Richard Quinn

Residents and attendings have divergent attitudes toward smartphone use during inpatient attending rounds, according to a researcher studying the topic.

Rachel Katz-Sidlow, MD, department of pediatrics, Jacobi Medical Center, Bronx, N.Y., is looking into the potential disadvantages of the phones if users are sending or receiving texts, emails, or pictures during rounds. Her preliminary research shows that a majority of faculty members believe a policy should be put in place to codify smartphone use.

“I truly think that policies to regulate smartphone use during patient management sessions are necessary, and will become commonplace in the near future until there are technology-driven solutions put into place,” says Dr. Katz-Sidlow.

Her research, currently in peer review for publication in the Journal of Hospital Medicine, comes as the ubiquity of smartphone technology has begun to be questioned by observers in the mainstream media. She says the majority of attendings and residents who responded to her initial questioning agree that smartphones “can be a serious source of distraction” during rounds.

The policy Dr. Katz-Sidlow is testing at Jacobi Medical Center defines a “smartphone” as any personal mobile communication device, including basic cellphones, Internet-enabled cellphones, and tablet computers. The beta policy restricts smartphone use during rounds to patient-care tasks, and would require all team members’ devices to be silenced or turned off at the beginning of rounds.

“Smartphones are here to stay and will become even more common in the future,” says Dr. Katz-Sidlow. “They’re such a valuable tool in medical education and patient care ... but there needs to be balance.”

Residents and attendings have divergent attitudes toward smartphone use during inpatient attending rounds, according to a researcher studying the topic.

Rachel Katz-Sidlow, MD, department of pediatrics, Jacobi Medical Center, Bronx, N.Y., is looking into the potential disadvantages of the phones if users are sending or receiving texts, emails, or pictures during rounds. Her preliminary research shows that a majority of faculty members believe a policy should be put in place to codify smartphone use.

“I truly think that policies to regulate smartphone use during patient management sessions are necessary, and will become commonplace in the near future until there are technology-driven solutions put into place,” says Dr. Katz-Sidlow.

Her research, currently in peer review for publication in the Journal of Hospital Medicine, comes as the ubiquity of smartphone technology has begun to be questioned by observers in the mainstream media. She says the majority of attendings and residents who responded to her initial questioning agree that smartphones “can be a serious source of distraction” during rounds.

The policy Dr. Katz-Sidlow is testing at Jacobi Medical Center defines a “smartphone” as any personal mobile communication device, including basic cellphones, Internet-enabled cellphones, and tablet computers. The beta policy restricts smartphone use during rounds to patient-care tasks, and would require all team members’ devices to be silenced or turned off at the beginning of rounds.

“Smartphones are here to stay and will become even more common in the future,” says Dr. Katz-Sidlow. “They’re such a valuable tool in medical education and patient care ... but there needs to be balance.”

Residents and attendings have divergent attitudes toward smartphone use during inpatient attending rounds, according to a researcher studying the topic.

Rachel Katz-Sidlow, MD, department of pediatrics, Jacobi Medical Center, Bronx, N.Y., is looking into the potential disadvantages of the phones if users are sending or receiving texts, emails, or pictures during rounds. Her preliminary research shows that a majority of faculty members believe a policy should be put in place to codify smartphone use.

“I truly think that policies to regulate smartphone use during patient management sessions are necessary, and will become commonplace in the near future until there are technology-driven solutions put into place,” says Dr. Katz-Sidlow.

Her research, currently in peer review for publication in the Journal of Hospital Medicine, comes as the ubiquity of smartphone technology has begun to be questioned by observers in the mainstream media. She says the majority of attendings and residents who responded to her initial questioning agree that smartphones “can be a serious source of distraction” during rounds.

The policy Dr. Katz-Sidlow is testing at Jacobi Medical Center defines a “smartphone” as any personal mobile communication device, including basic cellphones, Internet-enabled cellphones, and tablet computers. The beta policy restricts smartphone use during rounds to patient-care tasks, and would require all team members’ devices to be silenced or turned off at the beginning of rounds.

“Smartphones are here to stay and will become even more common in the future,” says Dr. Katz-Sidlow. “They’re such a valuable tool in medical education and patient care ... but there needs to be balance.”

The American College of Physicians Foundation (ACPF) has unveiled a quartet of new interventions aimed at improving care of atrial fibrillation (Afib) and stroke prevention.

Hospitalists are a core constituency for the tools, says Doron Schneider, MD, FACP, co-chair of the foundation's Initiative on Atrial Fibrillation and Stroke Prevention and medical director of the Center for Patient Safety and Healthcare Quality at Abington (Pa.) Health System.

"Atrial fibrillation is so common that the hospitalist is going to see it as primary diagnosis ... or as a background condition presenting with cellulitis and other conditions," Dr. Schneider says. "We want them to look at every patient, and if they have Afib, you don't want to treat the cellulitis and not treat the Afib because the Afib is not presenting. We want them to take a holistic approach."

The interventions are:

• A 20-page booklet for patients and caregivers titled “Afib: What You and Your Family Should Know.” The idea is to empower patients and their supporters with basic knowledge on how to live with their condition.
• Three patient education videos that cover basic facts, medication issues, and post-discharge tips for living a healthier lifestyle.
• A one-page physician support worksheet to help hospitalists and other physicians assess stroke risk and calculate outpatient bleeding risk.
• A guidebook on how to incorporate ACPF and other interventions into a hospital system’s practices.

Dr. Schneider adds that for "real and sustained change in quality initiatives," physicians need to improve all parts of a problem. “If you don't have systems redesigned to allow for education to be delivered or to get content to doctors, it's never going to happen," he says. "A lot of material is produced in the world that never gets to the bedside."

The American College of Physicians Foundation (ACPF) has unveiled a quartet of new interventions aimed at improving care of atrial fibrillation (Afib) and stroke prevention.

Hospitalists are a core constituency for the tools, says Doron Schneider, MD, FACP, co-chair of the foundation's Initiative on Atrial Fibrillation and Stroke Prevention and medical director of the Center for Patient Safety and Healthcare Quality at Abington (Pa.) Health System.

"Atrial fibrillation is so common that the hospitalist is going to see it as primary diagnosis ... or as a background condition presenting with cellulitis and other conditions," Dr. Schneider says. "We want them to look at every patient, and if they have Afib, you don't want to treat the cellulitis and not treat the Afib because the Afib is not presenting. We want them to take a holistic approach."

The interventions are:

• A 20-page booklet for patients and caregivers titled “Afib: What You and Your Family Should Know.” The idea is to empower patients and their supporters with basic knowledge on how to live with their condition.
• Three patient education videos that cover basic facts, medication issues, and post-discharge tips for living a healthier lifestyle.
• A one-page physician support worksheet to help hospitalists and other physicians assess stroke risk and calculate outpatient bleeding risk.
• A guidebook on how to incorporate ACPF and other interventions into a hospital system’s practices.

Dr. Schneider adds that for "real and sustained change in quality initiatives," physicians need to improve all parts of a problem. “If you don't have systems redesigned to allow for education to be delivered or to get content to doctors, it's never going to happen," he says. "A lot of material is produced in the world that never gets to the bedside."

The American College of Physicians Foundation (ACPF) has unveiled a quartet of new interventions aimed at improving care of atrial fibrillation (Afib) and stroke prevention.

Hospitalists are a core constituency for the tools, says Doron Schneider, MD, FACP, co-chair of the foundation's Initiative on Atrial Fibrillation and Stroke Prevention and medical director of the Center for Patient Safety and Healthcare Quality at Abington (Pa.) Health System.

"Atrial fibrillation is so common that the hospitalist is going to see it as primary diagnosis ... or as a background condition presenting with cellulitis and other conditions," Dr. Schneider says. "We want them to look at every patient, and if they have Afib, you don't want to treat the cellulitis and not treat the Afib because the Afib is not presenting. We want them to take a holistic approach."

The interventions are:

• A 20-page booklet for patients and caregivers titled “Afib: What You and Your Family Should Know.” The idea is to empower patients and their supporters with basic knowledge on how to live with their condition.
• Three patient education videos that cover basic facts, medication issues, and post-discharge tips for living a healthier lifestyle.
• A one-page physician support worksheet to help hospitalists and other physicians assess stroke risk and calculate outpatient bleeding risk.
• A guidebook on how to incorporate ACPF and other interventions into a hospital system’s practices.

Dr. Schneider adds that for "real and sustained change in quality initiatives," physicians need to improve all parts of a problem. “If you don't have systems redesigned to allow for education to be delivered or to get content to doctors, it's never going to happen," he says. "A lot of material is produced in the world that never gets to the bedside."

A hospitalist who works for one of the 32 organizations tapped in the inaugural cohort of Pioneer Accountable Care Organizations (ACOs) says HM should not expect major change in the short term from the new coordinated care model. But change will come in the long term.

"As we start to get data back and start to figure out where we can make the biggest positive impact on improving health for patients and also the impact of cost savings, then the hospitalist will be more involved," says Tierza Stephan, MD, FACP, SFHM, district medical director for hospitalists at Allina Hospitals & Clinics of Minneapolis.

The Pioneer designation was a Centers for Medicare & Medicaid Services (CMS) Innovation Center initiative crafted last summer for organizations and providers already experienced in providing coordinated care. A related model, the Medicare Shared Savings Program, does not require any previous experience with such contracts. The models set benchmarks for providers and institutions to qualify for shared shavings.

Dr. Stephan, a member of SHM's Practice Analysis Committee, helped the Allina Integrated Medical (AIM) Network become one of the Pioneer ACOs. The network includes 1,100 Allina doctors and 900 independent physicians from private clinics or practices. She says Allina has spent months preparing for the ACO: crafting its initial quality metrics, including generic drug utilization, timely turnaround of critical results, and patient satisfaction.

While all members of the network will share data to achieve better efficiency and cost savings, Dr. Stephan says it's too early in the process to say how well the program will work in practice. In the short term, she expects little daily change for HM physicians. Given the time it takes to get a program started, Dr. Stephan urges HM group leaders working on building an ACO, or those already in an approved program, to be a loud voice during the process.

"We're the primary care in the hospital, and primary care is really at the heart of accountable-care organizations," she says. "It really takes commitment by the entire healthcare community, and hospitalists interact with the entire healthcare community."

A hospitalist who works for one of the 32 organizations tapped in the inaugural cohort of Pioneer Accountable Care Organizations (ACOs) says HM should not expect major change in the short term from the new coordinated care model. But change will come in the long term.

"As we start to get data back and start to figure out where we can make the biggest positive impact on improving health for patients and also the impact of cost savings, then the hospitalist will be more involved," says Tierza Stephan, MD, FACP, SFHM, district medical director for hospitalists at Allina Hospitals & Clinics of Minneapolis.

The Pioneer designation was a Centers for Medicare & Medicaid Services (CMS) Innovation Center initiative crafted last summer for organizations and providers already experienced in providing coordinated care. A related model, the Medicare Shared Savings Program, does not require any previous experience with such contracts. The models set benchmarks for providers and institutions to qualify for shared shavings.

Dr. Stephan, a member of SHM's Practice Analysis Committee, helped the Allina Integrated Medical (AIM) Network become one of the Pioneer ACOs. The network includes 1,100 Allina doctors and 900 independent physicians from private clinics or practices. She says Allina has spent months preparing for the ACO: crafting its initial quality metrics, including generic drug utilization, timely turnaround of critical results, and patient satisfaction.

While all members of the network will share data to achieve better efficiency and cost savings, Dr. Stephan says it's too early in the process to say how well the program will work in practice. In the short term, she expects little daily change for HM physicians. Given the time it takes to get a program started, Dr. Stephan urges HM group leaders working on building an ACO, or those already in an approved program, to be a loud voice during the process.

"We're the primary care in the hospital, and primary care is really at the heart of accountable-care organizations," she says. "It really takes commitment by the entire healthcare community, and hospitalists interact with the entire healthcare community."

A hospitalist who works for one of the 32 organizations tapped in the inaugural cohort of Pioneer Accountable Care Organizations (ACOs) says HM should not expect major change in the short term from the new coordinated care model. But change will come in the long term.

"As we start to get data back and start to figure out where we can make the biggest positive impact on improving health for patients and also the impact of cost savings, then the hospitalist will be more involved," says Tierza Stephan, MD, FACP, SFHM, district medical director for hospitalists at Allina Hospitals & Clinics of Minneapolis.

The Pioneer designation was a Centers for Medicare & Medicaid Services (CMS) Innovation Center initiative crafted last summer for organizations and providers already experienced in providing coordinated care. A related model, the Medicare Shared Savings Program, does not require any previous experience with such contracts. The models set benchmarks for providers and institutions to qualify for shared shavings.

Dr. Stephan, a member of SHM's Practice Analysis Committee, helped the Allina Integrated Medical (AIM) Network become one of the Pioneer ACOs. The network includes 1,100 Allina doctors and 900 independent physicians from private clinics or practices. She says Allina has spent months preparing for the ACO: crafting its initial quality metrics, including generic drug utilization, timely turnaround of critical results, and patient satisfaction.

While all members of the network will share data to achieve better efficiency and cost savings, Dr. Stephan says it's too early in the process to say how well the program will work in practice. In the short term, she expects little daily change for HM physicians. Given the time it takes to get a program started, Dr. Stephan urges HM group leaders working on building an ACO, or those already in an approved program, to be a loud voice during the process.

"We're the primary care in the hospital, and primary care is really at the heart of accountable-care organizations," she says. "It really takes commitment by the entire healthcare community, and hospitalists interact with the entire healthcare community."

Hospitalists should consider the arena of antimicrobial stewardship one of the newest frontiers of clinical efficiency and cost savings, according to the author of a study in a supplement to this month's Journal of Hospital Medicine.

David Rosenberg, MD, MPH, FACP, SFHM, of the Department of Medicine, Section of Hospital Medicine at North Shore University Hospital in Manhasset, N.Y., says that changing the mindset on antibiotic resistance might seem like a daunting task, but it dovetails neatly with HM's current focus on quality and safety, particularly when it can help reduce length of stay (LOS).

"Think different about antibiotics and build that into your practice," he says.

The supplement highlights four related papers tackling the issues of appropriate initiation and selection of antibiotics, antimicrobial de-escalation strategies, duration and cessation of treatment, and Dr. Rosenberg's paper, "The Emerging Role of Hospitalists." The research includes an online CME component.

Dr. Rosenberg writes that hospitalists "are positioned as excellent champions of the principles and practices of antimicrobial stewardship." That means revamping the use of antibiotics both for individual patients and on an institutional level. That leadership means accepting that "culture change is slow" and physicians often feel "trapped" in letting an antibiotic treatment run its course rather than reassessing midstream.

Still, Dr. Rosenberg says, national guidelines on antibiotic overuse are likely to be developed in the coming years, and hospitalists would do well to get ahead of that curve.

"We're talking about the optimal treatment of patients we are already taking care of," he says. "Stewardship is a natural step forward."

Hospitalists should consider the arena of antimicrobial stewardship one of the newest frontiers of clinical efficiency and cost savings, according to the author of a study in a supplement to this month's Journal of Hospital Medicine.

David Rosenberg, MD, MPH, FACP, SFHM, of the Department of Medicine, Section of Hospital Medicine at North Shore University Hospital in Manhasset, N.Y., says that changing the mindset on antibiotic resistance might seem like a daunting task, but it dovetails neatly with HM's current focus on quality and safety, particularly when it can help reduce length of stay (LOS).

"Think different about antibiotics and build that into your practice," he says.

The supplement highlights four related papers tackling the issues of appropriate initiation and selection of antibiotics, antimicrobial de-escalation strategies, duration and cessation of treatment, and Dr. Rosenberg's paper, "The Emerging Role of Hospitalists." The research includes an online CME component.

Dr. Rosenberg writes that hospitalists "are positioned as excellent champions of the principles and practices of antimicrobial stewardship." That means revamping the use of antibiotics both for individual patients and on an institutional level. That leadership means accepting that "culture change is slow" and physicians often feel "trapped" in letting an antibiotic treatment run its course rather than reassessing midstream.

Still, Dr. Rosenberg says, national guidelines on antibiotic overuse are likely to be developed in the coming years, and hospitalists would do well to get ahead of that curve.

"We're talking about the optimal treatment of patients we are already taking care of," he says. "Stewardship is a natural step forward."

Hospitalists should consider the arena of antimicrobial stewardship one of the newest frontiers of clinical efficiency and cost savings, according to the author of a study in a supplement to this month's Journal of Hospital Medicine.

David Rosenberg, MD, MPH, FACP, SFHM, of the Department of Medicine, Section of Hospital Medicine at North Shore University Hospital in Manhasset, N.Y., says that changing the mindset on antibiotic resistance might seem like a daunting task, but it dovetails neatly with HM's current focus on quality and safety, particularly when it can help reduce length of stay (LOS).

"Think different about antibiotics and build that into your practice," he says.

The supplement highlights four related papers tackling the issues of appropriate initiation and selection of antibiotics, antimicrobial de-escalation strategies, duration and cessation of treatment, and Dr. Rosenberg's paper, "The Emerging Role of Hospitalists." The research includes an online CME component.

Dr. Rosenberg writes that hospitalists "are positioned as excellent champions of the principles and practices of antimicrobial stewardship." That means revamping the use of antibiotics both for individual patients and on an institutional level. That leadership means accepting that "culture change is slow" and physicians often feel "trapped" in letting an antibiotic treatment run its course rather than reassessing midstream.

Still, Dr. Rosenberg says, national guidelines on antibiotic overuse are likely to be developed in the coming years, and hospitalists would do well to get ahead of that curve.

"We're talking about the optimal treatment of patients we are already taking care of," he says. "Stewardship is a natural step forward."

Research that shows 1 in 3 adult patients does not see a physician within 30 days of discharge is the latest sign that more communication is needed between hospital physicians their community colleagues, a researcher says.

A report from the National Institute for Health Care Reform (NIHCR) found that after 90 days, 17.6% of adults still have not seen a physician, nurse practitioner, or physician assistant, says Anna Sommers, PhD, senior health researcher at the Center for Studying Health System Change, which conducts research for NIHCR. She adds that better communication between hospitalists and PCPs or specialists can be encouraged by important health information technology (HIT), but the process isn't a simple fix.

"That's not just about getting a shared medical record in place," she adds. "A medical record, even for just one inpatient stay, can be large. How does the doctor sift through all that? ... [Technology] can be part of the solution, but I think everyone is still learning how to use the technology and developing interfaces that are useful to the users. It's an evolving process.”

Hospitalists have helped address transitional-care issues with initiatives including post-discharge clinics, but more work needs to be done, Dr. Sommers says. She adds that the depth of the readmission issue is particularly striking as the research found that non-elderly adults with public coverage, a population that historically has higher rates of chronic conditions, were no more likely to see a doctor with 30 days of discharge than a person with private insurance.

"This problem is occurring all over the place," Dr. Sommers says. "It's a systematic problem, not a problem of one population in the health system."

Research that shows 1 in 3 adult patients does not see a physician within 30 days of discharge is the latest sign that more communication is needed between hospital physicians their community colleagues, a researcher says.

A report from the National Institute for Health Care Reform (NIHCR) found that after 90 days, 17.6% of adults still have not seen a physician, nurse practitioner, or physician assistant, says Anna Sommers, PhD, senior health researcher at the Center for Studying Health System Change, which conducts research for NIHCR. She adds that better communication between hospitalists and PCPs or specialists can be encouraged by important health information technology (HIT), but the process isn't a simple fix.

"That's not just about getting a shared medical record in place," she adds. "A medical record, even for just one inpatient stay, can be large. How does the doctor sift through all that? ... [Technology] can be part of the solution, but I think everyone is still learning how to use the technology and developing interfaces that are useful to the users. It's an evolving process.”

Hospitalists have helped address transitional-care issues with initiatives including post-discharge clinics, but more work needs to be done, Dr. Sommers says. She adds that the depth of the readmission issue is particularly striking as the research found that non-elderly adults with public coverage, a population that historically has higher rates of chronic conditions, were no more likely to see a doctor with 30 days of discharge than a person with private insurance.

"This problem is occurring all over the place," Dr. Sommers says. "It's a systematic problem, not a problem of one population in the health system."

Research that shows 1 in 3 adult patients does not see a physician within 30 days of discharge is the latest sign that more communication is needed between hospital physicians their community colleagues, a researcher says.

A report from the National Institute for Health Care Reform (NIHCR) found that after 90 days, 17.6% of adults still have not seen a physician, nurse practitioner, or physician assistant, says Anna Sommers, PhD, senior health researcher at the Center for Studying Health System Change, which conducts research for NIHCR. She adds that better communication between hospitalists and PCPs or specialists can be encouraged by important health information technology (HIT), but the process isn't a simple fix.

"That's not just about getting a shared medical record in place," she adds. "A medical record, even for just one inpatient stay, can be large. How does the doctor sift through all that? ... [Technology] can be part of the solution, but I think everyone is still learning how to use the technology and developing interfaces that are useful to the users. It's an evolving process.”

Hospitalists have helped address transitional-care issues with initiatives including post-discharge clinics, but more work needs to be done, Dr. Sommers says. She adds that the depth of the readmission issue is particularly striking as the research found that non-elderly adults with public coverage, a population that historically has higher rates of chronic conditions, were no more likely to see a doctor with 30 days of discharge than a person with private insurance.

"This problem is occurring all over the place," Dr. Sommers says. "It's a systematic problem, not a problem of one population in the health system."

A new report shows that 1 in 5 community hospitals operates in the red, but the chief strategy officer of the firm that conducted the survey thinks hospitals can help change that.

The second annual survey from healthcare information technology (HIT) provider Anthelio and leadership group Community Hospital 100 found that 22% of community hospitals operate with margins below 2%; another 38% operate below 1%. Rick Kneipper, Anthelio’s cofounder and chief strategy officer, says that hospitalists can be at the forefront “of the creative changes needed” to reduce costs and improve profitability.

“Hospital medicine groups and hospitals could free up significant funds to devote to improved patient-care services if they focus on their core competency of patient care and farm out their non-core, back-office services to experts who can use leverage to provide more efficient services at significantly reduced costs,” Kneipper wrote in an email to The Hospitalist. “Financial pressures have historically forced most industries to stop trying to be vertically integrated [trying to be ‘all things to all people’] and instead to focus on their core competencies—it’s time for healthcare to do the same.”

HM’s foothold at the intersection of clinical care and safety and QI positions the specialty to “respond to the new challenges of readmission penalties, evidenced-based medicine requirements, EMR implementation, and operation challenges,” Kneipper wrote.

For the full survey, please visit www.antheliohealth.com and search “survey.”

A new report shows that 1 in 5 community hospitals operates in the red, but the chief strategy officer of the firm that conducted the survey thinks hospitals can help change that.

The second annual survey from healthcare information technology (HIT) provider Anthelio and leadership group Community Hospital 100 found that 22% of community hospitals operate with margins below 2%; another 38% operate below 1%. Rick Kneipper, Anthelio’s cofounder and chief strategy officer, says that hospitalists can be at the forefront “of the creative changes needed” to reduce costs and improve profitability.

“Hospital medicine groups and hospitals could free up significant funds to devote to improved patient-care services if they focus on their core competency of patient care and farm out their non-core, back-office services to experts who can use leverage to provide more efficient services at significantly reduced costs,” Kneipper wrote in an email to The Hospitalist. “Financial pressures have historically forced most industries to stop trying to be vertically integrated [trying to be ‘all things to all people’] and instead to focus on their core competencies—it’s time for healthcare to do the same.”

HM’s foothold at the intersection of clinical care and safety and QI positions the specialty to “respond to the new challenges of readmission penalties, evidenced-based medicine requirements, EMR implementation, and operation challenges,” Kneipper wrote.

For the full survey, please visit www.antheliohealth.com and search “survey.”

A new report shows that 1 in 5 community hospitals operates in the red, but the chief strategy officer of the firm that conducted the survey thinks hospitals can help change that.

The second annual survey from healthcare information technology (HIT) provider Anthelio and leadership group Community Hospital 100 found that 22% of community hospitals operate with margins below 2%; another 38% operate below 1%. Rick Kneipper, Anthelio’s cofounder and chief strategy officer, says that hospitalists can be at the forefront “of the creative changes needed” to reduce costs and improve profitability.

“Hospital medicine groups and hospitals could free up significant funds to devote to improved patient-care services if they focus on their core competency of patient care and farm out their non-core, back-office services to experts who can use leverage to provide more efficient services at significantly reduced costs,” Kneipper wrote in an email to The Hospitalist. “Financial pressures have historically forced most industries to stop trying to be vertically integrated [trying to be ‘all things to all people’] and instead to focus on their core competencies—it’s time for healthcare to do the same.”

HM’s foothold at the intersection of clinical care and safety and QI positions the specialty to “respond to the new challenges of readmission penalties, evidenced-based medicine requirements, EMR implementation, and operation challenges,” Kneipper wrote.

For the full survey, please visit www.antheliohealth.com and search “survey.”

A new Michigan clinic for a hospital system's ED "frequent fliers" is a chance for HM to help streamline care delivery, a hospitalist involved in the effort says.

Doug Apple, MD, hospitalist division chief for Spectrum Health in Grand Rapids, Mich., says the Spectrum Health Medical Group Center for Integrative Medicine will help deal with patients who have used the ED at least 10 times in the past year. In the past, many of the patients would be admitted to the hospital, becoming part of a hospitalist's census. Often, they will have nonspecific conditions, such as chronic abdominal pain.

"Patients get admitted, they might not see the same hospitalist, they may not see the same surgical specialist or GI specialist," Dr. Apple says. "And so every time they get admitted, there's a different plan, there's a different diagnosis or idea. … The intent is to figure out how are these individuals able to get better care, more appropriate care, in an environment that allows them to actually have somebody that pays strict attention to what their needs are?"

Dr. Apple, who worked on the conceptual planning of the clinic, says hospitalists will have no hands-on role with its initial operation, other than referrals. But he says hospitalists who proactively identify patients best cared for via the clinic could save themselves readmissions and ensure better transitions of care.

"We're trying to figure out how we make these transitions, either into a hospital, or out of a hospital, or between an ED and back to the clinic," he adds. "We're trying to make sure these transitions do not become gaps in healthcare."

A new Michigan clinic for a hospital system's ED "frequent fliers" is a chance for HM to help streamline care delivery, a hospitalist involved in the effort says.

Doug Apple, MD, hospitalist division chief for Spectrum Health in Grand Rapids, Mich., says the Spectrum Health Medical Group Center for Integrative Medicine will help deal with patients who have used the ED at least 10 times in the past year. In the past, many of the patients would be admitted to the hospital, becoming part of a hospitalist's census. Often, they will have nonspecific conditions, such as chronic abdominal pain.

"Patients get admitted, they might not see the same hospitalist, they may not see the same surgical specialist or GI specialist," Dr. Apple says. "And so every time they get admitted, there's a different plan, there's a different diagnosis or idea. … The intent is to figure out how are these individuals able to get better care, more appropriate care, in an environment that allows them to actually have somebody that pays strict attention to what their needs are?"

Dr. Apple, who worked on the conceptual planning of the clinic, says hospitalists will have no hands-on role with its initial operation, other than referrals. But he says hospitalists who proactively identify patients best cared for via the clinic could save themselves readmissions and ensure better transitions of care.

"We're trying to figure out how we make these transitions, either into a hospital, or out of a hospital, or between an ED and back to the clinic," he adds. "We're trying to make sure these transitions do not become gaps in healthcare."

A new Michigan clinic for a hospital system's ED "frequent fliers" is a chance for HM to help streamline care delivery, a hospitalist involved in the effort says.

Doug Apple, MD, hospitalist division chief for Spectrum Health in Grand Rapids, Mich., says the Spectrum Health Medical Group Center for Integrative Medicine will help deal with patients who have used the ED at least 10 times in the past year. In the past, many of the patients would be admitted to the hospital, becoming part of a hospitalist's census. Often, they will have nonspecific conditions, such as chronic abdominal pain.

"Patients get admitted, they might not see the same hospitalist, they may not see the same surgical specialist or GI specialist," Dr. Apple says. "And so every time they get admitted, there's a different plan, there's a different diagnosis or idea. … The intent is to figure out how are these individuals able to get better care, more appropriate care, in an environment that allows them to actually have somebody that pays strict attention to what their needs are?"

Dr. Apple, who worked on the conceptual planning of the clinic, says hospitalists will have no hands-on role with its initial operation, other than referrals. But he says hospitalists who proactively identify patients best cared for via the clinic could save themselves readmissions and ensure better transitions of care.

"We're trying to figure out how we make these transitions, either into a hospital, or out of a hospital, or between an ED and back to the clinic," he adds. "We're trying to make sure these transitions do not become gaps in healthcare."

Adding a nurse practitioner (NP) to a resident physician team improves the efficiency of the discharge process but does nothing to decrease readmissions, according to a study in this month's Journal of Hospital Medicine.

In a randomized controlled trial at Massachusetts General Hospital (MGH) in Boston, NP use resulted in more discharge summaries completed within 24 hours when compared to a control group (67% vs 47%, P<0.001), according to the report, "Improving the Discharge Process by Embedding a Discharge Facilitator in a Resident Team." The study reported more follow-up appointments scheduled (62% vs. 36%, P<0.0001) scheduled and better attendance at those appointments within two weeks (36% vs. 23%, P<0.0002).

But for all the benefits, study author Kathleen Finn MD, MPhil, FACP, FHM, expresses disappointment in the fact that there was no significant difference between the groups in 30-day ED visits or 30-day readmissions.

"The literature suggests if we improve the discharge process, make it safer, and make sure patients have appropriate follow-ups in a timely fashion, we should be able to reduce readmissions," she says. "When we took a general medical population and did all that, we didn't get those results. However, its a single study, with one nurse, so its hard to say. But that was a little disappointing."

The study's results were enough to prompt the expansion of the program from one resident team to three. In the long term, Dr. Finn wants physician educators who are interested in limiting work hours and admissions to view the discharge process as just as important.

"We don't consider the discharge process as time-consuming, but it does take almost as much time as an admission does and yet patients are being discharged, even on admitting days,” she says. "The discharge is a very vulnerable time as the literature keeps showing. We need to rethink the discharge process."

Adding a nurse practitioner (NP) to a resident physician team improves the efficiency of the discharge process but does nothing to decrease readmissions, according to a study in this month's Journal of Hospital Medicine.

In a randomized controlled trial at Massachusetts General Hospital (MGH) in Boston, NP use resulted in more discharge summaries completed within 24 hours when compared to a control group (67% vs 47%, P<0.001), according to the report, "Improving the Discharge Process by Embedding a Discharge Facilitator in a Resident Team." The study reported more follow-up appointments scheduled (62% vs. 36%, P<0.0001) scheduled and better attendance at those appointments within two weeks (36% vs. 23%, P<0.0002).

But for all the benefits, study author Kathleen Finn MD, MPhil, FACP, FHM, expresses disappointment in the fact that there was no significant difference between the groups in 30-day ED visits or 30-day readmissions.

"The literature suggests if we improve the discharge process, make it safer, and make sure patients have appropriate follow-ups in a timely fashion, we should be able to reduce readmissions," she says. "When we took a general medical population and did all that, we didn't get those results. However, its a single study, with one nurse, so its hard to say. But that was a little disappointing."

The study's results were enough to prompt the expansion of the program from one resident team to three. In the long term, Dr. Finn wants physician educators who are interested in limiting work hours and admissions to view the discharge process as just as important.

"We don't consider the discharge process as time-consuming, but it does take almost as much time as an admission does and yet patients are being discharged, even on admitting days,” she says. "The discharge is a very vulnerable time as the literature keeps showing. We need to rethink the discharge process."

Adding a nurse practitioner (NP) to a resident physician team improves the efficiency of the discharge process but does nothing to decrease readmissions, according to a study in this month's Journal of Hospital Medicine.

In a randomized controlled trial at Massachusetts General Hospital (MGH) in Boston, NP use resulted in more discharge summaries completed within 24 hours when compared to a control group (67% vs 47%, P<0.001), according to the report, "Improving the Discharge Process by Embedding a Discharge Facilitator in a Resident Team." The study reported more follow-up appointments scheduled (62% vs. 36%, P<0.0001) scheduled and better attendance at those appointments within two weeks (36% vs. 23%, P<0.0002).

But for all the benefits, study author Kathleen Finn MD, MPhil, FACP, FHM, expresses disappointment in the fact that there was no significant difference between the groups in 30-day ED visits or 30-day readmissions.

"The literature suggests if we improve the discharge process, make it safer, and make sure patients have appropriate follow-ups in a timely fashion, we should be able to reduce readmissions," she says. "When we took a general medical population and did all that, we didn't get those results. However, its a single study, with one nurse, so its hard to say. But that was a little disappointing."

The study's results were enough to prompt the expansion of the program from one resident team to three. In the long term, Dr. Finn wants physician educators who are interested in limiting work hours and admissions to view the discharge process as just as important.

"We don't consider the discharge process as time-consuming, but it does take almost as much time as an admission does and yet patients are being discharged, even on admitting days,” she says. "The discharge is a very vulnerable time as the literature keeps showing. We need to rethink the discharge process."

The recently published Centers for Medicare & Medicaid Services (CMS) rules on accountable-care organizations (ACOs) are an improvement over the draft rules from this spring, but whether they spur wider formation of the new care model remains to be seen, a leading hospitalist says.

"They did some smart things," says Ron Greeno, MD, MHM, chief medical officer of Brentwood, Tenn.-based Cogent HMG and chair of SHM's Public Policy Committee. "I don't know yet that I have a great feel for how many people are going to apply—certainly more than before."

Released in March, the draft rules prompted more than 1,000 formal comments, spurring changes in several areas, including a significant reduction in the number of quality measures that CMS would monitor (33 from 65), and the elimination of assigning patients to ACOs retrospectively.

The revisions have been made to the Pioneer ACO Model, which offers higher payments to providers and organizations that already have experience with shared savings contracts, and a related program, the Medicare Shared Savings Program, which requires no previous experience.

Overall, the changes "increase incentives and eliminate downside risk," Dr. Greeno says, adding that he would like even more incentives to encourage more providers and organizations to participate. A recent white paper from healthcare research group Leavitt Partners of Salt Lake City identified 165 ACOs nationwide. Dr. Greeno believes that with more opportunity for providers and health systems to share in potential savings, that number can grow quickly.

In a comment letter posted to its website, SHM suggested "that limiting the incentive will also limit the results. ACOs that continually innovate to achieve progressive savings should have ongoing incentives to do so.”

"It's like [CMS] wants this to work, but they're almost scared people will make money doing this," he adds. "If you think this is important, make it worthwhile ... let organizations find the level of risk they're comfortable taking. And reward them accordingly if they're successful."

The recently published Centers for Medicare & Medicaid Services (CMS) rules on accountable-care organizations (ACOs) are an improvement over the draft rules from this spring, but whether they spur wider formation of the new care model remains to be seen, a leading hospitalist says.

"They did some smart things," says Ron Greeno, MD, MHM, chief medical officer of Brentwood, Tenn.-based Cogent HMG and chair of SHM's Public Policy Committee. "I don't know yet that I have a great feel for how many people are going to apply—certainly more than before."

Released in March, the draft rules prompted more than 1,000 formal comments, spurring changes in several areas, including a significant reduction in the number of quality measures that CMS would monitor (33 from 65), and the elimination of assigning patients to ACOs retrospectively.

The revisions have been made to the Pioneer ACO Model, which offers higher payments to providers and organizations that already have experience with shared savings contracts, and a related program, the Medicare Shared Savings Program, which requires no previous experience.

Overall, the changes "increase incentives and eliminate downside risk," Dr. Greeno says, adding that he would like even more incentives to encourage more providers and organizations to participate. A recent white paper from healthcare research group Leavitt Partners of Salt Lake City identified 165 ACOs nationwide. Dr. Greeno believes that with more opportunity for providers and health systems to share in potential savings, that number can grow quickly.

In a comment letter posted to its website, SHM suggested "that limiting the incentive will also limit the results. ACOs that continually innovate to achieve progressive savings should have ongoing incentives to do so.”

"It's like [CMS] wants this to work, but they're almost scared people will make money doing this," he adds. "If you think this is important, make it worthwhile ... let organizations find the level of risk they're comfortable taking. And reward them accordingly if they're successful."

The recently published Centers for Medicare & Medicaid Services (CMS) rules on accountable-care organizations (ACOs) are an improvement over the draft rules from this spring, but whether they spur wider formation of the new care model remains to be seen, a leading hospitalist says.

"They did some smart things," says Ron Greeno, MD, MHM, chief medical officer of Brentwood, Tenn.-based Cogent HMG and chair of SHM's Public Policy Committee. "I don't know yet that I have a great feel for how many people are going to apply—certainly more than before."

Released in March, the draft rules prompted more than 1,000 formal comments, spurring changes in several areas, including a significant reduction in the number of quality measures that CMS would monitor (33 from 65), and the elimination of assigning patients to ACOs retrospectively.

The revisions have been made to the Pioneer ACO Model, which offers higher payments to providers and organizations that already have experience with shared savings contracts, and a related program, the Medicare Shared Savings Program, which requires no previous experience.

Overall, the changes "increase incentives and eliminate downside risk," Dr. Greeno says, adding that he would like even more incentives to encourage more providers and organizations to participate. A recent white paper from healthcare research group Leavitt Partners of Salt Lake City identified 165 ACOs nationwide. Dr. Greeno believes that with more opportunity for providers and health systems to share in potential savings, that number can grow quickly.

In a comment letter posted to its website, SHM suggested "that limiting the incentive will also limit the results. ACOs that continually innovate to achieve progressive savings should have ongoing incentives to do so.”

"It's like [CMS] wants this to work, but they're almost scared people will make money doing this," he adds. "If you think this is important, make it worthwhile ... let organizations find the level of risk they're comfortable taking. And reward them accordingly if they're successful."

The Schumacher Group, which bills itself as the third-largest emergency and HM management firm in the U.S., is incorporating the use of smartphone applications, or apps, through its EDs nationwide. A similar technology could soon be in the offing for its HM operation.

The Lafayette, La.-based firm announced late last month that it was partnering with iTriage, a company that produces a free healthcare app for consumers, at its ED operation at North Okaloosa Medical Center in Crestview, Fla. The app will let patients and others learn details about the hospital and its services. And while David Grace, MD, FHM, the firm’s senior medical officer for hospital medicine, says there are no immediate plans to expand the usage to HM, the topic is being discussed.

"We're investigating it," he says, adding he sees a multitude of potential uses for healthcare apps, especially if they empower HM patients to become more involved in their care.

"I think any information that we can supply patients, whether we supply it or it's supplied through some other media, I think is a good thing," he says. "It increases their engagement. And any time the patient is more engaged in their healthcare, I think you develop better plans, better outcomes."

He cautions that there are potential pitfalls for physicians and patients. Patients need to be realistic about their breadth of knowledge, and doctors need to understand that a patient is not second-guessing them, just being interactive in the process.

It can "almost be one more line of safety checks in the whole healthcare continuum," Dr. Grace says. "The last time I looked, I've not seen too many practices of individuals out there hit 100% of everything 100% of the time. And while the errors numbers may be small, if you're the one discharged after a stroke not on an anti-platelet agent and have a massive stroke, that 1% was a pretty substantial number in your case."

The Schumacher Group, which bills itself as the third-largest emergency and HM management firm in the U.S., is incorporating the use of smartphone applications, or apps, through its EDs nationwide. A similar technology could soon be in the offing for its HM operation.

The Lafayette, La.-based firm announced late last month that it was partnering with iTriage, a company that produces a free healthcare app for consumers, at its ED operation at North Okaloosa Medical Center in Crestview, Fla. The app will let patients and others learn details about the hospital and its services. And while David Grace, MD, FHM, the firm’s senior medical officer for hospital medicine, says there are no immediate plans to expand the usage to HM, the topic is being discussed.

"We're investigating it," he says, adding he sees a multitude of potential uses for healthcare apps, especially if they empower HM patients to become more involved in their care.

"I think any information that we can supply patients, whether we supply it or it's supplied through some other media, I think is a good thing," he says. "It increases their engagement. And any time the patient is more engaged in their healthcare, I think you develop better plans, better outcomes."

He cautions that there are potential pitfalls for physicians and patients. Patients need to be realistic about their breadth of knowledge, and doctors need to understand that a patient is not second-guessing them, just being interactive in the process.

It can "almost be one more line of safety checks in the whole healthcare continuum," Dr. Grace says. "The last time I looked, I've not seen too many practices of individuals out there hit 100% of everything 100% of the time. And while the errors numbers may be small, if you're the one discharged after a stroke not on an anti-platelet agent and have a massive stroke, that 1% was a pretty substantial number in your case."

The Schumacher Group, which bills itself as the third-largest emergency and HM management firm in the U.S., is incorporating the use of smartphone applications, or apps, through its EDs nationwide. A similar technology could soon be in the offing for its HM operation.

The Lafayette, La.-based firm announced late last month that it was partnering with iTriage, a company that produces a free healthcare app for consumers, at its ED operation at North Okaloosa Medical Center in Crestview, Fla. The app will let patients and others learn details about the hospital and its services. And while David Grace, MD, FHM, the firm’s senior medical officer for hospital medicine, says there are no immediate plans to expand the usage to HM, the topic is being discussed.

"We're investigating it," he says, adding he sees a multitude of potential uses for healthcare apps, especially if they empower HM patients to become more involved in their care.

"I think any information that we can supply patients, whether we supply it or it's supplied through some other media, I think is a good thing," he says. "It increases their engagement. And any time the patient is more engaged in their healthcare, I think you develop better plans, better outcomes."

He cautions that there are potential pitfalls for physicians and patients. Patients need to be realistic about their breadth of knowledge, and doctors need to understand that a patient is not second-guessing them, just being interactive in the process.

It can "almost be one more line of safety checks in the whole healthcare continuum," Dr. Grace says. "The last time I looked, I've not seen too many practices of individuals out there hit 100% of everything 100% of the time. And while the errors numbers may be small, if you're the one discharged after a stroke not on an anti-platelet agent and have a massive stroke, that 1% was a pretty substantial number in your case."