Richard Quinn

The Centers for Medicare & Medicaid Services (CMS) on Aug. 23 introduced the Bundled Payments for Care Improvement Initiative, developed as part of the payment bundling provision of the Affordable Care Act (ACA). CMS has invited providers to apply to help test and develop four different models of bundling payments, which allow for great flexibility in selecting conditions, developing the care delivery structure, and determining how payments will be allocated among participating providers.

SHM learned last week that the Center for Medicare & Medicaid Innovation (CMMI) will accept nonbinding letters of intent for Model 1 of the program through Oct. 6. CMMI extended the deadline, originally set for Sept. 22, to give institutions and providers more time. Once institutions submit their letters of intent, the deadline to submit a formal application is Nov. 18.

The deadline for letters of intent for Models 2-4 remains Nov. 4, according to CMMI. The application deadline for those three models is March 15, 2012.

Felix Aguirre, MD, SFHM, vice president of medical affairs for North Hollywood, Calif.-based IPC: The Hospitalist Co., says HM group leaders should continue to monitor the process, but how involved they get depends on their individual situations and their relationship with an institution. “If you’re a private group, there’s a lot of weight on you to try to convince an acute-care facility to go down this risk-bearing road,” he says.

Dr. Aguirre says CMMI’s first three models are all “retrospective,” meaning hospitals and/or providers will be paid fees for service, and once episodic care is completed, as defined by each of the models, reconciliation will be made—and there is the real risk of having to pay back funds to CMS. In Model 4, the lone “prospective” setup, there is a single bundled payment up front “and you live and die by that money,” Dr. Aguirre says. “If it costs you a lot more to provide the service, it’s a true risk arrangement where you take a loss. Of course, if you have reduced costs by providing services a little more efficiently and you’ve saved a few dollars, you get to remain with those dollars.”

Dr. Aguirre also notes that of the four current models, Model 3 is the only one available directly to individual providers or HM groups as a risk-bearing entity, and only for post-acute-care services.

CMMI is expected to introduce at least a few more models in the coming months.

For more about CMS' bundling initiatives, visit our website.

The Centers for Medicare & Medicaid Services (CMS) on Aug. 23 introduced the Bundled Payments for Care Improvement Initiative, developed as part of the payment bundling provision of the Affordable Care Act (ACA). CMS has invited providers to apply to help test and develop four different models of bundling payments, which allow for great flexibility in selecting conditions, developing the care delivery structure, and determining how payments will be allocated among participating providers.

SHM learned last week that the Center for Medicare & Medicaid Innovation (CMMI) will accept nonbinding letters of intent for Model 1 of the program through Oct. 6. CMMI extended the deadline, originally set for Sept. 22, to give institutions and providers more time. Once institutions submit their letters of intent, the deadline to submit a formal application is Nov. 18.

The deadline for letters of intent for Models 2-4 remains Nov. 4, according to CMMI. The application deadline for those three models is March 15, 2012.

Felix Aguirre, MD, SFHM, vice president of medical affairs for North Hollywood, Calif.-based IPC: The Hospitalist Co., says HM group leaders should continue to monitor the process, but how involved they get depends on their individual situations and their relationship with an institution. “If you’re a private group, there’s a lot of weight on you to try to convince an acute-care facility to go down this risk-bearing road,” he says.

Dr. Aguirre says CMMI’s first three models are all “retrospective,” meaning hospitals and/or providers will be paid fees for service, and once episodic care is completed, as defined by each of the models, reconciliation will be made—and there is the real risk of having to pay back funds to CMS. In Model 4, the lone “prospective” setup, there is a single bundled payment up front “and you live and die by that money,” Dr. Aguirre says. “If it costs you a lot more to provide the service, it’s a true risk arrangement where you take a loss. Of course, if you have reduced costs by providing services a little more efficiently and you’ve saved a few dollars, you get to remain with those dollars.”

Dr. Aguirre also notes that of the four current models, Model 3 is the only one available directly to individual providers or HM groups as a risk-bearing entity, and only for post-acute-care services.

CMMI is expected to introduce at least a few more models in the coming months.

For more about CMS' bundling initiatives, visit our website.

The Centers for Medicare & Medicaid Services (CMS) on Aug. 23 introduced the Bundled Payments for Care Improvement Initiative, developed as part of the payment bundling provision of the Affordable Care Act (ACA). CMS has invited providers to apply to help test and develop four different models of bundling payments, which allow for great flexibility in selecting conditions, developing the care delivery structure, and determining how payments will be allocated among participating providers.

SHM learned last week that the Center for Medicare & Medicaid Innovation (CMMI) will accept nonbinding letters of intent for Model 1 of the program through Oct. 6. CMMI extended the deadline, originally set for Sept. 22, to give institutions and providers more time. Once institutions submit their letters of intent, the deadline to submit a formal application is Nov. 18.

The deadline for letters of intent for Models 2-4 remains Nov. 4, according to CMMI. The application deadline for those three models is March 15, 2012.

Felix Aguirre, MD, SFHM, vice president of medical affairs for North Hollywood, Calif.-based IPC: The Hospitalist Co., says HM group leaders should continue to monitor the process, but how involved they get depends on their individual situations and their relationship with an institution. “If you’re a private group, there’s a lot of weight on you to try to convince an acute-care facility to go down this risk-bearing road,” he says.

Dr. Aguirre says CMMI’s first three models are all “retrospective,” meaning hospitals and/or providers will be paid fees for service, and once episodic care is completed, as defined by each of the models, reconciliation will be made—and there is the real risk of having to pay back funds to CMS. In Model 4, the lone “prospective” setup, there is a single bundled payment up front “and you live and die by that money,” Dr. Aguirre says. “If it costs you a lot more to provide the service, it’s a true risk arrangement where you take a loss. Of course, if you have reduced costs by providing services a little more efficiently and you’ve saved a few dollars, you get to remain with those dollars.”

Dr. Aguirre also notes that of the four current models, Model 3 is the only one available directly to individual providers or HM groups as a risk-bearing entity, and only for post-acute-care services.

CMMI is expected to introduce at least a few more models in the coming months.

For more about CMS' bundling initiatives, visit our website.

HM groups looking for a new revenue stream would be well served to keep an eye on the explosive growth of palliative care, according to a former SHM president who also runs a palliative service.

Steven Pantilat, MD, FACP, SFHM, director of the Palliative Care Leadership Center at the University of California at San Francisco, says data released this summer by the Center to Advance Palliative Care (CAPC) show that 63% of hospitals have palliative-care teams, up from 24.5% in 2000. But growth is lagging in both smaller hospitals and hospitals in the South.

"Hospitals that are looking to improve the systems of care, hospitals that are looking to be more cutting-edge, looking to be adopters of new models of care are going to pursue both hospital medicine and palliative care," Dr. Pantilat says. "That is another way that hospitalists can demonstrate added value."

Dr. Pantilat, who helped create SHM's Palliative-Care Task Force, says hospitalists can provide primary palliative care and should be mindful to identify patients who should be referred to palliative teams. Hospitalists interested in learning more about palliative skills can pursue training programs through CAPC or the American Academy of Hospice and Palliative Medicine.

The growth of HM and palliative care have followed similar tracks in the past decade, and the business case for both services is similar, Dr. Pantilat says. Because demand still outweighs supply in both specialties, many institutions looking for palliative expertise would be pleased to have their HM group take that mantle, particularly as hospitalists are now caring for the majority of inpatients that would benefit from those services, he adds.

"Hospitalists are the ones taking care of those people with advanced, serious, and life-threatening illnesses," Dr. Pantilat says. "De facto, they are already doing this work."

HM groups looking for a new revenue stream would be well served to keep an eye on the explosive growth of palliative care, according to a former SHM president who also runs a palliative service.

Steven Pantilat, MD, FACP, SFHM, director of the Palliative Care Leadership Center at the University of California at San Francisco, says data released this summer by the Center to Advance Palliative Care (CAPC) show that 63% of hospitals have palliative-care teams, up from 24.5% in 2000. But growth is lagging in both smaller hospitals and hospitals in the South.

"Hospitals that are looking to improve the systems of care, hospitals that are looking to be more cutting-edge, looking to be adopters of new models of care are going to pursue both hospital medicine and palliative care," Dr. Pantilat says. "That is another way that hospitalists can demonstrate added value."

Dr. Pantilat, who helped create SHM's Palliative-Care Task Force, says hospitalists can provide primary palliative care and should be mindful to identify patients who should be referred to palliative teams. Hospitalists interested in learning more about palliative skills can pursue training programs through CAPC or the American Academy of Hospice and Palliative Medicine.

The growth of HM and palliative care have followed similar tracks in the past decade, and the business case for both services is similar, Dr. Pantilat says. Because demand still outweighs supply in both specialties, many institutions looking for palliative expertise would be pleased to have their HM group take that mantle, particularly as hospitalists are now caring for the majority of inpatients that would benefit from those services, he adds.

"Hospitalists are the ones taking care of those people with advanced, serious, and life-threatening illnesses," Dr. Pantilat says. "De facto, they are already doing this work."

HM groups looking for a new revenue stream would be well served to keep an eye on the explosive growth of palliative care, according to a former SHM president who also runs a palliative service.

Steven Pantilat, MD, FACP, SFHM, director of the Palliative Care Leadership Center at the University of California at San Francisco, says data released this summer by the Center to Advance Palliative Care (CAPC) show that 63% of hospitals have palliative-care teams, up from 24.5% in 2000. But growth is lagging in both smaller hospitals and hospitals in the South.

"Hospitals that are looking to improve the systems of care, hospitals that are looking to be more cutting-edge, looking to be adopters of new models of care are going to pursue both hospital medicine and palliative care," Dr. Pantilat says. "That is another way that hospitalists can demonstrate added value."

Dr. Pantilat, who helped create SHM's Palliative-Care Task Force, says hospitalists can provide primary palliative care and should be mindful to identify patients who should be referred to palliative teams. Hospitalists interested in learning more about palliative skills can pursue training programs through CAPC or the American Academy of Hospice and Palliative Medicine.

The growth of HM and palliative care have followed similar tracks in the past decade, and the business case for both services is similar, Dr. Pantilat says. Because demand still outweighs supply in both specialties, many institutions looking for palliative expertise would be pleased to have their HM group take that mantle, particularly as hospitalists are now caring for the majority of inpatients that would benefit from those services, he adds.

"Hospitalists are the ones taking care of those people with advanced, serious, and life-threatening illnesses," Dr. Pantilat says. "De facto, they are already doing this work."

A new study that shows cumulative antibiotic exposures appear to be associated with Clostridium difficile infections (CDI) should be seen as another reason to reduce the use of antibiotics to minimum levels, according to the paper's lead author.

"In terms of prevention, it's really important for us to start delineating [shortened antibiotic courses] in treating the primary infection," says Vanessa Stevens, PhD, a fellow at the Center for Health Outcomes, Pharmacoinformatics, and Epidemiology at the State University of New York at Buffalo. "What are the minimums that are necessary to accomplish the job?"

Dr. Stevens says CDI's growing incidence is clear; however, there is little research linking the risk to the total dose, duration, or number of antibiotics a patient receives. So her team set out to provide one of the first links. They found that compared to patients who received one antibiotic, the adjusted hazard ratios for those receiving two to five antibiotics were 2.5 (95% confidence interval [CI] 1.6-4.0), 3.3 (CI 2.2-5.2), and 9.6 (CI 6.1-15.1), respectively (Clin Infect Dis. 2011;53(1):42-48). Patients exposed to fluoroquinolones were associated with higher risk, while those given metronidazole saw reduced risk.

Dr. Stevens says she expected the research would confirm her suspicions that continued exposure to antibiotics increased risk of infection. Still, she says, the more difficult question is when to balance a minimalistic approach to antibiotic use with the need to aggressively deal with more acute primary infections.

"The risk of C. diff might be an acceptable risk in a case where you're treating a life-threatening infection," Dr. Stevens adds. "If you're treating acne or something that isn't a life-threatening condition to the patient, there has to be a balance."

A new study that shows cumulative antibiotic exposures appear to be associated with Clostridium difficile infections (CDI) should be seen as another reason to reduce the use of antibiotics to minimum levels, according to the paper's lead author.

"In terms of prevention, it's really important for us to start delineating [shortened antibiotic courses] in treating the primary infection," says Vanessa Stevens, PhD, a fellow at the Center for Health Outcomes, Pharmacoinformatics, and Epidemiology at the State University of New York at Buffalo. "What are the minimums that are necessary to accomplish the job?"

Dr. Stevens says CDI's growing incidence is clear; however, there is little research linking the risk to the total dose, duration, or number of antibiotics a patient receives. So her team set out to provide one of the first links. They found that compared to patients who received one antibiotic, the adjusted hazard ratios for those receiving two to five antibiotics were 2.5 (95% confidence interval [CI] 1.6-4.0), 3.3 (CI 2.2-5.2), and 9.6 (CI 6.1-15.1), respectively (Clin Infect Dis. 2011;53(1):42-48). Patients exposed to fluoroquinolones were associated with higher risk, while those given metronidazole saw reduced risk.

Dr. Stevens says she expected the research would confirm her suspicions that continued exposure to antibiotics increased risk of infection. Still, she says, the more difficult question is when to balance a minimalistic approach to antibiotic use with the need to aggressively deal with more acute primary infections.

"The risk of C. diff might be an acceptable risk in a case where you're treating a life-threatening infection," Dr. Stevens adds. "If you're treating acne or something that isn't a life-threatening condition to the patient, there has to be a balance."

A new study that shows cumulative antibiotic exposures appear to be associated with Clostridium difficile infections (CDI) should be seen as another reason to reduce the use of antibiotics to minimum levels, according to the paper's lead author.

"In terms of prevention, it's really important for us to start delineating [shortened antibiotic courses] in treating the primary infection," says Vanessa Stevens, PhD, a fellow at the Center for Health Outcomes, Pharmacoinformatics, and Epidemiology at the State University of New York at Buffalo. "What are the minimums that are necessary to accomplish the job?"

Dr. Stevens says CDI's growing incidence is clear; however, there is little research linking the risk to the total dose, duration, or number of antibiotics a patient receives. So her team set out to provide one of the first links. They found that compared to patients who received one antibiotic, the adjusted hazard ratios for those receiving two to five antibiotics were 2.5 (95% confidence interval [CI] 1.6-4.0), 3.3 (CI 2.2-5.2), and 9.6 (CI 6.1-15.1), respectively (Clin Infect Dis. 2011;53(1):42-48). Patients exposed to fluoroquinolones were associated with higher risk, while those given metronidazole saw reduced risk.

Dr. Stevens says she expected the research would confirm her suspicions that continued exposure to antibiotics increased risk of infection. Still, she says, the more difficult question is when to balance a minimalistic approach to antibiotic use with the need to aggressively deal with more acute primary infections.

"The risk of C. diff might be an acceptable risk in a case where you're treating a life-threatening infection," Dr. Stevens adds. "If you're treating acne or something that isn't a life-threatening condition to the patient, there has to be a balance."

A new risk prediction model for venous thromboembolism (VTE) that was validated in a recent study in England may portend a quicker way to test patients in the U.S.

A research team from the University of Nottingham in England developed an algorithm to measure a patient’s risk for VTE using data points often already collected by hospitalists, including information about chronic renal disease, heart failure, and body mass index. In the study, the risk prediction equation explained 33% of the variation in women and 34% in men in the validation cohort evaluated at five years (BMJ. 2011;343:d4656). The report added that the D statistic was 1.43 for women and 1.45 for men, while the receiver operating curve statistic was 0.75 for both sexes.

The researchers then created a website where physicians can input a set of data points on patients and generate a risk profile.

"The algorithm should be validated in the U.S., though we have no reason to think it won’t work in the U.S.," senior author Julia Hippisley-Cox, MD, FRCGP, MRCP, professor of clinical epidemiology and general practice at the University of Nottingham wrote in an email. "And assuming it performs well, then it could be used by hospital doctors to systematically risk assess patients for VTE risk on admission. Patients at high risk could be given prophylaxis."

Dr. Hippisley-Cox says it's too early to tell if the site will become a popular reference tool.

"The algorithm is published as open-source software, so anyone can use it for research," she writes. It "would be ... interesting to have a team of academics in the U.S. use it in a research project."

A new risk prediction model for venous thromboembolism (VTE) that was validated in a recent study in England may portend a quicker way to test patients in the U.S.

A research team from the University of Nottingham in England developed an algorithm to measure a patient’s risk for VTE using data points often already collected by hospitalists, including information about chronic renal disease, heart failure, and body mass index. In the study, the risk prediction equation explained 33% of the variation in women and 34% in men in the validation cohort evaluated at five years (BMJ. 2011;343:d4656). The report added that the D statistic was 1.43 for women and 1.45 for men, while the receiver operating curve statistic was 0.75 for both sexes.

The researchers then created a website where physicians can input a set of data points on patients and generate a risk profile.

"The algorithm should be validated in the U.S., though we have no reason to think it won’t work in the U.S.," senior author Julia Hippisley-Cox, MD, FRCGP, MRCP, professor of clinical epidemiology and general practice at the University of Nottingham wrote in an email. "And assuming it performs well, then it could be used by hospital doctors to systematically risk assess patients for VTE risk on admission. Patients at high risk could be given prophylaxis."

Dr. Hippisley-Cox says it's too early to tell if the site will become a popular reference tool.

"The algorithm is published as open-source software, so anyone can use it for research," she writes. It "would be ... interesting to have a team of academics in the U.S. use it in a research project."

A new risk prediction model for venous thromboembolism (VTE) that was validated in a recent study in England may portend a quicker way to test patients in the U.S.

A research team from the University of Nottingham in England developed an algorithm to measure a patient’s risk for VTE using data points often already collected by hospitalists, including information about chronic renal disease, heart failure, and body mass index. In the study, the risk prediction equation explained 33% of the variation in women and 34% in men in the validation cohort evaluated at five years (BMJ. 2011;343:d4656). The report added that the D statistic was 1.43 for women and 1.45 for men, while the receiver operating curve statistic was 0.75 for both sexes.

The researchers then created a website where physicians can input a set of data points on patients and generate a risk profile.

"The algorithm should be validated in the U.S., though we have no reason to think it won’t work in the U.S.," senior author Julia Hippisley-Cox, MD, FRCGP, MRCP, professor of clinical epidemiology and general practice at the University of Nottingham wrote in an email. "And assuming it performs well, then it could be used by hospital doctors to systematically risk assess patients for VTE risk on admission. Patients at high risk could be given prophylaxis."

Dr. Hippisley-Cox says it's too early to tell if the site will become a popular reference tool.

"The algorithm is published as open-source software, so anyone can use it for research," she writes. It "would be ... interesting to have a team of academics in the U.S. use it in a research project."

“Enter The Neurohospitalist” might sound like a medical spoof of a Bruce Lee movie, but it’s really a subspecialty’s announcement that it’s here to stay.

The clever moniker was the name of a plenary session at the 8th New York Symposium on Neurological Emergencies & Neurological Care, sponsored by Columbia University’s Center for Continuing Medical Education. The two-hour presentation on neurology’s take on HM was a new feature for the annual meeting, and to presenter

David Likosky, MD, SFHM, hospitalist and stroke program director at Evergreen Hospital Medical Center in Kirkland, Wash., it was the latest sign that the field of HM is cementing its future.

“The neurohospitalist world right now is where the hospital medicine world was, say, ten, fifteen years ago,” says Dr. Likosky, who is board-certified in both neurology and internal medicine.

Multiple fields have adopted the HM model, to the point that SHM is holding its first national specialty hospitalist meeting, Focused Practice in Hospital Medicine, on Nov. 4 in Las Vegas. The meeting is designed to help promote networking of people interested in the hospitalist model in various specialties, as well as to help identify issues related to those specialties. Click here for more information and registration.

But even within the growth of speciality hospitalist models, neurology might be the cohort embracing it the fastest. Dr. Likosky estimates there are 500 neurohospitalists practicing nationwide. The Neurohospitalist Society held its first meeting earlier this year, and the field’s first textbook, which he is contributing to, is set for release in November. The Academy of Neurology has a dedicated neurohospitalist section. And the subspecialty even has its own quarterly journal, The Neurohospitalist.

“There is now a critical mass of neurohospitalists,” Dr. Likosky says. “There’s also an increasing recognition by the neurointensivists that someone has to help them take care of these patients, either before they get to the unit or when they come out of the unit. … Most hospitals don’t have neurointensivists, but they have very ill neurology patients. That’s another niche for neurohospitalists. All specialties of intensivists are looking for help with these patients.”

Another panelist at the four-day Manhattan conference, William D. Freeman, MD, assistant professor of neurology at the Mayo Clinic in Jacksonville, Fla., says the continued success of the field will be judged on data. He says three areas of potential “low-hanging fruit” to focus on are:

• Increased use of intravenous tissue plasminogen activators (tPA). The FDA-approved “clot-busting therapy” has been shown to reverse the effects of ischemic stroke if given within a time-sensitive window of therapeutic opportunity.
• Reduced length of stay for stroke patients. Adherence to best practices, Dr. Freeman says, will most effectively reduce patient stays and will be the ones that also demonstrate quality and patient-safety attributes.
• Focus on stroke patient metrics. Administrators often focus on quality measures that are easily identifiable; Dr. Likosky says new programs have to be able to show they can meet those thresholds.

“Hospital administrators are new to the concept of a neurohospitalist,” Dr. Likosky adds. “It’s easier in that they get the hospitalist model because that’s been around for so long, but figuring out the expense of a neurohospitalist program, how that functionally works, are there enough volumes, are all questions that are being asked.”

Still, Drs. Freeman and Likosky agree that the advantages of the subspecialty—everything from physicians’ quality of life to newly satisfied specialists in other departments (who will have a quicker neuro consult available)—mean the nascent specialty can continue to grow in numbers and influence.

“The future is bright for neurohospitalists,” Dr. Freeman says.

Richard Quinn is a freelance writer based in New Jersey.

“Enter The Neurohospitalist” might sound like a medical spoof of a Bruce Lee movie, but it’s really a subspecialty’s announcement that it’s here to stay.

The clever moniker was the name of a plenary session at the 8th New York Symposium on Neurological Emergencies & Neurological Care, sponsored by Columbia University’s Center for Continuing Medical Education. The two-hour presentation on neurology’s take on HM was a new feature for the annual meeting, and to presenter

David Likosky, MD, SFHM, hospitalist and stroke program director at Evergreen Hospital Medical Center in Kirkland, Wash., it was the latest sign that the field of HM is cementing its future.

“The neurohospitalist world right now is where the hospital medicine world was, say, ten, fifteen years ago,” says Dr. Likosky, who is board-certified in both neurology and internal medicine.

Multiple fields have adopted the HM model, to the point that SHM is holding its first national specialty hospitalist meeting, Focused Practice in Hospital Medicine, on Nov. 4 in Las Vegas. The meeting is designed to help promote networking of people interested in the hospitalist model in various specialties, as well as to help identify issues related to those specialties. Click here for more information and registration.

But even within the growth of speciality hospitalist models, neurology might be the cohort embracing it the fastest. Dr. Likosky estimates there are 500 neurohospitalists practicing nationwide. The Neurohospitalist Society held its first meeting earlier this year, and the field’s first textbook, which he is contributing to, is set for release in November. The Academy of Neurology has a dedicated neurohospitalist section. And the subspecialty even has its own quarterly journal, The Neurohospitalist.

“There is now a critical mass of neurohospitalists,” Dr. Likosky says. “There’s also an increasing recognition by the neurointensivists that someone has to help them take care of these patients, either before they get to the unit or when they come out of the unit. … Most hospitals don’t have neurointensivists, but they have very ill neurology patients. That’s another niche for neurohospitalists. All specialties of intensivists are looking for help with these patients.”

Another panelist at the four-day Manhattan conference, William D. Freeman, MD, assistant professor of neurology at the Mayo Clinic in Jacksonville, Fla., says the continued success of the field will be judged on data. He says three areas of potential “low-hanging fruit” to focus on are:

• Increased use of intravenous tissue plasminogen activators (tPA). The FDA-approved “clot-busting therapy” has been shown to reverse the effects of ischemic stroke if given within a time-sensitive window of therapeutic opportunity.
• Reduced length of stay for stroke patients. Adherence to best practices, Dr. Freeman says, will most effectively reduce patient stays and will be the ones that also demonstrate quality and patient-safety attributes.
• Focus on stroke patient metrics. Administrators often focus on quality measures that are easily identifiable; Dr. Likosky says new programs have to be able to show they can meet those thresholds.

“Hospital administrators are new to the concept of a neurohospitalist,” Dr. Likosky adds. “It’s easier in that they get the hospitalist model because that’s been around for so long, but figuring out the expense of a neurohospitalist program, how that functionally works, are there enough volumes, are all questions that are being asked.”

Still, Drs. Freeman and Likosky agree that the advantages of the subspecialty—everything from physicians’ quality of life to newly satisfied specialists in other departments (who will have a quicker neuro consult available)—mean the nascent specialty can continue to grow in numbers and influence.

“The future is bright for neurohospitalists,” Dr. Freeman says.

Richard Quinn is a freelance writer based in New Jersey.

“Enter The Neurohospitalist” might sound like a medical spoof of a Bruce Lee movie, but it’s really a subspecialty’s announcement that it’s here to stay.

The clever moniker was the name of a plenary session at the 8th New York Symposium on Neurological Emergencies & Neurological Care, sponsored by Columbia University’s Center for Continuing Medical Education. The two-hour presentation on neurology’s take on HM was a new feature for the annual meeting, and to presenter

David Likosky, MD, SFHM, hospitalist and stroke program director at Evergreen Hospital Medical Center in Kirkland, Wash., it was the latest sign that the field of HM is cementing its future.

“The neurohospitalist world right now is where the hospital medicine world was, say, ten, fifteen years ago,” says Dr. Likosky, who is board-certified in both neurology and internal medicine.

Multiple fields have adopted the HM model, to the point that SHM is holding its first national specialty hospitalist meeting, Focused Practice in Hospital Medicine, on Nov. 4 in Las Vegas. The meeting is designed to help promote networking of people interested in the hospitalist model in various specialties, as well as to help identify issues related to those specialties. Click here for more information and registration.

But even within the growth of speciality hospitalist models, neurology might be the cohort embracing it the fastest. Dr. Likosky estimates there are 500 neurohospitalists practicing nationwide. The Neurohospitalist Society held its first meeting earlier this year, and the field’s first textbook, which he is contributing to, is set for release in November. The Academy of Neurology has a dedicated neurohospitalist section. And the subspecialty even has its own quarterly journal, The Neurohospitalist.

“There is now a critical mass of neurohospitalists,” Dr. Likosky says. “There’s also an increasing recognition by the neurointensivists that someone has to help them take care of these patients, either before they get to the unit or when they come out of the unit. … Most hospitals don’t have neurointensivists, but they have very ill neurology patients. That’s another niche for neurohospitalists. All specialties of intensivists are looking for help with these patients.”

Another panelist at the four-day Manhattan conference, William D. Freeman, MD, assistant professor of neurology at the Mayo Clinic in Jacksonville, Fla., says the continued success of the field will be judged on data. He says three areas of potential “low-hanging fruit” to focus on are:

• Increased use of intravenous tissue plasminogen activators (tPA). The FDA-approved “clot-busting therapy” has been shown to reverse the effects of ischemic stroke if given within a time-sensitive window of therapeutic opportunity.
• Reduced length of stay for stroke patients. Adherence to best practices, Dr. Freeman says, will most effectively reduce patient stays and will be the ones that also demonstrate quality and patient-safety attributes.
• Focus on stroke patient metrics. Administrators often focus on quality measures that are easily identifiable; Dr. Likosky says new programs have to be able to show they can meet those thresholds.

“Hospital administrators are new to the concept of a neurohospitalist,” Dr. Likosky adds. “It’s easier in that they get the hospitalist model because that’s been around for so long, but figuring out the expense of a neurohospitalist program, how that functionally works, are there enough volumes, are all questions that are being asked.”

Still, Drs. Freeman and Likosky agree that the advantages of the subspecialty—everything from physicians’ quality of life to newly satisfied specialists in other departments (who will have a quicker neuro consult available)—mean the nascent specialty can continue to grow in numbers and influence.

“The future is bright for neurohospitalists,” Dr. Freeman says.

Richard Quinn is a freelance writer based in New Jersey.

Hospitalists unfamiliar with palliative care might think that older patients are the ones generating higher costs per day and longer length of stay (LOS). But new research from a fellow hospitalist suggests that's not the case.

A report in this month's Journal of Hospital Medicine found that patients 65 years and older had a significantly lower cost per day ($811; P=0.02) and LOS (-1.8 days; P=0.003) for each decade increase in age (J Hosp Med. 2011;6(6):338-343). The data also show patients on surgical specialty services generate higher costs and higher LOS, a likely nod to the complexity of cases that land on those services, says University of Colorado Denver hospitalist Jean Youngwerth, MD.

"We were anticipating more from the start that patients who were older were going to have higher costs per day and LOS," says Dr. Youngwerth, who also serves as associate program director for the Colorado Palliative Medicine Fellowship and Director of the University of Colorado Hospital Palliative Care Consult Service. "A lot of times, it is younger patients who are the sickest of the sick.

"People will go full force on them and they won't necessarily have a lot of the conversations they'd be having with older patients. The assumption is 'They're young, they shouldn't be dying' … even though they're a very sick person."

Dr. Youngwerth says hospitalists working without the aid of institutional support can still make palliative-care discussions a priority.

"You don't need a specialist for that," she adds, "[for] sitting down and setting goals of care, learning about the person, and then making sure that we're matching what their goals and values are to their plan of care."

Hospitalists unfamiliar with palliative care might think that older patients are the ones generating higher costs per day and longer length of stay (LOS). But new research from a fellow hospitalist suggests that's not the case.

A report in this month's Journal of Hospital Medicine found that patients 65 years and older had a significantly lower cost per day ($811; P=0.02) and LOS (-1.8 days; P=0.003) for each decade increase in age (J Hosp Med. 2011;6(6):338-343). The data also show patients on surgical specialty services generate higher costs and higher LOS, a likely nod to the complexity of cases that land on those services, says University of Colorado Denver hospitalist Jean Youngwerth, MD.

"We were anticipating more from the start that patients who were older were going to have higher costs per day and LOS," says Dr. Youngwerth, who also serves as associate program director for the Colorado Palliative Medicine Fellowship and Director of the University of Colorado Hospital Palliative Care Consult Service. "A lot of times, it is younger patients who are the sickest of the sick.

"People will go full force on them and they won't necessarily have a lot of the conversations they'd be having with older patients. The assumption is 'They're young, they shouldn't be dying' … even though they're a very sick person."

Dr. Youngwerth says hospitalists working without the aid of institutional support can still make palliative-care discussions a priority.

"You don't need a specialist for that," she adds, "[for] sitting down and setting goals of care, learning about the person, and then making sure that we're matching what their goals and values are to their plan of care."

Hospitalists unfamiliar with palliative care might think that older patients are the ones generating higher costs per day and longer length of stay (LOS). But new research from a fellow hospitalist suggests that's not the case.

A report in this month's Journal of Hospital Medicine found that patients 65 years and older had a significantly lower cost per day ($811; P=0.02) and LOS (-1.8 days; P=0.003) for each decade increase in age (J Hosp Med. 2011;6(6):338-343). The data also show patients on surgical specialty services generate higher costs and higher LOS, a likely nod to the complexity of cases that land on those services, says University of Colorado Denver hospitalist Jean Youngwerth, MD.

"We were anticipating more from the start that patients who were older were going to have higher costs per day and LOS," says Dr. Youngwerth, who also serves as associate program director for the Colorado Palliative Medicine Fellowship and Director of the University of Colorado Hospital Palliative Care Consult Service. "A lot of times, it is younger patients who are the sickest of the sick.

"People will go full force on them and they won't necessarily have a lot of the conversations they'd be having with older patients. The assumption is 'They're young, they shouldn't be dying' … even though they're a very sick person."

Dr. Youngwerth says hospitalists working without the aid of institutional support can still make palliative-care discussions a priority.

"You don't need a specialist for that," she adds, "[for] sitting down and setting goals of care, learning about the person, and then making sure that we're matching what their goals and values are to their plan of care."

That the largest-ever study of glucose control in U.S. hospitals found roughly 1 in 3 patients are hyperglycemic (<180 mg/dL) during their hospital stay is no surprise to hospitalist Cheryl O'Malley, MD, FACP, program director of internal medicine at the Banner Good Samaritan Medical Center, Phoenix.

The data (PDF), based on point-of-care bedside glucose tests at 575 hospitals, showed hyperglycemia in 32.2% of ICU patients and 32% in non-ICU patients. Dr. O'Malley says the findings are further evidence that HM leaders have a duty to focus on glycemic control because so many of their patients are hyperglycemic.

Dr. O'Malley does her part as a mentor for SHM's Glycemic Control Mentored Initiative (GCMI) program, which recently expanded to a second cohort of 96 sites. The mentoring program has branched out to include nurses, physician assistants, and even two leading endocrinologists as mentors: Emory University School of Medicine's Guillermo Umpierrez, MD, FACP, FACE, and HealthPartners' John MacIndoe, MD.

SHM also has launched a microsite, dubbed eQUIPS (Electronic Quality Improvement Programs), which gives HM groups not involved in the mentoring program access to data analysis, benchmarking tools, and other services.

Kendall M. Rogers, MD, CPE, FACP, SFHM, associate professor of medicine and hospital medicine division chief at the University of New Mexico Health Sciences Center's Department of Internal Medicine, says SHM has always wanted to broaden the program to as many hospitals and physicians as possible to battle glycemic-control issues. And bringing in nationally respected endocrinologists as mentors furthers the goal to build "teams of experts within local hospitals."

"Hospitalists, endocrinologists, and other specialists have to work together," Dr. O'Malley adds. "The volume of work is just too much for any one group to bear."

That the largest-ever study of glucose control in U.S. hospitals found roughly 1 in 3 patients are hyperglycemic (<180 mg/dL) during their hospital stay is no surprise to hospitalist Cheryl O'Malley, MD, FACP, program director of internal medicine at the Banner Good Samaritan Medical Center, Phoenix.

The data (PDF), based on point-of-care bedside glucose tests at 575 hospitals, showed hyperglycemia in 32.2% of ICU patients and 32% in non-ICU patients. Dr. O'Malley says the findings are further evidence that HM leaders have a duty to focus on glycemic control because so many of their patients are hyperglycemic.

Dr. O'Malley does her part as a mentor for SHM's Glycemic Control Mentored Initiative (GCMI) program, which recently expanded to a second cohort of 96 sites. The mentoring program has branched out to include nurses, physician assistants, and even two leading endocrinologists as mentors: Emory University School of Medicine's Guillermo Umpierrez, MD, FACP, FACE, and HealthPartners' John MacIndoe, MD.

SHM also has launched a microsite, dubbed eQUIPS (Electronic Quality Improvement Programs), which gives HM groups not involved in the mentoring program access to data analysis, benchmarking tools, and other services.

Kendall M. Rogers, MD, CPE, FACP, SFHM, associate professor of medicine and hospital medicine division chief at the University of New Mexico Health Sciences Center's Department of Internal Medicine, says SHM has always wanted to broaden the program to as many hospitals and physicians as possible to battle glycemic-control issues. And bringing in nationally respected endocrinologists as mentors furthers the goal to build "teams of experts within local hospitals."

"Hospitalists, endocrinologists, and other specialists have to work together," Dr. O'Malley adds. "The volume of work is just too much for any one group to bear."

That the largest-ever study of glucose control in U.S. hospitals found roughly 1 in 3 patients are hyperglycemic (<180 mg/dL) during their hospital stay is no surprise to hospitalist Cheryl O'Malley, MD, FACP, program director of internal medicine at the Banner Good Samaritan Medical Center, Phoenix.

The data (PDF), based on point-of-care bedside glucose tests at 575 hospitals, showed hyperglycemia in 32.2% of ICU patients and 32% in non-ICU patients. Dr. O'Malley says the findings are further evidence that HM leaders have a duty to focus on glycemic control because so many of their patients are hyperglycemic.

Dr. O'Malley does her part as a mentor for SHM's Glycemic Control Mentored Initiative (GCMI) program, which recently expanded to a second cohort of 96 sites. The mentoring program has branched out to include nurses, physician assistants, and even two leading endocrinologists as mentors: Emory University School of Medicine's Guillermo Umpierrez, MD, FACP, FACE, and HealthPartners' John MacIndoe, MD.

SHM also has launched a microsite, dubbed eQUIPS (Electronic Quality Improvement Programs), which gives HM groups not involved in the mentoring program access to data analysis, benchmarking tools, and other services.

Kendall M. Rogers, MD, CPE, FACP, SFHM, associate professor of medicine and hospital medicine division chief at the University of New Mexico Health Sciences Center's Department of Internal Medicine, says SHM has always wanted to broaden the program to as many hospitals and physicians as possible to battle glycemic-control issues. And bringing in nationally respected endocrinologists as mentors furthers the goal to build "teams of experts within local hospitals."

"Hospitalists, endocrinologists, and other specialists have to work together," Dr. O'Malley adds. "The volume of work is just too much for any one group to bear."

“Enter The Neurohospitalist” might sound like a medical spoof of a Bruce Lee movie, but it’s really a subspecialty’s announcement that it’s here to stay.

The clever moniker was the name of a plenary session at the 8th New York Symposium on Neurological Emergencies & Neurological Care, sponsored by Columbia University’s Center for Continuing Medical Education. The two-hour presentation on neurology’s take on HM was a new feature for the annual meeting, and to presenter David Likosky, MD, SFHM, hospitalist and stroke program director at Evergreen Hospital Medical Center in Kirkland, Wash., it was the latest sign that the field of HM is cementing its future.

“The neurohospitalist world right now is where the hospital medicine world was, say, ten, fifteen years ago,” says Dr. Likosky, who is board-certified in both neurology and internal medicine.

Multiple fields have adopted the HM model, to the point that SHM is holding its first national specialty hospitalist meeting, Focused Practice in Hospital Medicine, on Nov. 4 in Las Vegas. The meeting is designed to help promote networking of people interested in the hospitalist model in various specialties, as well as to help identify issues related to those specialties. Click here for more information and registration.

But even within the growth of speciality hospitalist models, neurology might be the cohort embracing it the fastest. Dr. Likosky estimates there are 500 neurohospitalists practicing nationwide. The Neurohospitalist Society held its first meeting earlier this year, and the field’s first textbook, which he is contributing to, is set for release in November. The Academy of Neurology has a dedicated neurohospitalist section. And the subspecialty even has its own quarterly journal, The Neurohospitalist.

There is now a critical mass of neurohospitalists. There’s also an increasing recognition by the neurointensivists that someone has to help them take care of these patients, either before they get to the unit or when they come out of the unit.

—David Likosky, MD, SFHM, hospitalist, stroke program director, Evergreen Hospital Medical Center, Kirkland, Wash.

“There is now a critical mass of neurohospitalists,” Dr. Likosky says. “There’s also an increasing recognition by the neurointensivists that someone has to help them take care of these patients, either before they get to the unit or when they come out of the unit. … Most hospitals don’t have neurointensivists, but they have very ill neurology patients. That’s another niche for neurohospitalists. All specialties of intensivists are looking for help with these patients.”

Another panelist at the four-day Manhattan conference, William D. Freeman, MD, assistant professor of neurology at the Mayo Clinic in Jacksonville, Fla., says the continued success of the field will be judged on data. He says three areas of potential “low-hanging fruit” to focus on are:

• Increased use of intravenous tissue plasminogen activators (tPA). The FDA-approved “clot-busting therapy” has been shown to reverse the effects of ischemic stroke if given within a time-sensitive window of therapeutic opportunity.
• Reduced length of stay for stroke patients. Adherence to best practices, Dr. Freeman says, will most effectively reduce patient stays and will be the ones that also demonstrate quality and patient-safety attributes.
• Focus on stroke patient metrics. Administrators often focus on quality measures that are easily identifiable; Dr. Likosky says new programs have to be able to show they can meet those thresholds.

“Hospital administrators are new to the concept of a neurohospitalist,” Dr. Likosky adds. “It’s easier in that they get the hospitalist model because that’s been around for so long, but figuring out the expense of a neurohospitalist program, how that functionally works, are there enough volumes, are all questions that are being asked.”

Still, Drs. Freeman and Likosky agree that the advantages of the subspecialty—everything from physicians’ quality of life to newly satisfied specialists in other departments (who will have a quicker neuro consult available)—mean the nascent specialty can continue to grow in numbers and influence.

“The future is bright for neurohospitalists,” Dr. Freeman says.

Richard Quinn is a freelance writer based in New Jersey.

“Enter The Neurohospitalist” might sound like a medical spoof of a Bruce Lee movie, but it’s really a subspecialty’s announcement that it’s here to stay.

The clever moniker was the name of a plenary session at the 8th New York Symposium on Neurological Emergencies & Neurological Care, sponsored by Columbia University’s Center for Continuing Medical Education. The two-hour presentation on neurology’s take on HM was a new feature for the annual meeting, and to presenter David Likosky, MD, SFHM, hospitalist and stroke program director at Evergreen Hospital Medical Center in Kirkland, Wash., it was the latest sign that the field of HM is cementing its future.

“The neurohospitalist world right now is where the hospital medicine world was, say, ten, fifteen years ago,” says Dr. Likosky, who is board-certified in both neurology and internal medicine.

Multiple fields have adopted the HM model, to the point that SHM is holding its first national specialty hospitalist meeting, Focused Practice in Hospital Medicine, on Nov. 4 in Las Vegas. The meeting is designed to help promote networking of people interested in the hospitalist model in various specialties, as well as to help identify issues related to those specialties. Click here for more information and registration.

But even within the growth of speciality hospitalist models, neurology might be the cohort embracing it the fastest. Dr. Likosky estimates there are 500 neurohospitalists practicing nationwide. The Neurohospitalist Society held its first meeting earlier this year, and the field’s first textbook, which he is contributing to, is set for release in November. The Academy of Neurology has a dedicated neurohospitalist section. And the subspecialty even has its own quarterly journal, The Neurohospitalist.

There is now a critical mass of neurohospitalists. There’s also an increasing recognition by the neurointensivists that someone has to help them take care of these patients, either before they get to the unit or when they come out of the unit.

—David Likosky, MD, SFHM, hospitalist, stroke program director, Evergreen Hospital Medical Center, Kirkland, Wash.

“There is now a critical mass of neurohospitalists,” Dr. Likosky says. “There’s also an increasing recognition by the neurointensivists that someone has to help them take care of these patients, either before they get to the unit or when they come out of the unit. … Most hospitals don’t have neurointensivists, but they have very ill neurology patients. That’s another niche for neurohospitalists. All specialties of intensivists are looking for help with these patients.”

Another panelist at the four-day Manhattan conference, William D. Freeman, MD, assistant professor of neurology at the Mayo Clinic in Jacksonville, Fla., says the continued success of the field will be judged on data. He says three areas of potential “low-hanging fruit” to focus on are:

• Increased use of intravenous tissue plasminogen activators (tPA). The FDA-approved “clot-busting therapy” has been shown to reverse the effects of ischemic stroke if given within a time-sensitive window of therapeutic opportunity.
• Reduced length of stay for stroke patients. Adherence to best practices, Dr. Freeman says, will most effectively reduce patient stays and will be the ones that also demonstrate quality and patient-safety attributes.
• Focus on stroke patient metrics. Administrators often focus on quality measures that are easily identifiable; Dr. Likosky says new programs have to be able to show they can meet those thresholds.

“Hospital administrators are new to the concept of a neurohospitalist,” Dr. Likosky adds. “It’s easier in that they get the hospitalist model because that’s been around for so long, but figuring out the expense of a neurohospitalist program, how that functionally works, are there enough volumes, are all questions that are being asked.”

Still, Drs. Freeman and Likosky agree that the advantages of the subspecialty—everything from physicians’ quality of life to newly satisfied specialists in other departments (who will have a quicker neuro consult available)—mean the nascent specialty can continue to grow in numbers and influence.

“The future is bright for neurohospitalists,” Dr. Freeman says.

Richard Quinn is a freelance writer based in New Jersey.

“Enter The Neurohospitalist” might sound like a medical spoof of a Bruce Lee movie, but it’s really a subspecialty’s announcement that it’s here to stay.

The clever moniker was the name of a plenary session at the 8th New York Symposium on Neurological Emergencies & Neurological Care, sponsored by Columbia University’s Center for Continuing Medical Education. The two-hour presentation on neurology’s take on HM was a new feature for the annual meeting, and to presenter David Likosky, MD, SFHM, hospitalist and stroke program director at Evergreen Hospital Medical Center in Kirkland, Wash., it was the latest sign that the field of HM is cementing its future.

“The neurohospitalist world right now is where the hospital medicine world was, say, ten, fifteen years ago,” says Dr. Likosky, who is board-certified in both neurology and internal medicine.

Multiple fields have adopted the HM model, to the point that SHM is holding its first national specialty hospitalist meeting, Focused Practice in Hospital Medicine, on Nov. 4 in Las Vegas. The meeting is designed to help promote networking of people interested in the hospitalist model in various specialties, as well as to help identify issues related to those specialties. Click here for more information and registration.

But even within the growth of speciality hospitalist models, neurology might be the cohort embracing it the fastest. Dr. Likosky estimates there are 500 neurohospitalists practicing nationwide. The Neurohospitalist Society held its first meeting earlier this year, and the field’s first textbook, which he is contributing to, is set for release in November. The Academy of Neurology has a dedicated neurohospitalist section. And the subspecialty even has its own quarterly journal, The Neurohospitalist.

There is now a critical mass of neurohospitalists. There’s also an increasing recognition by the neurointensivists that someone has to help them take care of these patients, either before they get to the unit or when they come out of the unit.

—David Likosky, MD, SFHM, hospitalist, stroke program director, Evergreen Hospital Medical Center, Kirkland, Wash.

“There is now a critical mass of neurohospitalists,” Dr. Likosky says. “There’s also an increasing recognition by the neurointensivists that someone has to help them take care of these patients, either before they get to the unit or when they come out of the unit. … Most hospitals don’t have neurointensivists, but they have very ill neurology patients. That’s another niche for neurohospitalists. All specialties of intensivists are looking for help with these patients.”

Another panelist at the four-day Manhattan conference, William D. Freeman, MD, assistant professor of neurology at the Mayo Clinic in Jacksonville, Fla., says the continued success of the field will be judged on data. He says three areas of potential “low-hanging fruit” to focus on are:

• Increased use of intravenous tissue plasminogen activators (tPA). The FDA-approved “clot-busting therapy” has been shown to reverse the effects of ischemic stroke if given within a time-sensitive window of therapeutic opportunity.
• Reduced length of stay for stroke patients. Adherence to best practices, Dr. Freeman says, will most effectively reduce patient stays and will be the ones that also demonstrate quality and patient-safety attributes.
• Focus on stroke patient metrics. Administrators often focus on quality measures that are easily identifiable; Dr. Likosky says new programs have to be able to show they can meet those thresholds.

“Hospital administrators are new to the concept of a neurohospitalist,” Dr. Likosky adds. “It’s easier in that they get the hospitalist model because that’s been around for so long, but figuring out the expense of a neurohospitalist program, how that functionally works, are there enough volumes, are all questions that are being asked.”

Still, Drs. Freeman and Likosky agree that the advantages of the subspecialty—everything from physicians’ quality of life to newly satisfied specialists in other departments (who will have a quicker neuro consult available)—mean the nascent specialty can continue to grow in numbers and influence.

“The future is bright for neurohospitalists,” Dr. Freeman says.

Richard Quinn is a freelance writer based in New Jersey.

A new report that suggests the lower costs and reduced length of stay (LOS) associated with hospitalist care of hospitalized Medicare beneficiaries is offset by higher costs post-discharge highlights progress and opportunities for hospitalists, SHM's president says.

The federally-funded study published Monday in Annals of Internal Medicine showed that while hospitalists clearly reduced LOS and cut in-hospital spending (by $282 per hospital visit), Medicare costs in the 30 days post-discharge were $332 higher than those followed up by primary care physicians. Patients discharged by hospitalists were less likely to be sent straight home and more likely to be admitted to a nursing home.

SHM President Joseph Li, MD, SFHM, associate professor of medicine at Harvard Medical School and director of the hospital medicine division at Beth Israel Deaconess Medical Center in Boston, says the data underscores the need for programs like SHM's Project BOOST, which helps hospitals improve discharge and reduce readmissions.

Dr. Li notes two limitations to the research. First, the patients reviewed were all from 2001-2006, long before the current healthcare debate surrounding cost containment and patient safety. Second, the review does not account for the quality of medical care.

“The study was done at a time which was early in the hospitalist movement,” Dr. Li says. “It’s fair to say at that point we weren’t talking as a field as much about trying to prevent unnecessary readmissions. ... When I look at this study, I think it’s an opportunity for hospitalists to think how we can improve on communications with post-discharge facilities. How we can improve transitions.”

An accompanying editorial agreed, noting that while hospitalists and outpatient care might be viewed in different silos, “patients regularly move back and forth across that divide.”

“It is important to better understand the association between hospitalist care and costs,” editorial co-author Lena Chen, MD, MS, Division of General Medicine, University of Michigan, writes in an email to The Hospitalist. “This paper takes a big step towards addressing this subject with a large study, and will hopefully spur additional related research. That would be a good thing for hospital medicine.”

A new report that suggests the lower costs and reduced length of stay (LOS) associated with hospitalist care of hospitalized Medicare beneficiaries is offset by higher costs post-discharge highlights progress and opportunities for hospitalists, SHM's president says.

The federally-funded study published Monday in Annals of Internal Medicine showed that while hospitalists clearly reduced LOS and cut in-hospital spending (by $282 per hospital visit), Medicare costs in the 30 days post-discharge were $332 higher than those followed up by primary care physicians. Patients discharged by hospitalists were less likely to be sent straight home and more likely to be admitted to a nursing home.

SHM President Joseph Li, MD, SFHM, associate professor of medicine at Harvard Medical School and director of the hospital medicine division at Beth Israel Deaconess Medical Center in Boston, says the data underscores the need for programs like SHM's Project BOOST, which helps hospitals improve discharge and reduce readmissions.

Dr. Li notes two limitations to the research. First, the patients reviewed were all from 2001-2006, long before the current healthcare debate surrounding cost containment and patient safety. Second, the review does not account for the quality of medical care.

“The study was done at a time which was early in the hospitalist movement,” Dr. Li says. “It’s fair to say at that point we weren’t talking as a field as much about trying to prevent unnecessary readmissions. ... When I look at this study, I think it’s an opportunity for hospitalists to think how we can improve on communications with post-discharge facilities. How we can improve transitions.”

An accompanying editorial agreed, noting that while hospitalists and outpatient care might be viewed in different silos, “patients regularly move back and forth across that divide.”

“It is important to better understand the association between hospitalist care and costs,” editorial co-author Lena Chen, MD, MS, Division of General Medicine, University of Michigan, writes in an email to The Hospitalist. “This paper takes a big step towards addressing this subject with a large study, and will hopefully spur additional related research. That would be a good thing for hospital medicine.”

A new report that suggests the lower costs and reduced length of stay (LOS) associated with hospitalist care of hospitalized Medicare beneficiaries is offset by higher costs post-discharge highlights progress and opportunities for hospitalists, SHM's president says.

The federally-funded study published Monday in Annals of Internal Medicine showed that while hospitalists clearly reduced LOS and cut in-hospital spending (by $282 per hospital visit), Medicare costs in the 30 days post-discharge were $332 higher than those followed up by primary care physicians. Patients discharged by hospitalists were less likely to be sent straight home and more likely to be admitted to a nursing home.

SHM President Joseph Li, MD, SFHM, associate professor of medicine at Harvard Medical School and director of the hospital medicine division at Beth Israel Deaconess Medical Center in Boston, says the data underscores the need for programs like SHM's Project BOOST, which helps hospitals improve discharge and reduce readmissions.

Dr. Li notes two limitations to the research. First, the patients reviewed were all from 2001-2006, long before the current healthcare debate surrounding cost containment and patient safety. Second, the review does not account for the quality of medical care.

“The study was done at a time which was early in the hospitalist movement,” Dr. Li says. “It’s fair to say at that point we weren’t talking as a field as much about trying to prevent unnecessary readmissions. ... When I look at this study, I think it’s an opportunity for hospitalists to think how we can improve on communications with post-discharge facilities. How we can improve transitions.”

An accompanying editorial agreed, noting that while hospitalists and outpatient care might be viewed in different silos, “patients regularly move back and forth across that divide.”

“It is important to better understand the association between hospitalist care and costs,” editorial co-author Lena Chen, MD, MS, Division of General Medicine, University of Michigan, writes in an email to The Hospitalist. “This paper takes a big step towards addressing this subject with a large study, and will hopefully spur additional related research. That would be a good thing for hospital medicine.”

Health organizations and providers experienced in providing care across multiple settings have until Aug. 19 to apply for a new accountable care organizations (ACO) program through the Centers for Medicare & Medicaid Services (CMS) that promises to offer a higher level of savings than that offered through a previous initiative.

“Hospital medicine groups in and of themselves won’t be applying for it,” says Ron Greeno, MD, MHM, chief medical officer of Brentwood, Tenn.-based Cogent HMG, and chair of SHM's Public Policy Committee. “But the groups that are looking to participate will have hospitalists working for them.”

The new program, tiled the Pioneer ACO Model, was created to offer potentially higher payments to providers and organizations who have already worked under contracts tied to shared savings or care coordination. A related model, the Medicare Shared Savings Program, does not require any previous experience with such contracts. The latter program has completed accepting public comments, but no application deadline has yet been set. (updated Aug. 15, 2011)

Just how many groups apply for the Pioneer program will be interesting: Initially, CMS will enter participation agreements with up to 30 organizations, and each must serve at least 15,000 beneficiaries (5,000 in rural areas). The capped cohort size didn’t seem to spur additional interest, as CMS originally set an application deadline for July, but pushed it back a month after providers questioned whether they were given enough time.

Still, Dr. Greeno, for one, is anxious to see the first round of applications. “It won’t interest me in terms of who jumps in,” he says. “The robustness of the response is what I’m interested in…It’s not going to do (CMS) any good to build a program nobody participates in.”

Health organizations and providers experienced in providing care across multiple settings have until Aug. 19 to apply for a new accountable care organizations (ACO) program through the Centers for Medicare & Medicaid Services (CMS) that promises to offer a higher level of savings than that offered through a previous initiative.

“Hospital medicine groups in and of themselves won’t be applying for it,” says Ron Greeno, MD, MHM, chief medical officer of Brentwood, Tenn.-based Cogent HMG, and chair of SHM's Public Policy Committee. “But the groups that are looking to participate will have hospitalists working for them.”

The new program, tiled the Pioneer ACO Model, was created to offer potentially higher payments to providers and organizations who have already worked under contracts tied to shared savings or care coordination. A related model, the Medicare Shared Savings Program, does not require any previous experience with such contracts. The latter program has completed accepting public comments, but no application deadline has yet been set. (updated Aug. 15, 2011)

Just how many groups apply for the Pioneer program will be interesting: Initially, CMS will enter participation agreements with up to 30 organizations, and each must serve at least 15,000 beneficiaries (5,000 in rural areas). The capped cohort size didn’t seem to spur additional interest, as CMS originally set an application deadline for July, but pushed it back a month after providers questioned whether they were given enough time.

Still, Dr. Greeno, for one, is anxious to see the first round of applications. “It won’t interest me in terms of who jumps in,” he says. “The robustness of the response is what I’m interested in…It’s not going to do (CMS) any good to build a program nobody participates in.”

Health organizations and providers experienced in providing care across multiple settings have until Aug. 19 to apply for a new accountable care organizations (ACO) program through the Centers for Medicare & Medicaid Services (CMS) that promises to offer a higher level of savings than that offered through a previous initiative.

“Hospital medicine groups in and of themselves won’t be applying for it,” says Ron Greeno, MD, MHM, chief medical officer of Brentwood, Tenn.-based Cogent HMG, and chair of SHM's Public Policy Committee. “But the groups that are looking to participate will have hospitalists working for them.”

The new program, tiled the Pioneer ACO Model, was created to offer potentially higher payments to providers and organizations who have already worked under contracts tied to shared savings or care coordination. A related model, the Medicare Shared Savings Program, does not require any previous experience with such contracts. The latter program has completed accepting public comments, but no application deadline has yet been set. (updated Aug. 15, 2011)

Just how many groups apply for the Pioneer program will be interesting: Initially, CMS will enter participation agreements with up to 30 organizations, and each must serve at least 15,000 beneficiaries (5,000 in rural areas). The capped cohort size didn’t seem to spur additional interest, as CMS originally set an application deadline for July, but pushed it back a month after providers questioned whether they were given enough time.

Still, Dr. Greeno, for one, is anxious to see the first round of applications. “It won’t interest me in terms of who jumps in,” he says. “The robustness of the response is what I’m interested in…It’s not going to do (CMS) any good to build a program nobody participates in.”