Leadership Training

Dr. Torcson

Mangla Gulati, MD, FACP, FHM, an academic hospitalist and medical director of clinical effectiveness at University of Maryland Medical Center in Baltimore, had never been involved in a lobbying trip before the waning days of last year. But then, just as members of Congress were wrestling with potential Draconian cuts to Medicare reimbursements and a $10 million slash in Medicare funding for the National Quality Forum (NQF), Dr. Gulati found herself on a daylong trip with SHM government guru Laura Allendorf and an NQF representative to make a series of in-person appeals to politicians in Washington, D.C. “When you’re a practicing physician, even though you know there’s regulation and compliance and mandates, you really don’t understand how they come to fruition and what the thought process is,” says Dr. Gulati, secretary of SHM’s Maryland chapter. “It was really interesting to see the other side of that and how people up on the Hill make a lot of decisions based on the information that’s given to them.”

The Hill she’s referring to is none other than Capitol Hill, and Dr. Gulati is making a return just a few months after her visit. And this time, she’s bringing a few hundred hospitalists with her. Hospitalists on the Hill 2013 (www.hospitalmedicine 2013.org/advocacy) is the annual trek made by SHM leadership and rank-and-file members to lobby legislators and federal staffers “on the way policies affect your practice and your patients,” SHM says on its website. This year, the showing in Washington is expected to be among the best ever, as the lobbying trip is May 16, just before HM13’s full program kicks off at the Gaylord National Resort & Convention Center in National Harbor, Md.

The all-day affair kicks off in the morning, as participants will receive briefings from SHM Public Policy Committee Chair Ron Greeno, MD, FCCP, MHM, and Allendorf, SHM’s senior advisor for advocacy and government affairs. Then comes a two-hour training course from Advocacy Associates (http://advocacyassociates.com), a boutique communications firm that helps organizations, such as SHM, tailor their message to policymakers. After that, it’s a six-hour whirlwind of meetings with home-state legislators, career administrators, and aide-de-camps that one former participant described as “almost like speed-dial dating with congressmen and -women.” Lastly, participants regroup at day’s end for a debriefing.

“I think what’s different at SHM is we go to Washington with an agenda of how we can improve patient safety and quality outcomes,” says Patrick Torcson, MD, MMM, FACP, SFHM, chair of SHM’s Performance Measurement and Reporting Committee. “We’re not there about just protecting our turf and making sure that our reimbursement stays at a reasonable level. We’ve been very clear to offer innovations about care transitions and Project BOOST, and different things that can be done to improve things like quality and service for Medicare beneficiaries.”

Check out our 6-minute feature video: "Five Reasons You Should Attend HM13"

Dr. Torcson says congressional contacts he’s made in past years “always look forward to our visits, because we really do come with an attitude of how can we help fix a broken system.”

He counts several victories as fruit of the annual trip. First, he believes the trip has “clearly educated our politicians, congressional staffers, and CMS [the Centers for Medicare & Medicaid Services] that the predominant model of the way patients are taken care of in the hospital is by a hospitalist.”

Second, and more granularly, SHM really gets into the weeds. Take CMS’ Quality and Resource Use Report (QRUR), which is part of the rollout of its value-based purchasing modifier (VBPM). Dr. Torcson says SHM carefully reviewed the report to register its concerns about proper attribution, fair comparisons, relevant metrics, and other issues. In turn, CMS signaled its appreciation of SHM’s due diligence and has indicated a willingness to work with SHM to address its concerns.

CMS chief medical officer Patrick Conway, MD, MSc, FAAP, SFHM, sees it from both sides of the equation. A pediatric hospitalist by training, he has been on trips to push federal officials to promulgate rules that make the most sense for HM. But in his current job, he’s often the one being pushed—and he welcomes the visits.

“We’re trying to partner up with physicians,” he says.

Dr. Conway believes lobbying trips like SHM’s are critical to informing both politicians and professionals on what physicians need or want most.

“People often think, ‘How could it matter?’ Sure, some of it will be hits and misses. But you’ll hit some key points that resonate,” he says.

Hospitalist Rick Hilger, MD, SFHM, director of resident education and adjunct associate professor of medicine at the University of Minnesota Medical School in Minneapolis, learned that lesson last year during his first Hospitalists on the Hill. A first-time member of SHM’s Public Policy Committee, he met with the legislative assistants for U.S. Sens.

Al Franken (D-Minn.) and Amy Klobuchar (D-Minn.), as well as had a face-to-face meeting with U.S. Rep. Allyson Schwartz (D-Pa.). The latter has been a staunch advocate of Medicare payment reform, sponsoring several bills—with SHM’s support—to repeal the sustainable growth rate (SGR) formula.

“It’s an investment in time, and especially for the senators and congressmen and -women from your own state, it’s more about trying to develop a relationship,” Dr. Hilger says. “I’ve already exchanged emails with the aides that I met that day concerning other healthcare issues. … I’m not sure I can completely answer for the long-term impact, but it definitely feels better than doing nothing.”

How to Climb the Hill

SHM’s Hospitalists on the Hill event is May 16, the first day of HM13. Even if you can’t make it, these tips from SHM’s advocacy veterans are helpful when using SHM’s new Legislative Action Center (www.hospitalmedicine.org/advocacy).

• Don’t be afraid. Often, hospitalists think that lobbying efforts are only fruitful if done by industry leaders. SHM wants as many members involved as possible to strengthen its message. “Numbers are important,” Dr. Greeno says. “The more people we can get there to participate, the better. It just means the more people we can get in front of it.”
• Bring a point of view. “We all come to the table with different experiences, different thoughts on healthcare reform,” Dr. Hilger says. “So we try to come to a consensus for everyone. The worst thing you can do is to say nothing.”
• Be positive. Change doesn’t happen overnight, so take the long view on how valuable conversations with policy leaders can be and how they can further the progress started by the loudest voices in HM. “They’ve pushed the envelope,” Dr. Gulati says. “We need to keep pushing it, because if you don’t push, you can’t make change.”

Richard Quinn is a freelance writer in New Jersey.

Dr. Torcson

Mangla Gulati, MD, FACP, FHM, an academic hospitalist and medical director of clinical effectiveness at University of Maryland Medical Center in Baltimore, had never been involved in a lobbying trip before the waning days of last year. But then, just as members of Congress were wrestling with potential Draconian cuts to Medicare reimbursements and a $10 million slash in Medicare funding for the National Quality Forum (NQF), Dr. Gulati found herself on a daylong trip with SHM government guru Laura Allendorf and an NQF representative to make a series of in-person appeals to politicians in Washington, D.C. “When you’re a practicing physician, even though you know there’s regulation and compliance and mandates, you really don’t understand how they come to fruition and what the thought process is,” says Dr. Gulati, secretary of SHM’s Maryland chapter. “It was really interesting to see the other side of that and how people up on the Hill make a lot of decisions based on the information that’s given to them.”

The Hill she’s referring to is none other than Capitol Hill, and Dr. Gulati is making a return just a few months after her visit. And this time, she’s bringing a few hundred hospitalists with her. Hospitalists on the Hill 2013 (www.hospitalmedicine 2013.org/advocacy) is the annual trek made by SHM leadership and rank-and-file members to lobby legislators and federal staffers “on the way policies affect your practice and your patients,” SHM says on its website. This year, the showing in Washington is expected to be among the best ever, as the lobbying trip is May 16, just before HM13’s full program kicks off at the Gaylord National Resort & Convention Center in National Harbor, Md.

The all-day affair kicks off in the morning, as participants will receive briefings from SHM Public Policy Committee Chair Ron Greeno, MD, FCCP, MHM, and Allendorf, SHM’s senior advisor for advocacy and government affairs. Then comes a two-hour training course from Advocacy Associates (http://advocacyassociates.com), a boutique communications firm that helps organizations, such as SHM, tailor their message to policymakers. After that, it’s a six-hour whirlwind of meetings with home-state legislators, career administrators, and aide-de-camps that one former participant described as “almost like speed-dial dating with congressmen and -women.” Lastly, participants regroup at day’s end for a debriefing.

“I think what’s different at SHM is we go to Washington with an agenda of how we can improve patient safety and quality outcomes,” says Patrick Torcson, MD, MMM, FACP, SFHM, chair of SHM’s Performance Measurement and Reporting Committee. “We’re not there about just protecting our turf and making sure that our reimbursement stays at a reasonable level. We’ve been very clear to offer innovations about care transitions and Project BOOST, and different things that can be done to improve things like quality and service for Medicare beneficiaries.”

Check out our 6-minute feature video: "Five Reasons You Should Attend HM13"

Dr. Torcson says congressional contacts he’s made in past years “always look forward to our visits, because we really do come with an attitude of how can we help fix a broken system.”

He counts several victories as fruit of the annual trip. First, he believes the trip has “clearly educated our politicians, congressional staffers, and CMS [the Centers for Medicare & Medicaid Services] that the predominant model of the way patients are taken care of in the hospital is by a hospitalist.”

Second, and more granularly, SHM really gets into the weeds. Take CMS’ Quality and Resource Use Report (QRUR), which is part of the rollout of its value-based purchasing modifier (VBPM). Dr. Torcson says SHM carefully reviewed the report to register its concerns about proper attribution, fair comparisons, relevant metrics, and other issues. In turn, CMS signaled its appreciation of SHM’s due diligence and has indicated a willingness to work with SHM to address its concerns.

CMS chief medical officer Patrick Conway, MD, MSc, FAAP, SFHM, sees it from both sides of the equation. A pediatric hospitalist by training, he has been on trips to push federal officials to promulgate rules that make the most sense for HM. But in his current job, he’s often the one being pushed—and he welcomes the visits.

“We’re trying to partner up with physicians,” he says.

Dr. Conway believes lobbying trips like SHM’s are critical to informing both politicians and professionals on what physicians need or want most.

“People often think, ‘How could it matter?’ Sure, some of it will be hits and misses. But you’ll hit some key points that resonate,” he says.

Hospitalist Rick Hilger, MD, SFHM, director of resident education and adjunct associate professor of medicine at the University of Minnesota Medical School in Minneapolis, learned that lesson last year during his first Hospitalists on the Hill. A first-time member of SHM’s Public Policy Committee, he met with the legislative assistants for U.S. Sens.

Al Franken (D-Minn.) and Amy Klobuchar (D-Minn.), as well as had a face-to-face meeting with U.S. Rep. Allyson Schwartz (D-Pa.). The latter has been a staunch advocate of Medicare payment reform, sponsoring several bills—with SHM’s support—to repeal the sustainable growth rate (SGR) formula.

“It’s an investment in time, and especially for the senators and congressmen and -women from your own state, it’s more about trying to develop a relationship,” Dr. Hilger says. “I’ve already exchanged emails with the aides that I met that day concerning other healthcare issues. … I’m not sure I can completely answer for the long-term impact, but it definitely feels better than doing nothing.”

How to Climb the Hill

SHM’s Hospitalists on the Hill event is May 16, the first day of HM13. Even if you can’t make it, these tips from SHM’s advocacy veterans are helpful when using SHM’s new Legislative Action Center (www.hospitalmedicine.org/advocacy).

• Don’t be afraid. Often, hospitalists think that lobbying efforts are only fruitful if done by industry leaders. SHM wants as many members involved as possible to strengthen its message. “Numbers are important,” Dr. Greeno says. “The more people we can get there to participate, the better. It just means the more people we can get in front of it.”
• Bring a point of view. “We all come to the table with different experiences, different thoughts on healthcare reform,” Dr. Hilger says. “So we try to come to a consensus for everyone. The worst thing you can do is to say nothing.”
• Be positive. Change doesn’t happen overnight, so take the long view on how valuable conversations with policy leaders can be and how they can further the progress started by the loudest voices in HM. “They’ve pushed the envelope,” Dr. Gulati says. “We need to keep pushing it, because if you don’t push, you can’t make change.”

Richard Quinn is a freelance writer in New Jersey.

Dr. Torcson

Mangla Gulati, MD, FACP, FHM, an academic hospitalist and medical director of clinical effectiveness at University of Maryland Medical Center in Baltimore, had never been involved in a lobbying trip before the waning days of last year. But then, just as members of Congress were wrestling with potential Draconian cuts to Medicare reimbursements and a $10 million slash in Medicare funding for the National Quality Forum (NQF), Dr. Gulati found herself on a daylong trip with SHM government guru Laura Allendorf and an NQF representative to make a series of in-person appeals to politicians in Washington, D.C. “When you’re a practicing physician, even though you know there’s regulation and compliance and mandates, you really don’t understand how they come to fruition and what the thought process is,” says Dr. Gulati, secretary of SHM’s Maryland chapter. “It was really interesting to see the other side of that and how people up on the Hill make a lot of decisions based on the information that’s given to them.”

The Hill she’s referring to is none other than Capitol Hill, and Dr. Gulati is making a return just a few months after her visit. And this time, she’s bringing a few hundred hospitalists with her. Hospitalists on the Hill 2013 (www.hospitalmedicine 2013.org/advocacy) is the annual trek made by SHM leadership and rank-and-file members to lobby legislators and federal staffers “on the way policies affect your practice and your patients,” SHM says on its website. This year, the showing in Washington is expected to be among the best ever, as the lobbying trip is May 16, just before HM13’s full program kicks off at the Gaylord National Resort & Convention Center in National Harbor, Md.

The all-day affair kicks off in the morning, as participants will receive briefings from SHM Public Policy Committee Chair Ron Greeno, MD, FCCP, MHM, and Allendorf, SHM’s senior advisor for advocacy and government affairs. Then comes a two-hour training course from Advocacy Associates (http://advocacyassociates.com), a boutique communications firm that helps organizations, such as SHM, tailor their message to policymakers. After that, it’s a six-hour whirlwind of meetings with home-state legislators, career administrators, and aide-de-camps that one former participant described as “almost like speed-dial dating with congressmen and -women.” Lastly, participants regroup at day’s end for a debriefing.

“I think what’s different at SHM is we go to Washington with an agenda of how we can improve patient safety and quality outcomes,” says Patrick Torcson, MD, MMM, FACP, SFHM, chair of SHM’s Performance Measurement and Reporting Committee. “We’re not there about just protecting our turf and making sure that our reimbursement stays at a reasonable level. We’ve been very clear to offer innovations about care transitions and Project BOOST, and different things that can be done to improve things like quality and service for Medicare beneficiaries.”

Check out our 6-minute feature video: "Five Reasons You Should Attend HM13"

Dr. Torcson says congressional contacts he’s made in past years “always look forward to our visits, because we really do come with an attitude of how can we help fix a broken system.”

He counts several victories as fruit of the annual trip. First, he believes the trip has “clearly educated our politicians, congressional staffers, and CMS [the Centers for Medicare & Medicaid Services] that the predominant model of the way patients are taken care of in the hospital is by a hospitalist.”

Second, and more granularly, SHM really gets into the weeds. Take CMS’ Quality and Resource Use Report (QRUR), which is part of the rollout of its value-based purchasing modifier (VBPM). Dr. Torcson says SHM carefully reviewed the report to register its concerns about proper attribution, fair comparisons, relevant metrics, and other issues. In turn, CMS signaled its appreciation of SHM’s due diligence and has indicated a willingness to work with SHM to address its concerns.

CMS chief medical officer Patrick Conway, MD, MSc, FAAP, SFHM, sees it from both sides of the equation. A pediatric hospitalist by training, he has been on trips to push federal officials to promulgate rules that make the most sense for HM. But in his current job, he’s often the one being pushed—and he welcomes the visits.

“We’re trying to partner up with physicians,” he says.

Dr. Conway believes lobbying trips like SHM’s are critical to informing both politicians and professionals on what physicians need or want most.

“People often think, ‘How could it matter?’ Sure, some of it will be hits and misses. But you’ll hit some key points that resonate,” he says.

Hospitalist Rick Hilger, MD, SFHM, director of resident education and adjunct associate professor of medicine at the University of Minnesota Medical School in Minneapolis, learned that lesson last year during his first Hospitalists on the Hill. A first-time member of SHM’s Public Policy Committee, he met with the legislative assistants for U.S. Sens.

Al Franken (D-Minn.) and Amy Klobuchar (D-Minn.), as well as had a face-to-face meeting with U.S. Rep. Allyson Schwartz (D-Pa.). The latter has been a staunch advocate of Medicare payment reform, sponsoring several bills—with SHM’s support—to repeal the sustainable growth rate (SGR) formula.

“It’s an investment in time, and especially for the senators and congressmen and -women from your own state, it’s more about trying to develop a relationship,” Dr. Hilger says. “I’ve already exchanged emails with the aides that I met that day concerning other healthcare issues. … I’m not sure I can completely answer for the long-term impact, but it definitely feels better than doing nothing.”

How to Climb the Hill

SHM’s Hospitalists on the Hill event is May 16, the first day of HM13. Even if you can’t make it, these tips from SHM’s advocacy veterans are helpful when using SHM’s new Legislative Action Center (www.hospitalmedicine.org/advocacy).

• Don’t be afraid. Often, hospitalists think that lobbying efforts are only fruitful if done by industry leaders. SHM wants as many members involved as possible to strengthen its message. “Numbers are important,” Dr. Greeno says. “The more people we can get there to participate, the better. It just means the more people we can get in front of it.”
• Bring a point of view. “We all come to the table with different experiences, different thoughts on healthcare reform,” Dr. Hilger says. “So we try to come to a consensus for everyone. The worst thing you can do is to say nothing.”
• Be positive. Change doesn’t happen overnight, so take the long view on how valuable conversations with policy leaders can be and how they can further the progress started by the loudest voices in HM. “They’ve pushed the envelope,” Dr. Gulati says. “We need to keep pushing it, because if you don’t push, you can’t make change.”

Richard Quinn is a freelance writer in New Jersey.

Eight educational tracks, an equal number of credit bearing pre-courses, a score of small-group forums, three plenaries, and an SHM Town Hall meeting offers a lot of professional development in a four-day span. But that’s just a sampling of what HM13 has slated May 16-19 at the Gaylord National Resort & Convention Center in National Harbor, Md., just outside Washington, D.C.

So how does one get the most value out of the conference?

“The highest-yield content is going to depend on what your background is and how to spend that time in a way that augments your knowledge, your perspective, or your exposure to like-minded colleagues in a very individual way,” says HM13 course director Daniel Brotman, MD, FACP, SFHM, director of the hospitalist program at Johns Hopkins Hospital in Baltimore. “One of the things that’s so cool about hospital medicine is its diversity.”

But don’t take Dr. Brotman’s well-educated word for it. Here’s a list of recommendations from Team Hospitalist, the only reader-involvement group of its kind in HM, on events they would not miss this year.

The New Anticoagulants: When Should We Be Using Them?

2:45 p.m., May 17

Dr. Ma: “I’m very interested about the new anticoagulants talk. What I’m curious to see is what the speaker thinks about the survivability of these medications in our society, with so many lawyers. Pradaxa already has fallen out of favor. Let’s see what happens to Xarelto.”

How do CFOs Value Their Hospitalist Programs?

2:50 p.m., May 18

Dr. Ma: “The problem today is CFOs have to valuate their hospitalists in the setting of other specialists who also receive subsidies. There is less money to be spent on hospitalists, as other specialists vie for this allotment of savings from hospital-based value purchasing.”

Check out our 6-minute feature video: "Five Reasons You Should Attend HM13"

Mentoring/Coaching an Improvement Team: Lessons from SHM’s Mentored Implementation Programs

2:45 p.m., May 17

Dr. Perumalswami: “As a Project BOOST physician mentor in Illinois, I would highly recommend the session because the discussion will involve an inside look into valuable experience-based observations and analysis for the success of any process improvement team. The nature of teams and the culture of improvement at various sites will also be discussed. There will be a mentee side of the presentation, too, which will help other mentors of implementation programs better understand what the issues are ‘from the other side.’”

Strategies to Improve Communication with Patients and Families to Improve Care

2:45 p.m., May 17

Dr. Hale: “It is well known in pediatrics that you are treating two patients: both the child and the parents. If the family has a shared understanding of the child’s illness and there is collaboration for the care plan, there will be improved care.”

Neonatal HSV: When to Consider It, How to Evaluate for It, and How to Treat It

11 a.m., May 18

Dr. Hale: “Neonatal HSV is a devastating disease. It is essential to recognize high-risk patients to decrease morbidity and mortality for this illness. There have been recent updates in the understanding of epidemiology of this disease that can assist the provider in recognizing high-risk patients.”

Supporting Transition for Youth with Special Healthcare Needs: Coordinating Care and Preparing to Pass the Baton

4:15 p.m., May 18

Dr. Hale: “The transition of adolescents and young adults from pediatric-care teams to adult-medicine-care teams should be seamless for the sake of the patient, but often it is a blurry transition over the course of years. This session is high-yield for both pediatric and adult hospitalists.”

Getting Ready for Physician Value-Based Purchasing

9:50 a.m., May 19

Dr. Simone: “Dr. [Pat] Torcson’s presentation last year was one of the best at HM12, and I expect this year to be the same. He chairs SHM’s Performance Measurement and Reporting Committee and is well versed in these matters. He speaks in terms that will capture all audiences, whether they are experienced or new to the business aspects of medicine. Highly recommended.”

BOOSTing the Hospital Discharge Process: What Works and What Doesn’t

10:35 a.m., May 17

Dr. Simone: “Both panelists are excellent presenters as well as leading authorities when it comes to discharge processes. This presentation is very timely with the new CMS payment system, which penalizes unnecessary and unexpected readmissions.”

Success Stories: How to Integrate NPs and PAs into a Hospitalist Practice

4:15 p.m., May 18

Cardin: “This is an important session because, as every hard-working hospitalist knows, there simply aren’t enough physicians to fill the needs of our medically complex hospitalized patients. It is simply a reality that there will be an increased need in the future for mid-level providers, and it is valuable to maximize the success of a program by learning how to assimilate them into hospitalized practice.”

Diagnostic Errors and the Hospitalist: Why They Happen and How to Avoid Them

12:45 p.m., May 17

Cardin: “Half of practicing medicine is pattern recognition, and if there are patterns to making diagnostic errors, it would be so valuable to be aware of them. We have tremendous responsibility when caring for patients, and I think it is always beneficial to learn from mistakes.”

Richard Quinn is a freelance writer in New Jersey.

Eight educational tracks, an equal number of credit bearing pre-courses, a score of small-group forums, three plenaries, and an SHM Town Hall meeting offers a lot of professional development in a four-day span. But that’s just a sampling of what HM13 has slated May 16-19 at the Gaylord National Resort & Convention Center in National Harbor, Md., just outside Washington, D.C.

So how does one get the most value out of the conference?

“The highest-yield content is going to depend on what your background is and how to spend that time in a way that augments your knowledge, your perspective, or your exposure to like-minded colleagues in a very individual way,” says HM13 course director Daniel Brotman, MD, FACP, SFHM, director of the hospitalist program at Johns Hopkins Hospital in Baltimore. “One of the things that’s so cool about hospital medicine is its diversity.”

But don’t take Dr. Brotman’s well-educated word for it. Here’s a list of recommendations from Team Hospitalist, the only reader-involvement group of its kind in HM, on events they would not miss this year.

The New Anticoagulants: When Should We Be Using Them?

2:45 p.m., May 17

Dr. Ma: “I’m very interested about the new anticoagulants talk. What I’m curious to see is what the speaker thinks about the survivability of these medications in our society, with so many lawyers. Pradaxa already has fallen out of favor. Let’s see what happens to Xarelto.”

How do CFOs Value Their Hospitalist Programs?

2:50 p.m., May 18

Dr. Ma: “The problem today is CFOs have to valuate their hospitalists in the setting of other specialists who also receive subsidies. There is less money to be spent on hospitalists, as other specialists vie for this allotment of savings from hospital-based value purchasing.”

Check out our 6-minute feature video: "Five Reasons You Should Attend HM13"

Mentoring/Coaching an Improvement Team: Lessons from SHM’s Mentored Implementation Programs

2:45 p.m., May 17

Dr. Perumalswami: “As a Project BOOST physician mentor in Illinois, I would highly recommend the session because the discussion will involve an inside look into valuable experience-based observations and analysis for the success of any process improvement team. The nature of teams and the culture of improvement at various sites will also be discussed. There will be a mentee side of the presentation, too, which will help other mentors of implementation programs better understand what the issues are ‘from the other side.’”

Strategies to Improve Communication with Patients and Families to Improve Care

2:45 p.m., May 17

Dr. Hale: “It is well known in pediatrics that you are treating two patients: both the child and the parents. If the family has a shared understanding of the child’s illness and there is collaboration for the care plan, there will be improved care.”

Neonatal HSV: When to Consider It, How to Evaluate for It, and How to Treat It

11 a.m., May 18

Dr. Hale: “Neonatal HSV is a devastating disease. It is essential to recognize high-risk patients to decrease morbidity and mortality for this illness. There have been recent updates in the understanding of epidemiology of this disease that can assist the provider in recognizing high-risk patients.”

Supporting Transition for Youth with Special Healthcare Needs: Coordinating Care and Preparing to Pass the Baton

4:15 p.m., May 18

Dr. Hale: “The transition of adolescents and young adults from pediatric-care teams to adult-medicine-care teams should be seamless for the sake of the patient, but often it is a blurry transition over the course of years. This session is high-yield for both pediatric and adult hospitalists.”

Getting Ready for Physician Value-Based Purchasing

9:50 a.m., May 19

Dr. Simone: “Dr. [Pat] Torcson’s presentation last year was one of the best at HM12, and I expect this year to be the same. He chairs SHM’s Performance Measurement and Reporting Committee and is well versed in these matters. He speaks in terms that will capture all audiences, whether they are experienced or new to the business aspects of medicine. Highly recommended.”

BOOSTing the Hospital Discharge Process: What Works and What Doesn’t

10:35 a.m., May 17

Dr. Simone: “Both panelists are excellent presenters as well as leading authorities when it comes to discharge processes. This presentation is very timely with the new CMS payment system, which penalizes unnecessary and unexpected readmissions.”

Success Stories: How to Integrate NPs and PAs into a Hospitalist Practice

4:15 p.m., May 18

Cardin: “This is an important session because, as every hard-working hospitalist knows, there simply aren’t enough physicians to fill the needs of our medically complex hospitalized patients. It is simply a reality that there will be an increased need in the future for mid-level providers, and it is valuable to maximize the success of a program by learning how to assimilate them into hospitalized practice.”

Diagnostic Errors and the Hospitalist: Why They Happen and How to Avoid Them

12:45 p.m., May 17

Cardin: “Half of practicing medicine is pattern recognition, and if there are patterns to making diagnostic errors, it would be so valuable to be aware of them. We have tremendous responsibility when caring for patients, and I think it is always beneficial to learn from mistakes.”

Richard Quinn is a freelance writer in New Jersey.

Eight educational tracks, an equal number of credit bearing pre-courses, a score of small-group forums, three plenaries, and an SHM Town Hall meeting offers a lot of professional development in a four-day span. But that’s just a sampling of what HM13 has slated May 16-19 at the Gaylord National Resort & Convention Center in National Harbor, Md., just outside Washington, D.C.

So how does one get the most value out of the conference?

“The highest-yield content is going to depend on what your background is and how to spend that time in a way that augments your knowledge, your perspective, or your exposure to like-minded colleagues in a very individual way,” says HM13 course director Daniel Brotman, MD, FACP, SFHM, director of the hospitalist program at Johns Hopkins Hospital in Baltimore. “One of the things that’s so cool about hospital medicine is its diversity.”

But don’t take Dr. Brotman’s well-educated word for it. Here’s a list of recommendations from Team Hospitalist, the only reader-involvement group of its kind in HM, on events they would not miss this year.

The New Anticoagulants: When Should We Be Using Them?

2:45 p.m., May 17

Dr. Ma: “I’m very interested about the new anticoagulants talk. What I’m curious to see is what the speaker thinks about the survivability of these medications in our society, with so many lawyers. Pradaxa already has fallen out of favor. Let’s see what happens to Xarelto.”

How do CFOs Value Their Hospitalist Programs?

2:50 p.m., May 18

Dr. Ma: “The problem today is CFOs have to valuate their hospitalists in the setting of other specialists who also receive subsidies. There is less money to be spent on hospitalists, as other specialists vie for this allotment of savings from hospital-based value purchasing.”

Check out our 6-minute feature video: "Five Reasons You Should Attend HM13"

Mentoring/Coaching an Improvement Team: Lessons from SHM’s Mentored Implementation Programs

2:45 p.m., May 17

Dr. Perumalswami: “As a Project BOOST physician mentor in Illinois, I would highly recommend the session because the discussion will involve an inside look into valuable experience-based observations and analysis for the success of any process improvement team. The nature of teams and the culture of improvement at various sites will also be discussed. There will be a mentee side of the presentation, too, which will help other mentors of implementation programs better understand what the issues are ‘from the other side.’”

Strategies to Improve Communication with Patients and Families to Improve Care

2:45 p.m., May 17

Dr. Hale: “It is well known in pediatrics that you are treating two patients: both the child and the parents. If the family has a shared understanding of the child’s illness and there is collaboration for the care plan, there will be improved care.”

Neonatal HSV: When to Consider It, How to Evaluate for It, and How to Treat It

11 a.m., May 18

Dr. Hale: “Neonatal HSV is a devastating disease. It is essential to recognize high-risk patients to decrease morbidity and mortality for this illness. There have been recent updates in the understanding of epidemiology of this disease that can assist the provider in recognizing high-risk patients.”

Supporting Transition for Youth with Special Healthcare Needs: Coordinating Care and Preparing to Pass the Baton

4:15 p.m., May 18

Dr. Hale: “The transition of adolescents and young adults from pediatric-care teams to adult-medicine-care teams should be seamless for the sake of the patient, but often it is a blurry transition over the course of years. This session is high-yield for both pediatric and adult hospitalists.”

Getting Ready for Physician Value-Based Purchasing

9:50 a.m., May 19

Dr. Simone: “Dr. [Pat] Torcson’s presentation last year was one of the best at HM12, and I expect this year to be the same. He chairs SHM’s Performance Measurement and Reporting Committee and is well versed in these matters. He speaks in terms that will capture all audiences, whether they are experienced or new to the business aspects of medicine. Highly recommended.”

BOOSTing the Hospital Discharge Process: What Works and What Doesn’t

10:35 a.m., May 17

Dr. Simone: “Both panelists are excellent presenters as well as leading authorities when it comes to discharge processes. This presentation is very timely with the new CMS payment system, which penalizes unnecessary and unexpected readmissions.”

Success Stories: How to Integrate NPs and PAs into a Hospitalist Practice

4:15 p.m., May 18

Cardin: “This is an important session because, as every hard-working hospitalist knows, there simply aren’t enough physicians to fill the needs of our medically complex hospitalized patients. It is simply a reality that there will be an increased need in the future for mid-level providers, and it is valuable to maximize the success of a program by learning how to assimilate them into hospitalized practice.”

Diagnostic Errors and the Hospitalist: Why They Happen and How to Avoid Them

12:45 p.m., May 17

Cardin: “Half of practicing medicine is pattern recognition, and if there are patterns to making diagnostic errors, it would be so valuable to be aware of them. We have tremendous responsibility when caring for patients, and I think it is always beneficial to learn from mistakes.”

Richard Quinn is a freelance writer in New Jersey.

Click here to listen to Dr. Hilger

Check out our 6-minute feature video: "Five Reasons You Should Attend HM13"

Click here to listen to Dr. Hilger

Check out our 6-minute feature video: "Five Reasons You Should Attend HM13"

Click here to listen to Dr. Hilger

Check out our 6-minute feature video: "Five Reasons You Should Attend HM13"

Click here to listen to Dr. Duckworth

Click here to listen to Dr. Duckworth

Click here to listen to Dr. Duckworth

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

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

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

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

HQPS Online Academy modules

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

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

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

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

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

HQPS Online Academy modules

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

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

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

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

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

HQPS Online Academy modules

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

Hospitalists on the Hill

WHEN: May 16, 2013

WHERE: Washington, D.C.

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

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

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

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

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

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

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

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

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

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

Joshua Lapps is SHM's government relations specialist.

Hospitalists on the Hill

WHEN: May 16, 2013

WHERE: Washington, D.C.

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

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

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

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

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

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

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

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

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

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

Joshua Lapps is SHM's government relations specialist.

Hospitalists on the Hill

WHEN: May 16, 2013

WHERE: Washington, D.C.

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

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

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

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

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

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

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

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

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

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

Joshua Lapps is SHM's government relations specialist.

Danielle Scheurer, MD, MSCR, SFHM

Old habits are hard to break. We all get used to doing things in certain ways, and the longer we do it, it becomes increasingly difficult to do them differently. We clearly are clinging to old habits in the healthcare industry, despite compelling evidence that we need to figure out better ways of doing business. Our industry has been in a crisis for a very long time—rising costs, drastic reimbursement reductions from payors, and continually escalating risks and medical errors.

Clearly, something is not working.

This is a time when hospitalists should start thinking about dropping some of our Pulaskis.

Handy, Useful, Versatile, Reliable

A Pulaski is a versatile tool that combines an axe and an adze; it’s most commonly used in firefighting, but it is also used in trail-blazing, gardening, and woodworking (see right). The Pulaski was invented by Ed Pulaski, a forest ranger in the 1910s who almost died in a forest fire after being trapped in an old mine tunnel. After he barely survived, he invented the Pulaski as a means to reduce the risk of future firefighters being trapped in his same situation. For more than 100 years, this tool has come in handy in countless situations. It is versatile, irreplaceable, reliable—a must-have. Unless you don’t need it. And then it becomes a 22-pound handicap.

Donald Berwick, MD, MPP, spoke about the Pulaski 13 years ago in a powerful speech to the National Forum on Quality Improvement in Health Care; his presentation was titled “Escape Fire.”¹ He described the Mann Gulch fire of 1949, which took the lives of 13 young men when the fire did not behave as expected. The men were forced to outrun this fire, up a hill at a 76% slope, with the fire racing at them at 7 miles per hour, at an air temperature of 100 degrees. Only two firefighters survived. Those who perished tried to run up the hill with all of their gear, including their Pulaski, which served, at the time, only to slow them down. One survivor was lucky; he managed to get to the top of hill before the fire engulfed him. The other survivor, Wagner Dodge, was heroic. He realized the situation was hopeless and created a radical, innovative, and immediate solution to the problem at hand: He not only dropped his 22-pound handicap, but he also stopped running up the hill, stood still, and lit his own escape fire to avoid the larger fire at hand. The rest of the pack clung to the only option they could conceive of, which was outrunning the beast, despite the fact that it was traveling twice as fast as they were.

During his speech, Dr. Berwick also spoke of some of his personal experiences within U.S. hospitals that were filled with fear, uncertainty, and at times downright outrage; of misunderstandings, despicable care transitions, and daily medical errors or near misses. About how he and his wife struggled for security, appropriate treatments, and more answers than questions. He spoke of being in some of the best hospitals in the nation, and of being more organized and informed than most patients. Most patients would not possibly fare as well as the Berwicks, being under- or uninsured, of low health literacy, undereducated, or uninformed. It is incomprehensible that we have created a system that is so complicated and difficult to navigate that even the best and the brightest cannot traverse it unscathed. So it seems that sometimes the key to doing something better (or surviving, in the case of the Mann Gulch fire) is not knowing what new tools to adopt, but instead knowing what tools to get rid of.

Seize the Day

There is a dog park near my house that we take our dog to whenever we get a chance. There is a dog that frequents the park, a brown Labrador by the name of Gracie. Gracie’s favorite activity is fetching tennis balls; she dutifully catches the ball (usually in midair) and brings it back to her owner. When she gets back to her owner, she stands in front of him waiting for her order: “Drop it, Gracie.” As soon as Gracie hears the order, she drops the ball immediately. But she won’t drop the ball until ordered to do so—even though, by keeping the ball, she is that much further away from her next favorite activity. It seems like, to do the best for herself, she should come back and drop the ball, which would bring her that much closer to the one thing she loves best.

But she doesn’t. She waits dutifully for someone else to tell her when to drop the ball.

And interestingly, Gracie will not just drop it for anyone. When others at the park want to play with Gracie, and follow the lead of Gracie’s owner, and say “Drop it, Gracie,” she will look at the visitor, and then at her owner, looking for the approval that it really is in fact OK for her to drop it. Even after an approving look, she will hesitatingly drop the ball, and only after the stranger is a safe distance away, in case she needs to retrieve it sooner than later.

Many of us in the healthcare industry often wait for someone else to tell us when to start doing new things, but rarely do we expect, do we hear, or do we initiate the order to stop doing something. We need to think deeply about all the things we do that are useless Pulaskis, and about how to radically change the industry in which we work. Because this inching along is not going fast enough, and there is little evidence that we have made much progress in the last decade. So if you find yourself lugging around a Pulaski (or two), don’t just think about how to drop it, or when to drop it, or whether to drop it on certain days of the week. Just drop it, Gracie.

Dr. Scheurer is a hospitalist and chief quality officer at the Medical University of South Carolina in Charleston. She is physician editor of The Hospitalist. Email her at [email protected].

Reference

1. Berwick D. Escape fire: lessons for the future of health care. The Commonwealth Fund website. Available at: http://www.commonwealthfund.org/usr_doc/berwick_escapefire_563.pdf. Accessed Jan. 11, 2013.

Danielle Scheurer, MD, MSCR, SFHM

Old habits are hard to break. We all get used to doing things in certain ways, and the longer we do it, it becomes increasingly difficult to do them differently. We clearly are clinging to old habits in the healthcare industry, despite compelling evidence that we need to figure out better ways of doing business. Our industry has been in a crisis for a very long time—rising costs, drastic reimbursement reductions from payors, and continually escalating risks and medical errors.

Clearly, something is not working.

This is a time when hospitalists should start thinking about dropping some of our Pulaskis.

Handy, Useful, Versatile, Reliable

A Pulaski is a versatile tool that combines an axe and an adze; it’s most commonly used in firefighting, but it is also used in trail-blazing, gardening, and woodworking (see right). The Pulaski was invented by Ed Pulaski, a forest ranger in the 1910s who almost died in a forest fire after being trapped in an old mine tunnel. After he barely survived, he invented the Pulaski as a means to reduce the risk of future firefighters being trapped in his same situation. For more than 100 years, this tool has come in handy in countless situations. It is versatile, irreplaceable, reliable—a must-have. Unless you don’t need it. And then it becomes a 22-pound handicap.

Donald Berwick, MD, MPP, spoke about the Pulaski 13 years ago in a powerful speech to the National Forum on Quality Improvement in Health Care; his presentation was titled “Escape Fire.”¹ He described the Mann Gulch fire of 1949, which took the lives of 13 young men when the fire did not behave as expected. The men were forced to outrun this fire, up a hill at a 76% slope, with the fire racing at them at 7 miles per hour, at an air temperature of 100 degrees. Only two firefighters survived. Those who perished tried to run up the hill with all of their gear, including their Pulaski, which served, at the time, only to slow them down. One survivor was lucky; he managed to get to the top of hill before the fire engulfed him. The other survivor, Wagner Dodge, was heroic. He realized the situation was hopeless and created a radical, innovative, and immediate solution to the problem at hand: He not only dropped his 22-pound handicap, but he also stopped running up the hill, stood still, and lit his own escape fire to avoid the larger fire at hand. The rest of the pack clung to the only option they could conceive of, which was outrunning the beast, despite the fact that it was traveling twice as fast as they were.

During his speech, Dr. Berwick also spoke of some of his personal experiences within U.S. hospitals that were filled with fear, uncertainty, and at times downright outrage; of misunderstandings, despicable care transitions, and daily medical errors or near misses. About how he and his wife struggled for security, appropriate treatments, and more answers than questions. He spoke of being in some of the best hospitals in the nation, and of being more organized and informed than most patients. Most patients would not possibly fare as well as the Berwicks, being under- or uninsured, of low health literacy, undereducated, or uninformed. It is incomprehensible that we have created a system that is so complicated and difficult to navigate that even the best and the brightest cannot traverse it unscathed. So it seems that sometimes the key to doing something better (or surviving, in the case of the Mann Gulch fire) is not knowing what new tools to adopt, but instead knowing what tools to get rid of.

Seize the Day

There is a dog park near my house that we take our dog to whenever we get a chance. There is a dog that frequents the park, a brown Labrador by the name of Gracie. Gracie’s favorite activity is fetching tennis balls; she dutifully catches the ball (usually in midair) and brings it back to her owner. When she gets back to her owner, she stands in front of him waiting for her order: “Drop it, Gracie.” As soon as Gracie hears the order, she drops the ball immediately. But she won’t drop the ball until ordered to do so—even though, by keeping the ball, she is that much further away from her next favorite activity. It seems like, to do the best for herself, she should come back and drop the ball, which would bring her that much closer to the one thing she loves best.

But she doesn’t. She waits dutifully for someone else to tell her when to drop the ball.

And interestingly, Gracie will not just drop it for anyone. When others at the park want to play with Gracie, and follow the lead of Gracie’s owner, and say “Drop it, Gracie,” she will look at the visitor, and then at her owner, looking for the approval that it really is in fact OK for her to drop it. Even after an approving look, she will hesitatingly drop the ball, and only after the stranger is a safe distance away, in case she needs to retrieve it sooner than later.

Many of us in the healthcare industry often wait for someone else to tell us when to start doing new things, but rarely do we expect, do we hear, or do we initiate the order to stop doing something. We need to think deeply about all the things we do that are useless Pulaskis, and about how to radically change the industry in which we work. Because this inching along is not going fast enough, and there is little evidence that we have made much progress in the last decade. So if you find yourself lugging around a Pulaski (or two), don’t just think about how to drop it, or when to drop it, or whether to drop it on certain days of the week. Just drop it, Gracie.

Dr. Scheurer is a hospitalist and chief quality officer at the Medical University of South Carolina in Charleston. She is physician editor of The Hospitalist. Email her at [email protected].

Reference

1. Berwick D. Escape fire: lessons for the future of health care. The Commonwealth Fund website. Available at: http://www.commonwealthfund.org/usr_doc/berwick_escapefire_563.pdf. Accessed Jan. 11, 2013.

Danielle Scheurer, MD, MSCR, SFHM

Old habits are hard to break. We all get used to doing things in certain ways, and the longer we do it, it becomes increasingly difficult to do them differently. We clearly are clinging to old habits in the healthcare industry, despite compelling evidence that we need to figure out better ways of doing business. Our industry has been in a crisis for a very long time—rising costs, drastic reimbursement reductions from payors, and continually escalating risks and medical errors.

Clearly, something is not working.

This is a time when hospitalists should start thinking about dropping some of our Pulaskis.

Handy, Useful, Versatile, Reliable

A Pulaski is a versatile tool that combines an axe and an adze; it’s most commonly used in firefighting, but it is also used in trail-blazing, gardening, and woodworking (see right). The Pulaski was invented by Ed Pulaski, a forest ranger in the 1910s who almost died in a forest fire after being trapped in an old mine tunnel. After he barely survived, he invented the Pulaski as a means to reduce the risk of future firefighters being trapped in his same situation. For more than 100 years, this tool has come in handy in countless situations. It is versatile, irreplaceable, reliable—a must-have. Unless you don’t need it. And then it becomes a 22-pound handicap.

Donald Berwick, MD, MPP, spoke about the Pulaski 13 years ago in a powerful speech to the National Forum on Quality Improvement in Health Care; his presentation was titled “Escape Fire.”¹ He described the Mann Gulch fire of 1949, which took the lives of 13 young men when the fire did not behave as expected. The men were forced to outrun this fire, up a hill at a 76% slope, with the fire racing at them at 7 miles per hour, at an air temperature of 100 degrees. Only two firefighters survived. Those who perished tried to run up the hill with all of their gear, including their Pulaski, which served, at the time, only to slow them down. One survivor was lucky; he managed to get to the top of hill before the fire engulfed him. The other survivor, Wagner Dodge, was heroic. He realized the situation was hopeless and created a radical, innovative, and immediate solution to the problem at hand: He not only dropped his 22-pound handicap, but he also stopped running up the hill, stood still, and lit his own escape fire to avoid the larger fire at hand. The rest of the pack clung to the only option they could conceive of, which was outrunning the beast, despite the fact that it was traveling twice as fast as they were.

During his speech, Dr. Berwick also spoke of some of his personal experiences within U.S. hospitals that were filled with fear, uncertainty, and at times downright outrage; of misunderstandings, despicable care transitions, and daily medical errors or near misses. About how he and his wife struggled for security, appropriate treatments, and more answers than questions. He spoke of being in some of the best hospitals in the nation, and of being more organized and informed than most patients. Most patients would not possibly fare as well as the Berwicks, being under- or uninsured, of low health literacy, undereducated, or uninformed. It is incomprehensible that we have created a system that is so complicated and difficult to navigate that even the best and the brightest cannot traverse it unscathed. So it seems that sometimes the key to doing something better (or surviving, in the case of the Mann Gulch fire) is not knowing what new tools to adopt, but instead knowing what tools to get rid of.

Seize the Day

There is a dog park near my house that we take our dog to whenever we get a chance. There is a dog that frequents the park, a brown Labrador by the name of Gracie. Gracie’s favorite activity is fetching tennis balls; she dutifully catches the ball (usually in midair) and brings it back to her owner. When she gets back to her owner, she stands in front of him waiting for her order: “Drop it, Gracie.” As soon as Gracie hears the order, she drops the ball immediately. But she won’t drop the ball until ordered to do so—even though, by keeping the ball, she is that much further away from her next favorite activity. It seems like, to do the best for herself, she should come back and drop the ball, which would bring her that much closer to the one thing she loves best.

But she doesn’t. She waits dutifully for someone else to tell her when to drop the ball.

And interestingly, Gracie will not just drop it for anyone. When others at the park want to play with Gracie, and follow the lead of Gracie’s owner, and say “Drop it, Gracie,” she will look at the visitor, and then at her owner, looking for the approval that it really is in fact OK for her to drop it. Even after an approving look, she will hesitatingly drop the ball, and only after the stranger is a safe distance away, in case she needs to retrieve it sooner than later.

Many of us in the healthcare industry often wait for someone else to tell us when to start doing new things, but rarely do we expect, do we hear, or do we initiate the order to stop doing something. We need to think deeply about all the things we do that are useless Pulaskis, and about how to radically change the industry in which we work. Because this inching along is not going fast enough, and there is little evidence that we have made much progress in the last decade. So if you find yourself lugging around a Pulaski (or two), don’t just think about how to drop it, or when to drop it, or whether to drop it on certain days of the week. Just drop it, Gracie.

Dr. Scheurer is a hospitalist and chief quality officer at the Medical University of South Carolina in Charleston. She is physician editor of The Hospitalist. Email her at [email protected].

Reference

1. Berwick D. Escape fire: lessons for the future of health care. The Commonwealth Fund website. Available at: http://www.commonwealthfund.org/usr_doc/berwick_escapefire_563.pdf. Accessed Jan. 11, 2013.

Every year, thousands of hospitalists gather to share their experiences, challenges, and energy with each other at SHM’s annual meeting. In 2013, hospitalists can do all of that while visiting the nation’s capital.

And make a real difference by advocating on Capitol Hill for quality improvement and safety in hospitals.

And enjoy all the amenities of a first-class hotel and conference center under one roof.

And get ahead of the curve on some of the most pressing topics in healthcare, such as the American Board of Internal Medicine (ABIM) Foundation’s Choosing Wisely campaign.

But in order to do all of that, hospitalists have to register for HM13, and must do so quickly to save $50. The early registration deadline is March 19, earlier than in prior years. So don’t wait—sign up now at www.hospitalmedicine2013.org.

Choosing Wisely

Are you ready to make wise choices? HM13 provides unprecedented access to the hospitalist experts who developed the lists of recommendations for the Choosing Wisely campaign with two educational sessions and a pre-course.

Before HM13 kicks off, hospitalists John Bulger, DO, FACP, SFHM, and Ian Jenkins, MD, will direct a full-day Choosing Wisely pre-course on Thursday, May 16, featuring didactic sessions in the morning with national experts in QI on such topics as teambuilding and making the case for quality. The afternoon session will encompass highly interactive workgroups utilizing skills learned in the morning to develop a plan for how to “choose wisely.” Attendees will apply quality methodologies to frequently overutilized tests or procedures, resulting in an actual plan for embedding “avoids” or “never-dos” into their own practice in their own institutions.

On Saturday, May 18, Douglas Carlson, MD, and Ricardo Quinonez, MD, FAAP, FHM, will present “Addressing Overuse in Pediatric Hospital Medicine: The ABIM Choosing Wisely Campaign—PHM Recommendations,” and on Sunday, May 19, Drs. Bulger and Jenkins will present “Choosing Wisely: 5 Things Physicians and Patients Should Question.”

New Featured Speaker

Back by popular demand, hospitalist Patrick Conway, MD, MSc, FAAP, SFHM, chief medical officer and the director of the Office of Clinical Standards and Quality Centers for the Centers for Medicare & Medicaid Services (CMS), will speak on the role hospitalists will play as change agents for healthcare reform and patient safety in the years to come. Dr. Conway replaces quality expert Peter Pronovost, MD, who had a scheduling conflict and will not be able to speak at HM13.

Get Your Conference In Hand

Hospitalists continue to be ahead of the curve, and the technology at HM13 is no exception. This year’s HM13 At Hand conference app for smartphones and tablets enables conference-goers to plan their schedule ahead of time, download meeting content, play a scavenger hunt for prizes, and socialize with other attendees.

The app’s scheduling feature offers attendees the chance to explore their options ahead of time or make changes on the fly to their HM13 experience.

For links to download the HM13 app, visit www.hospitalmedicine.org.

Every year, thousands of hospitalists gather to share their experiences, challenges, and energy with each other at SHM’s annual meeting. In 2013, hospitalists can do all of that while visiting the nation’s capital.

And make a real difference by advocating on Capitol Hill for quality improvement and safety in hospitals.

And enjoy all the amenities of a first-class hotel and conference center under one roof.

And get ahead of the curve on some of the most pressing topics in healthcare, such as the American Board of Internal Medicine (ABIM) Foundation’s Choosing Wisely campaign.

But in order to do all of that, hospitalists have to register for HM13, and must do so quickly to save $50. The early registration deadline is March 19, earlier than in prior years. So don’t wait—sign up now at www.hospitalmedicine2013.org.

Choosing Wisely

Are you ready to make wise choices? HM13 provides unprecedented access to the hospitalist experts who developed the lists of recommendations for the Choosing Wisely campaign with two educational sessions and a pre-course.

Before HM13 kicks off, hospitalists John Bulger, DO, FACP, SFHM, and Ian Jenkins, MD, will direct a full-day Choosing Wisely pre-course on Thursday, May 16, featuring didactic sessions in the morning with national experts in QI on such topics as teambuilding and making the case for quality. The afternoon session will encompass highly interactive workgroups utilizing skills learned in the morning to develop a plan for how to “choose wisely.” Attendees will apply quality methodologies to frequently overutilized tests or procedures, resulting in an actual plan for embedding “avoids” or “never-dos” into their own practice in their own institutions.

On Saturday, May 18, Douglas Carlson, MD, and Ricardo Quinonez, MD, FAAP, FHM, will present “Addressing Overuse in Pediatric Hospital Medicine: The ABIM Choosing Wisely Campaign—PHM Recommendations,” and on Sunday, May 19, Drs. Bulger and Jenkins will present “Choosing Wisely: 5 Things Physicians and Patients Should Question.”

New Featured Speaker

Back by popular demand, hospitalist Patrick Conway, MD, MSc, FAAP, SFHM, chief medical officer and the director of the Office of Clinical Standards and Quality Centers for the Centers for Medicare & Medicaid Services (CMS), will speak on the role hospitalists will play as change agents for healthcare reform and patient safety in the years to come. Dr. Conway replaces quality expert Peter Pronovost, MD, who had a scheduling conflict and will not be able to speak at HM13.

Get Your Conference In Hand

Hospitalists continue to be ahead of the curve, and the technology at HM13 is no exception. This year’s HM13 At Hand conference app for smartphones and tablets enables conference-goers to plan their schedule ahead of time, download meeting content, play a scavenger hunt for prizes, and socialize with other attendees.

The app’s scheduling feature offers attendees the chance to explore their options ahead of time or make changes on the fly to their HM13 experience.

For links to download the HM13 app, visit www.hospitalmedicine.org.

Every year, thousands of hospitalists gather to share their experiences, challenges, and energy with each other at SHM’s annual meeting. In 2013, hospitalists can do all of that while visiting the nation’s capital.

And make a real difference by advocating on Capitol Hill for quality improvement and safety in hospitals.

And enjoy all the amenities of a first-class hotel and conference center under one roof.

And get ahead of the curve on some of the most pressing topics in healthcare, such as the American Board of Internal Medicine (ABIM) Foundation’s Choosing Wisely campaign.

But in order to do all of that, hospitalists have to register for HM13, and must do so quickly to save $50. The early registration deadline is March 19, earlier than in prior years. So don’t wait—sign up now at www.hospitalmedicine2013.org.

Choosing Wisely

Are you ready to make wise choices? HM13 provides unprecedented access to the hospitalist experts who developed the lists of recommendations for the Choosing Wisely campaign with two educational sessions and a pre-course.

Before HM13 kicks off, hospitalists John Bulger, DO, FACP, SFHM, and Ian Jenkins, MD, will direct a full-day Choosing Wisely pre-course on Thursday, May 16, featuring didactic sessions in the morning with national experts in QI on such topics as teambuilding and making the case for quality. The afternoon session will encompass highly interactive workgroups utilizing skills learned in the morning to develop a plan for how to “choose wisely.” Attendees will apply quality methodologies to frequently overutilized tests or procedures, resulting in an actual plan for embedding “avoids” or “never-dos” into their own practice in their own institutions.

On Saturday, May 18, Douglas Carlson, MD, and Ricardo Quinonez, MD, FAAP, FHM, will present “Addressing Overuse in Pediatric Hospital Medicine: The ABIM Choosing Wisely Campaign—PHM Recommendations,” and on Sunday, May 19, Drs. Bulger and Jenkins will present “Choosing Wisely: 5 Things Physicians and Patients Should Question.”

New Featured Speaker

Back by popular demand, hospitalist Patrick Conway, MD, MSc, FAAP, SFHM, chief medical officer and the director of the Office of Clinical Standards and Quality Centers for the Centers for Medicare & Medicaid Services (CMS), will speak on the role hospitalists will play as change agents for healthcare reform and patient safety in the years to come. Dr. Conway replaces quality expert Peter Pronovost, MD, who had a scheduling conflict and will not be able to speak at HM13.

Get Your Conference In Hand

Hospitalists continue to be ahead of the curve, and the technology at HM13 is no exception. This year’s HM13 At Hand conference app for smartphones and tablets enables conference-goers to plan their schedule ahead of time, download meeting content, play a scavenger hunt for prizes, and socialize with other attendees.

The app’s scheduling feature offers attendees the chance to explore their options ahead of time or make changes on the fly to their HM13 experience.

For links to download the HM13 app, visit www.hospitalmedicine.org.

More than 300 hospitalists and other clinicians recently attended the 13th annual Southern Hospital Medicine Conference in Atlanta. The conference is a joint collaboration between the Emory University School of Medicine in Atlanta and Ochsner Health System New Orleans. The meeting site has alternated between the two cities each year since 2005.

The prevailing conference theme in 2012 was “Value and Values in Hospital Medicine,” alluding to the value that hospitalists bring to the medical community and hospitals and the values shared by hospitalists. The conference offered five pre-courses and more than 50 sessions focused on educating hospitalists on current best practices within core topic areas, including clinical care, quality improvement, healthcare information technology, innovative care models, systems of care, and transitions of care. A judged poster competition featured research and clinical vignettes abstracts, with interesting clinical cases as well as new research in hospital medicine.

One of the highlights of this year’s conference was the keynote address delivered by Dr. William A. Bornstein, chief quality and medical officer of Emory Healthcare. Dr. Bornstein discussed the various aspects of quality and cost in hospital care. He described the challenges in defining quality and measuring cost when trying to calculate the “value” equation in medicine (value=quality/cost). He outlined the Institute of Medicine’s previously described STEEEP (safe, timely, effective, efficient, equitable, patient-centered) aims of quality in 2001.

Dr. Bornstein’s own definition for quality is “partnering with patients and families to reliably, 100% of the time, deliver when, where, and how they want it—and with minimal waste—care based on the best available evidence and consistent with patient and family values and preferences.” To measure outcome, he said, we need to address system structure (what’s in place before the patient arrives), process (what we do for the patient), and culture (how we can get the buy-in from all stakeholders). The sum of these factors achieves outcome, which requires risk adjustment and, ideally, long-term follow-up data, he said.

Dr. Bornstein also discussed the need to develop standard processes whereby equivalent clinicians can follow similar processes to achieve the same results. When physicians “do it the same” (i.e. standardized protocols), error rates and cost decrease, he explained.

Dr. Bornstein also focused on transformative solutions to address problems in healthcare as a whole, rather than attempting to fix problems piecemeal.

Jason Stein, MD, SFHM, offered another conference highlight: a pre-conference program and plenary session on an innovative approach to improve hospital outcomes through implementation of the accountable-care unit (ACU). Dr. Stein, director of the clinical research program at Emory School of Medicine, described the current state of hospital care as asynchronous, with various providers caring for the patient without much coordination. For example, the physician sees the patient at 9 a.m., followed by the nurse at 10 a.m., and then finally the visiting family at 11 a.m. The ACU model of care would involve all the providers rounding with the patient and family at a scheduled time daily to provide synchronous care.

Dr. Stein described an ACU as a geographic inpatient area consistently responsible for the clinical, service, and cost outcomes it produces. Features of this unit include:

• Assignment of physicians by units to enhance predictability;
• Cohesiveness and communication;
• Structured interdisciplinary bedside rounds to consistently deliver evidence-based, patient-centered care;
• Evaluation of performance data by unit instead of facility or service line; and
• A dyad partnership involving a nurse unit director and a physician unit medical director.

ACU implementation at Emory has led to decreased mortality, reduced length of stay, and improved patient satisfaction compared to traditional units, according to Dr. Stein. While the ACU might not be suited for all, he said, all hospitals can learn from various components of this innovative approach to deliver better patient care.

The ever-changing state of HM in the U.S. remains a challenge, but it continues to generate innovation and excitement. The high number of engaged participants from 30 different states attending the 13th annual Southern Hospital Medicine Conference demonstrates that hospitalists are eager to learn and ready to improve their practice in order to provide high-value healthcare in U.S. hospitals today.

Dr. Lee is vice chairman in the department of hospital medicine at Ochsner Health System. Dr. Smith is an assistant director for education in the division of hospital medicine at Emory University. Dr. Deitelzweig is system chairman in the department of hospital medicine and medical director for regional business development at Ochsner Health System. Dr. Wang is the division director of hospital medicine at Emory University. Dr. Dressler is director for education in the division of hospital medicine and an associate program director for the J. Willis Hurst Internal Medicine Residency Program at Emory University.

More than 300 hospitalists and other clinicians recently attended the 13th annual Southern Hospital Medicine Conference in Atlanta. The conference is a joint collaboration between the Emory University School of Medicine in Atlanta and Ochsner Health System New Orleans. The meeting site has alternated between the two cities each year since 2005.

The prevailing conference theme in 2012 was “Value and Values in Hospital Medicine,” alluding to the value that hospitalists bring to the medical community and hospitals and the values shared by hospitalists. The conference offered five pre-courses and more than 50 sessions focused on educating hospitalists on current best practices within core topic areas, including clinical care, quality improvement, healthcare information technology, innovative care models, systems of care, and transitions of care. A judged poster competition featured research and clinical vignettes abstracts, with interesting clinical cases as well as new research in hospital medicine.

One of the highlights of this year’s conference was the keynote address delivered by Dr. William A. Bornstein, chief quality and medical officer of Emory Healthcare. Dr. Bornstein discussed the various aspects of quality and cost in hospital care. He described the challenges in defining quality and measuring cost when trying to calculate the “value” equation in medicine (value=quality/cost). He outlined the Institute of Medicine’s previously described STEEEP (safe, timely, effective, efficient, equitable, patient-centered) aims of quality in 2001.

Dr. Bornstein’s own definition for quality is “partnering with patients and families to reliably, 100% of the time, deliver when, where, and how they want it—and with minimal waste—care based on the best available evidence and consistent with patient and family values and preferences.” To measure outcome, he said, we need to address system structure (what’s in place before the patient arrives), process (what we do for the patient), and culture (how we can get the buy-in from all stakeholders). The sum of these factors achieves outcome, which requires risk adjustment and, ideally, long-term follow-up data, he said.

Dr. Bornstein also discussed the need to develop standard processes whereby equivalent clinicians can follow similar processes to achieve the same results. When physicians “do it the same” (i.e. standardized protocols), error rates and cost decrease, he explained.

Dr. Bornstein also focused on transformative solutions to address problems in healthcare as a whole, rather than attempting to fix problems piecemeal.

Jason Stein, MD, SFHM, offered another conference highlight: a pre-conference program and plenary session on an innovative approach to improve hospital outcomes through implementation of the accountable-care unit (ACU). Dr. Stein, director of the clinical research program at Emory School of Medicine, described the current state of hospital care as asynchronous, with various providers caring for the patient without much coordination. For example, the physician sees the patient at 9 a.m., followed by the nurse at 10 a.m., and then finally the visiting family at 11 a.m. The ACU model of care would involve all the providers rounding with the patient and family at a scheduled time daily to provide synchronous care.

Dr. Stein described an ACU as a geographic inpatient area consistently responsible for the clinical, service, and cost outcomes it produces. Features of this unit include:

• Assignment of physicians by units to enhance predictability;
• Cohesiveness and communication;
• Structured interdisciplinary bedside rounds to consistently deliver evidence-based, patient-centered care;
• Evaluation of performance data by unit instead of facility or service line; and
• A dyad partnership involving a nurse unit director and a physician unit medical director.

ACU implementation at Emory has led to decreased mortality, reduced length of stay, and improved patient satisfaction compared to traditional units, according to Dr. Stein. While the ACU might not be suited for all, he said, all hospitals can learn from various components of this innovative approach to deliver better patient care.

The ever-changing state of HM in the U.S. remains a challenge, but it continues to generate innovation and excitement. The high number of engaged participants from 30 different states attending the 13th annual Southern Hospital Medicine Conference demonstrates that hospitalists are eager to learn and ready to improve their practice in order to provide high-value healthcare in U.S. hospitals today.

Dr. Lee is vice chairman in the department of hospital medicine at Ochsner Health System. Dr. Smith is an assistant director for education in the division of hospital medicine at Emory University. Dr. Deitelzweig is system chairman in the department of hospital medicine and medical director for regional business development at Ochsner Health System. Dr. Wang is the division director of hospital medicine at Emory University. Dr. Dressler is director for education in the division of hospital medicine and an associate program director for the J. Willis Hurst Internal Medicine Residency Program at Emory University.

More than 300 hospitalists and other clinicians recently attended the 13th annual Southern Hospital Medicine Conference in Atlanta. The conference is a joint collaboration between the Emory University School of Medicine in Atlanta and Ochsner Health System New Orleans. The meeting site has alternated between the two cities each year since 2005.

The prevailing conference theme in 2012 was “Value and Values in Hospital Medicine,” alluding to the value that hospitalists bring to the medical community and hospitals and the values shared by hospitalists. The conference offered five pre-courses and more than 50 sessions focused on educating hospitalists on current best practices within core topic areas, including clinical care, quality improvement, healthcare information technology, innovative care models, systems of care, and transitions of care. A judged poster competition featured research and clinical vignettes abstracts, with interesting clinical cases as well as new research in hospital medicine.

One of the highlights of this year’s conference was the keynote address delivered by Dr. William A. Bornstein, chief quality and medical officer of Emory Healthcare. Dr. Bornstein discussed the various aspects of quality and cost in hospital care. He described the challenges in defining quality and measuring cost when trying to calculate the “value” equation in medicine (value=quality/cost). He outlined the Institute of Medicine’s previously described STEEEP (safe, timely, effective, efficient, equitable, patient-centered) aims of quality in 2001.

Dr. Bornstein’s own definition for quality is “partnering with patients and families to reliably, 100% of the time, deliver when, where, and how they want it—and with minimal waste—care based on the best available evidence and consistent with patient and family values and preferences.” To measure outcome, he said, we need to address system structure (what’s in place before the patient arrives), process (what we do for the patient), and culture (how we can get the buy-in from all stakeholders). The sum of these factors achieves outcome, which requires risk adjustment and, ideally, long-term follow-up data, he said.

Dr. Bornstein also discussed the need to develop standard processes whereby equivalent clinicians can follow similar processes to achieve the same results. When physicians “do it the same” (i.e. standardized protocols), error rates and cost decrease, he explained.

Dr. Bornstein also focused on transformative solutions to address problems in healthcare as a whole, rather than attempting to fix problems piecemeal.

Jason Stein, MD, SFHM, offered another conference highlight: a pre-conference program and plenary session on an innovative approach to improve hospital outcomes through implementation of the accountable-care unit (ACU). Dr. Stein, director of the clinical research program at Emory School of Medicine, described the current state of hospital care as asynchronous, with various providers caring for the patient without much coordination. For example, the physician sees the patient at 9 a.m., followed by the nurse at 10 a.m., and then finally the visiting family at 11 a.m. The ACU model of care would involve all the providers rounding with the patient and family at a scheduled time daily to provide synchronous care.

Dr. Stein described an ACU as a geographic inpatient area consistently responsible for the clinical, service, and cost outcomes it produces. Features of this unit include:

• Assignment of physicians by units to enhance predictability;
• Cohesiveness and communication;
• Structured interdisciplinary bedside rounds to consistently deliver evidence-based, patient-centered care;
• Evaluation of performance data by unit instead of facility or service line; and
• A dyad partnership involving a nurse unit director and a physician unit medical director.

ACU implementation at Emory has led to decreased mortality, reduced length of stay, and improved patient satisfaction compared to traditional units, according to Dr. Stein. While the ACU might not be suited for all, he said, all hospitals can learn from various components of this innovative approach to deliver better patient care.

The ever-changing state of HM in the U.S. remains a challenge, but it continues to generate innovation and excitement. The high number of engaged participants from 30 different states attending the 13th annual Southern Hospital Medicine Conference demonstrates that hospitalists are eager to learn and ready to improve their practice in order to provide high-value healthcare in U.S. hospitals today.

Dr. Lee is vice chairman in the department of hospital medicine at Ochsner Health System. Dr. Smith is an assistant director for education in the division of hospital medicine at Emory University. Dr. Deitelzweig is system chairman in the department of hospital medicine and medical director for regional business development at Ochsner Health System. Dr. Wang is the division director of hospital medicine at Emory University. Dr. Dressler is director for education in the division of hospital medicine and an associate program director for the J. Willis Hurst Internal Medicine Residency Program at Emory University.

Ilan Alhadeff, MD, SFHM, program medical director for Cogent HMG at Hackensack University Medical Center in Hackensack, N.J., pays a lot of attention to the work relative-value units (wRVUs) his hospitalists are producing and the number of encounters they’re tallying. But he’s not particularly worried about what he sees on a daily, weekly, or even monthly basis; he takes a monthslong view of his data when he wants to forecast whether he is going to need to think about adding staff.

“When you look at months, you can start seeing trends,” Dr. Alhadeff says. “Let’s say there’s 16 to 18 average encounters. If your average is 16, you’re saying, ‘OK, you’re on the lower end of your normal.’ And if your average is 18, you’re on the higher end of normal. But if you start seeing 18 every month, odds are you’re going to start getting to 19. So at that point, that’s raising the thought that we need to start thinking about bringing someone else on.”

Dr. Alhadeff

It’s a dance HM group leaders around the country have to do when confronted with the age-old question: Should we expand our service? The answer is more art than science, experts say, as there is no standardized formula for knowing when your HM group should request more support from administration to add an FTE—or two or three. And, in a nod to the HM adage that if you’ve seen one HM group (HMG), then you’ve seen one HMG, the roadmap to expansion varies from place to place. But in a series of interviews with The Hospitalist, physicians, consultants, and management experts suggest there are broad themes that guide the process, including:

• Data. Dashboard metrics, such as average daily census (ADC), wRVUs, patient encounters, and length of stay (LOS), must be quantified. No discussion on expansion can be intelligibly made without a firm understanding of where a practice currently stands.
• Benchmarking. Collating figures isn’t enough. Measure your group against other local HMGs, regional groups, and national standards. SHM’s 2012 State of Hospital Medicine report is a good place to start.
• Scope or schedule. Pushing into new business lines (e.g. orthopedic comanagement) often requires new staff, as does adding shifts to provide 24-hour on-site coverage. Those arguments are different from the case to be made for expanding based on increased patient encounters.
• Physician buy-in. Group leaders cannot unilaterally determine it’s time to add staff, particularly in small-group settings in which hiring a new physician means taking revenue away from the existing group, if only in the short term. Talk with group members before embarking on expansion. Keep track of physician turnover. If hospitalists are leaving often, it could be a sign the group is understaffed.
• Administrative buy-in. If a group leader’s request for a new hire comes without months of conversation ahead of it, it’s likely too late. Prepare C-suite executives in advance about potential growth needs so the discussion does not feel like a surprise.
• Know your market. Don’t wait until a new active-adult community floods the hospital with patients to begin analyzing the impact new residents might have. The same goes for companies that are bringing thousands of new workers to an area.
• Prepare to do nothing. Too often, group leaders think the easiest solution is hiring a physician to lessen workload. Instead, exhaust improved efficiency options and infrastructure improvements that could accomplish the same goal.

“There is no one specific measure,” says Burke Kealey, MD, SFHM, medical director of hospital specialties at HealthPartners Medical Group in St. Paul, Minn., and an SHM board member. “You have to look at it from several different aspects, and all or most need to line up and say that, yes, you could use more help.”

Practice Analysis

Dr. Kealey, board liaison to SHM’s Practice Analysis Committee, says that benchmarking might be among the most important first steps in determining the right time to grow a practice. Group leaders should keep in mind, though, that comparative analysis to outside measures is only step one of gauging a group’s performance.

“The external benchmarking is easy,” he says. “You can look at SHM survey data. There are a lot of places that will do local market surveys; that’s easy stuff to look at. It’s the internal stuff that’s a bit harder to make the case for, ‘OK, yes, I am a little below the national benchmarks, but here’s why.’”

Dr. Kealey

In those instances, group leaders need to “look at the value equation” and engage hospital administrators in a discussion on why such metrics as wRVUs and ADC might not match local, regional, or national standards. Perhaps a hospital has a lower payor mix than the sample pool, or comparable regional institutions have a better mix of medical and surgical comanagement populations. Regardless of the details of the tailored explanation, the conversation must be one that’s ongoing between a group leader and the C-suite or it is likely to fail, Dr. Kealey says.

“It really gets to the partnership between the hospital and the hospitalist group and working together throughout the whole year, and not just looking at staffing needs, but looking at the hospital’s quality,” he adds. “It’s looking at [the hospital’s] ability to retain the surgeons and the specialists. It’s the leadership that you’re providing. It’s showing that you’re a real partner, so that when it does come time to make that value argument, that we need to grow...there is buy-in.

“If you’re not a true partner and you just come in as an adversary, I think your odds of success are not very high.”

Dr. Sloan

Steve Sloan, MD, a partner at AIM Hospitalist Group of Westmont, Ill., says that group leaders would be wise to obtain input from all of their physicians before adding a new doctor, as each new hire impacts compensation for existing staff members. In Dr. Sloan’s 16-member group, 11 physicians are partners who discuss growth plans. The other doctors are on partnership tracks. And while that makes discussions more difficult than when nine physicians formed the group in 2007, up-front dialogue is crucial, Dr. Sloan says.

“We try to get all the partners together to make major decisions, such as hiring,” he says. “We don’t need everyone involved in every decision, but it’s not just one or two people making the decision.”

The conversation about growth also differs if new hires are needed to move the group into a new business line or if the group is adding staff to deal with its current patient load. Both require a business case for expansion to be made, but either way, codifying expectations with hospital clients is another way to streamline the growth process, says Dr. Alhadeff. His group contracts with his hospital to provide services and has the ability to autonomously add or delete staff as needed. Although personnel moves don’t require prior approval from the hospital, there is “an expected fiscal responsibility on our end and predetermined agreement do so.”

The group also keeps administrative stakeholders updated to make sure everyone is on the same page. Other groups might delineate in a contract what thresholds need to be met for expansion to be viable.

“It needs to be agreed upon,” Dr. Alhadeff says. “I like the flexibility of being able to determine within our company what we’re doing. But in answer to that, there are unintentional consequences. If we determine that we’re going to bring on someone else, and then we see after a few months that there is not enough volume to support this new physician, we could run into a problem. We will then have to make a financial decision, and the worst thing is to have to fire someone.”

Dr. Alhadeff also worries about the flipside: failing to hire when staff is overworked.

“We run that risk also,” he says. “We are walking a tightrope all the time, and we need to balance that tightrope.”

When you’re putting out fires every day, you don’t have the luxury and the time to look out there and see what’s happening and know everything that’s going on. [Group leaders] need to understand the importance of [long-term analysis] and how all the pieces tie in together.

—Kenneth Hertz, FACMPE, principal, Medical Group Management Association Health Care Consulting Group, Denver

The Long View

Another tightrope is timing. Kenneth Hertz, FACMPE, principal of the Medical Group Management Association’s Health Care Consulting Group, says that it can take six months or longer to hire a physician, which means group leaders need to have a continual focus on whether growth is needed or will soon be needed. He suggests forecasting at least 12 to 18 months in advance to stay ahead of staffing needs.

Unfortunately, he says, analysis often gets put on hold in the shuffle of dealing with daily duties. “This is kind of generic to practice administrators, who are putting out fires almost every day. And when you’re putting out fires every day, you don’t have the luxury and the time to look out there and see what’s happening and know everything that’s going on,” he says. “They need to understand the importance of it and how all the pieces tie in together.”

Brian Hazen, MD, medical director of Inova Fairfax Hospital Group in Fairfax, Va., says an important approach is to realize growth isn’t always a good thing. HM group leaders often want to grow before they have stabilized their existing business lines, he says, and that can be the worst tack to take. He also notes that a group leader should ingratiate their program into the fabric of their hospital and not just rely on data to make the argument of the group’s value. That means putting hospitalists on committees, spearheading safety programs, and being seen as a partner in the institution.

“Job One is always patient safety and physician sanity,” he says. “If you are careful about growth and buy-in, and you do the committee work and support everybody so that you’re firmly entrenched in the hospital as a value, it’s much safer to grow. Growing for the sake of growing, you risk overexpansion, and that’s dangerous.”

Many hospitalist groups looking to grow will use locum tenens to bridge the staffing gap while they hire new employees (see “No Strings Attached,” December 2012, p. 36), but Dr. Hazen says without a longer view, that only serves as a Band-Aid.

Hertz, the consultant, often uses an analogy to show how important it is to be constantly planning ahead of the growth curve.

“It is a little bit like building roads,” he says. “Once you decide you need to add two lanes, by the time those are finished, you realize we really need to add two more lanes.”

Richard Quinn is a freelance writer in New Jersey.

Ilan Alhadeff, MD, SFHM, program medical director for Cogent HMG at Hackensack University Medical Center in Hackensack, N.J., pays a lot of attention to the work relative-value units (wRVUs) his hospitalists are producing and the number of encounters they’re tallying. But he’s not particularly worried about what he sees on a daily, weekly, or even monthly basis; he takes a monthslong view of his data when he wants to forecast whether he is going to need to think about adding staff.

“When you look at months, you can start seeing trends,” Dr. Alhadeff says. “Let’s say there’s 16 to 18 average encounters. If your average is 16, you’re saying, ‘OK, you’re on the lower end of your normal.’ And if your average is 18, you’re on the higher end of normal. But if you start seeing 18 every month, odds are you’re going to start getting to 19. So at that point, that’s raising the thought that we need to start thinking about bringing someone else on.”

Dr. Alhadeff

It’s a dance HM group leaders around the country have to do when confronted with the age-old question: Should we expand our service? The answer is more art than science, experts say, as there is no standardized formula for knowing when your HM group should request more support from administration to add an FTE—or two or three. And, in a nod to the HM adage that if you’ve seen one HM group (HMG), then you’ve seen one HMG, the roadmap to expansion varies from place to place. But in a series of interviews with The Hospitalist, physicians, consultants, and management experts suggest there are broad themes that guide the process, including:

• Data. Dashboard metrics, such as average daily census (ADC), wRVUs, patient encounters, and length of stay (LOS), must be quantified. No discussion on expansion can be intelligibly made without a firm understanding of where a practice currently stands.
• Benchmarking. Collating figures isn’t enough. Measure your group against other local HMGs, regional groups, and national standards. SHM’s 2012 State of Hospital Medicine report is a good place to start.
• Scope or schedule. Pushing into new business lines (e.g. orthopedic comanagement) often requires new staff, as does adding shifts to provide 24-hour on-site coverage. Those arguments are different from the case to be made for expanding based on increased patient encounters.
• Physician buy-in. Group leaders cannot unilaterally determine it’s time to add staff, particularly in small-group settings in which hiring a new physician means taking revenue away from the existing group, if only in the short term. Talk with group members before embarking on expansion. Keep track of physician turnover. If hospitalists are leaving often, it could be a sign the group is understaffed.
• Administrative buy-in. If a group leader’s request for a new hire comes without months of conversation ahead of it, it’s likely too late. Prepare C-suite executives in advance about potential growth needs so the discussion does not feel like a surprise.
• Know your market. Don’t wait until a new active-adult community floods the hospital with patients to begin analyzing the impact new residents might have. The same goes for companies that are bringing thousands of new workers to an area.
• Prepare to do nothing. Too often, group leaders think the easiest solution is hiring a physician to lessen workload. Instead, exhaust improved efficiency options and infrastructure improvements that could accomplish the same goal.

“There is no one specific measure,” says Burke Kealey, MD, SFHM, medical director of hospital specialties at HealthPartners Medical Group in St. Paul, Minn., and an SHM board member. “You have to look at it from several different aspects, and all or most need to line up and say that, yes, you could use more help.”

Practice Analysis

Dr. Kealey, board liaison to SHM’s Practice Analysis Committee, says that benchmarking might be among the most important first steps in determining the right time to grow a practice. Group leaders should keep in mind, though, that comparative analysis to outside measures is only step one of gauging a group’s performance.

“The external benchmarking is easy,” he says. “You can look at SHM survey data. There are a lot of places that will do local market surveys; that’s easy stuff to look at. It’s the internal stuff that’s a bit harder to make the case for, ‘OK, yes, I am a little below the national benchmarks, but here’s why.’”

Dr. Kealey

In those instances, group leaders need to “look at the value equation” and engage hospital administrators in a discussion on why such metrics as wRVUs and ADC might not match local, regional, or national standards. Perhaps a hospital has a lower payor mix than the sample pool, or comparable regional institutions have a better mix of medical and surgical comanagement populations. Regardless of the details of the tailored explanation, the conversation must be one that’s ongoing between a group leader and the C-suite or it is likely to fail, Dr. Kealey says.

“It really gets to the partnership between the hospital and the hospitalist group and working together throughout the whole year, and not just looking at staffing needs, but looking at the hospital’s quality,” he adds. “It’s looking at [the hospital’s] ability to retain the surgeons and the specialists. It’s the leadership that you’re providing. It’s showing that you’re a real partner, so that when it does come time to make that value argument, that we need to grow...there is buy-in.

“If you’re not a true partner and you just come in as an adversary, I think your odds of success are not very high.”

Dr. Sloan

Steve Sloan, MD, a partner at AIM Hospitalist Group of Westmont, Ill., says that group leaders would be wise to obtain input from all of their physicians before adding a new doctor, as each new hire impacts compensation for existing staff members. In Dr. Sloan’s 16-member group, 11 physicians are partners who discuss growth plans. The other doctors are on partnership tracks. And while that makes discussions more difficult than when nine physicians formed the group in 2007, up-front dialogue is crucial, Dr. Sloan says.

“We try to get all the partners together to make major decisions, such as hiring,” he says. “We don’t need everyone involved in every decision, but it’s not just one or two people making the decision.”

The conversation about growth also differs if new hires are needed to move the group into a new business line or if the group is adding staff to deal with its current patient load. Both require a business case for expansion to be made, but either way, codifying expectations with hospital clients is another way to streamline the growth process, says Dr. Alhadeff. His group contracts with his hospital to provide services and has the ability to autonomously add or delete staff as needed. Although personnel moves don’t require prior approval from the hospital, there is “an expected fiscal responsibility on our end and predetermined agreement do so.”

The group also keeps administrative stakeholders updated to make sure everyone is on the same page. Other groups might delineate in a contract what thresholds need to be met for expansion to be viable.

“It needs to be agreed upon,” Dr. Alhadeff says. “I like the flexibility of being able to determine within our company what we’re doing. But in answer to that, there are unintentional consequences. If we determine that we’re going to bring on someone else, and then we see after a few months that there is not enough volume to support this new physician, we could run into a problem. We will then have to make a financial decision, and the worst thing is to have to fire someone.”

Dr. Alhadeff also worries about the flipside: failing to hire when staff is overworked.

“We run that risk also,” he says. “We are walking a tightrope all the time, and we need to balance that tightrope.”

When you’re putting out fires every day, you don’t have the luxury and the time to look out there and see what’s happening and know everything that’s going on. [Group leaders] need to understand the importance of [long-term analysis] and how all the pieces tie in together.

—Kenneth Hertz, FACMPE, principal, Medical Group Management Association Health Care Consulting Group, Denver

The Long View

Another tightrope is timing. Kenneth Hertz, FACMPE, principal of the Medical Group Management Association’s Health Care Consulting Group, says that it can take six months or longer to hire a physician, which means group leaders need to have a continual focus on whether growth is needed or will soon be needed. He suggests forecasting at least 12 to 18 months in advance to stay ahead of staffing needs.

Unfortunately, he says, analysis often gets put on hold in the shuffle of dealing with daily duties. “This is kind of generic to practice administrators, who are putting out fires almost every day. And when you’re putting out fires every day, you don’t have the luxury and the time to look out there and see what’s happening and know everything that’s going on,” he says. “They need to understand the importance of it and how all the pieces tie in together.”

Brian Hazen, MD, medical director of Inova Fairfax Hospital Group in Fairfax, Va., says an important approach is to realize growth isn’t always a good thing. HM group leaders often want to grow before they have stabilized their existing business lines, he says, and that can be the worst tack to take. He also notes that a group leader should ingratiate their program into the fabric of their hospital and not just rely on data to make the argument of the group’s value. That means putting hospitalists on committees, spearheading safety programs, and being seen as a partner in the institution.

“Job One is always patient safety and physician sanity,” he says. “If you are careful about growth and buy-in, and you do the committee work and support everybody so that you’re firmly entrenched in the hospital as a value, it’s much safer to grow. Growing for the sake of growing, you risk overexpansion, and that’s dangerous.”

Many hospitalist groups looking to grow will use locum tenens to bridge the staffing gap while they hire new employees (see “No Strings Attached,” December 2012, p. 36), but Dr. Hazen says without a longer view, that only serves as a Band-Aid.

Hertz, the consultant, often uses an analogy to show how important it is to be constantly planning ahead of the growth curve.

“It is a little bit like building roads,” he says. “Once you decide you need to add two lanes, by the time those are finished, you realize we really need to add two more lanes.”

Richard Quinn is a freelance writer in New Jersey.

Ilan Alhadeff, MD, SFHM, program medical director for Cogent HMG at Hackensack University Medical Center in Hackensack, N.J., pays a lot of attention to the work relative-value units (wRVUs) his hospitalists are producing and the number of encounters they’re tallying. But he’s not particularly worried about what he sees on a daily, weekly, or even monthly basis; he takes a monthslong view of his data when he wants to forecast whether he is going to need to think about adding staff.

“When you look at months, you can start seeing trends,” Dr. Alhadeff says. “Let’s say there’s 16 to 18 average encounters. If your average is 16, you’re saying, ‘OK, you’re on the lower end of your normal.’ And if your average is 18, you’re on the higher end of normal. But if you start seeing 18 every month, odds are you’re going to start getting to 19. So at that point, that’s raising the thought that we need to start thinking about bringing someone else on.”

Dr. Alhadeff

It’s a dance HM group leaders around the country have to do when confronted with the age-old question: Should we expand our service? The answer is more art than science, experts say, as there is no standardized formula for knowing when your HM group should request more support from administration to add an FTE—or two or three. And, in a nod to the HM adage that if you’ve seen one HM group (HMG), then you’ve seen one HMG, the roadmap to expansion varies from place to place. But in a series of interviews with The Hospitalist, physicians, consultants, and management experts suggest there are broad themes that guide the process, including:

• Data. Dashboard metrics, such as average daily census (ADC), wRVUs, patient encounters, and length of stay (LOS), must be quantified. No discussion on expansion can be intelligibly made without a firm understanding of where a practice currently stands.
• Benchmarking. Collating figures isn’t enough. Measure your group against other local HMGs, regional groups, and national standards. SHM’s 2012 State of Hospital Medicine report is a good place to start.
• Scope or schedule. Pushing into new business lines (e.g. orthopedic comanagement) often requires new staff, as does adding shifts to provide 24-hour on-site coverage. Those arguments are different from the case to be made for expanding based on increased patient encounters.
• Physician buy-in. Group leaders cannot unilaterally determine it’s time to add staff, particularly in small-group settings in which hiring a new physician means taking revenue away from the existing group, if only in the short term. Talk with group members before embarking on expansion. Keep track of physician turnover. If hospitalists are leaving often, it could be a sign the group is understaffed.
• Administrative buy-in. If a group leader’s request for a new hire comes without months of conversation ahead of it, it’s likely too late. Prepare C-suite executives in advance about potential growth needs so the discussion does not feel like a surprise.
• Know your market. Don’t wait until a new active-adult community floods the hospital with patients to begin analyzing the impact new residents might have. The same goes for companies that are bringing thousands of new workers to an area.
• Prepare to do nothing. Too often, group leaders think the easiest solution is hiring a physician to lessen workload. Instead, exhaust improved efficiency options and infrastructure improvements that could accomplish the same goal.

“There is no one specific measure,” says Burke Kealey, MD, SFHM, medical director of hospital specialties at HealthPartners Medical Group in St. Paul, Minn., and an SHM board member. “You have to look at it from several different aspects, and all or most need to line up and say that, yes, you could use more help.”

Practice Analysis

Dr. Kealey, board liaison to SHM’s Practice Analysis Committee, says that benchmarking might be among the most important first steps in determining the right time to grow a practice. Group leaders should keep in mind, though, that comparative analysis to outside measures is only step one of gauging a group’s performance.

“The external benchmarking is easy,” he says. “You can look at SHM survey data. There are a lot of places that will do local market surveys; that’s easy stuff to look at. It’s the internal stuff that’s a bit harder to make the case for, ‘OK, yes, I am a little below the national benchmarks, but here’s why.’”

Dr. Kealey

In those instances, group leaders need to “look at the value equation” and engage hospital administrators in a discussion on why such metrics as wRVUs and ADC might not match local, regional, or national standards. Perhaps a hospital has a lower payor mix than the sample pool, or comparable regional institutions have a better mix of medical and surgical comanagement populations. Regardless of the details of the tailored explanation, the conversation must be one that’s ongoing between a group leader and the C-suite or it is likely to fail, Dr. Kealey says.

“It really gets to the partnership between the hospital and the hospitalist group and working together throughout the whole year, and not just looking at staffing needs, but looking at the hospital’s quality,” he adds. “It’s looking at [the hospital’s] ability to retain the surgeons and the specialists. It’s the leadership that you’re providing. It’s showing that you’re a real partner, so that when it does come time to make that value argument, that we need to grow...there is buy-in.

“If you’re not a true partner and you just come in as an adversary, I think your odds of success are not very high.”

Dr. Sloan

Steve Sloan, MD, a partner at AIM Hospitalist Group of Westmont, Ill., says that group leaders would be wise to obtain input from all of their physicians before adding a new doctor, as each new hire impacts compensation for existing staff members. In Dr. Sloan’s 16-member group, 11 physicians are partners who discuss growth plans. The other doctors are on partnership tracks. And while that makes discussions more difficult than when nine physicians formed the group in 2007, up-front dialogue is crucial, Dr. Sloan says.

“We try to get all the partners together to make major decisions, such as hiring,” he says. “We don’t need everyone involved in every decision, but it’s not just one or two people making the decision.”

The conversation about growth also differs if new hires are needed to move the group into a new business line or if the group is adding staff to deal with its current patient load. Both require a business case for expansion to be made, but either way, codifying expectations with hospital clients is another way to streamline the growth process, says Dr. Alhadeff. His group contracts with his hospital to provide services and has the ability to autonomously add or delete staff as needed. Although personnel moves don’t require prior approval from the hospital, there is “an expected fiscal responsibility on our end and predetermined agreement do so.”

The group also keeps administrative stakeholders updated to make sure everyone is on the same page. Other groups might delineate in a contract what thresholds need to be met for expansion to be viable.

“It needs to be agreed upon,” Dr. Alhadeff says. “I like the flexibility of being able to determine within our company what we’re doing. But in answer to that, there are unintentional consequences. If we determine that we’re going to bring on someone else, and then we see after a few months that there is not enough volume to support this new physician, we could run into a problem. We will then have to make a financial decision, and the worst thing is to have to fire someone.”

Dr. Alhadeff also worries about the flipside: failing to hire when staff is overworked.

“We run that risk also,” he says. “We are walking a tightrope all the time, and we need to balance that tightrope.”

When you’re putting out fires every day, you don’t have the luxury and the time to look out there and see what’s happening and know everything that’s going on. [Group leaders] need to understand the importance of [long-term analysis] and how all the pieces tie in together.

—Kenneth Hertz, FACMPE, principal, Medical Group Management Association Health Care Consulting Group, Denver

The Long View

Another tightrope is timing. Kenneth Hertz, FACMPE, principal of the Medical Group Management Association’s Health Care Consulting Group, says that it can take six months or longer to hire a physician, which means group leaders need to have a continual focus on whether growth is needed or will soon be needed. He suggests forecasting at least 12 to 18 months in advance to stay ahead of staffing needs.

Unfortunately, he says, analysis often gets put on hold in the shuffle of dealing with daily duties. “This is kind of generic to practice administrators, who are putting out fires almost every day. And when you’re putting out fires every day, you don’t have the luxury and the time to look out there and see what’s happening and know everything that’s going on,” he says. “They need to understand the importance of it and how all the pieces tie in together.”

Brian Hazen, MD, medical director of Inova Fairfax Hospital Group in Fairfax, Va., says an important approach is to realize growth isn’t always a good thing. HM group leaders often want to grow before they have stabilized their existing business lines, he says, and that can be the worst tack to take. He also notes that a group leader should ingratiate their program into the fabric of their hospital and not just rely on data to make the argument of the group’s value. That means putting hospitalists on committees, spearheading safety programs, and being seen as a partner in the institution.

“Job One is always patient safety and physician sanity,” he says. “If you are careful about growth and buy-in, and you do the committee work and support everybody so that you’re firmly entrenched in the hospital as a value, it’s much safer to grow. Growing for the sake of growing, you risk overexpansion, and that’s dangerous.”

Many hospitalist groups looking to grow will use locum tenens to bridge the staffing gap while they hire new employees (see “No Strings Attached,” December 2012, p. 36), but Dr. Hazen says without a longer view, that only serves as a Band-Aid.

Hertz, the consultant, often uses an analogy to show how important it is to be constantly planning ahead of the growth curve.

“It is a little bit like building roads,” he says. “Once you decide you need to add two lanes, by the time those are finished, you realize we really need to add two more lanes.”

Richard Quinn is a freelance writer in New Jersey.