved outcomes that reduce readmissions would equate to fewer overall patients, potentially requiring fewer hospitalists in the future. The recent proliferation of hospitalists in long-term acute-care hospitals (LTACs), rehabilitation centers, skilled-nursing facilities (SNFs), and other facilities likely will continue that trend, as HM practitioners adapt to the needs of what Dr. Spratling calls “hospital space in a new system.” Dr. Spratling goes as far as to wonder if the specialty’s skill set might even presage a new name, perhaps something like acute-care medical specialists.

 

“The acute-care management skills that they have in the hospital, we can use them in these other sites of care,” he adds. “They aren’t just limited to the hospital anymore.”

Another angle of career development is career inception, so newly minted by SHM president Eric Howell, MD, SFHM. In fact, Dr. Howell made recruitment of the next generation of hospitalists and HM leaders a major plank of his one-year term. Of the society’s 12,000 members, just 500 are medical students and house staff members. He’d like to triple that figure by HM14.

He believes that the same professional and personal factors that have swelled the specialty’s ranks to some 40,000 practitioners will appeal to younger physicians. On the clinical side, that includes a focus on QI at a time when health care is being pushed to be better and a chance to be a leader in the hospital of the future. On a positive note, Dr. Howell, chief of hospital medicine at Johns Hopkins Bayview Medical Center in Baltimore, says hospitalists continue to see their compensation rise along with good work-life balance.

“For our specialty to be just as powerful, and just as important, and thrive just as much in the next 16 years as it has in the past 16 years, we are going to need high-quality recruits—and a lot of them,” Dr. Howell says.

---

Richard Quinn is a freelance writer in New Jersey.

NATIONAL HARBOR, Md.—One might think that in today's ever-churning healthcare environment that is directing much of its ire to hospitals, Bob Wachter, MD, MHM, might be nervous about the future of the specialty he helped name. But Dr. Wachter, chief of the Division of Hospital Medicine at the University of California at San Francisco, really isn't worried.

He believes HM's reputation as "generalists able to solve all kinds of problems" means the specialty is poised to adapt and thrive, he told a crowded ballroom at HM13's final keynote address yesterday at the Gaylord National Resort & Convention Center.

The annual plenary session was the effective wrap-up of SHM's four-day annual meeting, which drew some 2,700 attendees.

"We will morph into what is needed," he said. "That will be all sorts of things: comanagement, dealing with the residency limits in teaching hospitals, systems improvement, cost reductions, transitions, working in skilled nursing facilities, all the specialty hospitalists…we will fill new niches."

Watch a 2-minute video excerpt from Dr. Wachter's HM13 keynote address

What Dr. Wachter does not want to see is that the field grows "fat and happy" as it is now firmly entrenched in the U.S. healthcare delivery system. In fact, he urged hospitalists to welcome change, particularly initiatives that improve quality and safety, reduce costs, and, ultimately, improve the patient experience.

"You can't survive and thrive in a world with the kinds of pressures that we have to improve performance, if you do business the same old way," he added. "It's no longer possible to achieve the things you need to achieve handling these as single projects. You need to transform the way you think about care."

NATIONAL HARBOR, Md.—One might think that in today's ever-churning healthcare environment that is directing much of its ire to hospitals, Bob Wachter, MD, MHM, might be nervous about the future of the specialty he helped name. But Dr. Wachter, chief of the Division of Hospital Medicine at the University of California at San Francisco, really isn't worried.

He believes HM's reputation as "generalists able to solve all kinds of problems" means the specialty is poised to adapt and thrive, he told a crowded ballroom at HM13's final keynote address yesterday at the Gaylord National Resort & Convention Center.

The annual plenary session was the effective wrap-up of SHM's four-day annual meeting, which drew some 2,700 attendees.

"We will morph into what is needed," he said. "That will be all sorts of things: comanagement, dealing with the residency limits in teaching hospitals, systems improvement, cost reductions, transitions, working in skilled nursing facilities, all the specialty hospitalists…we will fill new niches."

Watch a 2-minute video excerpt from Dr. Wachter's HM13 keynote address

What Dr. Wachter does not want to see is that the field grows "fat and happy" as it is now firmly entrenched in the U.S. healthcare delivery system. In fact, he urged hospitalists to welcome change, particularly initiatives that improve quality and safety, reduce costs, and, ultimately, improve the patient experience.

"You can't survive and thrive in a world with the kinds of pressures that we have to improve performance, if you do business the same old way," he added. "It's no longer possible to achieve the things you need to achieve handling these as single projects. You need to transform the way you think about care."

NATIONAL HARBOR, Md.—One might think that in today's ever-churning healthcare environment that is directing much of its ire to hospitals, Bob Wachter, MD, MHM, might be nervous about the future of the specialty he helped name. But Dr. Wachter, chief of the Division of Hospital Medicine at the University of California at San Francisco, really isn't worried.

He believes HM's reputation as "generalists able to solve all kinds of problems" means the specialty is poised to adapt and thrive, he told a crowded ballroom at HM13's final keynote address yesterday at the Gaylord National Resort & Convention Center.

The annual plenary session was the effective wrap-up of SHM's four-day annual meeting, which drew some 2,700 attendees.

"We will morph into what is needed," he said. "That will be all sorts of things: comanagement, dealing with the residency limits in teaching hospitals, systems improvement, cost reductions, transitions, working in skilled nursing facilities, all the specialty hospitalists…we will fill new niches."

Watch a 2-minute video excerpt from Dr. Wachter's HM13 keynote address

What Dr. Wachter does not want to see is that the field grows "fat and happy" as it is now firmly entrenched in the U.S. healthcare delivery system. In fact, he urged hospitalists to welcome change, particularly initiatives that improve quality and safety, reduce costs, and, ultimately, improve the patient experience.

"You can't survive and thrive in a world with the kinds of pressures that we have to improve performance, if you do business the same old way," he added. "It's no longer possible to achieve the things you need to achieve handling these as single projects. You need to transform the way you think about care."

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

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

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

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

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

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

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

 

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

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

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

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

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

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

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

 

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

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

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

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

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

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

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

 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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