Quality

Paired, robotlike devices that disperse a bleaching disinfectant into the air of hospital rooms, then detoxify the disinfecting chemical, were found to be highly effective at killing and preventing the spread of “superbug” bacteria, according to research from Johns Hopkins Hospital published in Clinical Infectious Diseases.⁵ Hydrogen peroxide vaporizers were first deployed in Singapore hospitals in 2002 during an outbreak of severe acute respiratory syndrome (SARS).

Almost half of a study group of 6,350 patients in and out of 180 hospital rooms over a two-and-a-half-year period received the enhanced cleaning technology, while the others received routine cleaning only. Manufactured by Bioquell Inc. of Horsham, Pa. (www.bioquell.com), each device is about the size of a washing machine. They were deployed in hospital rooms with sealed vents, dispersing a thin film of hydrogen peroxide across all exposed surfaces, equipment, floors, and walls. This approach reduced by 64% the number of patients who later became contaminated with any of the most common drug-resistant organisms, including methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci, Clostridium difficile, and Acinetobacter baumannii.

Spreading the bleaching vapor this way “represents a major technological advance in preventing the spread of dangerous bacteria inside hospital rooms,” says senior investigator Trish Perl, MD, MSc, professor of medicine and an infectious disease specialist at Johns Hopkins. The hospital announced in December that it would begin decontaminating isolation rooms with these devices as standard practice starting in January.

Reference

1. Passaretti CL, Otter JA, Reich NG, et al. An evaluation of environmental decontamination with hydrogen peroxide vapor for reducing the risk of patient acquisition of multidrug-resistant organisms. Clin Infect Dis. 2013;56(1):27-35.

Paired, robotlike devices that disperse a bleaching disinfectant into the air of hospital rooms, then detoxify the disinfecting chemical, were found to be highly effective at killing and preventing the spread of “superbug” bacteria, according to research from Johns Hopkins Hospital published in Clinical Infectious Diseases.⁵ Hydrogen peroxide vaporizers were first deployed in Singapore hospitals in 2002 during an outbreak of severe acute respiratory syndrome (SARS).

Almost half of a study group of 6,350 patients in and out of 180 hospital rooms over a two-and-a-half-year period received the enhanced cleaning technology, while the others received routine cleaning only. Manufactured by Bioquell Inc. of Horsham, Pa. (www.bioquell.com), each device is about the size of a washing machine. They were deployed in hospital rooms with sealed vents, dispersing a thin film of hydrogen peroxide across all exposed surfaces, equipment, floors, and walls. This approach reduced by 64% the number of patients who later became contaminated with any of the most common drug-resistant organisms, including methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci, Clostridium difficile, and Acinetobacter baumannii.

Spreading the bleaching vapor this way “represents a major technological advance in preventing the spread of dangerous bacteria inside hospital rooms,” says senior investigator Trish Perl, MD, MSc, professor of medicine and an infectious disease specialist at Johns Hopkins. The hospital announced in December that it would begin decontaminating isolation rooms with these devices as standard practice starting in January.

Reference

1. Passaretti CL, Otter JA, Reich NG, et al. An evaluation of environmental decontamination with hydrogen peroxide vapor for reducing the risk of patient acquisition of multidrug-resistant organisms. Clin Infect Dis. 2013;56(1):27-35.

Paired, robotlike devices that disperse a bleaching disinfectant into the air of hospital rooms, then detoxify the disinfecting chemical, were found to be highly effective at killing and preventing the spread of “superbug” bacteria, according to research from Johns Hopkins Hospital published in Clinical Infectious Diseases.⁵ Hydrogen peroxide vaporizers were first deployed in Singapore hospitals in 2002 during an outbreak of severe acute respiratory syndrome (SARS).

Almost half of a study group of 6,350 patients in and out of 180 hospital rooms over a two-and-a-half-year period received the enhanced cleaning technology, while the others received routine cleaning only. Manufactured by Bioquell Inc. of Horsham, Pa. (www.bioquell.com), each device is about the size of a washing machine. They were deployed in hospital rooms with sealed vents, dispersing a thin film of hydrogen peroxide across all exposed surfaces, equipment, floors, and walls. This approach reduced by 64% the number of patients who later became contaminated with any of the most common drug-resistant organisms, including methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci, Clostridium difficile, and Acinetobacter baumannii.

Spreading the bleaching vapor this way “represents a major technological advance in preventing the spread of dangerous bacteria inside hospital rooms,” says senior investigator Trish Perl, MD, MSc, professor of medicine and an infectious disease specialist at Johns Hopkins. The hospital announced in December that it would begin decontaminating isolation rooms with these devices as standard practice starting in January.

Reference

1. Passaretti CL, Otter JA, Reich NG, et al. An evaluation of environmental decontamination with hydrogen peroxide vapor for reducing the risk of patient acquisition of multidrug-resistant organisms. Clin Infect Dis. 2013;56(1):27-35.

A recent study from the University of Missouri to explore how patients react to physicians’ use of computerized clinical decision support systems finds that these devices could leave patients feeling ignored and dissatisfied with their medical care, potentially increasing noncompliance with treatment while distracting physicians from the patient encounter.¹

“Patients may be concerned that the decision aids reduce their face-to-face time with physicians,” says lead author Victoria Shaffer, PhD, assistant professor of health and psychological sciences at the University of Missouri. She recommends incorporating computerized systems as teaching tools to engage patients and help them understand their diagnoses and recommendations. “Anything physicians or nurses can do to humanize the process may make patients more comfortable,” she says.

The study presented participants with written descriptions of hypothetical physician-patient encounters, with the physician using unaided judgment, pursuing advice from a medical expert, or using computerized clinical decision support. Physicians using the latter were viewed as less capable, but participants also were less likely to assign those physicians responsibility for negative outcomes.

A concurrent study from Missouri, part of a $14 million project funded by the Centers for Medicare & Medicaid Services (CMS) to reduce avoidable rehospitalizations of nursing home residents, suggests that sophisticated information technology (IT) can lead to more robust and integrated communication strategies among clinical staff, as well as better-coordinated care.² Nursing informatics expert Gregory Alexander found that nursing homes with IT used it to help make clinical decisions, electronically track patient care, and securely relay medical information.

References

1. Shaffer VA, Probst CA, Merkle EC, Arkes HR, Mitchell AM. Why do patients derogate physicians who use a computer-based diagnostic support system? Med Decis Making. 2013;33(1):108-118.
2. Alexander GL, Steege LM, Pasupathy KS, Wise K. Case studies of IT sophistication in nursing homes: a mixed method approach to examine communication strategies about pressure ulcer prevention practices. SciVerse website. Available at: http://www.sciencedirect.com/science/article/pii/S0169814112001229. Accessed March 10, 2013.

A recent study from the University of Missouri to explore how patients react to physicians’ use of computerized clinical decision support systems finds that these devices could leave patients feeling ignored and dissatisfied with their medical care, potentially increasing noncompliance with treatment while distracting physicians from the patient encounter.¹

“Patients may be concerned that the decision aids reduce their face-to-face time with physicians,” says lead author Victoria Shaffer, PhD, assistant professor of health and psychological sciences at the University of Missouri. She recommends incorporating computerized systems as teaching tools to engage patients and help them understand their diagnoses and recommendations. “Anything physicians or nurses can do to humanize the process may make patients more comfortable,” she says.

The study presented participants with written descriptions of hypothetical physician-patient encounters, with the physician using unaided judgment, pursuing advice from a medical expert, or using computerized clinical decision support. Physicians using the latter were viewed as less capable, but participants also were less likely to assign those physicians responsibility for negative outcomes.

A concurrent study from Missouri, part of a $14 million project funded by the Centers for Medicare & Medicaid Services (CMS) to reduce avoidable rehospitalizations of nursing home residents, suggests that sophisticated information technology (IT) can lead to more robust and integrated communication strategies among clinical staff, as well as better-coordinated care.² Nursing informatics expert Gregory Alexander found that nursing homes with IT used it to help make clinical decisions, electronically track patient care, and securely relay medical information.

References

1. Shaffer VA, Probst CA, Merkle EC, Arkes HR, Mitchell AM. Why do patients derogate physicians who use a computer-based diagnostic support system? Med Decis Making. 2013;33(1):108-118.
2. Alexander GL, Steege LM, Pasupathy KS, Wise K. Case studies of IT sophistication in nursing homes: a mixed method approach to examine communication strategies about pressure ulcer prevention practices. SciVerse website. Available at: http://www.sciencedirect.com/science/article/pii/S0169814112001229. Accessed March 10, 2013.

A recent study from the University of Missouri to explore how patients react to physicians’ use of computerized clinical decision support systems finds that these devices could leave patients feeling ignored and dissatisfied with their medical care, potentially increasing noncompliance with treatment while distracting physicians from the patient encounter.¹

“Patients may be concerned that the decision aids reduce their face-to-face time with physicians,” says lead author Victoria Shaffer, PhD, assistant professor of health and psychological sciences at the University of Missouri. She recommends incorporating computerized systems as teaching tools to engage patients and help them understand their diagnoses and recommendations. “Anything physicians or nurses can do to humanize the process may make patients more comfortable,” she says.

The study presented participants with written descriptions of hypothetical physician-patient encounters, with the physician using unaided judgment, pursuing advice from a medical expert, or using computerized clinical decision support. Physicians using the latter were viewed as less capable, but participants also were less likely to assign those physicians responsibility for negative outcomes.

A concurrent study from Missouri, part of a $14 million project funded by the Centers for Medicare & Medicaid Services (CMS) to reduce avoidable rehospitalizations of nursing home residents, suggests that sophisticated information technology (IT) can lead to more robust and integrated communication strategies among clinical staff, as well as better-coordinated care.² Nursing informatics expert Gregory Alexander found that nursing homes with IT used it to help make clinical decisions, electronically track patient care, and securely relay medical information.

References

1. Shaffer VA, Probst CA, Merkle EC, Arkes HR, Mitchell AM. Why do patients derogate physicians who use a computer-based diagnostic support system? Med Decis Making. 2013;33(1):108-118.
2. Alexander GL, Steege LM, Pasupathy KS, Wise K. Case studies of IT sophistication in nursing homes: a mixed method approach to examine communication strategies about pressure ulcer prevention practices. SciVerse website. Available at: http://www.sciencedirect.com/science/article/pii/S0169814112001229. Accessed March 10, 2013.

A new Dartmouth Atlas Project study of Medicare 30-day hospital readmissions found that rates essentially stayed the same (15.9% for medical discharges) between 2008 and 2010. But readmission rates varied widely across regions, with medical discharges at 18.1% in Bronx, N.Y., versus 11.4% in Ogden, Utah.

The report, The Revolving Door: A Report on U.S. Hospital Readmissions, also incorporates results from in-depth interviews with patients and providers.¹ It sheds light on why so many patients (1 in 6 medical and 1 in 8 surgical discharges) end up back in the hospital so soon—and what hospitals, physicians, nurses, and others are doing to limit avoidable readmissions.

An online interactive map (available at www.rwjf.org) displays the Dartmouth data on 30-day readmissions by hospital referral region.

The research was supported and publicized by the Robert Wood Johnson Foundation of Princeton, N.J., which has a number of other efforts under way to address readmissions. Another recent study supported by the foundation’s Nurse Faculty Scholars Program found that increased nurse-to-patient staffing ratios and good working environments for nurses were associated with significantly reduced 30-day readmissions.²

The foundation recently named the five winners of its “Transitions to Better Care” video contest, in which hospitals and health systems submitted short films to highlight innovative local practices to improve care transitions before, during, and after discharge. Check out the winning videos by searching “contest” at rwjf.org.

References

1. The Dartmouth Atlas of Health Care. The Revolving Door: A Report on U.S. Hospital Readmissions. The Dartmouth Atlas of Health Care website. Available at: http://www.dartmouthatlas.org/pages/readmissions2013. Accessed March 10, 2013.
2. McHugh M, Ma C. Hospital nursing and 30-day readmissions among Medicare patients with heart failure, acute myocardial infarction, and pneumonia. Med Care. 2013;51(1):52-59.

A new Dartmouth Atlas Project study of Medicare 30-day hospital readmissions found that rates essentially stayed the same (15.9% for medical discharges) between 2008 and 2010. But readmission rates varied widely across regions, with medical discharges at 18.1% in Bronx, N.Y., versus 11.4% in Ogden, Utah.

The report, The Revolving Door: A Report on U.S. Hospital Readmissions, also incorporates results from in-depth interviews with patients and providers.¹ It sheds light on why so many patients (1 in 6 medical and 1 in 8 surgical discharges) end up back in the hospital so soon—and what hospitals, physicians, nurses, and others are doing to limit avoidable readmissions.

An online interactive map (available at www.rwjf.org) displays the Dartmouth data on 30-day readmissions by hospital referral region.

The research was supported and publicized by the Robert Wood Johnson Foundation of Princeton, N.J., which has a number of other efforts under way to address readmissions. Another recent study supported by the foundation’s Nurse Faculty Scholars Program found that increased nurse-to-patient staffing ratios and good working environments for nurses were associated with significantly reduced 30-day readmissions.²

The foundation recently named the five winners of its “Transitions to Better Care” video contest, in which hospitals and health systems submitted short films to highlight innovative local practices to improve care transitions before, during, and after discharge. Check out the winning videos by searching “contest” at rwjf.org.

References

1. The Dartmouth Atlas of Health Care. The Revolving Door: A Report on U.S. Hospital Readmissions. The Dartmouth Atlas of Health Care website. Available at: http://www.dartmouthatlas.org/pages/readmissions2013. Accessed March 10, 2013.
2. McHugh M, Ma C. Hospital nursing and 30-day readmissions among Medicare patients with heart failure, acute myocardial infarction, and pneumonia. Med Care. 2013;51(1):52-59.

A new Dartmouth Atlas Project study of Medicare 30-day hospital readmissions found that rates essentially stayed the same (15.9% for medical discharges) between 2008 and 2010. But readmission rates varied widely across regions, with medical discharges at 18.1% in Bronx, N.Y., versus 11.4% in Ogden, Utah.

The report, The Revolving Door: A Report on U.S. Hospital Readmissions, also incorporates results from in-depth interviews with patients and providers.¹ It sheds light on why so many patients (1 in 6 medical and 1 in 8 surgical discharges) end up back in the hospital so soon—and what hospitals, physicians, nurses, and others are doing to limit avoidable readmissions.

An online interactive map (available at www.rwjf.org) displays the Dartmouth data on 30-day readmissions by hospital referral region.

The research was supported and publicized by the Robert Wood Johnson Foundation of Princeton, N.J., which has a number of other efforts under way to address readmissions. Another recent study supported by the foundation’s Nurse Faculty Scholars Program found that increased nurse-to-patient staffing ratios and good working environments for nurses were associated with significantly reduced 30-day readmissions.²

The foundation recently named the five winners of its “Transitions to Better Care” video contest, in which hospitals and health systems submitted short films to highlight innovative local practices to improve care transitions before, during, and after discharge. Check out the winning videos by searching “contest” at rwjf.org.

References

1. The Dartmouth Atlas of Health Care. The Revolving Door: A Report on U.S. Hospital Readmissions. The Dartmouth Atlas of Health Care website. Available at: http://www.dartmouthatlas.org/pages/readmissions2013. Accessed March 10, 2013.
2. McHugh M, Ma C. Hospital nursing and 30-day readmissions among Medicare patients with heart failure, acute myocardial infarction, and pneumonia. Med Care. 2013;51(1):52-59.

Hospitalists play an increasingly pivotal role in ensuring the highest quality and safety for patients in hospitals. The implementation of healthcare reform has only heightened the importance of hospital quality and patient safety for hospitalists. To enable education and advancement of quality improvement (QI), SHM has developed the Hospital Quality & Patient Safety (HQPS) Online Academy (http://www.hospitalmedicine.org/hqps).

The HQPS Online Academy consists of Internet-based modules that provide training not included in traditional medical education. These modules bridge the gap between the conceptualization and practice of quality in hospitals, helping hospitalists to prepare and lead quality initiatives to improve patient outcomes. The modules allow healthcare providers to explore and evaluate current quality initiatives and practices, as well as reflect on ways to improve core measures within their hospital.

Each module focuses on a core principle of QI and patient safety, and provides three AMA PRA Category 1 credits.

SHM members who are insured with The Doctors Company can earn a 5% risk-management credit by completing the first five HQPS modules (see below). Eligible members also enjoy premium savings through a 5% program discount and a claims-free credit of up to 25%.

HQPS Online Academy modules

• Quality measurement and stakeholder interests
• Teamwork and communication
• Organizational knowledge and leadership skills
• Patient safety principles
• Quality and safety improvement methods and skills (RCA and FMEA)

Hospitalists play an increasingly pivotal role in ensuring the highest quality and safety for patients in hospitals. The implementation of healthcare reform has only heightened the importance of hospital quality and patient safety for hospitalists. To enable education and advancement of quality improvement (QI), SHM has developed the Hospital Quality & Patient Safety (HQPS) Online Academy (http://www.hospitalmedicine.org/hqps).

The HQPS Online Academy consists of Internet-based modules that provide training not included in traditional medical education. These modules bridge the gap between the conceptualization and practice of quality in hospitals, helping hospitalists to prepare and lead quality initiatives to improve patient outcomes. The modules allow healthcare providers to explore and evaluate current quality initiatives and practices, as well as reflect on ways to improve core measures within their hospital.

Each module focuses on a core principle of QI and patient safety, and provides three AMA PRA Category 1 credits.

SHM members who are insured with The Doctors Company can earn a 5% risk-management credit by completing the first five HQPS modules (see below). Eligible members also enjoy premium savings through a 5% program discount and a claims-free credit of up to 25%.

HQPS Online Academy modules

• Quality measurement and stakeholder interests
• Teamwork and communication
• Organizational knowledge and leadership skills
• Patient safety principles
• Quality and safety improvement methods and skills (RCA and FMEA)

Hospitalists play an increasingly pivotal role in ensuring the highest quality and safety for patients in hospitals. The implementation of healthcare reform has only heightened the importance of hospital quality and patient safety for hospitalists. To enable education and advancement of quality improvement (QI), SHM has developed the Hospital Quality & Patient Safety (HQPS) Online Academy (http://www.hospitalmedicine.org/hqps).

The HQPS Online Academy consists of Internet-based modules that provide training not included in traditional medical education. These modules bridge the gap between the conceptualization and practice of quality in hospitals, helping hospitalists to prepare and lead quality initiatives to improve patient outcomes. The modules allow healthcare providers to explore and evaluate current quality initiatives and practices, as well as reflect on ways to improve core measures within their hospital.

Each module focuses on a core principle of QI and patient safety, and provides three AMA PRA Category 1 credits.

SHM members who are insured with The Doctors Company can earn a 5% risk-management credit by completing the first five HQPS modules (see below). Eligible members also enjoy premium savings through a 5% program discount and a claims-free credit of up to 25%.

HQPS Online Academy modules

• Quality measurement and stakeholder interests
• Teamwork and communication
• Organizational knowledge and leadership skills
• Patient safety principles
• Quality and safety improvement methods and skills (RCA and FMEA)

Hospitalists on the Hill

WHEN: May 16, 2013

WHERE: Washington, D.C.

HOW: Register today at www.hospitalmedicine2013.org/onthehill Space is limited.

The American Taxpayer Relief Act, which was signed into law Jan. 3 to stave off the fiscal cliff, contained a little-mentioned provision that reauthorized $10 million in Medicare funding for the National Quality Forum (NQF). Hospitalists, taking on the role of policy advocates, helped secure this reauthorization and score a victory for national quality-improvement (QI) efforts.

The NQF is a nonprofit organization established to create consensus around national priorities and measures for performing reporting and improvement in healthcare. It receives funding through a variety of sources ranging from public funds, private organizations and membership dues. Since 2009, it has received $10 million annually from a U.S. Department of Health and Human Services contract. That contract, a significant portion of NQF funding, was set to end in 2012.

The Stand for Quality coalition, composed of healthcare organizations supportive of the NQF, helps ensure that Congress sustains funding and support of performance measurement reporting and QI. SHM historically has been a strong proponent of the NQF, pitching in at the start of Stand for Quality four years ago this month. As it became clear that the federal contract for the NQF was not likely to be renewed by Congress for the 2013 calendar year, the member organizations of Stand for Quality were asked to step up to the plate in any way they could.

Jumping at the opportunity to assist, SHM linked hospitalists to their members of Congress in support of the NQF. Through members of SHM's Public Policy and Performance Measurement and Reporting committees, SHM connected with congressional offices and urged them to join a sign-on letter from the office of U.S. Sen. Mark Begich (D-Alaska) office in support of continued NQF funding. Letters between members of Congress are a way that legislators internally lobby on behalf of a particular issue. Hearing from their constituents can help persuade a legislator to act.

Sharing professional expertise also can inform a legislator's decisions. SHM members have a wealth of specialized knowledge and experiences that greatly benefit health policy discussions. In December 2012, SHM was asked to join NQF staffers and several other organizations on Capitol Hill for visits with select members of Congress, including several physician-legislators. These meetings were designed to raise the profile of the important work NQF is doing for QI and to make sure that NQF funding was not forgotten in any debt deal.

Mangla Gulati, MD, FACP, FHM, a hospitalist and SHM member, participated in these visits on behalf of hospital medicine and provided much-needed physician input on the importance of NQF's work.

The benefits of in-person visits are mutual: Members of Congress learn more about the real-life effects of a particular policy and, according to Dr. Gulati, "the visits to the Hill were a very valuable experience and shed a whole new light on the challenges we face in medicine."

Taken together, these advocacy tactics—coalition-building, contacting congressional offices, and in-person visits in Washington—were crucial to securing NQF's funding reauthorization and are critical tools for the advocacy work at SHM. The most concrete and impactful advocacy includes positioning hospitalists on the front line and sharing their perspectives and experiences with policymakers and their staffs.

We hope you'll heed this call and join SHM in Washington, D.C., May 16 for Hospitalists on the Hill, part of SHM's annual meeting. For more information and to register, go to www.hospitalmedicine2013.org/onthehill.

Joshua Lapps is SHM's government relations specialist.

Hospitalists on the Hill

WHEN: May 16, 2013

WHERE: Washington, D.C.

HOW: Register today at www.hospitalmedicine2013.org/onthehill Space is limited.

The American Taxpayer Relief Act, which was signed into law Jan. 3 to stave off the fiscal cliff, contained a little-mentioned provision that reauthorized $10 million in Medicare funding for the National Quality Forum (NQF). Hospitalists, taking on the role of policy advocates, helped secure this reauthorization and score a victory for national quality-improvement (QI) efforts.

The NQF is a nonprofit organization established to create consensus around national priorities and measures for performing reporting and improvement in healthcare. It receives funding through a variety of sources ranging from public funds, private organizations and membership dues. Since 2009, it has received $10 million annually from a U.S. Department of Health and Human Services contract. That contract, a significant portion of NQF funding, was set to end in 2012.

The Stand for Quality coalition, composed of healthcare organizations supportive of the NQF, helps ensure that Congress sustains funding and support of performance measurement reporting and QI. SHM historically has been a strong proponent of the NQF, pitching in at the start of Stand for Quality four years ago this month. As it became clear that the federal contract for the NQF was not likely to be renewed by Congress for the 2013 calendar year, the member organizations of Stand for Quality were asked to step up to the plate in any way they could.

Jumping at the opportunity to assist, SHM linked hospitalists to their members of Congress in support of the NQF. Through members of SHM's Public Policy and Performance Measurement and Reporting committees, SHM connected with congressional offices and urged them to join a sign-on letter from the office of U.S. Sen. Mark Begich (D-Alaska) office in support of continued NQF funding. Letters between members of Congress are a way that legislators internally lobby on behalf of a particular issue. Hearing from their constituents can help persuade a legislator to act.

Sharing professional expertise also can inform a legislator's decisions. SHM members have a wealth of specialized knowledge and experiences that greatly benefit health policy discussions. In December 2012, SHM was asked to join NQF staffers and several other organizations on Capitol Hill for visits with select members of Congress, including several physician-legislators. These meetings were designed to raise the profile of the important work NQF is doing for QI and to make sure that NQF funding was not forgotten in any debt deal.

Mangla Gulati, MD, FACP, FHM, a hospitalist and SHM member, participated in these visits on behalf of hospital medicine and provided much-needed physician input on the importance of NQF's work.

The benefits of in-person visits are mutual: Members of Congress learn more about the real-life effects of a particular policy and, according to Dr. Gulati, "the visits to the Hill were a very valuable experience and shed a whole new light on the challenges we face in medicine."

Taken together, these advocacy tactics—coalition-building, contacting congressional offices, and in-person visits in Washington—were crucial to securing NQF's funding reauthorization and are critical tools for the advocacy work at SHM. The most concrete and impactful advocacy includes positioning hospitalists on the front line and sharing their perspectives and experiences with policymakers and their staffs.

We hope you'll heed this call and join SHM in Washington, D.C., May 16 for Hospitalists on the Hill, part of SHM's annual meeting. For more information and to register, go to www.hospitalmedicine2013.org/onthehill.

Joshua Lapps is SHM's government relations specialist.

Hospitalists on the Hill

WHEN: May 16, 2013

WHERE: Washington, D.C.

HOW: Register today at www.hospitalmedicine2013.org/onthehill Space is limited.

The American Taxpayer Relief Act, which was signed into law Jan. 3 to stave off the fiscal cliff, contained a little-mentioned provision that reauthorized $10 million in Medicare funding for the National Quality Forum (NQF). Hospitalists, taking on the role of policy advocates, helped secure this reauthorization and score a victory for national quality-improvement (QI) efforts.

The NQF is a nonprofit organization established to create consensus around national priorities and measures for performing reporting and improvement in healthcare. It receives funding through a variety of sources ranging from public funds, private organizations and membership dues. Since 2009, it has received $10 million annually from a U.S. Department of Health and Human Services contract. That contract, a significant portion of NQF funding, was set to end in 2012.

The Stand for Quality coalition, composed of healthcare organizations supportive of the NQF, helps ensure that Congress sustains funding and support of performance measurement reporting and QI. SHM historically has been a strong proponent of the NQF, pitching in at the start of Stand for Quality four years ago this month. As it became clear that the federal contract for the NQF was not likely to be renewed by Congress for the 2013 calendar year, the member organizations of Stand for Quality were asked to step up to the plate in any way they could.

Jumping at the opportunity to assist, SHM linked hospitalists to their members of Congress in support of the NQF. Through members of SHM's Public Policy and Performance Measurement and Reporting committees, SHM connected with congressional offices and urged them to join a sign-on letter from the office of U.S. Sen. Mark Begich (D-Alaska) office in support of continued NQF funding. Letters between members of Congress are a way that legislators internally lobby on behalf of a particular issue. Hearing from their constituents can help persuade a legislator to act.

Sharing professional expertise also can inform a legislator's decisions. SHM members have a wealth of specialized knowledge and experiences that greatly benefit health policy discussions. In December 2012, SHM was asked to join NQF staffers and several other organizations on Capitol Hill for visits with select members of Congress, including several physician-legislators. These meetings were designed to raise the profile of the important work NQF is doing for QI and to make sure that NQF funding was not forgotten in any debt deal.

Mangla Gulati, MD, FACP, FHM, a hospitalist and SHM member, participated in these visits on behalf of hospital medicine and provided much-needed physician input on the importance of NQF's work.

The benefits of in-person visits are mutual: Members of Congress learn more about the real-life effects of a particular policy and, according to Dr. Gulati, "the visits to the Hill were a very valuable experience and shed a whole new light on the challenges we face in medicine."

Taken together, these advocacy tactics—coalition-building, contacting congressional offices, and in-person visits in Washington—were crucial to securing NQF's funding reauthorization and are critical tools for the advocacy work at SHM. The most concrete and impactful advocacy includes positioning hospitalists on the front line and sharing their perspectives and experiences with policymakers and their staffs.

We hope you'll heed this call and join SHM in Washington, D.C., May 16 for Hospitalists on the Hill, part of SHM's annual meeting. For more information and to register, go to www.hospitalmedicine2013.org/onthehill.

Joshua Lapps is SHM's government relations specialist.

Awarded to a hospital by comparing an individual hospital’s performance measure rates during a certain period with all hospitals’ rates during the baseline period.

Awarded to a hospital by comparing an individual hospital’s performance measure rates during a certain period with all hospitals’ rates during the baseline period.

Awarded to a hospital by comparing an individual hospital’s performance measure rates during a certain period with all hospitals’ rates during the baseline period.

Does your team have:

• Eagerness to improve their discharge processes and reduce unnecessary readmissions and avoidable adverse events in the post-discharge period?
• A multidisciplinary team in place capable of working collaboratively to redesign existing care processes?
• A dedicated leader to manage the process of tailoring the BOOST intervention to your site’s needs and implementing BOOST?
• Support of at least one executive sponsor who can meet with the team monthly?
• Access to data support personnel needed to collect baseline and post-implementation data?

Does your team have:

• Eagerness to improve their discharge processes and reduce unnecessary readmissions and avoidable adverse events in the post-discharge period?
• A multidisciplinary team in place capable of working collaboratively to redesign existing care processes?
• A dedicated leader to manage the process of tailoring the BOOST intervention to your site’s needs and implementing BOOST?
• Support of at least one executive sponsor who can meet with the team monthly?
• Access to data support personnel needed to collect baseline and post-implementation data?

Does your team have:

• Eagerness to improve their discharge processes and reduce unnecessary readmissions and avoidable adverse events in the post-discharge period?
• A multidisciplinary team in place capable of working collaboratively to redesign existing care processes?
• A dedicated leader to manage the process of tailoring the BOOST intervention to your site’s needs and implementing BOOST?
• Support of at least one executive sponsor who can meet with the team monthly?
• Access to data support personnel needed to collect baseline and post-implementation data?

By Shaun Frost, MD, SFHM

It is difficult to disagree that patients and their families deserve to be satisfied with the care they receive, and furthermore that a satisfying care experience is the foundation upon which the ability to heal is based. Mention the subject of patient satisfaction, however, to care providers, and prepare for many to respond negatively. For most, this frustration likely stems from the challenges associated with satisfaction measurement, and the application of this measurement to provider performance reporting and reimbursement. Perhaps by focusing so intently on quantifying how happy patients are with their care, we have distracted ourselves from the real goal of creating patient experiences that enable optimal healing.

In some respects, healthcare’s preoccupation with satisfaction measurements seems analogous to administering a final examination before teaching the course material. If so, at this juncture, it would be prudent to back up and examine the curriculum required to master the subject matter necessary to perform well on the test. To this end, it is necessary to:

Identify the contributors to a satisfying patient experience, and Focus specifically on understanding patient expectations.

Expectation Examination

An essential reading on the subject of patient experience and satisfaction is a July/August 2005 article in The Hospitalist titled “Patient Satisfaction: the Hospitalist’s Role,” in which Patrick J. Torcson, MD, MMM, FACP, SFHM, introduces “The First Law of Service.”¹ According to this law, satisfaction can be mathematically defined as equal to patients’ perceptions of the care they received minus their expectations for that care (satisfaction=perception–expectation). Accordingly, if perception meets or exceeds expectation, an associated degree of satisfaction will be generated.

Both perceptions and expectations can be affected to create satisfaction. Remodeling a hospital lobby is an example of an effort to primarily influence patient perception. When considering efforts to influence patient expectations, it is useful to think of universal versus individual patient requirements, needs, desires, values, and goals. Examples of universal patient expectations (meaning expectations held by all or a majority of patients) would include receiving warm meals at scheduled times, having call lights answered in a timely manner, understanding the side effects of medications, and receiving instructions at the time of discharge. Examples of individual patient expectations (meaning expectations that are personally held by individual patients because of reasons unique to individual circumstances not common to everyone) would be need for low-cost medications due to economic hardship, prioritization of functional improvement versus pain elimination, and tolerance of treatment-related side effects.

It might be fair to say that in its pursuit to create satisfying patient experiences, our healthcare system has focused more on influencing perception and universal patient expectations than it has on addressing unique, personally held patient interests. In the future, we should attend more diligently to individual expectations. By doing so, patients will be better engaged, providers will be better informed, and satisfaction will follow.

Shared Decision-Making

You wouldn’t think of retaining a real estate agent to assist you in purchasing a home without informing that person about your personal needs. In order to satisfy you, the agent must understand what you expect in regard to such issues as price, square footage, yard size, community amenities, school district, proximity to work, etc. Just as your needs in shopping for a home can only be met by considering your personal expectations, your patient’s needs can only be met by understanding their individual healthcare requirements.

Unfortunately, understanding an individual patient’s expectations about their healthcare is more challenging than outlining a list of requirements for their ideal home. Although the reasons for this are multiple (see “Barriers to Understanding Patient Expectations,” left), the solution in large part rests in the application of shared decision-making (SDM).

SDM is defined as a collaborative communication process between provider and patient intended to help the patient decide among multiple acceptable healthcare choices in accordance with their preferences and values. SDM has been demonstrated to positively impact patient satisfaction, as well as care quality, resource utilization, and healthcare costs. A cornerstone feature of SDM is the use of decision aids to assist patients in identifying their personal healthcare expectations while simultaneously educating them about how those expectations apply to care plan options. Decision aids also benefit care providers by creating a standardized framework by which to solicit patients’ input regarding their preferences. When navigated appropriately, SDM balances the clinician’s expertise and knowledge with the patient’s goals and values.

Recent investigations into the application of SDM to HM practice have touted its effectiveness (e.g. when applied to low-risk chest pain evaluations) and questioned the creation of unintended negative consequences (e.g. on hospital resource consumption and affordability).^2,3 Despite limited data in the HM setting, several literature reviews examining the effectiveness of SDM across various care sites consistently linked it to greater patient satisfaction.⁴

It is important to realize that policymakers are lauding the promise of SDM and incorporating its use into rules, regulations, and funding opportunities. For example, the Centers for Medicare & Medicaid Services (CMS) requires SDM to participate in its accountable-care organization (ACO) programs, and several states recently have enacted legislation to promote SDM. Expect thus to experience future pressure to apply SDM in your hospitalist practice. Organizations dedicated to the advancement of SDM include the Society for Participatory Medicine, the Informed Medical Decisions Foundation, the Society for Medical Decision Making, and the Mayo Clinic. More information and resources are available on their websites.

Conclusions

Satisfaction surveys are tools for measuring the quality of patient care experiences. Although satisfaction surveying is an inexact science, and the application of survey results to performance evaluation is challenging, we must remember that the goal is to optimize patient experience. Necessary in the creation of a satisfying patient experience is a robust understanding of patient expectations. SDM is a promising communication strategy that can help both providers and patients better identify the personally held values and goals that determine patient care expectations.

Dr. Frost is president of SHM.

References

1. Torcson, P. Patient satisfaction: the hospitalist’s role. The Hospitalist website. Available at: http://www.the-hospitalist.org/details/article/256805/Patient_Satisfaction_the_Hospitalists_Role.html. Accessed Jan. 30, 2013.
2. Hess E, et al. The chest pain choice decision aid. A randomized trial. Circ Cardiovasc Qual Outcomes. 2012;5:251-259.
3. Tak, HJ, Meltzer, D. Effect of patient preference in medical decision-making on inpatient care [abstract]. J Hosp Med. 2012;7(Suppl 2):91.
4. Hostetter, M, Klein S. Helping patients make better treatment choices with decision aids. The Commonwealth Fund website. Available at: http://www.commonwealthfund.org/Newsletters/Quality-Matters/2012/October-November/In-Focus.aspx. Accessed Jan. 30, 2013.

By Shaun Frost, MD, SFHM

It is difficult to disagree that patients and their families deserve to be satisfied with the care they receive, and furthermore that a satisfying care experience is the foundation upon which the ability to heal is based. Mention the subject of patient satisfaction, however, to care providers, and prepare for many to respond negatively. For most, this frustration likely stems from the challenges associated with satisfaction measurement, and the application of this measurement to provider performance reporting and reimbursement. Perhaps by focusing so intently on quantifying how happy patients are with their care, we have distracted ourselves from the real goal of creating patient experiences that enable optimal healing.

In some respects, healthcare’s preoccupation with satisfaction measurements seems analogous to administering a final examination before teaching the course material. If so, at this juncture, it would be prudent to back up and examine the curriculum required to master the subject matter necessary to perform well on the test. To this end, it is necessary to:

Identify the contributors to a satisfying patient experience, and Focus specifically on understanding patient expectations.

Expectation Examination

An essential reading on the subject of patient experience and satisfaction is a July/August 2005 article in The Hospitalist titled “Patient Satisfaction: the Hospitalist’s Role,” in which Patrick J. Torcson, MD, MMM, FACP, SFHM, introduces “The First Law of Service.”¹ According to this law, satisfaction can be mathematically defined as equal to patients’ perceptions of the care they received minus their expectations for that care (satisfaction=perception–expectation). Accordingly, if perception meets or exceeds expectation, an associated degree of satisfaction will be generated.

Both perceptions and expectations can be affected to create satisfaction. Remodeling a hospital lobby is an example of an effort to primarily influence patient perception. When considering efforts to influence patient expectations, it is useful to think of universal versus individual patient requirements, needs, desires, values, and goals. Examples of universal patient expectations (meaning expectations held by all or a majority of patients) would include receiving warm meals at scheduled times, having call lights answered in a timely manner, understanding the side effects of medications, and receiving instructions at the time of discharge. Examples of individual patient expectations (meaning expectations that are personally held by individual patients because of reasons unique to individual circumstances not common to everyone) would be need for low-cost medications due to economic hardship, prioritization of functional improvement versus pain elimination, and tolerance of treatment-related side effects.

It might be fair to say that in its pursuit to create satisfying patient experiences, our healthcare system has focused more on influencing perception and universal patient expectations than it has on addressing unique, personally held patient interests. In the future, we should attend more diligently to individual expectations. By doing so, patients will be better engaged, providers will be better informed, and satisfaction will follow.

Shared Decision-Making

You wouldn’t think of retaining a real estate agent to assist you in purchasing a home without informing that person about your personal needs. In order to satisfy you, the agent must understand what you expect in regard to such issues as price, square footage, yard size, community amenities, school district, proximity to work, etc. Just as your needs in shopping for a home can only be met by considering your personal expectations, your patient’s needs can only be met by understanding their individual healthcare requirements.

Unfortunately, understanding an individual patient’s expectations about their healthcare is more challenging than outlining a list of requirements for their ideal home. Although the reasons for this are multiple (see “Barriers to Understanding Patient Expectations,” left), the solution in large part rests in the application of shared decision-making (SDM).

SDM is defined as a collaborative communication process between provider and patient intended to help the patient decide among multiple acceptable healthcare choices in accordance with their preferences and values. SDM has been demonstrated to positively impact patient satisfaction, as well as care quality, resource utilization, and healthcare costs. A cornerstone feature of SDM is the use of decision aids to assist patients in identifying their personal healthcare expectations while simultaneously educating them about how those expectations apply to care plan options. Decision aids also benefit care providers by creating a standardized framework by which to solicit patients’ input regarding their preferences. When navigated appropriately, SDM balances the clinician’s expertise and knowledge with the patient’s goals and values.

Recent investigations into the application of SDM to HM practice have touted its effectiveness (e.g. when applied to low-risk chest pain evaluations) and questioned the creation of unintended negative consequences (e.g. on hospital resource consumption and affordability).^2,3 Despite limited data in the HM setting, several literature reviews examining the effectiveness of SDM across various care sites consistently linked it to greater patient satisfaction.⁴

It is important to realize that policymakers are lauding the promise of SDM and incorporating its use into rules, regulations, and funding opportunities. For example, the Centers for Medicare & Medicaid Services (CMS) requires SDM to participate in its accountable-care organization (ACO) programs, and several states recently have enacted legislation to promote SDM. Expect thus to experience future pressure to apply SDM in your hospitalist practice. Organizations dedicated to the advancement of SDM include the Society for Participatory Medicine, the Informed Medical Decisions Foundation, the Society for Medical Decision Making, and the Mayo Clinic. More information and resources are available on their websites.

Conclusions

Satisfaction surveys are tools for measuring the quality of patient care experiences. Although satisfaction surveying is an inexact science, and the application of survey results to performance evaluation is challenging, we must remember that the goal is to optimize patient experience. Necessary in the creation of a satisfying patient experience is a robust understanding of patient expectations. SDM is a promising communication strategy that can help both providers and patients better identify the personally held values and goals that determine patient care expectations.

Dr. Frost is president of SHM.

References

1. Torcson, P. Patient satisfaction: the hospitalist’s role. The Hospitalist website. Available at: http://www.the-hospitalist.org/details/article/256805/Patient_Satisfaction_the_Hospitalists_Role.html. Accessed Jan. 30, 2013.
2. Hess E, et al. The chest pain choice decision aid. A randomized trial. Circ Cardiovasc Qual Outcomes. 2012;5:251-259.
3. Tak, HJ, Meltzer, D. Effect of patient preference in medical decision-making on inpatient care [abstract]. J Hosp Med. 2012;7(Suppl 2):91.
4. Hostetter, M, Klein S. Helping patients make better treatment choices with decision aids. The Commonwealth Fund website. Available at: http://www.commonwealthfund.org/Newsletters/Quality-Matters/2012/October-November/In-Focus.aspx. Accessed Jan. 30, 2013.

By Shaun Frost, MD, SFHM

It is difficult to disagree that patients and their families deserve to be satisfied with the care they receive, and furthermore that a satisfying care experience is the foundation upon which the ability to heal is based. Mention the subject of patient satisfaction, however, to care providers, and prepare for many to respond negatively. For most, this frustration likely stems from the challenges associated with satisfaction measurement, and the application of this measurement to provider performance reporting and reimbursement. Perhaps by focusing so intently on quantifying how happy patients are with their care, we have distracted ourselves from the real goal of creating patient experiences that enable optimal healing.

In some respects, healthcare’s preoccupation with satisfaction measurements seems analogous to administering a final examination before teaching the course material. If so, at this juncture, it would be prudent to back up and examine the curriculum required to master the subject matter necessary to perform well on the test. To this end, it is necessary to:

Identify the contributors to a satisfying patient experience, and Focus specifically on understanding patient expectations.

Expectation Examination

An essential reading on the subject of patient experience and satisfaction is a July/August 2005 article in The Hospitalist titled “Patient Satisfaction: the Hospitalist’s Role,” in which Patrick J. Torcson, MD, MMM, FACP, SFHM, introduces “The First Law of Service.”¹ According to this law, satisfaction can be mathematically defined as equal to patients’ perceptions of the care they received minus their expectations for that care (satisfaction=perception–expectation). Accordingly, if perception meets or exceeds expectation, an associated degree of satisfaction will be generated.

Both perceptions and expectations can be affected to create satisfaction. Remodeling a hospital lobby is an example of an effort to primarily influence patient perception. When considering efforts to influence patient expectations, it is useful to think of universal versus individual patient requirements, needs, desires, values, and goals. Examples of universal patient expectations (meaning expectations held by all or a majority of patients) would include receiving warm meals at scheduled times, having call lights answered in a timely manner, understanding the side effects of medications, and receiving instructions at the time of discharge. Examples of individual patient expectations (meaning expectations that are personally held by individual patients because of reasons unique to individual circumstances not common to everyone) would be need for low-cost medications due to economic hardship, prioritization of functional improvement versus pain elimination, and tolerance of treatment-related side effects.

It might be fair to say that in its pursuit to create satisfying patient experiences, our healthcare system has focused more on influencing perception and universal patient expectations than it has on addressing unique, personally held patient interests. In the future, we should attend more diligently to individual expectations. By doing so, patients will be better engaged, providers will be better informed, and satisfaction will follow.

Shared Decision-Making

You wouldn’t think of retaining a real estate agent to assist you in purchasing a home without informing that person about your personal needs. In order to satisfy you, the agent must understand what you expect in regard to such issues as price, square footage, yard size, community amenities, school district, proximity to work, etc. Just as your needs in shopping for a home can only be met by considering your personal expectations, your patient’s needs can only be met by understanding their individual healthcare requirements.

Unfortunately, understanding an individual patient’s expectations about their healthcare is more challenging than outlining a list of requirements for their ideal home. Although the reasons for this are multiple (see “Barriers to Understanding Patient Expectations,” left), the solution in large part rests in the application of shared decision-making (SDM).

SDM is defined as a collaborative communication process between provider and patient intended to help the patient decide among multiple acceptable healthcare choices in accordance with their preferences and values. SDM has been demonstrated to positively impact patient satisfaction, as well as care quality, resource utilization, and healthcare costs. A cornerstone feature of SDM is the use of decision aids to assist patients in identifying their personal healthcare expectations while simultaneously educating them about how those expectations apply to care plan options. Decision aids also benefit care providers by creating a standardized framework by which to solicit patients’ input regarding their preferences. When navigated appropriately, SDM balances the clinician’s expertise and knowledge with the patient’s goals and values.

Recent investigations into the application of SDM to HM practice have touted its effectiveness (e.g. when applied to low-risk chest pain evaluations) and questioned the creation of unintended negative consequences (e.g. on hospital resource consumption and affordability).^2,3 Despite limited data in the HM setting, several literature reviews examining the effectiveness of SDM across various care sites consistently linked it to greater patient satisfaction.⁴

It is important to realize that policymakers are lauding the promise of SDM and incorporating its use into rules, regulations, and funding opportunities. For example, the Centers for Medicare & Medicaid Services (CMS) requires SDM to participate in its accountable-care organization (ACO) programs, and several states recently have enacted legislation to promote SDM. Expect thus to experience future pressure to apply SDM in your hospitalist practice. Organizations dedicated to the advancement of SDM include the Society for Participatory Medicine, the Informed Medical Decisions Foundation, the Society for Medical Decision Making, and the Mayo Clinic. More information and resources are available on their websites.

Conclusions

Satisfaction surveys are tools for measuring the quality of patient care experiences. Although satisfaction surveying is an inexact science, and the application of survey results to performance evaluation is challenging, we must remember that the goal is to optimize patient experience. Necessary in the creation of a satisfying patient experience is a robust understanding of patient expectations. SDM is a promising communication strategy that can help both providers and patients better identify the personally held values and goals that determine patient care expectations.

Dr. Frost is president of SHM.

References

1. Torcson, P. Patient satisfaction: the hospitalist’s role. The Hospitalist website. Available at: http://www.the-hospitalist.org/details/article/256805/Patient_Satisfaction_the_Hospitalists_Role.html. Accessed Jan. 30, 2013.
2. Hess E, et al. The chest pain choice decision aid. A randomized trial. Circ Cardiovasc Qual Outcomes. 2012;5:251-259.
3. Tak, HJ, Meltzer, D. Effect of patient preference in medical decision-making on inpatient care [abstract]. J Hosp Med. 2012;7(Suppl 2):91.
4. Hostetter, M, Klein S. Helping patients make better treatment choices with decision aids. The Commonwealth Fund website. Available at: http://www.commonwealthfund.org/Newsletters/Quality-Matters/2012/October-November/In-Focus.aspx. Accessed Jan. 30, 2013.

HVBP’s First Efficiency Measure

Move over, cost, LOS—make room for ‘Medicare spending per beneficiary’

The unwritten rule in hospitalist circles is that lower cost and length of stay (LOS) mean higher efficiency, with hospitalists (me included) often pointing to one or both of these as a yardstick of performance in the efficiency domain. But if we lower hospital length of stay and costs while shifting costs to post-hospital care, have we solved anything?

This very question was raised by Kuo and Goodwin’s observational study that revealed that decreased hospital costs and LOS were offset by higher utilization and costs after discharge under hospitalist care.¹

Efficiency As a Domain of Quality

Using the Institute of Medicine’s (IOM) six domains of quality as a framework (see Table 1, right), the Centers for Medicare & Medicaid Services’ (CMS) Hospital Value-Based Purchasing (HVBP) program seeks to encourage enhanced quality in all of the IOM domains. For HVBP 2015, we see the addition of the first measure in the domain of efficiency.

You may be saying to yourself, “It’s only 2013. Why should I worry about HVBP 2015?” Here’s why: The measurement periods for HVBP 2015 are May to December 2011 (baseline) and May to December 2013 (performance). Hospitals can succeed under HVBP if they demonstrate improvement from baseline or attainment, which indicates maintenance of a high level of performance despite no substantial improvement from baseline. Medicare spending per beneficiary (MSPB) will make up 20% of the 2015 HVBP incentive pool for hospitals.

Medicare Spending Per Beneficiary Instead of Costs or LOS

Why did CMS choose to use MSPB as a measure and not simply hospital costs or length of stay? Measuring efficiency of hospital care has proven to be a sticky wicket. If one simply measures and rewards decreased hospital costs and/or length of stay (which you might legitimately argue is exactly what the current DRG system does by paying a case rate to the hospital), one runs the risk of shifting costs to settings beyond the four walls of the hospital, or even fueling higher rates of hospital readmissions. Also, physician costs and other costs (therapy, home care) are not accounted for; they are accounted for under MSPB (described below). Finally, hospital costs and LOS vary substantially across regions and by severity of illness of the patients being analyzed. This makes it difficult to compare, for example, LOS in California versus Massachusetts.

The MSPB is designed to be a comprehensive and equitable metric:

• It seeks to eliminate cost-shifting among settings by widening the time period from three days prior to 30 days post-inpatient-care episode;
• It looks at the full cost of care by including expenses from both Medicare Part A (hospital) and Part B (doctors, PT, OT, home health, others);
• It incorporates risk adjustment by taking into account differences in patient health status; and
• It seeks to level the playing field by using a price standardization methodology that factors in geographic payment differences in wages, practice costs, and payments for indirect medical education and disproportionate share hospitals (those that treat large numbers of the indigent population).

Driving High Performance in Medicare Spending Per Beneficiary

Hospitalists straddle the Part A and Part B elements of Medicare; they have one foot in the hospital and one foot in the physician practice world. They should be able to improve their hospitals’ performance under the MSPB yardstick. Since the performance measurement period starts in May, now is the time to sharpen your focus on MSPB.

Here are the top priorities for MSPB that I recommend for hospitalists:

Reduction of marginally beneficial resource utilization. This is a process of analyzing resource (e.g. pharmacy, radiology, laboratory, blood products) utilization for the purpose of minimizing costly practices that do not benefit the patient. This is an essential practice of a high-functioning hospitalist program. Through its participation in the Choosing Wisely campaign (see “Stop! Think Twice Before You Order,” p. 46), SHM has helped hospitalists have conversations about these practices with patients.

Hospital throughput. Work on “front end” throughput with the ED by having a process in place to quickly evaluate and facilitate potential admissions. Work with case management to assure timely (and early in the day) discharges.

Safe-discharge processes. We reviewed key elements of a safe discharge last month and provided a link to SHM’s Project BOOST (www.hospitalmedicine.org/boost). From the MSPB perspective: A safe discharge minimizes exorbitant spending after discharge.

Documentation integrity. Because MSPB is risk-adjusted, the more the record reflects patient severity of illness, the better your hospital will perform, all else being equal. Work collaboratively with your documentation integrity professionals!

Much of the success of the HM specialty has been built on the tenet that the hospitalist model delivers efficient inpatient care. In the coming years, the specialty’s contribution will increasingly be gauged by the MSPB measure.

Reference

1. Kuo YF, Goodwin JS. Association of hospitalist care with medical utilization after discharge: evidence of cost shift from a cohort study. Ann Intern Med. 2011;155(3):152-159.

Dr. Whitcomb is medical director of healthcare quality at Baystate Medical Center in Springfield, Mass. He is a co-founder and past president of SHM. Email him at [email protected].

HVBP’s First Efficiency Measure

Move over, cost, LOS—make room for ‘Medicare spending per beneficiary’

The unwritten rule in hospitalist circles is that lower cost and length of stay (LOS) mean higher efficiency, with hospitalists (me included) often pointing to one or both of these as a yardstick of performance in the efficiency domain. But if we lower hospital length of stay and costs while shifting costs to post-hospital care, have we solved anything?

This very question was raised by Kuo and Goodwin’s observational study that revealed that decreased hospital costs and LOS were offset by higher utilization and costs after discharge under hospitalist care.¹

Efficiency As a Domain of Quality

Using the Institute of Medicine’s (IOM) six domains of quality as a framework (see Table 1, right), the Centers for Medicare & Medicaid Services’ (CMS) Hospital Value-Based Purchasing (HVBP) program seeks to encourage enhanced quality in all of the IOM domains. For HVBP 2015, we see the addition of the first measure in the domain of efficiency.

You may be saying to yourself, “It’s only 2013. Why should I worry about HVBP 2015?” Here’s why: The measurement periods for HVBP 2015 are May to December 2011 (baseline) and May to December 2013 (performance). Hospitals can succeed under HVBP if they demonstrate improvement from baseline or attainment, which indicates maintenance of a high level of performance despite no substantial improvement from baseline. Medicare spending per beneficiary (MSPB) will make up 20% of the 2015 HVBP incentive pool for hospitals.

Medicare Spending Per Beneficiary Instead of Costs or LOS

Why did CMS choose to use MSPB as a measure and not simply hospital costs or length of stay? Measuring efficiency of hospital care has proven to be a sticky wicket. If one simply measures and rewards decreased hospital costs and/or length of stay (which you might legitimately argue is exactly what the current DRG system does by paying a case rate to the hospital), one runs the risk of shifting costs to settings beyond the four walls of the hospital, or even fueling higher rates of hospital readmissions. Also, physician costs and other costs (therapy, home care) are not accounted for; they are accounted for under MSPB (described below). Finally, hospital costs and LOS vary substantially across regions and by severity of illness of the patients being analyzed. This makes it difficult to compare, for example, LOS in California versus Massachusetts.

The MSPB is designed to be a comprehensive and equitable metric:

• It seeks to eliminate cost-shifting among settings by widening the time period from three days prior to 30 days post-inpatient-care episode;
• It looks at the full cost of care by including expenses from both Medicare Part A (hospital) and Part B (doctors, PT, OT, home health, others);
• It incorporates risk adjustment by taking into account differences in patient health status; and
• It seeks to level the playing field by using a price standardization methodology that factors in geographic payment differences in wages, practice costs, and payments for indirect medical education and disproportionate share hospitals (those that treat large numbers of the indigent population).

Driving High Performance in Medicare Spending Per Beneficiary

Hospitalists straddle the Part A and Part B elements of Medicare; they have one foot in the hospital and one foot in the physician practice world. They should be able to improve their hospitals’ performance under the MSPB yardstick. Since the performance measurement period starts in May, now is the time to sharpen your focus on MSPB.

Here are the top priorities for MSPB that I recommend for hospitalists:

Reduction of marginally beneficial resource utilization. This is a process of analyzing resource (e.g. pharmacy, radiology, laboratory, blood products) utilization for the purpose of minimizing costly practices that do not benefit the patient. This is an essential practice of a high-functioning hospitalist program. Through its participation in the Choosing Wisely campaign (see “Stop! Think Twice Before You Order,” p. 46), SHM has helped hospitalists have conversations about these practices with patients.

Hospital throughput. Work on “front end” throughput with the ED by having a process in place to quickly evaluate and facilitate potential admissions. Work with case management to assure timely (and early in the day) discharges.

Safe-discharge processes. We reviewed key elements of a safe discharge last month and provided a link to SHM’s Project BOOST (www.hospitalmedicine.org/boost). From the MSPB perspective: A safe discharge minimizes exorbitant spending after discharge.

Documentation integrity. Because MSPB is risk-adjusted, the more the record reflects patient severity of illness, the better your hospital will perform, all else being equal. Work collaboratively with your documentation integrity professionals!

Much of the success of the HM specialty has been built on the tenet that the hospitalist model delivers efficient inpatient care. In the coming years, the specialty’s contribution will increasingly be gauged by the MSPB measure.

Reference

1. Kuo YF, Goodwin JS. Association of hospitalist care with medical utilization after discharge: evidence of cost shift from a cohort study. Ann Intern Med. 2011;155(3):152-159.

Dr. Whitcomb is medical director of healthcare quality at Baystate Medical Center in Springfield, Mass. He is a co-founder and past president of SHM. Email him at [email protected].

HVBP’s First Efficiency Measure

Move over, cost, LOS—make room for ‘Medicare spending per beneficiary’

The unwritten rule in hospitalist circles is that lower cost and length of stay (LOS) mean higher efficiency, with hospitalists (me included) often pointing to one or both of these as a yardstick of performance in the efficiency domain. But if we lower hospital length of stay and costs while shifting costs to post-hospital care, have we solved anything?

This very question was raised by Kuo and Goodwin’s observational study that revealed that decreased hospital costs and LOS were offset by higher utilization and costs after discharge under hospitalist care.¹

Efficiency As a Domain of Quality

Using the Institute of Medicine’s (IOM) six domains of quality as a framework (see Table 1, right), the Centers for Medicare & Medicaid Services’ (CMS) Hospital Value-Based Purchasing (HVBP) program seeks to encourage enhanced quality in all of the IOM domains. For HVBP 2015, we see the addition of the first measure in the domain of efficiency.

You may be saying to yourself, “It’s only 2013. Why should I worry about HVBP 2015?” Here’s why: The measurement periods for HVBP 2015 are May to December 2011 (baseline) and May to December 2013 (performance). Hospitals can succeed under HVBP if they demonstrate improvement from baseline or attainment, which indicates maintenance of a high level of performance despite no substantial improvement from baseline. Medicare spending per beneficiary (MSPB) will make up 20% of the 2015 HVBP incentive pool for hospitals.

Medicare Spending Per Beneficiary Instead of Costs or LOS

Why did CMS choose to use MSPB as a measure and not simply hospital costs or length of stay? Measuring efficiency of hospital care has proven to be a sticky wicket. If one simply measures and rewards decreased hospital costs and/or length of stay (which you might legitimately argue is exactly what the current DRG system does by paying a case rate to the hospital), one runs the risk of shifting costs to settings beyond the four walls of the hospital, or even fueling higher rates of hospital readmissions. Also, physician costs and other costs (therapy, home care) are not accounted for; they are accounted for under MSPB (described below). Finally, hospital costs and LOS vary substantially across regions and by severity of illness of the patients being analyzed. This makes it difficult to compare, for example, LOS in California versus Massachusetts.

The MSPB is designed to be a comprehensive and equitable metric:

• It seeks to eliminate cost-shifting among settings by widening the time period from three days prior to 30 days post-inpatient-care episode;
• It looks at the full cost of care by including expenses from both Medicare Part A (hospital) and Part B (doctors, PT, OT, home health, others);
• It incorporates risk adjustment by taking into account differences in patient health status; and
• It seeks to level the playing field by using a price standardization methodology that factors in geographic payment differences in wages, practice costs, and payments for indirect medical education and disproportionate share hospitals (those that treat large numbers of the indigent population).

Driving High Performance in Medicare Spending Per Beneficiary

Hospitalists straddle the Part A and Part B elements of Medicare; they have one foot in the hospital and one foot in the physician practice world. They should be able to improve their hospitals’ performance under the MSPB yardstick. Since the performance measurement period starts in May, now is the time to sharpen your focus on MSPB.

Here are the top priorities for MSPB that I recommend for hospitalists:

Reduction of marginally beneficial resource utilization. This is a process of analyzing resource (e.g. pharmacy, radiology, laboratory, blood products) utilization for the purpose of minimizing costly practices that do not benefit the patient. This is an essential practice of a high-functioning hospitalist program. Through its participation in the Choosing Wisely campaign (see “Stop! Think Twice Before You Order,” p. 46), SHM has helped hospitalists have conversations about these practices with patients.

Hospital throughput. Work on “front end” throughput with the ED by having a process in place to quickly evaluate and facilitate potential admissions. Work with case management to assure timely (and early in the day) discharges.

Safe-discharge processes. We reviewed key elements of a safe discharge last month and provided a link to SHM’s Project BOOST (www.hospitalmedicine.org/boost). From the MSPB perspective: A safe discharge minimizes exorbitant spending after discharge.

Documentation integrity. Because MSPB is risk-adjusted, the more the record reflects patient severity of illness, the better your hospital will perform, all else being equal. Work collaboratively with your documentation integrity professionals!

Much of the success of the HM specialty has been built on the tenet that the hospitalist model delivers efficient inpatient care. In the coming years, the specialty’s contribution will increasingly be gauged by the MSPB measure.

Reference

1. Kuo YF, Goodwin JS. Association of hospitalist care with medical utilization after discharge: evidence of cost shift from a cohort study. Ann Intern Med. 2011;155(3):152-159.

Dr. Whitcomb is medical director of healthcare quality at Baystate Medical Center in Springfield, Mass. He is a co-founder and past president of SHM. Email him at [email protected].

The Choosing Wisely campaign is focused on better decision-making, improved quality, and decreased healthcare costs. Such focus on efficiency and cost-effectiveness also was part of the initial motivation for developing hospital medicine, says one of HM’s pioneering doctors.

Robert Wachter, MD, MHM, who heads the division of hospital medicine at the University of California at San Francisco, compares the current national obsession about healthcare waste with the medical quality and patient safety movements of the past decade.

“It’s the right time, the right message, and the right messenger,” says Dr. Wachter, who also chairs the American Board of Internal Medicine and sits on the board of the ABIM Foundation. “We’re a little scared about raised expectations. Delivering on them is going to be more difficult, even, than patient safety was, because ultimately it will require curtailing some income streams. You can’t reach the final outcome of cutting costs in healthcare without someone making less money.”

Dr. Wachter expects the medical community to hear “similar kinds of drumbeats about waste” from every corner of healthcare. “I think hospitalists should be active and enthusiastic partners in the Choosing Wisely campaign,” he says, “and leaders in American healthcare’s efforts to figure out how to purge waste from the system and decrease unnecessary expense.

The Choosing Wisely campaign is focused on better decision-making, improved quality, and decreased healthcare costs. Such focus on efficiency and cost-effectiveness also was part of the initial motivation for developing hospital medicine, says one of HM’s pioneering doctors.

Robert Wachter, MD, MHM, who heads the division of hospital medicine at the University of California at San Francisco, compares the current national obsession about healthcare waste with the medical quality and patient safety movements of the past decade.

“It’s the right time, the right message, and the right messenger,” says Dr. Wachter, who also chairs the American Board of Internal Medicine and sits on the board of the ABIM Foundation. “We’re a little scared about raised expectations. Delivering on them is going to be more difficult, even, than patient safety was, because ultimately it will require curtailing some income streams. You can’t reach the final outcome of cutting costs in healthcare without someone making less money.”

Dr. Wachter expects the medical community to hear “similar kinds of drumbeats about waste” from every corner of healthcare. “I think hospitalists should be active and enthusiastic partners in the Choosing Wisely campaign,” he says, “and leaders in American healthcare’s efforts to figure out how to purge waste from the system and decrease unnecessary expense.

The Choosing Wisely campaign is focused on better decision-making, improved quality, and decreased healthcare costs. Such focus on efficiency and cost-effectiveness also was part of the initial motivation for developing hospital medicine, says one of HM’s pioneering doctors.

Robert Wachter, MD, MHM, who heads the division of hospital medicine at the University of California at San Francisco, compares the current national obsession about healthcare waste with the medical quality and patient safety movements of the past decade.

“It’s the right time, the right message, and the right messenger,” says Dr. Wachter, who also chairs the American Board of Internal Medicine and sits on the board of the ABIM Foundation. “We’re a little scared about raised expectations. Delivering on them is going to be more difficult, even, than patient safety was, because ultimately it will require curtailing some income streams. You can’t reach the final outcome of cutting costs in healthcare without someone making less money.”

Dr. Wachter expects the medical community to hear “similar kinds of drumbeats about waste” from every corner of healthcare. “I think hospitalists should be active and enthusiastic partners in the Choosing Wisely campaign,” he says, “and leaders in American healthcare’s efforts to figure out how to purge waste from the system and decrease unnecessary expense.