Richard Quinn

The growth of specialty hospitalist medicine is an opportunity to improve patient outcomes, but the evolution of care delivery must be closely watched, according to one of the authors of an editorial in the Journal of the American Medical Association.

"It's a mistake to dig your heels in and insist on preserving traditional practice models when they may no longer fit," says John Nelson, MD, MHM, FACP, medical director of the hospitalist practice at Overlake Hospital Medical Center, Bellevue, Wash. "It's just as big a mistake to blindly hop on the hospitalist bandwagon without thinking deliberately about its costs and benefits and how to make it the best it can be."

Dr. Nelson, an SHM co-founder and practice management columnist for The Hospitalist, penned the editorial, "Specialty Hospitalists: Analyzing an Emerging Phenomenon,” with SHM CEO Larry Wellikson, MD, SFHM, and HM pioneer Robert Wachter, MD, MHM. The two-page article suggests that the growth of the hospitalist model to include such specialties as neurology, dermatology, obstetrics, surgery, and psychiatry is a natural extension of how the hospitalist model blossomed in the early 1990s.

"Doctors are headed elsewhere, away from the hospital," Dr. Nelson says. "The solution is, in many cases, if we can't get a lot of these doctors to do hospital work some of the time, can we get a few doctors to do hospital work all of the time?"

The article, which echoes a 2011 blog post by Dr. Wachter, proposes four guiding questions on whether the use of the hospitalist model is appropriate for a given specialty. Those answers are being answered by the marketplace which, in turn, is propelling the trend of specialty HM doctors.

"So many things that happen in medicine are engineered and tracked by some entity," Dr. Nelson says. "Not in this case—and that is huge."

The growth of specialty hospitalist medicine is an opportunity to improve patient outcomes, but the evolution of care delivery must be closely watched, according to one of the authors of an editorial in the Journal of the American Medical Association.

"It's a mistake to dig your heels in and insist on preserving traditional practice models when they may no longer fit," says John Nelson, MD, MHM, FACP, medical director of the hospitalist practice at Overlake Hospital Medical Center, Bellevue, Wash. "It's just as big a mistake to blindly hop on the hospitalist bandwagon without thinking deliberately about its costs and benefits and how to make it the best it can be."

Dr. Nelson, an SHM co-founder and practice management columnist for The Hospitalist, penned the editorial, "Specialty Hospitalists: Analyzing an Emerging Phenomenon,” with SHM CEO Larry Wellikson, MD, SFHM, and HM pioneer Robert Wachter, MD, MHM. The two-page article suggests that the growth of the hospitalist model to include such specialties as neurology, dermatology, obstetrics, surgery, and psychiatry is a natural extension of how the hospitalist model blossomed in the early 1990s.

"Doctors are headed elsewhere, away from the hospital," Dr. Nelson says. "The solution is, in many cases, if we can't get a lot of these doctors to do hospital work some of the time, can we get a few doctors to do hospital work all of the time?"

The article, which echoes a 2011 blog post by Dr. Wachter, proposes four guiding questions on whether the use of the hospitalist model is appropriate for a given specialty. Those answers are being answered by the marketplace which, in turn, is propelling the trend of specialty HM doctors.

"So many things that happen in medicine are engineered and tracked by some entity," Dr. Nelson says. "Not in this case—and that is huge."

The growth of specialty hospitalist medicine is an opportunity to improve patient outcomes, but the evolution of care delivery must be closely watched, according to one of the authors of an editorial in the Journal of the American Medical Association.

"It's a mistake to dig your heels in and insist on preserving traditional practice models when they may no longer fit," says John Nelson, MD, MHM, FACP, medical director of the hospitalist practice at Overlake Hospital Medical Center, Bellevue, Wash. "It's just as big a mistake to blindly hop on the hospitalist bandwagon without thinking deliberately about its costs and benefits and how to make it the best it can be."

Dr. Nelson, an SHM co-founder and practice management columnist for The Hospitalist, penned the editorial, "Specialty Hospitalists: Analyzing an Emerging Phenomenon,” with SHM CEO Larry Wellikson, MD, SFHM, and HM pioneer Robert Wachter, MD, MHM. The two-page article suggests that the growth of the hospitalist model to include such specialties as neurology, dermatology, obstetrics, surgery, and psychiatry is a natural extension of how the hospitalist model blossomed in the early 1990s.

"Doctors are headed elsewhere, away from the hospital," Dr. Nelson says. "The solution is, in many cases, if we can't get a lot of these doctors to do hospital work some of the time, can we get a few doctors to do hospital work all of the time?"

The article, which echoes a 2011 blog post by Dr. Wachter, proposes four guiding questions on whether the use of the hospitalist model is appropriate for a given specialty. Those answers are being answered by the marketplace which, in turn, is propelling the trend of specialty HM doctors.

"So many things that happen in medicine are engineered and tracked by some entity," Dr. Nelson says. "Not in this case—and that is huge."

Hospitalists should be aware of the privacy perils of social media, according to a lawyer helping to develop a webinar that will focus on the legal implications of healthcare workers' use of social media platforms.

"The idea that everyone has something important to say in 140 characters or less these days just seems to be part of a growing culture that doesn't consider the publication of private information to be an intrusion," says Gregory McNeer Jr., principal of Stratford Consulting in Winston-Salem, N.C. "There is a bit of a disconnect—whether it's with doctors, or patients, or nurses, or technicians, or whomever—as to what their obligations are under the law."

McNeer is partnering with law firm Maguire Woods and mobile technology firm Novarus Healthcare to host the online conference, called "HIPAA and Social Media: Strategies for Protecting Patient Privacy in a HITECH World." The intent, he says, is to raise awareness of the potential privacy pitfalls social media pose for physicians, and to guide session participants through the nuances of the Health Insurance Portability and Accountability Act (HIPAA) and the Health Information Technology for Economic and Clinical Health (HITECH) Act—measures focused on the protection of patient information.

McNeer says physicians who "vent about a bad day" could inadvertently release patient information that could draw regulatory attention. He points to several instances nationwide in which healthcare professionals have faced consequences for talking about patients on Facebook or posting X-rays online.

"We have a clear channel for unauthorized dissemination of protected healthcare information," he says. "Once somebody has tweeted something, the horse is out of the barn. But do you have a tool that will give you notification of the breach within 24 hours? Or do you wait until the lawsuit shows up?"

The webinar is at 1 p.m. May 30; email McNeer for more information or to register.

Hospitalists should be aware of the privacy perils of social media, according to a lawyer helping to develop a webinar that will focus on the legal implications of healthcare workers' use of social media platforms.

"The idea that everyone has something important to say in 140 characters or less these days just seems to be part of a growing culture that doesn't consider the publication of private information to be an intrusion," says Gregory McNeer Jr., principal of Stratford Consulting in Winston-Salem, N.C. "There is a bit of a disconnect—whether it's with doctors, or patients, or nurses, or technicians, or whomever—as to what their obligations are under the law."

McNeer is partnering with law firm Maguire Woods and mobile technology firm Novarus Healthcare to host the online conference, called "HIPAA and Social Media: Strategies for Protecting Patient Privacy in a HITECH World." The intent, he says, is to raise awareness of the potential privacy pitfalls social media pose for physicians, and to guide session participants through the nuances of the Health Insurance Portability and Accountability Act (HIPAA) and the Health Information Technology for Economic and Clinical Health (HITECH) Act—measures focused on the protection of patient information.

McNeer says physicians who "vent about a bad day" could inadvertently release patient information that could draw regulatory attention. He points to several instances nationwide in which healthcare professionals have faced consequences for talking about patients on Facebook or posting X-rays online.

"We have a clear channel for unauthorized dissemination of protected healthcare information," he says. "Once somebody has tweeted something, the horse is out of the barn. But do you have a tool that will give you notification of the breach within 24 hours? Or do you wait until the lawsuit shows up?"

The webinar is at 1 p.m. May 30; email McNeer for more information or to register.

Hospitalists should be aware of the privacy perils of social media, according to a lawyer helping to develop a webinar that will focus on the legal implications of healthcare workers' use of social media platforms.

"The idea that everyone has something important to say in 140 characters or less these days just seems to be part of a growing culture that doesn't consider the publication of private information to be an intrusion," says Gregory McNeer Jr., principal of Stratford Consulting in Winston-Salem, N.C. "There is a bit of a disconnect—whether it's with doctors, or patients, or nurses, or technicians, or whomever—as to what their obligations are under the law."

McNeer is partnering with law firm Maguire Woods and mobile technology firm Novarus Healthcare to host the online conference, called "HIPAA and Social Media: Strategies for Protecting Patient Privacy in a HITECH World." The intent, he says, is to raise awareness of the potential privacy pitfalls social media pose for physicians, and to guide session participants through the nuances of the Health Insurance Portability and Accountability Act (HIPAA) and the Health Information Technology for Economic and Clinical Health (HITECH) Act—measures focused on the protection of patient information.

McNeer says physicians who "vent about a bad day" could inadvertently release patient information that could draw regulatory attention. He points to several instances nationwide in which healthcare professionals have faced consequences for talking about patients on Facebook or posting X-rays online.

"We have a clear channel for unauthorized dissemination of protected healthcare information," he says. "Once somebody has tweeted something, the horse is out of the barn. But do you have a tool that will give you notification of the breach within 24 hours? Or do you wait until the lawsuit shows up?"

The webinar is at 1 p.m. May 30; email McNeer for more information or to register.

Click here to listen to Dr. Frost

Click here to listen to Dr. Frost

Click here to listen to Dr. Frost

Click here to listen to Dr. Conway

Click here to listen to Dr. Conway

Click here to listen to Dr. Conway

Click here to listen to Dr. Cumbler

Click here to listen to Dr. Arora

Click here to listen to Dr. Gard

Click here to listen to Dr. Cumbler

Click here to listen to Dr. Arora

Click here to listen to Dr. Gard

Click here to listen to Dr. Cumbler

Click here to listen to Dr. Arora

Click here to listen to Dr. Gard

SHM is pushing back against the Centers for Medicare & Medicaid Services’ (CMS) proposed rule [PDF] to extend to 10 years the "look-back period" for potential Medicare overpayments to providers.

Last month, SHM sent a letter [PDF] to Marilyn Tavenner, acting CMS administrator, calling for the look-back period to be halved to five years. SHM president Shaun Frost, MD, SFHM, FACP, wrote that the extended time frame could be problematic for hospitalists and other physicians.

"SHM was compelled to provide guidance on behalf of its members to protect them from the undue burden proposed in the Reporting and Returning of Overpayments rule," says SHM CEO Larry Wellikson, MD, SFHM. "Though SHM supports the goal of reducing overpayment, asking hospitalists and their hospitals to look back through 10 years of records to identify areas of overpayment is unreasonable."

CMS announced that the 10-year period was chosen to coincide with the statute of limitations of the False Claims Act. But SHM leaders note that most laws governing Medicare overpayments generally don’t exceed six years. Potential problems with the extended audit period include physicians who have moved on from a job and "may no longer have access to the documentation necessary for an adequate 10-year audit," according to the letter.

SHM also is pushing for CMS to include a calculation of "burdens and costs associated" with the extended look-back period in the proposed rule.

"SHM believes a measurement of the cost for all providers to perform a full 10-year audit would more fully illustrate the extent of the burden presented by the proposed look back period," Dr. Frost wrote in the letter.

SHM is pushing back against the Centers for Medicare & Medicaid Services’ (CMS) proposed rule [PDF] to extend to 10 years the "look-back period" for potential Medicare overpayments to providers.

Last month, SHM sent a letter [PDF] to Marilyn Tavenner, acting CMS administrator, calling for the look-back period to be halved to five years. SHM president Shaun Frost, MD, SFHM, FACP, wrote that the extended time frame could be problematic for hospitalists and other physicians.

"SHM was compelled to provide guidance on behalf of its members to protect them from the undue burden proposed in the Reporting and Returning of Overpayments rule," says SHM CEO Larry Wellikson, MD, SFHM. "Though SHM supports the goal of reducing overpayment, asking hospitalists and their hospitals to look back through 10 years of records to identify areas of overpayment is unreasonable."

CMS announced that the 10-year period was chosen to coincide with the statute of limitations of the False Claims Act. But SHM leaders note that most laws governing Medicare overpayments generally don’t exceed six years. Potential problems with the extended audit period include physicians who have moved on from a job and "may no longer have access to the documentation necessary for an adequate 10-year audit," according to the letter.

SHM also is pushing for CMS to include a calculation of "burdens and costs associated" with the extended look-back period in the proposed rule.

"SHM believes a measurement of the cost for all providers to perform a full 10-year audit would more fully illustrate the extent of the burden presented by the proposed look back period," Dr. Frost wrote in the letter.

SHM is pushing back against the Centers for Medicare & Medicaid Services’ (CMS) proposed rule [PDF] to extend to 10 years the "look-back period" for potential Medicare overpayments to providers.

Last month, SHM sent a letter [PDF] to Marilyn Tavenner, acting CMS administrator, calling for the look-back period to be halved to five years. SHM president Shaun Frost, MD, SFHM, FACP, wrote that the extended time frame could be problematic for hospitalists and other physicians.

"SHM was compelled to provide guidance on behalf of its members to protect them from the undue burden proposed in the Reporting and Returning of Overpayments rule," says SHM CEO Larry Wellikson, MD, SFHM. "Though SHM supports the goal of reducing overpayment, asking hospitalists and their hospitals to look back through 10 years of records to identify areas of overpayment is unreasonable."

CMS announced that the 10-year period was chosen to coincide with the statute of limitations of the False Claims Act. But SHM leaders note that most laws governing Medicare overpayments generally don’t exceed six years. Potential problems with the extended audit period include physicians who have moved on from a job and "may no longer have access to the documentation necessary for an adequate 10-year audit," according to the letter.

SHM also is pushing for CMS to include a calculation of "burdens and costs associated" with the extended look-back period in the proposed rule.

"SHM believes a measurement of the cost for all providers to perform a full 10-year audit would more fully illustrate the extent of the burden presented by the proposed look back period," Dr. Frost wrote in the letter.

A four-day bazaar of HM’s top minds and clinicians, all with a spectacular view of the Pacific Ocean. What wasn’t to like?

SHM’s annual meeting, held April 1-4 at the San Diego Convention Center, drew thousands to educational sessions, CME-eligible pre-courses, and plenary addresses delivered by CMS bigwig Patrick Conway, MD, MSc, FAAP, SFHM; political guru Norman Ornstein, PhD, MA, BA; and hospitalist pioneer Robert Wachter, MD, MHM.

Yet for all of the meeting’s individual branches, hospitalist Steven Pestka, MD, chief of the hospitalist service at Newton-Wellesley Hospital in Newton, Mass., sees the sum of its parts as its highest value.

“It is a great pause to recognize that there is excellence in hospitalist medicine,” he says. “Through the plenary sessions and the lectures, and various, very-high-quality presentations, it’s become very clear that this is a community to really respect.”

Richard Quinn is a freelance writer in New Jersey.

A four-day bazaar of HM’s top minds and clinicians, all with a spectacular view of the Pacific Ocean. What wasn’t to like?

SHM’s annual meeting, held April 1-4 at the San Diego Convention Center, drew thousands to educational sessions, CME-eligible pre-courses, and plenary addresses delivered by CMS bigwig Patrick Conway, MD, MSc, FAAP, SFHM; political guru Norman Ornstein, PhD, MA, BA; and hospitalist pioneer Robert Wachter, MD, MHM.

Yet for all of the meeting’s individual branches, hospitalist Steven Pestka, MD, chief of the hospitalist service at Newton-Wellesley Hospital in Newton, Mass., sees the sum of its parts as its highest value.

“It is a great pause to recognize that there is excellence in hospitalist medicine,” he says. “Through the plenary sessions and the lectures, and various, very-high-quality presentations, it’s become very clear that this is a community to really respect.”

Richard Quinn is a freelance writer in New Jersey.

A four-day bazaar of HM’s top minds and clinicians, all with a spectacular view of the Pacific Ocean. What wasn’t to like?

SHM’s annual meeting, held April 1-4 at the San Diego Convention Center, drew thousands to educational sessions, CME-eligible pre-courses, and plenary addresses delivered by CMS bigwig Patrick Conway, MD, MSc, FAAP, SFHM; political guru Norman Ornstein, PhD, MA, BA; and hospitalist pioneer Robert Wachter, MD, MHM.

Yet for all of the meeting’s individual branches, hospitalist Steven Pestka, MD, chief of the hospitalist service at Newton-Wellesley Hospital in Newton, Mass., sees the sum of its parts as its highest value.

“It is a great pause to recognize that there is excellence in hospitalist medicine,” he says. “Through the plenary sessions and the lectures, and various, very-high-quality presentations, it’s become very clear that this is a community to really respect.”

Richard Quinn is a freelance writer in New Jersey.

Dr. Pistoria

If such a thing exists, hospitalist Dwayne Gard, MD, of Memorial Health in Savannah, Ga., has a good practice management problem: In recent years, his HM group started collaborating with Memorial’s gastrointestinal team to admit their patients. Now, Dr. Gard and his colleagues are in similar discussions with neurosurgery. And ments provide steady revenue for the hospitalist group, too much growth, too fast, can be as dangerous as too little.

“There are a lot of demands, from an administrative standpoint, to cater to the needs of some of the subspecialists at a time where we really need to grow the number of hospitalists within our program before we even consider expanding our services,” says Dr. Gard, whose group has 10 FTE hospitalists and has an average patient census of 90-110 at the 500-bed hospital. “I let our administration know it’s a challenge we’re willing to take on as long as we have the support to get the staff in that we need to safely see those patients.”

Just how to let them know is the art of practice management, a topic that dominates much of SHM’s annual meeting. From a popular, daylong CME pre-course to a dedicated practice-management track, hospitalists looking for real-time advice on the business side of medicine came away from HM12 last month with brown bags full of tips.

“This is a huge pause, a huge opportunity to pause and remind ourselves what’s important,” says Steven Pestka, MD, chief of the hospitalist service at Newton-Wellesley Hospital in Newton, Mass. “And then recognizing that all those other things … need to be kept in context and need to be limited so that the core running of the group can be performed.”

For Dr. Gard, gaining management skills at this year’s annual meeting was a two-step process. First, they sent seven members of their HM groupthree hospitalists, two non-physician providers (NPPs), an administrator, and an office managerto San Diego. The annual-meeting team spread across as many sessions as they could, including pre-courses on value-based purchasing and practice management. Second, and perhaps more important, the team members didn’t decide ahead of time what advice they were going to glean; they came with agendas and schedules of what breakout sessions

they viewed as most valuable while remaining flexible.

“It always seems like while you’re here, you learn something you weren’t expecting,” Dr. Gard adds, “and something that’s actually maybe more pertinent than the reason you maybe thought about coming to the meeting to begin with. You can take that home as well.

“It’s important for our group because a lot of our new hires, the majority of our new hires, are residents within our own training program. Unless we hire hospitalists from outside our own network, it does tend to be the same people in the same system—not thinking outside the box, like we need to do in this day and age.”

Advanced Degrees of Hospital Medicine

Benjamin Frizner, MD, director of the hospitalist program at Saint Agnes Hospital in Baltimore, wonders whether earning an MBA would give him an advantage in “getting into the mind of the CEO and the C-suite.”

“What’s their frame of mind when I go into meetings, so I can talk their language, frame things in a different way?” Dr. Frizner says during a break in a practice-management pre-course. “The topics [at HM12] are focused to a lot of the problems we are facing.”

The issues are specific to individual HM groups. Dr. Frizner also wants to know how to better speak to colleagues and care team members in the hospitals his group services. Madonna Ringswald, DO, medical director of the hospitalist program at Baptist Hospital Northeast in La Grange, Ky., took over management of her group a little more than two years ago and came to San Diego to bounce questions off people who have more experience than she does. Dr. Pestka took home suggestions on how to recognize hospitalist performance in non-compensated ways.

“This is the best meeting I’ve ever been to,” Dr. Ringswald says. “If you can’t find a lecture [that appeals to you], there’s something wrong with you.”

Renewed Focus

Dr. Pistoria

In the annual meeting’s wrap-up address, Michael Pistoria, DO, FACP, SFHM, hospitalist at Lehigh Valley Health Network in Allentown, Pa., described the future of practice management as an amalgam of all the issues HM faces. Improved communication, a renewed focus on costs and high-value care, and continued adoption of best practices found at institutions across the country are all ways to better operate individual practices.

“We move ahead by doing what we do best in hospital medicine,” says Dr. Pistoria, the course director for HM13, which will be May 16-19, 2013, just outside of Washington, D.C. “We get together as teams, we collaborate with each other across our institutions, within our own institution, and professionally. We come up with that one small or big idea that improves care at the level of the patient and at the macro level.”

CMS’ CMO Offers Practice-Management Tips

Dr. Conway

Patrick Conway, MD, MSc, FAAP, SFHM, a pediatric hospitalist and chief medical officer of the Centers for Medicare & Medicaid Services (CMS), has advice for hospitalists looking to better manage their practice:

• Understand your hospital’s data. What is collected? What is analyzed? Where are the gaps in that research? What does it all mean for you?
• Take leadership roles. Lead multidisciplinary teams, teach others around you, become known for a focus on evidence-based approaches.
• Familiarize yourself with resources. CMS, SHM, and myriad other medical organizations and private agencies offer free or low-cost resources. When looking to solve problems, it’s possible someone already has done so.
• Create collaborative forums. Physicians feel engaged when they believe they can voice opinions in an accepting environment. The reverse is also true.
• Stay connected to clinical care, even if it’s just occasional shifts to help out.

“My challenge to you is please don’t sit on the sidelines,” Dr. Conway says. “Please be actively engaged in your local system in creating this change. This is not for me or CMS, but stating the obvious: It’s why we went into medicine.”

Dr. Pistoria

If such a thing exists, hospitalist Dwayne Gard, MD, of Memorial Health in Savannah, Ga., has a good practice management problem: In recent years, his HM group started collaborating with Memorial’s gastrointestinal team to admit their patients. Now, Dr. Gard and his colleagues are in similar discussions with neurosurgery. And ments provide steady revenue for the hospitalist group, too much growth, too fast, can be as dangerous as too little.

“There are a lot of demands, from an administrative standpoint, to cater to the needs of some of the subspecialists at a time where we really need to grow the number of hospitalists within our program before we even consider expanding our services,” says Dr. Gard, whose group has 10 FTE hospitalists and has an average patient census of 90-110 at the 500-bed hospital. “I let our administration know it’s a challenge we’re willing to take on as long as we have the support to get the staff in that we need to safely see those patients.”

Just how to let them know is the art of practice management, a topic that dominates much of SHM’s annual meeting. From a popular, daylong CME pre-course to a dedicated practice-management track, hospitalists looking for real-time advice on the business side of medicine came away from HM12 last month with brown bags full of tips.

“This is a huge pause, a huge opportunity to pause and remind ourselves what’s important,” says Steven Pestka, MD, chief of the hospitalist service at Newton-Wellesley Hospital in Newton, Mass. “And then recognizing that all those other things … need to be kept in context and need to be limited so that the core running of the group can be performed.”

For Dr. Gard, gaining management skills at this year’s annual meeting was a two-step process. First, they sent seven members of their HM groupthree hospitalists, two non-physician providers (NPPs), an administrator, and an office managerto San Diego. The annual-meeting team spread across as many sessions as they could, including pre-courses on value-based purchasing and practice management. Second, and perhaps more important, the team members didn’t decide ahead of time what advice they were going to glean; they came with agendas and schedules of what breakout sessions

they viewed as most valuable while remaining flexible.

“It always seems like while you’re here, you learn something you weren’t expecting,” Dr. Gard adds, “and something that’s actually maybe more pertinent than the reason you maybe thought about coming to the meeting to begin with. You can take that home as well.

“It’s important for our group because a lot of our new hires, the majority of our new hires, are residents within our own training program. Unless we hire hospitalists from outside our own network, it does tend to be the same people in the same system—not thinking outside the box, like we need to do in this day and age.”

Advanced Degrees of Hospital Medicine

Benjamin Frizner, MD, director of the hospitalist program at Saint Agnes Hospital in Baltimore, wonders whether earning an MBA would give him an advantage in “getting into the mind of the CEO and the C-suite.”

“What’s their frame of mind when I go into meetings, so I can talk their language, frame things in a different way?” Dr. Frizner says during a break in a practice-management pre-course. “The topics [at HM12] are focused to a lot of the problems we are facing.”

The issues are specific to individual HM groups. Dr. Frizner also wants to know how to better speak to colleagues and care team members in the hospitals his group services. Madonna Ringswald, DO, medical director of the hospitalist program at Baptist Hospital Northeast in La Grange, Ky., took over management of her group a little more than two years ago and came to San Diego to bounce questions off people who have more experience than she does. Dr. Pestka took home suggestions on how to recognize hospitalist performance in non-compensated ways.

“This is the best meeting I’ve ever been to,” Dr. Ringswald says. “If you can’t find a lecture [that appeals to you], there’s something wrong with you.”

Renewed Focus

Dr. Pistoria

In the annual meeting’s wrap-up address, Michael Pistoria, DO, FACP, SFHM, hospitalist at Lehigh Valley Health Network in Allentown, Pa., described the future of practice management as an amalgam of all the issues HM faces. Improved communication, a renewed focus on costs and high-value care, and continued adoption of best practices found at institutions across the country are all ways to better operate individual practices.

“We move ahead by doing what we do best in hospital medicine,” says Dr. Pistoria, the course director for HM13, which will be May 16-19, 2013, just outside of Washington, D.C. “We get together as teams, we collaborate with each other across our institutions, within our own institution, and professionally. We come up with that one small or big idea that improves care at the level of the patient and at the macro level.”

CMS’ CMO Offers Practice-Management Tips

Dr. Conway

Patrick Conway, MD, MSc, FAAP, SFHM, a pediatric hospitalist and chief medical officer of the Centers for Medicare & Medicaid Services (CMS), has advice for hospitalists looking to better manage their practice:

• Understand your hospital’s data. What is collected? What is analyzed? Where are the gaps in that research? What does it all mean for you?
• Take leadership roles. Lead multidisciplinary teams, teach others around you, become known for a focus on evidence-based approaches.
• Familiarize yourself with resources. CMS, SHM, and myriad other medical organizations and private agencies offer free or low-cost resources. When looking to solve problems, it’s possible someone already has done so.
• Create collaborative forums. Physicians feel engaged when they believe they can voice opinions in an accepting environment. The reverse is also true.
• Stay connected to clinical care, even if it’s just occasional shifts to help out.

“My challenge to you is please don’t sit on the sidelines,” Dr. Conway says. “Please be actively engaged in your local system in creating this change. This is not for me or CMS, but stating the obvious: It’s why we went into medicine.”

Dr. Pistoria

If such a thing exists, hospitalist Dwayne Gard, MD, of Memorial Health in Savannah, Ga., has a good practice management problem: In recent years, his HM group started collaborating with Memorial’s gastrointestinal team to admit their patients. Now, Dr. Gard and his colleagues are in similar discussions with neurosurgery. And ments provide steady revenue for the hospitalist group, too much growth, too fast, can be as dangerous as too little.

“There are a lot of demands, from an administrative standpoint, to cater to the needs of some of the subspecialists at a time where we really need to grow the number of hospitalists within our program before we even consider expanding our services,” says Dr. Gard, whose group has 10 FTE hospitalists and has an average patient census of 90-110 at the 500-bed hospital. “I let our administration know it’s a challenge we’re willing to take on as long as we have the support to get the staff in that we need to safely see those patients.”

Just how to let them know is the art of practice management, a topic that dominates much of SHM’s annual meeting. From a popular, daylong CME pre-course to a dedicated practice-management track, hospitalists looking for real-time advice on the business side of medicine came away from HM12 last month with brown bags full of tips.

“This is a huge pause, a huge opportunity to pause and remind ourselves what’s important,” says Steven Pestka, MD, chief of the hospitalist service at Newton-Wellesley Hospital in Newton, Mass. “And then recognizing that all those other things … need to be kept in context and need to be limited so that the core running of the group can be performed.”

For Dr. Gard, gaining management skills at this year’s annual meeting was a two-step process. First, they sent seven members of their HM groupthree hospitalists, two non-physician providers (NPPs), an administrator, and an office managerto San Diego. The annual-meeting team spread across as many sessions as they could, including pre-courses on value-based purchasing and practice management. Second, and perhaps more important, the team members didn’t decide ahead of time what advice they were going to glean; they came with agendas and schedules of what breakout sessions

they viewed as most valuable while remaining flexible.

“It always seems like while you’re here, you learn something you weren’t expecting,” Dr. Gard adds, “and something that’s actually maybe more pertinent than the reason you maybe thought about coming to the meeting to begin with. You can take that home as well.

“It’s important for our group because a lot of our new hires, the majority of our new hires, are residents within our own training program. Unless we hire hospitalists from outside our own network, it does tend to be the same people in the same system—not thinking outside the box, like we need to do in this day and age.”

Advanced Degrees of Hospital Medicine

Benjamin Frizner, MD, director of the hospitalist program at Saint Agnes Hospital in Baltimore, wonders whether earning an MBA would give him an advantage in “getting into the mind of the CEO and the C-suite.”

“What’s their frame of mind when I go into meetings, so I can talk their language, frame things in a different way?” Dr. Frizner says during a break in a practice-management pre-course. “The topics [at HM12] are focused to a lot of the problems we are facing.”

The issues are specific to individual HM groups. Dr. Frizner also wants to know how to better speak to colleagues and care team members in the hospitals his group services. Madonna Ringswald, DO, medical director of the hospitalist program at Baptist Hospital Northeast in La Grange, Ky., took over management of her group a little more than two years ago and came to San Diego to bounce questions off people who have more experience than she does. Dr. Pestka took home suggestions on how to recognize hospitalist performance in non-compensated ways.

“This is the best meeting I’ve ever been to,” Dr. Ringswald says. “If you can’t find a lecture [that appeals to you], there’s something wrong with you.”

Renewed Focus

Dr. Pistoria

In the annual meeting’s wrap-up address, Michael Pistoria, DO, FACP, SFHM, hospitalist at Lehigh Valley Health Network in Allentown, Pa., described the future of practice management as an amalgam of all the issues HM faces. Improved communication, a renewed focus on costs and high-value care, and continued adoption of best practices found at institutions across the country are all ways to better operate individual practices.

“We move ahead by doing what we do best in hospital medicine,” says Dr. Pistoria, the course director for HM13, which will be May 16-19, 2013, just outside of Washington, D.C. “We get together as teams, we collaborate with each other across our institutions, within our own institution, and professionally. We come up with that one small or big idea that improves care at the level of the patient and at the macro level.”

CMS’ CMO Offers Practice-Management Tips

Dr. Conway

Patrick Conway, MD, MSc, FAAP, SFHM, a pediatric hospitalist and chief medical officer of the Centers for Medicare & Medicaid Services (CMS), has advice for hospitalists looking to better manage their practice:

• Understand your hospital’s data. What is collected? What is analyzed? Where are the gaps in that research? What does it all mean for you?
• Take leadership roles. Lead multidisciplinary teams, teach others around you, become known for a focus on evidence-based approaches.
• Familiarize yourself with resources. CMS, SHM, and myriad other medical organizations and private agencies offer free or low-cost resources. When looking to solve problems, it’s possible someone already has done so.
• Create collaborative forums. Physicians feel engaged when they believe they can voice opinions in an accepting environment. The reverse is also true.
• Stay connected to clinical care, even if it’s just occasional shifts to help out.

“My challenge to you is please don’t sit on the sidelines,” Dr. Conway says. “Please be actively engaged in your local system in creating this change. This is not for me or CMS, but stating the obvious: It’s why we went into medicine.”

Eduard Vasilevskis, MD, is a member of SHM’s Research Committee and was a judge for the annual Research, Innovations, and Clinical Vignettes (RIV) poster competition at HM11 outside Dallas. But when the committee members discussed who would judge the HM12 contest, Dr. Vasilevskis passed. He had a poster he wanted to enter instead.

Smart move.

His poster took the top prize in the Research portion of the annual contest, as judged by a panel of hospitalist leaders and visiting professor Pamela Lipsett, MD, MHPE, FACS, FCCM, a professor in the department of surgery, anesthesiology, and critical-care medicine at Johns Hopkins University Schools of Medicine and Nursing in Baltimore.

“When you work in a specific research area and you’re really passionate about the subject you’re studying, you sometimes lose sight of how other people might care about it,” says Dr. Vasilevskis, a hospitalist and assistant professor of medicine in the section of hospital medicine at Vanderbilt University School of Medicine and Tennessee Valley-Nashville VA Hospital in Nashville. “It’s nice to have an audience to validate that.”

HM has “a really outstanding core of researchers,” he adds. “The people who are walking around in that group, I really look up to.”

The feeling was mutual, as a team of judges led by SHM Education Committee Chair Daniel Brotman, MD, FACP, FHM, set out to pick a winner in a contest that has grown so large, the Clinical Vignettes portion was broken into a separate session.

First, SHM selects which abstracts to accept. Then, 186 hospitalists or HM-led teams were invited to give poster presentations at the San Diego Convention Center. Then, 23 finalists were chosen for judging rounds. All of that happened before anyone got to the annual meeting. Once in the exhibit hall, two-clinician judging teams worked their way through two dozen research posters deemed the best of the best. Each team recommended a finalist except for one, which Dr. Brotman dubbed “the Russian judges.”

But from the get-go, it was clear that the work completed by Dr. Vasilevskis and his colleagues would be the winner. As the two-member teams went around naming the posters they wanted the full judging panel to visit, one of those who visited Dr. Vasilevskis was brief but enthusiastic in the description: “I really liked this one.”

So the judges went back to poster No. 63, “Veterans Administration Acute Care 30-Day Mortality Model: Development, Validation, and Performance Variation.” Dr. Brotman was impressed by the breadth of the study, which aimed to develop a hybrid administrative/clinical risk model to address the shortcomings of risk models that rely on only administrative data or clinical data.

The first number that caught the judges’ attention was 1,114,327. That’s how many patients were used in retrospective cohort study of 131 VA hospitals. Then it was the results, which were impressively accurate given the size of the sample.

“It was a strong survey with incredible methodological rigor, addressing an incredibly important issue,” Dr. Brotman says. Dr. Vasilevskis notes that few hospitals or health systems currently have access to the level of data available to his research team. But as electronic health records (EHR) capture more clinical and administrative data, the ability to build models like the one he presented will only increase. “The better your model, the more you can believe your results,” he adds. “And we want our clinicians and CEOs and hospital boards to believe those numbers.”

Eduard Vasilevskis, MD, is a member of SHM’s Research Committee and was a judge for the annual Research, Innovations, and Clinical Vignettes (RIV) poster competition at HM11 outside Dallas. But when the committee members discussed who would judge the HM12 contest, Dr. Vasilevskis passed. He had a poster he wanted to enter instead.

Smart move.

His poster took the top prize in the Research portion of the annual contest, as judged by a panel of hospitalist leaders and visiting professor Pamela Lipsett, MD, MHPE, FACS, FCCM, a professor in the department of surgery, anesthesiology, and critical-care medicine at Johns Hopkins University Schools of Medicine and Nursing in Baltimore.

“When you work in a specific research area and you’re really passionate about the subject you’re studying, you sometimes lose sight of how other people might care about it,” says Dr. Vasilevskis, a hospitalist and assistant professor of medicine in the section of hospital medicine at Vanderbilt University School of Medicine and Tennessee Valley-Nashville VA Hospital in Nashville. “It’s nice to have an audience to validate that.”

HM has “a really outstanding core of researchers,” he adds. “The people who are walking around in that group, I really look up to.”

The feeling was mutual, as a team of judges led by SHM Education Committee Chair Daniel Brotman, MD, FACP, FHM, set out to pick a winner in a contest that has grown so large, the Clinical Vignettes portion was broken into a separate session.

First, SHM selects which abstracts to accept. Then, 186 hospitalists or HM-led teams were invited to give poster presentations at the San Diego Convention Center. Then, 23 finalists were chosen for judging rounds. All of that happened before anyone got to the annual meeting. Once in the exhibit hall, two-clinician judging teams worked their way through two dozen research posters deemed the best of the best. Each team recommended a finalist except for one, which Dr. Brotman dubbed “the Russian judges.”

But from the get-go, it was clear that the work completed by Dr. Vasilevskis and his colleagues would be the winner. As the two-member teams went around naming the posters they wanted the full judging panel to visit, one of those who visited Dr. Vasilevskis was brief but enthusiastic in the description: “I really liked this one.”

So the judges went back to poster No. 63, “Veterans Administration Acute Care 30-Day Mortality Model: Development, Validation, and Performance Variation.” Dr. Brotman was impressed by the breadth of the study, which aimed to develop a hybrid administrative/clinical risk model to address the shortcomings of risk models that rely on only administrative data or clinical data.

The first number that caught the judges’ attention was 1,114,327. That’s how many patients were used in retrospective cohort study of 131 VA hospitals. Then it was the results, which were impressively accurate given the size of the sample.

“It was a strong survey with incredible methodological rigor, addressing an incredibly important issue,” Dr. Brotman says. Dr. Vasilevskis notes that few hospitals or health systems currently have access to the level of data available to his research team. But as electronic health records (EHR) capture more clinical and administrative data, the ability to build models like the one he presented will only increase. “The better your model, the more you can believe your results,” he adds. “And we want our clinicians and CEOs and hospital boards to believe those numbers.”

Eduard Vasilevskis, MD, is a member of SHM’s Research Committee and was a judge for the annual Research, Innovations, and Clinical Vignettes (RIV) poster competition at HM11 outside Dallas. But when the committee members discussed who would judge the HM12 contest, Dr. Vasilevskis passed. He had a poster he wanted to enter instead.

Smart move.

His poster took the top prize in the Research portion of the annual contest, as judged by a panel of hospitalist leaders and visiting professor Pamela Lipsett, MD, MHPE, FACS, FCCM, a professor in the department of surgery, anesthesiology, and critical-care medicine at Johns Hopkins University Schools of Medicine and Nursing in Baltimore.

“When you work in a specific research area and you’re really passionate about the subject you’re studying, you sometimes lose sight of how other people might care about it,” says Dr. Vasilevskis, a hospitalist and assistant professor of medicine in the section of hospital medicine at Vanderbilt University School of Medicine and Tennessee Valley-Nashville VA Hospital in Nashville. “It’s nice to have an audience to validate that.”

HM has “a really outstanding core of researchers,” he adds. “The people who are walking around in that group, I really look up to.”

The feeling was mutual, as a team of judges led by SHM Education Committee Chair Daniel Brotman, MD, FACP, FHM, set out to pick a winner in a contest that has grown so large, the Clinical Vignettes portion was broken into a separate session.

First, SHM selects which abstracts to accept. Then, 186 hospitalists or HM-led teams were invited to give poster presentations at the San Diego Convention Center. Then, 23 finalists were chosen for judging rounds. All of that happened before anyone got to the annual meeting. Once in the exhibit hall, two-clinician judging teams worked their way through two dozen research posters deemed the best of the best. Each team recommended a finalist except for one, which Dr. Brotman dubbed “the Russian judges.”

But from the get-go, it was clear that the work completed by Dr. Vasilevskis and his colleagues would be the winner. As the two-member teams went around naming the posters they wanted the full judging panel to visit, one of those who visited Dr. Vasilevskis was brief but enthusiastic in the description: “I really liked this one.”

So the judges went back to poster No. 63, “Veterans Administration Acute Care 30-Day Mortality Model: Development, Validation, and Performance Variation.” Dr. Brotman was impressed by the breadth of the study, which aimed to develop a hybrid administrative/clinical risk model to address the shortcomings of risk models that rely on only administrative data or clinical data.

The first number that caught the judges’ attention was 1,114,327. That’s how many patients were used in retrospective cohort study of 131 VA hospitals. Then it was the results, which were impressively accurate given the size of the sample.

“It was a strong survey with incredible methodological rigor, addressing an incredibly important issue,” Dr. Brotman says. Dr. Vasilevskis notes that few hospitals or health systems currently have access to the level of data available to his research team. But as electronic health records (EHR) capture more clinical and administrative data, the ability to build models like the one he presented will only increase. “The better your model, the more you can believe your results,” he adds. “And we want our clinicians and CEOs and hospital boards to believe those numbers.”

Informatics specialist David Knoepfler, MD, sat in the back row of a daylong HM12 pre-course that aimed to prepare hospitalists for the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) examination. The question-and-answer session was intended to help the longtime clinician pass his second certification renewal.

But it was utterly unnecessary.

Dr. Knoepfler is the chief medical information officer at Overlake Hospital Medical Center (http://www.overlakehospital.org/about-us/) in the Seattle suburb of Bellevue, Wash. As much as 90% of his time is spent on information technology (IT) duties, and since he is grandfathered, he does not need to get recertified. So why did he spend seven hours scribbling notes as though he was preparing for his first boards?

Pride in his career development, plain and simple.

“Despite my heavily administrative role, I want to stay in touch with the clinical side,” says Dr. Knoepfler, a practicing hospitalist for 20 years who hadn’t attended an SHM annual meeting in more than 10 years before participating in HM12 last month at the San Diego Convention Center. “I feel like I have to for my patients’ sake. Even if I’m doing 10 percent or 15 percent [of my time in clinical], I absolutely have to be practicing quality medicine.”

SHM’s annual meeting is a hotbed of lifelong learning. A majority of attendees each year say that the continuing medical education (CME) credits are a major draw. This year’s pre-course lineup included the MOC test preparation, hands-on classes in medical procedures and ultrasound usage, and a debut class on “How to Improve Performance in CMS’s Value-Based Purchasing Program,” which was led by SHM senior vice president Joseph Miller and

Patrick Torcson, MD, MMM, FAACP, SFHM, chair of SHM’s Performance Measurement and Reporting Committee.

Dr. Torcson

Career development, of course, means different things to different people. Dr. Knoepfler might have been focused on updating his clinical knowledge, but he is a technology expert whose main duties are to integrate health IT into the daily routine of his 349-bed hospital. So whether listening in a pre-course, attending a workshop, or meeting old or new colleagues for a drink, he spent the four-day conference constantly looking for ways to improve his job performance.

“My ears are constantly listening for how can I tie this into our electronic health record,” Dr. Knoepfler adds. “Whether it’s a clinical topic, an administrative topic, an insurance topic, a governmental topic, for me, I’m going to take all those back and see how I can make our electronic record work with the practitioners rather than fight them.”

A Learning Process

Former SHM president Jeff Weise, MD, professor of medicine and residency program director at Tulane University Health Sciences Center in New Orleans, feels so strongly about the value of professional development and the ABIM’s MOC process for hospital medicine that he and several society staffers held an impromptu session between plenary addresses to tackle perceived confusion with the Focused Practice in Hospital Medicine (FPHM) MOC pathway.

Dr. Weise

Dr. Weise says that the FPHM pathway does not mean doctors give up board certification in internal medicine, nor does it apply only to academic or community physicians.

Dr. Torcson, who works at St. Tammany Parish Hospital in Covington, La., says that the certification should be viewed as a “meaningful affirmation” of HM’s solidified place in the healthcare system.

“It’s really the right thing to do for our developing specialty,” he says. “We really have to distinguish ourselves, and there’s really no better brand distinction than a professional designation based on board certification and maintenance of certification.”

Ethan Cumbler, MD, FACP, of the University of Colorado Denver, led a portion of the MOC pre-course at HM12. He says that those who attend SHM’s annual meeting are able to take advantage of communal learning, which provides benefits that those who study alone can’t absorb. Taking a pre-test just teaches whether participants answered correctly or not. Questioning why the answer is what it is, with interactive feedback, is “a learning process,” he says.

“There’s a very different feel to learning in a group setting with your peers than to sitting down with a journal or a magazine or a textbook or an online module,” Dr. Cumbler says. “Part of what makes this conference engaging is not just content, it’s the milieu. It’s a social milieu of our peers, and we’re learning together and we’re exploring these difficult issues together.

“My sense is that the people who come to this are probably a cut above,” adds Dr. Cumbler, whose University of Colorado In-Hospital Stroke QI Team was the 2012 recipient of SHM’s Award for Excellence in Teamwork in Quality Improvement. “They are people who are really committed to being more evidence-based and understanding what the evidence is and how they apply that to their patients.”

Career Decisions

They are physicians like James Eppinette, MD, who became a hospitalist three years ago after 20 years in private practice as a primary-care physician (PCP). He joined a hospital-owned group at St. Francis Medical Center in Monroe, La., and HM12 was his first annual meeting—he attended because the meeting’s clinical focus provided him with professional development opportunities. He began with the pre-operative-care pre-course, an area in which he felt he wanted more exposure. From there, he bounced around clinical workshops.

“[HM12] has an incredible variety of tracks that you can pursue, so there’s something here for everybody,” Dr. Eppinette says, later adding that “my primary responsibility is clinical. That’s all I do is take care of people. I don’t manage people, I don’t run a practice, nor do I want to. That’s why I left 20 years of private practice to be a hospitalist. I just think it’s well set up structurally for an educational event.”

Dr. Eppinette, who took his notes back to the 12 hospitalists and nine pulmonologists in his hospitalist group, says that the decision to attend HM12 came from his increasing satisfaction with his late-career job change.

“I didn’t know how I would like going from an independent practitioner to being employed, hospital-owned. But I’ve done it three years,” he says, and “[I think this is] how I will finish my career. After three years, I’m kind of liking this road I’m on, so I’ve started looking into more about it.”

That level of personal accountability is a next step for hospitalists nationwide, according to new SHM president Shaun Frost, MD, SFHM, FACP, chief medical officer for the Northeast region of Brentwood, Tenn.-based Cogent HMG. Dr. Frost says that personal and professional accountability will be the drivers for HM’s continued growth and success, and that without individual physicians pushing their career development goals to new heights, the fastest-growing medical specialty in history could stall.

“We must all strive to consistently hold each other and hold ourselves personally accountable for embracing the work that is necessary to realize the potential of hospital medicine to be a true healthcare reform effector,” Dr. Frost says. “It’s time, I think, for each of us to put our money where our mouths have been.”

Informatics specialist David Knoepfler, MD, sat in the back row of a daylong HM12 pre-course that aimed to prepare hospitalists for the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) examination. The question-and-answer session was intended to help the longtime clinician pass his second certification renewal.

But it was utterly unnecessary.

Dr. Knoepfler is the chief medical information officer at Overlake Hospital Medical Center (http://www.overlakehospital.org/about-us/) in the Seattle suburb of Bellevue, Wash. As much as 90% of his time is spent on information technology (IT) duties, and since he is grandfathered, he does not need to get recertified. So why did he spend seven hours scribbling notes as though he was preparing for his first boards?

Pride in his career development, plain and simple.

“Despite my heavily administrative role, I want to stay in touch with the clinical side,” says Dr. Knoepfler, a practicing hospitalist for 20 years who hadn’t attended an SHM annual meeting in more than 10 years before participating in HM12 last month at the San Diego Convention Center. “I feel like I have to for my patients’ sake. Even if I’m doing 10 percent or 15 percent [of my time in clinical], I absolutely have to be practicing quality medicine.”

SHM’s annual meeting is a hotbed of lifelong learning. A majority of attendees each year say that the continuing medical education (CME) credits are a major draw. This year’s pre-course lineup included the MOC test preparation, hands-on classes in medical procedures and ultrasound usage, and a debut class on “How to Improve Performance in CMS’s Value-Based Purchasing Program,” which was led by SHM senior vice president Joseph Miller and

Patrick Torcson, MD, MMM, FAACP, SFHM, chair of SHM’s Performance Measurement and Reporting Committee.

Dr. Torcson

Career development, of course, means different things to different people. Dr. Knoepfler might have been focused on updating his clinical knowledge, but he is a technology expert whose main duties are to integrate health IT into the daily routine of his 349-bed hospital. So whether listening in a pre-course, attending a workshop, or meeting old or new colleagues for a drink, he spent the four-day conference constantly looking for ways to improve his job performance.

“My ears are constantly listening for how can I tie this into our electronic health record,” Dr. Knoepfler adds. “Whether it’s a clinical topic, an administrative topic, an insurance topic, a governmental topic, for me, I’m going to take all those back and see how I can make our electronic record work with the practitioners rather than fight them.”

A Learning Process

Former SHM president Jeff Weise, MD, professor of medicine and residency program director at Tulane University Health Sciences Center in New Orleans, feels so strongly about the value of professional development and the ABIM’s MOC process for hospital medicine that he and several society staffers held an impromptu session between plenary addresses to tackle perceived confusion with the Focused Practice in Hospital Medicine (FPHM) MOC pathway.

Dr. Weise

Dr. Weise says that the FPHM pathway does not mean doctors give up board certification in internal medicine, nor does it apply only to academic or community physicians.

Dr. Torcson, who works at St. Tammany Parish Hospital in Covington, La., says that the certification should be viewed as a “meaningful affirmation” of HM’s solidified place in the healthcare system.

“It’s really the right thing to do for our developing specialty,” he says. “We really have to distinguish ourselves, and there’s really no better brand distinction than a professional designation based on board certification and maintenance of certification.”

Ethan Cumbler, MD, FACP, of the University of Colorado Denver, led a portion of the MOC pre-course at HM12. He says that those who attend SHM’s annual meeting are able to take advantage of communal learning, which provides benefits that those who study alone can’t absorb. Taking a pre-test just teaches whether participants answered correctly or not. Questioning why the answer is what it is, with interactive feedback, is “a learning process,” he says.

“There’s a very different feel to learning in a group setting with your peers than to sitting down with a journal or a magazine or a textbook or an online module,” Dr. Cumbler says. “Part of what makes this conference engaging is not just content, it’s the milieu. It’s a social milieu of our peers, and we’re learning together and we’re exploring these difficult issues together.

“My sense is that the people who come to this are probably a cut above,” adds Dr. Cumbler, whose University of Colorado In-Hospital Stroke QI Team was the 2012 recipient of SHM’s Award for Excellence in Teamwork in Quality Improvement. “They are people who are really committed to being more evidence-based and understanding what the evidence is and how they apply that to their patients.”

Career Decisions

They are physicians like James Eppinette, MD, who became a hospitalist three years ago after 20 years in private practice as a primary-care physician (PCP). He joined a hospital-owned group at St. Francis Medical Center in Monroe, La., and HM12 was his first annual meeting—he attended because the meeting’s clinical focus provided him with professional development opportunities. He began with the pre-operative-care pre-course, an area in which he felt he wanted more exposure. From there, he bounced around clinical workshops.

“[HM12] has an incredible variety of tracks that you can pursue, so there’s something here for everybody,” Dr. Eppinette says, later adding that “my primary responsibility is clinical. That’s all I do is take care of people. I don’t manage people, I don’t run a practice, nor do I want to. That’s why I left 20 years of private practice to be a hospitalist. I just think it’s well set up structurally for an educational event.”

Dr. Eppinette, who took his notes back to the 12 hospitalists and nine pulmonologists in his hospitalist group, says that the decision to attend HM12 came from his increasing satisfaction with his late-career job change.

“I didn’t know how I would like going from an independent practitioner to being employed, hospital-owned. But I’ve done it three years,” he says, and “[I think this is] how I will finish my career. After three years, I’m kind of liking this road I’m on, so I’ve started looking into more about it.”

That level of personal accountability is a next step for hospitalists nationwide, according to new SHM president Shaun Frost, MD, SFHM, FACP, chief medical officer for the Northeast region of Brentwood, Tenn.-based Cogent HMG. Dr. Frost says that personal and professional accountability will be the drivers for HM’s continued growth and success, and that without individual physicians pushing their career development goals to new heights, the fastest-growing medical specialty in history could stall.

“We must all strive to consistently hold each other and hold ourselves personally accountable for embracing the work that is necessary to realize the potential of hospital medicine to be a true healthcare reform effector,” Dr. Frost says. “It’s time, I think, for each of us to put our money where our mouths have been.”

Informatics specialist David Knoepfler, MD, sat in the back row of a daylong HM12 pre-course that aimed to prepare hospitalists for the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) examination. The question-and-answer session was intended to help the longtime clinician pass his second certification renewal.

But it was utterly unnecessary.

Dr. Knoepfler is the chief medical information officer at Overlake Hospital Medical Center (http://www.overlakehospital.org/about-us/) in the Seattle suburb of Bellevue, Wash. As much as 90% of his time is spent on information technology (IT) duties, and since he is grandfathered, he does not need to get recertified. So why did he spend seven hours scribbling notes as though he was preparing for his first boards?

Pride in his career development, plain and simple.

“Despite my heavily administrative role, I want to stay in touch with the clinical side,” says Dr. Knoepfler, a practicing hospitalist for 20 years who hadn’t attended an SHM annual meeting in more than 10 years before participating in HM12 last month at the San Diego Convention Center. “I feel like I have to for my patients’ sake. Even if I’m doing 10 percent or 15 percent [of my time in clinical], I absolutely have to be practicing quality medicine.”

SHM’s annual meeting is a hotbed of lifelong learning. A majority of attendees each year say that the continuing medical education (CME) credits are a major draw. This year’s pre-course lineup included the MOC test preparation, hands-on classes in medical procedures and ultrasound usage, and a debut class on “How to Improve Performance in CMS’s Value-Based Purchasing Program,” which was led by SHM senior vice president Joseph Miller and

Patrick Torcson, MD, MMM, FAACP, SFHM, chair of SHM’s Performance Measurement and Reporting Committee.

Dr. Torcson

Career development, of course, means different things to different people. Dr. Knoepfler might have been focused on updating his clinical knowledge, but he is a technology expert whose main duties are to integrate health IT into the daily routine of his 349-bed hospital. So whether listening in a pre-course, attending a workshop, or meeting old or new colleagues for a drink, he spent the four-day conference constantly looking for ways to improve his job performance.

“My ears are constantly listening for how can I tie this into our electronic health record,” Dr. Knoepfler adds. “Whether it’s a clinical topic, an administrative topic, an insurance topic, a governmental topic, for me, I’m going to take all those back and see how I can make our electronic record work with the practitioners rather than fight them.”

A Learning Process

Former SHM president Jeff Weise, MD, professor of medicine and residency program director at Tulane University Health Sciences Center in New Orleans, feels so strongly about the value of professional development and the ABIM’s MOC process for hospital medicine that he and several society staffers held an impromptu session between plenary addresses to tackle perceived confusion with the Focused Practice in Hospital Medicine (FPHM) MOC pathway.

Dr. Weise

Dr. Weise says that the FPHM pathway does not mean doctors give up board certification in internal medicine, nor does it apply only to academic or community physicians.

Dr. Torcson, who works at St. Tammany Parish Hospital in Covington, La., says that the certification should be viewed as a “meaningful affirmation” of HM’s solidified place in the healthcare system.

“It’s really the right thing to do for our developing specialty,” he says. “We really have to distinguish ourselves, and there’s really no better brand distinction than a professional designation based on board certification and maintenance of certification.”

Ethan Cumbler, MD, FACP, of the University of Colorado Denver, led a portion of the MOC pre-course at HM12. He says that those who attend SHM’s annual meeting are able to take advantage of communal learning, which provides benefits that those who study alone can’t absorb. Taking a pre-test just teaches whether participants answered correctly or not. Questioning why the answer is what it is, with interactive feedback, is “a learning process,” he says.

“There’s a very different feel to learning in a group setting with your peers than to sitting down with a journal or a magazine or a textbook or an online module,” Dr. Cumbler says. “Part of what makes this conference engaging is not just content, it’s the milieu. It’s a social milieu of our peers, and we’re learning together and we’re exploring these difficult issues together.

“My sense is that the people who come to this are probably a cut above,” adds Dr. Cumbler, whose University of Colorado In-Hospital Stroke QI Team was the 2012 recipient of SHM’s Award for Excellence in Teamwork in Quality Improvement. “They are people who are really committed to being more evidence-based and understanding what the evidence is and how they apply that to their patients.”

Career Decisions

They are physicians like James Eppinette, MD, who became a hospitalist three years ago after 20 years in private practice as a primary-care physician (PCP). He joined a hospital-owned group at St. Francis Medical Center in Monroe, La., and HM12 was his first annual meeting—he attended because the meeting’s clinical focus provided him with professional development opportunities. He began with the pre-operative-care pre-course, an area in which he felt he wanted more exposure. From there, he bounced around clinical workshops.

“[HM12] has an incredible variety of tracks that you can pursue, so there’s something here for everybody,” Dr. Eppinette says, later adding that “my primary responsibility is clinical. That’s all I do is take care of people. I don’t manage people, I don’t run a practice, nor do I want to. That’s why I left 20 years of private practice to be a hospitalist. I just think it’s well set up structurally for an educational event.”

Dr. Eppinette, who took his notes back to the 12 hospitalists and nine pulmonologists in his hospitalist group, says that the decision to attend HM12 came from his increasing satisfaction with his late-career job change.

“I didn’t know how I would like going from an independent practitioner to being employed, hospital-owned. But I’ve done it three years,” he says, and “[I think this is] how I will finish my career. After three years, I’m kind of liking this road I’m on, so I’ve started looking into more about it.”

That level of personal accountability is a next step for hospitalists nationwide, according to new SHM president Shaun Frost, MD, SFHM, FACP, chief medical officer for the Northeast region of Brentwood, Tenn.-based Cogent HMG. Dr. Frost says that personal and professional accountability will be the drivers for HM’s continued growth and success, and that without individual physicians pushing their career development goals to new heights, the fastest-growing medical specialty in history could stall.

“We must all strive to consistently hold each other and hold ourselves personally accountable for embracing the work that is necessary to realize the potential of hospital medicine to be a true healthcare reform effector,” Dr. Frost says. “It’s time, I think, for each of us to put our money where our mouths have been.”