Richard Quinn

Every HM group should look into transitioning from a fee-for-service model to an accountable-care organization (ACO), a leading hospitalist told conference attendees recently at the Third National Accountable Care Organization Congress.

"You need to be tackling it now, but that doesn't mean you need to be aggressively doing it now," Edward Murphy, MD, chairman of Sound Physicians, told eWire days before he spoke at the ACO Congress on Oct. 31 in Los Angeles. "By tackling it, you need to be doing a hard-nosed assessment of what's best for your group and your patients."

Question: Why is the ACO model so difficult in some instances?

Answer: The problem with the healthcare system today is we’ve spent 100 years building up a system that is designed around, and competent at, delivering services for fees. We're really not set up to manage care.

Q: What is the No. 1 thing you want hospitalists to know about ACOs today?

A: Figure out every single day how to improve the care of your patients at a lower cost. And then, how you can demonstrate it in a quantitative and clear way. ACO-style payments are really only a value proposition centered on providing superior outcomes for patients at higher satisfaction for lower cost. That’s a fundamental value that will always be noteworthy.

Q: Is a hospitalist's job to lead the charge toward ACOs, or support those who do?

A: That's the sort of thing that people on the ground don't have to be told. They just know. If I were the leader of a hospitalist group someplace and really thought the smart thing to do was to think about how to move to an accountable-care model … I would know from my discussions with my colleagues, my discussions with hospital executives where everybody was.

Visit our website for more information about ACOs.

Every HM group should look into transitioning from a fee-for-service model to an accountable-care organization (ACO), a leading hospitalist told conference attendees recently at the Third National Accountable Care Organization Congress.

"You need to be tackling it now, but that doesn't mean you need to be aggressively doing it now," Edward Murphy, MD, chairman of Sound Physicians, told eWire days before he spoke at the ACO Congress on Oct. 31 in Los Angeles. "By tackling it, you need to be doing a hard-nosed assessment of what's best for your group and your patients."

Question: Why is the ACO model so difficult in some instances?

Answer: The problem with the healthcare system today is we’ve spent 100 years building up a system that is designed around, and competent at, delivering services for fees. We're really not set up to manage care.

Q: What is the No. 1 thing you want hospitalists to know about ACOs today?

A: Figure out every single day how to improve the care of your patients at a lower cost. And then, how you can demonstrate it in a quantitative and clear way. ACO-style payments are really only a value proposition centered on providing superior outcomes for patients at higher satisfaction for lower cost. That’s a fundamental value that will always be noteworthy.

Q: Is a hospitalist's job to lead the charge toward ACOs, or support those who do?

A: That's the sort of thing that people on the ground don't have to be told. They just know. If I were the leader of a hospitalist group someplace and really thought the smart thing to do was to think about how to move to an accountable-care model … I would know from my discussions with my colleagues, my discussions with hospital executives where everybody was.

Visit our website for more information about ACOs.

Every HM group should look into transitioning from a fee-for-service model to an accountable-care organization (ACO), a leading hospitalist told conference attendees recently at the Third National Accountable Care Organization Congress.

"You need to be tackling it now, but that doesn't mean you need to be aggressively doing it now," Edward Murphy, MD, chairman of Sound Physicians, told eWire days before he spoke at the ACO Congress on Oct. 31 in Los Angeles. "By tackling it, you need to be doing a hard-nosed assessment of what's best for your group and your patients."

Question: Why is the ACO model so difficult in some instances?

Answer: The problem with the healthcare system today is we’ve spent 100 years building up a system that is designed around, and competent at, delivering services for fees. We're really not set up to manage care.

Q: What is the No. 1 thing you want hospitalists to know about ACOs today?

A: Figure out every single day how to improve the care of your patients at a lower cost. And then, how you can demonstrate it in a quantitative and clear way. ACO-style payments are really only a value proposition centered on providing superior outcomes for patients at higher satisfaction for lower cost. That’s a fundamental value that will always be noteworthy.

Q: Is a hospitalist's job to lead the charge toward ACOs, or support those who do?

A: That's the sort of thing that people on the ground don't have to be told. They just know. If I were the leader of a hospitalist group someplace and really thought the smart thing to do was to think about how to move to an accountable-care model … I would know from my discussions with my colleagues, my discussions with hospital executives where everybody was.

Visit our website for more information about ACOs.

A national outbreak of fungal meningitis tied to contaminated steroids in epidural injections should make hospitalists vigilant with patients who present potential symptoms, says an infectious-disease (ID) specialist.

Earlier this month, health officials linked the outbreak to tainted batches of steroids used in spinal injections, and they say it could be weeks, or even months, before they know whether the incubation period for the disease is over, according to The New York Times.

"The key in my mind is that hospitalists ought to have a high index of suspicion for this right now," says hospitalist and ID expert James Pile, MD, FACP, SFHM, of the Cleveland Clinic. "If you encounter a patient you think may have meningitis, may have a brain stem stroke, may have an epidural abscess or vertebral osteomyelitis...at least think and ask the patient, or their family member, 'Did you receive an epidural steroid injection recently?'"

The answer to that question will help determine the best care delivery for hospitalists, and physicians should not rely on patients to relay the information without being asked for it, Dr. Pile says.

The outbreak has been traced to three contaminated batches of methylprednisolone produced by the New England Compounding Center in Framingham, Mass. The company, which is under criminal investigation, has been linked to at least 25 deaths and more than 317 infected patients. Although 14,000 people might have been injected with the contaminated compound, CDC officials say the likelihood of infection remains relatively low.

Dr. Pile says that while hospitalists might see only a handful of fungal meningitis cases in their careers, they still need to keep the possibility in mind when examining patients. It's a safe approach to take, particularly as the CDC continues to investigate the extent of the outbreak. The CDC has advised against antifungal prophylaxis or presumptive treatment of exposed asymptomatic patients without a diagnosed case of meningitis.

"This is just unfolding so quickly, it's a moving target," Dr. Pile adds. "How big it ends up being and what kinds of new or unusual manifestations present remain to be seen."

Visit our website for more information about infectious disease and hospital medicine.

A national outbreak of fungal meningitis tied to contaminated steroids in epidural injections should make hospitalists vigilant with patients who present potential symptoms, says an infectious-disease (ID) specialist.

Earlier this month, health officials linked the outbreak to tainted batches of steroids used in spinal injections, and they say it could be weeks, or even months, before they know whether the incubation period for the disease is over, according to The New York Times.

"The key in my mind is that hospitalists ought to have a high index of suspicion for this right now," says hospitalist and ID expert James Pile, MD, FACP, SFHM, of the Cleveland Clinic. "If you encounter a patient you think may have meningitis, may have a brain stem stroke, may have an epidural abscess or vertebral osteomyelitis...at least think and ask the patient, or their family member, 'Did you receive an epidural steroid injection recently?'"

The answer to that question will help determine the best care delivery for hospitalists, and physicians should not rely on patients to relay the information without being asked for it, Dr. Pile says.

The outbreak has been traced to three contaminated batches of methylprednisolone produced by the New England Compounding Center in Framingham, Mass. The company, which is under criminal investigation, has been linked to at least 25 deaths and more than 317 infected patients. Although 14,000 people might have been injected with the contaminated compound, CDC officials say the likelihood of infection remains relatively low.

Dr. Pile says that while hospitalists might see only a handful of fungal meningitis cases in their careers, they still need to keep the possibility in mind when examining patients. It's a safe approach to take, particularly as the CDC continues to investigate the extent of the outbreak. The CDC has advised against antifungal prophylaxis or presumptive treatment of exposed asymptomatic patients without a diagnosed case of meningitis.

"This is just unfolding so quickly, it's a moving target," Dr. Pile adds. "How big it ends up being and what kinds of new or unusual manifestations present remain to be seen."

Visit our website for more information about infectious disease and hospital medicine.

A national outbreak of fungal meningitis tied to contaminated steroids in epidural injections should make hospitalists vigilant with patients who present potential symptoms, says an infectious-disease (ID) specialist.

Earlier this month, health officials linked the outbreak to tainted batches of steroids used in spinal injections, and they say it could be weeks, or even months, before they know whether the incubation period for the disease is over, according to The New York Times.

"The key in my mind is that hospitalists ought to have a high index of suspicion for this right now," says hospitalist and ID expert James Pile, MD, FACP, SFHM, of the Cleveland Clinic. "If you encounter a patient you think may have meningitis, may have a brain stem stroke, may have an epidural abscess or vertebral osteomyelitis...at least think and ask the patient, or their family member, 'Did you receive an epidural steroid injection recently?'"

The answer to that question will help determine the best care delivery for hospitalists, and physicians should not rely on patients to relay the information without being asked for it, Dr. Pile says.

The outbreak has been traced to three contaminated batches of methylprednisolone produced by the New England Compounding Center in Framingham, Mass. The company, which is under criminal investigation, has been linked to at least 25 deaths and more than 317 infected patients. Although 14,000 people might have been injected with the contaminated compound, CDC officials say the likelihood of infection remains relatively low.

Dr. Pile says that while hospitalists might see only a handful of fungal meningitis cases in their careers, they still need to keep the possibility in mind when examining patients. It's a safe approach to take, particularly as the CDC continues to investigate the extent of the outbreak. The CDC has advised against antifungal prophylaxis or presumptive treatment of exposed asymptomatic patients without a diagnosed case of meningitis.

"This is just unfolding so quickly, it's a moving target," Dr. Pile adds. "How big it ends up being and what kinds of new or unusual manifestations present remain to be seen."

Visit our website for more information about infectious disease and hospital medicine.

NEW YORK—Hospitalists are poised to become key allies with hospital quality and safety officers nationwide, according to veteran hospitalist Jennifer Myers, MD, FHM, director of quality and safety education for Penn Medicine in Philadelphia.

Addressing hospitalists at the seventh annual Mid-Atlantic Hospital Medicine Symposium at Mount Sinai School of Medicine in New York, Dr. Myers said that while the challenges associated with quality improvement (QI) are many, HM leaders have the in-house relationships and respect to push the issue.

"There's really no other specialty more perfectly poised to lead this work," she told more than 180 symposium attendees Friday.

Dr. Myers, in an address titled "Enhancing Patient Safety," told The Hospitalist that HM leaders pursue three broad goals: to participate in QI programs already in place, to help create or foster a culture focused on addressing mistakes, and to teach those lessons to young physicians.

She urged physicians to actively report on mistakes and near misses, and earnestly address the processes that led to them. If a vehicle to discuss the mistakes doesn't exist at an institution, hospitalists can push to start one, she said. If a hospital doesn't have an electronic incident reporting system, a hospitalist can push to get one. "This is the goal," Dr. Myers added. "People coming to work and feeling they can be safe and report errors in the spirit of improvement."

She noted that many hospitalists already oversee quality and safety programs without any formal training. She recommended some of those physicians consider the Quality and Safety Educators Academy (QSEA), a three-day academy designed as a faculty development program and sponsored by SHM and the Alliance for Academic Internal Medicine (AAIM). The academy is March 7-9, 2013, in Tempe, Ariz.

NEW YORK—Hospitalists are poised to become key allies with hospital quality and safety officers nationwide, according to veteran hospitalist Jennifer Myers, MD, FHM, director of quality and safety education for Penn Medicine in Philadelphia.

Addressing hospitalists at the seventh annual Mid-Atlantic Hospital Medicine Symposium at Mount Sinai School of Medicine in New York, Dr. Myers said that while the challenges associated with quality improvement (QI) are many, HM leaders have the in-house relationships and respect to push the issue.

"There's really no other specialty more perfectly poised to lead this work," she told more than 180 symposium attendees Friday.

Dr. Myers, in an address titled "Enhancing Patient Safety," told The Hospitalist that HM leaders pursue three broad goals: to participate in QI programs already in place, to help create or foster a culture focused on addressing mistakes, and to teach those lessons to young physicians.

She urged physicians to actively report on mistakes and near misses, and earnestly address the processes that led to them. If a vehicle to discuss the mistakes doesn't exist at an institution, hospitalists can push to start one, she said. If a hospital doesn't have an electronic incident reporting system, a hospitalist can push to get one. "This is the goal," Dr. Myers added. "People coming to work and feeling they can be safe and report errors in the spirit of improvement."

She noted that many hospitalists already oversee quality and safety programs without any formal training. She recommended some of those physicians consider the Quality and Safety Educators Academy (QSEA), a three-day academy designed as a faculty development program and sponsored by SHM and the Alliance for Academic Internal Medicine (AAIM). The academy is March 7-9, 2013, in Tempe, Ariz.

NEW YORK—Hospitalists are poised to become key allies with hospital quality and safety officers nationwide, according to veteran hospitalist Jennifer Myers, MD, FHM, director of quality and safety education for Penn Medicine in Philadelphia.

Addressing hospitalists at the seventh annual Mid-Atlantic Hospital Medicine Symposium at Mount Sinai School of Medicine in New York, Dr. Myers said that while the challenges associated with quality improvement (QI) are many, HM leaders have the in-house relationships and respect to push the issue.

"There's really no other specialty more perfectly poised to lead this work," she told more than 180 symposium attendees Friday.

Dr. Myers, in an address titled "Enhancing Patient Safety," told The Hospitalist that HM leaders pursue three broad goals: to participate in QI programs already in place, to help create or foster a culture focused on addressing mistakes, and to teach those lessons to young physicians.

She urged physicians to actively report on mistakes and near misses, and earnestly address the processes that led to them. If a vehicle to discuss the mistakes doesn't exist at an institution, hospitalists can push to start one, she said. If a hospital doesn't have an electronic incident reporting system, a hospitalist can push to get one. "This is the goal," Dr. Myers added. "People coming to work and feeling they can be safe and report errors in the spirit of improvement."

She noted that many hospitalists already oversee quality and safety programs without any formal training. She recommended some of those physicians consider the Quality and Safety Educators Academy (QSEA), a three-day academy designed as a faculty development program and sponsored by SHM and the Alliance for Academic Internal Medicine (AAIM). The academy is March 7-9, 2013, in Tempe, Ariz.

SHM has joined scores of medical societies pushing Congress to stop pending cuts to Medicare that would directly impact hospitalists.

Scheduled to go into effect at the start of the New Year, the cuts include sequestration, which would reduce hospitalists' Medicare payments by 2%, and slash funding to the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC). This is in addition to a 27% cut to Medicare physician payment rates resulting from Medicare's sustainable growth rate (SGR) formula.

In a letter last month to congressional leaders [PDF], and an accompanying note to society members, SHM said hospitalists need to lobby legislators "to find a reasonable and measured solution to deficit reduction that does not include arbitrary across-the-board cuts to Medicare providers."

"Congress needs to know we're not happy," says SHM board member Eric Siegal, MD, SFHM, board liaison SHM's Public Policy Committee. "The only way that we are going to get them to change their behavior is if enough of us mobilize, and make enough noise to make it clear that we are not going to stand for this anymore."

Dr. Siegal says that because Congress has repeatedly delayed draconian cuts, there is a general consensus that another delay is likely. But Dr. Siegal also notes lobbying is still necessary to ensure that will happen. SHM has previously supported a meaningful replacement to the SGR, which has yet to receive significant action in Congress.

"What the entire healthcare community needs to push for is a solution," Dr. Siegal adds. "It's very hard to develop any kind of a strategy for how you're going to deliver care if every X number of months you have to worry [whether] you're going to take a massive cut in your compensation."

SHM has joined scores of medical societies pushing Congress to stop pending cuts to Medicare that would directly impact hospitalists.

Scheduled to go into effect at the start of the New Year, the cuts include sequestration, which would reduce hospitalists' Medicare payments by 2%, and slash funding to the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC). This is in addition to a 27% cut to Medicare physician payment rates resulting from Medicare's sustainable growth rate (SGR) formula.

In a letter last month to congressional leaders [PDF], and an accompanying note to society members, SHM said hospitalists need to lobby legislators "to find a reasonable and measured solution to deficit reduction that does not include arbitrary across-the-board cuts to Medicare providers."

"Congress needs to know we're not happy," says SHM board member Eric Siegal, MD, SFHM, board liaison SHM's Public Policy Committee. "The only way that we are going to get them to change their behavior is if enough of us mobilize, and make enough noise to make it clear that we are not going to stand for this anymore."

Dr. Siegal says that because Congress has repeatedly delayed draconian cuts, there is a general consensus that another delay is likely. But Dr. Siegal also notes lobbying is still necessary to ensure that will happen. SHM has previously supported a meaningful replacement to the SGR, which has yet to receive significant action in Congress.

"What the entire healthcare community needs to push for is a solution," Dr. Siegal adds. "It's very hard to develop any kind of a strategy for how you're going to deliver care if every X number of months you have to worry [whether] you're going to take a massive cut in your compensation."

SHM has joined scores of medical societies pushing Congress to stop pending cuts to Medicare that would directly impact hospitalists.

Scheduled to go into effect at the start of the New Year, the cuts include sequestration, which would reduce hospitalists' Medicare payments by 2%, and slash funding to the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC). This is in addition to a 27% cut to Medicare physician payment rates resulting from Medicare's sustainable growth rate (SGR) formula.

In a letter last month to congressional leaders [PDF], and an accompanying note to society members, SHM said hospitalists need to lobby legislators "to find a reasonable and measured solution to deficit reduction that does not include arbitrary across-the-board cuts to Medicare providers."

"Congress needs to know we're not happy," says SHM board member Eric Siegal, MD, SFHM, board liaison SHM's Public Policy Committee. "The only way that we are going to get them to change their behavior is if enough of us mobilize, and make enough noise to make it clear that we are not going to stand for this anymore."

Dr. Siegal says that because Congress has repeatedly delayed draconian cuts, there is a general consensus that another delay is likely. But Dr. Siegal also notes lobbying is still necessary to ensure that will happen. SHM has previously supported a meaningful replacement to the SGR, which has yet to receive significant action in Congress.

"What the entire healthcare community needs to push for is a solution," Dr. Siegal adds. "It's very hard to develop any kind of a strategy for how you're going to deliver care if every X number of months you have to worry [whether] you're going to take a massive cut in your compensation."

Bringing a neurohospitalist service into an academic medical center can reduce neurological patients' length of stay (LOS) at the facility, according to a study in Neurology.

The retrospective cohort study, "Effect of a Neurohospitalist Service on Outcomes at an Academic Medical Center," found that the mean LOS dropped to 4.6 days while the neurohospitalist service was in place, compared with 6.3 days during the pre-neurohospitalist period. However, adding the service didn't significantly reduce the median cost of care delivery ($6,758 vs. $7,241; P=0.25) or in-hospital mortality rate (1.6% vs. 1.2%; P=0.61), the study noted.

Lead author Vanja Douglas, MD, health sciences assistant clinical professor in the department of neurology at the University of California at San Francisco (UCSF) School of Medicine, says the study's impact is limited by its single-center universe of data. The study was conducted at a UCSF Medical Center in October 2006, but Dr. Douglas hopes similar studies at other academic or community centers will replicate the findings.

"If the current model people have in place is not necessarily focused on outcomes like LOS and cost, then making a change to a neurohospitalist model is likely to positively affect those outcomes," says Dr. Douglas, editor in chief of The Neurohospitalist.

Investigators tracked administrative data starting 21 months before UCSF added a neurohospitalist service and 27 months after. The service was comprised of one neurohospitalist focused solely on inpatients, which allowed other staff neurologists to focus on consultative cases throughout the hospital. Dr. Douglas says as HM groups look to improve their scope of practice and bottom line, studies such as his can lay the groundwork to make the investment.

"A lot of the groups that contract with hospitals are interested in partnering with subspecialty hospitalists," Dr. Douglas adds. "A neurohospitalist model has the potential to work, and the potential to improve outcomes."

Bringing a neurohospitalist service into an academic medical center can reduce neurological patients' length of stay (LOS) at the facility, according to a study in Neurology.

The retrospective cohort study, "Effect of a Neurohospitalist Service on Outcomes at an Academic Medical Center," found that the mean LOS dropped to 4.6 days while the neurohospitalist service was in place, compared with 6.3 days during the pre-neurohospitalist period. However, adding the service didn't significantly reduce the median cost of care delivery ($6,758 vs. $7,241; P=0.25) or in-hospital mortality rate (1.6% vs. 1.2%; P=0.61), the study noted.

Lead author Vanja Douglas, MD, health sciences assistant clinical professor in the department of neurology at the University of California at San Francisco (UCSF) School of Medicine, says the study's impact is limited by its single-center universe of data. The study was conducted at a UCSF Medical Center in October 2006, but Dr. Douglas hopes similar studies at other academic or community centers will replicate the findings.

"If the current model people have in place is not necessarily focused on outcomes like LOS and cost, then making a change to a neurohospitalist model is likely to positively affect those outcomes," says Dr. Douglas, editor in chief of The Neurohospitalist.

Investigators tracked administrative data starting 21 months before UCSF added a neurohospitalist service and 27 months after. The service was comprised of one neurohospitalist focused solely on inpatients, which allowed other staff neurologists to focus on consultative cases throughout the hospital. Dr. Douglas says as HM groups look to improve their scope of practice and bottom line, studies such as his can lay the groundwork to make the investment.

"A lot of the groups that contract with hospitals are interested in partnering with subspecialty hospitalists," Dr. Douglas adds. "A neurohospitalist model has the potential to work, and the potential to improve outcomes."

Bringing a neurohospitalist service into an academic medical center can reduce neurological patients' length of stay (LOS) at the facility, according to a study in Neurology.

The retrospective cohort study, "Effect of a Neurohospitalist Service on Outcomes at an Academic Medical Center," found that the mean LOS dropped to 4.6 days while the neurohospitalist service was in place, compared with 6.3 days during the pre-neurohospitalist period. However, adding the service didn't significantly reduce the median cost of care delivery ($6,758 vs. $7,241; P=0.25) or in-hospital mortality rate (1.6% vs. 1.2%; P=0.61), the study noted.

Lead author Vanja Douglas, MD, health sciences assistant clinical professor in the department of neurology at the University of California at San Francisco (UCSF) School of Medicine, says the study's impact is limited by its single-center universe of data. The study was conducted at a UCSF Medical Center in October 2006, but Dr. Douglas hopes similar studies at other academic or community centers will replicate the findings.

"If the current model people have in place is not necessarily focused on outcomes like LOS and cost, then making a change to a neurohospitalist model is likely to positively affect those outcomes," says Dr. Douglas, editor in chief of The Neurohospitalist.

Investigators tracked administrative data starting 21 months before UCSF added a neurohospitalist service and 27 months after. The service was comprised of one neurohospitalist focused solely on inpatients, which allowed other staff neurologists to focus on consultative cases throughout the hospital. Dr. Douglas says as HM groups look to improve their scope of practice and bottom line, studies such as his can lay the groundwork to make the investment.

"A lot of the groups that contract with hospitals are interested in partnering with subspecialty hospitalists," Dr. Douglas adds. "A neurohospitalist model has the potential to work, and the potential to improve outcomes."

A concerted effort by SHM members has helped win some hospitalists an exemption to the Centers for Medicare & Medicaid Services' (CMS) final rule on Stage 2 compliance for meaningful use [PDF] of electronic health records (EHR).

The "hardship exception" frees hospitalists who round at nursing homes and other post-acute-care facilities from being subject to penalties for not being "meaningful users." SHM successfully argued that it isn't fair for HM clinicians working in such institutions be held accountable for records they can't fully control.

SHM Public Policy Committee member Kerry Weiner, MD, chief clinical officer of IPC: The Hospitalist Company Inc. of North Hollywood, Calif., says about 30% of hospitalists are involved in care delivery at nursing homes, skilled nursing facilities, or other post-acute-care settings. Those physicians need to be aware of how CMS views their job in relation to new regulations.

"Once the physician leaves the hospital, they're generally considered an outpatient doctor by CMS, even though leaving an acute-care facility and going into a step-down unit like a skilled nursing facility is not really going into a primary-care or outpatient practice," Dr. Weiner says. "There are a number of regulations coming down, and hospitalists have to be sensitive to the differences in reimbursement and accountability they'll be held to. Just because you're a hospitalist doesn't mean the government considers you a hospitalist for their regulations."

CMS initially proposed that "eligible professionals" (EPs) needed to meet three criteria to be granted a hardship exception: a lack of face-to-face or telemedicine interaction with patients, a lack of follow-up need with patients, and the "lack of control over the availability" of certified EHR technology. After SHM voiced concern, CMS agreed that EPs who practice at multiple locations can be granted the exception solely for lack of control over the availability of the technology. Dr. Weiner says that CMS' willingness to make changes before finalizing the rule shows the agency understands how difficult the new rules can be.

"CMS has realized they may not get it right the first time," he adds. "This is a dynamic process, and even if they do get it right exactly, it's only right for a particular moment. Medicine is transitioning and changing all the time."

A concerted effort by SHM members has helped win some hospitalists an exemption to the Centers for Medicare & Medicaid Services' (CMS) final rule on Stage 2 compliance for meaningful use [PDF] of electronic health records (EHR).

The "hardship exception" frees hospitalists who round at nursing homes and other post-acute-care facilities from being subject to penalties for not being "meaningful users." SHM successfully argued that it isn't fair for HM clinicians working in such institutions be held accountable for records they can't fully control.

SHM Public Policy Committee member Kerry Weiner, MD, chief clinical officer of IPC: The Hospitalist Company Inc. of North Hollywood, Calif., says about 30% of hospitalists are involved in care delivery at nursing homes, skilled nursing facilities, or other post-acute-care settings. Those physicians need to be aware of how CMS views their job in relation to new regulations.

"Once the physician leaves the hospital, they're generally considered an outpatient doctor by CMS, even though leaving an acute-care facility and going into a step-down unit like a skilled nursing facility is not really going into a primary-care or outpatient practice," Dr. Weiner says. "There are a number of regulations coming down, and hospitalists have to be sensitive to the differences in reimbursement and accountability they'll be held to. Just because you're a hospitalist doesn't mean the government considers you a hospitalist for their regulations."

CMS initially proposed that "eligible professionals" (EPs) needed to meet three criteria to be granted a hardship exception: a lack of face-to-face or telemedicine interaction with patients, a lack of follow-up need with patients, and the "lack of control over the availability" of certified EHR technology. After SHM voiced concern, CMS agreed that EPs who practice at multiple locations can be granted the exception solely for lack of control over the availability of the technology. Dr. Weiner says that CMS' willingness to make changes before finalizing the rule shows the agency understands how difficult the new rules can be.

"CMS has realized they may not get it right the first time," he adds. "This is a dynamic process, and even if they do get it right exactly, it's only right for a particular moment. Medicine is transitioning and changing all the time."

A concerted effort by SHM members has helped win some hospitalists an exemption to the Centers for Medicare & Medicaid Services' (CMS) final rule on Stage 2 compliance for meaningful use [PDF] of electronic health records (EHR).

The "hardship exception" frees hospitalists who round at nursing homes and other post-acute-care facilities from being subject to penalties for not being "meaningful users." SHM successfully argued that it isn't fair for HM clinicians working in such institutions be held accountable for records they can't fully control.

SHM Public Policy Committee member Kerry Weiner, MD, chief clinical officer of IPC: The Hospitalist Company Inc. of North Hollywood, Calif., says about 30% of hospitalists are involved in care delivery at nursing homes, skilled nursing facilities, or other post-acute-care settings. Those physicians need to be aware of how CMS views their job in relation to new regulations.

"Once the physician leaves the hospital, they're generally considered an outpatient doctor by CMS, even though leaving an acute-care facility and going into a step-down unit like a skilled nursing facility is not really going into a primary-care or outpatient practice," Dr. Weiner says. "There are a number of regulations coming down, and hospitalists have to be sensitive to the differences in reimbursement and accountability they'll be held to. Just because you're a hospitalist doesn't mean the government considers you a hospitalist for their regulations."

CMS initially proposed that "eligible professionals" (EPs) needed to meet three criteria to be granted a hardship exception: a lack of face-to-face or telemedicine interaction with patients, a lack of follow-up need with patients, and the "lack of control over the availability" of certified EHR technology. After SHM voiced concern, CMS agreed that EPs who practice at multiple locations can be granted the exception solely for lack of control over the availability of the technology. Dr. Weiner says that CMS' willingness to make changes before finalizing the rule shows the agency understands how difficult the new rules can be.

"CMS has realized they may not get it right the first time," he adds. "This is a dynamic process, and even if they do get it right exactly, it's only right for a particular moment. Medicine is transitioning and changing all the time."

A concerted effort by SHM members has helped win some hospitalists an exemption to the Centers for Medicare & Medicaid Services' (CMS) final rule on Stage 2 compliance for meaningful use [PDF] of electronic health records (EHR).

The "hardship exception" frees hospitalists who round at nursing homes and other post-acute-care facilities from being subject to penalties for not being "meaningful users." SHM successfully argued that it isn't fair for HM clinicians working in such institutions be held accountable for records they can't fully control.

SHM Public Policy Committee member Kerry Weiner, MD, chief clinical officer of IPC: The Hospitalist Company Inc. of North Hollywood, Calif., says about 30% of hospitalists are involved in care delivery at nursing homes, skilled nursing facilities, or other post-acute-care settings. Those physicians need to be aware of how CMS views their job in relation to new regulations.

"Once the physician leaves the hospital, they're generally considered an outpatient doctor by CMS, even though leaving an acute-care facility and going into a step-down unit like a skilled nursing facility is not really going into a primary-care or outpatient practice," Dr. Weiner says. "There are a number of regulations coming down, and hospitalists have to be sensitive to the differences in reimbursement and accountability they'll be held to. Just because you're a hospitalist doesn't mean the government considers you a hospitalist for their regulations."

CMS initially proposed that "eligible professionals" (EPs) needed to meet three criteria to be granted a hardship exception: a lack of face-to-face or telemedicine interaction with patients, a lack of follow-up need with patients, and the "lack of control over the availability" of certified EHR technology. After SHM voiced concern, CMS agreed that EPs who practice at multiple locations can be granted the exception solely for lack of control over the availability of the technology. Dr. Weiner says that CMS' willingness to make changes before finalizing the rule shows the agency understands how difficult the new rules can be.

"CMS has realized they may not get it right the first time," he adds. "This is a dynamic process, and even if they do get it right exactly, it's only right for a particular moment. Medicine is transitioning and changing all the time."

A concerted effort by SHM members has helped win some hospitalists an exemption to the Centers for Medicare & Medicaid Services' (CMS) final rule on Stage 2 compliance for meaningful use [PDF] of electronic health records (EHR).

The "hardship exception" frees hospitalists who round at nursing homes and other post-acute-care facilities from being subject to penalties for not being "meaningful users." SHM successfully argued that it isn't fair for HM clinicians working in such institutions be held accountable for records they can't fully control.

SHM Public Policy Committee member Kerry Weiner, MD, chief clinical officer of IPC: The Hospitalist Company Inc. of North Hollywood, Calif., says about 30% of hospitalists are involved in care delivery at nursing homes, skilled nursing facilities, or other post-acute-care settings. Those physicians need to be aware of how CMS views their job in relation to new regulations.

"Once the physician leaves the hospital, they're generally considered an outpatient doctor by CMS, even though leaving an acute-care facility and going into a step-down unit like a skilled nursing facility is not really going into a primary-care or outpatient practice," Dr. Weiner says. "There are a number of regulations coming down, and hospitalists have to be sensitive to the differences in reimbursement and accountability they'll be held to. Just because you're a hospitalist doesn't mean the government considers you a hospitalist for their regulations."

CMS initially proposed that "eligible professionals" (EPs) needed to meet three criteria to be granted a hardship exception: a lack of face-to-face or telemedicine interaction with patients, a lack of follow-up need with patients, and the "lack of control over the availability" of certified EHR technology. After SHM voiced concern, CMS agreed that EPs who practice at multiple locations can be granted the exception solely for lack of control over the availability of the technology. Dr. Weiner says that CMS' willingness to make changes before finalizing the rule shows the agency understands how difficult the new rules can be.

"CMS has realized they may not get it right the first time," he adds. "This is a dynamic process, and even if they do get it right exactly, it's only right for a particular moment. Medicine is transitioning and changing all the time."

A concerted effort by SHM members has helped win some hospitalists an exemption to the Centers for Medicare & Medicaid Services' (CMS) final rule on Stage 2 compliance for meaningful use [PDF] of electronic health records (EHR).

The "hardship exception" frees hospitalists who round at nursing homes and other post-acute-care facilities from being subject to penalties for not being "meaningful users." SHM successfully argued that it isn't fair for HM clinicians working in such institutions be held accountable for records they can't fully control.

SHM Public Policy Committee member Kerry Weiner, MD, chief clinical officer of IPC: The Hospitalist Company Inc. of North Hollywood, Calif., says about 30% of hospitalists are involved in care delivery at nursing homes, skilled nursing facilities, or other post-acute-care settings. Those physicians need to be aware of how CMS views their job in relation to new regulations.

"Once the physician leaves the hospital, they're generally considered an outpatient doctor by CMS, even though leaving an acute-care facility and going into a step-down unit like a skilled nursing facility is not really going into a primary-care or outpatient practice," Dr. Weiner says. "There are a number of regulations coming down, and hospitalists have to be sensitive to the differences in reimbursement and accountability they'll be held to. Just because you're a hospitalist doesn't mean the government considers you a hospitalist for their regulations."

CMS initially proposed that "eligible professionals" (EPs) needed to meet three criteria to be granted a hardship exception: a lack of face-to-face or telemedicine interaction with patients, a lack of follow-up need with patients, and the "lack of control over the availability" of certified EHR technology. After SHM voiced concern, CMS agreed that EPs who practice at multiple locations can be granted the exception solely for lack of control over the availability of the technology. Dr. Weiner says that CMS' willingness to make changes before finalizing the rule shows the agency understands how difficult the new rules can be.

"CMS has realized they may not get it right the first time," he adds. "This is a dynamic process, and even if they do get it right exactly, it's only right for a particular moment. Medicine is transitioning and changing all the time."

Hospitalist-led teams in the ED help reduce diversions, improve patient flow, and provide more timely care to boarded patients, according to a study in the Journal of Hospital Medicine (JHM).

The single-center study, "Hospitalist-Led Medicine Emergency Department Team: Associations with Throughput, Timeliness of Patient Care, and Satisfaction," found a reduction in diversions due to medicine bed capacity of 27% (4.5% to 3%, P=<0.01). Boarded patients were rounded a mean of 2 hours and 9 minutes earlier with hospitalist-led teams; length of stay (LOS) in the ED, LOS in the hospital, and 48-hour returns were unchanged. The study, which took place at 477-bed Denver Health Medical Center (DHMC), assigned a hospitalist and an allied health provider to the ED during dayshifts. At night, ED coverage was rolled into the existing hospitalist duties.

Lead author Smitha R. Chadaga, MD, who works in DHMC's Department of Medicine, believes the study could spur more HM groups to consider dedicating a staffer to the ED. The team in Denver was created to care for medicine patients in the ED awaiting inpatient beds, and to work with nursing supervisors to improve bed management.

"There are numerous places that hospitalists can impact hospital flow, whether it's helping with bed management, providing consultative services to the ED, or caring for boarded patients," Dr. Chadaga says. "Knowing the ins and outs of inpatient medicine really lends itself well to some areas that hospitalists might not have thought about before."

Dr. Chadaga says the research is broadly applicable because HM groups can implement its different features. For example, adding a consultative phone service can help ED physicians determine whether a patient needs to be admitted and could improve patient flow.

Hospitalist-led teams in the ED help reduce diversions, improve patient flow, and provide more timely care to boarded patients, according to a study in the Journal of Hospital Medicine (JHM).

The single-center study, "Hospitalist-Led Medicine Emergency Department Team: Associations with Throughput, Timeliness of Patient Care, and Satisfaction," found a reduction in diversions due to medicine bed capacity of 27% (4.5% to 3%, P=<0.01). Boarded patients were rounded a mean of 2 hours and 9 minutes earlier with hospitalist-led teams; length of stay (LOS) in the ED, LOS in the hospital, and 48-hour returns were unchanged. The study, which took place at 477-bed Denver Health Medical Center (DHMC), assigned a hospitalist and an allied health provider to the ED during dayshifts. At night, ED coverage was rolled into the existing hospitalist duties.

Lead author Smitha R. Chadaga, MD, who works in DHMC's Department of Medicine, believes the study could spur more HM groups to consider dedicating a staffer to the ED. The team in Denver was created to care for medicine patients in the ED awaiting inpatient beds, and to work with nursing supervisors to improve bed management.

"There are numerous places that hospitalists can impact hospital flow, whether it's helping with bed management, providing consultative services to the ED, or caring for boarded patients," Dr. Chadaga says. "Knowing the ins and outs of inpatient medicine really lends itself well to some areas that hospitalists might not have thought about before."

Dr. Chadaga says the research is broadly applicable because HM groups can implement its different features. For example, adding a consultative phone service can help ED physicians determine whether a patient needs to be admitted and could improve patient flow.

Hospitalist-led teams in the ED help reduce diversions, improve patient flow, and provide more timely care to boarded patients, according to a study in the Journal of Hospital Medicine (JHM).

The single-center study, "Hospitalist-Led Medicine Emergency Department Team: Associations with Throughput, Timeliness of Patient Care, and Satisfaction," found a reduction in diversions due to medicine bed capacity of 27% (4.5% to 3%, P=<0.01). Boarded patients were rounded a mean of 2 hours and 9 minutes earlier with hospitalist-led teams; length of stay (LOS) in the ED, LOS in the hospital, and 48-hour returns were unchanged. The study, which took place at 477-bed Denver Health Medical Center (DHMC), assigned a hospitalist and an allied health provider to the ED during dayshifts. At night, ED coverage was rolled into the existing hospitalist duties.

Lead author Smitha R. Chadaga, MD, who works in DHMC's Department of Medicine, believes the study could spur more HM groups to consider dedicating a staffer to the ED. The team in Denver was created to care for medicine patients in the ED awaiting inpatient beds, and to work with nursing supervisors to improve bed management.

"There are numerous places that hospitalists can impact hospital flow, whether it's helping with bed management, providing consultative services to the ED, or caring for boarded patients," Dr. Chadaga says. "Knowing the ins and outs of inpatient medicine really lends itself well to some areas that hospitalists might not have thought about before."

Dr. Chadaga says the research is broadly applicable because HM groups can implement its different features. For example, adding a consultative phone service can help ED physicians determine whether a patient needs to be admitted and could improve patient flow.

An author of a report that estimates the national cost of unnecessary or wasteful healthcare at $750 billion per year hopes its findings will serve as a platform for hospitalists to spearhead improvements in healthcare delivery in the U.S.

The Institute of Medicine report, "Best Care at Lower Cost: The Path to Continuously Learning Health Care in America" [PDF], offers 10 broad recommendations that include reforming payment, adopting digital infrastructure, and simplifying transitional care. The paper was published earlier this month by a national committee of healthcare leaders, including Gary Kaplan, MD, FACP, FACMPE, FACPE, chairman and chief executive officer of Virginia Mason Health System in Seattle.

"The hospitalist is in a very unique position," Dr. Kaplan says. "They really are at the nexus of what we see as several of our key recommendations going forward."

In particular, Dr. Kaplan notes that healthcare delivery organizations should develop, implement, and fine-tune their "systems, engineering tools and process-improvement methods." Making such changes would help to "eliminate inefficiencies, remove unnecessary burdens on clinicians and staff, enhance patient experience, and improve patient health outcomes," he says.

"The hospitalists and the care teams with which the hospitalist connects are very critical to streamlining operations," Dr. Kaplan adds.

Many of the report's complaints about unnecessary testing, poor communication, and inefficient care delivery dovetail with the quality initiatives and practice-management improvements HM groups already push, Dr. Kaplan adds. To advance healthcare delivery's evolution, hospitalists should view the task of reform as an opportunity, not a challenge.

"There are very powerful opportunities for the hospitalist now to have great impact," he says. "To not just be the passive participants in a broken and dysfunctional system, but in many ways, [to be] one of the architects of an improved care system going forward."

An author of a report that estimates the national cost of unnecessary or wasteful healthcare at $750 billion per year hopes its findings will serve as a platform for hospitalists to spearhead improvements in healthcare delivery in the U.S.

The Institute of Medicine report, "Best Care at Lower Cost: The Path to Continuously Learning Health Care in America" [PDF], offers 10 broad recommendations that include reforming payment, adopting digital infrastructure, and simplifying transitional care. The paper was published earlier this month by a national committee of healthcare leaders, including Gary Kaplan, MD, FACP, FACMPE, FACPE, chairman and chief executive officer of Virginia Mason Health System in Seattle.

"The hospitalist is in a very unique position," Dr. Kaplan says. "They really are at the nexus of what we see as several of our key recommendations going forward."

In particular, Dr. Kaplan notes that healthcare delivery organizations should develop, implement, and fine-tune their "systems, engineering tools and process-improvement methods." Making such changes would help to "eliminate inefficiencies, remove unnecessary burdens on clinicians and staff, enhance patient experience, and improve patient health outcomes," he says.

"The hospitalists and the care teams with which the hospitalist connects are very critical to streamlining operations," Dr. Kaplan adds.

Many of the report's complaints about unnecessary testing, poor communication, and inefficient care delivery dovetail with the quality initiatives and practice-management improvements HM groups already push, Dr. Kaplan adds. To advance healthcare delivery's evolution, hospitalists should view the task of reform as an opportunity, not a challenge.

"There are very powerful opportunities for the hospitalist now to have great impact," he says. "To not just be the passive participants in a broken and dysfunctional system, but in many ways, [to be] one of the architects of an improved care system going forward."

An author of a report that estimates the national cost of unnecessary or wasteful healthcare at $750 billion per year hopes its findings will serve as a platform for hospitalists to spearhead improvements in healthcare delivery in the U.S.

The Institute of Medicine report, "Best Care at Lower Cost: The Path to Continuously Learning Health Care in America" [PDF], offers 10 broad recommendations that include reforming payment, adopting digital infrastructure, and simplifying transitional care. The paper was published earlier this month by a national committee of healthcare leaders, including Gary Kaplan, MD, FACP, FACMPE, FACPE, chairman and chief executive officer of Virginia Mason Health System in Seattle.

"The hospitalist is in a very unique position," Dr. Kaplan says. "They really are at the nexus of what we see as several of our key recommendations going forward."

In particular, Dr. Kaplan notes that healthcare delivery organizations should develop, implement, and fine-tune their "systems, engineering tools and process-improvement methods." Making such changes would help to "eliminate inefficiencies, remove unnecessary burdens on clinicians and staff, enhance patient experience, and improve patient health outcomes," he says.

"The hospitalists and the care teams with which the hospitalist connects are very critical to streamlining operations," Dr. Kaplan adds.

Many of the report's complaints about unnecessary testing, poor communication, and inefficient care delivery dovetail with the quality initiatives and practice-management improvements HM groups already push, Dr. Kaplan adds. To advance healthcare delivery's evolution, hospitalists should view the task of reform as an opportunity, not a challenge.

"There are very powerful opportunities for the hospitalist now to have great impact," he says. "To not just be the passive participants in a broken and dysfunctional system, but in many ways, [to be] one of the architects of an improved care system going forward."

The Centers for Medicare & Medicaid Services' (CMS) recently announced final rule [PDF] on Stage 2 compliance for "meaningful use" of electronic health records (EHR) has been met with mixed reactions among most providers and trade groups, including SHM which voiced its concerns back in July.

"It's the classic government mixed bag," says Brenda Pawlak, director of Manatt Health Solutions, a division of New York City law firm Manatt, Phelps & Phillips.

Physician groups, including SHM and the Medical Group Management Association (MGMA), have lauded CMS for pushing back the implementation of Stage 2 meaningful-use requirements to 2014 from 2013. They also praised the agency for halving to 5% the percentage of a practice's patients who interact with an online portal. But for some providers, even the 5% threshold will be difficult to meet. And because physicians have to meet all requirements to qualify for incentive bonuses, the issue could loom large for specific groups.

"I don't think the 10% to 5% is a substantive change," Pawlak says.

Although most hospitalists are not directly subject to "meaningful use" requirements, many are heavily involved with assisting their institutions with implementation. SHM, which voiced its concerns in a July letter to CMS, is following this topic closely.

Some physician groups also lamented that the deadline for Stage 1 compliance remains unchanged at 2015. As physicians and provider groups attempt to comply with myriad rules, Pawlak says, meeting the 5% threshold will emerge as more burdensome as the deadline approaches. Still, CMS and federal officials say, the final rule will help nudge the healthcare system further into the digital age.

"The big message here is the push on standards-based interoperability of information," says Farzad Mostashari, MD, ScM, of the U.S. Department of Health and Human Services' Office of the National Coordinator for Health Information Technology. "We are staying on course with the road map that we set in Stage 1."

The Centers for Medicare & Medicaid Services' (CMS) recently announced final rule [PDF] on Stage 2 compliance for "meaningful use" of electronic health records (EHR) has been met with mixed reactions among most providers and trade groups, including SHM which voiced its concerns back in July.

"It's the classic government mixed bag," says Brenda Pawlak, director of Manatt Health Solutions, a division of New York City law firm Manatt, Phelps & Phillips.

Physician groups, including SHM and the Medical Group Management Association (MGMA), have lauded CMS for pushing back the implementation of Stage 2 meaningful-use requirements to 2014 from 2013. They also praised the agency for halving to 5% the percentage of a practice's patients who interact with an online portal. But for some providers, even the 5% threshold will be difficult to meet. And because physicians have to meet all requirements to qualify for incentive bonuses, the issue could loom large for specific groups.

"I don't think the 10% to 5% is a substantive change," Pawlak says.

Although most hospitalists are not directly subject to "meaningful use" requirements, many are heavily involved with assisting their institutions with implementation. SHM, which voiced its concerns in a July letter to CMS, is following this topic closely.

Some physician groups also lamented that the deadline for Stage 1 compliance remains unchanged at 2015. As physicians and provider groups attempt to comply with myriad rules, Pawlak says, meeting the 5% threshold will emerge as more burdensome as the deadline approaches. Still, CMS and federal officials say, the final rule will help nudge the healthcare system further into the digital age.

"The big message here is the push on standards-based interoperability of information," says Farzad Mostashari, MD, ScM, of the U.S. Department of Health and Human Services' Office of the National Coordinator for Health Information Technology. "We are staying on course with the road map that we set in Stage 1."

The Centers for Medicare & Medicaid Services' (CMS) recently announced final rule [PDF] on Stage 2 compliance for "meaningful use" of electronic health records (EHR) has been met with mixed reactions among most providers and trade groups, including SHM which voiced its concerns back in July.

"It's the classic government mixed bag," says Brenda Pawlak, director of Manatt Health Solutions, a division of New York City law firm Manatt, Phelps & Phillips.

Physician groups, including SHM and the Medical Group Management Association (MGMA), have lauded CMS for pushing back the implementation of Stage 2 meaningful-use requirements to 2014 from 2013. They also praised the agency for halving to 5% the percentage of a practice's patients who interact with an online portal. But for some providers, even the 5% threshold will be difficult to meet. And because physicians have to meet all requirements to qualify for incentive bonuses, the issue could loom large for specific groups.

"I don't think the 10% to 5% is a substantive change," Pawlak says.

Although most hospitalists are not directly subject to "meaningful use" requirements, many are heavily involved with assisting their institutions with implementation. SHM, which voiced its concerns in a July letter to CMS, is following this topic closely.

Some physician groups also lamented that the deadline for Stage 1 compliance remains unchanged at 2015. As physicians and provider groups attempt to comply with myriad rules, Pawlak says, meeting the 5% threshold will emerge as more burdensome as the deadline approaches. Still, CMS and federal officials say, the final rule will help nudge the healthcare system further into the digital age.

"The big message here is the push on standards-based interoperability of information," says Farzad Mostashari, MD, ScM, of the U.S. Department of Health and Human Services' Office of the National Coordinator for Health Information Technology. "We are staying on course with the road map that we set in Stage 1."