Richard Quinn

The growing problem of obesity in America could pose a future liability issue for hospitalists and their employers, according to a bariatric surgeon.

Michael Jay Nusbaum, MD, FACS, FASMBS, FACN, says it's all too common for hospitalists and other physicians to "turf that patient out" to larger medical centers, but he cautions those doctors might be opening themselves to liability issues unless they can explain why they sent a patient elsewhere for care. For example, many hospitals lack wheelchairs, stretchers, tables, and gantries to hold morbidly obese patients.

"Is it really because you feel that the hospital lacks the infrastructure or because you just don't feel like taking on the additional liability that you're transferring the patient?" says Dr. Nusbaum, chief of bariatric surgery at Morristown (N.J.) Medical Center. "That's the question."

Dr. Nusbaum says hospitalists who believe their hospitals lack the proper equipment to treat obese patients should be "going out to the administration and saying, 'Look, we've got a liability issue. We don't have the equipment to take care of these patients if they start coming in.'"

He also believes that some physicians try to avoid obese patients for fear that their quality scores will drop. Dr. Nusbaum says that "disincentive" is built into the system, and it is incumbent on HM leaders and other physicians to push for change.

"The healthcare system in general is unprepared for the obesity epidemic," he adds. "And quite a bit of that is due to decreasing reimbursement and the fact that they need to lay out a lot of capital to take care of morbidly obese patients. ... It comes down to money."

The growing problem of obesity in America could pose a future liability issue for hospitalists and their employers, according to a bariatric surgeon.

Michael Jay Nusbaum, MD, FACS, FASMBS, FACN, says it's all too common for hospitalists and other physicians to "turf that patient out" to larger medical centers, but he cautions those doctors might be opening themselves to liability issues unless they can explain why they sent a patient elsewhere for care. For example, many hospitals lack wheelchairs, stretchers, tables, and gantries to hold morbidly obese patients.

"Is it really because you feel that the hospital lacks the infrastructure or because you just don't feel like taking on the additional liability that you're transferring the patient?" says Dr. Nusbaum, chief of bariatric surgery at Morristown (N.J.) Medical Center. "That's the question."

Dr. Nusbaum says hospitalists who believe their hospitals lack the proper equipment to treat obese patients should be "going out to the administration and saying, 'Look, we've got a liability issue. We don't have the equipment to take care of these patients if they start coming in.'"

He also believes that some physicians try to avoid obese patients for fear that their quality scores will drop. Dr. Nusbaum says that "disincentive" is built into the system, and it is incumbent on HM leaders and other physicians to push for change.

"The healthcare system in general is unprepared for the obesity epidemic," he adds. "And quite a bit of that is due to decreasing reimbursement and the fact that they need to lay out a lot of capital to take care of morbidly obese patients. ... It comes down to money."

The growing problem of obesity in America could pose a future liability issue for hospitalists and their employers, according to a bariatric surgeon.

Michael Jay Nusbaum, MD, FACS, FASMBS, FACN, says it's all too common for hospitalists and other physicians to "turf that patient out" to larger medical centers, but he cautions those doctors might be opening themselves to liability issues unless they can explain why they sent a patient elsewhere for care. For example, many hospitals lack wheelchairs, stretchers, tables, and gantries to hold morbidly obese patients.

"Is it really because you feel that the hospital lacks the infrastructure or because you just don't feel like taking on the additional liability that you're transferring the patient?" says Dr. Nusbaum, chief of bariatric surgery at Morristown (N.J.) Medical Center. "That's the question."

Dr. Nusbaum says hospitalists who believe their hospitals lack the proper equipment to treat obese patients should be "going out to the administration and saying, 'Look, we've got a liability issue. We don't have the equipment to take care of these patients if they start coming in.'"

He also believes that some physicians try to avoid obese patients for fear that their quality scores will drop. Dr. Nusbaum says that "disincentive" is built into the system, and it is incumbent on HM leaders and other physicians to push for change.

"The healthcare system in general is unprepared for the obesity epidemic," he adds. "And quite a bit of that is due to decreasing reimbursement and the fact that they need to lay out a lot of capital to take care of morbidly obese patients. ... It comes down to money."

A company pitching a new bacteria-resistant line of hospital linens is studying just how effective their product can be in the hospital setting.

PurThread Technologies Inc. is working with the University of Iowa on a second privacy curtain study that the company expects will show that their line of curtains, scrubs, doctor’s coats, bed linens, and patient gowns will help hospitalists and other inpatient physicians reduce the amount of bacteria they come into contact with. The research is the next step following a study presented at the Interscience Conference on Antimicrobial Agents and Chemotherapy meeting in September, which showed 92% of hospital privacy curtains were contaminated with potentially pathogenic bacteria, such as MRSA and VRE (vancomyicn-resistant enterococcus), within a week of being laundered.

The study was funded by PurThread and performed at the University of Iowa Hospital in Iowa City.

PurThread president and CEO Kathryn Bowsher says the company aims to take its first orders this year, thanks to a novel alloy it has woven into the fabrics it uses. As hospitals struggle to reach full compliance with hand hygiene and other safety measures, Bowsher believes her textiles are an easy answer.

“It’s always easier to re-engineer the system than it is to modify human behavior,” she adds. “And this would essentially be a plug-and-play solution. You stick these on the shelves and in the inventory of the hospital, instead of the traditional ones, and nobody has to think of it after that.”

A company pitching a new bacteria-resistant line of hospital linens is studying just how effective their product can be in the hospital setting.

PurThread Technologies Inc. is working with the University of Iowa on a second privacy curtain study that the company expects will show that their line of curtains, scrubs, doctor’s coats, bed linens, and patient gowns will help hospitalists and other inpatient physicians reduce the amount of bacteria they come into contact with. The research is the next step following a study presented at the Interscience Conference on Antimicrobial Agents and Chemotherapy meeting in September, which showed 92% of hospital privacy curtains were contaminated with potentially pathogenic bacteria, such as MRSA and VRE (vancomyicn-resistant enterococcus), within a week of being laundered.

The study was funded by PurThread and performed at the University of Iowa Hospital in Iowa City.

PurThread president and CEO Kathryn Bowsher says the company aims to take its first orders this year, thanks to a novel alloy it has woven into the fabrics it uses. As hospitals struggle to reach full compliance with hand hygiene and other safety measures, Bowsher believes her textiles are an easy answer.

“It’s always easier to re-engineer the system than it is to modify human behavior,” she adds. “And this would essentially be a plug-and-play solution. You stick these on the shelves and in the inventory of the hospital, instead of the traditional ones, and nobody has to think of it after that.”

A company pitching a new bacteria-resistant line of hospital linens is studying just how effective their product can be in the hospital setting.

PurThread Technologies Inc. is working with the University of Iowa on a second privacy curtain study that the company expects will show that their line of curtains, scrubs, doctor’s coats, bed linens, and patient gowns will help hospitalists and other inpatient physicians reduce the amount of bacteria they come into contact with. The research is the next step following a study presented at the Interscience Conference on Antimicrobial Agents and Chemotherapy meeting in September, which showed 92% of hospital privacy curtains were contaminated with potentially pathogenic bacteria, such as MRSA and VRE (vancomyicn-resistant enterococcus), within a week of being laundered.

The study was funded by PurThread and performed at the University of Iowa Hospital in Iowa City.

PurThread president and CEO Kathryn Bowsher says the company aims to take its first orders this year, thanks to a novel alloy it has woven into the fabrics it uses. As hospitals struggle to reach full compliance with hand hygiene and other safety measures, Bowsher believes her textiles are an easy answer.

“It’s always easier to re-engineer the system than it is to modify human behavior,” she adds. “And this would essentially be a plug-and-play solution. You stick these on the shelves and in the inventory of the hospital, instead of the traditional ones, and nobody has to think of it after that.”

An automated email system that notifies both hospitalists and PCPs about post-discharge test results can help ensure results don’t “fall through the cracks,” according to an abstract presented at HM11.

The report, “Design and Implementation of an Automated Email Notification System for Results of Tests Pending at Discharge,” suggests that by providing an automatic email when results are completed, inpatient physicians will be more responsible for the patient, and create a dialogue with primary-care physicians (PCPs) as well. The authors estimate that physicians are aware of 40% of the final results of tests pending at discharge.

“Things fall through the cracks,” says Anuj Dalal, MD, FHM, a hospitalist at Brigham and Women’s Hospital in Boston. “This is a method to make sure these test results don’t fall through the cracks.”

Dr. Dalal’s team created the automatic emails across five services—chemistry, hematology, microbiology, pathology, and radiology—in the past two years. Preliminary data show that the system helps ensure physicians are aware of more test results, but additional research is needed.

Still, Dr. Dalal believes creating an email system at a given institution helps if only by drawing attention to the issue of pending results once a patient has left the hospital. And even if the implementation of the system at a less-wired hospital is difficult, the omnipresence of email should help with adopting.

“Everyone has email today,” he adds.

An automated email system that notifies both hospitalists and PCPs about post-discharge test results can help ensure results don’t “fall through the cracks,” according to an abstract presented at HM11.

The report, “Design and Implementation of an Automated Email Notification System for Results of Tests Pending at Discharge,” suggests that by providing an automatic email when results are completed, inpatient physicians will be more responsible for the patient, and create a dialogue with primary-care physicians (PCPs) as well. The authors estimate that physicians are aware of 40% of the final results of tests pending at discharge.

“Things fall through the cracks,” says Anuj Dalal, MD, FHM, a hospitalist at Brigham and Women’s Hospital in Boston. “This is a method to make sure these test results don’t fall through the cracks.”

Dr. Dalal’s team created the automatic emails across five services—chemistry, hematology, microbiology, pathology, and radiology—in the past two years. Preliminary data show that the system helps ensure physicians are aware of more test results, but additional research is needed.

Still, Dr. Dalal believes creating an email system at a given institution helps if only by drawing attention to the issue of pending results once a patient has left the hospital. And even if the implementation of the system at a less-wired hospital is difficult, the omnipresence of email should help with adopting.

“Everyone has email today,” he adds.

An automated email system that notifies both hospitalists and PCPs about post-discharge test results can help ensure results don’t “fall through the cracks,” according to an abstract presented at HM11.

The report, “Design and Implementation of an Automated Email Notification System for Results of Tests Pending at Discharge,” suggests that by providing an automatic email when results are completed, inpatient physicians will be more responsible for the patient, and create a dialogue with primary-care physicians (PCPs) as well. The authors estimate that physicians are aware of 40% of the final results of tests pending at discharge.

“Things fall through the cracks,” says Anuj Dalal, MD, FHM, a hospitalist at Brigham and Women’s Hospital in Boston. “This is a method to make sure these test results don’t fall through the cracks.”

Dr. Dalal’s team created the automatic emails across five services—chemistry, hematology, microbiology, pathology, and radiology—in the past two years. Preliminary data show that the system helps ensure physicians are aware of more test results, but additional research is needed.

Still, Dr. Dalal believes creating an email system at a given institution helps if only by drawing attention to the issue of pending results once a patient has left the hospital. And even if the implementation of the system at a less-wired hospital is difficult, the omnipresence of email should help with adopting.

“Everyone has email today,” he adds.

Clinical informatics, the principle of blending health information technology (HIT) with patient care, is going mainstream. The subspecialty, popular in hospitalist circles, is scheduled to offer board certification following its recent approval by the American Board of Medical Specialties. The first examination will be administered by the American Board of Preventative Medicine and could be held as early as fall 2012, with certificates awarded early in 2013.

AMIA, the informatics trade group, believes the recognition will help push more medical schools to integrate informatics into the curriculum, which will only further solidify the subspecialty place in modern medicine.

Clinical informatics, the principle of blending health information technology (HIT) with patient care, is going mainstream. The subspecialty, popular in hospitalist circles, is scheduled to offer board certification following its recent approval by the American Board of Medical Specialties. The first examination will be administered by the American Board of Preventative Medicine and could be held as early as fall 2012, with certificates awarded early in 2013.

AMIA, the informatics trade group, believes the recognition will help push more medical schools to integrate informatics into the curriculum, which will only further solidify the subspecialty place in modern medicine.

Clinical informatics, the principle of blending health information technology (HIT) with patient care, is going mainstream. The subspecialty, popular in hospitalist circles, is scheduled to offer board certification following its recent approval by the American Board of Medical Specialties. The first examination will be administered by the American Board of Preventative Medicine and could be held as early as fall 2012, with certificates awarded early in 2013.

AMIA, the informatics trade group, believes the recognition will help push more medical schools to integrate informatics into the curriculum, which will only further solidify the subspecialty place in modern medicine.

Heparin prophylaxis had no significant impact on mortality rates in medical patients, according to a new report in Annals of Internal Medicine. And one of the authors suggests that the results should push hospitalists to use a more critical eye when considering pharmacological prophylaxis.

"Venous Thromboembolism Prophylaxis in Hospitalized Medical Patients and Those With Stroke: A Background Review for an American College of Physicians Clinical Practice Guideline" showed that in medical patients, heparin prophylaxis had no "statistically significant effect on any outcome in patients with acute stroke except for an increase in major bleeding events" (OR, 1.66 [CI, 1.20 to 2.28]). The authors concluded that precautionary use of heparin might have reduced pulmonary embolisms in both medical and stroke patients, but combined with upticks in bleeding and major bleeding events, the overall outcome results "in little or no net benefit."

"Our results do not really decide the issue for a physician and a patient whether prophylaxis should be used but rather show that this is a question that is still very much up in the air," says author Frank Lederle, MD, professor of medicine at the Minneapolis VA Medical Center. "That there may be good reasons to use prophylaxis, but it certainly shouldn't be something we're mandating or trying to achieve uniformity on when we don't have the evidence to do so."

Dr. Lederle adds that while some researchers are publishing papers on how well hospitalists and other physicians adhere to prophylactic procedures, he'd like to see more evidence-based analysis of the tactic's efficacy.

"The reason that this is not universally accepted by physicians is that people are aware that the data aren't that supportive of it," he says. "And that, really, the question should go back to 'Does it work and in whom does it work?' not 'Why are physicians failing to follow a guideline?'"

Heparin prophylaxis had no significant impact on mortality rates in medical patients, according to a new report in Annals of Internal Medicine. And one of the authors suggests that the results should push hospitalists to use a more critical eye when considering pharmacological prophylaxis.

"Venous Thromboembolism Prophylaxis in Hospitalized Medical Patients and Those With Stroke: A Background Review for an American College of Physicians Clinical Practice Guideline" showed that in medical patients, heparin prophylaxis had no "statistically significant effect on any outcome in patients with acute stroke except for an increase in major bleeding events" (OR, 1.66 [CI, 1.20 to 2.28]). The authors concluded that precautionary use of heparin might have reduced pulmonary embolisms in both medical and stroke patients, but combined with upticks in bleeding and major bleeding events, the overall outcome results "in little or no net benefit."

"Our results do not really decide the issue for a physician and a patient whether prophylaxis should be used but rather show that this is a question that is still very much up in the air," says author Frank Lederle, MD, professor of medicine at the Minneapolis VA Medical Center. "That there may be good reasons to use prophylaxis, but it certainly shouldn't be something we're mandating or trying to achieve uniformity on when we don't have the evidence to do so."

Dr. Lederle adds that while some researchers are publishing papers on how well hospitalists and other physicians adhere to prophylactic procedures, he'd like to see more evidence-based analysis of the tactic's efficacy.

"The reason that this is not universally accepted by physicians is that people are aware that the data aren't that supportive of it," he says. "And that, really, the question should go back to 'Does it work and in whom does it work?' not 'Why are physicians failing to follow a guideline?'"

Heparin prophylaxis had no significant impact on mortality rates in medical patients, according to a new report in Annals of Internal Medicine. And one of the authors suggests that the results should push hospitalists to use a more critical eye when considering pharmacological prophylaxis.

"Venous Thromboembolism Prophylaxis in Hospitalized Medical Patients and Those With Stroke: A Background Review for an American College of Physicians Clinical Practice Guideline" showed that in medical patients, heparin prophylaxis had no "statistically significant effect on any outcome in patients with acute stroke except for an increase in major bleeding events" (OR, 1.66 [CI, 1.20 to 2.28]). The authors concluded that precautionary use of heparin might have reduced pulmonary embolisms in both medical and stroke patients, but combined with upticks in bleeding and major bleeding events, the overall outcome results "in little or no net benefit."

"Our results do not really decide the issue for a physician and a patient whether prophylaxis should be used but rather show that this is a question that is still very much up in the air," says author Frank Lederle, MD, professor of medicine at the Minneapolis VA Medical Center. "That there may be good reasons to use prophylaxis, but it certainly shouldn't be something we're mandating or trying to achieve uniformity on when we don't have the evidence to do so."

Dr. Lederle adds that while some researchers are publishing papers on how well hospitalists and other physicians adhere to prophylactic procedures, he'd like to see more evidence-based analysis of the tactic's efficacy.

"The reason that this is not universally accepted by physicians is that people are aware that the data aren't that supportive of it," he says. "And that, really, the question should go back to 'Does it work and in whom does it work?' not 'Why are physicians failing to follow a guideline?'"

Modesty comes naturally to IPC The Hospitalist Co. executive Dave Bowman, MD. He shies from the spotlight and seeks to downplay his own accomplishments in favor of talking about the results of those he works with.

That tack got a bit more difficult last month when Dr. Bowman, based in Tucson, Ariz., received the Medical Group Management Association (MGMA) and American College of Medical Practice Executives' (ACMPE) "Physician Executive of the Year" award for 2011. It's the second year in a row the honor went to an HM leader; last year's winner was IPC chief executive Adam Singer, MD.

Dr. Bowman was praised both for his professional skills and the heroic role he played providing medical aid in the immediate aftermath of the Jan. 8 shooting in Tucson that left six people dead and injured 13 others, including U.S. Rep. Gabrielle Giffords (D-Ariz.)

Dr. Bowman tried to downplay the award until it was presented at a conference last month in Las Vegas. "When I step back and look at it from a non-physician-jaundiced view, that was a pretty neat thing. I was very humbled and grateful," he says.

He quickly adds, though, that the award means those he works with are doing their jobs just as exceptionally.

"You have to have a team to take care of people," he says. "If you're a lone wolf, you can do a good job for your 16 patients that day. But what happens when you leave? ... You have to be part of a team to ensure the good work you’re doing is continued."

Dr. Bowman, IPC's executive director in Tucson, has grown his group's practice to more than 75 physicians and non-physician providers. He notes that all of his providers with at least one year of seniority sit on at least one committee at their institution.

But his most sage advice for hospitalist leaders?

"Get involved, be out there," he says. "Take night call because you have two letters after your name that says you can do it. ... Be involved clinically, not just administratively."

Modesty comes naturally to IPC The Hospitalist Co. executive Dave Bowman, MD. He shies from the spotlight and seeks to downplay his own accomplishments in favor of talking about the results of those he works with.

That tack got a bit more difficult last month when Dr. Bowman, based in Tucson, Ariz., received the Medical Group Management Association (MGMA) and American College of Medical Practice Executives' (ACMPE) "Physician Executive of the Year" award for 2011. It's the second year in a row the honor went to an HM leader; last year's winner was IPC chief executive Adam Singer, MD.

Dr. Bowman was praised both for his professional skills and the heroic role he played providing medical aid in the immediate aftermath of the Jan. 8 shooting in Tucson that left six people dead and injured 13 others, including U.S. Rep. Gabrielle Giffords (D-Ariz.)

Dr. Bowman tried to downplay the award until it was presented at a conference last month in Las Vegas. "When I step back and look at it from a non-physician-jaundiced view, that was a pretty neat thing. I was very humbled and grateful," he says.

He quickly adds, though, that the award means those he works with are doing their jobs just as exceptionally.

"You have to have a team to take care of people," he says. "If you're a lone wolf, you can do a good job for your 16 patients that day. But what happens when you leave? ... You have to be part of a team to ensure the good work you’re doing is continued."

Dr. Bowman, IPC's executive director in Tucson, has grown his group's practice to more than 75 physicians and non-physician providers. He notes that all of his providers with at least one year of seniority sit on at least one committee at their institution.

But his most sage advice for hospitalist leaders?

"Get involved, be out there," he says. "Take night call because you have two letters after your name that says you can do it. ... Be involved clinically, not just administratively."

Modesty comes naturally to IPC The Hospitalist Co. executive Dave Bowman, MD. He shies from the spotlight and seeks to downplay his own accomplishments in favor of talking about the results of those he works with.

That tack got a bit more difficult last month when Dr. Bowman, based in Tucson, Ariz., received the Medical Group Management Association (MGMA) and American College of Medical Practice Executives' (ACMPE) "Physician Executive of the Year" award for 2011. It's the second year in a row the honor went to an HM leader; last year's winner was IPC chief executive Adam Singer, MD.

Dr. Bowman was praised both for his professional skills and the heroic role he played providing medical aid in the immediate aftermath of the Jan. 8 shooting in Tucson that left six people dead and injured 13 others, including U.S. Rep. Gabrielle Giffords (D-Ariz.)

Dr. Bowman tried to downplay the award until it was presented at a conference last month in Las Vegas. "When I step back and look at it from a non-physician-jaundiced view, that was a pretty neat thing. I was very humbled and grateful," he says.

He quickly adds, though, that the award means those he works with are doing their jobs just as exceptionally.

"You have to have a team to take care of people," he says. "If you're a lone wolf, you can do a good job for your 16 patients that day. But what happens when you leave? ... You have to be part of a team to ensure the good work you’re doing is continued."

Dr. Bowman, IPC's executive director in Tucson, has grown his group's practice to more than 75 physicians and non-physician providers. He notes that all of his providers with at least one year of seniority sit on at least one committee at their institution.

But his most sage advice for hospitalist leaders?

"Get involved, be out there," he says. "Take night call because you have two letters after your name that says you can do it. ... Be involved clinically, not just administratively."

A recent report (PDF) from The Commonwealth Fund that suggests the quality and efficacy of the U.S. healthcare system has remained relatively static in the past three years has bright spots for HM, an academic hospitalist says.

Kedar Mate, MD, assistant professor of medicine with the division of hospital medicine at Weill Cornell Medical School in New York City, says the report, which was compiled before any of the facets of the Affordable Care Act were implemented, helps argue why hospitalists are poised to take the reins of those needed quality reforms.

"They're the natural leaders of this work moving forward from the physician perspective," says Dr. Mate, a faculty member at the Institute for Healthcare Improvement in Cambridge, Mass. "They have a strong role to play in shepherding and championing and really being the arms and legs of the quality and safety movement, in many ways. Not only leading it, but actually executing it."

The report released last month, "Why Not the Best? Results from the National Scorecard on U.S. Health System Performance, 2011," measures 42 indicators of healthcare quality, access, efficiency, equity, and healthy lives. In overall terms, the U.S. score has varied only slightly in the third national scorecard. And while the report cautions that year-to-year analyses of quality measures are not directly comparable because of changing categories, Dr. Mate notes there have been significant improvements in areas that HM and health system improvement efforts have targeted.

The study, for example, reports half of adults with high blood pressure had the condition under control in 2007-2008, up from 31% in 1999-2000. The data also show that the rate of controlled blood sugar levels in adults with diabetes ticked up to 86% in 2007-2008 from 79% in 1999-2000.

"Where we turn our attention, particularly with focused quality initiatives, we're seeing some measurable change," Dr. Mate says. "There's absolutely value in identifying and knowing where we are seeing benefits, because those ought to be built upon."

A recent report (PDF) from The Commonwealth Fund that suggests the quality and efficacy of the U.S. healthcare system has remained relatively static in the past three years has bright spots for HM, an academic hospitalist says.

Kedar Mate, MD, assistant professor of medicine with the division of hospital medicine at Weill Cornell Medical School in New York City, says the report, which was compiled before any of the facets of the Affordable Care Act were implemented, helps argue why hospitalists are poised to take the reins of those needed quality reforms.

"They're the natural leaders of this work moving forward from the physician perspective," says Dr. Mate, a faculty member at the Institute for Healthcare Improvement in Cambridge, Mass. "They have a strong role to play in shepherding and championing and really being the arms and legs of the quality and safety movement, in many ways. Not only leading it, but actually executing it."

The report released last month, "Why Not the Best? Results from the National Scorecard on U.S. Health System Performance, 2011," measures 42 indicators of healthcare quality, access, efficiency, equity, and healthy lives. In overall terms, the U.S. score has varied only slightly in the third national scorecard. And while the report cautions that year-to-year analyses of quality measures are not directly comparable because of changing categories, Dr. Mate notes there have been significant improvements in areas that HM and health system improvement efforts have targeted.

The study, for example, reports half of adults with high blood pressure had the condition under control in 2007-2008, up from 31% in 1999-2000. The data also show that the rate of controlled blood sugar levels in adults with diabetes ticked up to 86% in 2007-2008 from 79% in 1999-2000.

"Where we turn our attention, particularly with focused quality initiatives, we're seeing some measurable change," Dr. Mate says. "There's absolutely value in identifying and knowing where we are seeing benefits, because those ought to be built upon."

A recent report (PDF) from The Commonwealth Fund that suggests the quality and efficacy of the U.S. healthcare system has remained relatively static in the past three years has bright spots for HM, an academic hospitalist says.

Kedar Mate, MD, assistant professor of medicine with the division of hospital medicine at Weill Cornell Medical School in New York City, says the report, which was compiled before any of the facets of the Affordable Care Act were implemented, helps argue why hospitalists are poised to take the reins of those needed quality reforms.

"They're the natural leaders of this work moving forward from the physician perspective," says Dr. Mate, a faculty member at the Institute for Healthcare Improvement in Cambridge, Mass. "They have a strong role to play in shepherding and championing and really being the arms and legs of the quality and safety movement, in many ways. Not only leading it, but actually executing it."

The report released last month, "Why Not the Best? Results from the National Scorecard on U.S. Health System Performance, 2011," measures 42 indicators of healthcare quality, access, efficiency, equity, and healthy lives. In overall terms, the U.S. score has varied only slightly in the third national scorecard. And while the report cautions that year-to-year analyses of quality measures are not directly comparable because of changing categories, Dr. Mate notes there have been significant improvements in areas that HM and health system improvement efforts have targeted.

The study, for example, reports half of adults with high blood pressure had the condition under control in 2007-2008, up from 31% in 1999-2000. The data also show that the rate of controlled blood sugar levels in adults with diabetes ticked up to 86% in 2007-2008 from 79% in 1999-2000.

"Where we turn our attention, particularly with focused quality initiatives, we're seeing some measurable change," Dr. Mate says. "There's absolutely value in identifying and knowing where we are seeing benefits, because those ought to be built upon."

A risk measurement model created by the Heart Institute at Intermountain Medical Center in Murray, Utah, may one day be a familiar tool to HM groups.

Known as the Intermountain Risk Score (http://intermountainhealthcare.org/IMRS/), the tool uses 15 parameters culled from complete blood counts (CBC) and the basic metabolic profile (BMP) to determine risk. The model, which is free, was used to stratify mortality risk in heart failure patients receiving an internal cardioverter defibrillator (ICD) in a paper presented in September at the 15th annual scientific meeting of the Heart Failure Society of America.

The report found that mortality at one-year post-ICD was 2.4%, 11.8%, and 28.2% for the low-, moderate-, and high-risk groups, respectively. And while the study was narrow in its topic, Benjamin Horne, PhD, director of cardiovascular and genetic epidemiology at the institute, says its application to a multitude of inpatient settings is a natural evolution for the tool.

“One of the things about the innovation of this risk score is the lab tests are so common already,” Dr. Horne says. “They are so familiar to physicians. They’ve been around for decades. What no one had realized before is they had additional risk information contained within them.”

A risk measurement model created by the Heart Institute at Intermountain Medical Center in Murray, Utah, may one day be a familiar tool to HM groups.

Known as the Intermountain Risk Score (http://intermountainhealthcare.org/IMRS/), the tool uses 15 parameters culled from complete blood counts (CBC) and the basic metabolic profile (BMP) to determine risk. The model, which is free, was used to stratify mortality risk in heart failure patients receiving an internal cardioverter defibrillator (ICD) in a paper presented in September at the 15th annual scientific meeting of the Heart Failure Society of America.

The report found that mortality at one-year post-ICD was 2.4%, 11.8%, and 28.2% for the low-, moderate-, and high-risk groups, respectively. And while the study was narrow in its topic, Benjamin Horne, PhD, director of cardiovascular and genetic epidemiology at the institute, says its application to a multitude of inpatient settings is a natural evolution for the tool.

“One of the things about the innovation of this risk score is the lab tests are so common already,” Dr. Horne says. “They are so familiar to physicians. They’ve been around for decades. What no one had realized before is they had additional risk information contained within them.”

A risk measurement model created by the Heart Institute at Intermountain Medical Center in Murray, Utah, may one day be a familiar tool to HM groups.

Known as the Intermountain Risk Score (http://intermountainhealthcare.org/IMRS/), the tool uses 15 parameters culled from complete blood counts (CBC) and the basic metabolic profile (BMP) to determine risk. The model, which is free, was used to stratify mortality risk in heart failure patients receiving an internal cardioverter defibrillator (ICD) in a paper presented in September at the 15th annual scientific meeting of the Heart Failure Society of America.

The report found that mortality at one-year post-ICD was 2.4%, 11.8%, and 28.2% for the low-, moderate-, and high-risk groups, respectively. And while the study was narrow in its topic, Benjamin Horne, PhD, director of cardiovascular and genetic epidemiology at the institute, says its application to a multitude of inpatient settings is a natural evolution for the tool.

“One of the things about the innovation of this risk score is the lab tests are so common already,” Dr. Horne says. “They are so familiar to physicians. They’ve been around for decades. What no one had realized before is they had additional risk information contained within them.”

The reduction President Obama has proposed to a formula used by the Independent Payment Advisory Board (IPAB), created last year by the Affordable Care Act to cut Medicare costs without affecting quality. The formula IPAB currently uses as a baseline for growth estimates is GDP per capita, plus 1%. The president has proposed to reduce that figure to GDP plus 0.5%. The lower threshold means IPAB will have deeper cuts to make. Accordingly, hospitalists are watching the proposal, as it could lower federal reimbursements as IPAB looks for ways to cut Medicare spending

The reduction President Obama has proposed to a formula used by the Independent Payment Advisory Board (IPAB), created last year by the Affordable Care Act to cut Medicare costs without affecting quality. The formula IPAB currently uses as a baseline for growth estimates is GDP per capita, plus 1%. The president has proposed to reduce that figure to GDP plus 0.5%. The lower threshold means IPAB will have deeper cuts to make. Accordingly, hospitalists are watching the proposal, as it could lower federal reimbursements as IPAB looks for ways to cut Medicare spending

The reduction President Obama has proposed to a formula used by the Independent Payment Advisory Board (IPAB), created last year by the Affordable Care Act to cut Medicare costs without affecting quality. The formula IPAB currently uses as a baseline for growth estimates is GDP per capita, plus 1%. The president has proposed to reduce that figure to GDP plus 0.5%. The lower threshold means IPAB will have deeper cuts to make. Accordingly, hospitalists are watching the proposal, as it could lower federal reimbursements as IPAB looks for ways to cut Medicare spending

A hospitalist at Beth Israel Deaconess Medical Center in Boston has created an iPhone application to help give academic HM groups fingertip access to Bayesian nomograms and real-time research.

Hospitalist Elizabeth Farrell, MD, says an app dubbed Medicine Toolkit (www.medicinetoolkit.com) should be available for download in a matter of weeks. The app has two components. The first is Bayes at the Bedside, a database of likelihood ratios (LRs) for more than 150 commonly used physical exam findings, labs, and imaging studies paired with an automated Bayesian nomogram to visually display the theorem and its application to clinical decision-making. The second piece of the program is Pocket Evidence, a compilation of more than 300 review articles, consensus guidelines, meta-analyses, and new and notable articles. Both components will be updated monthly.

“I really am envisioning it as a teaching tool and one that could be used by attendings to teach residents, interns, and medical students alike to facilitate critical thinking and evidence-based medicine,” Dr. Farrell says. “It can be used on rounds, in the clinic, or in the classroom.”

Dr. Farrell, a hospitalist for two years, had the idea to develop the application after printing out nomograms on index cards to use on rounds. She gave cards to team members and printed LRs on the back.

“It was a lot of fun, the team loved it, it worked great,” Dr. Farrell says. “But a lot of times I’d find that I ran out of the index cards, or someone on the team left theirs back in the workroom, or we didn’t have the LR for the test we were talking about. It resulted in a lot of missed teaching opportunities.”

A hospitalist at Beth Israel Deaconess Medical Center in Boston has created an iPhone application to help give academic HM groups fingertip access to Bayesian nomograms and real-time research.

Hospitalist Elizabeth Farrell, MD, says an app dubbed Medicine Toolkit (www.medicinetoolkit.com) should be available for download in a matter of weeks. The app has two components. The first is Bayes at the Bedside, a database of likelihood ratios (LRs) for more than 150 commonly used physical exam findings, labs, and imaging studies paired with an automated Bayesian nomogram to visually display the theorem and its application to clinical decision-making. The second piece of the program is Pocket Evidence, a compilation of more than 300 review articles, consensus guidelines, meta-analyses, and new and notable articles. Both components will be updated monthly.

“I really am envisioning it as a teaching tool and one that could be used by attendings to teach residents, interns, and medical students alike to facilitate critical thinking and evidence-based medicine,” Dr. Farrell says. “It can be used on rounds, in the clinic, or in the classroom.”

Dr. Farrell, a hospitalist for two years, had the idea to develop the application after printing out nomograms on index cards to use on rounds. She gave cards to team members and printed LRs on the back.

“It was a lot of fun, the team loved it, it worked great,” Dr. Farrell says. “But a lot of times I’d find that I ran out of the index cards, or someone on the team left theirs back in the workroom, or we didn’t have the LR for the test we were talking about. It resulted in a lot of missed teaching opportunities.”

A hospitalist at Beth Israel Deaconess Medical Center in Boston has created an iPhone application to help give academic HM groups fingertip access to Bayesian nomograms and real-time research.

Hospitalist Elizabeth Farrell, MD, says an app dubbed Medicine Toolkit (www.medicinetoolkit.com) should be available for download in a matter of weeks. The app has two components. The first is Bayes at the Bedside, a database of likelihood ratios (LRs) for more than 150 commonly used physical exam findings, labs, and imaging studies paired with an automated Bayesian nomogram to visually display the theorem and its application to clinical decision-making. The second piece of the program is Pocket Evidence, a compilation of more than 300 review articles, consensus guidelines, meta-analyses, and new and notable articles. Both components will be updated monthly.

“I really am envisioning it as a teaching tool and one that could be used by attendings to teach residents, interns, and medical students alike to facilitate critical thinking and evidence-based medicine,” Dr. Farrell says. “It can be used on rounds, in the clinic, or in the classroom.”

Dr. Farrell, a hospitalist for two years, had the idea to develop the application after printing out nomograms on index cards to use on rounds. She gave cards to team members and printed LRs on the back.

“It was a lot of fun, the team loved it, it worked great,” Dr. Farrell says. “But a lot of times I’d find that I ran out of the index cards, or someone on the team left theirs back in the workroom, or we didn’t have the LR for the test we were talking about. It resulted in a lot of missed teaching opportunities.”