Richard Quinn

In a Venn diagram, patient handoffs would fall at the intersection of quality improvement (QI), patient safety, and technology.

Vineet Arora, MD, MPP, FACP, FHM, associate professor of medicine at the University of Chicago, wants hospitalists to understand that best practices in transitional care only work efficiently if they incorporate pieces from all three spheres. Hospitalists who focus too much on the outcome of an individual case might fail to utilize technology that could create a systemic protocol that would improve outcomes across multiple cases, she says. Similarly, hospitalists who leave notes in an electronic health record (EHR) can mistakenly believe that the next physician will interpret that information perfectly despite a lack of verbal and physical cues that guide verbal communication.

Dr. Arora

“People may fall into the fallacy that electronic health records actually equal good handoffs,” says Dr. Arora, a faculty member at HM12 last month in San Diego who led a breakout session that focused on the obstacles of handoffs. “The challenge is that handoffs actually are about a verbal exchange of informationa conversation and a dialogue, in conjunction with and supplemented with written communication. Technology certainly has the ability to revolutionize the way we review information and access information, but it will not change the way we speak about the information.”

The crossroads of patient safety, QI, and the use of technology from medical devices to iPhones was a major theme at SHM’s annual meeting, April 1-4 at the San Diego Convention Center. Hospitalist leaders agree that clinicians must focus on all three tenets to improve healthcare delivery, particularly in the face of generational healthcare reform. But they also acknowledge that finding a balance between best practices, budget and staffing constraints, and the rigors of daily practice is difficult.

Hospitalist Mark Lyons, MD, who works on residency programs and a patient-handoff initiative at Methodist Health System of Dallas, says that sessions on QI and patient safety provide new ideas from industry leaders who are in the trenches. To wit, he was impressed by the suggestions from Dr. Arora’s handoffs session as she described cases in which she was involved.

“They understand the limitations and the other things that go along with doing the actual act itself,” Dr. Lyons says. “They understand those things and take them into consideration. And you appreciate that.”

He and other hospitalists at HM12 agree that when leading practices are promoted at national forums, they take on the imprimatur of evidence-based procedures that physicians want to bring back to their respective HM groups. And QI suggestions promoted by physicians, not management, often tend to be more readily accepted.

“When you force change upon people, then it really leads to resistance,” Dr. Lyons says. “These are good opportunities to learn different strategies, to learn easier ways to present new ideas to people, to encourage them to do better, and to make it easier for them to do those things.”

Anuj Dalal, MD, FHM, a hospitalist at Brigham and Women’s Hospital in Boston, says technology can range from global EHRs across a multiple-institutional health system to microblogs to practice-centered wikis that promote communication between physicians. But integrating those technologies into care delivery that improves outcomes hinges not on technical hurdles, but on physicians accepting their validity and utility, he says. Once clinicians start digitally codifying the informal communication tools they currently use, patient-specific communication can improve.

And while Dr. Dalal, who co-led a session on the use of wikis as a communication-management strategy, adds that despite the little research linking those technological tacks to patient outcomes, he believes they are related.

“We’re using our devices, our iPads, our iPhones, our Android devices, to send information to other providers, but that information may not be transparent to other people,” says Dr. Dalal, who heads an SHM technology subcommittee. “But if you have it on a blog, a patient-specific Facebook, or a patient-specific Twitter, than everyone who subscribes to that will have access to the whole discussion.”

Dr. Dalal cautions that the details of legal compliance are important to ensure private patient information is safely transmitted. He anticipates vendors will market products that will balance the need for that privacy with a wider dissemination of information to ensure all involved physicians know what they need to know. One example: He expects the internal-messaging components of EHRs to improve in the next few years.

“It wouldn’t surprise me if these companies start realizing we need to support patient-specific communication in informal dialogues using microblogs and mobile devices,” he adds. “If they don’t do that, they’re probably going to miss the boat.”

The power of technology, large and small, must be balanced with what hospitalist pioneer Robert Wachter, MD, MHM, calls “foundational knowledge.” Dr. Wachter, who counts chair-elect of the American Board of Internal Medicine (ABIM) among his myriad titles, says that hospitalists can’t be slaves to technology. He relates it to a well-known adage in the aviation industry in which planes have become so advanced that some pilots would be incapable of flying them should the technology fail. In one quip, it is said that two people will soon populate cockpits: a pilot and a dog. The pilot’s job is to feed the dog, while the dog’s job is to bite the pilot’s hand if he tries to touch the controls.

Dr. Wachter

“As we move quickly, briskly, appropriately into this new world of computerization, if we aren’t constantly asking ourselves what have we lost in terms of our relationship with patients, we will really screw things up,” Dr. Wachter says. “This is not an argument to be Luddites, it’s not an argument to send back your meaningful use and get rid of the computers. We need them, but we have to be very thoughtful about how we maintain this balance.”

Patrick Conway, MD, MSc, FAAP, SFHM, a pediatric hospitalist and chief medical officer of the Centers for Medicare & Medicaid Services (CMS), says that to tie quality, safety, and technology together, government has to be willing to back therapies, then determine whether their efficacy deserves financial coverage.

One example Dr. Conway cites is the use of intravascular shunts. After backing their use initially for Medicare patients, it was determined that compared with medical management, the therapy had greater risks for death and stroke—and cost about 100 times more. Still, Dr. Conway says, determining how well the shunt works is exactly the process medicine should go through.

“When we have these new technologies that made a promise, we want to get them to market where they might help patients, but we also want to make sure evidence is developed to make sure they truly benefit patients,” he says, later adding, “I think this catalyst for health system transformation is important, and it’s teaching vision coupled with that execution.”

A well-planned blending of quality and technology can lead to improved patient safety, Dr. Arora says. But physicians and HM group leaders have to be proactive. Those with a clinical focus must seek out their IT counterparts and provide guidance on what information users need to access from electronic interfaces. Chief medical information officers and their staffs must seek feedback from providers before creating templates that don’t serve the clinical functions of end users.

Put simply: The fight to improve outcomes requires all parties to be properly armed. “You can choose a weapon,” she adds, “but you still have to choose it wisely and customize it to fit the needs of your organization.”

In a Venn diagram, patient handoffs would fall at the intersection of quality improvement (QI), patient safety, and technology.

Vineet Arora, MD, MPP, FACP, FHM, associate professor of medicine at the University of Chicago, wants hospitalists to understand that best practices in transitional care only work efficiently if they incorporate pieces from all three spheres. Hospitalists who focus too much on the outcome of an individual case might fail to utilize technology that could create a systemic protocol that would improve outcomes across multiple cases, she says. Similarly, hospitalists who leave notes in an electronic health record (EHR) can mistakenly believe that the next physician will interpret that information perfectly despite a lack of verbal and physical cues that guide verbal communication.

Dr. Arora

“People may fall into the fallacy that electronic health records actually equal good handoffs,” says Dr. Arora, a faculty member at HM12 last month in San Diego who led a breakout session that focused on the obstacles of handoffs. “The challenge is that handoffs actually are about a verbal exchange of informationa conversation and a dialogue, in conjunction with and supplemented with written communication. Technology certainly has the ability to revolutionize the way we review information and access information, but it will not change the way we speak about the information.”

The crossroads of patient safety, QI, and the use of technology from medical devices to iPhones was a major theme at SHM’s annual meeting, April 1-4 at the San Diego Convention Center. Hospitalist leaders agree that clinicians must focus on all three tenets to improve healthcare delivery, particularly in the face of generational healthcare reform. But they also acknowledge that finding a balance between best practices, budget and staffing constraints, and the rigors of daily practice is difficult.

Hospitalist Mark Lyons, MD, who works on residency programs and a patient-handoff initiative at Methodist Health System of Dallas, says that sessions on QI and patient safety provide new ideas from industry leaders who are in the trenches. To wit, he was impressed by the suggestions from Dr. Arora’s handoffs session as she described cases in which she was involved.

“They understand the limitations and the other things that go along with doing the actual act itself,” Dr. Lyons says. “They understand those things and take them into consideration. And you appreciate that.”

He and other hospitalists at HM12 agree that when leading practices are promoted at national forums, they take on the imprimatur of evidence-based procedures that physicians want to bring back to their respective HM groups. And QI suggestions promoted by physicians, not management, often tend to be more readily accepted.

“When you force change upon people, then it really leads to resistance,” Dr. Lyons says. “These are good opportunities to learn different strategies, to learn easier ways to present new ideas to people, to encourage them to do better, and to make it easier for them to do those things.”

Anuj Dalal, MD, FHM, a hospitalist at Brigham and Women’s Hospital in Boston, says technology can range from global EHRs across a multiple-institutional health system to microblogs to practice-centered wikis that promote communication between physicians. But integrating those technologies into care delivery that improves outcomes hinges not on technical hurdles, but on physicians accepting their validity and utility, he says. Once clinicians start digitally codifying the informal communication tools they currently use, patient-specific communication can improve.

And while Dr. Dalal, who co-led a session on the use of wikis as a communication-management strategy, adds that despite the little research linking those technological tacks to patient outcomes, he believes they are related.

“We’re using our devices, our iPads, our iPhones, our Android devices, to send information to other providers, but that information may not be transparent to other people,” says Dr. Dalal, who heads an SHM technology subcommittee. “But if you have it on a blog, a patient-specific Facebook, or a patient-specific Twitter, than everyone who subscribes to that will have access to the whole discussion.”

Dr. Dalal cautions that the details of legal compliance are important to ensure private patient information is safely transmitted. He anticipates vendors will market products that will balance the need for that privacy with a wider dissemination of information to ensure all involved physicians know what they need to know. One example: He expects the internal-messaging components of EHRs to improve in the next few years.

“It wouldn’t surprise me if these companies start realizing we need to support patient-specific communication in informal dialogues using microblogs and mobile devices,” he adds. “If they don’t do that, they’re probably going to miss the boat.”

The power of technology, large and small, must be balanced with what hospitalist pioneer Robert Wachter, MD, MHM, calls “foundational knowledge.” Dr. Wachter, who counts chair-elect of the American Board of Internal Medicine (ABIM) among his myriad titles, says that hospitalists can’t be slaves to technology. He relates it to a well-known adage in the aviation industry in which planes have become so advanced that some pilots would be incapable of flying them should the technology fail. In one quip, it is said that two people will soon populate cockpits: a pilot and a dog. The pilot’s job is to feed the dog, while the dog’s job is to bite the pilot’s hand if he tries to touch the controls.

Dr. Wachter

“As we move quickly, briskly, appropriately into this new world of computerization, if we aren’t constantly asking ourselves what have we lost in terms of our relationship with patients, we will really screw things up,” Dr. Wachter says. “This is not an argument to be Luddites, it’s not an argument to send back your meaningful use and get rid of the computers. We need them, but we have to be very thoughtful about how we maintain this balance.”

Patrick Conway, MD, MSc, FAAP, SFHM, a pediatric hospitalist and chief medical officer of the Centers for Medicare & Medicaid Services (CMS), says that to tie quality, safety, and technology together, government has to be willing to back therapies, then determine whether their efficacy deserves financial coverage.

One example Dr. Conway cites is the use of intravascular shunts. After backing their use initially for Medicare patients, it was determined that compared with medical management, the therapy had greater risks for death and stroke—and cost about 100 times more. Still, Dr. Conway says, determining how well the shunt works is exactly the process medicine should go through.

“When we have these new technologies that made a promise, we want to get them to market where they might help patients, but we also want to make sure evidence is developed to make sure they truly benefit patients,” he says, later adding, “I think this catalyst for health system transformation is important, and it’s teaching vision coupled with that execution.”

A well-planned blending of quality and technology can lead to improved patient safety, Dr. Arora says. But physicians and HM group leaders have to be proactive. Those with a clinical focus must seek out their IT counterparts and provide guidance on what information users need to access from electronic interfaces. Chief medical information officers and their staffs must seek feedback from providers before creating templates that don’t serve the clinical functions of end users.

Put simply: The fight to improve outcomes requires all parties to be properly armed. “You can choose a weapon,” she adds, “but you still have to choose it wisely and customize it to fit the needs of your organization.”

In a Venn diagram, patient handoffs would fall at the intersection of quality improvement (QI), patient safety, and technology.

Vineet Arora, MD, MPP, FACP, FHM, associate professor of medicine at the University of Chicago, wants hospitalists to understand that best practices in transitional care only work efficiently if they incorporate pieces from all three spheres. Hospitalists who focus too much on the outcome of an individual case might fail to utilize technology that could create a systemic protocol that would improve outcomes across multiple cases, she says. Similarly, hospitalists who leave notes in an electronic health record (EHR) can mistakenly believe that the next physician will interpret that information perfectly despite a lack of verbal and physical cues that guide verbal communication.

Dr. Arora

“People may fall into the fallacy that electronic health records actually equal good handoffs,” says Dr. Arora, a faculty member at HM12 last month in San Diego who led a breakout session that focused on the obstacles of handoffs. “The challenge is that handoffs actually are about a verbal exchange of informationa conversation and a dialogue, in conjunction with and supplemented with written communication. Technology certainly has the ability to revolutionize the way we review information and access information, but it will not change the way we speak about the information.”

The crossroads of patient safety, QI, and the use of technology from medical devices to iPhones was a major theme at SHM’s annual meeting, April 1-4 at the San Diego Convention Center. Hospitalist leaders agree that clinicians must focus on all three tenets to improve healthcare delivery, particularly in the face of generational healthcare reform. But they also acknowledge that finding a balance between best practices, budget and staffing constraints, and the rigors of daily practice is difficult.

Hospitalist Mark Lyons, MD, who works on residency programs and a patient-handoff initiative at Methodist Health System of Dallas, says that sessions on QI and patient safety provide new ideas from industry leaders who are in the trenches. To wit, he was impressed by the suggestions from Dr. Arora’s handoffs session as she described cases in which she was involved.

“They understand the limitations and the other things that go along with doing the actual act itself,” Dr. Lyons says. “They understand those things and take them into consideration. And you appreciate that.”

He and other hospitalists at HM12 agree that when leading practices are promoted at national forums, they take on the imprimatur of evidence-based procedures that physicians want to bring back to their respective HM groups. And QI suggestions promoted by physicians, not management, often tend to be more readily accepted.

“When you force change upon people, then it really leads to resistance,” Dr. Lyons says. “These are good opportunities to learn different strategies, to learn easier ways to present new ideas to people, to encourage them to do better, and to make it easier for them to do those things.”

Anuj Dalal, MD, FHM, a hospitalist at Brigham and Women’s Hospital in Boston, says technology can range from global EHRs across a multiple-institutional health system to microblogs to practice-centered wikis that promote communication between physicians. But integrating those technologies into care delivery that improves outcomes hinges not on technical hurdles, but on physicians accepting their validity and utility, he says. Once clinicians start digitally codifying the informal communication tools they currently use, patient-specific communication can improve.

And while Dr. Dalal, who co-led a session on the use of wikis as a communication-management strategy, adds that despite the little research linking those technological tacks to patient outcomes, he believes they are related.

“We’re using our devices, our iPads, our iPhones, our Android devices, to send information to other providers, but that information may not be transparent to other people,” says Dr. Dalal, who heads an SHM technology subcommittee. “But if you have it on a blog, a patient-specific Facebook, or a patient-specific Twitter, than everyone who subscribes to that will have access to the whole discussion.”

Dr. Dalal cautions that the details of legal compliance are important to ensure private patient information is safely transmitted. He anticipates vendors will market products that will balance the need for that privacy with a wider dissemination of information to ensure all involved physicians know what they need to know. One example: He expects the internal-messaging components of EHRs to improve in the next few years.

“It wouldn’t surprise me if these companies start realizing we need to support patient-specific communication in informal dialogues using microblogs and mobile devices,” he adds. “If they don’t do that, they’re probably going to miss the boat.”

The power of technology, large and small, must be balanced with what hospitalist pioneer Robert Wachter, MD, MHM, calls “foundational knowledge.” Dr. Wachter, who counts chair-elect of the American Board of Internal Medicine (ABIM) among his myriad titles, says that hospitalists can’t be slaves to technology. He relates it to a well-known adage in the aviation industry in which planes have become so advanced that some pilots would be incapable of flying them should the technology fail. In one quip, it is said that two people will soon populate cockpits: a pilot and a dog. The pilot’s job is to feed the dog, while the dog’s job is to bite the pilot’s hand if he tries to touch the controls.

Dr. Wachter

“As we move quickly, briskly, appropriately into this new world of computerization, if we aren’t constantly asking ourselves what have we lost in terms of our relationship with patients, we will really screw things up,” Dr. Wachter says. “This is not an argument to be Luddites, it’s not an argument to send back your meaningful use and get rid of the computers. We need them, but we have to be very thoughtful about how we maintain this balance.”

Patrick Conway, MD, MSc, FAAP, SFHM, a pediatric hospitalist and chief medical officer of the Centers for Medicare & Medicaid Services (CMS), says that to tie quality, safety, and technology together, government has to be willing to back therapies, then determine whether their efficacy deserves financial coverage.

One example Dr. Conway cites is the use of intravascular shunts. After backing their use initially for Medicare patients, it was determined that compared with medical management, the therapy had greater risks for death and stroke—and cost about 100 times more. Still, Dr. Conway says, determining how well the shunt works is exactly the process medicine should go through.

“When we have these new technologies that made a promise, we want to get them to market where they might help patients, but we also want to make sure evidence is developed to make sure they truly benefit patients,” he says, later adding, “I think this catalyst for health system transformation is important, and it’s teaching vision coupled with that execution.”

A well-planned blending of quality and technology can lead to improved patient safety, Dr. Arora says. But physicians and HM group leaders have to be proactive. Those with a clinical focus must seek out their IT counterparts and provide guidance on what information users need to access from electronic interfaces. Chief medical information officers and their staffs must seek feedback from providers before creating templates that don’t serve the clinical functions of end users.

Put simply: The fight to improve outcomes requires all parties to be properly armed. “You can choose a weapon,” she adds, “but you still have to choose it wisely and customize it to fit the needs of your organization.”

Jin Park, MD, is worried. She worries about the health of her patients, her hospital, and her HM group. She frets that the U.S. healthcare system will be too slow to implement must-needed change—the kind of national transformation that will improve care, contain costs, and eliminate political jousting.

“I’m a doctor with more than a decade of experience; I don’t have a personal concern. I have a community concern, a societal concern,” says Dr. Park, one of 17 hospitalists at Adventist Health in Portland, Ore. “I think adversity is good, and given the magnetism of the change, I feel like only the monsters are going to be able to survive. But you can’t just have the Kaiser [Permanentes] and the Monarch [Healthcares] and all these other examples take over the entire country. I mean, that’s not going to happen, right?”

Dr. Park wasn’t the only anxious hospitalist at HM12, held last month at the San Diego Convention Center. She and more than 150 others listened to SHM Public Policy Committee Chair Ron Greeno, MD, MHM, explain in detail the Accountable Care Organization (ACO) program being ramped up by the Centers for Medicare & Medicaid Services (CMS). Dr. Greeno, chief medical officer for Brentwood, Tenn.-based Cogent HMG, outlined how ACOs are designed to change the healthcare payment paradigm.

“They want to change doctors, hospitals, nursing homes, everybody that provides healthcare, from being profit centers to being cost centers,” Dr. Greeno said. “Right now, we’re profit centers. We do something, we get paid; we don’t do it, we don’t get paid. You see a patient, you get paid for that; your hospital admits a patient, you get paid for that. They’re a profit center. Under a [capitation] methodology, everything’s flipped on its head. If we admit a patient, we have to pay for that. We use those dollars; we’re now a cost center.”

For hospitalists, he added, that means making themselves more valuable by providing cost-effective care that translates into a healthier population.

On the Horizon: Systematic Change

While payment reform was a central theme of the annual meeting, another main takeaway was the shift of Medicare from a payor for quantity (fee-for-service) to a payor for quality (value-based purchasing).

It’s “systematically linking quality to payment,” said Patrick Conway, MD, MSc, FAAP, SFHM, a pediatric hospitalist, chief medical officer of CMS, and director of the Office of Clinical Standards and Quality at the U.S. Department of Health and Human Services in Washington, D.C. “We are transitioning to a more value-based purchaser, an active purchaser, and a catalyst for health system change. Our aims: better care for individuals, better health for populations, and lower cost for improvement.”

One in 3 Americans uses Medicare or Medicaid, the nation’s largest provider of healthcare coverage. And that number could rise when health exchanges launch in 2014 as part of the Affordable Care Act (ACA), Dr. Conway said. Combined, the two agencies spend about $800 billion annually. Medicare alone spends more than $1.5 billion per day.

Dr. Conway acknowledged the difficulty in changing the system, especially at the “ground level.” In addition to outlining key CMS’ initiatives, he indicated one of the main goals of his position is to “learn how to scale and spread successful interventions.”

They want to change doctors, hospitals, nursing homes, everybody that provides healthcare, from being profit centers to being cost centers.

—Ron Greeno, MD, MHM

“Quality can be measured and improved at multiple levels,” he told more than 2,000 hospitalists at the opening keynote address. “We’ve got the individual physician level, the group level, and then the community level. So we’re thinking about these three levels of measurement and how we align across those three levels.”

Dr. Conway, who volunteers for pediatric HM shifts on weekends, said CMS is especially excited about the Center for Medicare and Medicaid Innovation, an ACA creation that is gaining momentum with its Petri-dish-like efforts to improve quality and contain costs.

“We haven’t scaled any of these yet. We’re in testing mode,” Dr. Conway said. “I think the important point is that we have to figure out pre-testing mode, agree on evaluation models, without actuaries, that if these things work, we’re actually able to scale them to the program. This has so much robust support and applications, one could argue that we’re going to have so much interest that, one, it will be difficult to evaluate, but also, depending on how much interest you have, it could almost be at scale out of the gate.”

The Perfect Storm

National elections, Supreme Court activism, and public outrage at an “utterly dysfunctional” Congress: That’s how Norm Ornstein, PhD, MA, resident scholar at the American Enterprise Institute for Public Policy Research and a policy analyst for CBS News, views the day-to-day workings inside the Beltway.

Ornstein explained that “tribalism” is worse now than during any of his 40-plus years in Washington. He doesn’t see it getting any better, either, and wouldn’t be surprised if another wave of voter dissent tips the scales of power this November.

“We are a fairly evenly divided country,” Ornstein said, using a football analogy to describe the major political parties. “The basic reality is the Democratic Party has gravitated over to its own 20- or 25-yard line from its normal place, which was around its 40-yard line. The Republican Party, however, has moved behind its goalpost right now.”

Ornstein said he doesn’t think the U.S. Supreme Court will declare the ACA unconstitutional. Even though he’s skeptical of the conservative-leaning court’s motives, he said, “overturning even the individual mandate doesn’t make a lot of sense.”

Even so, he told hospitalists that the ever-increasing cost of healthcare, combined with America’s aging population, translates into a hostile political climate.

“All of that makes your challenge that much greater,” he said.

No matter what happens in the 2012 elections, Ornstein explained that at the end of December, a political “perfect storm” is brewing.

“Barack Obama will still be the president until Jan. 20, 2013. All of the Bush tax cuts expire the last day of December. The agreement that extended the payroll tax cut, unemployment insurance, and the doc-pay fix also expire at the end of December,” he explained. “Jan. 1, 2013, the Draconian sequesters—mindless, across-the-board cuts in defense and discretionary spending, not sparing any programs, designed to try and force them to the table to reach a broader budget deal but they couldn’t reach—all begin. And that’s $50 billion taken from what is already a pretty tight discretionary domestic budget.

“So fasten your seat belts for what’s going to be an extremely bumpy ride over the next several months, and a very murky picture for what will follow.”

Don’t Give Up

Many hospitalists think advocacy is beyond their pay grade, assuming their voice or idea will get lost in the bureaucracy that is the nation’s capital. Dr. Conway exhorted hospitalists to stay in the fight, partner with hospital administration, and champion quality initiatives.

“We’re all in this together,” he said. “You can understand your hospital’s performance statement, share data within and outside your hospital, be actively engaged in your hospital value-based purchasing programs and inpatient quality reporting. Physician leadership and professionalism, I think, is incredibly important.”

Jin Park, MD, is worried. She worries about the health of her patients, her hospital, and her HM group. She frets that the U.S. healthcare system will be too slow to implement must-needed change—the kind of national transformation that will improve care, contain costs, and eliminate political jousting.

“I’m a doctor with more than a decade of experience; I don’t have a personal concern. I have a community concern, a societal concern,” says Dr. Park, one of 17 hospitalists at Adventist Health in Portland, Ore. “I think adversity is good, and given the magnetism of the change, I feel like only the monsters are going to be able to survive. But you can’t just have the Kaiser [Permanentes] and the Monarch [Healthcares] and all these other examples take over the entire country. I mean, that’s not going to happen, right?”

Dr. Park wasn’t the only anxious hospitalist at HM12, held last month at the San Diego Convention Center. She and more than 150 others listened to SHM Public Policy Committee Chair Ron Greeno, MD, MHM, explain in detail the Accountable Care Organization (ACO) program being ramped up by the Centers for Medicare & Medicaid Services (CMS). Dr. Greeno, chief medical officer for Brentwood, Tenn.-based Cogent HMG, outlined how ACOs are designed to change the healthcare payment paradigm.

“They want to change doctors, hospitals, nursing homes, everybody that provides healthcare, from being profit centers to being cost centers,” Dr. Greeno said. “Right now, we’re profit centers. We do something, we get paid; we don’t do it, we don’t get paid. You see a patient, you get paid for that; your hospital admits a patient, you get paid for that. They’re a profit center. Under a [capitation] methodology, everything’s flipped on its head. If we admit a patient, we have to pay for that. We use those dollars; we’re now a cost center.”

For hospitalists, he added, that means making themselves more valuable by providing cost-effective care that translates into a healthier population.

On the Horizon: Systematic Change

While payment reform was a central theme of the annual meeting, another main takeaway was the shift of Medicare from a payor for quantity (fee-for-service) to a payor for quality (value-based purchasing).

It’s “systematically linking quality to payment,” said Patrick Conway, MD, MSc, FAAP, SFHM, a pediatric hospitalist, chief medical officer of CMS, and director of the Office of Clinical Standards and Quality at the U.S. Department of Health and Human Services in Washington, D.C. “We are transitioning to a more value-based purchaser, an active purchaser, and a catalyst for health system change. Our aims: better care for individuals, better health for populations, and lower cost for improvement.”

One in 3 Americans uses Medicare or Medicaid, the nation’s largest provider of healthcare coverage. And that number could rise when health exchanges launch in 2014 as part of the Affordable Care Act (ACA), Dr. Conway said. Combined, the two agencies spend about $800 billion annually. Medicare alone spends more than $1.5 billion per day.

Dr. Conway acknowledged the difficulty in changing the system, especially at the “ground level.” In addition to outlining key CMS’ initiatives, he indicated one of the main goals of his position is to “learn how to scale and spread successful interventions.”

They want to change doctors, hospitals, nursing homes, everybody that provides healthcare, from being profit centers to being cost centers.

—Ron Greeno, MD, MHM

“Quality can be measured and improved at multiple levels,” he told more than 2,000 hospitalists at the opening keynote address. “We’ve got the individual physician level, the group level, and then the community level. So we’re thinking about these three levels of measurement and how we align across those three levels.”

Dr. Conway, who volunteers for pediatric HM shifts on weekends, said CMS is especially excited about the Center for Medicare and Medicaid Innovation, an ACA creation that is gaining momentum with its Petri-dish-like efforts to improve quality and contain costs.

“We haven’t scaled any of these yet. We’re in testing mode,” Dr. Conway said. “I think the important point is that we have to figure out pre-testing mode, agree on evaluation models, without actuaries, that if these things work, we’re actually able to scale them to the program. This has so much robust support and applications, one could argue that we’re going to have so much interest that, one, it will be difficult to evaluate, but also, depending on how much interest you have, it could almost be at scale out of the gate.”

The Perfect Storm

National elections, Supreme Court activism, and public outrage at an “utterly dysfunctional” Congress: That’s how Norm Ornstein, PhD, MA, resident scholar at the American Enterprise Institute for Public Policy Research and a policy analyst for CBS News, views the day-to-day workings inside the Beltway.

Ornstein explained that “tribalism” is worse now than during any of his 40-plus years in Washington. He doesn’t see it getting any better, either, and wouldn’t be surprised if another wave of voter dissent tips the scales of power this November.

“We are a fairly evenly divided country,” Ornstein said, using a football analogy to describe the major political parties. “The basic reality is the Democratic Party has gravitated over to its own 20- or 25-yard line from its normal place, which was around its 40-yard line. The Republican Party, however, has moved behind its goalpost right now.”

Ornstein said he doesn’t think the U.S. Supreme Court will declare the ACA unconstitutional. Even though he’s skeptical of the conservative-leaning court’s motives, he said, “overturning even the individual mandate doesn’t make a lot of sense.”

Even so, he told hospitalists that the ever-increasing cost of healthcare, combined with America’s aging population, translates into a hostile political climate.

“All of that makes your challenge that much greater,” he said.

No matter what happens in the 2012 elections, Ornstein explained that at the end of December, a political “perfect storm” is brewing.

“Barack Obama will still be the president until Jan. 20, 2013. All of the Bush tax cuts expire the last day of December. The agreement that extended the payroll tax cut, unemployment insurance, and the doc-pay fix also expire at the end of December,” he explained. “Jan. 1, 2013, the Draconian sequesters—mindless, across-the-board cuts in defense and discretionary spending, not sparing any programs, designed to try and force them to the table to reach a broader budget deal but they couldn’t reach—all begin. And that’s $50 billion taken from what is already a pretty tight discretionary domestic budget.

“So fasten your seat belts for what’s going to be an extremely bumpy ride over the next several months, and a very murky picture for what will follow.”

Don’t Give Up

Many hospitalists think advocacy is beyond their pay grade, assuming their voice or idea will get lost in the bureaucracy that is the nation’s capital. Dr. Conway exhorted hospitalists to stay in the fight, partner with hospital administration, and champion quality initiatives.

“We’re all in this together,” he said. “You can understand your hospital’s performance statement, share data within and outside your hospital, be actively engaged in your hospital value-based purchasing programs and inpatient quality reporting. Physician leadership and professionalism, I think, is incredibly important.”

Jin Park, MD, is worried. She worries about the health of her patients, her hospital, and her HM group. She frets that the U.S. healthcare system will be too slow to implement must-needed change—the kind of national transformation that will improve care, contain costs, and eliminate political jousting.

“I’m a doctor with more than a decade of experience; I don’t have a personal concern. I have a community concern, a societal concern,” says Dr. Park, one of 17 hospitalists at Adventist Health in Portland, Ore. “I think adversity is good, and given the magnetism of the change, I feel like only the monsters are going to be able to survive. But you can’t just have the Kaiser [Permanentes] and the Monarch [Healthcares] and all these other examples take over the entire country. I mean, that’s not going to happen, right?”

Dr. Park wasn’t the only anxious hospitalist at HM12, held last month at the San Diego Convention Center. She and more than 150 others listened to SHM Public Policy Committee Chair Ron Greeno, MD, MHM, explain in detail the Accountable Care Organization (ACO) program being ramped up by the Centers for Medicare & Medicaid Services (CMS). Dr. Greeno, chief medical officer for Brentwood, Tenn.-based Cogent HMG, outlined how ACOs are designed to change the healthcare payment paradigm.

“They want to change doctors, hospitals, nursing homes, everybody that provides healthcare, from being profit centers to being cost centers,” Dr. Greeno said. “Right now, we’re profit centers. We do something, we get paid; we don’t do it, we don’t get paid. You see a patient, you get paid for that; your hospital admits a patient, you get paid for that. They’re a profit center. Under a [capitation] methodology, everything’s flipped on its head. If we admit a patient, we have to pay for that. We use those dollars; we’re now a cost center.”

For hospitalists, he added, that means making themselves more valuable by providing cost-effective care that translates into a healthier population.

On the Horizon: Systematic Change

While payment reform was a central theme of the annual meeting, another main takeaway was the shift of Medicare from a payor for quantity (fee-for-service) to a payor for quality (value-based purchasing).

It’s “systematically linking quality to payment,” said Patrick Conway, MD, MSc, FAAP, SFHM, a pediatric hospitalist, chief medical officer of CMS, and director of the Office of Clinical Standards and Quality at the U.S. Department of Health and Human Services in Washington, D.C. “We are transitioning to a more value-based purchaser, an active purchaser, and a catalyst for health system change. Our aims: better care for individuals, better health for populations, and lower cost for improvement.”

One in 3 Americans uses Medicare or Medicaid, the nation’s largest provider of healthcare coverage. And that number could rise when health exchanges launch in 2014 as part of the Affordable Care Act (ACA), Dr. Conway said. Combined, the two agencies spend about $800 billion annually. Medicare alone spends more than $1.5 billion per day.

Dr. Conway acknowledged the difficulty in changing the system, especially at the “ground level.” In addition to outlining key CMS’ initiatives, he indicated one of the main goals of his position is to “learn how to scale and spread successful interventions.”

They want to change doctors, hospitals, nursing homes, everybody that provides healthcare, from being profit centers to being cost centers.

—Ron Greeno, MD, MHM

“Quality can be measured and improved at multiple levels,” he told more than 2,000 hospitalists at the opening keynote address. “We’ve got the individual physician level, the group level, and then the community level. So we’re thinking about these three levels of measurement and how we align across those three levels.”

Dr. Conway, who volunteers for pediatric HM shifts on weekends, said CMS is especially excited about the Center for Medicare and Medicaid Innovation, an ACA creation that is gaining momentum with its Petri-dish-like efforts to improve quality and contain costs.

“We haven’t scaled any of these yet. We’re in testing mode,” Dr. Conway said. “I think the important point is that we have to figure out pre-testing mode, agree on evaluation models, without actuaries, that if these things work, we’re actually able to scale them to the program. This has so much robust support and applications, one could argue that we’re going to have so much interest that, one, it will be difficult to evaluate, but also, depending on how much interest you have, it could almost be at scale out of the gate.”

The Perfect Storm

National elections, Supreme Court activism, and public outrage at an “utterly dysfunctional” Congress: That’s how Norm Ornstein, PhD, MA, resident scholar at the American Enterprise Institute for Public Policy Research and a policy analyst for CBS News, views the day-to-day workings inside the Beltway.

Ornstein explained that “tribalism” is worse now than during any of his 40-plus years in Washington. He doesn’t see it getting any better, either, and wouldn’t be surprised if another wave of voter dissent tips the scales of power this November.

“We are a fairly evenly divided country,” Ornstein said, using a football analogy to describe the major political parties. “The basic reality is the Democratic Party has gravitated over to its own 20- or 25-yard line from its normal place, which was around its 40-yard line. The Republican Party, however, has moved behind its goalpost right now.”

Ornstein said he doesn’t think the U.S. Supreme Court will declare the ACA unconstitutional. Even though he’s skeptical of the conservative-leaning court’s motives, he said, “overturning even the individual mandate doesn’t make a lot of sense.”

Even so, he told hospitalists that the ever-increasing cost of healthcare, combined with America’s aging population, translates into a hostile political climate.

“All of that makes your challenge that much greater,” he said.

No matter what happens in the 2012 elections, Ornstein explained that at the end of December, a political “perfect storm” is brewing.

“Barack Obama will still be the president until Jan. 20, 2013. All of the Bush tax cuts expire the last day of December. The agreement that extended the payroll tax cut, unemployment insurance, and the doc-pay fix also expire at the end of December,” he explained. “Jan. 1, 2013, the Draconian sequesters—mindless, across-the-board cuts in defense and discretionary spending, not sparing any programs, designed to try and force them to the table to reach a broader budget deal but they couldn’t reach—all begin. And that’s $50 billion taken from what is already a pretty tight discretionary domestic budget.

“So fasten your seat belts for what’s going to be an extremely bumpy ride over the next several months, and a very murky picture for what will follow.”

Don’t Give Up

Many hospitalists think advocacy is beyond their pay grade, assuming their voice or idea will get lost in the bureaucracy that is the nation’s capital. Dr. Conway exhorted hospitalists to stay in the fight, partner with hospital administration, and champion quality initiatives.

“We’re all in this together,” he said. “You can understand your hospital’s performance statement, share data within and outside your hospital, be actively engaged in your hospital value-based purchasing programs and inpatient quality reporting. Physician leadership and professionalism, I think, is incredibly important.”

Hospitalist Ashish Jha, MD, MPH, doesn't want people to take his research on the value of pay-for-performance models the wrong way. Although a new study he worked on found no evidence that the Medicare Premier Hospital Quality Incentive Demonstration (HQID) led to decreased rates of 30-day mortality, he believes the program's structure—not its concept—is at issue.

"It's not that pay for performance doesn't work,” says Dr. Jha, associate professor of health policy and management at Harvard School of Public Health in Boston. "What we had in the HQID was pretty small incentives and mostly focused on processes of care, some of which are important, many of which are not. When you have that as your structure, it's not shocking to see in retrospect that it didn't have a big impact on outcomes."

The report, "The Long-Term Effect of Premier Pay for Performance on Patient Outcomes," showed that the composite 30-day mortality rates for patients with acute myocardial infarction, congestive heart failure, pneumonia, and coronary-artery bypass grafts were similar for Premier and non-Premier hospitals (12.33% and 12.40%, respectively; 95% confidence interval, -0.40 to 0.26).

Dr. Jha says the results were surprising, but he believes that HQID, value-based purchasing, and any pay-for-performance model can only succeed if they more narrowly focus on outcomes. For example, he says, HQID should not have weighed reductions in 30-day mortality rates on par with providing smoking-cessation worksheets to patients at discharge.

"You need much stronger incentives," he says. If hospitals focus on outcomes—and, specifically, on the right outcomes—they will figure out what processes they need to engage in and refine, he says. "Hospitalists are going to be the key people there. If they know that their mortality rates are high, they're going to work on trying to figure out why."

Hospitalist Ashish Jha, MD, MPH, doesn't want people to take his research on the value of pay-for-performance models the wrong way. Although a new study he worked on found no evidence that the Medicare Premier Hospital Quality Incentive Demonstration (HQID) led to decreased rates of 30-day mortality, he believes the program's structure—not its concept—is at issue.

"It's not that pay for performance doesn't work,” says Dr. Jha, associate professor of health policy and management at Harvard School of Public Health in Boston. "What we had in the HQID was pretty small incentives and mostly focused on processes of care, some of which are important, many of which are not. When you have that as your structure, it's not shocking to see in retrospect that it didn't have a big impact on outcomes."

The report, "The Long-Term Effect of Premier Pay for Performance on Patient Outcomes," showed that the composite 30-day mortality rates for patients with acute myocardial infarction, congestive heart failure, pneumonia, and coronary-artery bypass grafts were similar for Premier and non-Premier hospitals (12.33% and 12.40%, respectively; 95% confidence interval, -0.40 to 0.26).

Dr. Jha says the results were surprising, but he believes that HQID, value-based purchasing, and any pay-for-performance model can only succeed if they more narrowly focus on outcomes. For example, he says, HQID should not have weighed reductions in 30-day mortality rates on par with providing smoking-cessation worksheets to patients at discharge.

"You need much stronger incentives," he says. If hospitals focus on outcomes—and, specifically, on the right outcomes—they will figure out what processes they need to engage in and refine, he says. "Hospitalists are going to be the key people there. If they know that their mortality rates are high, they're going to work on trying to figure out why."

Hospitalist Ashish Jha, MD, MPH, doesn't want people to take his research on the value of pay-for-performance models the wrong way. Although a new study he worked on found no evidence that the Medicare Premier Hospital Quality Incentive Demonstration (HQID) led to decreased rates of 30-day mortality, he believes the program's structure—not its concept—is at issue.

"It's not that pay for performance doesn't work,” says Dr. Jha, associate professor of health policy and management at Harvard School of Public Health in Boston. "What we had in the HQID was pretty small incentives and mostly focused on processes of care, some of which are important, many of which are not. When you have that as your structure, it's not shocking to see in retrospect that it didn't have a big impact on outcomes."

The report, "The Long-Term Effect of Premier Pay for Performance on Patient Outcomes," showed that the composite 30-day mortality rates for patients with acute myocardial infarction, congestive heart failure, pneumonia, and coronary-artery bypass grafts were similar for Premier and non-Premier hospitals (12.33% and 12.40%, respectively; 95% confidence interval, -0.40 to 0.26).

Dr. Jha says the results were surprising, but he believes that HQID, value-based purchasing, and any pay-for-performance model can only succeed if they more narrowly focus on outcomes. For example, he says, HQID should not have weighed reductions in 30-day mortality rates on par with providing smoking-cessation worksheets to patients at discharge.

"You need much stronger incentives," he says. If hospitals focus on outcomes—and, specifically, on the right outcomes—they will figure out what processes they need to engage in and refine, he says. "Hospitalists are going to be the key people there. If they know that their mortality rates are high, they're going to work on trying to figure out why."

The creators of the first measurement tool for hospitalist programs hope that it becomes a standardized gauge for HM practice performance.

The Greeno-Hawley Hospital Medicine Index, unveiled earlier this month by Cogent HMG, uses a 26-question survey to measure HM group performance in five categories: alignment, performance management, infrastructure, operational processes, and leadership and people. The score will offer HM leaders a perspective on where their group stands in comparison with other hospitalist programs.

"It's meant to be a snapshot in time," says Beth Hawley, MBA, FACHE, Cogent's chief customer experience officer, who helped develop the index with Ron Greeno, MD, MHM, the company's chief medical officer. It is intended to help programs pinpoint the areas on which they need to focus in order to improve their performance, she says.

The index will be formally demonstrated at the American College of Physician Executives meeting April 30 in San Francisco. It will be available online in May.

Hawley says that once programs begin using the index, Cogent can assimilate and review the data to determine whether the tool can serve as a predictive model. Until then, it can be a guidepost for practice improvement for HM leaders who have never before had comparative tools.

"People would sit there thinking they're doing a great job but they only know their little market or their hospital," she says, "and really don’t see the broad picture of where hospital medicine is going and what a hospital medicine program can do for a hospital."

The creators of the first measurement tool for hospitalist programs hope that it becomes a standardized gauge for HM practice performance.

The Greeno-Hawley Hospital Medicine Index, unveiled earlier this month by Cogent HMG, uses a 26-question survey to measure HM group performance in five categories: alignment, performance management, infrastructure, operational processes, and leadership and people. The score will offer HM leaders a perspective on where their group stands in comparison with other hospitalist programs.

"It's meant to be a snapshot in time," says Beth Hawley, MBA, FACHE, Cogent's chief customer experience officer, who helped develop the index with Ron Greeno, MD, MHM, the company's chief medical officer. It is intended to help programs pinpoint the areas on which they need to focus in order to improve their performance, she says.

The index will be formally demonstrated at the American College of Physician Executives meeting April 30 in San Francisco. It will be available online in May.

Hawley says that once programs begin using the index, Cogent can assimilate and review the data to determine whether the tool can serve as a predictive model. Until then, it can be a guidepost for practice improvement for HM leaders who have never before had comparative tools.

"People would sit there thinking they're doing a great job but they only know their little market or their hospital," she says, "and really don’t see the broad picture of where hospital medicine is going and what a hospital medicine program can do for a hospital."

The creators of the first measurement tool for hospitalist programs hope that it becomes a standardized gauge for HM practice performance.

The Greeno-Hawley Hospital Medicine Index, unveiled earlier this month by Cogent HMG, uses a 26-question survey to measure HM group performance in five categories: alignment, performance management, infrastructure, operational processes, and leadership and people. The score will offer HM leaders a perspective on where their group stands in comparison with other hospitalist programs.

"It's meant to be a snapshot in time," says Beth Hawley, MBA, FACHE, Cogent's chief customer experience officer, who helped develop the index with Ron Greeno, MD, MHM, the company's chief medical officer. It is intended to help programs pinpoint the areas on which they need to focus in order to improve their performance, she says.

The index will be formally demonstrated at the American College of Physician Executives meeting April 30 in San Francisco. It will be available online in May.

Hawley says that once programs begin using the index, Cogent can assimilate and review the data to determine whether the tool can serve as a predictive model. Until then, it can be a guidepost for practice improvement for HM leaders who have never before had comparative tools.

"People would sit there thinking they're doing a great job but they only know their little market or their hospital," she says, "and really don’t see the broad picture of where hospital medicine is going and what a hospital medicine program can do for a hospital."

Click here to listen to Dr. Li

Click here to listen to Janet Corrigan

Click here to listen to Dr. Li

Click here to listen to Janet Corrigan

Click here to listen to Dr. Li

Click here to listen to Janet Corrigan

A new report that suggests cognitive function tends to decline substantially when older patients are admitted to the hospital could be an opportunity for hospitalists to be proactive in developing interventional therapies to combat the deterioration.

"Cognitive Decline after Hospitalization in a Community Population of Older Persons," published last month in Neurology, found that patients' global cognitive score declined a mean of 0.031 units per year before the first hospitalization, compared with 0.075 units per year thereafter, a more-than-twofold increase. Similar declines were seen in episodic memory (a 3.3-fold increase post-hospitalization) and executive function (a 1.7-fold increase post-hospitalization), according to the survey. More severe illness, longer hospital stay, and older age were associated with even faster cognitive decline after hospitalization.

David Likosky, MD, SFHM, a hospitalist and medical director of The Evergreen Neuroscience Institute in Kirkland, Wash., and a faculty member at HM12 last week in San Diego, says that more research could identify why cognitive functions decrease, as well as assist in developing techniques and therapies that could address the issue.

"A great next step would be to assess short-term cognitive changes post-hospitalization and [watch] how those evolve in the months that follow," Dr. Likosky tells The Hospitalist. "This has implications for discharge planning, and potentially for readmission risk. The step after that will be to determine what strategies might help prevent the cognitive decline seen in the study."

Such a process, he says, has a multiple advantages: First, it can help patients and their families prepare for possible scenarios; second, it provides opportunities for hospitalists to proactively address the issue of cognitive decline.

"If we as hospitalists can intervene to change this rate of decline," says Dr. Likosky, "we can make a great difference in patients' lives."

A new report that suggests cognitive function tends to decline substantially when older patients are admitted to the hospital could be an opportunity for hospitalists to be proactive in developing interventional therapies to combat the deterioration.

"Cognitive Decline after Hospitalization in a Community Population of Older Persons," published last month in Neurology, found that patients' global cognitive score declined a mean of 0.031 units per year before the first hospitalization, compared with 0.075 units per year thereafter, a more-than-twofold increase. Similar declines were seen in episodic memory (a 3.3-fold increase post-hospitalization) and executive function (a 1.7-fold increase post-hospitalization), according to the survey. More severe illness, longer hospital stay, and older age were associated with even faster cognitive decline after hospitalization.

David Likosky, MD, SFHM, a hospitalist and medical director of The Evergreen Neuroscience Institute in Kirkland, Wash., and a faculty member at HM12 last week in San Diego, says that more research could identify why cognitive functions decrease, as well as assist in developing techniques and therapies that could address the issue.

"A great next step would be to assess short-term cognitive changes post-hospitalization and [watch] how those evolve in the months that follow," Dr. Likosky tells The Hospitalist. "This has implications for discharge planning, and potentially for readmission risk. The step after that will be to determine what strategies might help prevent the cognitive decline seen in the study."

Such a process, he says, has a multiple advantages: First, it can help patients and their families prepare for possible scenarios; second, it provides opportunities for hospitalists to proactively address the issue of cognitive decline.

"If we as hospitalists can intervene to change this rate of decline," says Dr. Likosky, "we can make a great difference in patients' lives."

A new report that suggests cognitive function tends to decline substantially when older patients are admitted to the hospital could be an opportunity for hospitalists to be proactive in developing interventional therapies to combat the deterioration.

"Cognitive Decline after Hospitalization in a Community Population of Older Persons," published last month in Neurology, found that patients' global cognitive score declined a mean of 0.031 units per year before the first hospitalization, compared with 0.075 units per year thereafter, a more-than-twofold increase. Similar declines were seen in episodic memory (a 3.3-fold increase post-hospitalization) and executive function (a 1.7-fold increase post-hospitalization), according to the survey. More severe illness, longer hospital stay, and older age were associated with even faster cognitive decline after hospitalization.

David Likosky, MD, SFHM, a hospitalist and medical director of The Evergreen Neuroscience Institute in Kirkland, Wash., and a faculty member at HM12 last week in San Diego, says that more research could identify why cognitive functions decrease, as well as assist in developing techniques and therapies that could address the issue.

"A great next step would be to assess short-term cognitive changes post-hospitalization and [watch] how those evolve in the months that follow," Dr. Likosky tells The Hospitalist. "This has implications for discharge planning, and potentially for readmission risk. The step after that will be to determine what strategies might help prevent the cognitive decline seen in the study."

Such a process, he says, has a multiple advantages: First, it can help patients and their families prepare for possible scenarios; second, it provides opportunities for hospitalists to proactively address the issue of cognitive decline.

"If we as hospitalists can intervene to change this rate of decline," says Dr. Likosky, "we can make a great difference in patients' lives."

When Robert Wachter, MD, MHM, graduated from medical school in 1983, he thought he knew what a great doctor was. When he gave the penultimate address to a packed house at the Society of Hospital Medicine’s annual meeting in San Diego on Wednesday, he said that definition has changed—and will continue to evolve as hospitalists tackle the challenges of delivering high-value, cost-conscious care in an age of healthcare reform.

“We need to be great team players, but we also need to be great leaders,” said Dr. Wachter, professor and chief of the division of hospital medicine. chief of the medical service at the University of California San Francisco Medical Center and chair-elect for the American Board of Internal Medicine. “We need to embrace useful technology, but we can’t be slaves to it … improve systems of care, but welcome personal and group accountability. Strive for a balanced life but remember medicine is more a calling than a job. And think about the patients’ needs before our own. These are core and enduring values even as we move into this new era.”

Dr. Wachter’s plenary, titled “The Great Physician, Circa 2012: How Hospitalists Must Lead Efforts to Identify and Become This New Breed,” highlighted the balance HM practitioners must find in an increasingly complex healthcare system. He suggested hospitalists view themselves as technologically savvy “lifelong learners” whose reputation for systems improvement positions them perfectly to champion reform.

“We have big targets on us and I think they are appropriate,” said Dr. Wachter. “There are others who should have targets as well, but the main target has to be us. Change is impossible if we don’t embrace change.”

When Robert Wachter, MD, MHM, graduated from medical school in 1983, he thought he knew what a great doctor was. When he gave the penultimate address to a packed house at the Society of Hospital Medicine’s annual meeting in San Diego on Wednesday, he said that definition has changed—and will continue to evolve as hospitalists tackle the challenges of delivering high-value, cost-conscious care in an age of healthcare reform.

“We need to be great team players, but we also need to be great leaders,” said Dr. Wachter, professor and chief of the division of hospital medicine. chief of the medical service at the University of California San Francisco Medical Center and chair-elect for the American Board of Internal Medicine. “We need to embrace useful technology, but we can’t be slaves to it … improve systems of care, but welcome personal and group accountability. Strive for a balanced life but remember medicine is more a calling than a job. And think about the patients’ needs before our own. These are core and enduring values even as we move into this new era.”

Dr. Wachter’s plenary, titled “The Great Physician, Circa 2012: How Hospitalists Must Lead Efforts to Identify and Become This New Breed,” highlighted the balance HM practitioners must find in an increasingly complex healthcare system. He suggested hospitalists view themselves as technologically savvy “lifelong learners” whose reputation for systems improvement positions them perfectly to champion reform.

“We have big targets on us and I think they are appropriate,” said Dr. Wachter. “There are others who should have targets as well, but the main target has to be us. Change is impossible if we don’t embrace change.”

When Robert Wachter, MD, MHM, graduated from medical school in 1983, he thought he knew what a great doctor was. When he gave the penultimate address to a packed house at the Society of Hospital Medicine’s annual meeting in San Diego on Wednesday, he said that definition has changed—and will continue to evolve as hospitalists tackle the challenges of delivering high-value, cost-conscious care in an age of healthcare reform.

“We need to be great team players, but we also need to be great leaders,” said Dr. Wachter, professor and chief of the division of hospital medicine. chief of the medical service at the University of California San Francisco Medical Center and chair-elect for the American Board of Internal Medicine. “We need to embrace useful technology, but we can’t be slaves to it … improve systems of care, but welcome personal and group accountability. Strive for a balanced life but remember medicine is more a calling than a job. And think about the patients’ needs before our own. These are core and enduring values even as we move into this new era.”

Dr. Wachter’s plenary, titled “The Great Physician, Circa 2012: How Hospitalists Must Lead Efforts to Identify and Become This New Breed,” highlighted the balance HM practitioners must find in an increasingly complex healthcare system. He suggested hospitalists view themselves as technologically savvy “lifelong learners” whose reputation for systems improvement positions them perfectly to champion reform.

“We have big targets on us and I think they are appropriate,” said Dr. Wachter. “There are others who should have targets as well, but the main target has to be us. Change is impossible if we don’t embrace change.”

The future of hospital medicine is rooted in the accountability of its practitioners, the new SHM president said Tuesday morning at the Society of Hospital Medicine’s annual meeting.

Shaun Frost, MD, SFHM, FACP, chief medical officer for the Northeast region for Cogent HMG, used his inaugural address at the HM12 award ceremony as a clarion call for HM leaders to view personal and professional accountability as a challenge.

“Delivering genuine results is now what we definitely must do, because the train that is healthcare reform has clearly left the station,” he said. “If we don’t jump aboard this train by delivering tangible and measurable results through true quality performance improvements and honest cost containment, I’m afraid that the consequences could be disastrous for our hospitals, for our communities, for us individually, and for the profession of hospital medicine.”

Dr. Frost said that providing evidence-based improvements will solidify the specialty’s status as a “successful historical improvement to the practice of medicine.” HM leaders who have prided themselves on leading the push for quality have done an admirable job of becoming change agents at their institutions over the past 15 years, said Dr. Frost. And now, he added, the field's reputation is staked to the next wave of reform.

“It’s time for each of us to put our money where our mouths have been,” he said.

Adds outgoing society president Joseph Ming-Wah Li, MD, SFHM: “Expectations are higher than ever for hospital medicine and for SHM … can we meet those expectations? What’s the story that’s going to be told about hospital medicine and SHM five, 10 years from now?”

The future of hospital medicine is rooted in the accountability of its practitioners, the new SHM president said Tuesday morning at the Society of Hospital Medicine’s annual meeting.

Shaun Frost, MD, SFHM, FACP, chief medical officer for the Northeast region for Cogent HMG, used his inaugural address at the HM12 award ceremony as a clarion call for HM leaders to view personal and professional accountability as a challenge.

“Delivering genuine results is now what we definitely must do, because the train that is healthcare reform has clearly left the station,” he said. “If we don’t jump aboard this train by delivering tangible and measurable results through true quality performance improvements and honest cost containment, I’m afraid that the consequences could be disastrous for our hospitals, for our communities, for us individually, and for the profession of hospital medicine.”

Dr. Frost said that providing evidence-based improvements will solidify the specialty’s status as a “successful historical improvement to the practice of medicine.” HM leaders who have prided themselves on leading the push for quality have done an admirable job of becoming change agents at their institutions over the past 15 years, said Dr. Frost. And now, he added, the field's reputation is staked to the next wave of reform.

“It’s time for each of us to put our money where our mouths have been,” he said.

Adds outgoing society president Joseph Ming-Wah Li, MD, SFHM: “Expectations are higher than ever for hospital medicine and for SHM … can we meet those expectations? What’s the story that’s going to be told about hospital medicine and SHM five, 10 years from now?”

The future of hospital medicine is rooted in the accountability of its practitioners, the new SHM president said Tuesday morning at the Society of Hospital Medicine’s annual meeting.

Shaun Frost, MD, SFHM, FACP, chief medical officer for the Northeast region for Cogent HMG, used his inaugural address at the HM12 award ceremony as a clarion call for HM leaders to view personal and professional accountability as a challenge.

“Delivering genuine results is now what we definitely must do, because the train that is healthcare reform has clearly left the station,” he said. “If we don’t jump aboard this train by delivering tangible and measurable results through true quality performance improvements and honest cost containment, I’m afraid that the consequences could be disastrous for our hospitals, for our communities, for us individually, and for the profession of hospital medicine.”

Dr. Frost said that providing evidence-based improvements will solidify the specialty’s status as a “successful historical improvement to the practice of medicine.” HM leaders who have prided themselves on leading the push for quality have done an admirable job of becoming change agents at their institutions over the past 15 years, said Dr. Frost. And now, he added, the field's reputation is staked to the next wave of reform.

“It’s time for each of us to put our money where our mouths have been,” he said.

Adds outgoing society president Joseph Ming-Wah Li, MD, SFHM: “Expectations are higher than ever for hospital medicine and for SHM … can we meet those expectations? What’s the story that’s going to be told about hospital medicine and SHM five, 10 years from now?”

HM12 formally kicked off for thousands of hospitalists on Monday morning with two plenary addresses that couldn't have been more different.

First up, Patrick Conway, MD, MSc, FAAP, SFHM, a pediatric hospitalist and chief medical officer of the Centers for Medicare & Medicaid Services (CMS), provided a rapid-fire insight into the breadth of CMS and asked hospitalists to consider the government behemoth as a partner in systems change. Political analyst Norman Ornstein, PhD, MA, then presented a global view of the dysfunction racking the political system (once he finished an opening monologue of political jibes that would have made late-night writers proud).

But while the plenary perspectives differed in theme, they converged on implication: The next few years will be a period of change for healthcare and HM.

"The fact is if we had a political system operating on all cylinders at this point, if we had a law put into place and then assurances that it would continue, and that everybody would be making a good faith effort to make it work, it would still hold years of tumult ahead as we try to figure out how we can change cultures, change behaviors, and still along the way provide quality care at a price that is going to be acceptable enough in the system to make it work,” Ornstein said.

Dr. Conway summed it up this way: “better health, better care, and lower cost.”

Dr. Conway, who maintains a presence in the clinical world by working unpaid weekend shifts at Children's National Medical Center in Washington, D.C., says that while individual hospitalists might feel their contribution is too small to translate to systems change, they are wrong. Change, he says, begins at the local level.

"My challenge to you is: Please don't sit on the sidelines," Dr. Conway said. "Please be actively engaged in your local system in creating this change."

HM12 formally kicked off for thousands of hospitalists on Monday morning with two plenary addresses that couldn't have been more different.

First up, Patrick Conway, MD, MSc, FAAP, SFHM, a pediatric hospitalist and chief medical officer of the Centers for Medicare & Medicaid Services (CMS), provided a rapid-fire insight into the breadth of CMS and asked hospitalists to consider the government behemoth as a partner in systems change. Political analyst Norman Ornstein, PhD, MA, then presented a global view of the dysfunction racking the political system (once he finished an opening monologue of political jibes that would have made late-night writers proud).

But while the plenary perspectives differed in theme, they converged on implication: The next few years will be a period of change for healthcare and HM.

"The fact is if we had a political system operating on all cylinders at this point, if we had a law put into place and then assurances that it would continue, and that everybody would be making a good faith effort to make it work, it would still hold years of tumult ahead as we try to figure out how we can change cultures, change behaviors, and still along the way provide quality care at a price that is going to be acceptable enough in the system to make it work,” Ornstein said.

Dr. Conway summed it up this way: “better health, better care, and lower cost.”

Dr. Conway, who maintains a presence in the clinical world by working unpaid weekend shifts at Children's National Medical Center in Washington, D.C., says that while individual hospitalists might feel their contribution is too small to translate to systems change, they are wrong. Change, he says, begins at the local level.

"My challenge to you is: Please don't sit on the sidelines," Dr. Conway said. "Please be actively engaged in your local system in creating this change."

HM12 formally kicked off for thousands of hospitalists on Monday morning with two plenary addresses that couldn't have been more different.

First up, Patrick Conway, MD, MSc, FAAP, SFHM, a pediatric hospitalist and chief medical officer of the Centers for Medicare & Medicaid Services (CMS), provided a rapid-fire insight into the breadth of CMS and asked hospitalists to consider the government behemoth as a partner in systems change. Political analyst Norman Ornstein, PhD, MA, then presented a global view of the dysfunction racking the political system (once he finished an opening monologue of political jibes that would have made late-night writers proud).

But while the plenary perspectives differed in theme, they converged on implication: The next few years will be a period of change for healthcare and HM.

"The fact is if we had a political system operating on all cylinders at this point, if we had a law put into place and then assurances that it would continue, and that everybody would be making a good faith effort to make it work, it would still hold years of tumult ahead as we try to figure out how we can change cultures, change behaviors, and still along the way provide quality care at a price that is going to be acceptable enough in the system to make it work,” Ornstein said.

Dr. Conway summed it up this way: “better health, better care, and lower cost.”

Dr. Conway, who maintains a presence in the clinical world by working unpaid weekend shifts at Children's National Medical Center in Washington, D.C., says that while individual hospitalists might feel their contribution is too small to translate to systems change, they are wrong. Change, he says, begins at the local level.

"My challenge to you is: Please don't sit on the sidelines," Dr. Conway said. "Please be actively engaged in your local system in creating this change."

Sitting in the back of a conference room at the San Diego Convention Center on Sunday morning, Benjamin Frizner, MD, listens intently as a panel of HM experts debates the finer points of how best to implement and manage multidisciplinary rounds. The conversation, one of dozens to be tackled at a daylong pre-course on practice management, gave Dr. Frizner and dozens of physicians around him applicable advice, new viewpoints, and time to think about the big picture.

Welcome to HM12.

"The topics are focused to a lot of the problems we are facing," says Dr. Frizner, director of the hospitalist program at Saint Agnes Hospital in Baltimore. "It really gives us the whole day to just focus."

Of course, the four-day meeting is only just starting. Sunday is dedicated to eight pre-courses that offer CME credits, including a new session, "How to Improve Performance in CMS' Value-Based Purchasing Program." Other pre-courses dealt with ABIM Maintenance of Certification, critical care, perioperative care, and hands-on training in ultrasound and other medical procedures.

The annual meeting continues Monday, April 2, and includes the Research, Innovations, and Clinical Vignettes (RIV) poster competition and plenary addresses from Patrick Conway, MD, MSc, FAAP, SFHM, a pediatric hospitalist and chief medical officer of the Centers for Medicare & Medicaid Services (CMS); political commentator Norman Ornstein, PhD, MA, BA; and HM pioneer Robert Wachter, MD, MHM.

"This is the best meeting I've ever been to," says Madonna Ringswald, DO, medical director of the hospitalist program at Baptist Hospital Northeast in La Grange, Ky., who attended the practice management pre-course. "If you can’t find a lecture [that appeals to you], there’s something wrong with you."

Sitting in the back of a conference room at the San Diego Convention Center on Sunday morning, Benjamin Frizner, MD, listens intently as a panel of HM experts debates the finer points of how best to implement and manage multidisciplinary rounds. The conversation, one of dozens to be tackled at a daylong pre-course on practice management, gave Dr. Frizner and dozens of physicians around him applicable advice, new viewpoints, and time to think about the big picture.

Welcome to HM12.

"The topics are focused to a lot of the problems we are facing," says Dr. Frizner, director of the hospitalist program at Saint Agnes Hospital in Baltimore. "It really gives us the whole day to just focus."

Of course, the four-day meeting is only just starting. Sunday is dedicated to eight pre-courses that offer CME credits, including a new session, "How to Improve Performance in CMS' Value-Based Purchasing Program." Other pre-courses dealt with ABIM Maintenance of Certification, critical care, perioperative care, and hands-on training in ultrasound and other medical procedures.

The annual meeting continues Monday, April 2, and includes the Research, Innovations, and Clinical Vignettes (RIV) poster competition and plenary addresses from Patrick Conway, MD, MSc, FAAP, SFHM, a pediatric hospitalist and chief medical officer of the Centers for Medicare & Medicaid Services (CMS); political commentator Norman Ornstein, PhD, MA, BA; and HM pioneer Robert Wachter, MD, MHM.

"This is the best meeting I've ever been to," says Madonna Ringswald, DO, medical director of the hospitalist program at Baptist Hospital Northeast in La Grange, Ky., who attended the practice management pre-course. "If you can’t find a lecture [that appeals to you], there’s something wrong with you."

Sitting in the back of a conference room at the San Diego Convention Center on Sunday morning, Benjamin Frizner, MD, listens intently as a panel of HM experts debates the finer points of how best to implement and manage multidisciplinary rounds. The conversation, one of dozens to be tackled at a daylong pre-course on practice management, gave Dr. Frizner and dozens of physicians around him applicable advice, new viewpoints, and time to think about the big picture.

Welcome to HM12.

"The topics are focused to a lot of the problems we are facing," says Dr. Frizner, director of the hospitalist program at Saint Agnes Hospital in Baltimore. "It really gives us the whole day to just focus."

Of course, the four-day meeting is only just starting. Sunday is dedicated to eight pre-courses that offer CME credits, including a new session, "How to Improve Performance in CMS' Value-Based Purchasing Program." Other pre-courses dealt with ABIM Maintenance of Certification, critical care, perioperative care, and hands-on training in ultrasound and other medical procedures.

The annual meeting continues Monday, April 2, and includes the Research, Innovations, and Clinical Vignettes (RIV) poster competition and plenary addresses from Patrick Conway, MD, MSc, FAAP, SFHM, a pediatric hospitalist and chief medical officer of the Centers for Medicare & Medicaid Services (CMS); political commentator Norman Ornstein, PhD, MA, BA; and HM pioneer Robert Wachter, MD, MHM.

"This is the best meeting I've ever been to," says Madonna Ringswald, DO, medical director of the hospitalist program at Baptist Hospital Northeast in La Grange, Ky., who attended the practice management pre-course. "If you can’t find a lecture [that appeals to you], there’s something wrong with you."