Jane Jerrard

As hospitalists take on more demanding leadership roles, the climb up the career ladder evolves into a juggling act: Hospitalists typically try to handle a full patient load as well as new administrative duties.

If a hospitalist continues to ascend, those administrative duties can begin to consume the schedule. The individual—and the group—could face important decisions about priorities, schedules, and money.

“Hospital medicine is only ten years old; we’re still trying to figure this out,” says Mary Jo Gorman, MD, MBA, chief executive officer of Advanced ICU Care in St. Louis and a past president of SHM. “It’s always a challenge. You identify that you have a need for someone to take charge of an administrative task, but it can take as long as a year to free up [the hospitalist’s] time so that it can get done.”

If you have found yourself in this position, you know that something has to give. “I’ve seen high-energy physicians who think that they can do it all—and they had to,” says Joan C. Faro, MD, FACP, MBA, chief medical officer at John T. Mather Memorial Hospital in Port Jefferson, N.Y. “That is not sustainable. It can’t last forever.”

The question is, how can a hospitalist effectively balance their clinical and administrative duties? Furthermore, what happens when the scales tip in favor—and to the detriment—of one or the other?

When the Juggling Begins

Hospitalists usually add “extra” duties to their normal workloads to advance their careers. Few relinquish their clinical duties as they join committees, further their training, lead a research project, or take on administrative duties.

Dr. Faro says a hospitalist should be able to “head up a focused project or serve on committees” and still be able to meet all their clinical duties. “Once you get beyond that, you need a certain amount of protected time” for administrative or project work, she says. “And when you start to have people reporting to you, you absolutely need that protected time.”

Assigning administrative tasks to physicians who regularly see patients depends on the group structure and requires a clearly defined job description. “If a group is really going to make this work, then you have to pay people for that extra time,” Dr. Gorman says.

Ideally, HM groups have job descriptions for physicians who are called upon to see patients and handle administrative duties. Contracts should include specifications for “protected time,” as well as compensation for new responsibilities.

Clinical-Hour Cutbacks

As administrative duties grow, something has to give. Hospitalists who want to pursue positions of leadership know that that something is hours spent delivering patient care. “If you’re a hospitalist-administrator who wants to make the leap to vice president or department chair or chief medical officer, you need to devote a lot of time to your administrative work,” Dr. Faro says. “You can’t make that leap without putting in those hours.”

So what is a reasonable division of time for, say, the director of an HM program or department? “It’s impossible to pinpoint, but I’d say roughly that [a director] should spend not less than 25% or 30% of their time, and certainly not more than 50% of their time, on clinical work,” Dr. Faro estimates.

Even upper-level physician-administrators should maintain a clinical practice simply to monitor the work their department is doing. “It’s not about [clinical] skills as much as it is about whether you can relate to physicians’ day-to-day work, to their frustrations,” Dr. Gorman says. “That’s a management challenge no matter who you are. For example, if hospitalists are complaining about a new EMR [electronic medical record] system, are you going to say, ‘Oh, just put up with it; it’s not that bad. It will be fine’? Or are you out there trying it and saying, ‘Holy cow, this is really inefficient. We have to change this’?”

On the flip side, how much time should be devoted to administrative tasks? The answer depends on the size of your program and the amount of work you have to do, Dr. Faro says. Group directors and department heads normally make themselves available during regular weekday hours. That usually means you’ll have to fit in your clinical work around meetings, budgets, and presentations.

Can You Give Up Clinical Duties?

It’s natural for physicians to be reluctant to relinquish patient care; some reach a point where they have to make the tough decision to stop clinical work altogether.

“You may figure out that you want to pursue an administrative role, but you don’t want to give up clinical work,” says Dr. Gorman, who spent 15 years juggling a full clinical schedule with administrative duties before she became a full-time administrator. “You get plenty of opportunities to make that decision as you’re crossing back and forth.”

You might want to evaluate your options and make the choice sooner rather than later. Once you’re in administration, the decision might be forced upon you. “Eventually, you’ll find that critical things are happening all hours of the day, any given day of the week, in administration as well as clinical practice,” Dr. Faro says. “There’s a point at which you realize that part-time [administrative work] just doesn’t work. You realize that your expertise and guidance are needed.”

Dr. Gorman warns that there are risks and changes involved with becoming a full-time administrator. Once you decide to give up your clinical practice and go the leadership route, your career is “in the hands of someone else,” she points out. “Your position could be eliminated. You could be fired or replaced. … That is a concern. A lot of people keep their hand in on clinical skills for that reason.” You also might find that advancing a management career requires moving to a new organization or a different part of the country.

On the other hand, the rewards of a career in administration can’t be overlooked. “It’s very satisfying personally,” Dr. Faro says. “It’s inventive; you’re constantly solving problems that didn’t exist yesterday.

“It’s a different kind of job satisfaction. It’s a very personal decision. There are people who realize that this just isn’t for them.” TH

Jane Jerrard is a freelance writer based in Chicago.

As hospitalists take on more demanding leadership roles, the climb up the career ladder evolves into a juggling act: Hospitalists typically try to handle a full patient load as well as new administrative duties.

If a hospitalist continues to ascend, those administrative duties can begin to consume the schedule. The individual—and the group—could face important decisions about priorities, schedules, and money.

“Hospital medicine is only ten years old; we’re still trying to figure this out,” says Mary Jo Gorman, MD, MBA, chief executive officer of Advanced ICU Care in St. Louis and a past president of SHM. “It’s always a challenge. You identify that you have a need for someone to take charge of an administrative task, but it can take as long as a year to free up [the hospitalist’s] time so that it can get done.”

If you have found yourself in this position, you know that something has to give. “I’ve seen high-energy physicians who think that they can do it all—and they had to,” says Joan C. Faro, MD, FACP, MBA, chief medical officer at John T. Mather Memorial Hospital in Port Jefferson, N.Y. “That is not sustainable. It can’t last forever.”

The question is, how can a hospitalist effectively balance their clinical and administrative duties? Furthermore, what happens when the scales tip in favor—and to the detriment—of one or the other?

When the Juggling Begins

Hospitalists usually add “extra” duties to their normal workloads to advance their careers. Few relinquish their clinical duties as they join committees, further their training, lead a research project, or take on administrative duties.

Dr. Faro says a hospitalist should be able to “head up a focused project or serve on committees” and still be able to meet all their clinical duties. “Once you get beyond that, you need a certain amount of protected time” for administrative or project work, she says. “And when you start to have people reporting to you, you absolutely need that protected time.”

Assigning administrative tasks to physicians who regularly see patients depends on the group structure and requires a clearly defined job description. “If a group is really going to make this work, then you have to pay people for that extra time,” Dr. Gorman says.

Ideally, HM groups have job descriptions for physicians who are called upon to see patients and handle administrative duties. Contracts should include specifications for “protected time,” as well as compensation for new responsibilities.

Clinical-Hour Cutbacks

As administrative duties grow, something has to give. Hospitalists who want to pursue positions of leadership know that that something is hours spent delivering patient care. “If you’re a hospitalist-administrator who wants to make the leap to vice president or department chair or chief medical officer, you need to devote a lot of time to your administrative work,” Dr. Faro says. “You can’t make that leap without putting in those hours.”

So what is a reasonable division of time for, say, the director of an HM program or department? “It’s impossible to pinpoint, but I’d say roughly that [a director] should spend not less than 25% or 30% of their time, and certainly not more than 50% of their time, on clinical work,” Dr. Faro estimates.

Even upper-level physician-administrators should maintain a clinical practice simply to monitor the work their department is doing. “It’s not about [clinical] skills as much as it is about whether you can relate to physicians’ day-to-day work, to their frustrations,” Dr. Gorman says. “That’s a management challenge no matter who you are. For example, if hospitalists are complaining about a new EMR [electronic medical record] system, are you going to say, ‘Oh, just put up with it; it’s not that bad. It will be fine’? Or are you out there trying it and saying, ‘Holy cow, this is really inefficient. We have to change this’?”

On the flip side, how much time should be devoted to administrative tasks? The answer depends on the size of your program and the amount of work you have to do, Dr. Faro says. Group directors and department heads normally make themselves available during regular weekday hours. That usually means you’ll have to fit in your clinical work around meetings, budgets, and presentations.

Can You Give Up Clinical Duties?

It’s natural for physicians to be reluctant to relinquish patient care; some reach a point where they have to make the tough decision to stop clinical work altogether.

“You may figure out that you want to pursue an administrative role, but you don’t want to give up clinical work,” says Dr. Gorman, who spent 15 years juggling a full clinical schedule with administrative duties before she became a full-time administrator. “You get plenty of opportunities to make that decision as you’re crossing back and forth.”

You might want to evaluate your options and make the choice sooner rather than later. Once you’re in administration, the decision might be forced upon you. “Eventually, you’ll find that critical things are happening all hours of the day, any given day of the week, in administration as well as clinical practice,” Dr. Faro says. “There’s a point at which you realize that part-time [administrative work] just doesn’t work. You realize that your expertise and guidance are needed.”

Dr. Gorman warns that there are risks and changes involved with becoming a full-time administrator. Once you decide to give up your clinical practice and go the leadership route, your career is “in the hands of someone else,” she points out. “Your position could be eliminated. You could be fired or replaced. … That is a concern. A lot of people keep their hand in on clinical skills for that reason.” You also might find that advancing a management career requires moving to a new organization or a different part of the country.

On the other hand, the rewards of a career in administration can’t be overlooked. “It’s very satisfying personally,” Dr. Faro says. “It’s inventive; you’re constantly solving problems that didn’t exist yesterday.

“It’s a different kind of job satisfaction. It’s a very personal decision. There are people who realize that this just isn’t for them.” TH

Jane Jerrard is a freelance writer based in Chicago.

As hospitalists take on more demanding leadership roles, the climb up the career ladder evolves into a juggling act: Hospitalists typically try to handle a full patient load as well as new administrative duties.

If a hospitalist continues to ascend, those administrative duties can begin to consume the schedule. The individual—and the group—could face important decisions about priorities, schedules, and money.

“Hospital medicine is only ten years old; we’re still trying to figure this out,” says Mary Jo Gorman, MD, MBA, chief executive officer of Advanced ICU Care in St. Louis and a past president of SHM. “It’s always a challenge. You identify that you have a need for someone to take charge of an administrative task, but it can take as long as a year to free up [the hospitalist’s] time so that it can get done.”

If you have found yourself in this position, you know that something has to give. “I’ve seen high-energy physicians who think that they can do it all—and they had to,” says Joan C. Faro, MD, FACP, MBA, chief medical officer at John T. Mather Memorial Hospital in Port Jefferson, N.Y. “That is not sustainable. It can’t last forever.”

The question is, how can a hospitalist effectively balance their clinical and administrative duties? Furthermore, what happens when the scales tip in favor—and to the detriment—of one or the other?

When the Juggling Begins

Hospitalists usually add “extra” duties to their normal workloads to advance their careers. Few relinquish their clinical duties as they join committees, further their training, lead a research project, or take on administrative duties.

Dr. Faro says a hospitalist should be able to “head up a focused project or serve on committees” and still be able to meet all their clinical duties. “Once you get beyond that, you need a certain amount of protected time” for administrative or project work, she says. “And when you start to have people reporting to you, you absolutely need that protected time.”

Assigning administrative tasks to physicians who regularly see patients depends on the group structure and requires a clearly defined job description. “If a group is really going to make this work, then you have to pay people for that extra time,” Dr. Gorman says.

Ideally, HM groups have job descriptions for physicians who are called upon to see patients and handle administrative duties. Contracts should include specifications for “protected time,” as well as compensation for new responsibilities.

Clinical-Hour Cutbacks

As administrative duties grow, something has to give. Hospitalists who want to pursue positions of leadership know that that something is hours spent delivering patient care. “If you’re a hospitalist-administrator who wants to make the leap to vice president or department chair or chief medical officer, you need to devote a lot of time to your administrative work,” Dr. Faro says. “You can’t make that leap without putting in those hours.”

So what is a reasonable division of time for, say, the director of an HM program or department? “It’s impossible to pinpoint, but I’d say roughly that [a director] should spend not less than 25% or 30% of their time, and certainly not more than 50% of their time, on clinical work,” Dr. Faro estimates.

Even upper-level physician-administrators should maintain a clinical practice simply to monitor the work their department is doing. “It’s not about [clinical] skills as much as it is about whether you can relate to physicians’ day-to-day work, to their frustrations,” Dr. Gorman says. “That’s a management challenge no matter who you are. For example, if hospitalists are complaining about a new EMR [electronic medical record] system, are you going to say, ‘Oh, just put up with it; it’s not that bad. It will be fine’? Or are you out there trying it and saying, ‘Holy cow, this is really inefficient. We have to change this’?”

On the flip side, how much time should be devoted to administrative tasks? The answer depends on the size of your program and the amount of work you have to do, Dr. Faro says. Group directors and department heads normally make themselves available during regular weekday hours. That usually means you’ll have to fit in your clinical work around meetings, budgets, and presentations.

Can You Give Up Clinical Duties?

It’s natural for physicians to be reluctant to relinquish patient care; some reach a point where they have to make the tough decision to stop clinical work altogether.

“You may figure out that you want to pursue an administrative role, but you don’t want to give up clinical work,” says Dr. Gorman, who spent 15 years juggling a full clinical schedule with administrative duties before she became a full-time administrator. “You get plenty of opportunities to make that decision as you’re crossing back and forth.”

You might want to evaluate your options and make the choice sooner rather than later. Once you’re in administration, the decision might be forced upon you. “Eventually, you’ll find that critical things are happening all hours of the day, any given day of the week, in administration as well as clinical practice,” Dr. Faro says. “There’s a point at which you realize that part-time [administrative work] just doesn’t work. You realize that your expertise and guidance are needed.”

Dr. Gorman warns that there are risks and changes involved with becoming a full-time administrator. Once you decide to give up your clinical practice and go the leadership route, your career is “in the hands of someone else,” she points out. “Your position could be eliminated. You could be fired or replaced. … That is a concern. A lot of people keep their hand in on clinical skills for that reason.” You also might find that advancing a management career requires moving to a new organization or a different part of the country.

On the other hand, the rewards of a career in administration can’t be overlooked. “It’s very satisfying personally,” Dr. Faro says. “It’s inventive; you’re constantly solving problems that didn’t exist yesterday.

“It’s a different kind of job satisfaction. It’s a very personal decision. There are people who realize that this just isn’t for them.” TH

Jane Jerrard is a freelance writer based in Chicago.

How do you spend your time off? Do you neglect your to-do list in favor of rest and relaxation, or do you race around trying to get everything done? How you use your free time affects your energy level and on-the-job enthusiasm. Hospitalists who learn to make the most of their time off reduce their stress and master the elusive work-life balance, and are more likely to avoid burnout. It’s especially true of physicians who work long hours followed by multiple days of downtime.

“I tell hospitalists … that they have to know what a sense of ‘work-life balance’ means to them,” says Iris Grimm, creator of the Balanced Physician program and founder of Marietta, Ga.-based Master Performance Inc. (www.balanced physician.com). Understanding what you need to lead a healthy, balanced life is crucial to your happiness and well-being on and off the job.

Hospitalists who work long shifts also face extended stretches of time off that are vital to recharging one’s batteries. “One of the challenges they have is to find a routine,” Grimm says. “As human beings, we prefer to have a daily routine, which is a benefit from a health standpoint. These people have different sleep patterns when they’re off, which can throw off their bodies, which in turn has an effect on health and well-being.”

Plan to Cope

The allure of regular, extended time off—namely, the seven-day-on, seven-day-off schedule model—can factor heavily into a physician’s decision to choose an HM career. A full week off is ideal for some, but not so ideal for others.

Many think the seven-on, seven-off schedule increases the likelihood of physician burnout. Others think the exact opposite. No matter what, the “intense shift” model is not going away anytime soon, says Chad Whelan, MD, FHM, associate professor of medicine and director of the division of hospital medicine at Loyola University Chicago Stritch School of Medicine.

The first step in maximizing your personal time is to accept your schedule. “Whatever schedule you’re working, you’re going to be working when others are not,” Dr. Whelan says. “You have to recognize that, and you have to own it.”

Once you accept the fact that you’ll miss out on some activities—from dinner parties to your child’s Little League baseball games—that fall on your workdays, you can move on to a key component of maximizing your days off: the art of planning.

Planning your days off helps ensure that you don’t end up wasting them. “Your plan could include exercise, visiting with friends, and keeping up with CME,” Grimm says. Dr. Whelan agrees: “You have to do some active planning to schedule things that need to get done.” He knows from personal experience that “the mundane details are easy to drop; instead of grocery shopping, you end up ordering in. I find that if I schedule these things—even at a funky time like late at night—I’ll get them done.”

Planning works both ways. “Part of balance is using time in your off days to prepare for when you’ll be working,” Grimm says. For example, make sure you have food in your refrigerator so that you can have a healthy breakfast and occasionally prepare dinners in advance that you can quickly heat up after your shift.

Focusing your organizational skills and planning on personal “to-dos” will lighten the load of a long workday. “Automate as much as possible—such as paying bills,” Grimm advises, “and delegate what you can. The less you have to keep track of, the less stress you’ll feel and the more energy you’ll find to do what you’re paid to do.”

Time for Self

Physicians, especially those with families, need to remember to make time for themselves “so that you won’t build resentment toward others,” Grimm says. “Doing something for yourself refills your energy tank.” Whether it’s exercising, going fishing, volunteering at the community center, downloading photos from your digital camera, or reading a book, “it’s different for everyone,” Grimm points out. “You have to know what you need.”

Dr. Whelan—who is a runner—focuses on physical activity to relieve stress and re-energize his mind and body. “It’s hard, because people who are serious about exercise, however you define ‘serious,’ are told to exercise on a consistent schedule. Well, we don’t have consistent schedules,” he says. “The key is to recognize that this is a challenge and find a creative way to schedule it, just like we make other decisions creatively. You have to make an upfront commitment.”

Whatever you do to “refill your tank,” there’s a good reason to devote time to it. “The more we do for ourselves, the more we can do for others,” Grimm says. “It’s not an hour-to-hour ratio; you might just need a five-minute meditation at the end of the day. … I always challenge my clients to be aware of what gives them energy and what takes energy away from them. This is essential for work, and essential for life.”

Leave Work Behind

One of the hardest things to learn—a lesson left out of medical school texts—is how to leave the stress and responsibility of the job at the office. “These are intense jobs; they’re high-stress,” Dr. Whelan explains. “The good thing about being a hospitalist is that when you’re off, you’re off. But it’s important to be able to compartmentalize.”

Dr. Whelan learned a couple of simple strategies to help with this concept. “At the end of every work day, after you’ve signed off, dedicate some time to transition. It can be just 10 or 15 minutes. Don’t answer the phone or e-mail; just dedicate that time to transition,” he says. “Run through your day and process each part—whether that’s each patient or each administrative task—emotionally and intellectually. For each one, make a plan for what you’ll do tomorrow. Once you’ve worked through your day this way, you can allow yourself to let it go.”

He also advises hospitalists to use on-the-job time when it’s available, rather than overlapping work and personal time. “There are parts of your business that can be done when you’re not seeing patients, such as reading journals,” Dr. Whelan says. “Try to schedule those things into your [work day], so you don’t end up catching up on them at home.”

Find Your Balance

Make it a point to make the most of your time off. Plan it in advance to ensure you do what you need to do and what you want to do. Think creatively and include all types of activities. And be sure to include time for yourself.

“There are very few of us who can sustain a life made up entirely of work and still be happy,” Dr. Whelan says. “Eventually, you’ll start to resent the work, and that’s the stuff that leads to burnout. You’re also probably not doing as good a job.”

One final piece of advice: Be prepared to change.

“You need to be self-aware, and you need to realize that your definition of balance will shift with age, responsibility, and goals,” Grimm says. TH

Jane Jerrard is a freelance writer based in Chicago.

How do you spend your time off? Do you neglect your to-do list in favor of rest and relaxation, or do you race around trying to get everything done? How you use your free time affects your energy level and on-the-job enthusiasm. Hospitalists who learn to make the most of their time off reduce their stress and master the elusive work-life balance, and are more likely to avoid burnout. It’s especially true of physicians who work long hours followed by multiple days of downtime.

“I tell hospitalists … that they have to know what a sense of ‘work-life balance’ means to them,” says Iris Grimm, creator of the Balanced Physician program and founder of Marietta, Ga.-based Master Performance Inc. (www.balanced physician.com). Understanding what you need to lead a healthy, balanced life is crucial to your happiness and well-being on and off the job.

Hospitalists who work long shifts also face extended stretches of time off that are vital to recharging one’s batteries. “One of the challenges they have is to find a routine,” Grimm says. “As human beings, we prefer to have a daily routine, which is a benefit from a health standpoint. These people have different sleep patterns when they’re off, which can throw off their bodies, which in turn has an effect on health and well-being.”

Plan to Cope

The allure of regular, extended time off—namely, the seven-day-on, seven-day-off schedule model—can factor heavily into a physician’s decision to choose an HM career. A full week off is ideal for some, but not so ideal for others.

Many think the seven-on, seven-off schedule increases the likelihood of physician burnout. Others think the exact opposite. No matter what, the “intense shift” model is not going away anytime soon, says Chad Whelan, MD, FHM, associate professor of medicine and director of the division of hospital medicine at Loyola University Chicago Stritch School of Medicine.

The first step in maximizing your personal time is to accept your schedule. “Whatever schedule you’re working, you’re going to be working when others are not,” Dr. Whelan says. “You have to recognize that, and you have to own it.”

Once you accept the fact that you’ll miss out on some activities—from dinner parties to your child’s Little League baseball games—that fall on your workdays, you can move on to a key component of maximizing your days off: the art of planning.

Planning your days off helps ensure that you don’t end up wasting them. “Your plan could include exercise, visiting with friends, and keeping up with CME,” Grimm says. Dr. Whelan agrees: “You have to do some active planning to schedule things that need to get done.” He knows from personal experience that “the mundane details are easy to drop; instead of grocery shopping, you end up ordering in. I find that if I schedule these things—even at a funky time like late at night—I’ll get them done.”

Planning works both ways. “Part of balance is using time in your off days to prepare for when you’ll be working,” Grimm says. For example, make sure you have food in your refrigerator so that you can have a healthy breakfast and occasionally prepare dinners in advance that you can quickly heat up after your shift.

Focusing your organizational skills and planning on personal “to-dos” will lighten the load of a long workday. “Automate as much as possible—such as paying bills,” Grimm advises, “and delegate what you can. The less you have to keep track of, the less stress you’ll feel and the more energy you’ll find to do what you’re paid to do.”

Time for Self

Physicians, especially those with families, need to remember to make time for themselves “so that you won’t build resentment toward others,” Grimm says. “Doing something for yourself refills your energy tank.” Whether it’s exercising, going fishing, volunteering at the community center, downloading photos from your digital camera, or reading a book, “it’s different for everyone,” Grimm points out. “You have to know what you need.”

Dr. Whelan—who is a runner—focuses on physical activity to relieve stress and re-energize his mind and body. “It’s hard, because people who are serious about exercise, however you define ‘serious,’ are told to exercise on a consistent schedule. Well, we don’t have consistent schedules,” he says. “The key is to recognize that this is a challenge and find a creative way to schedule it, just like we make other decisions creatively. You have to make an upfront commitment.”

Whatever you do to “refill your tank,” there’s a good reason to devote time to it. “The more we do for ourselves, the more we can do for others,” Grimm says. “It’s not an hour-to-hour ratio; you might just need a five-minute meditation at the end of the day. … I always challenge my clients to be aware of what gives them energy and what takes energy away from them. This is essential for work, and essential for life.”

Leave Work Behind

One of the hardest things to learn—a lesson left out of medical school texts—is how to leave the stress and responsibility of the job at the office. “These are intense jobs; they’re high-stress,” Dr. Whelan explains. “The good thing about being a hospitalist is that when you’re off, you’re off. But it’s important to be able to compartmentalize.”

Dr. Whelan learned a couple of simple strategies to help with this concept. “At the end of every work day, after you’ve signed off, dedicate some time to transition. It can be just 10 or 15 minutes. Don’t answer the phone or e-mail; just dedicate that time to transition,” he says. “Run through your day and process each part—whether that’s each patient or each administrative task—emotionally and intellectually. For each one, make a plan for what you’ll do tomorrow. Once you’ve worked through your day this way, you can allow yourself to let it go.”

He also advises hospitalists to use on-the-job time when it’s available, rather than overlapping work and personal time. “There are parts of your business that can be done when you’re not seeing patients, such as reading journals,” Dr. Whelan says. “Try to schedule those things into your [work day], so you don’t end up catching up on them at home.”

Find Your Balance

Make it a point to make the most of your time off. Plan it in advance to ensure you do what you need to do and what you want to do. Think creatively and include all types of activities. And be sure to include time for yourself.

“There are very few of us who can sustain a life made up entirely of work and still be happy,” Dr. Whelan says. “Eventually, you’ll start to resent the work, and that’s the stuff that leads to burnout. You’re also probably not doing as good a job.”

One final piece of advice: Be prepared to change.

“You need to be self-aware, and you need to realize that your definition of balance will shift with age, responsibility, and goals,” Grimm says. TH

Jane Jerrard is a freelance writer based in Chicago.

How do you spend your time off? Do you neglect your to-do list in favor of rest and relaxation, or do you race around trying to get everything done? How you use your free time affects your energy level and on-the-job enthusiasm. Hospitalists who learn to make the most of their time off reduce their stress and master the elusive work-life balance, and are more likely to avoid burnout. It’s especially true of physicians who work long hours followed by multiple days of downtime.

“I tell hospitalists … that they have to know what a sense of ‘work-life balance’ means to them,” says Iris Grimm, creator of the Balanced Physician program and founder of Marietta, Ga.-based Master Performance Inc. (www.balanced physician.com). Understanding what you need to lead a healthy, balanced life is crucial to your happiness and well-being on and off the job.

Hospitalists who work long shifts also face extended stretches of time off that are vital to recharging one’s batteries. “One of the challenges they have is to find a routine,” Grimm says. “As human beings, we prefer to have a daily routine, which is a benefit from a health standpoint. These people have different sleep patterns when they’re off, which can throw off their bodies, which in turn has an effect on health and well-being.”

Plan to Cope

The allure of regular, extended time off—namely, the seven-day-on, seven-day-off schedule model—can factor heavily into a physician’s decision to choose an HM career. A full week off is ideal for some, but not so ideal for others.

Many think the seven-on, seven-off schedule increases the likelihood of physician burnout. Others think the exact opposite. No matter what, the “intense shift” model is not going away anytime soon, says Chad Whelan, MD, FHM, associate professor of medicine and director of the division of hospital medicine at Loyola University Chicago Stritch School of Medicine.

The first step in maximizing your personal time is to accept your schedule. “Whatever schedule you’re working, you’re going to be working when others are not,” Dr. Whelan says. “You have to recognize that, and you have to own it.”

Once you accept the fact that you’ll miss out on some activities—from dinner parties to your child’s Little League baseball games—that fall on your workdays, you can move on to a key component of maximizing your days off: the art of planning.

Planning your days off helps ensure that you don’t end up wasting them. “Your plan could include exercise, visiting with friends, and keeping up with CME,” Grimm says. Dr. Whelan agrees: “You have to do some active planning to schedule things that need to get done.” He knows from personal experience that “the mundane details are easy to drop; instead of grocery shopping, you end up ordering in. I find that if I schedule these things—even at a funky time like late at night—I’ll get them done.”

Planning works both ways. “Part of balance is using time in your off days to prepare for when you’ll be working,” Grimm says. For example, make sure you have food in your refrigerator so that you can have a healthy breakfast and occasionally prepare dinners in advance that you can quickly heat up after your shift.

Focusing your organizational skills and planning on personal “to-dos” will lighten the load of a long workday. “Automate as much as possible—such as paying bills,” Grimm advises, “and delegate what you can. The less you have to keep track of, the less stress you’ll feel and the more energy you’ll find to do what you’re paid to do.”

Time for Self

Physicians, especially those with families, need to remember to make time for themselves “so that you won’t build resentment toward others,” Grimm says. “Doing something for yourself refills your energy tank.” Whether it’s exercising, going fishing, volunteering at the community center, downloading photos from your digital camera, or reading a book, “it’s different for everyone,” Grimm points out. “You have to know what you need.”

Dr. Whelan—who is a runner—focuses on physical activity to relieve stress and re-energize his mind and body. “It’s hard, because people who are serious about exercise, however you define ‘serious,’ are told to exercise on a consistent schedule. Well, we don’t have consistent schedules,” he says. “The key is to recognize that this is a challenge and find a creative way to schedule it, just like we make other decisions creatively. You have to make an upfront commitment.”

Whatever you do to “refill your tank,” there’s a good reason to devote time to it. “The more we do for ourselves, the more we can do for others,” Grimm says. “It’s not an hour-to-hour ratio; you might just need a five-minute meditation at the end of the day. … I always challenge my clients to be aware of what gives them energy and what takes energy away from them. This is essential for work, and essential for life.”

Leave Work Behind

One of the hardest things to learn—a lesson left out of medical school texts—is how to leave the stress and responsibility of the job at the office. “These are intense jobs; they’re high-stress,” Dr. Whelan explains. “The good thing about being a hospitalist is that when you’re off, you’re off. But it’s important to be able to compartmentalize.”

Dr. Whelan learned a couple of simple strategies to help with this concept. “At the end of every work day, after you’ve signed off, dedicate some time to transition. It can be just 10 or 15 minutes. Don’t answer the phone or e-mail; just dedicate that time to transition,” he says. “Run through your day and process each part—whether that’s each patient or each administrative task—emotionally and intellectually. For each one, make a plan for what you’ll do tomorrow. Once you’ve worked through your day this way, you can allow yourself to let it go.”

He also advises hospitalists to use on-the-job time when it’s available, rather than overlapping work and personal time. “There are parts of your business that can be done when you’re not seeing patients, such as reading journals,” Dr. Whelan says. “Try to schedule those things into your [work day], so you don’t end up catching up on them at home.”

Find Your Balance

Make it a point to make the most of your time off. Plan it in advance to ensure you do what you need to do and what you want to do. Think creatively and include all types of activities. And be sure to include time for yourself.

“There are very few of us who can sustain a life made up entirely of work and still be happy,” Dr. Whelan says. “Eventually, you’ll start to resent the work, and that’s the stuff that leads to burnout. You’re also probably not doing as good a job.”

One final piece of advice: Be prepared to change.

“You need to be self-aware, and you need to realize that your definition of balance will shift with age, responsibility, and goals,” Grimm says. TH

Jane Jerrard is a freelance writer based in Chicago.

If you’ve been a hospitalist leader for a few years, you likely are familiar with the specter of the disruptive physician. Most group leaders dread dealing with a hospitalist who exhibits behavior that upsets the group or the hospital staff; fewer meet the task head-on and try to change that behavior; and fewer still enjoy the challenge.

If you fall into one of the first two categories, take comfort in knowing you aren’t alone. But if you know that problem hospitalists are a management challenge, you should seek counsel or training to address such issues when they arise.

Define “Disruptive”

Managers are responsible for maintaining equilibrium in their HM groups, so it’s important to understand what constitutes disruptive behavior. “What it really comes down to is behavior which can impair patient care, collegiality, and the overall work in the hospital,” says Aaron Gottesman, MD, FACP, director of hospitalist services at Staten Island University Hospital in New York. “If a specific physician or other staff member acts in a way that hampers staff satisfaction, patient satisfaction, and obviously care, then that is disruptive.”

Disruptive behavior in the hospital can come from any staff member, not just physicians. Disruptive physicians receive greater attention because their bad behavior is more likely to be noticed and reported. And they do tend to get angry. “Physicians are time-sensitive, and they’re perfectionists,” says Timothy J. Keogh, PhD, assistant professor at the Citadel School of Business Administration in Charleston, S.C., who has researched physicians’ personality traits. “When they’re put in a stressful situation—such as an ED or ICU, where the outcomes may be uncertain and they’re operating on insufficient sleep or under stress—you may see this behavior.”

Although HM is a stressful career path with challenges of its own, Dr. Gottesman says he rarely notices the same level of disruptive behavior as can be found in the ED, OR, or ICU. “I don’t think it occurs among hospitalists any more than among the general physician population,” he says. “Hospitalists are not under the same time constraints; they don’t have as much stress or pressure—or at least they have a different kind.”

So who is responsible for dealing with a physician who behaves badly? In all cases, it should be the individual’s immediate supervisor.

Policy Preparation

The crucial component in dealing with a disruptive employee is to have an official behavior policy that is shared with everyone in your organization. The Joint Commission recently required hospitals to employ a code of conduct that outlines acceptable and unacceptable behavior, and it sets a process for addressing problematic behavior.

“You can bet physicians and nurses know it, including the disruptive individuals,” Dr. Keogh says. “This will make it much easier for executives to enforce.”

Dr. Gottesman relies on his organization’s policy. “It’s absolutely critical to have a sense of direction, to know what’s appropriate and what’s inappropriate, to have a procedure to follow,” he says. “Having policies and protocol in place is also critical for legal protection if the situation escalates. It protects the physician, the staff, the patients, and the institution.”

Dr. Keogh, a faculty member of SHM’s Leadership Academy, recommends that all physician employees learn their code of conduct policy. “To prevent downstream behaviors, when you get a new hire, don’t just give them this statement—read that section to them out loud,” he advises. “This ensures that they notice it, and gives hospitalist executives a much stronger position when something happens.”

Face-to-Face Meeting

There are two proven methods to successfully deal with disruptive behavior: 1) React to it immediately, and 2) follow up to ensure it doesn’t happen again. When you receive a complaint about a disruptive hospitalist, gather all the information you can on the incident and schedule a meeting to discuss it with the party accused of poor behavior.

“The first occurrence should result in an informal conversation. ‘You stepped over the line here, and we have to make sure it doesn’t happen again,’ ” Dr. Keogh says. He recommends that a human resources staffer be present at this meeting, and supervisors should come prepared with documentation.

“You have to sit them down and go over a written document—don’t just talk about word-of-mouth. Go over the documented occurrence of the behavior,” Dr. Keogh explains. “Talk through what they did, and let them know that you both have to find a way to ensure that it doesn’t happen again. They’ll rationalize their behavior at first, but make sure they understand that it’s unacceptable.”

In the case of an allegation or a one-on-one dispute, Dr. Gottesman advises you “clarify both sides before taking any action. I hear both sides of the story, then we find some common ground and work toward a solution.” In his experience, he says, “by and large, most physicians tend to be responsive when spoken to in a constructive, positive fashion. Let them know that you’re here to support them, not prosecute them. You need to maintain a professional demeanor.”

Dr. Keogh says oftentimes the first disciplinary meeting will be enough to end the disruptive behavior. If the same individual has another incident, schedule a second meeting and emphasize the seriousness of the infraction and disciplinary measures. You might want to have a senior manager, such as your chief medical officer, join the discussion. Officially document the problem and identify the consequences if the employee is disruptive again.

Followup Is Key

Another key to quashing disruptive behavior is doing your part to ensure it doesn’t happen again. “The problem is that the impact is residual on the people around that individual, whether it’s the nurses or patients,” Dr. Keogh says. “The results are avoidance and silence.”

Supervisors should follow up on the disruptive behavior by placing themselves in the problem employee’s way; doing so will let you see how they work and how others react to them, and it will show that you’re keeping an eye on them. “The [manager] has to show ongoing oversight of that individual, with occasional walks in the [hospital halls] and ongoing verbal encouragement, to show that someone is paying attention,” Dr. Keogh says. “They can fall back into bad behaviors if they think no one is watching.” Positive recognition of good behavior and outcomes (i.e., improved patient satisfaction) also helps reinforce your followup.

Depending on the individual and the situation, dealing with a disruptive behavior can be a long-term, never-ending job. But it’s a necessary one.

“There has to be zero tolerance,” Dr. Gottesman says. “People should be comfortable and confident with reporting this behavior. It should not be accepted as a normal part of work to put up with it. And they should know that the situation will be looked at objectively, and both sides will be heard.” TH

Jane Jerrard is a freelance writer based in Chicago.

If you’ve been a hospitalist leader for a few years, you likely are familiar with the specter of the disruptive physician. Most group leaders dread dealing with a hospitalist who exhibits behavior that upsets the group or the hospital staff; fewer meet the task head-on and try to change that behavior; and fewer still enjoy the challenge.

If you fall into one of the first two categories, take comfort in knowing you aren’t alone. But if you know that problem hospitalists are a management challenge, you should seek counsel or training to address such issues when they arise.

Define “Disruptive”

Managers are responsible for maintaining equilibrium in their HM groups, so it’s important to understand what constitutes disruptive behavior. “What it really comes down to is behavior which can impair patient care, collegiality, and the overall work in the hospital,” says Aaron Gottesman, MD, FACP, director of hospitalist services at Staten Island University Hospital in New York. “If a specific physician or other staff member acts in a way that hampers staff satisfaction, patient satisfaction, and obviously care, then that is disruptive.”

Disruptive behavior in the hospital can come from any staff member, not just physicians. Disruptive physicians receive greater attention because their bad behavior is more likely to be noticed and reported. And they do tend to get angry. “Physicians are time-sensitive, and they’re perfectionists,” says Timothy J. Keogh, PhD, assistant professor at the Citadel School of Business Administration in Charleston, S.C., who has researched physicians’ personality traits. “When they’re put in a stressful situation—such as an ED or ICU, where the outcomes may be uncertain and they’re operating on insufficient sleep or under stress—you may see this behavior.”

Although HM is a stressful career path with challenges of its own, Dr. Gottesman says he rarely notices the same level of disruptive behavior as can be found in the ED, OR, or ICU. “I don’t think it occurs among hospitalists any more than among the general physician population,” he says. “Hospitalists are not under the same time constraints; they don’t have as much stress or pressure—or at least they have a different kind.”

So who is responsible for dealing with a physician who behaves badly? In all cases, it should be the individual’s immediate supervisor.

Policy Preparation

The crucial component in dealing with a disruptive employee is to have an official behavior policy that is shared with everyone in your organization. The Joint Commission recently required hospitals to employ a code of conduct that outlines acceptable and unacceptable behavior, and it sets a process for addressing problematic behavior.

“You can bet physicians and nurses know it, including the disruptive individuals,” Dr. Keogh says. “This will make it much easier for executives to enforce.”

Dr. Gottesman relies on his organization’s policy. “It’s absolutely critical to have a sense of direction, to know what’s appropriate and what’s inappropriate, to have a procedure to follow,” he says. “Having policies and protocol in place is also critical for legal protection if the situation escalates. It protects the physician, the staff, the patients, and the institution.”

Dr. Keogh, a faculty member of SHM’s Leadership Academy, recommends that all physician employees learn their code of conduct policy. “To prevent downstream behaviors, when you get a new hire, don’t just give them this statement—read that section to them out loud,” he advises. “This ensures that they notice it, and gives hospitalist executives a much stronger position when something happens.”

Face-to-Face Meeting

There are two proven methods to successfully deal with disruptive behavior: 1) React to it immediately, and 2) follow up to ensure it doesn’t happen again. When you receive a complaint about a disruptive hospitalist, gather all the information you can on the incident and schedule a meeting to discuss it with the party accused of poor behavior.

“The first occurrence should result in an informal conversation. ‘You stepped over the line here, and we have to make sure it doesn’t happen again,’ ” Dr. Keogh says. He recommends that a human resources staffer be present at this meeting, and supervisors should come prepared with documentation.

“You have to sit them down and go over a written document—don’t just talk about word-of-mouth. Go over the documented occurrence of the behavior,” Dr. Keogh explains. “Talk through what they did, and let them know that you both have to find a way to ensure that it doesn’t happen again. They’ll rationalize their behavior at first, but make sure they understand that it’s unacceptable.”

In the case of an allegation or a one-on-one dispute, Dr. Gottesman advises you “clarify both sides before taking any action. I hear both sides of the story, then we find some common ground and work toward a solution.” In his experience, he says, “by and large, most physicians tend to be responsive when spoken to in a constructive, positive fashion. Let them know that you’re here to support them, not prosecute them. You need to maintain a professional demeanor.”

Dr. Keogh says oftentimes the first disciplinary meeting will be enough to end the disruptive behavior. If the same individual has another incident, schedule a second meeting and emphasize the seriousness of the infraction and disciplinary measures. You might want to have a senior manager, such as your chief medical officer, join the discussion. Officially document the problem and identify the consequences if the employee is disruptive again.

Followup Is Key

Another key to quashing disruptive behavior is doing your part to ensure it doesn’t happen again. “The problem is that the impact is residual on the people around that individual, whether it’s the nurses or patients,” Dr. Keogh says. “The results are avoidance and silence.”

Supervisors should follow up on the disruptive behavior by placing themselves in the problem employee’s way; doing so will let you see how they work and how others react to them, and it will show that you’re keeping an eye on them. “The [manager] has to show ongoing oversight of that individual, with occasional walks in the [hospital halls] and ongoing verbal encouragement, to show that someone is paying attention,” Dr. Keogh says. “They can fall back into bad behaviors if they think no one is watching.” Positive recognition of good behavior and outcomes (i.e., improved patient satisfaction) also helps reinforce your followup.

Depending on the individual and the situation, dealing with a disruptive behavior can be a long-term, never-ending job. But it’s a necessary one.

“There has to be zero tolerance,” Dr. Gottesman says. “People should be comfortable and confident with reporting this behavior. It should not be accepted as a normal part of work to put up with it. And they should know that the situation will be looked at objectively, and both sides will be heard.” TH

Jane Jerrard is a freelance writer based in Chicago.

If you’ve been a hospitalist leader for a few years, you likely are familiar with the specter of the disruptive physician. Most group leaders dread dealing with a hospitalist who exhibits behavior that upsets the group or the hospital staff; fewer meet the task head-on and try to change that behavior; and fewer still enjoy the challenge.

If you fall into one of the first two categories, take comfort in knowing you aren’t alone. But if you know that problem hospitalists are a management challenge, you should seek counsel or training to address such issues when they arise.

Define “Disruptive”

Managers are responsible for maintaining equilibrium in their HM groups, so it’s important to understand what constitutes disruptive behavior. “What it really comes down to is behavior which can impair patient care, collegiality, and the overall work in the hospital,” says Aaron Gottesman, MD, FACP, director of hospitalist services at Staten Island University Hospital in New York. “If a specific physician or other staff member acts in a way that hampers staff satisfaction, patient satisfaction, and obviously care, then that is disruptive.”

Disruptive behavior in the hospital can come from any staff member, not just physicians. Disruptive physicians receive greater attention because their bad behavior is more likely to be noticed and reported. And they do tend to get angry. “Physicians are time-sensitive, and they’re perfectionists,” says Timothy J. Keogh, PhD, assistant professor at the Citadel School of Business Administration in Charleston, S.C., who has researched physicians’ personality traits. “When they’re put in a stressful situation—such as an ED or ICU, where the outcomes may be uncertain and they’re operating on insufficient sleep or under stress—you may see this behavior.”

Although HM is a stressful career path with challenges of its own, Dr. Gottesman says he rarely notices the same level of disruptive behavior as can be found in the ED, OR, or ICU. “I don’t think it occurs among hospitalists any more than among the general physician population,” he says. “Hospitalists are not under the same time constraints; they don’t have as much stress or pressure—or at least they have a different kind.”

So who is responsible for dealing with a physician who behaves badly? In all cases, it should be the individual’s immediate supervisor.

Policy Preparation

The crucial component in dealing with a disruptive employee is to have an official behavior policy that is shared with everyone in your organization. The Joint Commission recently required hospitals to employ a code of conduct that outlines acceptable and unacceptable behavior, and it sets a process for addressing problematic behavior.

“You can bet physicians and nurses know it, including the disruptive individuals,” Dr. Keogh says. “This will make it much easier for executives to enforce.”

Dr. Gottesman relies on his organization’s policy. “It’s absolutely critical to have a sense of direction, to know what’s appropriate and what’s inappropriate, to have a procedure to follow,” he says. “Having policies and protocol in place is also critical for legal protection if the situation escalates. It protects the physician, the staff, the patients, and the institution.”

Dr. Keogh, a faculty member of SHM’s Leadership Academy, recommends that all physician employees learn their code of conduct policy. “To prevent downstream behaviors, when you get a new hire, don’t just give them this statement—read that section to them out loud,” he advises. “This ensures that they notice it, and gives hospitalist executives a much stronger position when something happens.”

Face-to-Face Meeting

There are two proven methods to successfully deal with disruptive behavior: 1) React to it immediately, and 2) follow up to ensure it doesn’t happen again. When you receive a complaint about a disruptive hospitalist, gather all the information you can on the incident and schedule a meeting to discuss it with the party accused of poor behavior.

“The first occurrence should result in an informal conversation. ‘You stepped over the line here, and we have to make sure it doesn’t happen again,’ ” Dr. Keogh says. He recommends that a human resources staffer be present at this meeting, and supervisors should come prepared with documentation.

“You have to sit them down and go over a written document—don’t just talk about word-of-mouth. Go over the documented occurrence of the behavior,” Dr. Keogh explains. “Talk through what they did, and let them know that you both have to find a way to ensure that it doesn’t happen again. They’ll rationalize their behavior at first, but make sure they understand that it’s unacceptable.”

In the case of an allegation or a one-on-one dispute, Dr. Gottesman advises you “clarify both sides before taking any action. I hear both sides of the story, then we find some common ground and work toward a solution.” In his experience, he says, “by and large, most physicians tend to be responsive when spoken to in a constructive, positive fashion. Let them know that you’re here to support them, not prosecute them. You need to maintain a professional demeanor.”

Dr. Keogh says oftentimes the first disciplinary meeting will be enough to end the disruptive behavior. If the same individual has another incident, schedule a second meeting and emphasize the seriousness of the infraction and disciplinary measures. You might want to have a senior manager, such as your chief medical officer, join the discussion. Officially document the problem and identify the consequences if the employee is disruptive again.

Followup Is Key

Another key to quashing disruptive behavior is doing your part to ensure it doesn’t happen again. “The problem is that the impact is residual on the people around that individual, whether it’s the nurses or patients,” Dr. Keogh says. “The results are avoidance and silence.”

Supervisors should follow up on the disruptive behavior by placing themselves in the problem employee’s way; doing so will let you see how they work and how others react to them, and it will show that you’re keeping an eye on them. “The [manager] has to show ongoing oversight of that individual, with occasional walks in the [hospital halls] and ongoing verbal encouragement, to show that someone is paying attention,” Dr. Keogh says. “They can fall back into bad behaviors if they think no one is watching.” Positive recognition of good behavior and outcomes (i.e., improved patient satisfaction) also helps reinforce your followup.

Depending on the individual and the situation, dealing with a disruptive behavior can be a long-term, never-ending job. But it’s a necessary one.

“There has to be zero tolerance,” Dr. Gottesman says. “People should be comfortable and confident with reporting this behavior. It should not be accepted as a normal part of work to put up with it. And they should know that the situation will be looked at objectively, and both sides will be heard.” TH

Jane Jerrard is a freelance writer based in Chicago.

Some healthcare providers probably missed an important change buried within the 2009 Medicare Physician Fee Schedule: New rules for physician enrollment have drastically reduced the period for retroactive billing. Effective April 1, physicians enrolling or re-enrolling with Medicare can only submit a bill for services provided up to 30 days prior to the effective date, rather than for the prior 27 months.

Those who miss this deadline will be denied reimbursement for services to Medicare patients seen before the deadline. And those who move to a new job (“change of location,” in Medicare parlance) and fail to update their address within 30 days risk a two-year suspension from receiving Medicare payments.

What It Means

Essentially, HM group leaders must make sure they are ready to credential a new hire long before they start working. Before now, groups had months to get new hires enrolled in the Medicare system; now, with just 30 days to enroll, you need to start your credentialing and enrollment process early—before the physician’s start date, if possible.

“In a nutshell, groups are going to have to be more proactive than ever before in getting paperwork submitted for new providers,” says Derise Woods, operations project manager for Knoxville, Tenn.-based TeamHealth. “The situation we often face is that the provider is found and placed, and sometimes the paperwork does not get submitted right away. The natural focus is to get them on board and then get them up and running.”

If that is the case in your group, you should create a checklist for enrollment in Medicare and for other payors. Then, as soon as your new hire signs the contract, require them to submit all available information (e.g., DEA number and proof of board certification).

Woods says the rule states that “retroactive billing can start from the provider’s start date or from the date the enrollment is received at [Medicare], whichever is later.”

Even if you don’t capture all the necessary information, enroll the new physician as soon as possible. According to the Centers for Medicare & Medicaid Services (CMS), incomplete applications will be denied, but the date of the original filing will be preserved. So if a hospitalist begins working for your group Sept. 1, and you submit the enrollment application Sept. 7, the hospitalist can bill retroactively starting Sept. 7, even if that application is kicked back to you for more information and doesn’t get resolved for several weeks.

Large and Small Groups

Missing the new enrollment deadline means reimbursement losses. Hospitalists provide services to a significant number of Medicare patients, so cutting back on retroactive billing could hurt the bottom line. “In most [HM] instances where Medicare is a large portion of income, this has potential to disrupt a practice,” Woods says, noting TeamHealth has yet to see the impact of the new enrollment rules.

Which entity incurs the loss of Medicare payments depends on your program’s payment structure. “For instance, TeamHealth contracts with our providers and pays them an hourly rate,” says Woods, explaining that the third-party contractor will suffer any loss of fees. “In a hospital-based program, the hospital might bill for the provider—and that provider may not get paid.”

Smaller HM groups might not have as much experience with these changes simply because they don’t hire physicians as often. “I did not know about this,” says Heidi Tessler, MD, president of the Colorado Hospitalist Company in Denver. “We contract with a billing company [for physician enrollments], and we would have been caught flat-footed with our next hire.”

Small groups could end up scrambling when they need to fill a position, especially if it’s a quick turnover. Groups that outsource their recruiting and billing should plan to communicate with those companies to expedite the enrollment process, Woods says.

TeamHealth, the largest provider of hospital-based clinical outsourcing in the U.S., has made numerous changes to accommodate the new enrollment rules, all the way up to a new business development group. “They now take this new rule into consideration when we are planning to start providing service,” Woods says. “Our recruiters are helping. They are ensuring that new providers fill out their paperwork and get it in. Understandably, physicians can let paperwork sit for a number of days.”

The good news is CMS has made it easier—and faster—to enroll through a Web-based portal called PECOS (Provider Enrollment, Chain, and Ownership System), which can be accessed at www.cms.hhs.gov/MedicareProviderSupEnroll/.

Central Source

SHM has consolidated essential sources on the new rules to include:

• Medicare’s all-inclusive Web section on provider enrollment is www.cms.hhs.gov/medicareprovidersupenroll.
• The CMS manual on enrollment is at www.cms.hhs.gov. Click on “manuals,” then “Internet-only manuals”; select “Publication 100-08, Program Integrity Manual,” then “Chapter 10.”
• AMA provides an overview on its Web site, and, with the Medical Group Management Association (MGMA), has developed a toolkit to guide physicians through the new rules. “The toolkit is probably the best resource available,” says Leslie Flores, principal in Nelson/Flores Associates, a national hospitalist management consulting firm and director of SHM’s Practice Management Institute. AMA and MGMA members can access the toolkit at www.mgma.com/policy/default.aspx?id=5712.

“SHM wants to make sure we communicate these new rules to our members,” says Flores, “and provide direction to resources they can use.” Check www.hospitalmedicine.org for the latest links and information. TH

Jane Jerrard is a freelance writer based in Chicago.

Some healthcare providers probably missed an important change buried within the 2009 Medicare Physician Fee Schedule: New rules for physician enrollment have drastically reduced the period for retroactive billing. Effective April 1, physicians enrolling or re-enrolling with Medicare can only submit a bill for services provided up to 30 days prior to the effective date, rather than for the prior 27 months.

Those who miss this deadline will be denied reimbursement for services to Medicare patients seen before the deadline. And those who move to a new job (“change of location,” in Medicare parlance) and fail to update their address within 30 days risk a two-year suspension from receiving Medicare payments.

What It Means

Essentially, HM group leaders must make sure they are ready to credential a new hire long before they start working. Before now, groups had months to get new hires enrolled in the Medicare system; now, with just 30 days to enroll, you need to start your credentialing and enrollment process early—before the physician’s start date, if possible.

“In a nutshell, groups are going to have to be more proactive than ever before in getting paperwork submitted for new providers,” says Derise Woods, operations project manager for Knoxville, Tenn.-based TeamHealth. “The situation we often face is that the provider is found and placed, and sometimes the paperwork does not get submitted right away. The natural focus is to get them on board and then get them up and running.”

If that is the case in your group, you should create a checklist for enrollment in Medicare and for other payors. Then, as soon as your new hire signs the contract, require them to submit all available information (e.g., DEA number and proof of board certification).

Woods says the rule states that “retroactive billing can start from the provider’s start date or from the date the enrollment is received at [Medicare], whichever is later.”

Even if you don’t capture all the necessary information, enroll the new physician as soon as possible. According to the Centers for Medicare & Medicaid Services (CMS), incomplete applications will be denied, but the date of the original filing will be preserved. So if a hospitalist begins working for your group Sept. 1, and you submit the enrollment application Sept. 7, the hospitalist can bill retroactively starting Sept. 7, even if that application is kicked back to you for more information and doesn’t get resolved for several weeks.

Large and Small Groups

Missing the new enrollment deadline means reimbursement losses. Hospitalists provide services to a significant number of Medicare patients, so cutting back on retroactive billing could hurt the bottom line. “In most [HM] instances where Medicare is a large portion of income, this has potential to disrupt a practice,” Woods says, noting TeamHealth has yet to see the impact of the new enrollment rules.

Which entity incurs the loss of Medicare payments depends on your program’s payment structure. “For instance, TeamHealth contracts with our providers and pays them an hourly rate,” says Woods, explaining that the third-party contractor will suffer any loss of fees. “In a hospital-based program, the hospital might bill for the provider—and that provider may not get paid.”

Smaller HM groups might not have as much experience with these changes simply because they don’t hire physicians as often. “I did not know about this,” says Heidi Tessler, MD, president of the Colorado Hospitalist Company in Denver. “We contract with a billing company [for physician enrollments], and we would have been caught flat-footed with our next hire.”

Small groups could end up scrambling when they need to fill a position, especially if it’s a quick turnover. Groups that outsource their recruiting and billing should plan to communicate with those companies to expedite the enrollment process, Woods says.

TeamHealth, the largest provider of hospital-based clinical outsourcing in the U.S., has made numerous changes to accommodate the new enrollment rules, all the way up to a new business development group. “They now take this new rule into consideration when we are planning to start providing service,” Woods says. “Our recruiters are helping. They are ensuring that new providers fill out their paperwork and get it in. Understandably, physicians can let paperwork sit for a number of days.”

The good news is CMS has made it easier—and faster—to enroll through a Web-based portal called PECOS (Provider Enrollment, Chain, and Ownership System), which can be accessed at www.cms.hhs.gov/MedicareProviderSupEnroll/.

Central Source

SHM has consolidated essential sources on the new rules to include:

• Medicare’s all-inclusive Web section on provider enrollment is www.cms.hhs.gov/medicareprovidersupenroll.
• The CMS manual on enrollment is at www.cms.hhs.gov. Click on “manuals,” then “Internet-only manuals”; select “Publication 100-08, Program Integrity Manual,” then “Chapter 10.”
• AMA provides an overview on its Web site, and, with the Medical Group Management Association (MGMA), has developed a toolkit to guide physicians through the new rules. “The toolkit is probably the best resource available,” says Leslie Flores, principal in Nelson/Flores Associates, a national hospitalist management consulting firm and director of SHM’s Practice Management Institute. AMA and MGMA members can access the toolkit at www.mgma.com/policy/default.aspx?id=5712.

“SHM wants to make sure we communicate these new rules to our members,” says Flores, “and provide direction to resources they can use.” Check www.hospitalmedicine.org for the latest links and information. TH

Jane Jerrard is a freelance writer based in Chicago.

Some healthcare providers probably missed an important change buried within the 2009 Medicare Physician Fee Schedule: New rules for physician enrollment have drastically reduced the period for retroactive billing. Effective April 1, physicians enrolling or re-enrolling with Medicare can only submit a bill for services provided up to 30 days prior to the effective date, rather than for the prior 27 months.

Those who miss this deadline will be denied reimbursement for services to Medicare patients seen before the deadline. And those who move to a new job (“change of location,” in Medicare parlance) and fail to update their address within 30 days risk a two-year suspension from receiving Medicare payments.

What It Means

Essentially, HM group leaders must make sure they are ready to credential a new hire long before they start working. Before now, groups had months to get new hires enrolled in the Medicare system; now, with just 30 days to enroll, you need to start your credentialing and enrollment process early—before the physician’s start date, if possible.

“In a nutshell, groups are going to have to be more proactive than ever before in getting paperwork submitted for new providers,” says Derise Woods, operations project manager for Knoxville, Tenn.-based TeamHealth. “The situation we often face is that the provider is found and placed, and sometimes the paperwork does not get submitted right away. The natural focus is to get them on board and then get them up and running.”

If that is the case in your group, you should create a checklist for enrollment in Medicare and for other payors. Then, as soon as your new hire signs the contract, require them to submit all available information (e.g., DEA number and proof of board certification).

Woods says the rule states that “retroactive billing can start from the provider’s start date or from the date the enrollment is received at [Medicare], whichever is later.”

Even if you don’t capture all the necessary information, enroll the new physician as soon as possible. According to the Centers for Medicare & Medicaid Services (CMS), incomplete applications will be denied, but the date of the original filing will be preserved. So if a hospitalist begins working for your group Sept. 1, and you submit the enrollment application Sept. 7, the hospitalist can bill retroactively starting Sept. 7, even if that application is kicked back to you for more information and doesn’t get resolved for several weeks.

Large and Small Groups

Missing the new enrollment deadline means reimbursement losses. Hospitalists provide services to a significant number of Medicare patients, so cutting back on retroactive billing could hurt the bottom line. “In most [HM] instances where Medicare is a large portion of income, this has potential to disrupt a practice,” Woods says, noting TeamHealth has yet to see the impact of the new enrollment rules.

Which entity incurs the loss of Medicare payments depends on your program’s payment structure. “For instance, TeamHealth contracts with our providers and pays them an hourly rate,” says Woods, explaining that the third-party contractor will suffer any loss of fees. “In a hospital-based program, the hospital might bill for the provider—and that provider may not get paid.”

Smaller HM groups might not have as much experience with these changes simply because they don’t hire physicians as often. “I did not know about this,” says Heidi Tessler, MD, president of the Colorado Hospitalist Company in Denver. “We contract with a billing company [for physician enrollments], and we would have been caught flat-footed with our next hire.”

Small groups could end up scrambling when they need to fill a position, especially if it’s a quick turnover. Groups that outsource their recruiting and billing should plan to communicate with those companies to expedite the enrollment process, Woods says.

TeamHealth, the largest provider of hospital-based clinical outsourcing in the U.S., has made numerous changes to accommodate the new enrollment rules, all the way up to a new business development group. “They now take this new rule into consideration when we are planning to start providing service,” Woods says. “Our recruiters are helping. They are ensuring that new providers fill out their paperwork and get it in. Understandably, physicians can let paperwork sit for a number of days.”

The good news is CMS has made it easier—and faster—to enroll through a Web-based portal called PECOS (Provider Enrollment, Chain, and Ownership System), which can be accessed at www.cms.hhs.gov/MedicareProviderSupEnroll/.

Central Source

SHM has consolidated essential sources on the new rules to include:

• Medicare’s all-inclusive Web section on provider enrollment is www.cms.hhs.gov/medicareprovidersupenroll.
• The CMS manual on enrollment is at www.cms.hhs.gov. Click on “manuals,” then “Internet-only manuals”; select “Publication 100-08, Program Integrity Manual,” then “Chapter 10.”
• AMA provides an overview on its Web site, and, with the Medical Group Management Association (MGMA), has developed a toolkit to guide physicians through the new rules. “The toolkit is probably the best resource available,” says Leslie Flores, principal in Nelson/Flores Associates, a national hospitalist management consulting firm and director of SHM’s Practice Management Institute. AMA and MGMA members can access the toolkit at www.mgma.com/policy/default.aspx?id=5712.

“SHM wants to make sure we communicate these new rules to our members,” says Flores, “and provide direction to resources they can use.” Check www.hospitalmedicine.org for the latest links and information. TH

Jane Jerrard is a freelance writer based in Chicago.

How healthy is your hospital? When considering your answer, tally up latex gloves, sterilizing cleansers, disposable instruments, and gowns as pluses. However, these items and hundreds more can count against your facility—when you consider the effect your hospital has on its immediate (and not so immediate) environment.

Hospitals are tremendous producers of toxins, including mercury and excess pharmaceuticals, as well as solid and hazardous wastes.

“In healthcare, the footprint we’re leaving behind directly impacts our health,” points out Mary Daubach-Larsen, director of material operations and chairman of the Green LEEDers Task Force at Advocate Lutheran General Hospital in Park Ridge, Ill.

Many hospitals are taking steps to reduce that footprint.

It’s Easy Being Green

Hospitals that want to make a commitment to become more environmentally friendly can hire a full-time expert to guide their efforts, and/or they can appoint a task force—often called a green team. Lutheran General has had great success with the green team model.

A 617-bed teaching, research, and tertiary care hospital and Level 1 trauma center, Lutheran General is one of the largest hospitals in the Chicago area. Under the leadership of Daubach-Larsen, the hospital’s Green LEEDers Task Force has made great strides in several areas, earning Lutheran General a national 2006 Partners in Change award from Hospitals for a Healthy Environment (H2E).

“We’ve been recycling for more than five years,” says Daubach-Larsen. “We’ve stepped up and widened our efforts to include recycling glass, plastic, and aluminum, and we’re also reducing mercury in our environment. We’re close to being mercury free—that’s a goal of all [U.S.] hospitals.”

Lutheran General is now focusing on reducing toxins, examining their cleansers and their disposal of pharmaceuticals.

Like most hospitals that make an environmental commitment, Lutheran General began its efforts with guidance from H2E (www.h2e-online.org), a nonprofit group founded by the American Hospital Association, the U.S. Environmental Protection Agency, Health Care Without Harm, and the American Nurses Association.

“H2E’s mission is to green the entire healthcare sector,” says Laura Brannen, executive director of H2E. “We focus on reducing waste, toxic chemicals, and mercury.” Hospitals can join H2E for free, and nearly 25% of all U.S. hospitals currently belong to H2E.

About the Green Team

An effective hospital green team should include members from multiple departments, to ensure that new environmentally friendly practices, such as using recycling bins for specific waste materials or purchasing “green” cleansers, are taught to all applicable staff and followed by all necessary departments.

“A traditional green team brings together people from a variety of backgrounds,” says Brannen. “It’s best to have a balance between people who need to be [on the team] and those who are motivated to be there because they care.”

In addition to Daubach-Larsen, Lutheran General’s task force includes four nurses, a physician, a psychologist, and representatives from food/nutrition, infection control, pharmacy, public relations, physician relations, and guests from facilities.

Catholic Healthcare West (CHW), which made a commitment to environmentally friendly practices in 1996, has an environmental action committee at each of its 40 hospitals.

“Each of these committees is responsible for establishing goals, monitoring progress, overseeing implementation, and training staff at their hospital,” explains Sister Mary Ellen Leciejewski, OP, ecology program coordinator, CHW, Santa Cruz, Calif. “They also look for groups in their community that they should be partnering with.”

In addition to this overall team, Brannen recommends two other groups for a successful approach: recycling coordinators and an executive group. “Recycling coordinators are department liaisons for the staff in that area,” she explains. “They’re responsible for number and placement of recycling bins, labeling, and staff training in their area. This brings implementation down directly where it’s happening. You can have a coordinator for every shift.”

As for the executive level, Brannen recommends an “environmental leadership council” made up of the highest-level executives possible from a variety of departments. “This council would only meet twice a year, or maybe quarterly,” explains Brannen. “They make institutional decisions and commitments. They might sign off on an environmental mission statement, for example. They legitimize in a big way what the institution is doing.”

Talk Trash

An easy and obvious place to start an environmental effort is by reducing the amount of waste your hospital produces.

“It makes sense to start with waste and move on from there,” advises Daubach-Larsen of starting a Green Team effort. “H2E offers a waste management template to help you gather data on your waste streams. You can use that data to show management” how much more efficiently your hospital can work. She advises that hospitals audit their various waste outputs, including hazardous waste, recycling, and general trash, with the help of their waste vendor. “You can save money immediately, starting with a study of what’s going on,” she says.

With the data collected on waste and the buy-in of management, you can begin the work of shifting more waste toward recycling—or perhaps eliminating some waste altogether.

“Improve your relationship with your waste vendor,” advises Daubach-Larsen. “You can start to push them to accept more recyclables. When they realize there’s a demand, they’ll accept different materials.”

Address Toxins, Energy, and More

Beyond reducing waste, hospitals can make many environmental improvements—it’s simply a matter of choosing priorities. “The spectrum is large and can be overwhelming,” admits Daubach-Larsen.

In addition to waste and recycling, H2E helps hospitals address a wide variety of environmental issues. “We’ve moved on to environmentally friendly purchasing, green building, safer material choices, and energy efficiency,” says Brannen.

One area many green hospitals are beginning to watch closely is their purchasing, including their vendors. “We’re members of a group purchasing company that has green management strategies,” says Daubach-Larsen. “Most of the big groups are now on that bandwagon.” As part of their green purchasing habits, Lutheran General is trying to expand their use of products that are environmentally friendly. “We’ve also started sending out an RFP [request for proposal] asking vendors about their practices,” says Daubach-Larsen.

“Supply chain management is so important,” stresses Leciejewski. “If we watch what’s coming in our front door, we don’t have to worry so much about what we’re sending out our back door.”

CHW is currently working on multiple projects, including reprocessing surgical instruments, responsible disposal of their electronic waste (such as computers), reusable sharp’s containers, and a commitment to the healthiest food possible. “We’re looking at everything from working with organic vendors to the silverware and Styrofoam we use in our cafeterias,” says Leciejewski.

Another area of environmental consciousness is new construction. So-called green building is becoming a trend that reaches beyond healthcare. “If you’re not designing a green building before you break ground, you’re behind the times,” says Brannen. “This movement is really gaining steam, and the cost payback is pretty staggering over the life of the building.”

Daubach-Larsen adds, “Even if you’re not building, you can still incorporate new behaviors that will reduce your footprint on the environment.”

Save the Environment=Save Money

Are green practices too expensive for some hospitals? “The challenge is that people say they don’t have the money to spend [on better environmental practices], but they’re spending too much [now] and they’re tossing resources,” says Brannen.

Daubach-Larsen adds, “There are a lot of efficiencies” that can be realized through green practices. “Reducing solid waste and increasing recycling can save money,” she points out. “Our numbers of hazardous waste, or ‘red bag waste,’ are very low compared to other hospitals—it costs more to dispose of this waste.”

Green Hospitalists?

Where do hospitalists and other physicians fit into the green team picture? “There are hospitalists [who] get the relationships between their hospital[s] and the environment,” says Daubach-Larsen. “They can be ambassadors for that message.”

While green team leadership tends to fall on hospital operations staff, physicians can provide tremendous support simply by advocating with hospital leadership. “Executive sponsorship is key,” says Daubach-Larsen. “And physicians have a direct line to management. They can communicate that their satisfaction in the organization would be improved if that organization took an interest in the environment.”

Brannen says that physicians are “often the hardest community to reach” when spreading the message of environmentally friendly changes. “They can advocate or they can pitch in; having them in a leadership role is best, particularly if they have clout.”

Leciejewski recommends that hospitalists get involved in specific efforts. “We know that PVC (polyvinyl chloride )/DEHP (di[2-ethylhexyl]phthalate) IV bags are a known carcinogen, especially for preemies,” she says. “Doctors can support changing to different products or bring new products to our attention. They can write letters to [the companies we purchase from].”

Has your hospital made a commitment to reduce waste or otherwise reduce its footprint on the environment? If not, consider recommending a green team to start with some easy changes that can make a difference—and join the growing number of hospitals and healthcare workers committed to healing the environment.

“By collaborating, we can make a difference,” says Leciejewski. “Restoring the earth depends on us coming together as a community.” TH

Jane Jerrard is a frequent contributor to The Hospitalist.

How healthy is your hospital? When considering your answer, tally up latex gloves, sterilizing cleansers, disposable instruments, and gowns as pluses. However, these items and hundreds more can count against your facility—when you consider the effect your hospital has on its immediate (and not so immediate) environment.

Hospitals are tremendous producers of toxins, including mercury and excess pharmaceuticals, as well as solid and hazardous wastes.

“In healthcare, the footprint we’re leaving behind directly impacts our health,” points out Mary Daubach-Larsen, director of material operations and chairman of the Green LEEDers Task Force at Advocate Lutheran General Hospital in Park Ridge, Ill.

Many hospitals are taking steps to reduce that footprint.

It’s Easy Being Green

Hospitals that want to make a commitment to become more environmentally friendly can hire a full-time expert to guide their efforts, and/or they can appoint a task force—often called a green team. Lutheran General has had great success with the green team model.

A 617-bed teaching, research, and tertiary care hospital and Level 1 trauma center, Lutheran General is one of the largest hospitals in the Chicago area. Under the leadership of Daubach-Larsen, the hospital’s Green LEEDers Task Force has made great strides in several areas, earning Lutheran General a national 2006 Partners in Change award from Hospitals for a Healthy Environment (H2E).

“We’ve been recycling for more than five years,” says Daubach-Larsen. “We’ve stepped up and widened our efforts to include recycling glass, plastic, and aluminum, and we’re also reducing mercury in our environment. We’re close to being mercury free—that’s a goal of all [U.S.] hospitals.”

Lutheran General is now focusing on reducing toxins, examining their cleansers and their disposal of pharmaceuticals.

Like most hospitals that make an environmental commitment, Lutheran General began its efforts with guidance from H2E (www.h2e-online.org), a nonprofit group founded by the American Hospital Association, the U.S. Environmental Protection Agency, Health Care Without Harm, and the American Nurses Association.

“H2E’s mission is to green the entire healthcare sector,” says Laura Brannen, executive director of H2E. “We focus on reducing waste, toxic chemicals, and mercury.” Hospitals can join H2E for free, and nearly 25% of all U.S. hospitals currently belong to H2E.

About the Green Team

An effective hospital green team should include members from multiple departments, to ensure that new environmentally friendly practices, such as using recycling bins for specific waste materials or purchasing “green” cleansers, are taught to all applicable staff and followed by all necessary departments.

“A traditional green team brings together people from a variety of backgrounds,” says Brannen. “It’s best to have a balance between people who need to be [on the team] and those who are motivated to be there because they care.”

In addition to Daubach-Larsen, Lutheran General’s task force includes four nurses, a physician, a psychologist, and representatives from food/nutrition, infection control, pharmacy, public relations, physician relations, and guests from facilities.

Catholic Healthcare West (CHW), which made a commitment to environmentally friendly practices in 1996, has an environmental action committee at each of its 40 hospitals.

“Each of these committees is responsible for establishing goals, monitoring progress, overseeing implementation, and training staff at their hospital,” explains Sister Mary Ellen Leciejewski, OP, ecology program coordinator, CHW, Santa Cruz, Calif. “They also look for groups in their community that they should be partnering with.”

In addition to this overall team, Brannen recommends two other groups for a successful approach: recycling coordinators and an executive group. “Recycling coordinators are department liaisons for the staff in that area,” she explains. “They’re responsible for number and placement of recycling bins, labeling, and staff training in their area. This brings implementation down directly where it’s happening. You can have a coordinator for every shift.”

As for the executive level, Brannen recommends an “environmental leadership council” made up of the highest-level executives possible from a variety of departments. “This council would only meet twice a year, or maybe quarterly,” explains Brannen. “They make institutional decisions and commitments. They might sign off on an environmental mission statement, for example. They legitimize in a big way what the institution is doing.”

Talk Trash

An easy and obvious place to start an environmental effort is by reducing the amount of waste your hospital produces.

“It makes sense to start with waste and move on from there,” advises Daubach-Larsen of starting a Green Team effort. “H2E offers a waste management template to help you gather data on your waste streams. You can use that data to show management” how much more efficiently your hospital can work. She advises that hospitals audit their various waste outputs, including hazardous waste, recycling, and general trash, with the help of their waste vendor. “You can save money immediately, starting with a study of what’s going on,” she says.

With the data collected on waste and the buy-in of management, you can begin the work of shifting more waste toward recycling—or perhaps eliminating some waste altogether.

“Improve your relationship with your waste vendor,” advises Daubach-Larsen. “You can start to push them to accept more recyclables. When they realize there’s a demand, they’ll accept different materials.”

Address Toxins, Energy, and More

Beyond reducing waste, hospitals can make many environmental improvements—it’s simply a matter of choosing priorities. “The spectrum is large and can be overwhelming,” admits Daubach-Larsen.

In addition to waste and recycling, H2E helps hospitals address a wide variety of environmental issues. “We’ve moved on to environmentally friendly purchasing, green building, safer material choices, and energy efficiency,” says Brannen.

One area many green hospitals are beginning to watch closely is their purchasing, including their vendors. “We’re members of a group purchasing company that has green management strategies,” says Daubach-Larsen. “Most of the big groups are now on that bandwagon.” As part of their green purchasing habits, Lutheran General is trying to expand their use of products that are environmentally friendly. “We’ve also started sending out an RFP [request for proposal] asking vendors about their practices,” says Daubach-Larsen.

“Supply chain management is so important,” stresses Leciejewski. “If we watch what’s coming in our front door, we don’t have to worry so much about what we’re sending out our back door.”

CHW is currently working on multiple projects, including reprocessing surgical instruments, responsible disposal of their electronic waste (such as computers), reusable sharp’s containers, and a commitment to the healthiest food possible. “We’re looking at everything from working with organic vendors to the silverware and Styrofoam we use in our cafeterias,” says Leciejewski.

Another area of environmental consciousness is new construction. So-called green building is becoming a trend that reaches beyond healthcare. “If you’re not designing a green building before you break ground, you’re behind the times,” says Brannen. “This movement is really gaining steam, and the cost payback is pretty staggering over the life of the building.”

Daubach-Larsen adds, “Even if you’re not building, you can still incorporate new behaviors that will reduce your footprint on the environment.”

Save the Environment=Save Money

Are green practices too expensive for some hospitals? “The challenge is that people say they don’t have the money to spend [on better environmental practices], but they’re spending too much [now] and they’re tossing resources,” says Brannen.

Daubach-Larsen adds, “There are a lot of efficiencies” that can be realized through green practices. “Reducing solid waste and increasing recycling can save money,” she points out. “Our numbers of hazardous waste, or ‘red bag waste,’ are very low compared to other hospitals—it costs more to dispose of this waste.”

Green Hospitalists?

Where do hospitalists and other physicians fit into the green team picture? “There are hospitalists [who] get the relationships between their hospital[s] and the environment,” says Daubach-Larsen. “They can be ambassadors for that message.”

While green team leadership tends to fall on hospital operations staff, physicians can provide tremendous support simply by advocating with hospital leadership. “Executive sponsorship is key,” says Daubach-Larsen. “And physicians have a direct line to management. They can communicate that their satisfaction in the organization would be improved if that organization took an interest in the environment.”

Brannen says that physicians are “often the hardest community to reach” when spreading the message of environmentally friendly changes. “They can advocate or they can pitch in; having them in a leadership role is best, particularly if they have clout.”

Leciejewski recommends that hospitalists get involved in specific efforts. “We know that PVC (polyvinyl chloride )/DEHP (di[2-ethylhexyl]phthalate) IV bags are a known carcinogen, especially for preemies,” she says. “Doctors can support changing to different products or bring new products to our attention. They can write letters to [the companies we purchase from].”

Has your hospital made a commitment to reduce waste or otherwise reduce its footprint on the environment? If not, consider recommending a green team to start with some easy changes that can make a difference—and join the growing number of hospitals and healthcare workers committed to healing the environment.

“By collaborating, we can make a difference,” says Leciejewski. “Restoring the earth depends on us coming together as a community.” TH

Jane Jerrard is a frequent contributor to The Hospitalist.

How healthy is your hospital? When considering your answer, tally up latex gloves, sterilizing cleansers, disposable instruments, and gowns as pluses. However, these items and hundreds more can count against your facility—when you consider the effect your hospital has on its immediate (and not so immediate) environment.

Hospitals are tremendous producers of toxins, including mercury and excess pharmaceuticals, as well as solid and hazardous wastes.

“In healthcare, the footprint we’re leaving behind directly impacts our health,” points out Mary Daubach-Larsen, director of material operations and chairman of the Green LEEDers Task Force at Advocate Lutheran General Hospital in Park Ridge, Ill.

Many hospitals are taking steps to reduce that footprint.

It’s Easy Being Green

Hospitals that want to make a commitment to become more environmentally friendly can hire a full-time expert to guide their efforts, and/or they can appoint a task force—often called a green team. Lutheran General has had great success with the green team model.

A 617-bed teaching, research, and tertiary care hospital and Level 1 trauma center, Lutheran General is one of the largest hospitals in the Chicago area. Under the leadership of Daubach-Larsen, the hospital’s Green LEEDers Task Force has made great strides in several areas, earning Lutheran General a national 2006 Partners in Change award from Hospitals for a Healthy Environment (H2E).

“We’ve been recycling for more than five years,” says Daubach-Larsen. “We’ve stepped up and widened our efforts to include recycling glass, plastic, and aluminum, and we’re also reducing mercury in our environment. We’re close to being mercury free—that’s a goal of all [U.S.] hospitals.”

Lutheran General is now focusing on reducing toxins, examining their cleansers and their disposal of pharmaceuticals.

Like most hospitals that make an environmental commitment, Lutheran General began its efforts with guidance from H2E (www.h2e-online.org), a nonprofit group founded by the American Hospital Association, the U.S. Environmental Protection Agency, Health Care Without Harm, and the American Nurses Association.

“H2E’s mission is to green the entire healthcare sector,” says Laura Brannen, executive director of H2E. “We focus on reducing waste, toxic chemicals, and mercury.” Hospitals can join H2E for free, and nearly 25% of all U.S. hospitals currently belong to H2E.

About the Green Team

An effective hospital green team should include members from multiple departments, to ensure that new environmentally friendly practices, such as using recycling bins for specific waste materials or purchasing “green” cleansers, are taught to all applicable staff and followed by all necessary departments.

“A traditional green team brings together people from a variety of backgrounds,” says Brannen. “It’s best to have a balance between people who need to be [on the team] and those who are motivated to be there because they care.”

In addition to Daubach-Larsen, Lutheran General’s task force includes four nurses, a physician, a psychologist, and representatives from food/nutrition, infection control, pharmacy, public relations, physician relations, and guests from facilities.

Catholic Healthcare West (CHW), which made a commitment to environmentally friendly practices in 1996, has an environmental action committee at each of its 40 hospitals.

“Each of these committees is responsible for establishing goals, monitoring progress, overseeing implementation, and training staff at their hospital,” explains Sister Mary Ellen Leciejewski, OP, ecology program coordinator, CHW, Santa Cruz, Calif. “They also look for groups in their community that they should be partnering with.”

In addition to this overall team, Brannen recommends two other groups for a successful approach: recycling coordinators and an executive group. “Recycling coordinators are department liaisons for the staff in that area,” she explains. “They’re responsible for number and placement of recycling bins, labeling, and staff training in their area. This brings implementation down directly where it’s happening. You can have a coordinator for every shift.”

As for the executive level, Brannen recommends an “environmental leadership council” made up of the highest-level executives possible from a variety of departments. “This council would only meet twice a year, or maybe quarterly,” explains Brannen. “They make institutional decisions and commitments. They might sign off on an environmental mission statement, for example. They legitimize in a big way what the institution is doing.”

Talk Trash

An easy and obvious place to start an environmental effort is by reducing the amount of waste your hospital produces.

“It makes sense to start with waste and move on from there,” advises Daubach-Larsen of starting a Green Team effort. “H2E offers a waste management template to help you gather data on your waste streams. You can use that data to show management” how much more efficiently your hospital can work. She advises that hospitals audit their various waste outputs, including hazardous waste, recycling, and general trash, with the help of their waste vendor. “You can save money immediately, starting with a study of what’s going on,” she says.

With the data collected on waste and the buy-in of management, you can begin the work of shifting more waste toward recycling—or perhaps eliminating some waste altogether.

“Improve your relationship with your waste vendor,” advises Daubach-Larsen. “You can start to push them to accept more recyclables. When they realize there’s a demand, they’ll accept different materials.”

Address Toxins, Energy, and More

Beyond reducing waste, hospitals can make many environmental improvements—it’s simply a matter of choosing priorities. “The spectrum is large and can be overwhelming,” admits Daubach-Larsen.

In addition to waste and recycling, H2E helps hospitals address a wide variety of environmental issues. “We’ve moved on to environmentally friendly purchasing, green building, safer material choices, and energy efficiency,” says Brannen.

One area many green hospitals are beginning to watch closely is their purchasing, including their vendors. “We’re members of a group purchasing company that has green management strategies,” says Daubach-Larsen. “Most of the big groups are now on that bandwagon.” As part of their green purchasing habits, Lutheran General is trying to expand their use of products that are environmentally friendly. “We’ve also started sending out an RFP [request for proposal] asking vendors about their practices,” says Daubach-Larsen.

“Supply chain management is so important,” stresses Leciejewski. “If we watch what’s coming in our front door, we don’t have to worry so much about what we’re sending out our back door.”

CHW is currently working on multiple projects, including reprocessing surgical instruments, responsible disposal of their electronic waste (such as computers), reusable sharp’s containers, and a commitment to the healthiest food possible. “We’re looking at everything from working with organic vendors to the silverware and Styrofoam we use in our cafeterias,” says Leciejewski.

Another area of environmental consciousness is new construction. So-called green building is becoming a trend that reaches beyond healthcare. “If you’re not designing a green building before you break ground, you’re behind the times,” says Brannen. “This movement is really gaining steam, and the cost payback is pretty staggering over the life of the building.”

Daubach-Larsen adds, “Even if you’re not building, you can still incorporate new behaviors that will reduce your footprint on the environment.”

Save the Environment=Save Money

Are green practices too expensive for some hospitals? “The challenge is that people say they don’t have the money to spend [on better environmental practices], but they’re spending too much [now] and they’re tossing resources,” says Brannen.

Daubach-Larsen adds, “There are a lot of efficiencies” that can be realized through green practices. “Reducing solid waste and increasing recycling can save money,” she points out. “Our numbers of hazardous waste, or ‘red bag waste,’ are very low compared to other hospitals—it costs more to dispose of this waste.”

Green Hospitalists?

Where do hospitalists and other physicians fit into the green team picture? “There are hospitalists [who] get the relationships between their hospital[s] and the environment,” says Daubach-Larsen. “They can be ambassadors for that message.”

While green team leadership tends to fall on hospital operations staff, physicians can provide tremendous support simply by advocating with hospital leadership. “Executive sponsorship is key,” says Daubach-Larsen. “And physicians have a direct line to management. They can communicate that their satisfaction in the organization would be improved if that organization took an interest in the environment.”

Brannen says that physicians are “often the hardest community to reach” when spreading the message of environmentally friendly changes. “They can advocate or they can pitch in; having them in a leadership role is best, particularly if they have clout.”

Leciejewski recommends that hospitalists get involved in specific efforts. “We know that PVC (polyvinyl chloride )/DEHP (di[2-ethylhexyl]phthalate) IV bags are a known carcinogen, especially for preemies,” she says. “Doctors can support changing to different products or bring new products to our attention. They can write letters to [the companies we purchase from].”

Has your hospital made a commitment to reduce waste or otherwise reduce its footprint on the environment? If not, consider recommending a green team to start with some easy changes that can make a difference—and join the growing number of hospitals and healthcare workers committed to healing the environment.

“By collaborating, we can make a difference,” says Leciejewski. “Restoring the earth depends on us coming together as a community.” TH

Jane Jerrard is a frequent contributor to The Hospitalist.

A mystery. That’s what MedPAC is to many hospitalists. You might recognize the name from communications about Medicare’s physician fee schedule, but what is this entity, what power does it possess, and how does it affect the work you do and the pay you receive?

MedPAC is the Medicare Payment Advisory Commission, an independent agency established by the Balanced Budget Act of 1997. Its mission is to advise Congress on issues affecting Medicare, including payments to private health plans participating in Medicare as well as providers in Medicare’s traditional fee-for-service program. MedPAC also analyzes and advises legislators on two issues on HM’s radar: access to care and quality of care.

Ear of the Law

Why is MedPAC important to hospitalists? Money. The commission advises Congress on how Medicare is going to pay for healthcare services, and Medicare is a major payor for any hospitalist, says Ron Greeno, MD, FHM, chief medical officer of Cogent Healthcare in Irvine, Calif., and a member of SHM’s Public Policy Committee. “The majority of patients we’ll be taking care of in any hospital are Medicare patients,” he says, “and it’s not just how we get paid, but all the regulations around that. … MedPAC will weigh in on that and certainly shape the thinking of lawmakers.”

“MedPAC is about payment … but obviously there are other policy issues they weigh in on,” Dr. Greeno says. For example, MedPAC makes specific recommendations on the physician fee schedule and determines how hospitalists document and code.

How It Works

The commission is made up of 17 volunteer members from a diverse spectrum of healthcare backgrounds. Commissioners are appointed to three-year renewable terms. An executive director and staff of analysts with backgrounds in economics, health policy, public health, and medicine support the agency.

MedPAC holds monthly public meetings in Washington, D.C., to discuss Medicare issues and policy questions, and to formulate recommendations to Congress. Meetings include research presentations by MedPAC staff, policy experts, and interested parties. Each meeting allows time for public comment.

The commission provides its recommendations to Congress in biannual reports, issued in March and June. MedPAC also advises Congress through comment on reports and proposed regulations issued by the U.S. Department of Health and Human Services (HHS), testimony, and briefings for congressional staff.

A New Role

This year, as President Obama and his administration push for rapid and major healthcare changes, Dr. Greeno says MedPAC’s role will shift as Congress speeds toward new solutions. “How things are going to get done is already different than it was last year,” he says. “The pace of the government’s attempts to change how Medicare looks has picked up considerably.”

Citing SHM’s Public Policy Committee meetings with lawmakers in March, Dr. Greeno says healthcare reform is on the fast track. “Everything we were hearing from CMS [Centers for Medicare and Medicaid Services], the American Hospital Association, and MedPAC indicated that they’re looking to have a healthcare reform bill to Congress by summer,” he says. “When you have that kind of pace, things will come from a lot of different areas.”

Dr. Greeno uses pay for performance as one example of how government can be slow to change healthcare policy. “That process has taken years, but it’s still a small percentage of how we’re paid,” Dr. Greeno says, noting the current administration has expressed interest in changing course on the policy. “Now we may have complete reform of Medicare payments. In light of the rapidness of this pace, I’m not sure MedPAC’s role will be the same. They’ll continue to be a resource to Congress, but the commissioners are volunteers with full-time jobs; they meet once a month, while legislation is being worked on pretty much around the clock right now.”

MedPAC Sets the Tone

Even if the commission isn’t prepared to make direct recommendations for new legislation in the next few months, it still has significant influence. Since its inception, MedPac has routinely “set the tone” for policy reform, Dr. Greeno stresses. “For example, the healthcare reform legislation will likely include bundling payments to hospitals and physicians who work in hospitals,” he says. “MedPAC has already made recommendations to do this, as well as to start demonstration projects.” Earlier this year, sites were selected for Medicare’s Acute Care Episode (ACE) demonstration, under which a single global payment will be made for inpatient facility and professional services. “The same is true of the idea of paying based on quality, not patient volume,” Dr. Greeno says. “The commission has made recommendations on this.”

Then again, no one can say how the future of healthcare reform will unfold, or how quickly things will move this year. “The healthcare bill introduced this summer could completely do away with fee-for-service payments,” Dr. Greeno says. “Of course, nobody knows when—or if—that bill will get passed.” TH

Jane Jerrard is a medical writer based in Chicago.

A mystery. That’s what MedPAC is to many hospitalists. You might recognize the name from communications about Medicare’s physician fee schedule, but what is this entity, what power does it possess, and how does it affect the work you do and the pay you receive?

MedPAC is the Medicare Payment Advisory Commission, an independent agency established by the Balanced Budget Act of 1997. Its mission is to advise Congress on issues affecting Medicare, including payments to private health plans participating in Medicare as well as providers in Medicare’s traditional fee-for-service program. MedPAC also analyzes and advises legislators on two issues on HM’s radar: access to care and quality of care.

Ear of the Law

Why is MedPAC important to hospitalists? Money. The commission advises Congress on how Medicare is going to pay for healthcare services, and Medicare is a major payor for any hospitalist, says Ron Greeno, MD, FHM, chief medical officer of Cogent Healthcare in Irvine, Calif., and a member of SHM’s Public Policy Committee. “The majority of patients we’ll be taking care of in any hospital are Medicare patients,” he says, “and it’s not just how we get paid, but all the regulations around that. … MedPAC will weigh in on that and certainly shape the thinking of lawmakers.”

“MedPAC is about payment … but obviously there are other policy issues they weigh in on,” Dr. Greeno says. For example, MedPAC makes specific recommendations on the physician fee schedule and determines how hospitalists document and code.

How It Works

The commission is made up of 17 volunteer members from a diverse spectrum of healthcare backgrounds. Commissioners are appointed to three-year renewable terms. An executive director and staff of analysts with backgrounds in economics, health policy, public health, and medicine support the agency.

MedPAC holds monthly public meetings in Washington, D.C., to discuss Medicare issues and policy questions, and to formulate recommendations to Congress. Meetings include research presentations by MedPAC staff, policy experts, and interested parties. Each meeting allows time for public comment.

The commission provides its recommendations to Congress in biannual reports, issued in March and June. MedPAC also advises Congress through comment on reports and proposed regulations issued by the U.S. Department of Health and Human Services (HHS), testimony, and briefings for congressional staff.

A New Role

This year, as President Obama and his administration push for rapid and major healthcare changes, Dr. Greeno says MedPAC’s role will shift as Congress speeds toward new solutions. “How things are going to get done is already different than it was last year,” he says. “The pace of the government’s attempts to change how Medicare looks has picked up considerably.”

Citing SHM’s Public Policy Committee meetings with lawmakers in March, Dr. Greeno says healthcare reform is on the fast track. “Everything we were hearing from CMS [Centers for Medicare and Medicaid Services], the American Hospital Association, and MedPAC indicated that they’re looking to have a healthcare reform bill to Congress by summer,” he says. “When you have that kind of pace, things will come from a lot of different areas.”

Dr. Greeno uses pay for performance as one example of how government can be slow to change healthcare policy. “That process has taken years, but it’s still a small percentage of how we’re paid,” Dr. Greeno says, noting the current administration has expressed interest in changing course on the policy. “Now we may have complete reform of Medicare payments. In light of the rapidness of this pace, I’m not sure MedPAC’s role will be the same. They’ll continue to be a resource to Congress, but the commissioners are volunteers with full-time jobs; they meet once a month, while legislation is being worked on pretty much around the clock right now.”

MedPAC Sets the Tone

Even if the commission isn’t prepared to make direct recommendations for new legislation in the next few months, it still has significant influence. Since its inception, MedPac has routinely “set the tone” for policy reform, Dr. Greeno stresses. “For example, the healthcare reform legislation will likely include bundling payments to hospitals and physicians who work in hospitals,” he says. “MedPAC has already made recommendations to do this, as well as to start demonstration projects.” Earlier this year, sites were selected for Medicare’s Acute Care Episode (ACE) demonstration, under which a single global payment will be made for inpatient facility and professional services. “The same is true of the idea of paying based on quality, not patient volume,” Dr. Greeno says. “The commission has made recommendations on this.”

Then again, no one can say how the future of healthcare reform will unfold, or how quickly things will move this year. “The healthcare bill introduced this summer could completely do away with fee-for-service payments,” Dr. Greeno says. “Of course, nobody knows when—or if—that bill will get passed.” TH

Jane Jerrard is a medical writer based in Chicago.

A mystery. That’s what MedPAC is to many hospitalists. You might recognize the name from communications about Medicare’s physician fee schedule, but what is this entity, what power does it possess, and how does it affect the work you do and the pay you receive?

MedPAC is the Medicare Payment Advisory Commission, an independent agency established by the Balanced Budget Act of 1997. Its mission is to advise Congress on issues affecting Medicare, including payments to private health plans participating in Medicare as well as providers in Medicare’s traditional fee-for-service program. MedPAC also analyzes and advises legislators on two issues on HM’s radar: access to care and quality of care.

Ear of the Law

Why is MedPAC important to hospitalists? Money. The commission advises Congress on how Medicare is going to pay for healthcare services, and Medicare is a major payor for any hospitalist, says Ron Greeno, MD, FHM, chief medical officer of Cogent Healthcare in Irvine, Calif., and a member of SHM’s Public Policy Committee. “The majority of patients we’ll be taking care of in any hospital are Medicare patients,” he says, “and it’s not just how we get paid, but all the regulations around that. … MedPAC will weigh in on that and certainly shape the thinking of lawmakers.”

“MedPAC is about payment … but obviously there are other policy issues they weigh in on,” Dr. Greeno says. For example, MedPAC makes specific recommendations on the physician fee schedule and determines how hospitalists document and code.

How It Works

The commission is made up of 17 volunteer members from a diverse spectrum of healthcare backgrounds. Commissioners are appointed to three-year renewable terms. An executive director and staff of analysts with backgrounds in economics, health policy, public health, and medicine support the agency.

MedPAC holds monthly public meetings in Washington, D.C., to discuss Medicare issues and policy questions, and to formulate recommendations to Congress. Meetings include research presentations by MedPAC staff, policy experts, and interested parties. Each meeting allows time for public comment.

The commission provides its recommendations to Congress in biannual reports, issued in March and June. MedPAC also advises Congress through comment on reports and proposed regulations issued by the U.S. Department of Health and Human Services (HHS), testimony, and briefings for congressional staff.

A New Role

This year, as President Obama and his administration push for rapid and major healthcare changes, Dr. Greeno says MedPAC’s role will shift as Congress speeds toward new solutions. “How things are going to get done is already different than it was last year,” he says. “The pace of the government’s attempts to change how Medicare looks has picked up considerably.”

Citing SHM’s Public Policy Committee meetings with lawmakers in March, Dr. Greeno says healthcare reform is on the fast track. “Everything we were hearing from CMS [Centers for Medicare and Medicaid Services], the American Hospital Association, and MedPAC indicated that they’re looking to have a healthcare reform bill to Congress by summer,” he says. “When you have that kind of pace, things will come from a lot of different areas.”

Dr. Greeno uses pay for performance as one example of how government can be slow to change healthcare policy. “That process has taken years, but it’s still a small percentage of how we’re paid,” Dr. Greeno says, noting the current administration has expressed interest in changing course on the policy. “Now we may have complete reform of Medicare payments. In light of the rapidness of this pace, I’m not sure MedPAC’s role will be the same. They’ll continue to be a resource to Congress, but the commissioners are volunteers with full-time jobs; they meet once a month, while legislation is being worked on pretty much around the clock right now.”

MedPAC Sets the Tone

Even if the commission isn’t prepared to make direct recommendations for new legislation in the next few months, it still has significant influence. Since its inception, MedPac has routinely “set the tone” for policy reform, Dr. Greeno stresses. “For example, the healthcare reform legislation will likely include bundling payments to hospitals and physicians who work in hospitals,” he says. “MedPAC has already made recommendations to do this, as well as to start demonstration projects.” Earlier this year, sites were selected for Medicare’s Acute Care Episode (ACE) demonstration, under which a single global payment will be made for inpatient facility and professional services. “The same is true of the idea of paying based on quality, not patient volume,” Dr. Greeno says. “The commission has made recommendations on this.”

Then again, no one can say how the future of healthcare reform will unfold, or how quickly things will move this year. “The healthcare bill introduced this summer could completely do away with fee-for-service payments,” Dr. Greeno says. “Of course, nobody knows when—or if—that bill will get passed.” TH

Jane Jerrard is a medical writer based in Chicago.

Physicians routinely are deluged with offers for certifications in hospital medicine, geriatric medicine and other specialties. Unaccredited boards have been set up to solicit phony certifications requiring no training, testing or medical background review, according to Christine Cassel, MD, president and CEO of the American Board of Internal Medicine (ABIM).

ABIM is concerned about the welfare of patients who may choose doctors representing themselves as "board certified" based on a certificate from one of these unaccredited boards.

"Physicians should trust their instincts," Dr. Cassel says. "If a deal seems too good to be true, it probably is. Hospitalists should be especially wary of solicitations from the American Board of Hospital Physicians (ABOHP). The organization is not a member of the American Board of Medical Specialties (ABMS), and is not recognized by key healthcare credentialing accreditation entities."

Robert Wachter, MD, chief of the division of hospital medicine at the University of California San Francisco Medical Center and chair of ABIM's Committee on Hospital Medicine Focused Recognition, adds, "The ABIM has been working hard to create a pathway that recognizes the professional focus of internist-hospitalists, and I hope it will be available in the not-so-distant future. Personally, I encourage all hospitalists to pursue board certification and keep their certification up-to-date. This scam points out the importance of ensuring that the certification is legitimate."

If an unrecognizable organization sends you a board certificate offer, alert ABIM at security@abim.org.

Physicians routinely are deluged with offers for certifications in hospital medicine, geriatric medicine and other specialties. Unaccredited boards have been set up to solicit phony certifications requiring no training, testing or medical background review, according to Christine Cassel, MD, president and CEO of the American Board of Internal Medicine (ABIM).

ABIM is concerned about the welfare of patients who may choose doctors representing themselves as "board certified" based on a certificate from one of these unaccredited boards.

"Physicians should trust their instincts," Dr. Cassel says. "If a deal seems too good to be true, it probably is. Hospitalists should be especially wary of solicitations from the American Board of Hospital Physicians (ABOHP). The organization is not a member of the American Board of Medical Specialties (ABMS), and is not recognized by key healthcare credentialing accreditation entities."

Robert Wachter, MD, chief of the division of hospital medicine at the University of California San Francisco Medical Center and chair of ABIM's Committee on Hospital Medicine Focused Recognition, adds, "The ABIM has been working hard to create a pathway that recognizes the professional focus of internist-hospitalists, and I hope it will be available in the not-so-distant future. Personally, I encourage all hospitalists to pursue board certification and keep their certification up-to-date. This scam points out the importance of ensuring that the certification is legitimate."

If an unrecognizable organization sends you a board certificate offer, alert ABIM at security@abim.org.

Physicians routinely are deluged with offers for certifications in hospital medicine, geriatric medicine and other specialties. Unaccredited boards have been set up to solicit phony certifications requiring no training, testing or medical background review, according to Christine Cassel, MD, president and CEO of the American Board of Internal Medicine (ABIM).

ABIM is concerned about the welfare of patients who may choose doctors representing themselves as "board certified" based on a certificate from one of these unaccredited boards.

"Physicians should trust their instincts," Dr. Cassel says. "If a deal seems too good to be true, it probably is. Hospitalists should be especially wary of solicitations from the American Board of Hospital Physicians (ABOHP). The organization is not a member of the American Board of Medical Specialties (ABMS), and is not recognized by key healthcare credentialing accreditation entities."

Robert Wachter, MD, chief of the division of hospital medicine at the University of California San Francisco Medical Center and chair of ABIM's Committee on Hospital Medicine Focused Recognition, adds, "The ABIM has been working hard to create a pathway that recognizes the professional focus of internist-hospitalists, and I hope it will be available in the not-so-distant future. Personally, I encourage all hospitalists to pursue board certification and keep their certification up-to-date. This scam points out the importance of ensuring that the certification is legitimate."

If an unrecognizable organization sends you a board certificate offer, alert ABIM at security@abim.org.

Sen. Max Baucus (D-Mont.) might be the most devoted champion of healthcare reform on Capitol Hill today. He chairs the Senate Finance Committee, which has jurisdiction over Medicare, Medicaid, the State Children’s Health Insurance Program (SCHIP), and other healthcare entitlement programs. He has worked for healthcare reform in large and small measures, and recently put forth a comprehensive—and controversial—plan for changing the U.S. healthcare system.

Sen. Baucus penned a white paper, “Call to Action: Health Care Reform 2009,” which was published after the November election and outlines his proposals for universal healthcare coverage. Although he hopes to introduce some form of his white paper as a Senate bill, as of press time, he had not done so.

A Stanford Law graduate, Sen. Baucus was the executive director of the 1972 Montana Constitutional Convention, which rewrote that state’s constitution. He has served in public office since 1973, including six consecutive terms in the U.S. Senate.

The Hospitalist caught up with Sen. Baucus to discuss national healthcare reform and how hospitalists can—and will—factor into the changes.

Question: You are pushing for action on healthcare reform in 2009. What’s the status of your first piece of healthcare legislation this year?

Answer: My goal is to craft consensus legislation and move it through the Congress and into law. Now that Congress has passed the American Recovery and Reinvestment Act, I intend to return the attention of the Finance Committee to health reform.

Q: Where will funding come from for some of the immediate healthcare initiatives you’d like to see?

A: Healthcare reform will require an upfront investment in order to achieve the savings we all know are possible. It is my intention that after 10 years, the U.S. will spend no more on healthcare than is currently projected, but we will spend those resources more efficiently and will provide better-quality coverage to all Americans. One of the reasons healthcare reform is so important is that if we ignore the problems in the system and fail to act, healthcare costs will only grow. Acting now is a cost-saving proposition.

Q: As coverage is provided for more Americans, what steps should be taken to ensure an adequate number of physicians, hospital beds, clinics, etc.?

A: With more people in the healthcare system, we will need more physicians and resources. My plan increases the number of primary-care doctors by strengthening the role of primary care. Today, America’s system undervalues primary care relative to specialty care. This has caused fewer medical students to choose careers in primary care. My plan will increase the supply of primary-care practitioners by using federal reimbursement systems and other means to improve the value placed on their work.

My plan also builds on existing resources that have been successful in delivering primary-care services, like community health centers. The proposal I’ve put forward increases funding for low-income and rural clinics designated by Medicare as Federally Qualified Health Centers. [It would provide] more funding for Rural Health Clinics. By strengthening community and rural providers, we can improve access to primary care and better manage conditions before they become serious. That will keep people healthier and save money in the long run.

Q: You call for refocusing payment incentives from quantity of care to quality of care. Do you have CMS’ Physician Quality Reporting Initiative (PQRI) in mind to help move the focus of compensation?

A: My plan builds on a number of programs that are already in place to improve the quality of care, including PQRI, which provides incentives for physicians who track and report data on the quality of care they provide. My plan would expand this initiative using cutting-edge technology to collect and analyze data on quality, and improve it by increasing outreach, information, and assistance to doctors who participate in the program. ... My plan would expand gain-sharing programs, which allow providers to share savings from improved efficiency and quality.

Q: SHM has identified improvements in care coordination, particularly as patients transition from the hospital to the home, as an important element of health reform. You, too, have identified this as priority. Can you elaborate on the types of proposals to improve care transitions that we might see in your healthcare reform bill?

A: Today’s healthcare system doesn’t do enough to encourage healthcare providers to work together, which can be particularly detrimental for patients who are transitioning from hospital to home. According to some estimates, 18% of Medicare hospital admissions result in a rehospitalization within 30 days. This is simply unacceptable, and it is avoidable. Providers can work better together to ensure that patients receive proper follow-up care post-discharge.

In my blueprint for reform, I laid out a series of proposals to encourage greater collaboration among providers. These proposals include a plan to reduce hospital readmissions through increasing public disclosure around readmission rates and, in later years, reducing payment rates for hospitals with readmissions above a certain benchmark. My plan also identifies “bundling” hospital and physician payments under Medicare as a way to encourage greater provider collaboration across a patient’s episode of care, and other concepts like the development of accountable care organizations. My hope is that these proposals will encourage and reward health providers who work together to provide patients the best possible care.

Q: Regarding value-based purchasing, your paper states, “Every effort must be made to align hospital and physician quality goals.” Would this alignment apply to bonus payments, and if so, will it necessitate loosening current restrictions on gain-sharing?

A: Successful implementation of new payment and delivery system models may require changes to the regulatory structure governing provider collaboration. ... It is critical that we strike an appropriate balance between offering providers incentives to work together while also protecting against financial conflicts of interest that could negatively impact quality of care. Regarding value-based purchasing, we are continuing to explore ways to encourage hospitals and doctors to work together to improve quality and are evaluating the best way to align payment incentives to meet this goal.

Q: How can hospitalists help with healthcare reform efforts?

A: As is true with all members of the healthcare community, I encourage hospitalists to work with me and my colleagues throughout the reform process. It is certain to take significant cooperation to create a more accessible, lower-cost, higher-quality system, but I’m confident that working together, we will succeed. I’m asking everyone in the healthcare community to help me create a “can-do” environment for healthcare reform. All stakeholders have a particular focus, and I am willing to listen to every issue. But our collective focus should be on [making] the health system better for everyone.

As always, I appreciate all questions, comments, and concerns, and I look forward to working with all stakeholders throughout this process. TH

Jane Jerrard is a medical writer based in Chicago.

Sen. Max Baucus (D-Mont.) might be the most devoted champion of healthcare reform on Capitol Hill today. He chairs the Senate Finance Committee, which has jurisdiction over Medicare, Medicaid, the State Children’s Health Insurance Program (SCHIP), and other healthcare entitlement programs. He has worked for healthcare reform in large and small measures, and recently put forth a comprehensive—and controversial—plan for changing the U.S. healthcare system.

Sen. Baucus penned a white paper, “Call to Action: Health Care Reform 2009,” which was published after the November election and outlines his proposals for universal healthcare coverage. Although he hopes to introduce some form of his white paper as a Senate bill, as of press time, he had not done so.

A Stanford Law graduate, Sen. Baucus was the executive director of the 1972 Montana Constitutional Convention, which rewrote that state’s constitution. He has served in public office since 1973, including six consecutive terms in the U.S. Senate.

The Hospitalist caught up with Sen. Baucus to discuss national healthcare reform and how hospitalists can—and will—factor into the changes.

Question: You are pushing for action on healthcare reform in 2009. What’s the status of your first piece of healthcare legislation this year?

Answer: My goal is to craft consensus legislation and move it through the Congress and into law. Now that Congress has passed the American Recovery and Reinvestment Act, I intend to return the attention of the Finance Committee to health reform.

Q: Where will funding come from for some of the immediate healthcare initiatives you’d like to see?

A: Healthcare reform will require an upfront investment in order to achieve the savings we all know are possible. It is my intention that after 10 years, the U.S. will spend no more on healthcare than is currently projected, but we will spend those resources more efficiently and will provide better-quality coverage to all Americans. One of the reasons healthcare reform is so important is that if we ignore the problems in the system and fail to act, healthcare costs will only grow. Acting now is a cost-saving proposition.

Q: As coverage is provided for more Americans, what steps should be taken to ensure an adequate number of physicians, hospital beds, clinics, etc.?

A: With more people in the healthcare system, we will need more physicians and resources. My plan increases the number of primary-care doctors by strengthening the role of primary care. Today, America’s system undervalues primary care relative to specialty care. This has caused fewer medical students to choose careers in primary care. My plan will increase the supply of primary-care practitioners by using federal reimbursement systems and other means to improve the value placed on their work.

My plan also builds on existing resources that have been successful in delivering primary-care services, like community health centers. The proposal I’ve put forward increases funding for low-income and rural clinics designated by Medicare as Federally Qualified Health Centers. [It would provide] more funding for Rural Health Clinics. By strengthening community and rural providers, we can improve access to primary care and better manage conditions before they become serious. That will keep people healthier and save money in the long run.

Q: You call for refocusing payment incentives from quantity of care to quality of care. Do you have CMS’ Physician Quality Reporting Initiative (PQRI) in mind to help move the focus of compensation?

A: My plan builds on a number of programs that are already in place to improve the quality of care, including PQRI, which provides incentives for physicians who track and report data on the quality of care they provide. My plan would expand this initiative using cutting-edge technology to collect and analyze data on quality, and improve it by increasing outreach, information, and assistance to doctors who participate in the program. ... My plan would expand gain-sharing programs, which allow providers to share savings from improved efficiency and quality.

Q: SHM has identified improvements in care coordination, particularly as patients transition from the hospital to the home, as an important element of health reform. You, too, have identified this as priority. Can you elaborate on the types of proposals to improve care transitions that we might see in your healthcare reform bill?

A: Today’s healthcare system doesn’t do enough to encourage healthcare providers to work together, which can be particularly detrimental for patients who are transitioning from hospital to home. According to some estimates, 18% of Medicare hospital admissions result in a rehospitalization within 30 days. This is simply unacceptable, and it is avoidable. Providers can work better together to ensure that patients receive proper follow-up care post-discharge.

In my blueprint for reform, I laid out a series of proposals to encourage greater collaboration among providers. These proposals include a plan to reduce hospital readmissions through increasing public disclosure around readmission rates and, in later years, reducing payment rates for hospitals with readmissions above a certain benchmark. My plan also identifies “bundling” hospital and physician payments under Medicare as a way to encourage greater provider collaboration across a patient’s episode of care, and other concepts like the development of accountable care organizations. My hope is that these proposals will encourage and reward health providers who work together to provide patients the best possible care.

Q: Regarding value-based purchasing, your paper states, “Every effort must be made to align hospital and physician quality goals.” Would this alignment apply to bonus payments, and if so, will it necessitate loosening current restrictions on gain-sharing?

A: Successful implementation of new payment and delivery system models may require changes to the regulatory structure governing provider collaboration. ... It is critical that we strike an appropriate balance between offering providers incentives to work together while also protecting against financial conflicts of interest that could negatively impact quality of care. Regarding value-based purchasing, we are continuing to explore ways to encourage hospitals and doctors to work together to improve quality and are evaluating the best way to align payment incentives to meet this goal.

Q: How can hospitalists help with healthcare reform efforts?

A: As is true with all members of the healthcare community, I encourage hospitalists to work with me and my colleagues throughout the reform process. It is certain to take significant cooperation to create a more accessible, lower-cost, higher-quality system, but I’m confident that working together, we will succeed. I’m asking everyone in the healthcare community to help me create a “can-do” environment for healthcare reform. All stakeholders have a particular focus, and I am willing to listen to every issue. But our collective focus should be on [making] the health system better for everyone.

As always, I appreciate all questions, comments, and concerns, and I look forward to working with all stakeholders throughout this process. TH

Jane Jerrard is a medical writer based in Chicago.

Sen. Max Baucus (D-Mont.) might be the most devoted champion of healthcare reform on Capitol Hill today. He chairs the Senate Finance Committee, which has jurisdiction over Medicare, Medicaid, the State Children’s Health Insurance Program (SCHIP), and other healthcare entitlement programs. He has worked for healthcare reform in large and small measures, and recently put forth a comprehensive—and controversial—plan for changing the U.S. healthcare system.

Sen. Baucus penned a white paper, “Call to Action: Health Care Reform 2009,” which was published after the November election and outlines his proposals for universal healthcare coverage. Although he hopes to introduce some form of his white paper as a Senate bill, as of press time, he had not done so.

A Stanford Law graduate, Sen. Baucus was the executive director of the 1972 Montana Constitutional Convention, which rewrote that state’s constitution. He has served in public office since 1973, including six consecutive terms in the U.S. Senate.

The Hospitalist caught up with Sen. Baucus to discuss national healthcare reform and how hospitalists can—and will—factor into the changes.

Question: You are pushing for action on healthcare reform in 2009. What’s the status of your first piece of healthcare legislation this year?

Answer: My goal is to craft consensus legislation and move it through the Congress and into law. Now that Congress has passed the American Recovery and Reinvestment Act, I intend to return the attention of the Finance Committee to health reform.

Q: Where will funding come from for some of the immediate healthcare initiatives you’d like to see?

A: Healthcare reform will require an upfront investment in order to achieve the savings we all know are possible. It is my intention that after 10 years, the U.S. will spend no more on healthcare than is currently projected, but we will spend those resources more efficiently and will provide better-quality coverage to all Americans. One of the reasons healthcare reform is so important is that if we ignore the problems in the system and fail to act, healthcare costs will only grow. Acting now is a cost-saving proposition.

Q: As coverage is provided for more Americans, what steps should be taken to ensure an adequate number of physicians, hospital beds, clinics, etc.?

A: With more people in the healthcare system, we will need more physicians and resources. My plan increases the number of primary-care doctors by strengthening the role of primary care. Today, America’s system undervalues primary care relative to specialty care. This has caused fewer medical students to choose careers in primary care. My plan will increase the supply of primary-care practitioners by using federal reimbursement systems and other means to improve the value placed on their work.

My plan also builds on existing resources that have been successful in delivering primary-care services, like community health centers. The proposal I’ve put forward increases funding for low-income and rural clinics designated by Medicare as Federally Qualified Health Centers. [It would provide] more funding for Rural Health Clinics. By strengthening community and rural providers, we can improve access to primary care and better manage conditions before they become serious. That will keep people healthier and save money in the long run.

Q: You call for refocusing payment incentives from quantity of care to quality of care. Do you have CMS’ Physician Quality Reporting Initiative (PQRI) in mind to help move the focus of compensation?

A: My plan builds on a number of programs that are already in place to improve the quality of care, including PQRI, which provides incentives for physicians who track and report data on the quality of care they provide. My plan would expand this initiative using cutting-edge technology to collect and analyze data on quality, and improve it by increasing outreach, information, and assistance to doctors who participate in the program. ... My plan would expand gain-sharing programs, which allow providers to share savings from improved efficiency and quality.

Q: SHM has identified improvements in care coordination, particularly as patients transition from the hospital to the home, as an important element of health reform. You, too, have identified this as priority. Can you elaborate on the types of proposals to improve care transitions that we might see in your healthcare reform bill?

A: Today’s healthcare system doesn’t do enough to encourage healthcare providers to work together, which can be particularly detrimental for patients who are transitioning from hospital to home. According to some estimates, 18% of Medicare hospital admissions result in a rehospitalization within 30 days. This is simply unacceptable, and it is avoidable. Providers can work better together to ensure that patients receive proper follow-up care post-discharge.

In my blueprint for reform, I laid out a series of proposals to encourage greater collaboration among providers. These proposals include a plan to reduce hospital readmissions through increasing public disclosure around readmission rates and, in later years, reducing payment rates for hospitals with readmissions above a certain benchmark. My plan also identifies “bundling” hospital and physician payments under Medicare as a way to encourage greater provider collaboration across a patient’s episode of care, and other concepts like the development of accountable care organizations. My hope is that these proposals will encourage and reward health providers who work together to provide patients the best possible care.

Q: Regarding value-based purchasing, your paper states, “Every effort must be made to align hospital and physician quality goals.” Would this alignment apply to bonus payments, and if so, will it necessitate loosening current restrictions on gain-sharing?

A: Successful implementation of new payment and delivery system models may require changes to the regulatory structure governing provider collaboration. ... It is critical that we strike an appropriate balance between offering providers incentives to work together while also protecting against financial conflicts of interest that could negatively impact quality of care. Regarding value-based purchasing, we are continuing to explore ways to encourage hospitals and doctors to work together to improve quality and are evaluating the best way to align payment incentives to meet this goal.

Q: How can hospitalists help with healthcare reform efforts?

A: As is true with all members of the healthcare community, I encourage hospitalists to work with me and my colleagues throughout the reform process. It is certain to take significant cooperation to create a more accessible, lower-cost, higher-quality system, but I’m confident that working together, we will succeed. I’m asking everyone in the healthcare community to help me create a “can-do” environment for healthcare reform. All stakeholders have a particular focus, and I am willing to listen to every issue. But our collective focus should be on [making] the health system better for everyone.

As always, I appreciate all questions, comments, and concerns, and I look forward to working with all stakeholders throughout this process. TH

Jane Jerrard is a medical writer based in Chicago.

Hospitalists who are planning on advancing their careers—particularly those working toward leadership roles—need to acquire or sharpen their skills through additional training: conferences and seminars, online courses, self-study, or university classes.

The Hospitalist spoke with several HM leaders and a physician executive coach about what makes an employee promotion material. Here are their “continuing education” suggestions for ambitious hospitalists.

Invest in Yourself

The first step in selecting a training venue is to identify your goal. What do you need to learn? How much time, effort, and money do you want to devote to the training? “There are avenues for physicians to pursue if they want to develop some leadership skills,” says Francine R. Gaillour, MD, MBA, FACPE, executive director of the Physician Coaching Institute in Bellevue, Wash.

One route, which requires a considerable investment, is to pursue a master’s of business administration (MBA) degree. “I don’t recommend this for most physicians. However, a lot of physicians choose this,” Dr. Gaillour says. “It will help mainly on the business side of becoming a leader, and there are several MBA programs that cater specifically to physicians, or to healthcare.”

A number of the nation’s top universities offer advanced degrees for physicians, including:

• The University of Tennessee offers a physician executive MBA;
• The University of California at Irvine offers a healthcare executive MBA;
• The University of South Florida offers an executive MBA for physicians; and
• The University of Massachusetts offers an MBA program through the American College of Physician Executives (ACPE).

For many hospitalist leaders, an MBA is not necessary. Instead, you might prefer to sign up for a certificate program or short-term course in physician leadership. “For example, here in my area, the University of Washington offers a nine-month course in medical management,” Dr. Gaillour explains. “You attend one evening a week, and it covers the essential concepts in being a leader in the medical field. The course kind of skims the surface of a number of important topics.”

A practical—and popular—way to acquire targeted training is by taking focused leadership courses and workshops offered by such organizations as SHM or ACPE.

Start with SHM

As the chair of SHM’s Leadership Committee, Eric Howell, MD, FHM, SHM board member and director of Collaborative Inpatient Medicine Service in the Department of Medicine at Johns Hopkins Bayview Medical Center in Baltimore, is closely involved in the society’s Leadership Academy. “Anybody can sign up for this—hospitalists, nonphysicians, even administrators,” he explains. “Level 1 has no prerequisites, and Level 2 requires only that you’ve completed Level 1 or something equivalent.”

The Level 1 Academy is “probably best for those looking to improve their leadership skills in whatever venue they’re in—an HM group, nursing unit, you name it,” Dr. Howell says. “You can use it to figure out what you need more help with and then branch out to an ACPE [course] or something like that—even an MBA program.”

The next Leadership Academy is Sept. 14-17 in Miami.

Physician-Specific Leadership Courses

ACPE offers a wealth of physician leadership education options, including live and online courses. The core curriculum includes courses that cover the basics of negotiation, managing physicians, finance, and more. ACPE also offers courses that count toward four different medical management degrees, including an MBA.

“The ACPE is probably the No. 1 resource for physicians who want to develop skills in leadership,” says Dr. Gaillour, who is an ACPE fellow. “Their core courses are valuable, as well as fun and interesting. Beyond the basics, you can go as deep as you want in a specific area. About one-third of their curriculum is newer topics for more experienced physicians.”

Dr. Howell says ACPE courses “get a lot of traction among the leadership [committee]. They have courses relevant to hospitalists and hospital leaders.”

Patience Agborbesong, MD, has completed several ACPE courses. Currently an assistant professor as well as the medical director of the hospitalist program at Wake Forest University Baptist Medical Center in Winston-Salem, N.C., Dr. Agborbesong first discovered ACPE courses as a newly promoted HM group director. “I took ‘Managing Physician Performance,’ a Web-based class with an actual instructor,” she says. “That course was particularly helpful to me. It covered interviewing job candidates, giving feedback and performance reviews, and dealing with disruptive individuals.”

One difference between SHM’s Leadership Academy and ACPE courses is class makeup. SHM’s Academy attracts a hospitalist crowd; physicians from all specialties attend ACPE courses. “I like the SHM Leadership Academy because it focuses on the hospital environment,” Dr. Agborbesong says, “but the ACPE is good, too, because I like to know how other worlds work—like private practice.”

Teach the Teacher

For academic hospitalists, a whole subset of specialized training exists, including the new Academic Hospitalist Academy. Co-sponsored by SHM, the Society of General Internal Medicine (SGIM), and the Association of Chiefs of General Internal Medicine (ACGIM), the academy will teach the practical knowledge, skills, and attitudes necessary to succeed as an academic hospitalist.

“The first one will take place in November,” says Jeffrey Wiese, MD, FACP, FHM, SHM board member and associate professor of medicine at Tulane University Health Sciences Center in New Orleans, as well as associate chairman of medicine and director of the Tulane Internal Medicine Residency Program. The four-day course “covers teaching, working on research, and generally putting together a portfolio of academic work. It will also include some education on quality, knowing that academic hospitalists do a lot of research on this.”

Dr. Weise also recommends the Teaching Hospital Educators (THE) Course: “What Clinical Teachers in Hospital Medicine Need to Know.” It is offered as a pre-course at HM09 this month in Chicago. It debuted at the 2008 annual meeting and drew rave reviews, Dr. Wiese says. “This is a one-day course that focuses on the teaching component of being an academic hospitalist,” he says.

In-House Opportunities

Don’t overlook training opportunities offered by your group or institution, as they can help you save on travel and registration costs. “Investing yourself in whatever you have available is essential,” Dr. Howell stresses. “Most organizations have some leadership training, or some mentorship program. Even if it’s something like a course on dealing with difficult people offered by your human resources department, this is a great place to start, especially for those hospitalists just beginning to think about leadership.”

A side benefit of taking training offered by your employer is that you’ll position yourself for further training at your organization’s expense: “Many groups are willing to invest in their leaders, and I think they would give you CME money for leadership training … if you’ve demonstrated your interest by going to those free [in-house] courses, or taken it upon yourself to take a community college class or an online course,” Dr. Howell says. “This shows you’re ready to invest in yourself.”

Dr. Agborbesong helped compile a list of leadership training resources, which is available on SHM’s Web site at www.hospitalmedicine.org/LeadershipSpecialInterest. TH

Jane Jerrard is a freelance writer based in Chicago. She also writes Public Policy for The Hospitalist.

Hospitalists who are planning on advancing their careers—particularly those working toward leadership roles—need to acquire or sharpen their skills through additional training: conferences and seminars, online courses, self-study, or university classes.

The Hospitalist spoke with several HM leaders and a physician executive coach about what makes an employee promotion material. Here are their “continuing education” suggestions for ambitious hospitalists.

Invest in Yourself

The first step in selecting a training venue is to identify your goal. What do you need to learn? How much time, effort, and money do you want to devote to the training? “There are avenues for physicians to pursue if they want to develop some leadership skills,” says Francine R. Gaillour, MD, MBA, FACPE, executive director of the Physician Coaching Institute in Bellevue, Wash.

One route, which requires a considerable investment, is to pursue a master’s of business administration (MBA) degree. “I don’t recommend this for most physicians. However, a lot of physicians choose this,” Dr. Gaillour says. “It will help mainly on the business side of becoming a leader, and there are several MBA programs that cater specifically to physicians, or to healthcare.”

A number of the nation’s top universities offer advanced degrees for physicians, including:

• The University of Tennessee offers a physician executive MBA;
• The University of California at Irvine offers a healthcare executive MBA;
• The University of South Florida offers an executive MBA for physicians; and
• The University of Massachusetts offers an MBA program through the American College of Physician Executives (ACPE).

For many hospitalist leaders, an MBA is not necessary. Instead, you might prefer to sign up for a certificate program or short-term course in physician leadership. “For example, here in my area, the University of Washington offers a nine-month course in medical management,” Dr. Gaillour explains. “You attend one evening a week, and it covers the essential concepts in being a leader in the medical field. The course kind of skims the surface of a number of important topics.”

A practical—and popular—way to acquire targeted training is by taking focused leadership courses and workshops offered by such organizations as SHM or ACPE.

Start with SHM

As the chair of SHM’s Leadership Committee, Eric Howell, MD, FHM, SHM board member and director of Collaborative Inpatient Medicine Service in the Department of Medicine at Johns Hopkins Bayview Medical Center in Baltimore, is closely involved in the society’s Leadership Academy. “Anybody can sign up for this—hospitalists, nonphysicians, even administrators,” he explains. “Level 1 has no prerequisites, and Level 2 requires only that you’ve completed Level 1 or something equivalent.”

The Level 1 Academy is “probably best for those looking to improve their leadership skills in whatever venue they’re in—an HM group, nursing unit, you name it,” Dr. Howell says. “You can use it to figure out what you need more help with and then branch out to an ACPE [course] or something like that—even an MBA program.”

The next Leadership Academy is Sept. 14-17 in Miami.

Physician-Specific Leadership Courses

ACPE offers a wealth of physician leadership education options, including live and online courses. The core curriculum includes courses that cover the basics of negotiation, managing physicians, finance, and more. ACPE also offers courses that count toward four different medical management degrees, including an MBA.

“The ACPE is probably the No. 1 resource for physicians who want to develop skills in leadership,” says Dr. Gaillour, who is an ACPE fellow. “Their core courses are valuable, as well as fun and interesting. Beyond the basics, you can go as deep as you want in a specific area. About one-third of their curriculum is newer topics for more experienced physicians.”

Dr. Howell says ACPE courses “get a lot of traction among the leadership [committee]. They have courses relevant to hospitalists and hospital leaders.”

Patience Agborbesong, MD, has completed several ACPE courses. Currently an assistant professor as well as the medical director of the hospitalist program at Wake Forest University Baptist Medical Center in Winston-Salem, N.C., Dr. Agborbesong first discovered ACPE courses as a newly promoted HM group director. “I took ‘Managing Physician Performance,’ a Web-based class with an actual instructor,” she says. “That course was particularly helpful to me. It covered interviewing job candidates, giving feedback and performance reviews, and dealing with disruptive individuals.”

One difference between SHM’s Leadership Academy and ACPE courses is class makeup. SHM’s Academy attracts a hospitalist crowd; physicians from all specialties attend ACPE courses. “I like the SHM Leadership Academy because it focuses on the hospital environment,” Dr. Agborbesong says, “but the ACPE is good, too, because I like to know how other worlds work—like private practice.”

Teach the Teacher

For academic hospitalists, a whole subset of specialized training exists, including the new Academic Hospitalist Academy. Co-sponsored by SHM, the Society of General Internal Medicine (SGIM), and the Association of Chiefs of General Internal Medicine (ACGIM), the academy will teach the practical knowledge, skills, and attitudes necessary to succeed as an academic hospitalist.

“The first one will take place in November,” says Jeffrey Wiese, MD, FACP, FHM, SHM board member and associate professor of medicine at Tulane University Health Sciences Center in New Orleans, as well as associate chairman of medicine and director of the Tulane Internal Medicine Residency Program. The four-day course “covers teaching, working on research, and generally putting together a portfolio of academic work. It will also include some education on quality, knowing that academic hospitalists do a lot of research on this.”

Dr. Weise also recommends the Teaching Hospital Educators (THE) Course: “What Clinical Teachers in Hospital Medicine Need to Know.” It is offered as a pre-course at HM09 this month in Chicago. It debuted at the 2008 annual meeting and drew rave reviews, Dr. Wiese says. “This is a one-day course that focuses on the teaching component of being an academic hospitalist,” he says.

In-House Opportunities

Don’t overlook training opportunities offered by your group or institution, as they can help you save on travel and registration costs. “Investing yourself in whatever you have available is essential,” Dr. Howell stresses. “Most organizations have some leadership training, or some mentorship program. Even if it’s something like a course on dealing with difficult people offered by your human resources department, this is a great place to start, especially for those hospitalists just beginning to think about leadership.”

A side benefit of taking training offered by your employer is that you’ll position yourself for further training at your organization’s expense: “Many groups are willing to invest in their leaders, and I think they would give you CME money for leadership training … if you’ve demonstrated your interest by going to those free [in-house] courses, or taken it upon yourself to take a community college class or an online course,” Dr. Howell says. “This shows you’re ready to invest in yourself.”

Dr. Agborbesong helped compile a list of leadership training resources, which is available on SHM’s Web site at www.hospitalmedicine.org/LeadershipSpecialInterest. TH

Jane Jerrard is a freelance writer based in Chicago. She also writes Public Policy for The Hospitalist.

Hospitalists who are planning on advancing their careers—particularly those working toward leadership roles—need to acquire or sharpen their skills through additional training: conferences and seminars, online courses, self-study, or university classes.

The Hospitalist spoke with several HM leaders and a physician executive coach about what makes an employee promotion material. Here are their “continuing education” suggestions for ambitious hospitalists.

Invest in Yourself

The first step in selecting a training venue is to identify your goal. What do you need to learn? How much time, effort, and money do you want to devote to the training? “There are avenues for physicians to pursue if they want to develop some leadership skills,” says Francine R. Gaillour, MD, MBA, FACPE, executive director of the Physician Coaching Institute in Bellevue, Wash.

One route, which requires a considerable investment, is to pursue a master’s of business administration (MBA) degree. “I don’t recommend this for most physicians. However, a lot of physicians choose this,” Dr. Gaillour says. “It will help mainly on the business side of becoming a leader, and there are several MBA programs that cater specifically to physicians, or to healthcare.”

A number of the nation’s top universities offer advanced degrees for physicians, including:

• The University of Tennessee offers a physician executive MBA;
• The University of California at Irvine offers a healthcare executive MBA;
• The University of South Florida offers an executive MBA for physicians; and
• The University of Massachusetts offers an MBA program through the American College of Physician Executives (ACPE).

For many hospitalist leaders, an MBA is not necessary. Instead, you might prefer to sign up for a certificate program or short-term course in physician leadership. “For example, here in my area, the University of Washington offers a nine-month course in medical management,” Dr. Gaillour explains. “You attend one evening a week, and it covers the essential concepts in being a leader in the medical field. The course kind of skims the surface of a number of important topics.”

A practical—and popular—way to acquire targeted training is by taking focused leadership courses and workshops offered by such organizations as SHM or ACPE.

Start with SHM

As the chair of SHM’s Leadership Committee, Eric Howell, MD, FHM, SHM board member and director of Collaborative Inpatient Medicine Service in the Department of Medicine at Johns Hopkins Bayview Medical Center in Baltimore, is closely involved in the society’s Leadership Academy. “Anybody can sign up for this—hospitalists, nonphysicians, even administrators,” he explains. “Level 1 has no prerequisites, and Level 2 requires only that you’ve completed Level 1 or something equivalent.”

The Level 1 Academy is “probably best for those looking to improve their leadership skills in whatever venue they’re in—an HM group, nursing unit, you name it,” Dr. Howell says. “You can use it to figure out what you need more help with and then branch out to an ACPE [course] or something like that—even an MBA program.”

The next Leadership Academy is Sept. 14-17 in Miami.

Physician-Specific Leadership Courses

ACPE offers a wealth of physician leadership education options, including live and online courses. The core curriculum includes courses that cover the basics of negotiation, managing physicians, finance, and more. ACPE also offers courses that count toward four different medical management degrees, including an MBA.

“The ACPE is probably the No. 1 resource for physicians who want to develop skills in leadership,” says Dr. Gaillour, who is an ACPE fellow. “Their core courses are valuable, as well as fun and interesting. Beyond the basics, you can go as deep as you want in a specific area. About one-third of their curriculum is newer topics for more experienced physicians.”

Dr. Howell says ACPE courses “get a lot of traction among the leadership [committee]. They have courses relevant to hospitalists and hospital leaders.”

Patience Agborbesong, MD, has completed several ACPE courses. Currently an assistant professor as well as the medical director of the hospitalist program at Wake Forest University Baptist Medical Center in Winston-Salem, N.C., Dr. Agborbesong first discovered ACPE courses as a newly promoted HM group director. “I took ‘Managing Physician Performance,’ a Web-based class with an actual instructor,” she says. “That course was particularly helpful to me. It covered interviewing job candidates, giving feedback and performance reviews, and dealing with disruptive individuals.”

One difference between SHM’s Leadership Academy and ACPE courses is class makeup. SHM’s Academy attracts a hospitalist crowd; physicians from all specialties attend ACPE courses. “I like the SHM Leadership Academy because it focuses on the hospital environment,” Dr. Agborbesong says, “but the ACPE is good, too, because I like to know how other worlds work—like private practice.”

Teach the Teacher

For academic hospitalists, a whole subset of specialized training exists, including the new Academic Hospitalist Academy. Co-sponsored by SHM, the Society of General Internal Medicine (SGIM), and the Association of Chiefs of General Internal Medicine (ACGIM), the academy will teach the practical knowledge, skills, and attitudes necessary to succeed as an academic hospitalist.

“The first one will take place in November,” says Jeffrey Wiese, MD, FACP, FHM, SHM board member and associate professor of medicine at Tulane University Health Sciences Center in New Orleans, as well as associate chairman of medicine and director of the Tulane Internal Medicine Residency Program. The four-day course “covers teaching, working on research, and generally putting together a portfolio of academic work. It will also include some education on quality, knowing that academic hospitalists do a lot of research on this.”

Dr. Weise also recommends the Teaching Hospital Educators (THE) Course: “What Clinical Teachers in Hospital Medicine Need to Know.” It is offered as a pre-course at HM09 this month in Chicago. It debuted at the 2008 annual meeting and drew rave reviews, Dr. Wiese says. “This is a one-day course that focuses on the teaching component of being an academic hospitalist,” he says.

In-House Opportunities

Don’t overlook training opportunities offered by your group or institution, as they can help you save on travel and registration costs. “Investing yourself in whatever you have available is essential,” Dr. Howell stresses. “Most organizations have some leadership training, or some mentorship program. Even if it’s something like a course on dealing with difficult people offered by your human resources department, this is a great place to start, especially for those hospitalists just beginning to think about leadership.”

A side benefit of taking training offered by your employer is that you’ll position yourself for further training at your organization’s expense: “Many groups are willing to invest in their leaders, and I think they would give you CME money for leadership training … if you’ve demonstrated your interest by going to those free [in-house] courses, or taken it upon yourself to take a community college class or an online course,” Dr. Howell says. “This shows you’re ready to invest in yourself.”

Dr. Agborbesong helped compile a list of leadership training resources, which is available on SHM’s Web site at www.hospitalmedicine.org/LeadershipSpecialInterest. TH

Jane Jerrard is a freelance writer based in Chicago. She also writes Public Policy for The Hospitalist.

Change is in the air. With a new ad-ministration promising to be a change agent, an overhauled Congress, and a seemingly unanimous national interest in tackling healthcare reform, what changes can hospital medicine expect in 2009?

“I think there’s certainly the political will and interest now,” says Eric Siegal, MD, chair of SHM’s Public Policy Committee. “We haven’t had enough political will to ‘go big’ until recently. Now that we have it, the trillion-dollar question is where the money will come from.”

With that in mind, let’s explore three of the hottest healthcare issues:

Comprehensive Healthcare Reform

Providing healthcare coverage to all or most Americans was a centerpiece of President Obama’s campaign and a significant part of a proposal published by Senate Finance Committee Chairman Max Baucus (D-Mont.). Any actual reform will come through legislation, which will have to spell out who is covered and how, and where the money will come from. Any legislation will have to pass both the House and the Senate before Obama can sign it into law.

“The Democrats have certainly said [healthcare reform] is going to happen. Obama has talked about it … but how bipartisan will the effort be?” Dr. Siegal says. “This is too big and important for unilateral action; any durable healthcare reform must have bipartisan support. I do think that everyone can agree that the healthcare system is going to bankrupt itself if we don’t make changes.”

Dr. Siegal is skeptical that a major reform bill of any stripe will be passed anytime soon. “Given the depth of the recession and the projected cost of the stimulus package, my guess is that we will not see significant healthcare reform legislation passed in 2009,” he predicts. “However, I think that 2009 is still going to be an important year in that Congress will lay much of the foundation for new legislation. My guess is that 2010 is the year to look for major healthcare reform. And we want to make sure that the reform that happens is in the best interests of healthcare and of hospitalists.”

Less encompassing aspects of healthcare reform, the “easy stuff,” should have enough votes to pass in 2009, Dr. Siegal says. A good example is the State Children’s Health Insurance Program (SCHIP), which was passed the first week of February and increases the number of children eligible for free medical coverage from 7 million to 11 million. “SCHIP was as close to a slam dunk as possible.”

Major overhauls to the system, such as the healthcare exchange outlined in Sen. Baucus’ proposal or a major reworking of Medicare, may come about further down the road. “Those are going to take a lot of time, energy, and money,” Dr. Siegal says, “and I think that Congress has bigger fish to fry right now.”

Physician Fee Schedule

Last summer, physician fees paid by Medicare were slashed by 10.6% and then restored—with a 1.1% increase—when Congress overrode a presidential veto. SHM members were among the many physicians who fought the fee cut with letters and e-mails to Congress. However, the current fee schedule is short-lived: A 20% fee cut is scheduled for 2010. Will hospitalists and others have to go through the same battle all over again to maintain their Medicare payments?

Bradley Flansbaum, DO, MPH, chief of the hospitalist section at Lenox Hill Hospital in New York City and a member of SHM’s Public Policy Committee, points out “there are some proposals to modify the SGR [sustainable growth rate] formula, so this may not be the hot issue it was in 2008.” The SGR is used to set reimbursement rates for specific services and have been targeted by numerous stakeholders as flawed.

Regardless of the reimbursement formula, the Centers for Medicare and Medicaid Services (CMS) physician fee schedule might become less crucial to hospitalists’ income. “In the context of healthcare reform, you have to wonder if fee-for-service is even going to be relevant,” Dr. Flansbaum explains. “I think that Congress and MedPAC will think things through and admit that we can’t keep Band-Aiding a broken system.”

A major system overhaul might be looming. “This may not happen this year,” he says, “but I think that if Congress needs to avert the pay cut, then they will say they’re doing this one more time, with the caveat that payment will be drastically different” in the near future.

Delivery System Reform

A third hot topic for 2009 is legislation and consideration of changes in the healthcare delivery system, including payment reform, healthcare information technology, and improving care coordination.

“We think that payment reform is central to reshaping the healthcare system,” Dr. Siegal says.

As for moving toward a fee-for-quality system: “Well, there’s politics and there’s policy,” Dr. Flansbaum says. “Politics says we need to reward quality. However, the policy is that the methods of measuring quality haven’t evolved to the point where we can go forward. Everything is in beta-testing right now; we’re not ready to make any sweeping decisions. The delivery system has to be well-thought-out. It’s complicated.”

For example, in 2008, the CMS published a proposed inpatient prospective payment system rule, which included additional categories of hospital-acquired conditions that would no longer carry higher Medicare payments. The list caused industry alarm because some of the conditions—including Clostridium difficile-associated disease (see “Clostridium Difficile Infection: Are We Doing Enough,” p. 12)—were seen as only partially preventable in hospitalized patients or not entirely hospital-acquired.

The lesson learned? Any reform to healthcare delivery must be carefully considered, along with input from the medical community. “Healthcare is 16% of the gross domestic product. You don’t take that and spin it around in one day,” Dr. Flansbaum says. “It’s best to approach reform slowly and really think it through.”

Even so, there is no guarantee that reform legislation will make it through Congress.

“Another aspect to consider is that there are ideological differences between Democrats and Republicans,” Dr. Flansbaum adds. “ … Many Republicans are miles away from [Democrats] ideologically. Further still, with Daschle’s exit, it is unclear how his replacement will approach any overhaul.”

Of course, nobody has a crystal ball. This year may bring forth less drastic changes than hospital medicine is predicting. Then again, considering the economic and political climate, reform could take place faster than seems possible.

Only time will tell. TH

Jane Jerrard is a medical writer based in Chicago.

Change is in the air. With a new ad-ministration promising to be a change agent, an overhauled Congress, and a seemingly unanimous national interest in tackling healthcare reform, what changes can hospital medicine expect in 2009?

“I think there’s certainly the political will and interest now,” says Eric Siegal, MD, chair of SHM’s Public Policy Committee. “We haven’t had enough political will to ‘go big’ until recently. Now that we have it, the trillion-dollar question is where the money will come from.”

With that in mind, let’s explore three of the hottest healthcare issues:

Comprehensive Healthcare Reform

Providing healthcare coverage to all or most Americans was a centerpiece of President Obama’s campaign and a significant part of a proposal published by Senate Finance Committee Chairman Max Baucus (D-Mont.). Any actual reform will come through legislation, which will have to spell out who is covered and how, and where the money will come from. Any legislation will have to pass both the House and the Senate before Obama can sign it into law.

“The Democrats have certainly said [healthcare reform] is going to happen. Obama has talked about it … but how bipartisan will the effort be?” Dr. Siegal says. “This is too big and important for unilateral action; any durable healthcare reform must have bipartisan support. I do think that everyone can agree that the healthcare system is going to bankrupt itself if we don’t make changes.”

Dr. Siegal is skeptical that a major reform bill of any stripe will be passed anytime soon. “Given the depth of the recession and the projected cost of the stimulus package, my guess is that we will not see significant healthcare reform legislation passed in 2009,” he predicts. “However, I think that 2009 is still going to be an important year in that Congress will lay much of the foundation for new legislation. My guess is that 2010 is the year to look for major healthcare reform. And we want to make sure that the reform that happens is in the best interests of healthcare and of hospitalists.”

Less encompassing aspects of healthcare reform, the “easy stuff,” should have enough votes to pass in 2009, Dr. Siegal says. A good example is the State Children’s Health Insurance Program (SCHIP), which was passed the first week of February and increases the number of children eligible for free medical coverage from 7 million to 11 million. “SCHIP was as close to a slam dunk as possible.”

Major overhauls to the system, such as the healthcare exchange outlined in Sen. Baucus’ proposal or a major reworking of Medicare, may come about further down the road. “Those are going to take a lot of time, energy, and money,” Dr. Siegal says, “and I think that Congress has bigger fish to fry right now.”

Physician Fee Schedule

Last summer, physician fees paid by Medicare were slashed by 10.6% and then restored—with a 1.1% increase—when Congress overrode a presidential veto. SHM members were among the many physicians who fought the fee cut with letters and e-mails to Congress. However, the current fee schedule is short-lived: A 20% fee cut is scheduled for 2010. Will hospitalists and others have to go through the same battle all over again to maintain their Medicare payments?

Bradley Flansbaum, DO, MPH, chief of the hospitalist section at Lenox Hill Hospital in New York City and a member of SHM’s Public Policy Committee, points out “there are some proposals to modify the SGR [sustainable growth rate] formula, so this may not be the hot issue it was in 2008.” The SGR is used to set reimbursement rates for specific services and have been targeted by numerous stakeholders as flawed.

Regardless of the reimbursement formula, the Centers for Medicare and Medicaid Services (CMS) physician fee schedule might become less crucial to hospitalists’ income. “In the context of healthcare reform, you have to wonder if fee-for-service is even going to be relevant,” Dr. Flansbaum explains. “I think that Congress and MedPAC will think things through and admit that we can’t keep Band-Aiding a broken system.”

A major system overhaul might be looming. “This may not happen this year,” he says, “but I think that if Congress needs to avert the pay cut, then they will say they’re doing this one more time, with the caveat that payment will be drastically different” in the near future.

Delivery System Reform

A third hot topic for 2009 is legislation and consideration of changes in the healthcare delivery system, including payment reform, healthcare information technology, and improving care coordination.

“We think that payment reform is central to reshaping the healthcare system,” Dr. Siegal says.

As for moving toward a fee-for-quality system: “Well, there’s politics and there’s policy,” Dr. Flansbaum says. “Politics says we need to reward quality. However, the policy is that the methods of measuring quality haven’t evolved to the point where we can go forward. Everything is in beta-testing right now; we’re not ready to make any sweeping decisions. The delivery system has to be well-thought-out. It’s complicated.”

For example, in 2008, the CMS published a proposed inpatient prospective payment system rule, which included additional categories of hospital-acquired conditions that would no longer carry higher Medicare payments. The list caused industry alarm because some of the conditions—including Clostridium difficile-associated disease (see “Clostridium Difficile Infection: Are We Doing Enough,” p. 12)—were seen as only partially preventable in hospitalized patients or not entirely hospital-acquired.

The lesson learned? Any reform to healthcare delivery must be carefully considered, along with input from the medical community. “Healthcare is 16% of the gross domestic product. You don’t take that and spin it around in one day,” Dr. Flansbaum says. “It’s best to approach reform slowly and really think it through.”

Even so, there is no guarantee that reform legislation will make it through Congress.

“Another aspect to consider is that there are ideological differences between Democrats and Republicans,” Dr. Flansbaum adds. “ … Many Republicans are miles away from [Democrats] ideologically. Further still, with Daschle’s exit, it is unclear how his replacement will approach any overhaul.”

Of course, nobody has a crystal ball. This year may bring forth less drastic changes than hospital medicine is predicting. Then again, considering the economic and political climate, reform could take place faster than seems possible.

Only time will tell. TH

Jane Jerrard is a medical writer based in Chicago.

Change is in the air. With a new ad-ministration promising to be a change agent, an overhauled Congress, and a seemingly unanimous national interest in tackling healthcare reform, what changes can hospital medicine expect in 2009?

“I think there’s certainly the political will and interest now,” says Eric Siegal, MD, chair of SHM’s Public Policy Committee. “We haven’t had enough political will to ‘go big’ until recently. Now that we have it, the trillion-dollar question is where the money will come from.”

With that in mind, let’s explore three of the hottest healthcare issues:

Comprehensive Healthcare Reform

Providing healthcare coverage to all or most Americans was a centerpiece of President Obama’s campaign and a significant part of a proposal published by Senate Finance Committee Chairman Max Baucus (D-Mont.). Any actual reform will come through legislation, which will have to spell out who is covered and how, and where the money will come from. Any legislation will have to pass both the House and the Senate before Obama can sign it into law.

“The Democrats have certainly said [healthcare reform] is going to happen. Obama has talked about it … but how bipartisan will the effort be?” Dr. Siegal says. “This is too big and important for unilateral action; any durable healthcare reform must have bipartisan support. I do think that everyone can agree that the healthcare system is going to bankrupt itself if we don’t make changes.”

Dr. Siegal is skeptical that a major reform bill of any stripe will be passed anytime soon. “Given the depth of the recession and the projected cost of the stimulus package, my guess is that we will not see significant healthcare reform legislation passed in 2009,” he predicts. “However, I think that 2009 is still going to be an important year in that Congress will lay much of the foundation for new legislation. My guess is that 2010 is the year to look for major healthcare reform. And we want to make sure that the reform that happens is in the best interests of healthcare and of hospitalists.”

Less encompassing aspects of healthcare reform, the “easy stuff,” should have enough votes to pass in 2009, Dr. Siegal says. A good example is the State Children’s Health Insurance Program (SCHIP), which was passed the first week of February and increases the number of children eligible for free medical coverage from 7 million to 11 million. “SCHIP was as close to a slam dunk as possible.”

Major overhauls to the system, such as the healthcare exchange outlined in Sen. Baucus’ proposal or a major reworking of Medicare, may come about further down the road. “Those are going to take a lot of time, energy, and money,” Dr. Siegal says, “and I think that Congress has bigger fish to fry right now.”

Physician Fee Schedule

Last summer, physician fees paid by Medicare were slashed by 10.6% and then restored—with a 1.1% increase—when Congress overrode a presidential veto. SHM members were among the many physicians who fought the fee cut with letters and e-mails to Congress. However, the current fee schedule is short-lived: A 20% fee cut is scheduled for 2010. Will hospitalists and others have to go through the same battle all over again to maintain their Medicare payments?

Bradley Flansbaum, DO, MPH, chief of the hospitalist section at Lenox Hill Hospital in New York City and a member of SHM’s Public Policy Committee, points out “there are some proposals to modify the SGR [sustainable growth rate] formula, so this may not be the hot issue it was in 2008.” The SGR is used to set reimbursement rates for specific services and have been targeted by numerous stakeholders as flawed.

Regardless of the reimbursement formula, the Centers for Medicare and Medicaid Services (CMS) physician fee schedule might become less crucial to hospitalists’ income. “In the context of healthcare reform, you have to wonder if fee-for-service is even going to be relevant,” Dr. Flansbaum explains. “I think that Congress and MedPAC will think things through and admit that we can’t keep Band-Aiding a broken system.”

A major system overhaul might be looming. “This may not happen this year,” he says, “but I think that if Congress needs to avert the pay cut, then they will say they’re doing this one more time, with the caveat that payment will be drastically different” in the near future.

Delivery System Reform

A third hot topic for 2009 is legislation and consideration of changes in the healthcare delivery system, including payment reform, healthcare information technology, and improving care coordination.

“We think that payment reform is central to reshaping the healthcare system,” Dr. Siegal says.

As for moving toward a fee-for-quality system: “Well, there’s politics and there’s policy,” Dr. Flansbaum says. “Politics says we need to reward quality. However, the policy is that the methods of measuring quality haven’t evolved to the point where we can go forward. Everything is in beta-testing right now; we’re not ready to make any sweeping decisions. The delivery system has to be well-thought-out. It’s complicated.”

For example, in 2008, the CMS published a proposed inpatient prospective payment system rule, which included additional categories of hospital-acquired conditions that would no longer carry higher Medicare payments. The list caused industry alarm because some of the conditions—including Clostridium difficile-associated disease (see “Clostridium Difficile Infection: Are We Doing Enough,” p. 12)—were seen as only partially preventable in hospitalized patients or not entirely hospital-acquired.

The lesson learned? Any reform to healthcare delivery must be carefully considered, along with input from the medical community. “Healthcare is 16% of the gross domestic product. You don’t take that and spin it around in one day,” Dr. Flansbaum says. “It’s best to approach reform slowly and really think it through.”

Even so, there is no guarantee that reform legislation will make it through Congress.

“Another aspect to consider is that there are ideological differences between Democrats and Republicans,” Dr. Flansbaum adds. “ … Many Republicans are miles away from [Democrats] ideologically. Further still, with Daschle’s exit, it is unclear how his replacement will approach any overhaul.”

Of course, nobody has a crystal ball. This year may bring forth less drastic changes than hospital medicine is predicting. Then again, considering the economic and political climate, reform could take place faster than seems possible.

Only time will tell. TH

Jane Jerrard is a medical writer based in Chicago.