A dosage recommendation in the August 2012 article “What is the Optimal Therapy for Acute DVT” (p. 17) should have read: The 2012 American College of Chest Physicians (ACCP) guidelines on antithrombotic therapy for VTE recommends initial therapy with LMWH or fondaparinux (rather than IV or SC UFH). The guidelines suggest that LMWH once-daily dosing is favored over twice-daily dosing, based mainly on patient convenience, although this is a weak recommendation (2C) based on the overall quality of the data. The recommendation applies only if the daily dosing of the LMWH, including tinzaparin, dalteparin, and nadroparin, is equivalent to the twice-daily dosing (i.e. dalteparin may be dosed at 100 units/kg BID vs. 200 units/kg daily). Of importance, enoxaparin has not been studied at a once-daily dose (2 mg/kg), which is equivalent to the twice-daily dosing regimen (1 mg/kg twice daily). Additionally, one study suggests that once-daily dosing of enoxaparin 1.5 mg/kg might be inferior to 1 mg/kg twice daily dosing; therefore, caution must be exercised in applying this recommendation to the LMWH enoxaparin.^3,27,28

A dosage recommendation in the August 2012 article “What is the Optimal Therapy for Acute DVT” (p. 17) should have read: The 2012 American College of Chest Physicians (ACCP) guidelines on antithrombotic therapy for VTE recommends initial therapy with LMWH or fondaparinux (rather than IV or SC UFH). The guidelines suggest that LMWH once-daily dosing is favored over twice-daily dosing, based mainly on patient convenience, although this is a weak recommendation (2C) based on the overall quality of the data. The recommendation applies only if the daily dosing of the LMWH, including tinzaparin, dalteparin, and nadroparin, is equivalent to the twice-daily dosing (i.e. dalteparin may be dosed at 100 units/kg BID vs. 200 units/kg daily). Of importance, enoxaparin has not been studied at a once-daily dose (2 mg/kg), which is equivalent to the twice-daily dosing regimen (1 mg/kg twice daily). Additionally, one study suggests that once-daily dosing of enoxaparin 1.5 mg/kg might be inferior to 1 mg/kg twice daily dosing; therefore, caution must be exercised in applying this recommendation to the LMWH enoxaparin.^3,27,28

A dosage recommendation in the August 2012 article “What is the Optimal Therapy for Acute DVT” (p. 17) should have read: The 2012 American College of Chest Physicians (ACCP) guidelines on antithrombotic therapy for VTE recommends initial therapy with LMWH or fondaparinux (rather than IV or SC UFH). The guidelines suggest that LMWH once-daily dosing is favored over twice-daily dosing, based mainly on patient convenience, although this is a weak recommendation (2C) based on the overall quality of the data. The recommendation applies only if the daily dosing of the LMWH, including tinzaparin, dalteparin, and nadroparin, is equivalent to the twice-daily dosing (i.e. dalteparin may be dosed at 100 units/kg BID vs. 200 units/kg daily). Of importance, enoxaparin has not been studied at a once-daily dose (2 mg/kg), which is equivalent to the twice-daily dosing regimen (1 mg/kg twice daily). Additionally, one study suggests that once-daily dosing of enoxaparin 1.5 mg/kg might be inferior to 1 mg/kg twice daily dosing; therefore, caution must be exercised in applying this recommendation to the LMWH enoxaparin.^3,27,28

Dr. Hospitalist

One of our providers wants to use adult hospitalists for coverage of inpatient orthopedic surgery patients. Is this acceptable practice? Are there qualifiers?

–Libby Gardner

Dr. Hospitalist responds:

Let’s see how far we can tackle this open-ended question. There has been lots of discussion on the topic of comanagement in the past by people eminently more qualified than I am. Still, it never hurts to take a fresh look at things.

For one, on the subject of admissions, I am a firm believer that hospitalists should admit all adult hip fractures. The overwhelming majority of the time, these patients are elderly with comorbid conditions. Sure, they are going to get their hip fixed, because the alternative is usually unacceptable, but some thought needs to go into the process. The orthopedic surgeon sees a hip that needs fixing and not much else. When issues like renal failure, afib, CHF, prior DVT, or dementia are present, hospitalists should take charge of the case. It is the best way to ensure that the patient receives optimal medical care and the documentation that goes along with it. I love our orthopedic surgeons, but I don’t want them primarily admitting, managing, and discharging my elderly patients. Let the surgeon do what they do best, which is operate, and leave the rest to us.

On the subject of orthopedic trauma, I take the exact opposite tack—this is not something for which I or most of my colleagues have expertise. A young, healthy patient with trauma should be admitted by the orthopedic service; that patient population’s complications are much more likely to be directly related to their trauma.

When it comes to elective surgery, when the admitting surgeon (orthopedic or otherwise) wants the help of a hospitalist, then I think it is of paramount importance to have clear “rules of engagement.” I think with good expectations, you can have a fantastic working relationship with your surgeons. Without them, it becomes a nightmare.

Here are my HM group’s rules for elective orthopedic surgery:

• Orthopedics handles all pain medications and VTE prophylaxis, including discharge prescriptions.
• Medicine handles all admit and discharge medication reconciliation (“med rec”).
• There is shared discussion on:

  • Need for transfusion; and
  • The VTE prophylaxis when a patient already is on chronic anticoagulation.

We do not vary from this protocol. I never adjust a patient’s pain medications. Even the floor nurses know this. Because I’m doing the admit med rec, it also means that the patient doesn’t have their HCTZ continued after 600cc of EBL and spinal anesthesia.

The system works because the rules are clear and the communication is consistent. This does not mean that we cover the orthopedic service at night. They are equally responsible for their patients under the items outlined above. In my view—and this might sound simplistic—the surgeon caused the post-op pain, so they should be responsible for managing it. On VTE prophylaxis, I might take a more nuanced view, but for our surgeons, they own the wound and the post-op follow-up, so they get the choice on what agent to use.

Would I accept an arrangement in which I covered all the orthopedic issues out of regular hours? Nope—not when they have primary responsibility for the case; they should always be directly available to the nurse. I think that anything else would be a system ripe for abuse.

Our exact rules will not work for every situation, but I would strongly encourage the two basic tenets from above: No. 1, the hospitalist should primarily admit and manage elderly hip fractures, and No. 2, clear rules of engagement should be established with your orthopedic or surgery group. It’s a discussion worth having during daylight hours, because trying to figure out the rules at 3 in the morning rarely ends well.

Dr. Hospitalist

One of our providers wants to use adult hospitalists for coverage of inpatient orthopedic surgery patients. Is this acceptable practice? Are there qualifiers?

–Libby Gardner

Dr. Hospitalist responds:

Let’s see how far we can tackle this open-ended question. There has been lots of discussion on the topic of comanagement in the past by people eminently more qualified than I am. Still, it never hurts to take a fresh look at things.

For one, on the subject of admissions, I am a firm believer that hospitalists should admit all adult hip fractures. The overwhelming majority of the time, these patients are elderly with comorbid conditions. Sure, they are going to get their hip fixed, because the alternative is usually unacceptable, but some thought needs to go into the process. The orthopedic surgeon sees a hip that needs fixing and not much else. When issues like renal failure, afib, CHF, prior DVT, or dementia are present, hospitalists should take charge of the case. It is the best way to ensure that the patient receives optimal medical care and the documentation that goes along with it. I love our orthopedic surgeons, but I don’t want them primarily admitting, managing, and discharging my elderly patients. Let the surgeon do what they do best, which is operate, and leave the rest to us.

On the subject of orthopedic trauma, I take the exact opposite tack—this is not something for which I or most of my colleagues have expertise. A young, healthy patient with trauma should be admitted by the orthopedic service; that patient population’s complications are much more likely to be directly related to their trauma.

When it comes to elective surgery, when the admitting surgeon (orthopedic or otherwise) wants the help of a hospitalist, then I think it is of paramount importance to have clear “rules of engagement.” I think with good expectations, you can have a fantastic working relationship with your surgeons. Without them, it becomes a nightmare.

Here are my HM group’s rules for elective orthopedic surgery:

• Orthopedics handles all pain medications and VTE prophylaxis, including discharge prescriptions.
• Medicine handles all admit and discharge medication reconciliation (“med rec”).
• There is shared discussion on:

  • Need for transfusion; and
  • The VTE prophylaxis when a patient already is on chronic anticoagulation.

We do not vary from this protocol. I never adjust a patient’s pain medications. Even the floor nurses know this. Because I’m doing the admit med rec, it also means that the patient doesn’t have their HCTZ continued after 600cc of EBL and spinal anesthesia.

The system works because the rules are clear and the communication is consistent. This does not mean that we cover the orthopedic service at night. They are equally responsible for their patients under the items outlined above. In my view—and this might sound simplistic—the surgeon caused the post-op pain, so they should be responsible for managing it. On VTE prophylaxis, I might take a more nuanced view, but for our surgeons, they own the wound and the post-op follow-up, so they get the choice on what agent to use.

Would I accept an arrangement in which I covered all the orthopedic issues out of regular hours? Nope—not when they have primary responsibility for the case; they should always be directly available to the nurse. I think that anything else would be a system ripe for abuse.

Our exact rules will not work for every situation, but I would strongly encourage the two basic tenets from above: No. 1, the hospitalist should primarily admit and manage elderly hip fractures, and No. 2, clear rules of engagement should be established with your orthopedic or surgery group. It’s a discussion worth having during daylight hours, because trying to figure out the rules at 3 in the morning rarely ends well.

Dr. Hospitalist

One of our providers wants to use adult hospitalists for coverage of inpatient orthopedic surgery patients. Is this acceptable practice? Are there qualifiers?

–Libby Gardner

Dr. Hospitalist responds:

Let’s see how far we can tackle this open-ended question. There has been lots of discussion on the topic of comanagement in the past by people eminently more qualified than I am. Still, it never hurts to take a fresh look at things.

For one, on the subject of admissions, I am a firm believer that hospitalists should admit all adult hip fractures. The overwhelming majority of the time, these patients are elderly with comorbid conditions. Sure, they are going to get their hip fixed, because the alternative is usually unacceptable, but some thought needs to go into the process. The orthopedic surgeon sees a hip that needs fixing and not much else. When issues like renal failure, afib, CHF, prior DVT, or dementia are present, hospitalists should take charge of the case. It is the best way to ensure that the patient receives optimal medical care and the documentation that goes along with it. I love our orthopedic surgeons, but I don’t want them primarily admitting, managing, and discharging my elderly patients. Let the surgeon do what they do best, which is operate, and leave the rest to us.

On the subject of orthopedic trauma, I take the exact opposite tack—this is not something for which I or most of my colleagues have expertise. A young, healthy patient with trauma should be admitted by the orthopedic service; that patient population’s complications are much more likely to be directly related to their trauma.

When it comes to elective surgery, when the admitting surgeon (orthopedic or otherwise) wants the help of a hospitalist, then I think it is of paramount importance to have clear “rules of engagement.” I think with good expectations, you can have a fantastic working relationship with your surgeons. Without them, it becomes a nightmare.

Here are my HM group’s rules for elective orthopedic surgery:

• Orthopedics handles all pain medications and VTE prophylaxis, including discharge prescriptions.
• Medicine handles all admit and discharge medication reconciliation (“med rec”).
• There is shared discussion on:

  • Need for transfusion; and
  • The VTE prophylaxis when a patient already is on chronic anticoagulation.

We do not vary from this protocol. I never adjust a patient’s pain medications. Even the floor nurses know this. Because I’m doing the admit med rec, it also means that the patient doesn’t have their HCTZ continued after 600cc of EBL and spinal anesthesia.

The system works because the rules are clear and the communication is consistent. This does not mean that we cover the orthopedic service at night. They are equally responsible for their patients under the items outlined above. In my view—and this might sound simplistic—the surgeon caused the post-op pain, so they should be responsible for managing it. On VTE prophylaxis, I might take a more nuanced view, but for our surgeons, they own the wound and the post-op follow-up, so they get the choice on what agent to use.

Would I accept an arrangement in which I covered all the orthopedic issues out of regular hours? Nope—not when they have primary responsibility for the case; they should always be directly available to the nurse. I think that anything else would be a system ripe for abuse.

Our exact rules will not work for every situation, but I would strongly encourage the two basic tenets from above: No. 1, the hospitalist should primarily admit and manage elderly hip fractures, and No. 2, clear rules of engagement should be established with your orthopedic or surgery group. It’s a discussion worth having during daylight hours, because trying to figure out the rules at 3 in the morning rarely ends well.

Hospitalists join SHM for lots of reasons, but the ability to network with hospitalists across the country is among the top motivators. In an emerging medical specialty, being able to collaborate and connect with peers is critical to career development and improving care.

Now, SHM has made connecting and collaborating easier than ever with Hospital Medicine Exchange (HMX), the first online community exclusively for hospitalists and hot topics in HM. Using HMX, hospitalists can start public discussions, post responses, and share files in one location.

For fast-moving issues, such as healthcare reform and hospitalist program management, HMX enables hospitalists to go straight to the source of some of the most important innovations: other hospitalists.

Using HMX is easy. Hospitalists log in to HMX using their SHM member username and password at HMXchange.org (automated assistance is available for those who don’t know their usernames or passwords). Once logged into HMX, hospitalists can browse communities, check out recent discussion threads, and update their profiles. Members can browse contacts to connect with thousands of other HMX users.

In addition to being the new home for conversations in hospital medicine, communities within HMX are replacing an array of legacy programs (e.g. the email listservs for practice management and SHM’s Leadership Academy alumni). HMX provides new flexibility not available in older systems like the listservs. Users can now opt into communities easily and decide how often they receive updates via email.

Conversation-Starters

Some hospitalists began collaborating with the HMX platform nearly a year ago. At the time, the platform was known as Higher Logic and supported SHM’s CODE-H, an educational program for hospital coding, along with SHM’s Hospital Value-Based Purchasing Toolkit (HVBP), a set of online resources and a community for hospitalists preparing their hospitals for value-based purchasing.

Patrick Torcson, MD, MMM, FACP, SFHM, led the HVBP community and sees the promise that HMX offers hospitalists. “It’s a nice synthesis of both content and resources because of the networking element,” he says. “It has a very real personal element as well.”

The HVBP community used HMX as equal parts educational session, networking, and library. Dr. Torcson and community members presented webinars, then followed up with discussions. Community members also shared resources about value-based purchasing through the discussion threads and the online library.

The immediate online interaction proved to be especially valuable when discussing a topic that was anything but static, he says.

“Because hospital value-based purchasing was unfolding over a timeline from [the Centers for Medicare & Medicaid Services (CMS)], we were able to add content as the program unfolded, including policy papers from Washington, webinars, and other relevant information,” Dr. Torcson explains. “For something like value-based purchasing, there’s no definitive source, so the collaboration was helpful. It’s true for a lot of topics in hospital medicine.

“To have a community tool like this that can accommodate for all the different inputs is really very valuable,” he adds.

HMX is a nice synthesis of both content and resources because of the networking element. It has a very real personal element as well.

—Patrick Torcson, MD, MMM, FACP, SFHM, chair, SHM’s Performance Measuring and Reporting Committee

Something for Every Member

In addition to a community for general issues affecting hospitalists, HMX also features specific communities designed to facilitate conversations on particular issues. As the communities evolve and conversations develop, SHM will add new communities.

Because so many hospitalists access the Internet from mobile devices, HMX is available for iPhones, iPads, and Android platforms through a third-party mobile application. Instructions for downloading and using the app are available at the HMX website.

SHM notified certain listserv users and others about the HMX introduction in August and September. Users quickly took to the new platform. Within a week of introducing HMX, nearly 100 hospitalists logged in for the first time.

The early interest in HMX isn’t surprising to Dr. Torcson, who says he “definitely” will use HMX in the future.

“It’s a great way to share best practices and case studies,” he says. “The personal dimension was really nice to connect so easily with the hospital medicine community. It’s nice to get the perspectives from other colleagues around the country and in different settings.”

Brendon Shank is SHM’s associate vice president of communications.

Hospitalists join SHM for lots of reasons, but the ability to network with hospitalists across the country is among the top motivators. In an emerging medical specialty, being able to collaborate and connect with peers is critical to career development and improving care.

Now, SHM has made connecting and collaborating easier than ever with Hospital Medicine Exchange (HMX), the first online community exclusively for hospitalists and hot topics in HM. Using HMX, hospitalists can start public discussions, post responses, and share files in one location.

For fast-moving issues, such as healthcare reform and hospitalist program management, HMX enables hospitalists to go straight to the source of some of the most important innovations: other hospitalists.

Using HMX is easy. Hospitalists log in to HMX using their SHM member username and password at HMXchange.org (automated assistance is available for those who don’t know their usernames or passwords). Once logged into HMX, hospitalists can browse communities, check out recent discussion threads, and update their profiles. Members can browse contacts to connect with thousands of other HMX users.

In addition to being the new home for conversations in hospital medicine, communities within HMX are replacing an array of legacy programs (e.g. the email listservs for practice management and SHM’s Leadership Academy alumni). HMX provides new flexibility not available in older systems like the listservs. Users can now opt into communities easily and decide how often they receive updates via email.

Conversation-Starters

Some hospitalists began collaborating with the HMX platform nearly a year ago. At the time, the platform was known as Higher Logic and supported SHM’s CODE-H, an educational program for hospital coding, along with SHM’s Hospital Value-Based Purchasing Toolkit (HVBP), a set of online resources and a community for hospitalists preparing their hospitals for value-based purchasing.

Patrick Torcson, MD, MMM, FACP, SFHM, led the HVBP community and sees the promise that HMX offers hospitalists. “It’s a nice synthesis of both content and resources because of the networking element,” he says. “It has a very real personal element as well.”

The HVBP community used HMX as equal parts educational session, networking, and library. Dr. Torcson and community members presented webinars, then followed up with discussions. Community members also shared resources about value-based purchasing through the discussion threads and the online library.

The immediate online interaction proved to be especially valuable when discussing a topic that was anything but static, he says.

“Because hospital value-based purchasing was unfolding over a timeline from [the Centers for Medicare & Medicaid Services (CMS)], we were able to add content as the program unfolded, including policy papers from Washington, webinars, and other relevant information,” Dr. Torcson explains. “For something like value-based purchasing, there’s no definitive source, so the collaboration was helpful. It’s true for a lot of topics in hospital medicine.

“To have a community tool like this that can accommodate for all the different inputs is really very valuable,” he adds.

HMX is a nice synthesis of both content and resources because of the networking element. It has a very real personal element as well.

—Patrick Torcson, MD, MMM, FACP, SFHM, chair, SHM’s Performance Measuring and Reporting Committee

Something for Every Member

In addition to a community for general issues affecting hospitalists, HMX also features specific communities designed to facilitate conversations on particular issues. As the communities evolve and conversations develop, SHM will add new communities.

Because so many hospitalists access the Internet from mobile devices, HMX is available for iPhones, iPads, and Android platforms through a third-party mobile application. Instructions for downloading and using the app are available at the HMX website.

SHM notified certain listserv users and others about the HMX introduction in August and September. Users quickly took to the new platform. Within a week of introducing HMX, nearly 100 hospitalists logged in for the first time.

The early interest in HMX isn’t surprising to Dr. Torcson, who says he “definitely” will use HMX in the future.

“It’s a great way to share best practices and case studies,” he says. “The personal dimension was really nice to connect so easily with the hospital medicine community. It’s nice to get the perspectives from other colleagues around the country and in different settings.”

Brendon Shank is SHM’s associate vice president of communications.

Hospitalists join SHM for lots of reasons, but the ability to network with hospitalists across the country is among the top motivators. In an emerging medical specialty, being able to collaborate and connect with peers is critical to career development and improving care.

Now, SHM has made connecting and collaborating easier than ever with Hospital Medicine Exchange (HMX), the first online community exclusively for hospitalists and hot topics in HM. Using HMX, hospitalists can start public discussions, post responses, and share files in one location.

For fast-moving issues, such as healthcare reform and hospitalist program management, HMX enables hospitalists to go straight to the source of some of the most important innovations: other hospitalists.

Using HMX is easy. Hospitalists log in to HMX using their SHM member username and password at HMXchange.org (automated assistance is available for those who don’t know their usernames or passwords). Once logged into HMX, hospitalists can browse communities, check out recent discussion threads, and update their profiles. Members can browse contacts to connect with thousands of other HMX users.

In addition to being the new home for conversations in hospital medicine, communities within HMX are replacing an array of legacy programs (e.g. the email listservs for practice management and SHM’s Leadership Academy alumni). HMX provides new flexibility not available in older systems like the listservs. Users can now opt into communities easily and decide how often they receive updates via email.

Conversation-Starters

Some hospitalists began collaborating with the HMX platform nearly a year ago. At the time, the platform was known as Higher Logic and supported SHM’s CODE-H, an educational program for hospital coding, along with SHM’s Hospital Value-Based Purchasing Toolkit (HVBP), a set of online resources and a community for hospitalists preparing their hospitals for value-based purchasing.

Patrick Torcson, MD, MMM, FACP, SFHM, led the HVBP community and sees the promise that HMX offers hospitalists. “It’s a nice synthesis of both content and resources because of the networking element,” he says. “It has a very real personal element as well.”

The HVBP community used HMX as equal parts educational session, networking, and library. Dr. Torcson and community members presented webinars, then followed up with discussions. Community members also shared resources about value-based purchasing through the discussion threads and the online library.

The immediate online interaction proved to be especially valuable when discussing a topic that was anything but static, he says.

“Because hospital value-based purchasing was unfolding over a timeline from [the Centers for Medicare & Medicaid Services (CMS)], we were able to add content as the program unfolded, including policy papers from Washington, webinars, and other relevant information,” Dr. Torcson explains. “For something like value-based purchasing, there’s no definitive source, so the collaboration was helpful. It’s true for a lot of topics in hospital medicine.

“To have a community tool like this that can accommodate for all the different inputs is really very valuable,” he adds.

HMX is a nice synthesis of both content and resources because of the networking element. It has a very real personal element as well.

—Patrick Torcson, MD, MMM, FACP, SFHM, chair, SHM’s Performance Measuring and Reporting Committee

Something for Every Member

In addition to a community for general issues affecting hospitalists, HMX also features specific communities designed to facilitate conversations on particular issues. As the communities evolve and conversations develop, SHM will add new communities.

Because so many hospitalists access the Internet from mobile devices, HMX is available for iPhones, iPads, and Android platforms through a third-party mobile application. Instructions for downloading and using the app are available at the HMX website.

SHM notified certain listserv users and others about the HMX introduction in August and September. Users quickly took to the new platform. Within a week of introducing HMX, nearly 100 hospitalists logged in for the first time.

The early interest in HMX isn’t surprising to Dr. Torcson, who says he “definitely” will use HMX in the future.

“It’s a great way to share best practices and case studies,” he says. “The personal dimension was really nice to connect so easily with the hospital medicine community. It’s nice to get the perspectives from other colleagues around the country and in different settings.”

Brendon Shank is SHM’s associate vice president of communications.

Susan D. Hutchins, MD, has been named medical director of hospitalist services at Memorial Hermann The Woodlands Hospital in The Woodlands, Texas. Dr. Hutchins’ new responsibilities include managing nine hospitalists, two nurse practitioners, and one registered nurse as part of Memorial Hermann’s inpatient hospitalist program.

Lewis L. Low, MD, FCCM, FACP, has been promoted to senior vice president and chief medical officer of Legacy Health System in the Portland, Ore., and Vancouver, Wash., areas. Dr. Low has been commended by his colleagues for his supervision of several of Legacy’s hospitalist programs within the Portland metropolitan area.

Business Moves

Helena Regional Medical Center in Helena, Ark., began offering hospitalist services in September. Hospitalists will staff the 155-bed facility 24 hours a day in order to further the hospital’s mission of “Quality Care, Right Here.”

Inpatient Physicians of Southwest Florida (ISSF), a newly formed hospitalist group, has begun offering HM services in the Lee Memorial Health System’s Fort Myers, Fla.-area hospitals. ISSF is a collaborative between Brentwood, Tenn.-based Cogent HMG and the Hospitalist Group of Southwest Florida.

The Mauldin, S.C.-based OB Hospitalist Group has expanded its services to include the Owensboro Medical Health System’s 477-bed flagship facility in Owensboro, Ky., which serves northwestern Kentucky and southwestern Indiana.

—Michael O’Neal

Susan D. Hutchins, MD, has been named medical director of hospitalist services at Memorial Hermann The Woodlands Hospital in The Woodlands, Texas. Dr. Hutchins’ new responsibilities include managing nine hospitalists, two nurse practitioners, and one registered nurse as part of Memorial Hermann’s inpatient hospitalist program.

Lewis L. Low, MD, FCCM, FACP, has been promoted to senior vice president and chief medical officer of Legacy Health System in the Portland, Ore., and Vancouver, Wash., areas. Dr. Low has been commended by his colleagues for his supervision of several of Legacy’s hospitalist programs within the Portland metropolitan area.

Business Moves

Helena Regional Medical Center in Helena, Ark., began offering hospitalist services in September. Hospitalists will staff the 155-bed facility 24 hours a day in order to further the hospital’s mission of “Quality Care, Right Here.”

Inpatient Physicians of Southwest Florida (ISSF), a newly formed hospitalist group, has begun offering HM services in the Lee Memorial Health System’s Fort Myers, Fla.-area hospitals. ISSF is a collaborative between Brentwood, Tenn.-based Cogent HMG and the Hospitalist Group of Southwest Florida.

The Mauldin, S.C.-based OB Hospitalist Group has expanded its services to include the Owensboro Medical Health System’s 477-bed flagship facility in Owensboro, Ky., which serves northwestern Kentucky and southwestern Indiana.

—Michael O’Neal

Susan D. Hutchins, MD, has been named medical director of hospitalist services at Memorial Hermann The Woodlands Hospital in The Woodlands, Texas. Dr. Hutchins’ new responsibilities include managing nine hospitalists, two nurse practitioners, and one registered nurse as part of Memorial Hermann’s inpatient hospitalist program.

Lewis L. Low, MD, FCCM, FACP, has been promoted to senior vice president and chief medical officer of Legacy Health System in the Portland, Ore., and Vancouver, Wash., areas. Dr. Low has been commended by his colleagues for his supervision of several of Legacy’s hospitalist programs within the Portland metropolitan area.

Business Moves

Helena Regional Medical Center in Helena, Ark., began offering hospitalist services in September. Hospitalists will staff the 155-bed facility 24 hours a day in order to further the hospital’s mission of “Quality Care, Right Here.”

Inpatient Physicians of Southwest Florida (ISSF), a newly formed hospitalist group, has begun offering HM services in the Lee Memorial Health System’s Fort Myers, Fla.-area hospitals. ISSF is a collaborative between Brentwood, Tenn.-based Cogent HMG and the Hospitalist Group of Southwest Florida.

The Mauldin, S.C.-based OB Hospitalist Group has expanded its services to include the Owensboro Medical Health System’s 477-bed flagship facility in Owensboro, Ky., which serves northwestern Kentucky and southwestern Indiana.

—Michael O’Neal

Kenric Maynor, MD, MPH, FHM

CAREER: Prior to joining Geisinger, Dr. Maynor served as a Robert Wood Johnson Clinical Scholar in Internal Medicine at Johns Hopkins Medical Center, Baltimore.

Education: University of North Carolina School of Medicine, internal medicine residency at Yale-New Haven Hospital; and internal medicine fellowship at Johns Hopkins Medical Center.

Notable: Dr. Maynor’s responsibilities at Geisinger will include oversight of eight medical centers, as well as leading the implementation of a new hospitalist program at Geisinger Community Medical Center in Scranton, Pa., which is planned to be operational by fall.

FYI: A Native American member of the Lumbee Tribe in southeastern North Carolina, Dr. Maynor is an avid Baltimore Orioles fan.

Quotable: “Being designated as a Fellow in the Society of Hospital Medicine has confirmed to my institution my commitment to the growth and the development of hospitalists’ principles of quality improvement, innovation, and patient safety. It has given me instant access to other Fellows with similar interests to allow for networking and collaboration.”

Kenric Maynor, MD, MPH, FHM

CAREER: Prior to joining Geisinger, Dr. Maynor served as a Robert Wood Johnson Clinical Scholar in Internal Medicine at Johns Hopkins Medical Center, Baltimore.

Education: University of North Carolina School of Medicine, internal medicine residency at Yale-New Haven Hospital; and internal medicine fellowship at Johns Hopkins Medical Center.

Notable: Dr. Maynor’s responsibilities at Geisinger will include oversight of eight medical centers, as well as leading the implementation of a new hospitalist program at Geisinger Community Medical Center in Scranton, Pa., which is planned to be operational by fall.

FYI: A Native American member of the Lumbee Tribe in southeastern North Carolina, Dr. Maynor is an avid Baltimore Orioles fan.

Quotable: “Being designated as a Fellow in the Society of Hospital Medicine has confirmed to my institution my commitment to the growth and the development of hospitalists’ principles of quality improvement, innovation, and patient safety. It has given me instant access to other Fellows with similar interests to allow for networking and collaboration.”

Kenric Maynor, MD, MPH, FHM

CAREER: Prior to joining Geisinger, Dr. Maynor served as a Robert Wood Johnson Clinical Scholar in Internal Medicine at Johns Hopkins Medical Center, Baltimore.

Education: University of North Carolina School of Medicine, internal medicine residency at Yale-New Haven Hospital; and internal medicine fellowship at Johns Hopkins Medical Center.

Notable: Dr. Maynor’s responsibilities at Geisinger will include oversight of eight medical centers, as well as leading the implementation of a new hospitalist program at Geisinger Community Medical Center in Scranton, Pa., which is planned to be operational by fall.

FYI: A Native American member of the Lumbee Tribe in southeastern North Carolina, Dr. Maynor is an avid Baltimore Orioles fan.

Quotable: “Being designated as a Fellow in the Society of Hospital Medicine has confirmed to my institution my commitment to the growth and the development of hospitalists’ principles of quality improvement, innovation, and patient safety. It has given me instant access to other Fellows with similar interests to allow for networking and collaboration.”

Enter text here

Enter text here

Enter text here

The healthcare market is saturated with fee-for-service reimbursement schemes. The Bureau of Labor Statistics estimates that 78% of employer-sponsored health insurance plans are some type of fee-for-service plan.¹ In Medicare, about 75% of beneficiaries use the traditional fee-for-service program.² Fee-for-service denotes that payments are made on individual services, billed separately, irrespective of outcome and, in some cases, necessity.

The physician value-based payment modifier (VBPM) is an initiative that will begin shifting Medicare reimbursement for physicians away from fee-for-service schemes and toward some type of pay-for-performance model.

For hospitalists, this will have a marked impact on HM practice and might have reverberating effects in the field itself.

Established under the 2008 Medicare Improvements for Patients and Providers Act (MIPPA) and expanded under the 2010 Affordable Care Act (ACA), the VBPM will be applied to all physicians by 2017.

The VBPM program is the physician version of hospital value-based purchasing; both are designed to move the basis of payment toward the quality of care delivered, not simply for the quantity of services rendered. By linking quality measurement with payment, the Centers for Medicare & Medicaid Services (CMS) hopes to start paying for value.

While legislation required the creation of pay-for-performance programs for physicians and hospitals, the design and implementation details have been delegated to CMS, part of the U.S. Department of Health and Human Services. Thus, CMS has oversight on the specifics of the program. These specifics are promulgated through the federal rulemaking process, which requires such agencies as CMS to seek input from the general public—as well as medical societies, including SHM—as rules are proposed and finalized. Generally, there is a 30- to 90-day period after a rule is proposed for public comment, after which a rule will be finalized.

For the VBPM and its performance period starting next year, the guidelines were published for public comment in a proposed rule for the fiscal-year 2013 Physician Fee Schedule. The final rule, which will provide more definitive guidance for hospitalists, is slated to come out in November.

Hospitalists should be cognizant of how quality measurements apply to their practice and find ways to participate in such quality measurement programs as the Physician Quality Reporting System (PQRS). PQRS will become the evaluative backbone of the VBPM. It is imperative that hospitalists stay abreast of these transformative changes in the healthcare system and work to ensure that their practice patterns, which fill critical gaps in patient care, are adequately represented in these changes.

Although legislation and legislative advocacy are undoubtedly important features of policymaking, participating in the federal rulemaking process is a vital tool for helping to shape healthcare. SHM actively pursues regulatory issues in order to advocate for hospitalists and their patients. The experiences and expertise of members are critical for SHM to be able to accurately represent the specialty.

By staying informed on health policy and being engaged with SHM, members can provide invaluable perspectives to help transform the field and revolutionize the healthcare system.

Josh Lapps is SHM's government relations specialist.

References

1. U.S. Bureau of Labor Statistics. Program Perspectives: fee-for-service plans. U.S. Bureau of Labor Statistics website. Available at: http://www.bls.gov/opub/perspectives/program_perspectives_vol2_issue5.pdf. Accessed Aug. 15, 2012.
2. The Henry J. Kaiser Family Foundation. Medicare at a glance. The Henry J. Kaiser Family Foundation website. Available at: http://www.kff.org/medicare/upload/1066_11.pdf. Accessed Aug. 29, 2012.

The healthcare market is saturated with fee-for-service reimbursement schemes. The Bureau of Labor Statistics estimates that 78% of employer-sponsored health insurance plans are some type of fee-for-service plan.¹ In Medicare, about 75% of beneficiaries use the traditional fee-for-service program.² Fee-for-service denotes that payments are made on individual services, billed separately, irrespective of outcome and, in some cases, necessity.

The physician value-based payment modifier (VBPM) is an initiative that will begin shifting Medicare reimbursement for physicians away from fee-for-service schemes and toward some type of pay-for-performance model.

For hospitalists, this will have a marked impact on HM practice and might have reverberating effects in the field itself.

Established under the 2008 Medicare Improvements for Patients and Providers Act (MIPPA) and expanded under the 2010 Affordable Care Act (ACA), the VBPM will be applied to all physicians by 2017.

The VBPM program is the physician version of hospital value-based purchasing; both are designed to move the basis of payment toward the quality of care delivered, not simply for the quantity of services rendered. By linking quality measurement with payment, the Centers for Medicare & Medicaid Services (CMS) hopes to start paying for value.

While legislation required the creation of pay-for-performance programs for physicians and hospitals, the design and implementation details have been delegated to CMS, part of the U.S. Department of Health and Human Services. Thus, CMS has oversight on the specifics of the program. These specifics are promulgated through the federal rulemaking process, which requires such agencies as CMS to seek input from the general public—as well as medical societies, including SHM—as rules are proposed and finalized. Generally, there is a 30- to 90-day period after a rule is proposed for public comment, after which a rule will be finalized.

For the VBPM and its performance period starting next year, the guidelines were published for public comment in a proposed rule for the fiscal-year 2013 Physician Fee Schedule. The final rule, which will provide more definitive guidance for hospitalists, is slated to come out in November.

Hospitalists should be cognizant of how quality measurements apply to their practice and find ways to participate in such quality measurement programs as the Physician Quality Reporting System (PQRS). PQRS will become the evaluative backbone of the VBPM. It is imperative that hospitalists stay abreast of these transformative changes in the healthcare system and work to ensure that their practice patterns, which fill critical gaps in patient care, are adequately represented in these changes.

Although legislation and legislative advocacy are undoubtedly important features of policymaking, participating in the federal rulemaking process is a vital tool for helping to shape healthcare. SHM actively pursues regulatory issues in order to advocate for hospitalists and their patients. The experiences and expertise of members are critical for SHM to be able to accurately represent the specialty.

By staying informed on health policy and being engaged with SHM, members can provide invaluable perspectives to help transform the field and revolutionize the healthcare system.

Josh Lapps is SHM's government relations specialist.

References

1. U.S. Bureau of Labor Statistics. Program Perspectives: fee-for-service plans. U.S. Bureau of Labor Statistics website. Available at: http://www.bls.gov/opub/perspectives/program_perspectives_vol2_issue5.pdf. Accessed Aug. 15, 2012.
2. The Henry J. Kaiser Family Foundation. Medicare at a glance. The Henry J. Kaiser Family Foundation website. Available at: http://www.kff.org/medicare/upload/1066_11.pdf. Accessed Aug. 29, 2012.

The healthcare market is saturated with fee-for-service reimbursement schemes. The Bureau of Labor Statistics estimates that 78% of employer-sponsored health insurance plans are some type of fee-for-service plan.¹ In Medicare, about 75% of beneficiaries use the traditional fee-for-service program.² Fee-for-service denotes that payments are made on individual services, billed separately, irrespective of outcome and, in some cases, necessity.

The physician value-based payment modifier (VBPM) is an initiative that will begin shifting Medicare reimbursement for physicians away from fee-for-service schemes and toward some type of pay-for-performance model.

For hospitalists, this will have a marked impact on HM practice and might have reverberating effects in the field itself.

Established under the 2008 Medicare Improvements for Patients and Providers Act (MIPPA) and expanded under the 2010 Affordable Care Act (ACA), the VBPM will be applied to all physicians by 2017.

The VBPM program is the physician version of hospital value-based purchasing; both are designed to move the basis of payment toward the quality of care delivered, not simply for the quantity of services rendered. By linking quality measurement with payment, the Centers for Medicare & Medicaid Services (CMS) hopes to start paying for value.

While legislation required the creation of pay-for-performance programs for physicians and hospitals, the design and implementation details have been delegated to CMS, part of the U.S. Department of Health and Human Services. Thus, CMS has oversight on the specifics of the program. These specifics are promulgated through the federal rulemaking process, which requires such agencies as CMS to seek input from the general public—as well as medical societies, including SHM—as rules are proposed and finalized. Generally, there is a 30- to 90-day period after a rule is proposed for public comment, after which a rule will be finalized.

For the VBPM and its performance period starting next year, the guidelines were published for public comment in a proposed rule for the fiscal-year 2013 Physician Fee Schedule. The final rule, which will provide more definitive guidance for hospitalists, is slated to come out in November.

Hospitalists should be cognizant of how quality measurements apply to their practice and find ways to participate in such quality measurement programs as the Physician Quality Reporting System (PQRS). PQRS will become the evaluative backbone of the VBPM. It is imperative that hospitalists stay abreast of these transformative changes in the healthcare system and work to ensure that their practice patterns, which fill critical gaps in patient care, are adequately represented in these changes.

Although legislation and legislative advocacy are undoubtedly important features of policymaking, participating in the federal rulemaking process is a vital tool for helping to shape healthcare. SHM actively pursues regulatory issues in order to advocate for hospitalists and their patients. The experiences and expertise of members are critical for SHM to be able to accurately represent the specialty.

By staying informed on health policy and being engaged with SHM, members can provide invaluable perspectives to help transform the field and revolutionize the healthcare system.

Josh Lapps is SHM's government relations specialist.

References

1. U.S. Bureau of Labor Statistics. Program Perspectives: fee-for-service plans. U.S. Bureau of Labor Statistics website. Available at: http://www.bls.gov/opub/perspectives/program_perspectives_vol2_issue5.pdf. Accessed Aug. 15, 2012.
2. The Henry J. Kaiser Family Foundation. Medicare at a glance. The Henry J. Kaiser Family Foundation website. Available at: http://www.kff.org/medicare/upload/1066_11.pdf. Accessed Aug. 29, 2012.

Tomorrow’s hospital will be increasingly oriented around quality and safety; today’s students must prepare to thrive in that environment.

That’s the philosophy behind SHM’s Quality and Safety Educators Academy (QSEA). Now in its second year, the two-and-a-half-day academy trains hospitalist educators to teach medical students and residents about quality and safety.

QSEA, co-hosted by SHM and the Alliance for Academic Internal Medicine, is March 7-9 at Tempe Mission Palms in Tempe, Ariz. Registration is now open at www.hospitalmedicine.org/qsea.

“In order to be successful, we must teach medical students and residents about these goals so that they incorporate them into their practice from day one,” says Jennifer S. Myers, MD, associate professor of clinical medicine, patient safety officer, and director of quality and safety education at the University of Pennsylvania’s Perelman School of Medicine in Philadelphia.

Progress in quality improvement (QI) and patient safety has been slow because many current physicians aren’t familiar with the materials, creating what Dr. Myers refers to as a “faculty development” gap. QSEA is the first and only academy designed to close that gap for hospitalist faculty by giving them specific knowledge, skills, a take-home toolkit, and a brand-new peer network of other quality-minded educators.

A major part of the academy is dedicated to the career trajectory of educators and, in Dr. Myers’ words, “how a hospitalist can be successful in making quality and safety education a career path.”

Despite the serious topics, she also is quick to point out that the academy is anything but dry.

“You have to experience it,” she says. “We have a ton of fun. You will leave with a new family.”

At the end of the inaugural QSEA, the faculty and course directors were so energized by the attendees that they formed a human pyramid. “It was a great moment,” she says.

Dr. Myers says she still enjoys receiving email from QSEA attendees about their new adventures in quality and safety education. “This makes it all worth it and why the QSEA team does this work,” she says.

Tomorrow’s hospital will be increasingly oriented around quality and safety; today’s students must prepare to thrive in that environment.

That’s the philosophy behind SHM’s Quality and Safety Educators Academy (QSEA). Now in its second year, the two-and-a-half-day academy trains hospitalist educators to teach medical students and residents about quality and safety.

QSEA, co-hosted by SHM and the Alliance for Academic Internal Medicine, is March 7-9 at Tempe Mission Palms in Tempe, Ariz. Registration is now open at www.hospitalmedicine.org/qsea.

“In order to be successful, we must teach medical students and residents about these goals so that they incorporate them into their practice from day one,” says Jennifer S. Myers, MD, associate professor of clinical medicine, patient safety officer, and director of quality and safety education at the University of Pennsylvania’s Perelman School of Medicine in Philadelphia.

Progress in quality improvement (QI) and patient safety has been slow because many current physicians aren’t familiar with the materials, creating what Dr. Myers refers to as a “faculty development” gap. QSEA is the first and only academy designed to close that gap for hospitalist faculty by giving them specific knowledge, skills, a take-home toolkit, and a brand-new peer network of other quality-minded educators.

A major part of the academy is dedicated to the career trajectory of educators and, in Dr. Myers’ words, “how a hospitalist can be successful in making quality and safety education a career path.”

Despite the serious topics, she also is quick to point out that the academy is anything but dry.

“You have to experience it,” she says. “We have a ton of fun. You will leave with a new family.”

At the end of the inaugural QSEA, the faculty and course directors were so energized by the attendees that they formed a human pyramid. “It was a great moment,” she says.

Dr. Myers says she still enjoys receiving email from QSEA attendees about their new adventures in quality and safety education. “This makes it all worth it and why the QSEA team does this work,” she says.

Tomorrow’s hospital will be increasingly oriented around quality and safety; today’s students must prepare to thrive in that environment.

That’s the philosophy behind SHM’s Quality and Safety Educators Academy (QSEA). Now in its second year, the two-and-a-half-day academy trains hospitalist educators to teach medical students and residents about quality and safety.

QSEA, co-hosted by SHM and the Alliance for Academic Internal Medicine, is March 7-9 at Tempe Mission Palms in Tempe, Ariz. Registration is now open at www.hospitalmedicine.org/qsea.

“In order to be successful, we must teach medical students and residents about these goals so that they incorporate them into their practice from day one,” says Jennifer S. Myers, MD, associate professor of clinical medicine, patient safety officer, and director of quality and safety education at the University of Pennsylvania’s Perelman School of Medicine in Philadelphia.

Progress in quality improvement (QI) and patient safety has been slow because many current physicians aren’t familiar with the materials, creating what Dr. Myers refers to as a “faculty development” gap. QSEA is the first and only academy designed to close that gap for hospitalist faculty by giving them specific knowledge, skills, a take-home toolkit, and a brand-new peer network of other quality-minded educators.

A major part of the academy is dedicated to the career trajectory of educators and, in Dr. Myers’ words, “how a hospitalist can be successful in making quality and safety education a career path.”

Despite the serious topics, she also is quick to point out that the academy is anything but dry.

“You have to experience it,” she says. “We have a ton of fun. You will leave with a new family.”

At the end of the inaugural QSEA, the faculty and course directors were so energized by the attendees that they formed a human pyramid. “It was a great moment,” she says.

Dr. Myers says she still enjoys receiving email from QSEA attendees about their new adventures in quality and safety education. “This makes it all worth it and why the QSEA team does this work,” she says.

Interested in becoming a leader in hospital medicine? Know someone who would be a great leader? SHM is seeking nominations for three open seats for its board of directors. These positions serve a three-year term beginning in May 2013.

Take this opportunity to help determine the course of this rapidly growing specialty.

Send all nominations—including a one-page nomination letter, CV, and recent headshot—no later than Oct. 31 to Joy Barnosky at [email protected]. For full eligibility and nomination requirements, visit www.hospitalmedicine.org and click on “About SHM,” then “Election Information.”

If you have questions, email [email protected] or call 267-702-2614.

Interested in becoming a leader in hospital medicine? Know someone who would be a great leader? SHM is seeking nominations for three open seats for its board of directors. These positions serve a three-year term beginning in May 2013.

Take this opportunity to help determine the course of this rapidly growing specialty.

Send all nominations—including a one-page nomination letter, CV, and recent headshot—no later than Oct. 31 to Joy Barnosky at [email protected]. For full eligibility and nomination requirements, visit www.hospitalmedicine.org and click on “About SHM,” then “Election Information.”

If you have questions, email [email protected] or call 267-702-2614.

Interested in becoming a leader in hospital medicine? Know someone who would be a great leader? SHM is seeking nominations for three open seats for its board of directors. These positions serve a three-year term beginning in May 2013.

Take this opportunity to help determine the course of this rapidly growing specialty.

Send all nominations—including a one-page nomination letter, CV, and recent headshot—no later than Oct. 31 to Joy Barnosky at [email protected]. For full eligibility and nomination requirements, visit www.hospitalmedicine.org and click on “About SHM,” then “Election Information.”

If you have questions, email [email protected] or call 267-702-2614.

Last month The Hospitalist reported new 2012 State of Hospital Medicine survey data showing that 57% of those adult medicine hospitalist groups providing surgical comanagement services typically do so as admitting/attending physician, as opposed to serving in a consultant role. For groups providing medical subspecialty comanagement, the admitting/attending rate was a whopping 85%.

But just how common is comanagement these days, and what else do we know about hospitalists’ evolving scope of practice? It’s hard to compare this year’s survey results with those presented in last year’s report because previously this information was reported for all HM groups combined while this year adult and pediatric groups are reported separately. In addition, the survey population was different this year since MGMA survey participants were no longer included. But if you ask almost anyone working in HM today, they probably will tell you that the pressure to assume increased comanagement responsibilities for more and more types of patients is intense.

One of the new questions this year asked respondents to characterize their scope of services by selecting one of the following three options:

click for large version

• We maintain a scope of practice that resembles traditional hospital-based internal medicine (or pediatrics, if applicable).
• Our practice scope has evolved to include some services that are outside of traditional internal medicine practice (or pediatrics, if applicable), e.g., admitting/managing patients with intracranial hemorrhage, small bowel obstruction or hip fracture.
• Our practice scope has evolved to encompass admitting a full range of hospital patients in the age group for which we are responsible, with the exception of OB and emergency surgery patients (i.e. nearly “universal admitter”).

A remarkable 45% of adult medicine hospitalist groups reported that their scope has evolved toward a nearly universal admitter role, while only a quarter of such groups reported maintaining a traditional internal medicine scope (see Figure 1, below). The broader scope of practice was more common in the Midwest, among private hospitalist-only groups and those employed by management companies, and in non-teaching hospitals. Not surprisingly, academic hospital medicine groups and those employed by university/medical schools tended to maintain narrower internal medicine-focused scopes.

As to the prevalence of comanagement, this year 94% of groups serving adults only reported providing surgical comanagement services (either admitting or consulting), while 70% reported providing comanagement for medical subspecialty patients. Seven years ago, SHM’s 2005 survey found that 87% of adult medicine groups provided surgical comanagement (SHM didn’t ask about medical comanagement).

So yes, the proportion of groups providing surgical comanagement has increased, but not dramatically.

Although we don’t know for sure since the question wasn’t asked in 2005, I suspect we’d find that most groups providing surgical (and probably medical subspecialty) comanagement in 2005 served as consultants; today the preponderance serve as admitting/attending physician for such patients. That’s a significant scope evolution that’s not obvious from just looking at the percent of groups that provide comanagement.

A comprehensive list of services routinely provided by HM groups is available in the new 2012 State of Hospital Medicine report, with breakdowns by group type, geographic region, employment model, and academic/teaching status. Hopefully, SHM will continue to survey this important topic so that scope evolution can be tracked going forward.

Last month The Hospitalist reported new 2012 State of Hospital Medicine survey data showing that 57% of those adult medicine hospitalist groups providing surgical comanagement services typically do so as admitting/attending physician, as opposed to serving in a consultant role. For groups providing medical subspecialty comanagement, the admitting/attending rate was a whopping 85%.

But just how common is comanagement these days, and what else do we know about hospitalists’ evolving scope of practice? It’s hard to compare this year’s survey results with those presented in last year’s report because previously this information was reported for all HM groups combined while this year adult and pediatric groups are reported separately. In addition, the survey population was different this year since MGMA survey participants were no longer included. But if you ask almost anyone working in HM today, they probably will tell you that the pressure to assume increased comanagement responsibilities for more and more types of patients is intense.

One of the new questions this year asked respondents to characterize their scope of services by selecting one of the following three options:

click for large version

• We maintain a scope of practice that resembles traditional hospital-based internal medicine (or pediatrics, if applicable).
• Our practice scope has evolved to include some services that are outside of traditional internal medicine practice (or pediatrics, if applicable), e.g., admitting/managing patients with intracranial hemorrhage, small bowel obstruction or hip fracture.
• Our practice scope has evolved to encompass admitting a full range of hospital patients in the age group for which we are responsible, with the exception of OB and emergency surgery patients (i.e. nearly “universal admitter”).

A remarkable 45% of adult medicine hospitalist groups reported that their scope has evolved toward a nearly universal admitter role, while only a quarter of such groups reported maintaining a traditional internal medicine scope (see Figure 1, below). The broader scope of practice was more common in the Midwest, among private hospitalist-only groups and those employed by management companies, and in non-teaching hospitals. Not surprisingly, academic hospital medicine groups and those employed by university/medical schools tended to maintain narrower internal medicine-focused scopes.

As to the prevalence of comanagement, this year 94% of groups serving adults only reported providing surgical comanagement services (either admitting or consulting), while 70% reported providing comanagement for medical subspecialty patients. Seven years ago, SHM’s 2005 survey found that 87% of adult medicine groups provided surgical comanagement (SHM didn’t ask about medical comanagement).

So yes, the proportion of groups providing surgical comanagement has increased, but not dramatically.

Although we don’t know for sure since the question wasn’t asked in 2005, I suspect we’d find that most groups providing surgical (and probably medical subspecialty) comanagement in 2005 served as consultants; today the preponderance serve as admitting/attending physician for such patients. That’s a significant scope evolution that’s not obvious from just looking at the percent of groups that provide comanagement.

A comprehensive list of services routinely provided by HM groups is available in the new 2012 State of Hospital Medicine report, with breakdowns by group type, geographic region, employment model, and academic/teaching status. Hopefully, SHM will continue to survey this important topic so that scope evolution can be tracked going forward.

Last month The Hospitalist reported new 2012 State of Hospital Medicine survey data showing that 57% of those adult medicine hospitalist groups providing surgical comanagement services typically do so as admitting/attending physician, as opposed to serving in a consultant role. For groups providing medical subspecialty comanagement, the admitting/attending rate was a whopping 85%.

But just how common is comanagement these days, and what else do we know about hospitalists’ evolving scope of practice? It’s hard to compare this year’s survey results with those presented in last year’s report because previously this information was reported for all HM groups combined while this year adult and pediatric groups are reported separately. In addition, the survey population was different this year since MGMA survey participants were no longer included. But if you ask almost anyone working in HM today, they probably will tell you that the pressure to assume increased comanagement responsibilities for more and more types of patients is intense.

One of the new questions this year asked respondents to characterize their scope of services by selecting one of the following three options:

click for large version

• We maintain a scope of practice that resembles traditional hospital-based internal medicine (or pediatrics, if applicable).
• Our practice scope has evolved to include some services that are outside of traditional internal medicine practice (or pediatrics, if applicable), e.g., admitting/managing patients with intracranial hemorrhage, small bowel obstruction or hip fracture.
• Our practice scope has evolved to encompass admitting a full range of hospital patients in the age group for which we are responsible, with the exception of OB and emergency surgery patients (i.e. nearly “universal admitter”).

A remarkable 45% of adult medicine hospitalist groups reported that their scope has evolved toward a nearly universal admitter role, while only a quarter of such groups reported maintaining a traditional internal medicine scope (see Figure 1, below). The broader scope of practice was more common in the Midwest, among private hospitalist-only groups and those employed by management companies, and in non-teaching hospitals. Not surprisingly, academic hospital medicine groups and those employed by university/medical schools tended to maintain narrower internal medicine-focused scopes.

As to the prevalence of comanagement, this year 94% of groups serving adults only reported providing surgical comanagement services (either admitting or consulting), while 70% reported providing comanagement for medical subspecialty patients. Seven years ago, SHM’s 2005 survey found that 87% of adult medicine groups provided surgical comanagement (SHM didn’t ask about medical comanagement).

So yes, the proportion of groups providing surgical comanagement has increased, but not dramatically.

Although we don’t know for sure since the question wasn’t asked in 2005, I suspect we’d find that most groups providing surgical (and probably medical subspecialty) comanagement in 2005 served as consultants; today the preponderance serve as admitting/attending physician for such patients. That’s a significant scope evolution that’s not obvious from just looking at the percent of groups that provide comanagement.

A comprehensive list of services routinely provided by HM groups is available in the new 2012 State of Hospital Medicine report, with breakdowns by group type, geographic region, employment model, and academic/teaching status. Hopefully, SHM will continue to survey this important topic so that scope evolution can be tracked going forward.