Richard Quinn

A bill proposed in Congress to streamline the audit process of the Centers for Medicare & Medicaid Service (CMS) is being hailed by hospitalists as a needed step forward.

The Audit & Appeal Fairness, Integrity, and Reforms in Medicare (AFIRM) Act of 2015 would speed up the Recovery Audit Contractor (RAC) appeal process, shorten look-back periods, increase transparency, and allow licensed attorneys to serve as Medicare magistrates to adjudicate certain appeals. The proposed legislation, which was passed by the Senate Committee on Finance in June, is sponsored by Sen. Orrin Hatch (R-Utah) and Sen. Ron Wyden (D-Ore.).

"Although RAC audits, appeals, and hospital payment issues may seem convoluted and not a direct hospitalist issue, the flawed audit and appeals system has negative downstream effects on hospitalist practice, autonomy, and ultimately negatively impacts the patients we care for," SHM Public Policy Committee member Ann Sheehy, MD, MS, FHM, writes in an email to The Hospitalist. "We need audits in the Medicare system, but RAC reform is needed and long overdue."

Dr. Sheehy, a hospitalist at the University of Wisconsin School of Medicine and Public Health in Madison, testified in May 2014 before the House Committee on Ways and Means' Subcommittee on Health about the impact Medicare's two-midnight rule and RAC audit process have on hospitals.

Dr. Sheehy says hospitalists dealing with RAC audits of patients under observation status can wait years for appeals to be heard.

"At the heart of the observation problem is the reality that a provider's clinical judgment can be questioned by an auditor up to three years after care was delivered and payment denied," Dr. Sheehy adds.

The pending bill's bipartisan support is a hopeful sign, says hospitalist Jairy Hunter III, MD, MBA, SFHM, associate executive medical director for case management and care transitions at the Medical University of South Carolina in Charleston. Dr. Hunter, who attended SHM's Hospitalists on the Hill advocacy day last March, says efforts to streamline bureaucratic issues are an indication that politicians are starting to understand the impact of CMS' myriad rules and regulations.

"We advocated for much more sweeping improvements, but in my view, this is somewhat of a start," he says. "It means that Congress and the lawmakers are hearing what we're saying." TH

Visit our website for information on avoiding a Medicare audit.

A bill proposed in Congress to streamline the audit process of the Centers for Medicare & Medicaid Service (CMS) is being hailed by hospitalists as a needed step forward.

The Audit & Appeal Fairness, Integrity, and Reforms in Medicare (AFIRM) Act of 2015 would speed up the Recovery Audit Contractor (RAC) appeal process, shorten look-back periods, increase transparency, and allow licensed attorneys to serve as Medicare magistrates to adjudicate certain appeals. The proposed legislation, which was passed by the Senate Committee on Finance in June, is sponsored by Sen. Orrin Hatch (R-Utah) and Sen. Ron Wyden (D-Ore.).

"Although RAC audits, appeals, and hospital payment issues may seem convoluted and not a direct hospitalist issue, the flawed audit and appeals system has negative downstream effects on hospitalist practice, autonomy, and ultimately negatively impacts the patients we care for," SHM Public Policy Committee member Ann Sheehy, MD, MS, FHM, writes in an email to The Hospitalist. "We need audits in the Medicare system, but RAC reform is needed and long overdue."

Dr. Sheehy, a hospitalist at the University of Wisconsin School of Medicine and Public Health in Madison, testified in May 2014 before the House Committee on Ways and Means' Subcommittee on Health about the impact Medicare's two-midnight rule and RAC audit process have on hospitals.

Dr. Sheehy says hospitalists dealing with RAC audits of patients under observation status can wait years for appeals to be heard.

"At the heart of the observation problem is the reality that a provider's clinical judgment can be questioned by an auditor up to three years after care was delivered and payment denied," Dr. Sheehy adds.

The pending bill's bipartisan support is a hopeful sign, says hospitalist Jairy Hunter III, MD, MBA, SFHM, associate executive medical director for case management and care transitions at the Medical University of South Carolina in Charleston. Dr. Hunter, who attended SHM's Hospitalists on the Hill advocacy day last March, says efforts to streamline bureaucratic issues are an indication that politicians are starting to understand the impact of CMS' myriad rules and regulations.

"We advocated for much more sweeping improvements, but in my view, this is somewhat of a start," he says. "It means that Congress and the lawmakers are hearing what we're saying." TH

Visit our website for information on avoiding a Medicare audit.

A bill proposed in Congress to streamline the audit process of the Centers for Medicare & Medicaid Service (CMS) is being hailed by hospitalists as a needed step forward.

The Audit & Appeal Fairness, Integrity, and Reforms in Medicare (AFIRM) Act of 2015 would speed up the Recovery Audit Contractor (RAC) appeal process, shorten look-back periods, increase transparency, and allow licensed attorneys to serve as Medicare magistrates to adjudicate certain appeals. The proposed legislation, which was passed by the Senate Committee on Finance in June, is sponsored by Sen. Orrin Hatch (R-Utah) and Sen. Ron Wyden (D-Ore.).

"Although RAC audits, appeals, and hospital payment issues may seem convoluted and not a direct hospitalist issue, the flawed audit and appeals system has negative downstream effects on hospitalist practice, autonomy, and ultimately negatively impacts the patients we care for," SHM Public Policy Committee member Ann Sheehy, MD, MS, FHM, writes in an email to The Hospitalist. "We need audits in the Medicare system, but RAC reform is needed and long overdue."

Dr. Sheehy, a hospitalist at the University of Wisconsin School of Medicine and Public Health in Madison, testified in May 2014 before the House Committee on Ways and Means' Subcommittee on Health about the impact Medicare's two-midnight rule and RAC audit process have on hospitals.

Dr. Sheehy says hospitalists dealing with RAC audits of patients under observation status can wait years for appeals to be heard.

"At the heart of the observation problem is the reality that a provider's clinical judgment can be questioned by an auditor up to three years after care was delivered and payment denied," Dr. Sheehy adds.

The pending bill's bipartisan support is a hopeful sign, says hospitalist Jairy Hunter III, MD, MBA, SFHM, associate executive medical director for case management and care transitions at the Medical University of South Carolina in Charleston. Dr. Hunter, who attended SHM's Hospitalists on the Hill advocacy day last March, says efforts to streamline bureaucratic issues are an indication that politicians are starting to understand the impact of CMS' myriad rules and regulations.

"We advocated for much more sweeping improvements, but in my view, this is somewhat of a start," he says. "It means that Congress and the lawmakers are hearing what we're saying." TH

Visit our website for information on avoiding a Medicare audit.

The lead author of a new Journal of Hospital Medicine report says one step hospitalists can take toward reducing preventable rehospitalizations is identifying the common traits of frequently admitted patients.

Marilyn Szekendi, PhD, RN, director of quality research at University Health System Consortium (UHC) in Chicago, says learning the characteristics that lead to frequent admissions—defined as patients who are admitted five or more times within one year—can help identify solutions for preventing repeated hospitalizations. UHC is an alliance of nonprofit academic medical centers and their affiliated hospitals.

"The good news here is that this is very doable," Dr. Szekendi says. "Every hospital can run this analysis…and actually create a list of who these patients are, along with their names and medical record numbers, so you can look at their diagnosis, you can look at other characteristics of the patient, and do a real-time assessment of who they are."

For their report, Dr. Szekendi and colleagues studied 28,291 patients admitted 180,185 times to academic medical centers in the U.S. from 2011 to 2012. While the cohort comprised just 1.6% of all patients, it accounted for 8% of all admissions and 7% of direct costs.

Common factors linked with frequent readmissions included having significantly more comorbidities (an average of 7.1 versus 2.5), and 84% of their admissions are to medical services. In addition, this patient population has higher rates of psychosis or substance abuse, the researchers note. Although frequently admitted patients are slightly more likely than other patients to be on Medicaid or to be uninsured (27.6% versus 21.6%), nearly three-quarters have private or Medicare coverage.

"We know that there are many other factors that we didn't have data for, [such as] housing status, patients' preexisting access to other kinds of medical care," Dr. Szekendi says. "If we could do some further look at factors that define these patients, both nationally and individually, hospitals then would have some additional, really useful information about the patients that would further inform their improvement efforts. Going beyond the data...is the next step.”

Visit our website for more information on hospitalists' role in preventing readmissions.

The lead author of a new Journal of Hospital Medicine report says one step hospitalists can take toward reducing preventable rehospitalizations is identifying the common traits of frequently admitted patients.

Marilyn Szekendi, PhD, RN, director of quality research at University Health System Consortium (UHC) in Chicago, says learning the characteristics that lead to frequent admissions—defined as patients who are admitted five or more times within one year—can help identify solutions for preventing repeated hospitalizations. UHC is an alliance of nonprofit academic medical centers and their affiliated hospitals.

"The good news here is that this is very doable," Dr. Szekendi says. "Every hospital can run this analysis…and actually create a list of who these patients are, along with their names and medical record numbers, so you can look at their diagnosis, you can look at other characteristics of the patient, and do a real-time assessment of who they are."

For their report, Dr. Szekendi and colleagues studied 28,291 patients admitted 180,185 times to academic medical centers in the U.S. from 2011 to 2012. While the cohort comprised just 1.6% of all patients, it accounted for 8% of all admissions and 7% of direct costs.

Common factors linked with frequent readmissions included having significantly more comorbidities (an average of 7.1 versus 2.5), and 84% of their admissions are to medical services. In addition, this patient population has higher rates of psychosis or substance abuse, the researchers note. Although frequently admitted patients are slightly more likely than other patients to be on Medicaid or to be uninsured (27.6% versus 21.6%), nearly three-quarters have private or Medicare coverage.

"We know that there are many other factors that we didn't have data for, [such as] housing status, patients' preexisting access to other kinds of medical care," Dr. Szekendi says. "If we could do some further look at factors that define these patients, both nationally and individually, hospitals then would have some additional, really useful information about the patients that would further inform their improvement efforts. Going beyond the data...is the next step.”

Visit our website for more information on hospitalists' role in preventing readmissions.

The lead author of a new Journal of Hospital Medicine report says one step hospitalists can take toward reducing preventable rehospitalizations is identifying the common traits of frequently admitted patients.

Marilyn Szekendi, PhD, RN, director of quality research at University Health System Consortium (UHC) in Chicago, says learning the characteristics that lead to frequent admissions—defined as patients who are admitted five or more times within one year—can help identify solutions for preventing repeated hospitalizations. UHC is an alliance of nonprofit academic medical centers and their affiliated hospitals.

"The good news here is that this is very doable," Dr. Szekendi says. "Every hospital can run this analysis…and actually create a list of who these patients are, along with their names and medical record numbers, so you can look at their diagnosis, you can look at other characteristics of the patient, and do a real-time assessment of who they are."

For their report, Dr. Szekendi and colleagues studied 28,291 patients admitted 180,185 times to academic medical centers in the U.S. from 2011 to 2012. While the cohort comprised just 1.6% of all patients, it accounted for 8% of all admissions and 7% of direct costs.

Common factors linked with frequent readmissions included having significantly more comorbidities (an average of 7.1 versus 2.5), and 84% of their admissions are to medical services. In addition, this patient population has higher rates of psychosis or substance abuse, the researchers note. Although frequently admitted patients are slightly more likely than other patients to be on Medicaid or to be uninsured (27.6% versus 21.6%), nearly three-quarters have private or Medicare coverage.

"We know that there are many other factors that we didn't have data for, [such as] housing status, patients' preexisting access to other kinds of medical care," Dr. Szekendi says. "If we could do some further look at factors that define these patients, both nationally and individually, hospitals then would have some additional, really useful information about the patients that would further inform their improvement efforts. Going beyond the data...is the next step.”

Visit our website for more information on hospitalists' role in preventing readmissions.

Christopher Frost, MD, FHM, has accomplished a lot in his career. He retired as a major from the U.S. Air Force Reserve. He's been an ED physician. And now he is the chief medical officer of hospital-based physicians for Hospital Corporation of America.

Yet, he considers being the newest member of SHM's Board of Directors a distinct honor.

"I am truly humbled to be participating with this group of energetic, intelligent, and wise individuals that comprise the SHM board," Dr. Frost says in an e-mail interview with The Hospitalist. "[I'm] very eager to participate with this group, and ultimately, I would like for us, not me, to be able to say we had some positive impact on the specialty, whether that be for our providers, patients, families, or some combination thereof."

Question: What drew you to hospital medicine?

Answer: During my chief [residency] year, I started moonlighting as a hospitalist for a large hematology/oncology group. I enjoyed the experience but did not really consider hospital medicine as a career option until I received a call asking if I knew of any residents who might be interested in joining a hospital medicine group undergoing rapid growth. Up until that moment, hospital medicine was just a moonlighting gig. It was still a relatively nascent specialty, and I did not realize it could be a career path. The call served as a catalyst to rethink my options.

Q: What keeps you engaged in the specialty?

A: The specialty attracts change agents. Individuals that are not necessarily satisfied with the status quo but instead are interested in collaborating with others to affect change. From a local level, in our community hospitals where hospitalists chair committees or serve as chiefs of staff, all the way to the national level where hospitalists are serving in such roles as the CMO of the Centers for Medicare & Medicaid Services or as the U.S. Surgeon General.

Q: As a new board member, what do you now realize that you didn’t before?

A: One is what it means to be a part of a “big tent” organization, and the other is an appreciation of the breadth and depth of the talent found among the SHM staff. I knew that SHM was involved in a lot of different activities and that several other specialty societies and organizations seek out SHM based on the collaborative nature of our specialty society; however, I didn't appreciate just how broad the scope of involvement extends. TH

Visit our website for more information on leadership.

Christopher Frost, MD, FHM, has accomplished a lot in his career. He retired as a major from the U.S. Air Force Reserve. He's been an ED physician. And now he is the chief medical officer of hospital-based physicians for Hospital Corporation of America.

Yet, he considers being the newest member of SHM's Board of Directors a distinct honor.

"I am truly humbled to be participating with this group of energetic, intelligent, and wise individuals that comprise the SHM board," Dr. Frost says in an e-mail interview with The Hospitalist. "[I'm] very eager to participate with this group, and ultimately, I would like for us, not me, to be able to say we had some positive impact on the specialty, whether that be for our providers, patients, families, or some combination thereof."

Question: What drew you to hospital medicine?

Answer: During my chief [residency] year, I started moonlighting as a hospitalist for a large hematology/oncology group. I enjoyed the experience but did not really consider hospital medicine as a career option until I received a call asking if I knew of any residents who might be interested in joining a hospital medicine group undergoing rapid growth. Up until that moment, hospital medicine was just a moonlighting gig. It was still a relatively nascent specialty, and I did not realize it could be a career path. The call served as a catalyst to rethink my options.

Q: What keeps you engaged in the specialty?

A: The specialty attracts change agents. Individuals that are not necessarily satisfied with the status quo but instead are interested in collaborating with others to affect change. From a local level, in our community hospitals where hospitalists chair committees or serve as chiefs of staff, all the way to the national level where hospitalists are serving in such roles as the CMO of the Centers for Medicare & Medicaid Services or as the U.S. Surgeon General.

Q: As a new board member, what do you now realize that you didn’t before?

A: One is what it means to be a part of a “big tent” organization, and the other is an appreciation of the breadth and depth of the talent found among the SHM staff. I knew that SHM was involved in a lot of different activities and that several other specialty societies and organizations seek out SHM based on the collaborative nature of our specialty society; however, I didn't appreciate just how broad the scope of involvement extends. TH

Visit our website for more information on leadership.

Christopher Frost, MD, FHM, has accomplished a lot in his career. He retired as a major from the U.S. Air Force Reserve. He's been an ED physician. And now he is the chief medical officer of hospital-based physicians for Hospital Corporation of America.

Yet, he considers being the newest member of SHM's Board of Directors a distinct honor.

"I am truly humbled to be participating with this group of energetic, intelligent, and wise individuals that comprise the SHM board," Dr. Frost says in an e-mail interview with The Hospitalist. "[I'm] very eager to participate with this group, and ultimately, I would like for us, not me, to be able to say we had some positive impact on the specialty, whether that be for our providers, patients, families, or some combination thereof."

Question: What drew you to hospital medicine?

Answer: During my chief [residency] year, I started moonlighting as a hospitalist for a large hematology/oncology group. I enjoyed the experience but did not really consider hospital medicine as a career option until I received a call asking if I knew of any residents who might be interested in joining a hospital medicine group undergoing rapid growth. Up until that moment, hospital medicine was just a moonlighting gig. It was still a relatively nascent specialty, and I did not realize it could be a career path. The call served as a catalyst to rethink my options.

Q: What keeps you engaged in the specialty?

A: The specialty attracts change agents. Individuals that are not necessarily satisfied with the status quo but instead are interested in collaborating with others to affect change. From a local level, in our community hospitals where hospitalists chair committees or serve as chiefs of staff, all the way to the national level where hospitalists are serving in such roles as the CMO of the Centers for Medicare & Medicaid Services or as the U.S. Surgeon General.

Q: As a new board member, what do you now realize that you didn’t before?

A: One is what it means to be a part of a “big tent” organization, and the other is an appreciation of the breadth and depth of the talent found among the SHM staff. I knew that SHM was involved in a lot of different activities and that several other specialty societies and organizations seek out SHM based on the collaborative nature of our specialty society; however, I didn't appreciate just how broad the scope of involvement extends. TH

Visit our website for more information on leadership.

Studies show nearly one in three hospitalists will experience long-term exhaustion or diminished interest in their work.1 Burned out physicians have low empathy, don’t communicate well, and provide poor quality of care. Not only does burnout lower quality of care, it is also costly and affects physicians’ personal lives. Unfortunately, despite more than a decade of research and effort to improve burnout, there seems to be no secret formula.

“We see burnout in our quality metrics. We see it in increased medical errors. Patient compliance can be tied to burnout and poor patient satisfaction, as well,” said Jerome C. Siy, MD, CHIE, SFHM, during his HM15 session last month at the Gaylord National Resort and Conference Center in National Harbor, Md. “What is really important to understand is that burnout results in high turnover and early retirement. Conservative estimates tell us a burned out physician can cost the hospital system $250,000.”

Dr. Siy’s talk, “Preventing Hospitalist Burnout through Engagement,” went beyond the basics of burnout (higher rates of substance abuse, depression, suicidal ideation, and family conflicts) and explored the systematic reasons for its occurrence in hospital medicine. The 2009 winner of SHM’s Award for Clinical Excellence also outlined a handful of ways HM groups can engage and combat burnout.

“What is interesting is that the rate that our profession has burnout is inversely proportional to the rate of the U.S. general population,” said Dr. Siy, assistant professor of medicine at the University of Minnesota Medical School and department head of hospital medicine at HealthPartners Medical Group in Minneapolis. “In the general U.S. population, the higher your level of education, the lower the rates of burnout. And yet we, physicians, have a remarkably high rate of burnout compared with those at our education level.

“And when they broke it out by specialty, it was front-line physicians that have the highest rates of burnout.”

Dr. Siy says burnout is partly the fault of the “system,” in terms of workload and performance pressures. His hospitalist group has implemented mindfulness training with a guru and empathy training with age simulators. They employ geographic-based teams and bedside rounds with nursing. They’ve even hired scribes on the observation unit.

“Not only are we trying to address burnout from the individual physician perspective, but we’re trying to address the causes of burnout,” he says.

Dr. Siy also showed attendees a video on engagement by best-selling author Daniel Pink. The three factors Pink believes lead to better performance and personal satisfaction are autonomy, mastery, purpose. And Pink encourages business leaders to “take compensation off the table.”

“He talks about how compensation is important and drives things, but actually, if you are fair with your compensation, it no longer incents your workforce,” Dr. Siy reiterates. “So if compensation is a big issue for you, you should know that.”

Most important, he says, “It’s about creating a culture.” He provided this list of ways to engage hospitalists:

• Add a measure of physician engagement to your scorecard;
• Translate engagement data by having presence in the workspace, even when off service;
• Employ individualized and group time to provide feedback and mentoring, develop relationships, learn new skills, and grow;
• Have physicians lead and partner in quality improvement efforts;
• Have regular, formal meetings with opportunities for open discussion;
• Incorporate professional development into your culture;
• Develop a common sense of purpose inside and outside of the hospital; and
• Structure compensation to reflect your values.

“Everyone in your group has to have an opportunity to grow,” he says. “They need to know that you, the group leaders … and the system care about them.” TH

 

Reference

1. Hinami K, Whelan CT, Miller JA, Wolosin RJ, Wetterneck TB, Society of Hospital Medicine Career Satisfaction Task Force. Job characteristics, satisfaction, and burnout across hospitalist practice models. J Hosp Med. 2012;7(5):402-410.

Studies show nearly one in three hospitalists will experience long-term exhaustion or diminished interest in their work.1 Burned out physicians have low empathy, don’t communicate well, and provide poor quality of care. Not only does burnout lower quality of care, it is also costly and affects physicians’ personal lives. Unfortunately, despite more than a decade of research and effort to improve burnout, there seems to be no secret formula.

“We see burnout in our quality metrics. We see it in increased medical errors. Patient compliance can be tied to burnout and poor patient satisfaction, as well,” said Jerome C. Siy, MD, CHIE, SFHM, during his HM15 session last month at the Gaylord National Resort and Conference Center in National Harbor, Md. “What is really important to understand is that burnout results in high turnover and early retirement. Conservative estimates tell us a burned out physician can cost the hospital system $250,000.”

Dr. Siy’s talk, “Preventing Hospitalist Burnout through Engagement,” went beyond the basics of burnout (higher rates of substance abuse, depression, suicidal ideation, and family conflicts) and explored the systematic reasons for its occurrence in hospital medicine. The 2009 winner of SHM’s Award for Clinical Excellence also outlined a handful of ways HM groups can engage and combat burnout.

“What is interesting is that the rate that our profession has burnout is inversely proportional to the rate of the U.S. general population,” said Dr. Siy, assistant professor of medicine at the University of Minnesota Medical School and department head of hospital medicine at HealthPartners Medical Group in Minneapolis. “In the general U.S. population, the higher your level of education, the lower the rates of burnout. And yet we, physicians, have a remarkably high rate of burnout compared with those at our education level.

“And when they broke it out by specialty, it was front-line physicians that have the highest rates of burnout.”

Dr. Siy says burnout is partly the fault of the “system,” in terms of workload and performance pressures. His hospitalist group has implemented mindfulness training with a guru and empathy training with age simulators. They employ geographic-based teams and bedside rounds with nursing. They’ve even hired scribes on the observation unit.

“Not only are we trying to address burnout from the individual physician perspective, but we’re trying to address the causes of burnout,” he says.

Dr. Siy also showed attendees a video on engagement by best-selling author Daniel Pink. The three factors Pink believes lead to better performance and personal satisfaction are autonomy, mastery, purpose. And Pink encourages business leaders to “take compensation off the table.”

“He talks about how compensation is important and drives things, but actually, if you are fair with your compensation, it no longer incents your workforce,” Dr. Siy reiterates. “So if compensation is a big issue for you, you should know that.”

Most important, he says, “It’s about creating a culture.” He provided this list of ways to engage hospitalists:

• Add a measure of physician engagement to your scorecard;
• Translate engagement data by having presence in the workspace, even when off service;
• Employ individualized and group time to provide feedback and mentoring, develop relationships, learn new skills, and grow;
• Have physicians lead and partner in quality improvement efforts;
• Have regular, formal meetings with opportunities for open discussion;
• Incorporate professional development into your culture;
• Develop a common sense of purpose inside and outside of the hospital; and
• Structure compensation to reflect your values.

“Everyone in your group has to have an opportunity to grow,” he says. “They need to know that you, the group leaders … and the system care about them.” TH

 

Reference

1. Hinami K, Whelan CT, Miller JA, Wolosin RJ, Wetterneck TB, Society of Hospital Medicine Career Satisfaction Task Force. Job characteristics, satisfaction, and burnout across hospitalist practice models. J Hosp Med. 2012;7(5):402-410.

Studies show nearly one in three hospitalists will experience long-term exhaustion or diminished interest in their work.1 Burned out physicians have low empathy, don’t communicate well, and provide poor quality of care. Not only does burnout lower quality of care, it is also costly and affects physicians’ personal lives. Unfortunately, despite more than a decade of research and effort to improve burnout, there seems to be no secret formula.

“We see burnout in our quality metrics. We see it in increased medical errors. Patient compliance can be tied to burnout and poor patient satisfaction, as well,” said Jerome C. Siy, MD, CHIE, SFHM, during his HM15 session last month at the Gaylord National Resort and Conference Center in National Harbor, Md. “What is really important to understand is that burnout results in high turnover and early retirement. Conservative estimates tell us a burned out physician can cost the hospital system $250,000.”

Dr. Siy’s talk, “Preventing Hospitalist Burnout through Engagement,” went beyond the basics of burnout (higher rates of substance abuse, depression, suicidal ideation, and family conflicts) and explored the systematic reasons for its occurrence in hospital medicine. The 2009 winner of SHM’s Award for Clinical Excellence also outlined a handful of ways HM groups can engage and combat burnout.

“What is interesting is that the rate that our profession has burnout is inversely proportional to the rate of the U.S. general population,” said Dr. Siy, assistant professor of medicine at the University of Minnesota Medical School and department head of hospital medicine at HealthPartners Medical Group in Minneapolis. “In the general U.S. population, the higher your level of education, the lower the rates of burnout. And yet we, physicians, have a remarkably high rate of burnout compared with those at our education level.

“And when they broke it out by specialty, it was front-line physicians that have the highest rates of burnout.”

Dr. Siy says burnout is partly the fault of the “system,” in terms of workload and performance pressures. His hospitalist group has implemented mindfulness training with a guru and empathy training with age simulators. They employ geographic-based teams and bedside rounds with nursing. They’ve even hired scribes on the observation unit.

“Not only are we trying to address burnout from the individual physician perspective, but we’re trying to address the causes of burnout,” he says.

Dr. Siy also showed attendees a video on engagement by best-selling author Daniel Pink. The three factors Pink believes lead to better performance and personal satisfaction are autonomy, mastery, purpose. And Pink encourages business leaders to “take compensation off the table.”

“He talks about how compensation is important and drives things, but actually, if you are fair with your compensation, it no longer incents your workforce,” Dr. Siy reiterates. “So if compensation is a big issue for you, you should know that.”

Most important, he says, “It’s about creating a culture.” He provided this list of ways to engage hospitalists:

• Add a measure of physician engagement to your scorecard;
• Translate engagement data by having presence in the workspace, even when off service;
• Employ individualized and group time to provide feedback and mentoring, develop relationships, learn new skills, and grow;
• Have physicians lead and partner in quality improvement efforts;
• Have regular, formal meetings with opportunities for open discussion;
• Incorporate professional development into your culture;
• Develop a common sense of purpose inside and outside of the hospital; and
• Structure compensation to reflect your values.

“Everyone in your group has to have an opportunity to grow,” he says. “They need to know that you, the group leaders … and the system care about them.” TH

 

Reference

1. Hinami K, Whelan CT, Miller JA, Wolosin RJ, Wetterneck TB, Society of Hospital Medicine Career Satisfaction Task Force. Job characteristics, satisfaction, and burnout across hospitalist practice models. J Hosp Med. 2012;7(5):402-410.

NATIONAL HARBOR, Md.—Cherry trees weren’t the only things that blossomed around Washington last month. SHM’s annual meeting, with roughly 2,500 attendees, featured 100 educational sessions, a day of Congressional lobbying, and plenaries from the “Checklist Doctor” and the Dean of Hospital Medicine. Pre-courses, the popular poster competition, and updates on everything from anticoagulants to VTE helped round out HM15, the specialty’s biggest annual event.

“I come to the meeting,” says new SHM President Robert Harrington, Jr., MD, SFHM, “and then for the next 362 days, this is enough to get me through the rest of the year ‘til I come back.”

NATIONAL HARBOR, Md.—Cherry trees weren’t the only things that blossomed around Washington last month. SHM’s annual meeting, with roughly 2,500 attendees, featured 100 educational sessions, a day of Congressional lobbying, and plenaries from the “Checklist Doctor” and the Dean of Hospital Medicine. Pre-courses, the popular poster competition, and updates on everything from anticoagulants to VTE helped round out HM15, the specialty’s biggest annual event.

“I come to the meeting,” says new SHM President Robert Harrington, Jr., MD, SFHM, “and then for the next 362 days, this is enough to get me through the rest of the year ‘til I come back.”

NATIONAL HARBOR, Md.—Cherry trees weren’t the only things that blossomed around Washington last month. SHM’s annual meeting, with roughly 2,500 attendees, featured 100 educational sessions, a day of Congressional lobbying, and plenaries from the “Checklist Doctor” and the Dean of Hospital Medicine. Pre-courses, the popular poster competition, and updates on everything from anticoagulants to VTE helped round out HM15, the specialty’s biggest annual event.

“I come to the meeting,” says new SHM President Robert Harrington, Jr., MD, SFHM, “and then for the next 362 days, this is enough to get me through the rest of the year ‘til I come back.”

NATIONAL HARBOR, Md.—Don Lee, MD, MPH, is building what one might call an analog quality improvement (QI) project focused on reducing readmissions. What the medical director for clinical integration at Columbia St. Mary’s in Milwaukee does is work with patient navigators to make follow-up phone calls after discharge to get ahead of potential issues.

What he wants to do is design a system that ensures that happens.

So, he came to HM15 for help.

“I’m very interested in continuous quality improvement. I wanted to work on how to not only get the project off the ground, but also to make sure what we are doing is good, and it’s doing what it’s supposed to be doing,” Dr. Lee says.

Well, he came to the right place. Quality and patient safety are hallmarks of the annual meeting; this year’s gathering was no exception. Plenaries provided advice from national thought leaders on improving safety by improving the patient experience; breakout sessions focused on how to build, maintain, and sustain QI projects; and SHM unveiled a new educational track dubbed the “Doctor-Patient Relationship.”

Hospital medicine, and healthcare in a broader sense, needs to be able to define safety better to attack it proactively, says Maureen Bisognano, president and CEO of the Institute for Healthcare Improvement (IHI). She compared medicine to NASA, which tracks its missions in a continuum of both successes and failures to understand what processes and protocols lay behind each.

Medicine has no such pathway laid out to date, though Bisognano said her task for the next year is to try to define one.

“We don’t know what the system of safety looks like,” she said. “We don’t know how many times we duplicate tests on admission because we haven’t connected with primary care. We don’t know how many times we send somebody home with inadequate social support, no food, and no way to pick up their prescription.

“We don’t have a sense of where our near-misses are, so we don’t have a vision of safety.”

Hospitalist Kedar Mate, MD, senior vice president for innovation at IHI, says that QI projects can seem daunting in the midst of daily censuses, hospital committee meetings, and a myriad of other responsibilities physicians face. But much of that fear is perception. A project can be simple or system-wide. The trick is just getting started in the face of perceived hurdles, he adds.

“Language around quality improvement tends to confuse and create mystery, and the jargon and so on creates interference,” says Dr. Mate, an assistant professor of medicine at Weill Cornell Medical College in New York City and a research fellow at Harvard Medical School’s Division of Global Health Equity. “It’s not that mysterious. It’s kind of a straightforward thing, actually, if you work through it logically and stepwise.”

And, as front-line providers, hospitalists are primed to lead healthcare systems in how to deliver care, he said.

“Formerly, physicians were iterant, right?” Dr. Mate adds. “They would come in and out of institutions and didn’t really have a stake in the game, on some level, of institutional quality. That’s totally different now.”

But, while the individual hospitalist has a responsibility to embrace safety initiatives, employers and industry groups have a duty to provide the proper resources to make that connection easier.

“The individual’s responsibility is to try to access that information to carry on in the face of busy schedules and busy lives,” Dr. Mate says. “SHM, IHI, and others have a responsibility to try to make those that are inclined able to continue and able to build and move their efforts forward in an even more productive way.”

 

Inclined docs like Dr. Lee, who know that their hospitals collect reams of data that can be useful for patient safety projects, many times have no idea how to extract said data. He has learned that partnering with “gatekeepers” is a way to help others help him.

“We are collecting data every second, every minute,” Dr. Lee says. “It’s amazing how much data we have, but to actually sift through it and make it meaningful is very difficult. You have to know what questions to ask and you have to get buy-in from the [gatekeepers], because they get thousands of requests for data extraction.”

---

Richard Quinn is a freelance writer in New Jersey.

NATIONAL HARBOR, Md.—Don Lee, MD, MPH, is building what one might call an analog quality improvement (QI) project focused on reducing readmissions. What the medical director for clinical integration at Columbia St. Mary’s in Milwaukee does is work with patient navigators to make follow-up phone calls after discharge to get ahead of potential issues.

What he wants to do is design a system that ensures that happens.

So, he came to HM15 for help.

“I’m very interested in continuous quality improvement. I wanted to work on how to not only get the project off the ground, but also to make sure what we are doing is good, and it’s doing what it’s supposed to be doing,” Dr. Lee says.

Well, he came to the right place. Quality and patient safety are hallmarks of the annual meeting; this year’s gathering was no exception. Plenaries provided advice from national thought leaders on improving safety by improving the patient experience; breakout sessions focused on how to build, maintain, and sustain QI projects; and SHM unveiled a new educational track dubbed the “Doctor-Patient Relationship.”

Hospital medicine, and healthcare in a broader sense, needs to be able to define safety better to attack it proactively, says Maureen Bisognano, president and CEO of the Institute for Healthcare Improvement (IHI). She compared medicine to NASA, which tracks its missions in a continuum of both successes and failures to understand what processes and protocols lay behind each.

Medicine has no such pathway laid out to date, though Bisognano said her task for the next year is to try to define one.

“We don’t know what the system of safety looks like,” she said. “We don’t know how many times we duplicate tests on admission because we haven’t connected with primary care. We don’t know how many times we send somebody home with inadequate social support, no food, and no way to pick up their prescription.

“We don’t have a sense of where our near-misses are, so we don’t have a vision of safety.”

Hospitalist Kedar Mate, MD, senior vice president for innovation at IHI, says that QI projects can seem daunting in the midst of daily censuses, hospital committee meetings, and a myriad of other responsibilities physicians face. But much of that fear is perception. A project can be simple or system-wide. The trick is just getting started in the face of perceived hurdles, he adds.

“Language around quality improvement tends to confuse and create mystery, and the jargon and so on creates interference,” says Dr. Mate, an assistant professor of medicine at Weill Cornell Medical College in New York City and a research fellow at Harvard Medical School’s Division of Global Health Equity. “It’s not that mysterious. It’s kind of a straightforward thing, actually, if you work through it logically and stepwise.”

And, as front-line providers, hospitalists are primed to lead healthcare systems in how to deliver care, he said.

“Formerly, physicians were iterant, right?” Dr. Mate adds. “They would come in and out of institutions and didn’t really have a stake in the game, on some level, of institutional quality. That’s totally different now.”

But, while the individual hospitalist has a responsibility to embrace safety initiatives, employers and industry groups have a duty to provide the proper resources to make that connection easier.

“The individual’s responsibility is to try to access that information to carry on in the face of busy schedules and busy lives,” Dr. Mate says. “SHM, IHI, and others have a responsibility to try to make those that are inclined able to continue and able to build and move their efforts forward in an even more productive way.”

 

Inclined docs like Dr. Lee, who know that their hospitals collect reams of data that can be useful for patient safety projects, many times have no idea how to extract said data. He has learned that partnering with “gatekeepers” is a way to help others help him.

“We are collecting data every second, every minute,” Dr. Lee says. “It’s amazing how much data we have, but to actually sift through it and make it meaningful is very difficult. You have to know what questions to ask and you have to get buy-in from the [gatekeepers], because they get thousands of requests for data extraction.”

---

Richard Quinn is a freelance writer in New Jersey.

NATIONAL HARBOR, Md.—Don Lee, MD, MPH, is building what one might call an analog quality improvement (QI) project focused on reducing readmissions. What the medical director for clinical integration at Columbia St. Mary’s in Milwaukee does is work with patient navigators to make follow-up phone calls after discharge to get ahead of potential issues.

What he wants to do is design a system that ensures that happens.

So, he came to HM15 for help.

“I’m very interested in continuous quality improvement. I wanted to work on how to not only get the project off the ground, but also to make sure what we are doing is good, and it’s doing what it’s supposed to be doing,” Dr. Lee says.

Well, he came to the right place. Quality and patient safety are hallmarks of the annual meeting; this year’s gathering was no exception. Plenaries provided advice from national thought leaders on improving safety by improving the patient experience; breakout sessions focused on how to build, maintain, and sustain QI projects; and SHM unveiled a new educational track dubbed the “Doctor-Patient Relationship.”

Hospital medicine, and healthcare in a broader sense, needs to be able to define safety better to attack it proactively, says Maureen Bisognano, president and CEO of the Institute for Healthcare Improvement (IHI). She compared medicine to NASA, which tracks its missions in a continuum of both successes and failures to understand what processes and protocols lay behind each.

Medicine has no such pathway laid out to date, though Bisognano said her task for the next year is to try to define one.

“We don’t know what the system of safety looks like,” she said. “We don’t know how many times we duplicate tests on admission because we haven’t connected with primary care. We don’t know how many times we send somebody home with inadequate social support, no food, and no way to pick up their prescription.

“We don’t have a sense of where our near-misses are, so we don’t have a vision of safety.”

Hospitalist Kedar Mate, MD, senior vice president for innovation at IHI, says that QI projects can seem daunting in the midst of daily censuses, hospital committee meetings, and a myriad of other responsibilities physicians face. But much of that fear is perception. A project can be simple or system-wide. The trick is just getting started in the face of perceived hurdles, he adds.

“Language around quality improvement tends to confuse and create mystery, and the jargon and so on creates interference,” says Dr. Mate, an assistant professor of medicine at Weill Cornell Medical College in New York City and a research fellow at Harvard Medical School’s Division of Global Health Equity. “It’s not that mysterious. It’s kind of a straightforward thing, actually, if you work through it logically and stepwise.”

And, as front-line providers, hospitalists are primed to lead healthcare systems in how to deliver care, he said.

“Formerly, physicians were iterant, right?” Dr. Mate adds. “They would come in and out of institutions and didn’t really have a stake in the game, on some level, of institutional quality. That’s totally different now.”

But, while the individual hospitalist has a responsibility to embrace safety initiatives, employers and industry groups have a duty to provide the proper resources to make that connection easier.

“The individual’s responsibility is to try to access that information to carry on in the face of busy schedules and busy lives,” Dr. Mate says. “SHM, IHI, and others have a responsibility to try to make those that are inclined able to continue and able to build and move their efforts forward in an even more productive way.”

 

Inclined docs like Dr. Lee, who know that their hospitals collect reams of data that can be useful for patient safety projects, many times have no idea how to extract said data. He has learned that partnering with “gatekeepers” is a way to help others help him.

“We are collecting data every second, every minute,” Dr. Lee says. “It’s amazing how much data we have, but to actually sift through it and make it meaningful is very difficult. You have to know what questions to ask and you have to get buy-in from the [gatekeepers], because they get thousands of requests for data extraction.”

---

Richard Quinn is a freelance writer in New Jersey.

NATIONAL HARBOR, Md.—Armed with blue folders chockablock with agendas, talking points, and fact sheets, about 100 hospitalists boarded three charter buses and descended on Capitol Hill last month like a swarm of erudite high schoolers on a class trip.

Clad in state-themed ties, suits, and dresses, the group’s goal was singular: Introduce the concept of hospital medicine to every senator, representative, and Congressional staffer who would take the time to meet them, and let those folks know that SHM and its members stand at the ready to serve as a resource for politicians.

“We don’t go to Washington and say, ‘You need to pay hospitalists more money,’” says SHM CEO Larry Wellikson, MD, MHM. “We go and we say, ‘You have a problem. We have a solution. Why don’t we work together to create the future?’ This is what people need to hear. This is a breath of fresh air, and that’s why we get invited back and we’re part of the discussion.”

This year’s discussion was formally titled Hospitalists on the Hill, version 2015. The turnout always improves when the annual meeting is just across the Potomac River at the Gaylord National Resort & Convention Center, as it has been for three of the past six years. The society ferried hospitalists to the offices of Washington power players with three goals this year:

• Push for support for the Improving Access to Medicare Coverage Act of 2015 (H.R. 1571 and S. 843), as it would adjust Medicare rules to allow observation status to be counted toward the three-day inpatient rule for coverage of care in skilled nursing facilities.
• Ask for support for the Personalize Your Care Act, a soon-to-be-reintroduced bill from U.S. Rep. Earl Blumenauer (D-Ore.) authorizing Medicare to pay for end-of-life care discussions and building in opportunities for patients to participate in their long-term care planning.
• Push for Congress to repeal the sustainable growth rate (SGR) formula and create a “pathway towards payment models that reward quality and efficiency.” This legislative “ask,” to use lobbying parlance, is an evergreen that has been an SHM priority for years.

Jodi Strong, director of operations at Novant Health, a 12-hospital group based in Charlotte, N.C., says that she joined this year’s advocacy pilgrimage for the first time because, in a time of generational upheaval in the American healthcare system, every voice should be heard.

“One vote does make a difference, and I want to be a part of that process,” she says, adding, “Hospitalists are very instrumental in the patient, the care that they receive, where they go after they’ve had a hospital visit, how they connect with the patient’s primary care physician.”

The trick of lobbying is getting those in power to see the world as those in practice do. It helps when the two are friends. H.E. “Chip” Walpole Jr., MS, MD, regional medical director of Select Medical of Greenville, S.C., has known U.S. Rep. Trey Gowdy (R-S.C.) for years. When they talk about medical issues, it helps the congressman get a stethoscope-on-the-ground view.

“He’ll say, ‘I know I can trust Chip and he’ll give me a straight answer for a problem,’” Dr. Walpole says. “Then it’s about inviting them, to say ‘Hey, come and see. You want to learn a little bit more about what we do in the hospital? Come and see our facility.’”

 

And, while many first-time Hill Day attendees get nervous about trying to impress the Beltway, Dr. Walpole views it from the flip side.

“Any time you get to have face-to-face time with one of your Congressional leaders, whether it be a representative or senator, you talk to the people that actually directly influence and impact not only the work that we do, but the work that we do for our patients,” he says. “In that regard, we represent a voice for them, to explain to them who we are and what we do and what our patients’ needs are.

“They depend on us.”

That’s the message that Stephanie Vance, who founded Washington-based Advocacy Associates LLC, pushed as she prepped the laymen lobbyists for more than an hour before sending them off to their meetings. Vance, a 25-year veteran of the political scene, reminded hospitalists during the breakfast prep session that those in Congress are elected to serve—and that means they’re elected to listen.

Hospitalist Gordon Johnson, MD, FACP, FHM, got the message. He’s president of the SHM’s Oregon Chapter, but he had never done a lobbying trip like this before. The appeal was simple and effective to him.

“The more of us that are involved, the more meaningful it is,” he says. “When [members of Congress and their staffs] have people coming from their constituency, that carries a message. It does carry a stronger message.”

But, as with patient discharge, the message is always strongest with good follow-up. Vance, known to many as “the advocacy guru,” urged hospitalists to follow up after their meetings—an occasional phone call or e-mail to let the person know that, should they have any questions, a hospitalist is standing by to provide answers. To Dr. Walpole, a connection like that can be worth more than hiring a white-shoed lobbying firm.

“When you put a face with someone—‘Oh, I know Chip, I know Richard from back home,’—they make a connection with someone that is real and personal to them,” he says. “And, ultimately, that can probably make a bigger difference in influencing how they represent us than anything else.”

---

Richard Quinn is a freelance writer in New Jersey.

NATIONAL HARBOR, Md.—Armed with blue folders chockablock with agendas, talking points, and fact sheets, about 100 hospitalists boarded three charter buses and descended on Capitol Hill last month like a swarm of erudite high schoolers on a class trip.

Clad in state-themed ties, suits, and dresses, the group’s goal was singular: Introduce the concept of hospital medicine to every senator, representative, and Congressional staffer who would take the time to meet them, and let those folks know that SHM and its members stand at the ready to serve as a resource for politicians.

“We don’t go to Washington and say, ‘You need to pay hospitalists more money,’” says SHM CEO Larry Wellikson, MD, MHM. “We go and we say, ‘You have a problem. We have a solution. Why don’t we work together to create the future?’ This is what people need to hear. This is a breath of fresh air, and that’s why we get invited back and we’re part of the discussion.”

This year’s discussion was formally titled Hospitalists on the Hill, version 2015. The turnout always improves when the annual meeting is just across the Potomac River at the Gaylord National Resort & Convention Center, as it has been for three of the past six years. The society ferried hospitalists to the offices of Washington power players with three goals this year:

• Push for support for the Improving Access to Medicare Coverage Act of 2015 (H.R. 1571 and S. 843), as it would adjust Medicare rules to allow observation status to be counted toward the three-day inpatient rule for coverage of care in skilled nursing facilities.
• Ask for support for the Personalize Your Care Act, a soon-to-be-reintroduced bill from U.S. Rep. Earl Blumenauer (D-Ore.) authorizing Medicare to pay for end-of-life care discussions and building in opportunities for patients to participate in their long-term care planning.
• Push for Congress to repeal the sustainable growth rate (SGR) formula and create a “pathway towards payment models that reward quality and efficiency.” This legislative “ask,” to use lobbying parlance, is an evergreen that has been an SHM priority for years.

Jodi Strong, director of operations at Novant Health, a 12-hospital group based in Charlotte, N.C., says that she joined this year’s advocacy pilgrimage for the first time because, in a time of generational upheaval in the American healthcare system, every voice should be heard.

“One vote does make a difference, and I want to be a part of that process,” she says, adding, “Hospitalists are very instrumental in the patient, the care that they receive, where they go after they’ve had a hospital visit, how they connect with the patient’s primary care physician.”

The trick of lobbying is getting those in power to see the world as those in practice do. It helps when the two are friends. H.E. “Chip” Walpole Jr., MS, MD, regional medical director of Select Medical of Greenville, S.C., has known U.S. Rep. Trey Gowdy (R-S.C.) for years. When they talk about medical issues, it helps the congressman get a stethoscope-on-the-ground view.

“He’ll say, ‘I know I can trust Chip and he’ll give me a straight answer for a problem,’” Dr. Walpole says. “Then it’s about inviting them, to say ‘Hey, come and see. You want to learn a little bit more about what we do in the hospital? Come and see our facility.’”

 

And, while many first-time Hill Day attendees get nervous about trying to impress the Beltway, Dr. Walpole views it from the flip side.

“Any time you get to have face-to-face time with one of your Congressional leaders, whether it be a representative or senator, you talk to the people that actually directly influence and impact not only the work that we do, but the work that we do for our patients,” he says. “In that regard, we represent a voice for them, to explain to them who we are and what we do and what our patients’ needs are.

“They depend on us.”

That’s the message that Stephanie Vance, who founded Washington-based Advocacy Associates LLC, pushed as she prepped the laymen lobbyists for more than an hour before sending them off to their meetings. Vance, a 25-year veteran of the political scene, reminded hospitalists during the breakfast prep session that those in Congress are elected to serve—and that means they’re elected to listen.

Hospitalist Gordon Johnson, MD, FACP, FHM, got the message. He’s president of the SHM’s Oregon Chapter, but he had never done a lobbying trip like this before. The appeal was simple and effective to him.

“The more of us that are involved, the more meaningful it is,” he says. “When [members of Congress and their staffs] have people coming from their constituency, that carries a message. It does carry a stronger message.”

But, as with patient discharge, the message is always strongest with good follow-up. Vance, known to many as “the advocacy guru,” urged hospitalists to follow up after their meetings—an occasional phone call or e-mail to let the person know that, should they have any questions, a hospitalist is standing by to provide answers. To Dr. Walpole, a connection like that can be worth more than hiring a white-shoed lobbying firm.

“When you put a face with someone—‘Oh, I know Chip, I know Richard from back home,’—they make a connection with someone that is real and personal to them,” he says. “And, ultimately, that can probably make a bigger difference in influencing how they represent us than anything else.”

---

Richard Quinn is a freelance writer in New Jersey.

NATIONAL HARBOR, Md.—Armed with blue folders chockablock with agendas, talking points, and fact sheets, about 100 hospitalists boarded three charter buses and descended on Capitol Hill last month like a swarm of erudite high schoolers on a class trip.

Clad in state-themed ties, suits, and dresses, the group’s goal was singular: Introduce the concept of hospital medicine to every senator, representative, and Congressional staffer who would take the time to meet them, and let those folks know that SHM and its members stand at the ready to serve as a resource for politicians.

“We don’t go to Washington and say, ‘You need to pay hospitalists more money,’” says SHM CEO Larry Wellikson, MD, MHM. “We go and we say, ‘You have a problem. We have a solution. Why don’t we work together to create the future?’ This is what people need to hear. This is a breath of fresh air, and that’s why we get invited back and we’re part of the discussion.”

This year’s discussion was formally titled Hospitalists on the Hill, version 2015. The turnout always improves when the annual meeting is just across the Potomac River at the Gaylord National Resort & Convention Center, as it has been for three of the past six years. The society ferried hospitalists to the offices of Washington power players with three goals this year:

• Push for support for the Improving Access to Medicare Coverage Act of 2015 (H.R. 1571 and S. 843), as it would adjust Medicare rules to allow observation status to be counted toward the three-day inpatient rule for coverage of care in skilled nursing facilities.
• Ask for support for the Personalize Your Care Act, a soon-to-be-reintroduced bill from U.S. Rep. Earl Blumenauer (D-Ore.) authorizing Medicare to pay for end-of-life care discussions and building in opportunities for patients to participate in their long-term care planning.
• Push for Congress to repeal the sustainable growth rate (SGR) formula and create a “pathway towards payment models that reward quality and efficiency.” This legislative “ask,” to use lobbying parlance, is an evergreen that has been an SHM priority for years.

Jodi Strong, director of operations at Novant Health, a 12-hospital group based in Charlotte, N.C., says that she joined this year’s advocacy pilgrimage for the first time because, in a time of generational upheaval in the American healthcare system, every voice should be heard.

“One vote does make a difference, and I want to be a part of that process,” she says, adding, “Hospitalists are very instrumental in the patient, the care that they receive, where they go after they’ve had a hospital visit, how they connect with the patient’s primary care physician.”

The trick of lobbying is getting those in power to see the world as those in practice do. It helps when the two are friends. H.E. “Chip” Walpole Jr., MS, MD, regional medical director of Select Medical of Greenville, S.C., has known U.S. Rep. Trey Gowdy (R-S.C.) for years. When they talk about medical issues, it helps the congressman get a stethoscope-on-the-ground view.

“He’ll say, ‘I know I can trust Chip and he’ll give me a straight answer for a problem,’” Dr. Walpole says. “Then it’s about inviting them, to say ‘Hey, come and see. You want to learn a little bit more about what we do in the hospital? Come and see our facility.’”

 

And, while many first-time Hill Day attendees get nervous about trying to impress the Beltway, Dr. Walpole views it from the flip side.

“Any time you get to have face-to-face time with one of your Congressional leaders, whether it be a representative or senator, you talk to the people that actually directly influence and impact not only the work that we do, but the work that we do for our patients,” he says. “In that regard, we represent a voice for them, to explain to them who we are and what we do and what our patients’ needs are.

“They depend on us.”

That’s the message that Stephanie Vance, who founded Washington-based Advocacy Associates LLC, pushed as she prepped the laymen lobbyists for more than an hour before sending them off to their meetings. Vance, a 25-year veteran of the political scene, reminded hospitalists during the breakfast prep session that those in Congress are elected to serve—and that means they’re elected to listen.

Hospitalist Gordon Johnson, MD, FACP, FHM, got the message. He’s president of the SHM’s Oregon Chapter, but he had never done a lobbying trip like this before. The appeal was simple and effective to him.

“The more of us that are involved, the more meaningful it is,” he says. “When [members of Congress and their staffs] have people coming from their constituency, that carries a message. It does carry a stronger message.”

But, as with patient discharge, the message is always strongest with good follow-up. Vance, known to many as “the advocacy guru,” urged hospitalists to follow up after their meetings—an occasional phone call or e-mail to let the person know that, should they have any questions, a hospitalist is standing by to provide answers. To Dr. Walpole, a connection like that can be worth more than hiring a white-shoed lobbying firm.

“When you put a face with someone—‘Oh, I know Chip, I know Richard from back home,’—they make a connection with someone that is real and personal to them,” he says. “And, ultimately, that can probably make a bigger difference in influencing how they represent us than anything else.”

---

Richard Quinn is a freelance writer in New Jersey.

NATIONAL HARBOR, Md.—On one end of the cavernous exhibit hall space at HM15 stood Brendan Sullivan, OMS-II, a second-year medical student, practically grinning as he showcased his poster on the effects of bedside rounds with nurses. On the other side stood Donald Tashkin, MD, a pulmonologist who began his training in the 1960s and was talking like a younger man about his poster on drug therapies for exacerbated cases of COPD.

Both men were first-time presenters at SHM’s annual Research, Innovations, and Clinical Vignettes (RIV) poster competition. The contest has become one of the meeting’s most popular rites, growing so big it now spans two of the conference’s four days. This year’s competition drew a record 1,297 abstracts, topping the prior record of 1,132 and fully double the 634 abstracts submitted for HM10, according to SHM.

What makes the contest popular is that its posters are as varied as the presenters’ motives.

Take Sullivan, a student at Midwestern University Chicago College of Osteopathic Medicine in Downers Grove, Ill. His poster, “Examining the Future of Hospitalist Medicine: Impact of Bedside Rounding with Nurses on Patient Care,” served as his introduction to the specialty.

“You can see the tangible results [hospitalists] have,” he says. “Working with the nurses, the nurses recognize [hospitalists] as a continuous part of hospital life. It just seems like, as a field, there’s definitely a lot of opportunity for medical students like me, who want to go into internal medicine but [are] not really sure what aspect of internal medicine. Hospital medicine is definitely a very viable career option.”

Sullivan’s project came about because of work with his faculty mentor, a second-year hospitalist. At HM15, with the titans of the field walking around him, Sullivan showed his work off proudly but respectfully.

“It’s definitely a learning experience for me,” he says. “I’m just taking a backseat and soaking it all in. I realize that being one of the youngest and more inexperienced members here, I have a lot to learn .… I spent eight weeks in a field they’ve been doing for 20 years.”

But experience doesn’t mean a poster presenter has been here before. Dr. Tashkin, a veteran pulmonologist at UCLA’s David Geffen School of Medicine in Los Angeles, had never been to an SHM annual meeting. He presented two related posters on COPD drug therapies.

Where Sullivan was awed by the experience, Dr. Tashkin was in it for the academic stimulation that comes with bouncing medical ideas off of medical minds.

“It’s an intellectual enjoyment,” he says. “You can learn things when you talk to people, because they give you certain insights that you never thought of before. It’s not about ego; I’ll tell you that.”

Poster presenters say that a lot. The sharing of projects isn’t about adulation, they say. It’s about finding fellow hospitalists who are dealing with the kinds of issues that plague all hospital medicine groups. That’s why Greta Boynton, MD, SFHM, enjoys the RIV sessions.

“When you walk around and see all the great work that other people have done, most people are working on very similar things, like readmission rates or quality or [patient] satisfaction,” says Dr. Boynton, division chief of hospital medicine for Baystate Health in Springfield, Mass. “You get a lot of practical suggestions for things that you could implement in your own group.”

 

Dr. Boynton, regional medical director for the Northeast for Sound Physicians, has thought that for years, but this year she took the added step of presenting her first two posters. While showcasing one titled “Unit Medical Director as Career Development for Young Hospitalist,” she said years of seeing work similar to her own left her wondering why she didn’t present.

“I’ve done a lot of practice management and process improvement initiatives over the years, and I have not brought them forward here,” she says. “Then when you see other people working on similar things, you kind of kick yourself for not showing how you did it.”

So she did it. And now she’s glad she did.

“I feel proud of my hospitalist team,” Dr. Boynton says. “The fact that people are interested in it, the fact that they’re asking questions—practical questions on how it might look on a smaller team—very rewarding.”

Rehan Qayyum, MBBS, medical director of the academic hospitalist program at University of Tennessee College of Medicine in Chattanooga, Tenn., has found one reward particularly useful: peer review.

Over the course of roughly 10 posters presented over the years, he has used the comments of passersby to hone his writing skills. He is now transforming his poster, “Effect of HCAHPS Reporting Patient Satisfaction with Physicians,” into a paper he plans to publish.

The RIV session is free editing.

“They’re talking about what they think about how I should be looking at things that are not very clear, or things they may have interest in,” Dr. Qayyum says. “When I’m writing the discussion part or when I’m writing the methods and results part, I may focus on those [comments], add those parts, maybe. Or highlight those things in discussion where people show interest.

“I may be more focused in what I’m doing and may lose what may be important for other people. But being here and letting other people see my work and discuss it with me … that helps a lot.”

---

Richard Quinn is a freelance writer in New Jersey.

NATIONAL HARBOR, Md.—On one end of the cavernous exhibit hall space at HM15 stood Brendan Sullivan, OMS-II, a second-year medical student, practically grinning as he showcased his poster on the effects of bedside rounds with nurses. On the other side stood Donald Tashkin, MD, a pulmonologist who began his training in the 1960s and was talking like a younger man about his poster on drug therapies for exacerbated cases of COPD.

Both men were first-time presenters at SHM’s annual Research, Innovations, and Clinical Vignettes (RIV) poster competition. The contest has become one of the meeting’s most popular rites, growing so big it now spans two of the conference’s four days. This year’s competition drew a record 1,297 abstracts, topping the prior record of 1,132 and fully double the 634 abstracts submitted for HM10, according to SHM.

What makes the contest popular is that its posters are as varied as the presenters’ motives.

Take Sullivan, a student at Midwestern University Chicago College of Osteopathic Medicine in Downers Grove, Ill. His poster, “Examining the Future of Hospitalist Medicine: Impact of Bedside Rounding with Nurses on Patient Care,” served as his introduction to the specialty.

“You can see the tangible results [hospitalists] have,” he says. “Working with the nurses, the nurses recognize [hospitalists] as a continuous part of hospital life. It just seems like, as a field, there’s definitely a lot of opportunity for medical students like me, who want to go into internal medicine but [are] not really sure what aspect of internal medicine. Hospital medicine is definitely a very viable career option.”

Sullivan’s project came about because of work with his faculty mentor, a second-year hospitalist. At HM15, with the titans of the field walking around him, Sullivan showed his work off proudly but respectfully.

“It’s definitely a learning experience for me,” he says. “I’m just taking a backseat and soaking it all in. I realize that being one of the youngest and more inexperienced members here, I have a lot to learn .… I spent eight weeks in a field they’ve been doing for 20 years.”

But experience doesn’t mean a poster presenter has been here before. Dr. Tashkin, a veteran pulmonologist at UCLA’s David Geffen School of Medicine in Los Angeles, had never been to an SHM annual meeting. He presented two related posters on COPD drug therapies.

Where Sullivan was awed by the experience, Dr. Tashkin was in it for the academic stimulation that comes with bouncing medical ideas off of medical minds.

“It’s an intellectual enjoyment,” he says. “You can learn things when you talk to people, because they give you certain insights that you never thought of before. It’s not about ego; I’ll tell you that.”

Poster presenters say that a lot. The sharing of projects isn’t about adulation, they say. It’s about finding fellow hospitalists who are dealing with the kinds of issues that plague all hospital medicine groups. That’s why Greta Boynton, MD, SFHM, enjoys the RIV sessions.

“When you walk around and see all the great work that other people have done, most people are working on very similar things, like readmission rates or quality or [patient] satisfaction,” says Dr. Boynton, division chief of hospital medicine for Baystate Health in Springfield, Mass. “You get a lot of practical suggestions for things that you could implement in your own group.”

 

Dr. Boynton, regional medical director for the Northeast for Sound Physicians, has thought that for years, but this year she took the added step of presenting her first two posters. While showcasing one titled “Unit Medical Director as Career Development for Young Hospitalist,” she said years of seeing work similar to her own left her wondering why she didn’t present.

“I’ve done a lot of practice management and process improvement initiatives over the years, and I have not brought them forward here,” she says. “Then when you see other people working on similar things, you kind of kick yourself for not showing how you did it.”

So she did it. And now she’s glad she did.

“I feel proud of my hospitalist team,” Dr. Boynton says. “The fact that people are interested in it, the fact that they’re asking questions—practical questions on how it might look on a smaller team—very rewarding.”

Rehan Qayyum, MBBS, medical director of the academic hospitalist program at University of Tennessee College of Medicine in Chattanooga, Tenn., has found one reward particularly useful: peer review.

Over the course of roughly 10 posters presented over the years, he has used the comments of passersby to hone his writing skills. He is now transforming his poster, “Effect of HCAHPS Reporting Patient Satisfaction with Physicians,” into a paper he plans to publish.

The RIV session is free editing.

“They’re talking about what they think about how I should be looking at things that are not very clear, or things they may have interest in,” Dr. Qayyum says. “When I’m writing the discussion part or when I’m writing the methods and results part, I may focus on those [comments], add those parts, maybe. Or highlight those things in discussion where people show interest.

“I may be more focused in what I’m doing and may lose what may be important for other people. But being here and letting other people see my work and discuss it with me … that helps a lot.”

---

Richard Quinn is a freelance writer in New Jersey.

NATIONAL HARBOR, Md.—On one end of the cavernous exhibit hall space at HM15 stood Brendan Sullivan, OMS-II, a second-year medical student, practically grinning as he showcased his poster on the effects of bedside rounds with nurses. On the other side stood Donald Tashkin, MD, a pulmonologist who began his training in the 1960s and was talking like a younger man about his poster on drug therapies for exacerbated cases of COPD.

Both men were first-time presenters at SHM’s annual Research, Innovations, and Clinical Vignettes (RIV) poster competition. The contest has become one of the meeting’s most popular rites, growing so big it now spans two of the conference’s four days. This year’s competition drew a record 1,297 abstracts, topping the prior record of 1,132 and fully double the 634 abstracts submitted for HM10, according to SHM.

What makes the contest popular is that its posters are as varied as the presenters’ motives.

Take Sullivan, a student at Midwestern University Chicago College of Osteopathic Medicine in Downers Grove, Ill. His poster, “Examining the Future of Hospitalist Medicine: Impact of Bedside Rounding with Nurses on Patient Care,” served as his introduction to the specialty.

“You can see the tangible results [hospitalists] have,” he says. “Working with the nurses, the nurses recognize [hospitalists] as a continuous part of hospital life. It just seems like, as a field, there’s definitely a lot of opportunity for medical students like me, who want to go into internal medicine but [are] not really sure what aspect of internal medicine. Hospital medicine is definitely a very viable career option.”

Sullivan’s project came about because of work with his faculty mentor, a second-year hospitalist. At HM15, with the titans of the field walking around him, Sullivan showed his work off proudly but respectfully.

“It’s definitely a learning experience for me,” he says. “I’m just taking a backseat and soaking it all in. I realize that being one of the youngest and more inexperienced members here, I have a lot to learn .… I spent eight weeks in a field they’ve been doing for 20 years.”

But experience doesn’t mean a poster presenter has been here before. Dr. Tashkin, a veteran pulmonologist at UCLA’s David Geffen School of Medicine in Los Angeles, had never been to an SHM annual meeting. He presented two related posters on COPD drug therapies.

Where Sullivan was awed by the experience, Dr. Tashkin was in it for the academic stimulation that comes with bouncing medical ideas off of medical minds.

“It’s an intellectual enjoyment,” he says. “You can learn things when you talk to people, because they give you certain insights that you never thought of before. It’s not about ego; I’ll tell you that.”

Poster presenters say that a lot. The sharing of projects isn’t about adulation, they say. It’s about finding fellow hospitalists who are dealing with the kinds of issues that plague all hospital medicine groups. That’s why Greta Boynton, MD, SFHM, enjoys the RIV sessions.

“When you walk around and see all the great work that other people have done, most people are working on very similar things, like readmission rates or quality or [patient] satisfaction,” says Dr. Boynton, division chief of hospital medicine for Baystate Health in Springfield, Mass. “You get a lot of practical suggestions for things that you could implement in your own group.”

 

Dr. Boynton, regional medical director for the Northeast for Sound Physicians, has thought that for years, but this year she took the added step of presenting her first two posters. While showcasing one titled “Unit Medical Director as Career Development for Young Hospitalist,” she said years of seeing work similar to her own left her wondering why she didn’t present.

“I’ve done a lot of practice management and process improvement initiatives over the years, and I have not brought them forward here,” she says. “Then when you see other people working on similar things, you kind of kick yourself for not showing how you did it.”

So she did it. And now she’s glad she did.

“I feel proud of my hospitalist team,” Dr. Boynton says. “The fact that people are interested in it, the fact that they’re asking questions—practical questions on how it might look on a smaller team—very rewarding.”

Rehan Qayyum, MBBS, medical director of the academic hospitalist program at University of Tennessee College of Medicine in Chattanooga, Tenn., has found one reward particularly useful: peer review.

Over the course of roughly 10 posters presented over the years, he has used the comments of passersby to hone his writing skills. He is now transforming his poster, “Effect of HCAHPS Reporting Patient Satisfaction with Physicians,” into a paper he plans to publish.

The RIV session is free editing.

“They’re talking about what they think about how I should be looking at things that are not very clear, or things they may have interest in,” Dr. Qayyum says. “When I’m writing the discussion part or when I’m writing the methods and results part, I may focus on those [comments], add those parts, maybe. Or highlight those things in discussion where people show interest.

“I may be more focused in what I’m doing and may lose what may be important for other people. But being here and letting other people see my work and discuss it with me … that helps a lot.”

---

Richard Quinn is a freelance writer in New Jersey.

QUESTION: SHM CEO Larry Wellikson, MD, MHM, calls the country’s roughly 48,000 hospitalists “agents of change.” The Hospitalist asked HM15 why is it important that hospitalists be those people?

“Because our healthcare system is broken in a lot of ways, and a lot of patients fall through the cracks or they don’t get good follow-up. Part of helping that and helping to fix our system is being willing to make changes and think of innovative ways, new ways to do things.”

–Lorrie Saville, NP, assistant medical director, Carilion Roanoke Memorial Hospital, Roanoke, Va.

“We have to stay dynamic, and change is the nature of things. We have to change what we do to adapt to new environments and new circumstances. … We have to keep an eye on the goals, which are cutting costs, length of stay, decreased rates of mortality, and patient satisfaction.”

–Hospitalist Ahmed Farag, MD Rex Hospital, Raleigh, N.C.

“For me, for patients’ sake, we always need to be in good practice. We should always be up to date. When we don’t actually go through quality improvement projects or we don’t try to obtain or achieve certain milestones, then we’ll always be behind. We could actually be harming a lot of patients without necessarily knowing. … It’s important from a patient perspective; that’s why it’s important to me and should be important to every physician.”

–Hospitalist Zahra’a Salah, MD St. Mary Mercy Livonia Hospital, Livonia, Mich.

“Because nobody else is doing it. In my opinion, hospital medicine over the years has become the operational machinery for the health systems and hospitals around the country. By all means, I think the hospitalist should be at the forefront to leading the change, or whatever we call the new evolution of medicine in the country.”

–Ajay Kumar, MD, MECP, FACP, SFHM, chief, Department of Medicine, Hartford Hospital, Hartford, Conn.

QUESTION: SHM CEO Larry Wellikson, MD, MHM, calls the country’s roughly 48,000 hospitalists “agents of change.” The Hospitalist asked HM15 why is it important that hospitalists be those people?

“Because our healthcare system is broken in a lot of ways, and a lot of patients fall through the cracks or they don’t get good follow-up. Part of helping that and helping to fix our system is being willing to make changes and think of innovative ways, new ways to do things.”

–Lorrie Saville, NP, assistant medical director, Carilion Roanoke Memorial Hospital, Roanoke, Va.

“We have to stay dynamic, and change is the nature of things. We have to change what we do to adapt to new environments and new circumstances. … We have to keep an eye on the goals, which are cutting costs, length of stay, decreased rates of mortality, and patient satisfaction.”

–Hospitalist Ahmed Farag, MD Rex Hospital, Raleigh, N.C.

“For me, for patients’ sake, we always need to be in good practice. We should always be up to date. When we don’t actually go through quality improvement projects or we don’t try to obtain or achieve certain milestones, then we’ll always be behind. We could actually be harming a lot of patients without necessarily knowing. … It’s important from a patient perspective; that’s why it’s important to me and should be important to every physician.”

–Hospitalist Zahra’a Salah, MD St. Mary Mercy Livonia Hospital, Livonia, Mich.

“Because nobody else is doing it. In my opinion, hospital medicine over the years has become the operational machinery for the health systems and hospitals around the country. By all means, I think the hospitalist should be at the forefront to leading the change, or whatever we call the new evolution of medicine in the country.”

–Ajay Kumar, MD, MECP, FACP, SFHM, chief, Department of Medicine, Hartford Hospital, Hartford, Conn.

QUESTION: SHM CEO Larry Wellikson, MD, MHM, calls the country’s roughly 48,000 hospitalists “agents of change.” The Hospitalist asked HM15 why is it important that hospitalists be those people?

“Because our healthcare system is broken in a lot of ways, and a lot of patients fall through the cracks or they don’t get good follow-up. Part of helping that and helping to fix our system is being willing to make changes and think of innovative ways, new ways to do things.”

–Lorrie Saville, NP, assistant medical director, Carilion Roanoke Memorial Hospital, Roanoke, Va.

“We have to stay dynamic, and change is the nature of things. We have to change what we do to adapt to new environments and new circumstances. … We have to keep an eye on the goals, which are cutting costs, length of stay, decreased rates of mortality, and patient satisfaction.”

–Hospitalist Ahmed Farag, MD Rex Hospital, Raleigh, N.C.

“For me, for patients’ sake, we always need to be in good practice. We should always be up to date. When we don’t actually go through quality improvement projects or we don’t try to obtain or achieve certain milestones, then we’ll always be behind. We could actually be harming a lot of patients without necessarily knowing. … It’s important from a patient perspective; that’s why it’s important to me and should be important to every physician.”

–Hospitalist Zahra’a Salah, MD St. Mary Mercy Livonia Hospital, Livonia, Mich.

“Because nobody else is doing it. In my opinion, hospital medicine over the years has become the operational machinery for the health systems and hospitals around the country. By all means, I think the hospitalist should be at the forefront to leading the change, or whatever we call the new evolution of medicine in the country.”

–Ajay Kumar, MD, MECP, FACP, SFHM, chief, Department of Medicine, Hartford Hospital, Hartford, Conn.

NATIONAL HARBOR, Md.—The conversation about hospitalists and technology can be pretty big. Rigmarole with rollout of an electronic health records (EHR) system is as much a rite of physician passage as Match Day. Administrators and C-suiters agonize over sprawling national initiatives (i.e., the Health Information Technology for Economic and Clinical Health [HITECH] Act of 2009) and the delayed implementation of the 10th revision of the International Statistical Classification of Diseases coding system (ICD-10). And there’s not an informatics officer in the country who doesn’t struggle with the term “meaningful use.”

Yet at HM15, one of the most interesting technology discussions wasn’t about the biggest of the big. In fact, it was about the smallest of the small: mobile applications, better known as apps. App usage on the ever-more-ubiquitous smartphones and tablets, used by patients and physicians alike, is a topic in its infancy. But hospitalist Roger Yu, MD, of Mayo Clinic in Rochester, Minn., says that hospitalists need to get ahead of the issue. He knows patients will soon start asking them more and more questions.

“Some of the older generation may not be savvy enough to utilize these apps themselves, but the next generation, who are these older patients’ caregivers, are savvy enough, and they are very facile with their use of mobile technology,” says Dr. Yu, who helped lead one of the annual meeting’s best attended workshops, “Dr. Hi Tech Hospitalist: Improving Quality and Value of Care Using Mobile Apps.”

“So we need to be able to advise them, because they will come to us as physicians thinking that we have expertise in this.”

Anuj Dalal, MD, FHM, a hospitalist at Brigham and Women’s Hospital in Boston, says that one of the impediments to knowing the best apps is the pure size of the marketplace. There are some 44,000 applications related to healthcare. Although the bulk of those are consumer-related applications focused on diet, fitness, and personal health, many can be resources for hospitalists. But first, medical professionals need the marketplace to develop a reliable app certification process, Dr. Dalal says.

“They will provide [physicians’ board] certification, and patients will start relying on them for advice just as you would rely on Consumer Reports,” he says. “I think that will help individual providers and patients decide what is a good app and what is an effective app, which apps they should use and which apps they shouldn’t use.”

Of course, some physicians frustrated with regulation prefer to see the government stay out of technology in healthcare. The FDA currently reviews apps with direct ties to medical devices, but the remainder of the app marketplace is wide open for some entity to fill the certification void.

“I think there are a lot of people who are fearful of overregulation, but right now I think we’re at the point of underregulation,” Dr. Yu says. “There’s a sweet spot. I think if there is a standard that people can meet, companies can meet, technologies can meet, that’ll give a lot of structure and guidance to people who want to make their own apps.”

Part of the difficulty of vetting apps is what Cheng-Kai Kao, MD, medical director of informatics at the University of Chicago Medicine, calls the “hype cycle.”

 

“When it first shows up, there’s a lot of hype, there’s a lot of hope for the technology, and you [drill] down, and eventually you find what’s real,” he says. “We are looking for what are the things that we hope mobile apps can really do.”

Hospitalist Lisa Bonwell, MD, of Colorado Health Medical Group in Colorado Springs, sees discharge as one useful time to work with patients via applications. She believes many patients would find electronic instructions delivered through their smartphone or tablet more useful than the deluge of paperwork many now receive.

“When I discharge a patient from our system, they get a stack of papers,” she says. “I was recently a patient in the ER. I looked at that [stack of paperwork] and said, ‘There is nothing useful here. This is ridiculous.’

“I mean, it’s all this medical, legal stuff [patients] have to have, so I think that really turns off people. This would be much more usable to them.”

---

Richard Quinn is a freelance writer in New Jersey.

NATIONAL HARBOR, Md.—The conversation about hospitalists and technology can be pretty big. Rigmarole with rollout of an electronic health records (EHR) system is as much a rite of physician passage as Match Day. Administrators and C-suiters agonize over sprawling national initiatives (i.e., the Health Information Technology for Economic and Clinical Health [HITECH] Act of 2009) and the delayed implementation of the 10th revision of the International Statistical Classification of Diseases coding system (ICD-10). And there’s not an informatics officer in the country who doesn’t struggle with the term “meaningful use.”

Yet at HM15, one of the most interesting technology discussions wasn’t about the biggest of the big. In fact, it was about the smallest of the small: mobile applications, better known as apps. App usage on the ever-more-ubiquitous smartphones and tablets, used by patients and physicians alike, is a topic in its infancy. But hospitalist Roger Yu, MD, of Mayo Clinic in Rochester, Minn., says that hospitalists need to get ahead of the issue. He knows patients will soon start asking them more and more questions.

“Some of the older generation may not be savvy enough to utilize these apps themselves, but the next generation, who are these older patients’ caregivers, are savvy enough, and they are very facile with their use of mobile technology,” says Dr. Yu, who helped lead one of the annual meeting’s best attended workshops, “Dr. Hi Tech Hospitalist: Improving Quality and Value of Care Using Mobile Apps.”

“So we need to be able to advise them, because they will come to us as physicians thinking that we have expertise in this.”

Anuj Dalal, MD, FHM, a hospitalist at Brigham and Women’s Hospital in Boston, says that one of the impediments to knowing the best apps is the pure size of the marketplace. There are some 44,000 applications related to healthcare. Although the bulk of those are consumer-related applications focused on diet, fitness, and personal health, many can be resources for hospitalists. But first, medical professionals need the marketplace to develop a reliable app certification process, Dr. Dalal says.

“They will provide [physicians’ board] certification, and patients will start relying on them for advice just as you would rely on Consumer Reports,” he says. “I think that will help individual providers and patients decide what is a good app and what is an effective app, which apps they should use and which apps they shouldn’t use.”

Of course, some physicians frustrated with regulation prefer to see the government stay out of technology in healthcare. The FDA currently reviews apps with direct ties to medical devices, but the remainder of the app marketplace is wide open for some entity to fill the certification void.

“I think there are a lot of people who are fearful of overregulation, but right now I think we’re at the point of underregulation,” Dr. Yu says. “There’s a sweet spot. I think if there is a standard that people can meet, companies can meet, technologies can meet, that’ll give a lot of structure and guidance to people who want to make their own apps.”

Part of the difficulty of vetting apps is what Cheng-Kai Kao, MD, medical director of informatics at the University of Chicago Medicine, calls the “hype cycle.”

 

“When it first shows up, there’s a lot of hype, there’s a lot of hope for the technology, and you [drill] down, and eventually you find what’s real,” he says. “We are looking for what are the things that we hope mobile apps can really do.”

Hospitalist Lisa Bonwell, MD, of Colorado Health Medical Group in Colorado Springs, sees discharge as one useful time to work with patients via applications. She believes many patients would find electronic instructions delivered through their smartphone or tablet more useful than the deluge of paperwork many now receive.

“When I discharge a patient from our system, they get a stack of papers,” she says. “I was recently a patient in the ER. I looked at that [stack of paperwork] and said, ‘There is nothing useful here. This is ridiculous.’

“I mean, it’s all this medical, legal stuff [patients] have to have, so I think that really turns off people. This would be much more usable to them.”

---

Richard Quinn is a freelance writer in New Jersey.

NATIONAL HARBOR, Md.—The conversation about hospitalists and technology can be pretty big. Rigmarole with rollout of an electronic health records (EHR) system is as much a rite of physician passage as Match Day. Administrators and C-suiters agonize over sprawling national initiatives (i.e., the Health Information Technology for Economic and Clinical Health [HITECH] Act of 2009) and the delayed implementation of the 10th revision of the International Statistical Classification of Diseases coding system (ICD-10). And there’s not an informatics officer in the country who doesn’t struggle with the term “meaningful use.”

Yet at HM15, one of the most interesting technology discussions wasn’t about the biggest of the big. In fact, it was about the smallest of the small: mobile applications, better known as apps. App usage on the ever-more-ubiquitous smartphones and tablets, used by patients and physicians alike, is a topic in its infancy. But hospitalist Roger Yu, MD, of Mayo Clinic in Rochester, Minn., says that hospitalists need to get ahead of the issue. He knows patients will soon start asking them more and more questions.

“Some of the older generation may not be savvy enough to utilize these apps themselves, but the next generation, who are these older patients’ caregivers, are savvy enough, and they are very facile with their use of mobile technology,” says Dr. Yu, who helped lead one of the annual meeting’s best attended workshops, “Dr. Hi Tech Hospitalist: Improving Quality and Value of Care Using Mobile Apps.”

“So we need to be able to advise them, because they will come to us as physicians thinking that we have expertise in this.”

Anuj Dalal, MD, FHM, a hospitalist at Brigham and Women’s Hospital in Boston, says that one of the impediments to knowing the best apps is the pure size of the marketplace. There are some 44,000 applications related to healthcare. Although the bulk of those are consumer-related applications focused on diet, fitness, and personal health, many can be resources for hospitalists. But first, medical professionals need the marketplace to develop a reliable app certification process, Dr. Dalal says.

“They will provide [physicians’ board] certification, and patients will start relying on them for advice just as you would rely on Consumer Reports,” he says. “I think that will help individual providers and patients decide what is a good app and what is an effective app, which apps they should use and which apps they shouldn’t use.”

Of course, some physicians frustrated with regulation prefer to see the government stay out of technology in healthcare. The FDA currently reviews apps with direct ties to medical devices, but the remainder of the app marketplace is wide open for some entity to fill the certification void.

“I think there are a lot of people who are fearful of overregulation, but right now I think we’re at the point of underregulation,” Dr. Yu says. “There’s a sweet spot. I think if there is a standard that people can meet, companies can meet, technologies can meet, that’ll give a lot of structure and guidance to people who want to make their own apps.”

Part of the difficulty of vetting apps is what Cheng-Kai Kao, MD, medical director of informatics at the University of Chicago Medicine, calls the “hype cycle.”

 

“When it first shows up, there’s a lot of hype, there’s a lot of hope for the technology, and you [drill] down, and eventually you find what’s real,” he says. “We are looking for what are the things that we hope mobile apps can really do.”

Hospitalist Lisa Bonwell, MD, of Colorado Health Medical Group in Colorado Springs, sees discharge as one useful time to work with patients via applications. She believes many patients would find electronic instructions delivered through their smartphone or tablet more useful than the deluge of paperwork many now receive.

“When I discharge a patient from our system, they get a stack of papers,” she says. “I was recently a patient in the ER. I looked at that [stack of paperwork] and said, ‘There is nothing useful here. This is ridiculous.’

“I mean, it’s all this medical, legal stuff [patients] have to have, so I think that really turns off people. This would be much more usable to them.”

---

Richard Quinn is a freelance writer in New Jersey.