Amy Boutwell, MD, MPP, a hospitalist and founder of Collaborative Healthcare Strategies, talks about what clinicians can do to help improve care transitions based on her experience directing IHI’s STAAR Initiative (State-Action on Avoidable Re-hospitalizations).

Amy Boutwell, MD, MPP, a hospitalist and founder of Collaborative Healthcare Strategies, talks about what clinicians can do to help improve care transitions based on her experience directing IHI’s STAAR Initiative (State-Action on Avoidable Re-hospitalizations).

Amy Boutwell, MD, MPP, a hospitalist and founder of Collaborative Healthcare Strategies, talks about what clinicians can do to help improve care transitions based on her experience directing IHI’s STAAR Initiative (State-Action on Avoidable Re-hospitalizations).

Johns Hopkins hospitalist Eric Howell, MD, SFHM, discusses connections between SHM, hospitalist practices, handoffs, and successful care transitions.

Johns Hopkins hospitalist Eric Howell, MD, SFHM, discusses connections between SHM, hospitalist practices, handoffs, and successful care transitions.

Johns Hopkins hospitalist Eric Howell, MD, SFHM, discusses connections between SHM, hospitalist practices, handoffs, and successful care transitions.

Editor’s note: First of a two-part series examining bundled payments and hospital medicine. Additionally, Dr. Whitcomb works for a company that is an Awardee Convener in the CMS Bundled Payments for Care Improvement (BPCI) Initiative.

The Centers for Medicare and Medicaid Services’ (CMS) bundled payment initiative was announced in August 2011 and has been “live” since October 2013, when a handful of healthcare systems launched bundled payment programs. In 2014, the CMS initiative grew substantially as a result of large-scale interest on the part of hospitals, physician groups, skilled nursing facilities (SNFs), and others in testing the model, which can be described as a single payment for an episode of care.

The BPCI initiative will be a large-scale program by July 1; it starts with an April 1 cohort launch and will result in the program’s presence in all 50 states, with hundreds of physician practices and hospitals participating. The 2015 cohort will involve a large number of hospitalist practices, participating as “episode initiators” that bear clinical and economic responsibility for the bundle, or as “gainsharers” who are eligible to receive incentive payments if they can reduce costs while maintaining measurable quality for an episode of care.

How Does Bundled Payment Work?

The BPCI initiative is a large-scale, three- to five-year demonstration to test bundled payment in patients with fee-for-service Medicare. The most common model, referred to as Model 2, involves an inpatient hospitalization for one of 48 defined episodes, which include both medical and surgical conditions, followed by a recovery period lasting 30, 60, or 90 days.

Each hospital or physician practice that is considering entering the BPCI program receives prices for all 48 episodes based on a 2009-2012 historical average of Medicare part A and B claims associated with that hospital or physician group. After analyzing those prices, the hospital or physician practice may elect to choose the bundles that have a good chance of being successful—where actual spending comes in under the historical target price—based on care improvement expectations in their local system. In Model 2, CMS takes 2% off the target price for 90-day episodes and 3% off the target price for 30- and 60-day episodes, making it all the more important to choose bundles that demonstrate a high likelihood of success.

The revenue cycle for hospitals and physicians in the program does not change. They submit claims for their services and receive reimbursement as they always have; however, after the end of each quarter, when the majority of part A and B claims have been processed, a “look back” at actual spending for all participating episodes is reconciled against the baseline price derived from 2009-2012. If there is a net savings compared to the baseline, monies can be distributed to the participating providers—the hospital or physician practice—and those providers may further share some of the savings with other physicians/providers who have signed a gainsharing contract.

Hospitalists and BPCI

Hospitalist practices participate in the CMS program either as episode initiators or gainsharers. As episode initiators, they “own” the bundle, which means they bear economic risk for the program. In this capacity, overall savings will mean the hospitalist practice has a new revenue stream, which could be substantial; however, the practice is also responsible for any losses.

Other hospitalist practices have become gainsharers in the program, which means they have signed an agreement enabling them to receive payments in addition to professional fee revenues for activities that reduce costs while maintaining or improving quality. Such activities are referred to as “care redesign” in the program. Gainsharers do not bear financial risk.

Where Will Savings Come From?

Perhaps ironically for hospitalists, the main source of savings in the BPCI program comes from post-acute care and readmissions. For example, for common conditions like heart failure, COPD, and pneumonia, Medicare spends almost as much on post-acute care and readmissions in the first 30 days after discharge as it does on the index hospitalization.¹ As a result, the BPCI program adds further emphasis on preventing readmissions when added to existing pressures, and there is a new premium placed on “right-sizing” the usage of SNF and other post-acute facilities, such as inpatient rehabilitation and long-term acute care hospitals. For hospitalists, this means that new rigor is needed to connect to the post-acute setting, such as determining why a patient is being discharged to a skilled facility.

Another savings pool, called “internal cost savings,” is available to reward decreasing inpatient utilization from, for example, testing, imaging, and implantable devices.

Conclusion

Bundled payment might be the biggest thing to come along for hospitalists since the patient safety movement launched some 16 years ago. Why? Although accountable care organizations have largely focused on ambulatory practice, bundled payment has a major focus on hospital care and on the post-acute care decisions that are made during the hospitalization. If bundled payment proves to be an effective way to pay for—and organize—care, hospitalists will play a central role in the success of this innovation.

In part two of this series, I will explore specific roles hospitalists play in successful bundled payment programs.

Reference

1. Mechanic R. Post-acute care: the next frontier for controlling Medicare spending. N Engl J Med. 2014;370(8):692-694.

Editor’s note: First of a two-part series examining bundled payments and hospital medicine. Additionally, Dr. Whitcomb works for a company that is an Awardee Convener in the CMS Bundled Payments for Care Improvement (BPCI) Initiative.

The Centers for Medicare and Medicaid Services’ (CMS) bundled payment initiative was announced in August 2011 and has been “live” since October 2013, when a handful of healthcare systems launched bundled payment programs. In 2014, the CMS initiative grew substantially as a result of large-scale interest on the part of hospitals, physician groups, skilled nursing facilities (SNFs), and others in testing the model, which can be described as a single payment for an episode of care.

The BPCI initiative will be a large-scale program by July 1; it starts with an April 1 cohort launch and will result in the program’s presence in all 50 states, with hundreds of physician practices and hospitals participating. The 2015 cohort will involve a large number of hospitalist practices, participating as “episode initiators” that bear clinical and economic responsibility for the bundle, or as “gainsharers” who are eligible to receive incentive payments if they can reduce costs while maintaining measurable quality for an episode of care.

How Does Bundled Payment Work?

The BPCI initiative is a large-scale, three- to five-year demonstration to test bundled payment in patients with fee-for-service Medicare. The most common model, referred to as Model 2, involves an inpatient hospitalization for one of 48 defined episodes, which include both medical and surgical conditions, followed by a recovery period lasting 30, 60, or 90 days.

Each hospital or physician practice that is considering entering the BPCI program receives prices for all 48 episodes based on a 2009-2012 historical average of Medicare part A and B claims associated with that hospital or physician group. After analyzing those prices, the hospital or physician practice may elect to choose the bundles that have a good chance of being successful—where actual spending comes in under the historical target price—based on care improvement expectations in their local system. In Model 2, CMS takes 2% off the target price for 90-day episodes and 3% off the target price for 30- and 60-day episodes, making it all the more important to choose bundles that demonstrate a high likelihood of success.

The revenue cycle for hospitals and physicians in the program does not change. They submit claims for their services and receive reimbursement as they always have; however, after the end of each quarter, when the majority of part A and B claims have been processed, a “look back” at actual spending for all participating episodes is reconciled against the baseline price derived from 2009-2012. If there is a net savings compared to the baseline, monies can be distributed to the participating providers—the hospital or physician practice—and those providers may further share some of the savings with other physicians/providers who have signed a gainsharing contract.

Hospitalists and BPCI

Hospitalist practices participate in the CMS program either as episode initiators or gainsharers. As episode initiators, they “own” the bundle, which means they bear economic risk for the program. In this capacity, overall savings will mean the hospitalist practice has a new revenue stream, which could be substantial; however, the practice is also responsible for any losses.

Other hospitalist practices have become gainsharers in the program, which means they have signed an agreement enabling them to receive payments in addition to professional fee revenues for activities that reduce costs while maintaining or improving quality. Such activities are referred to as “care redesign” in the program. Gainsharers do not bear financial risk.

Where Will Savings Come From?

Perhaps ironically for hospitalists, the main source of savings in the BPCI program comes from post-acute care and readmissions. For example, for common conditions like heart failure, COPD, and pneumonia, Medicare spends almost as much on post-acute care and readmissions in the first 30 days after discharge as it does on the index hospitalization.¹ As a result, the BPCI program adds further emphasis on preventing readmissions when added to existing pressures, and there is a new premium placed on “right-sizing” the usage of SNF and other post-acute facilities, such as inpatient rehabilitation and long-term acute care hospitals. For hospitalists, this means that new rigor is needed to connect to the post-acute setting, such as determining why a patient is being discharged to a skilled facility.

Another savings pool, called “internal cost savings,” is available to reward decreasing inpatient utilization from, for example, testing, imaging, and implantable devices.

Conclusion

Bundled payment might be the biggest thing to come along for hospitalists since the patient safety movement launched some 16 years ago. Why? Although accountable care organizations have largely focused on ambulatory practice, bundled payment has a major focus on hospital care and on the post-acute care decisions that are made during the hospitalization. If bundled payment proves to be an effective way to pay for—and organize—care, hospitalists will play a central role in the success of this innovation.

In part two of this series, I will explore specific roles hospitalists play in successful bundled payment programs.

Reference

1. Mechanic R. Post-acute care: the next frontier for controlling Medicare spending. N Engl J Med. 2014;370(8):692-694.

Editor’s note: First of a two-part series examining bundled payments and hospital medicine. Additionally, Dr. Whitcomb works for a company that is an Awardee Convener in the CMS Bundled Payments for Care Improvement (BPCI) Initiative.

The Centers for Medicare and Medicaid Services’ (CMS) bundled payment initiative was announced in August 2011 and has been “live” since October 2013, when a handful of healthcare systems launched bundled payment programs. In 2014, the CMS initiative grew substantially as a result of large-scale interest on the part of hospitals, physician groups, skilled nursing facilities (SNFs), and others in testing the model, which can be described as a single payment for an episode of care.

The BPCI initiative will be a large-scale program by July 1; it starts with an April 1 cohort launch and will result in the program’s presence in all 50 states, with hundreds of physician practices and hospitals participating. The 2015 cohort will involve a large number of hospitalist practices, participating as “episode initiators” that bear clinical and economic responsibility for the bundle, or as “gainsharers” who are eligible to receive incentive payments if they can reduce costs while maintaining measurable quality for an episode of care.

How Does Bundled Payment Work?

The BPCI initiative is a large-scale, three- to five-year demonstration to test bundled payment in patients with fee-for-service Medicare. The most common model, referred to as Model 2, involves an inpatient hospitalization for one of 48 defined episodes, which include both medical and surgical conditions, followed by a recovery period lasting 30, 60, or 90 days.

Each hospital or physician practice that is considering entering the BPCI program receives prices for all 48 episodes based on a 2009-2012 historical average of Medicare part A and B claims associated with that hospital or physician group. After analyzing those prices, the hospital or physician practice may elect to choose the bundles that have a good chance of being successful—where actual spending comes in under the historical target price—based on care improvement expectations in their local system. In Model 2, CMS takes 2% off the target price for 90-day episodes and 3% off the target price for 30- and 60-day episodes, making it all the more important to choose bundles that demonstrate a high likelihood of success.

The revenue cycle for hospitals and physicians in the program does not change. They submit claims for their services and receive reimbursement as they always have; however, after the end of each quarter, when the majority of part A and B claims have been processed, a “look back” at actual spending for all participating episodes is reconciled against the baseline price derived from 2009-2012. If there is a net savings compared to the baseline, monies can be distributed to the participating providers—the hospital or physician practice—and those providers may further share some of the savings with other physicians/providers who have signed a gainsharing contract.

Hospitalists and BPCI

Hospitalist practices participate in the CMS program either as episode initiators or gainsharers. As episode initiators, they “own” the bundle, which means they bear economic risk for the program. In this capacity, overall savings will mean the hospitalist practice has a new revenue stream, which could be substantial; however, the practice is also responsible for any losses.

Other hospitalist practices have become gainsharers in the program, which means they have signed an agreement enabling them to receive payments in addition to professional fee revenues for activities that reduce costs while maintaining or improving quality. Such activities are referred to as “care redesign” in the program. Gainsharers do not bear financial risk.

Where Will Savings Come From?

Perhaps ironically for hospitalists, the main source of savings in the BPCI program comes from post-acute care and readmissions. For example, for common conditions like heart failure, COPD, and pneumonia, Medicare spends almost as much on post-acute care and readmissions in the first 30 days after discharge as it does on the index hospitalization.¹ As a result, the BPCI program adds further emphasis on preventing readmissions when added to existing pressures, and there is a new premium placed on “right-sizing” the usage of SNF and other post-acute facilities, such as inpatient rehabilitation and long-term acute care hospitals. For hospitalists, this means that new rigor is needed to connect to the post-acute setting, such as determining why a patient is being discharged to a skilled facility.

Another savings pool, called “internal cost savings,” is available to reward decreasing inpatient utilization from, for example, testing, imaging, and implantable devices.

Conclusion

Bundled payment might be the biggest thing to come along for hospitalists since the patient safety movement launched some 16 years ago. Why? Although accountable care organizations have largely focused on ambulatory practice, bundled payment has a major focus on hospital care and on the post-acute care decisions that are made during the hospitalization. If bundled payment proves to be an effective way to pay for—and organize—care, hospitalists will play a central role in the success of this innovation.

In part two of this series, I will explore specific roles hospitalists play in successful bundled payment programs.

Reference

1. Mechanic R. Post-acute care: the next frontier for controlling Medicare spending. N Engl J Med. 2014;370(8):692-694.

Ticagrelor tablets

Photo courtesy of AstraZeneca

The US Food and Drug Administration (FDA) has approved a new administration option for the antiplatelet agent ticagrelor (Brilinta).

The agency has decided that, for patients with acute coronary syndrome (ACS) who cannot swallow ticagrelor tablets whole, the pills may be crushed and administered in water by swallowing or via nasogastric tube.

Ticagrelor is the only P2Y12 inhibitor that is FDA-approved to be administered in this way.

“We know that some patients who experience a heart attack are unable to swallow medications whole, yet it is important for these patients to receive and continue their oral antiplatelet therapy,” said Steven Zelenkofske, DO, Vice President of US Medical Affairs, Cardiovascular, at AstraZeneca, the company developing ticagrelor.

Survey data have shown that 40% of adults in the general population experience problems swallowing pills, and this difficulty may increase with age. Moreover, some patients who experience a heart attack have difficulty swallowing medications in the emergency setting.

So the new administration option for ticagrelor is intended to give healthcare professionals flexibility in treating their ACS patients.

Ticagrelor is a direct-acting P2Y12 receptor antagonist that works by inhibiting platelet activation. The drug is available in 90 mg tablets, to be administered with a single 180 mg oral loading dose (two 90 mg tablets) followed by a twice daily, 90 mg maintenance dose.

Following an initial loading dose of aspirin, ticagrelor should be used with a maintenance dose of aspirin at 75 mg to 100 mg once daily (an 81 mg dose in the US).

Results of the PLATO trial showed that, in ACS patients, ticagrelor can reduce the rate of a combined endpoint of cardiovascular death, myocardial infarction, and stroke, when compared to clopidogrel. The difference between treatments was driven by cardiovascular death and myocardial infarction, with no difference in the rate of stroke.

For more information on ticagrelor, see the full prescribing information.

Ticagrelor tablets

Photo courtesy of AstraZeneca

The US Food and Drug Administration (FDA) has approved a new administration option for the antiplatelet agent ticagrelor (Brilinta).

The agency has decided that, for patients with acute coronary syndrome (ACS) who cannot swallow ticagrelor tablets whole, the pills may be crushed and administered in water by swallowing or via nasogastric tube.

Ticagrelor is the only P2Y12 inhibitor that is FDA-approved to be administered in this way.

“We know that some patients who experience a heart attack are unable to swallow medications whole, yet it is important for these patients to receive and continue their oral antiplatelet therapy,” said Steven Zelenkofske, DO, Vice President of US Medical Affairs, Cardiovascular, at AstraZeneca, the company developing ticagrelor.

Survey data have shown that 40% of adults in the general population experience problems swallowing pills, and this difficulty may increase with age. Moreover, some patients who experience a heart attack have difficulty swallowing medications in the emergency setting.

So the new administration option for ticagrelor is intended to give healthcare professionals flexibility in treating their ACS patients.

Ticagrelor is a direct-acting P2Y12 receptor antagonist that works by inhibiting platelet activation. The drug is available in 90 mg tablets, to be administered with a single 180 mg oral loading dose (two 90 mg tablets) followed by a twice daily, 90 mg maintenance dose.

Following an initial loading dose of aspirin, ticagrelor should be used with a maintenance dose of aspirin at 75 mg to 100 mg once daily (an 81 mg dose in the US).

Results of the PLATO trial showed that, in ACS patients, ticagrelor can reduce the rate of a combined endpoint of cardiovascular death, myocardial infarction, and stroke, when compared to clopidogrel. The difference between treatments was driven by cardiovascular death and myocardial infarction, with no difference in the rate of stroke.

For more information on ticagrelor, see the full prescribing information.

Ticagrelor tablets

Photo courtesy of AstraZeneca

The US Food and Drug Administration (FDA) has approved a new administration option for the antiplatelet agent ticagrelor (Brilinta).

The agency has decided that, for patients with acute coronary syndrome (ACS) who cannot swallow ticagrelor tablets whole, the pills may be crushed and administered in water by swallowing or via nasogastric tube.

Ticagrelor is the only P2Y12 inhibitor that is FDA-approved to be administered in this way.

“We know that some patients who experience a heart attack are unable to swallow medications whole, yet it is important for these patients to receive and continue their oral antiplatelet therapy,” said Steven Zelenkofske, DO, Vice President of US Medical Affairs, Cardiovascular, at AstraZeneca, the company developing ticagrelor.

Survey data have shown that 40% of adults in the general population experience problems swallowing pills, and this difficulty may increase with age. Moreover, some patients who experience a heart attack have difficulty swallowing medications in the emergency setting.

So the new administration option for ticagrelor is intended to give healthcare professionals flexibility in treating their ACS patients.

Ticagrelor is a direct-acting P2Y12 receptor antagonist that works by inhibiting platelet activation. The drug is available in 90 mg tablets, to be administered with a single 180 mg oral loading dose (two 90 mg tablets) followed by a twice daily, 90 mg maintenance dose.

Following an initial loading dose of aspirin, ticagrelor should be used with a maintenance dose of aspirin at 75 mg to 100 mg once daily (an 81 mg dose in the US).

Results of the PLATO trial showed that, in ACS patients, ticagrelor can reduce the rate of a combined endpoint of cardiovascular death, myocardial infarction, and stroke, when compared to clopidogrel. The difference between treatments was driven by cardiovascular death and myocardial infarction, with no difference in the rate of stroke.

For more information on ticagrelor, see the full prescribing information.

Small, rural, and community-based hospitals face many of the same concerns about readmissions as large ones. James Baumgartner, MD, chief hospitalist at Essentia Health-St. Joseph’s Medical Center in Brainerd, Minn., population 13,517, was asked if he sees the readmissions issue playing out differently in rural settings.

“I don’t think so, and I’ve practiced in bigger cities,” he says. “For the past two years, we’ve had a team-based approach here, with a multidisciplinary committee meeting monthly to work on making transitions of care better.”

The recent adoption of joint rounding by hospitalists and nurses also makes a difference, he says. To ensure that patients can get post-discharge medical appointments when they need them, Dr. Baumgartner’s group approached local PCPs within the same health system.

“They responded by reserving at least one open slot at the start of every day for seeing our recently discharged patients,” he says.

Kristi Howell, RN, director of quality initiatives at Richland Memorial Hospital, a 65-bed acute care facility in Olney, Ill., population 8,631, says the trend in smaller and rural hospitals is moving toward more personalized patient care and the use of one-on-one transitional care coordinators.

“We have the advantage of being closer to our patients and providing a more personalized discharge plan than may be possible at a larger facility,” she says. Nevertheless, Howell and her colleagues are “deeply concerned about readmissions.”

“Physicians in this area experience difficulty with readmissions due to our rural patients’ lack of access to larger facilities and medical specialties,” she says. “Noncompliance is another problem, mostly due to lack of health literacy and financial resources. Of course, it is well known that the shortage of primary care doctors is a contributor to poorer health outcomes for rural residents.”

Randy Ferrance, DC, MD, FAAP, SFHM, medical director of the hospitalist service at 47-bed Riverside Tappahannock Hospital in Tappahannock, Va., population 2,393, says he’s “tried all sorts of things, with little impact on readmissions,” although his five-member groups’ readmission rate is “actually low compared with the national average.”

“We make appointments for the first week after discharge,” he says. “We’re small enough that we can call the PCP. We know them. We all belong to the same medical group.”

Dr. Ferrance covers shifts in the ED on occasion. He says some patients in the community prefer to get their medical care at the ED. “And in the ED, if they don’t look well, they get admitted,” he says.

Larry Beresford is a freelance writer in Alameda, Calif.

Small, rural, and community-based hospitals face many of the same concerns about readmissions as large ones. James Baumgartner, MD, chief hospitalist at Essentia Health-St. Joseph’s Medical Center in Brainerd, Minn., population 13,517, was asked if he sees the readmissions issue playing out differently in rural settings.

“I don’t think so, and I’ve practiced in bigger cities,” he says. “For the past two years, we’ve had a team-based approach here, with a multidisciplinary committee meeting monthly to work on making transitions of care better.”

The recent adoption of joint rounding by hospitalists and nurses also makes a difference, he says. To ensure that patients can get post-discharge medical appointments when they need them, Dr. Baumgartner’s group approached local PCPs within the same health system.

“They responded by reserving at least one open slot at the start of every day for seeing our recently discharged patients,” he says.

Kristi Howell, RN, director of quality initiatives at Richland Memorial Hospital, a 65-bed acute care facility in Olney, Ill., population 8,631, says the trend in smaller and rural hospitals is moving toward more personalized patient care and the use of one-on-one transitional care coordinators.

“We have the advantage of being closer to our patients and providing a more personalized discharge plan than may be possible at a larger facility,” she says. Nevertheless, Howell and her colleagues are “deeply concerned about readmissions.”

“Physicians in this area experience difficulty with readmissions due to our rural patients’ lack of access to larger facilities and medical specialties,” she says. “Noncompliance is another problem, mostly due to lack of health literacy and financial resources. Of course, it is well known that the shortage of primary care doctors is a contributor to poorer health outcomes for rural residents.”

Randy Ferrance, DC, MD, FAAP, SFHM, medical director of the hospitalist service at 47-bed Riverside Tappahannock Hospital in Tappahannock, Va., population 2,393, says he’s “tried all sorts of things, with little impact on readmissions,” although his five-member groups’ readmission rate is “actually low compared with the national average.”

“We make appointments for the first week after discharge,” he says. “We’re small enough that we can call the PCP. We know them. We all belong to the same medical group.”

Dr. Ferrance covers shifts in the ED on occasion. He says some patients in the community prefer to get their medical care at the ED. “And in the ED, if they don’t look well, they get admitted,” he says.

Larry Beresford is a freelance writer in Alameda, Calif.

Small, rural, and community-based hospitals face many of the same concerns about readmissions as large ones. James Baumgartner, MD, chief hospitalist at Essentia Health-St. Joseph’s Medical Center in Brainerd, Minn., population 13,517, was asked if he sees the readmissions issue playing out differently in rural settings.

“I don’t think so, and I’ve practiced in bigger cities,” he says. “For the past two years, we’ve had a team-based approach here, with a multidisciplinary committee meeting monthly to work on making transitions of care better.”

The recent adoption of joint rounding by hospitalists and nurses also makes a difference, he says. To ensure that patients can get post-discharge medical appointments when they need them, Dr. Baumgartner’s group approached local PCPs within the same health system.

“They responded by reserving at least one open slot at the start of every day for seeing our recently discharged patients,” he says.

Kristi Howell, RN, director of quality initiatives at Richland Memorial Hospital, a 65-bed acute care facility in Olney, Ill., population 8,631, says the trend in smaller and rural hospitals is moving toward more personalized patient care and the use of one-on-one transitional care coordinators.

“We have the advantage of being closer to our patients and providing a more personalized discharge plan than may be possible at a larger facility,” she says. Nevertheless, Howell and her colleagues are “deeply concerned about readmissions.”

“Physicians in this area experience difficulty with readmissions due to our rural patients’ lack of access to larger facilities and medical specialties,” she says. “Noncompliance is another problem, mostly due to lack of health literacy and financial resources. Of course, it is well known that the shortage of primary care doctors is a contributor to poorer health outcomes for rural residents.”

Randy Ferrance, DC, MD, FAAP, SFHM, medical director of the hospitalist service at 47-bed Riverside Tappahannock Hospital in Tappahannock, Va., population 2,393, says he’s “tried all sorts of things, with little impact on readmissions,” although his five-member groups’ readmission rate is “actually low compared with the national average.”

“We make appointments for the first week after discharge,” he says. “We’re small enough that we can call the PCP. We know them. We all belong to the same medical group.”

Dr. Ferrance covers shifts in the ED on occasion. He says some patients in the community prefer to get their medical care at the ED. “And in the ED, if they don’t look well, they get admitted,” he says.

Larry Beresford is a freelance writer in Alameda, Calif.

Are colleagues and co-workers who are coming back from HM15 with renewed enthusiasm for the hospital medicine movement making you jealous? Now is the time to start planning for next year. Mark your calendars and start coordinating schedules today for HM16. Registration is now open. For more information, visit www.hospitalmedicine.org/events.

Are colleagues and co-workers who are coming back from HM15 with renewed enthusiasm for the hospital medicine movement making you jealous? Now is the time to start planning for next year. Mark your calendars and start coordinating schedules today for HM16. Registration is now open. For more information, visit www.hospitalmedicine.org/events.

Are colleagues and co-workers who are coming back from HM15 with renewed enthusiasm for the hospital medicine movement making you jealous? Now is the time to start planning for next year. Mark your calendars and start coordinating schedules today for HM16. Registration is now open. For more information, visit www.hospitalmedicine.org/events.

Hospitalists are what make SHM’s annual meeting great. Feedback from hospitalists about what worked well and what SHM can do differently are an important part of making each meeting better than the next.

SHM has e-mailed a brief survey to all hospitalists, whether they attended HM15 or not, to ask how to make the next HM16 the most valuable conference for hospitalists possible. Please check your e-mail and fill out the survey. If you have not received the survey but would like to submit your feedback, please let us know at [email protected].

Hospitalists are what make SHM’s annual meeting great. Feedback from hospitalists about what worked well and what SHM can do differently are an important part of making each meeting better than the next.

SHM has e-mailed a brief survey to all hospitalists, whether they attended HM15 or not, to ask how to make the next HM16 the most valuable conference for hospitalists possible. Please check your e-mail and fill out the survey. If you have not received the survey but would like to submit your feedback, please let us know at [email protected].

Hospitalists are what make SHM’s annual meeting great. Feedback from hospitalists about what worked well and what SHM can do differently are an important part of making each meeting better than the next.

SHM has e-mailed a brief survey to all hospitalists, whether they attended HM15 or not, to ask how to make the next HM16 the most valuable conference for hospitalists possible. Please check your e-mail and fill out the survey. If you have not received the survey but would like to submit your feedback, please let us know at [email protected].

Are you ready to meet and greet the next great generation of hospitalists? Or do you work with medical students and residents interested in becoming hospitalists?

For hospitalists and physicians in training in cities across the country, new events hosted by SHM will introduce medical students and residents to available opportunities. And for others, SHM is now providing content on the Tumblr-powered new website.

Are you ready to meet and greet the next great generation of hospitalists? Or do you work with medical students and residents interested in becoming hospitalists?

For hospitalists and physicians in training in cities across the country, new events hosted by SHM will introduce medical students and residents to available opportunities. And for others, SHM is now providing content on the Tumblr-powered new website.

Are you ready to meet and greet the next great generation of hospitalists? Or do you work with medical students and residents interested in becoming hospitalists?

For hospitalists and physicians in training in cities across the country, new events hosted by SHM will introduce medical students and residents to available opportunities. And for others, SHM is now providing content on the Tumblr-powered new website.

For hospitalists, learning doesn’t stop when SHM’s annual meeting ends. Instead, it’s a year-round endeavor to stay ahead of the trends in clinical practice, practice management, and quality improvement. That’s why SHM provides educational opportunities throughout the year:

Leadership Academy 2015

October 19-22

Austin, Texas

Want to show your boss you’re serious about career advancement and improving your hospital medicine group? SHM’s Leadership Academy helps hospitalists of all stripes become the leaders that today’s hospitals need. From management training to financial storytelling and creating culture change, Leadership Academy covers all of the topics that hospitalists need to work in a high-performance environment.

For more information, visit www.hospitalmedicine.org/leadership.

Also in October, SHM will be offering two other popular conferences: the Academic Hospitalist Academy and the Nurse Practitioner/Physician Assistant Boot Camp. Visit www.hospitalmedicine.org/events for details.

SHM’s Learning Portal

Stay up to speed on the latest CME modules from your own desk or living room using SHM’s Learning Portal. The portal now presents “Consultative & Perioperative Medicine Essentials for Hospitalists” from SHMConsults, including:

• SHMConsults Prerequisite Evaluation;
• Early Identification and Management of Severe Sepsis;
• Pulmonary Risk Management in the Perioperative Setting; and
• The Role of the Medical Consultant.

The Learning Portal also features online CME programs for education about anticoagulants:

• Management of Target Specific Oral Anticoagulants (TSOACs) in the Inpatient and Perioperative Setting;
• The Inpatient Management of Anticoagulation for Patients with Atrial Fibrillation;
• Anticoagulation for VTE & Management of VTE (a two-part module);
• Reversal of New Oral Anticoagulants;
• Establishing Inpatient Programs to Improve Anticoagulation Management; and
• Periprocedural Management of Anticoagulants.

For hospitalists, learning doesn’t stop when SHM’s annual meeting ends. Instead, it’s a year-round endeavor to stay ahead of the trends in clinical practice, practice management, and quality improvement. That’s why SHM provides educational opportunities throughout the year:

Leadership Academy 2015

October 19-22

Austin, Texas

Want to show your boss you’re serious about career advancement and improving your hospital medicine group? SHM’s Leadership Academy helps hospitalists of all stripes become the leaders that today’s hospitals need. From management training to financial storytelling and creating culture change, Leadership Academy covers all of the topics that hospitalists need to work in a high-performance environment.

For more information, visit www.hospitalmedicine.org/leadership.

Also in October, SHM will be offering two other popular conferences: the Academic Hospitalist Academy and the Nurse Practitioner/Physician Assistant Boot Camp. Visit www.hospitalmedicine.org/events for details.

SHM’s Learning Portal

Stay up to speed on the latest CME modules from your own desk or living room using SHM’s Learning Portal. The portal now presents “Consultative & Perioperative Medicine Essentials for Hospitalists” from SHMConsults, including:

• SHMConsults Prerequisite Evaluation;
• Early Identification and Management of Severe Sepsis;
• Pulmonary Risk Management in the Perioperative Setting; and
• The Role of the Medical Consultant.

The Learning Portal also features online CME programs for education about anticoagulants:

• Management of Target Specific Oral Anticoagulants (TSOACs) in the Inpatient and Perioperative Setting;
• The Inpatient Management of Anticoagulation for Patients with Atrial Fibrillation;
• Anticoagulation for VTE & Management of VTE (a two-part module);
• Reversal of New Oral Anticoagulants;
• Establishing Inpatient Programs to Improve Anticoagulation Management; and
• Periprocedural Management of Anticoagulants.

For hospitalists, learning doesn’t stop when SHM’s annual meeting ends. Instead, it’s a year-round endeavor to stay ahead of the trends in clinical practice, practice management, and quality improvement. That’s why SHM provides educational opportunities throughout the year:

Leadership Academy 2015

October 19-22

Austin, Texas

Want to show your boss you’re serious about career advancement and improving your hospital medicine group? SHM’s Leadership Academy helps hospitalists of all stripes become the leaders that today’s hospitals need. From management training to financial storytelling and creating culture change, Leadership Academy covers all of the topics that hospitalists need to work in a high-performance environment.

For more information, visit www.hospitalmedicine.org/leadership.

Also in October, SHM will be offering two other popular conferences: the Academic Hospitalist Academy and the Nurse Practitioner/Physician Assistant Boot Camp. Visit www.hospitalmedicine.org/events for details.

SHM’s Learning Portal

Stay up to speed on the latest CME modules from your own desk or living room using SHM’s Learning Portal. The portal now presents “Consultative & Perioperative Medicine Essentials for Hospitalists” from SHMConsults, including:

• SHMConsults Prerequisite Evaluation;
• Early Identification and Management of Severe Sepsis;
• Pulmonary Risk Management in the Perioperative Setting; and
• The Role of the Medical Consultant.

The Learning Portal also features online CME programs for education about anticoagulants:

• Management of Target Specific Oral Anticoagulants (TSOACs) in the Inpatient and Perioperative Setting;
• The Inpatient Management of Anticoagulation for Patients with Atrial Fibrillation;
• Anticoagulation for VTE & Management of VTE (a two-part module);
• Reversal of New Oral Anticoagulants;
• Establishing Inpatient Programs to Improve Anticoagulation Management; and
• Periprocedural Management of Anticoagulants.

Every hospital wants to bring health to its community, and hospitalists can play a major role in bringing that value to patients—both during and after their hospital stays. From handoffs to managing diabetic patients to many of the other issues hospitalists tackle on a daily basis, SHM provides resources and access to the experts—all from its website.

Project BOOST now accepts applications year-round for the program and will be presenting a free webinar on April 15 to present Project BOOST’s new program offerings.

To register for the webinar, visit www.hospitalmedicine.org/boost.

Every hospital wants to bring health to its community, and hospitalists can play a major role in bringing that value to patients—both during and after their hospital stays. From handoffs to managing diabetic patients to many of the other issues hospitalists tackle on a daily basis, SHM provides resources and access to the experts—all from its website.

Project BOOST now accepts applications year-round for the program and will be presenting a free webinar on April 15 to present Project BOOST’s new program offerings.

To register for the webinar, visit www.hospitalmedicine.org/boost.

Every hospital wants to bring health to its community, and hospitalists can play a major role in bringing that value to patients—both during and after their hospital stays. From handoffs to managing diabetic patients to many of the other issues hospitalists tackle on a daily basis, SHM provides resources and access to the experts—all from its website.

Project BOOST now accepts applications year-round for the program and will be presenting a free webinar on April 15 to present Project BOOST’s new program offerings.

To register for the webinar, visit www.hospitalmedicine.org/boost.