Jane Jerrard

Your physical appearance—the image and demeanor you present in your work environment—plays an important role in your career. If you aspire to a leadership position or are looking for a new job, be sure to examine your outward style as carefully as you craft your curriculum vitae.

“This is a huge, woefully unexplored way that physicians relate to the world,” says Mary Frances Lyons, MD, an executive search consultant with Witt/Kiefer in St. Louis. “Let’s call it body language. It’s the attitude or deportment you show. If you’re not the most corporate person in the world, you can still appear to be open, enthusiastic about your work, and have integrity.”

Kindergarten Revisited

Dr. Lyons frequently coaches physician executives before job interviews. She instructs many of them in the basics: standing up straight, making eye contact, smiling, and having a firm handshake. “This is literally your chance to connect with other people,” she says. “Send a signal that you want to connect, that you’re open, and you’ll bring that out in them as well.”

Her advice may seem simplistic, and she agrees. “You can literally learn this stuff in kindergarten—but many physicians don’t do it,” she says. “Their currency of credibility is how smart they are, and they rely on that. The truth is that no one in medical school ever teaches physicians that a large part of their medical success is how they interact with and relate to others—including patients, their boss, payers, and colleagues.” As a clinician, you can get by with minimal social skills or attention to your demeanor, but Dr. Lyons warns, “If you want to move up the food chain, this is professionally important.”

Typically, hospitalists are insulated from the traditional office dress code (i.e., suits and ties and heels), but doctors are not immune to the basic standards of workplace appearance. “For better or for worse, hospital medicine groups are not corporate,” Dr. Lyons points out. “The question is, how do you become corporate enough to get the job offer or the promotion?”

Look the Part

If you want a higher-level position, whether you’re aiming for a promotion, interviewing for an important committee position, or seeking a new job, consider the impression you make before you open your mouth.

“Your style and attitude is more important than how you dress,” Dr. Lyons says. “However, appearance-wise, you want to look professional and serious … not somber. Be appropriate and nondescript; you don’t want interesting clothes or clothes that make a statement. You want people to think, ‘What a professional person,’ not ‘Wow, I really love those earrings.’ ”

When you have an important interview or meeting, wear a dark business suit. Pantsuits are fine for women, Dr. Lyons says. “You can never, ever go wrong with a suit,” she says. “You don’t want the people interviewing you to be better dressed than you. Your appearance signals how you’ll present yourself to patients.”

Ultimately, a physician’s behavior and professional interactions are significant considerations in the hiring process, says Kenneth Simone, DO, owner of Hospitalist and Practice Solutions in Veazie, Maine, and author of the upcoming book “Hospitalist Recruitment and Retention: Building a Hospital Medicine Program.” “It will affect relationships with all stakeholders in the healthcare system. Furthermore, if the hospitalist’s professional relationship with the nursing staff and other hospital staff disintegrates, it can affect patient care.”

Listen Up

During a job interview, promotional interview, or committee chair interview, the balance between how much you say and when you stop talking can reveal much about your attitude. Hiring managers look for leaders who can listen as well as they direct. “Doctors have no idea how to listen,” Dr. Lyons says. “I sometimes recommend that a client limit himself or herself to three sentences to answer a question.” Dr. Simone agrees. “A job candidate should discuss their professional and personal interests when queried but should refrain from dominating the discussion. It should be an interactive exchange,” he says.

Dr. Lyons recommends preparing for an interview by putting together a three- to five-minute presentation about who you are as a professional. Your interviewers will already have your resume, so avoid recounting what they already know. “If you’re having trouble with these things, put on your interview suit, then videotape yourself giving your presentation,” Dr. Lyons says. “Watch it and ask yourself, ‘Would I hire this person?’ It’s a grim exercise, but it’s effective.”

Consider your demeanor and make changes that allow you to show off your personal strengths and your ability to connect. Simple changes—upgrades, if you will—can lift you above your competition. “If concerns arise with one candidate, the rule of thumb is to avoid taking a chance on hiring a potential problem physician,” Dr. Simone says. “Recruitment is expensive. It has been estimated that making an incorrect [hire] can cost a program up to $100,000, when you consider expenses such as headhunter fees, sign-on bonus, moving expenses, and advertising, in addition to lost revenues for the program while staff participate in the recruitment process and lost productivity when the program is down one provider.”

A good attitude, openness to others, and a professional demeanor can bolster your career path. As Dr. Lyons points out, “If you don’t interview well, other people will make all the major decisions for your career. Physicians have not been taught to interview well. The good news is, it’s not that hard.” TH

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

Your physical appearance—the image and demeanor you present in your work environment—plays an important role in your career. If you aspire to a leadership position or are looking for a new job, be sure to examine your outward style as carefully as you craft your curriculum vitae.

“This is a huge, woefully unexplored way that physicians relate to the world,” says Mary Frances Lyons, MD, an executive search consultant with Witt/Kiefer in St. Louis. “Let’s call it body language. It’s the attitude or deportment you show. If you’re not the most corporate person in the world, you can still appear to be open, enthusiastic about your work, and have integrity.”

Kindergarten Revisited

Dr. Lyons frequently coaches physician executives before job interviews. She instructs many of them in the basics: standing up straight, making eye contact, smiling, and having a firm handshake. “This is literally your chance to connect with other people,” she says. “Send a signal that you want to connect, that you’re open, and you’ll bring that out in them as well.”

Her advice may seem simplistic, and she agrees. “You can literally learn this stuff in kindergarten—but many physicians don’t do it,” she says. “Their currency of credibility is how smart they are, and they rely on that. The truth is that no one in medical school ever teaches physicians that a large part of their medical success is how they interact with and relate to others—including patients, their boss, payers, and colleagues.” As a clinician, you can get by with minimal social skills or attention to your demeanor, but Dr. Lyons warns, “If you want to move up the food chain, this is professionally important.”

Typically, hospitalists are insulated from the traditional office dress code (i.e., suits and ties and heels), but doctors are not immune to the basic standards of workplace appearance. “For better or for worse, hospital medicine groups are not corporate,” Dr. Lyons points out. “The question is, how do you become corporate enough to get the job offer or the promotion?”

Look the Part

If you want a higher-level position, whether you’re aiming for a promotion, interviewing for an important committee position, or seeking a new job, consider the impression you make before you open your mouth.

“Your style and attitude is more important than how you dress,” Dr. Lyons says. “However, appearance-wise, you want to look professional and serious … not somber. Be appropriate and nondescript; you don’t want interesting clothes or clothes that make a statement. You want people to think, ‘What a professional person,’ not ‘Wow, I really love those earrings.’ ”

When you have an important interview or meeting, wear a dark business suit. Pantsuits are fine for women, Dr. Lyons says. “You can never, ever go wrong with a suit,” she says. “You don’t want the people interviewing you to be better dressed than you. Your appearance signals how you’ll present yourself to patients.”

Ultimately, a physician’s behavior and professional interactions are significant considerations in the hiring process, says Kenneth Simone, DO, owner of Hospitalist and Practice Solutions in Veazie, Maine, and author of the upcoming book “Hospitalist Recruitment and Retention: Building a Hospital Medicine Program.” “It will affect relationships with all stakeholders in the healthcare system. Furthermore, if the hospitalist’s professional relationship with the nursing staff and other hospital staff disintegrates, it can affect patient care.”

Listen Up

During a job interview, promotional interview, or committee chair interview, the balance between how much you say and when you stop talking can reveal much about your attitude. Hiring managers look for leaders who can listen as well as they direct. “Doctors have no idea how to listen,” Dr. Lyons says. “I sometimes recommend that a client limit himself or herself to three sentences to answer a question.” Dr. Simone agrees. “A job candidate should discuss their professional and personal interests when queried but should refrain from dominating the discussion. It should be an interactive exchange,” he says.

Dr. Lyons recommends preparing for an interview by putting together a three- to five-minute presentation about who you are as a professional. Your interviewers will already have your resume, so avoid recounting what they already know. “If you’re having trouble with these things, put on your interview suit, then videotape yourself giving your presentation,” Dr. Lyons says. “Watch it and ask yourself, ‘Would I hire this person?’ It’s a grim exercise, but it’s effective.”

Consider your demeanor and make changes that allow you to show off your personal strengths and your ability to connect. Simple changes—upgrades, if you will—can lift you above your competition. “If concerns arise with one candidate, the rule of thumb is to avoid taking a chance on hiring a potential problem physician,” Dr. Simone says. “Recruitment is expensive. It has been estimated that making an incorrect [hire] can cost a program up to $100,000, when you consider expenses such as headhunter fees, sign-on bonus, moving expenses, and advertising, in addition to lost revenues for the program while staff participate in the recruitment process and lost productivity when the program is down one provider.”

A good attitude, openness to others, and a professional demeanor can bolster your career path. As Dr. Lyons points out, “If you don’t interview well, other people will make all the major decisions for your career. Physicians have not been taught to interview well. The good news is, it’s not that hard.” TH

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

Your physical appearance—the image and demeanor you present in your work environment—plays an important role in your career. If you aspire to a leadership position or are looking for a new job, be sure to examine your outward style as carefully as you craft your curriculum vitae.

“This is a huge, woefully unexplored way that physicians relate to the world,” says Mary Frances Lyons, MD, an executive search consultant with Witt/Kiefer in St. Louis. “Let’s call it body language. It’s the attitude or deportment you show. If you’re not the most corporate person in the world, you can still appear to be open, enthusiastic about your work, and have integrity.”

Kindergarten Revisited

Dr. Lyons frequently coaches physician executives before job interviews. She instructs many of them in the basics: standing up straight, making eye contact, smiling, and having a firm handshake. “This is literally your chance to connect with other people,” she says. “Send a signal that you want to connect, that you’re open, and you’ll bring that out in them as well.”

Her advice may seem simplistic, and she agrees. “You can literally learn this stuff in kindergarten—but many physicians don’t do it,” she says. “Their currency of credibility is how smart they are, and they rely on that. The truth is that no one in medical school ever teaches physicians that a large part of their medical success is how they interact with and relate to others—including patients, their boss, payers, and colleagues.” As a clinician, you can get by with minimal social skills or attention to your demeanor, but Dr. Lyons warns, “If you want to move up the food chain, this is professionally important.”

Typically, hospitalists are insulated from the traditional office dress code (i.e., suits and ties and heels), but doctors are not immune to the basic standards of workplace appearance. “For better or for worse, hospital medicine groups are not corporate,” Dr. Lyons points out. “The question is, how do you become corporate enough to get the job offer or the promotion?”

Look the Part

If you want a higher-level position, whether you’re aiming for a promotion, interviewing for an important committee position, or seeking a new job, consider the impression you make before you open your mouth.

“Your style and attitude is more important than how you dress,” Dr. Lyons says. “However, appearance-wise, you want to look professional and serious … not somber. Be appropriate and nondescript; you don’t want interesting clothes or clothes that make a statement. You want people to think, ‘What a professional person,’ not ‘Wow, I really love those earrings.’ ”

When you have an important interview or meeting, wear a dark business suit. Pantsuits are fine for women, Dr. Lyons says. “You can never, ever go wrong with a suit,” she says. “You don’t want the people interviewing you to be better dressed than you. Your appearance signals how you’ll present yourself to patients.”

Ultimately, a physician’s behavior and professional interactions are significant considerations in the hiring process, says Kenneth Simone, DO, owner of Hospitalist and Practice Solutions in Veazie, Maine, and author of the upcoming book “Hospitalist Recruitment and Retention: Building a Hospital Medicine Program.” “It will affect relationships with all stakeholders in the healthcare system. Furthermore, if the hospitalist’s professional relationship with the nursing staff and other hospital staff disintegrates, it can affect patient care.”

Listen Up

During a job interview, promotional interview, or committee chair interview, the balance between how much you say and when you stop talking can reveal much about your attitude. Hiring managers look for leaders who can listen as well as they direct. “Doctors have no idea how to listen,” Dr. Lyons says. “I sometimes recommend that a client limit himself or herself to three sentences to answer a question.” Dr. Simone agrees. “A job candidate should discuss their professional and personal interests when queried but should refrain from dominating the discussion. It should be an interactive exchange,” he says.

Dr. Lyons recommends preparing for an interview by putting together a three- to five-minute presentation about who you are as a professional. Your interviewers will already have your resume, so avoid recounting what they already know. “If you’re having trouble with these things, put on your interview suit, then videotape yourself giving your presentation,” Dr. Lyons says. “Watch it and ask yourself, ‘Would I hire this person?’ It’s a grim exercise, but it’s effective.”

Consider your demeanor and make changes that allow you to show off your personal strengths and your ability to connect. Simple changes—upgrades, if you will—can lift you above your competition. “If concerns arise with one candidate, the rule of thumb is to avoid taking a chance on hiring a potential problem physician,” Dr. Simone says. “Recruitment is expensive. It has been estimated that making an incorrect [hire] can cost a program up to $100,000, when you consider expenses such as headhunter fees, sign-on bonus, moving expenses, and advertising, in addition to lost revenues for the program while staff participate in the recruitment process and lost productivity when the program is down one provider.”

A good attitude, openness to others, and a professional demeanor can bolster your career path. As Dr. Lyons points out, “If you don’t interview well, other people will make all the major decisions for your career. Physicians have not been taught to interview well. The good news is, it’s not that hard.” TH

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

Now, more than ever, major changes in the way healthcare is provided, measured, and paid for seem to be coming from a single source: the Centers for Medicare and Medicaid Services (CMS). From the Physician Quality Reporting Initiative (PQRI) to last summer’s Medicare Physician Fee Schedule, CMS has an ever-growing influence on U.S. healthcare.

Although it has published numerous articles about CMS and its policies, The Hospitalist has never offered an explanatory overview of one of the largest healthcare agencies in the world. In order to help hospitalists understand the policies, payments, and trends that affect them every day, we have prepared this CMS fact sheet.

Agency Background

CMS falls under the jurisdiction of the U.S. Department of Health and Human Services, and is tasked primarily with administering the Medicare program and working in partnership with state governments to administer Medicaid and the State Children’s Health Insurance Program (SCHIP). CMS’ current mission is “to ensure effective, up-to-date healthcare coverage and to promote quality care for beneficiaries,” which is a more modern focus than when the Medicare and Medicaid programs were first signed into law in 1965. Those programs were created solely to provide healthcare coverage to Americans over the age of 65, as well as low-income children and people with certain disabilities.

CMS has grown in size and scope since its inception. “First and foremost, CMS is the largest single payor for healthcare in the United States,” says Patrick J. Torcson, MD, MMM, FACP, director of hospital medicine at St. Tammany Parish Hospital in Covington, La., and chair of SHM’s Performance and Standards Committee. Insurance companies model their coverage and fee schedules after CMS. “That makes it very important for reimbursement.”

Approximately 45 million Americans are Medicare beneficiaries, and CMS pays reimbursements for more than 90 million people through the Medicare, Medicaid, and SCHIP programs. Hospitalists treat so many of these beneficiaries that Dr. Torcson estimates CMS represents “at least a third” of the payor mix for most adult hospitalists. For hospitals, the percentage is larger: “For acute-care public hospitals, I’d estimate that Medicare is probably 50% of the payor mix,” Dr. Torcson says.

Part A and Part B

When a beneficiary is hospitalized, Medicare pays separately for hospital services (Part A) and physician services (Part B). Because of their unique role in the hospital, most hospitalists receive payment through both Medicare reimbursement plans. “Physicians are never paid under Part A, but most hospital medicine groups receive some subsidy from their hospital, and, of course, that money originally comes from Part A,” Dr. Torcson explains.

Medicare Part A reimbursement applies to inpatient care in hospitals, critical-access hospitals, and skilled nursing facilities. It does not apply to custodial or long-term care, but it does help cover hospice care and some home healthcare.

Medicare Part B covers medically necessary services and supplies. Most beneficiaries pay a premium to receive this coverage, which includes outpatient care, doctor services, physical or occupational therapists, and additional home healthcare. Part B also covers nonphysician services and procedures.

Part B reimbursement is dictated by the CMS Physician Fee Schedule, which is released every year in the agency’s Final Rule (see “Medicare Modifications,” January 2009, p. 17). You may recall the scramble each of the past three years to urge Congress to avert a 10.6% cut in Part B payments to doctors.

“From the physician side, we still have this …hanging over our heads,” Dr. Torcson says. “Every year, we manage to avert a 10% cut in pay. Now we only have until this summer to block that cut again, unless there is a complete reform of how Part B is reimbursed.”

Congress Calls the Shots

Although CMS administers the Medicare programs and writes the checks, Congress sets the agency’s budgets and directives. Congress must pass into law every CMS initiative, including the Physician Compare Web site that publicizes PQRI data and reimbursement for follow-up inpatient telehealth consultations.

Congress is advised on healthcare issues by an independent agency, the Medicare Payment Advisory Commission (MedPAC). The 17-member MedPAC board advises Congress about payments to providers in Medicare’s traditional fee-for-service program as well as private health plans participating in Medicare. MedPAC also is tasked with analyzing access to care, quality of care, and other issues relating to Medicare. “They’re not a governing board,” Dr. Torcson says. “MedPAC clearly functions as an advisory panel. The final authority is through Congress.”

CMS Sets the Direction

In addition to putting money in hospitalists’ pockets, CMS plays an important role in setting nationwide trends for healthcare payment and policies. As the largest and most powerful payor in the U.S., the agency often acts as a model for other payors—namely, private insurance companies.

Dr. Torcson points to two historic changes in payment reform: “By 1983, there was a turning point when hospitals began getting payment through the DRG [diagnosis-related group] system. Private payors started following along.” And when the Medicare physician fee schedule was introduced in the 1990s, “private payors began basing their physician payments on the physician fee schedule.”

Private payors are watching CMS initiatives (e.g., PQRI and value-based purchasing) to see how physician payment develops in the future.

“CMS is powerful and it’s going to become more so,” Dr. Torcson predicts. “It’s going to continue to be a model of healthcare reform, with its focus on aligning quality and cost in concepts like value-based purchasing.”

For the time being, no one knows the exact shape U.S. healthcare reform will take or how fast it might happen. But one thing is certain: CMS will be at the forefront of changes that have a major effect on how hospitalists work, as well as how they are compensated. TH

Jane Jerrard is a medical writer based in Chicago.

Now, more than ever, major changes in the way healthcare is provided, measured, and paid for seem to be coming from a single source: the Centers for Medicare and Medicaid Services (CMS). From the Physician Quality Reporting Initiative (PQRI) to last summer’s Medicare Physician Fee Schedule, CMS has an ever-growing influence on U.S. healthcare.

Although it has published numerous articles about CMS and its policies, The Hospitalist has never offered an explanatory overview of one of the largest healthcare agencies in the world. In order to help hospitalists understand the policies, payments, and trends that affect them every day, we have prepared this CMS fact sheet.

Agency Background

CMS falls under the jurisdiction of the U.S. Department of Health and Human Services, and is tasked primarily with administering the Medicare program and working in partnership with state governments to administer Medicaid and the State Children’s Health Insurance Program (SCHIP). CMS’ current mission is “to ensure effective, up-to-date healthcare coverage and to promote quality care for beneficiaries,” which is a more modern focus than when the Medicare and Medicaid programs were first signed into law in 1965. Those programs were created solely to provide healthcare coverage to Americans over the age of 65, as well as low-income children and people with certain disabilities.

CMS has grown in size and scope since its inception. “First and foremost, CMS is the largest single payor for healthcare in the United States,” says Patrick J. Torcson, MD, MMM, FACP, director of hospital medicine at St. Tammany Parish Hospital in Covington, La., and chair of SHM’s Performance and Standards Committee. Insurance companies model their coverage and fee schedules after CMS. “That makes it very important for reimbursement.”

Approximately 45 million Americans are Medicare beneficiaries, and CMS pays reimbursements for more than 90 million people through the Medicare, Medicaid, and SCHIP programs. Hospitalists treat so many of these beneficiaries that Dr. Torcson estimates CMS represents “at least a third” of the payor mix for most adult hospitalists. For hospitals, the percentage is larger: “For acute-care public hospitals, I’d estimate that Medicare is probably 50% of the payor mix,” Dr. Torcson says.

Part A and Part B

When a beneficiary is hospitalized, Medicare pays separately for hospital services (Part A) and physician services (Part B). Because of their unique role in the hospital, most hospitalists receive payment through both Medicare reimbursement plans. “Physicians are never paid under Part A, but most hospital medicine groups receive some subsidy from their hospital, and, of course, that money originally comes from Part A,” Dr. Torcson explains.

Medicare Part A reimbursement applies to inpatient care in hospitals, critical-access hospitals, and skilled nursing facilities. It does not apply to custodial or long-term care, but it does help cover hospice care and some home healthcare.

Medicare Part B covers medically necessary services and supplies. Most beneficiaries pay a premium to receive this coverage, which includes outpatient care, doctor services, physical or occupational therapists, and additional home healthcare. Part B also covers nonphysician services and procedures.

Part B reimbursement is dictated by the CMS Physician Fee Schedule, which is released every year in the agency’s Final Rule (see “Medicare Modifications,” January 2009, p. 17). You may recall the scramble each of the past three years to urge Congress to avert a 10.6% cut in Part B payments to doctors.

“From the physician side, we still have this …hanging over our heads,” Dr. Torcson says. “Every year, we manage to avert a 10% cut in pay. Now we only have until this summer to block that cut again, unless there is a complete reform of how Part B is reimbursed.”

Congress Calls the Shots

Although CMS administers the Medicare programs and writes the checks, Congress sets the agency’s budgets and directives. Congress must pass into law every CMS initiative, including the Physician Compare Web site that publicizes PQRI data and reimbursement for follow-up inpatient telehealth consultations.

Congress is advised on healthcare issues by an independent agency, the Medicare Payment Advisory Commission (MedPAC). The 17-member MedPAC board advises Congress about payments to providers in Medicare’s traditional fee-for-service program as well as private health plans participating in Medicare. MedPAC also is tasked with analyzing access to care, quality of care, and other issues relating to Medicare. “They’re not a governing board,” Dr. Torcson says. “MedPAC clearly functions as an advisory panel. The final authority is through Congress.”

CMS Sets the Direction

In addition to putting money in hospitalists’ pockets, CMS plays an important role in setting nationwide trends for healthcare payment and policies. As the largest and most powerful payor in the U.S., the agency often acts as a model for other payors—namely, private insurance companies.

Dr. Torcson points to two historic changes in payment reform: “By 1983, there was a turning point when hospitals began getting payment through the DRG [diagnosis-related group] system. Private payors started following along.” And when the Medicare physician fee schedule was introduced in the 1990s, “private payors began basing their physician payments on the physician fee schedule.”

Private payors are watching CMS initiatives (e.g., PQRI and value-based purchasing) to see how physician payment develops in the future.

“CMS is powerful and it’s going to become more so,” Dr. Torcson predicts. “It’s going to continue to be a model of healthcare reform, with its focus on aligning quality and cost in concepts like value-based purchasing.”

For the time being, no one knows the exact shape U.S. healthcare reform will take or how fast it might happen. But one thing is certain: CMS will be at the forefront of changes that have a major effect on how hospitalists work, as well as how they are compensated. TH

Jane Jerrard is a medical writer based in Chicago.

Now, more than ever, major changes in the way healthcare is provided, measured, and paid for seem to be coming from a single source: the Centers for Medicare and Medicaid Services (CMS). From the Physician Quality Reporting Initiative (PQRI) to last summer’s Medicare Physician Fee Schedule, CMS has an ever-growing influence on U.S. healthcare.

Although it has published numerous articles about CMS and its policies, The Hospitalist has never offered an explanatory overview of one of the largest healthcare agencies in the world. In order to help hospitalists understand the policies, payments, and trends that affect them every day, we have prepared this CMS fact sheet.

Agency Background

CMS falls under the jurisdiction of the U.S. Department of Health and Human Services, and is tasked primarily with administering the Medicare program and working in partnership with state governments to administer Medicaid and the State Children’s Health Insurance Program (SCHIP). CMS’ current mission is “to ensure effective, up-to-date healthcare coverage and to promote quality care for beneficiaries,” which is a more modern focus than when the Medicare and Medicaid programs were first signed into law in 1965. Those programs were created solely to provide healthcare coverage to Americans over the age of 65, as well as low-income children and people with certain disabilities.

CMS has grown in size and scope since its inception. “First and foremost, CMS is the largest single payor for healthcare in the United States,” says Patrick J. Torcson, MD, MMM, FACP, director of hospital medicine at St. Tammany Parish Hospital in Covington, La., and chair of SHM’s Performance and Standards Committee. Insurance companies model their coverage and fee schedules after CMS. “That makes it very important for reimbursement.”

Approximately 45 million Americans are Medicare beneficiaries, and CMS pays reimbursements for more than 90 million people through the Medicare, Medicaid, and SCHIP programs. Hospitalists treat so many of these beneficiaries that Dr. Torcson estimates CMS represents “at least a third” of the payor mix for most adult hospitalists. For hospitals, the percentage is larger: “For acute-care public hospitals, I’d estimate that Medicare is probably 50% of the payor mix,” Dr. Torcson says.

Part A and Part B

When a beneficiary is hospitalized, Medicare pays separately for hospital services (Part A) and physician services (Part B). Because of their unique role in the hospital, most hospitalists receive payment through both Medicare reimbursement plans. “Physicians are never paid under Part A, but most hospital medicine groups receive some subsidy from their hospital, and, of course, that money originally comes from Part A,” Dr. Torcson explains.

Medicare Part A reimbursement applies to inpatient care in hospitals, critical-access hospitals, and skilled nursing facilities. It does not apply to custodial or long-term care, but it does help cover hospice care and some home healthcare.

Medicare Part B covers medically necessary services and supplies. Most beneficiaries pay a premium to receive this coverage, which includes outpatient care, doctor services, physical or occupational therapists, and additional home healthcare. Part B also covers nonphysician services and procedures.

Part B reimbursement is dictated by the CMS Physician Fee Schedule, which is released every year in the agency’s Final Rule (see “Medicare Modifications,” January 2009, p. 17). You may recall the scramble each of the past three years to urge Congress to avert a 10.6% cut in Part B payments to doctors.

“From the physician side, we still have this …hanging over our heads,” Dr. Torcson says. “Every year, we manage to avert a 10% cut in pay. Now we only have until this summer to block that cut again, unless there is a complete reform of how Part B is reimbursed.”

Congress Calls the Shots

Although CMS administers the Medicare programs and writes the checks, Congress sets the agency’s budgets and directives. Congress must pass into law every CMS initiative, including the Physician Compare Web site that publicizes PQRI data and reimbursement for follow-up inpatient telehealth consultations.

Congress is advised on healthcare issues by an independent agency, the Medicare Payment Advisory Commission (MedPAC). The 17-member MedPAC board advises Congress about payments to providers in Medicare’s traditional fee-for-service program as well as private health plans participating in Medicare. MedPAC also is tasked with analyzing access to care, quality of care, and other issues relating to Medicare. “They’re not a governing board,” Dr. Torcson says. “MedPAC clearly functions as an advisory panel. The final authority is through Congress.”

CMS Sets the Direction

In addition to putting money in hospitalists’ pockets, CMS plays an important role in setting nationwide trends for healthcare payment and policies. As the largest and most powerful payor in the U.S., the agency often acts as a model for other payors—namely, private insurance companies.

Dr. Torcson points to two historic changes in payment reform: “By 1983, there was a turning point when hospitals began getting payment through the DRG [diagnosis-related group] system. Private payors started following along.” And when the Medicare physician fee schedule was introduced in the 1990s, “private payors began basing their physician payments on the physician fee schedule.”

Private payors are watching CMS initiatives (e.g., PQRI and value-based purchasing) to see how physician payment develops in the future.

“CMS is powerful and it’s going to become more so,” Dr. Torcson predicts. “It’s going to continue to be a model of healthcare reform, with its focus on aligning quality and cost in concepts like value-based purchasing.”

For the time being, no one knows the exact shape U.S. healthcare reform will take or how fast it might happen. But one thing is certain: CMS will be at the forefront of changes that have a major effect on how hospitalists work, as well as how they are compensated. TH

Jane Jerrard is a medical writer based in Chicago.

Networking is crucial to career advancement, no matter what your long-term goals are. Connecting with others in hospital medicine, general healthcare, and business can build your knowledge base, your support system, and your reputation. But how—and why—should hospitalists present themselves to the influential people they need to know?

The Need to Network

You may think it’s not necessary to expand your list of contacts within hospital medicine. Put another way, why bother to network? Vineet Arora, MD, MA, assistant professor of medicine at the Pritzker School of Medicine at University of Chicago, points to a paper, “Strength of Weak Ties,” published in the May 1973 American Journal of Sociology by sociologist Mark Granovetter. In the paper, he presents a social science theory that says “the people who are most helpful to you are those who you don’t know well,” Dr. Arora says. Granovetter’s theory suggests that in marketing or politics, the weak ties enable individuals to reach populations and audiences that are not accessible via strong ties.

“It’s not your friends or the people you know the best who are most likely to help you get a job,” Dr. Arora says. “Those people have already helped you as much as they can.” The main lesson here, she says, is to “think carefully about reaching outside your comfort zone. Introduce yourself to a stranger; it’s to your advantage to cultivate these weak ties.”

To increase your number of “weak ties” in hospital medicine, follow these simple steps:

Step 1: Establish Goals

Consider why you’re networking in order to focus your efforts and target your contacts. Are you looking for a new position? Do you want to transform yourself into the go-to hospitalist in a specific clinical area? Are you looking to learn leadership skills?

Once you’ve determined what you want to get out of networking—and it might be more than one goal—outline a brief elevator speech. It’s a one-minute explanation of who you are and what you’re interested in. It will prepare you to open a conversation with a stranger. “You should present yourself in a concise way,” Dr. Arora stresses. “State who you are and what your interests are.”

Step 2: Make a Plan

Once you know your goals and are able to state them clearly and eloquently, map out your networking strategy. You may simply keep this in the back of your mind for the short term, or you may specifically plan on attending events that will allow you to network with the appropriate people, such as hiring managers, experts in your area of interest, or HM movers and shakers.

“Figure out who the people are in your field of interest who are making waves, and go where they are,” Dr. Arora says. But “don’t just attend the meetings. Be proactive.”

Choose your conferences wisely. For example, if you’re interested in leadership skills or a leadership position, consider SHM’s biannual Leadership Academy. “Not only is this a terrific learning opportunity, it’s a very strong networking environment,” says Russell L. Holman, MD, chief operating officer for Cogent Healthcare in Nashville, Tenn., and past president of SHM. “You’re sharing a room with 120 or 130 leaders or leaders-in-training.”

Dozens of annual conferences and courses are available for networking, including clinical CME courses offered by universities. “The American College of Physician Executives [ACPE] has advanced training courses not only in management, but in quality improvement and a variety of other interests,” Dr. Holman explains.

Networking at industry events may not have an immediate payoff, Dr. Arora warns. “You’re probably not going to land a job or land an opportunity at a meeting,” she says, “but you float your name and get to know people.”

Step 3: Let the Networking Begin

With your short speech ready to go, attend a conference or meeting with key industry leaders and simply approach influential individuals you’d like to meet.

“The way it’s done is even more important than where and when you do it,” Dr. Holman says. “You don’t want to come across as pushy, aggressive, or needy.” Simply introduce yourself with a handshake, rely on your elevator speech for a brief explanation, then give that person a chance to talk. Ask questions about how their career advanced, then ask if they know of any opportunities for you, he says.

If your initial conversation is rushed—say, you’re approaching a speaker after a presentation—keep your conversation brief. “At an event like an SHM meeting, it may be difficult to catch certain people,” Dr. Holman says. “If you can, at least shake their hand and exchange business cards, then follow up with an e-mail and ask for 15 minutes of their time. This is very acceptable; it happens to me all the time.”

Another key piece of advice: “Don’t ask them to contact you—you be the one to send an e-mail,” Dr. Holman says.

Step 4: Follow Up

Soon after the in-person meeting, send a follow-up e-mail. Carefully consider your subject line to ensure your message is read. Reference your encounter in the message (e.g., “We met after your presentation at the conference in Miami”) to remind the person who you are. Depending on your goals, you may ask for information to be forwarded, contacts for additional networking, or request a brief telephone conversation.

“A lot of speakers post their e-mail in their presentation,” Dr. Arora points out. “If you don’t get a chance to talk to them in person, send them a message after you get home. People love to get feedback. Comment on their presentation and introduce yourself that way.”

Hospitalists can strengthen their connections with an offer to reciprocate: “You want to be as helpful as you are helped,” Dr. Holman says. “End the conversation with the offer: ‘If there is any way that I can help you, let me know.’ ”

Set goals, practice your elevator speech, venture out and introduce yourself, and follow up.

These simple steps will help you in your networking efforts, and likely will help advance your career. TH

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

Networking is crucial to career advancement, no matter what your long-term goals are. Connecting with others in hospital medicine, general healthcare, and business can build your knowledge base, your support system, and your reputation. But how—and why—should hospitalists present themselves to the influential people they need to know?

The Need to Network

You may think it’s not necessary to expand your list of contacts within hospital medicine. Put another way, why bother to network? Vineet Arora, MD, MA, assistant professor of medicine at the Pritzker School of Medicine at University of Chicago, points to a paper, “Strength of Weak Ties,” published in the May 1973 American Journal of Sociology by sociologist Mark Granovetter. In the paper, he presents a social science theory that says “the people who are most helpful to you are those who you don’t know well,” Dr. Arora says. Granovetter’s theory suggests that in marketing or politics, the weak ties enable individuals to reach populations and audiences that are not accessible via strong ties.

“It’s not your friends or the people you know the best who are most likely to help you get a job,” Dr. Arora says. “Those people have already helped you as much as they can.” The main lesson here, she says, is to “think carefully about reaching outside your comfort zone. Introduce yourself to a stranger; it’s to your advantage to cultivate these weak ties.”

To increase your number of “weak ties” in hospital medicine, follow these simple steps:

Step 1: Establish Goals

Consider why you’re networking in order to focus your efforts and target your contacts. Are you looking for a new position? Do you want to transform yourself into the go-to hospitalist in a specific clinical area? Are you looking to learn leadership skills?

Once you’ve determined what you want to get out of networking—and it might be more than one goal—outline a brief elevator speech. It’s a one-minute explanation of who you are and what you’re interested in. It will prepare you to open a conversation with a stranger. “You should present yourself in a concise way,” Dr. Arora stresses. “State who you are and what your interests are.”

Step 2: Make a Plan

Once you know your goals and are able to state them clearly and eloquently, map out your networking strategy. You may simply keep this in the back of your mind for the short term, or you may specifically plan on attending events that will allow you to network with the appropriate people, such as hiring managers, experts in your area of interest, or HM movers and shakers.

“Figure out who the people are in your field of interest who are making waves, and go where they are,” Dr. Arora says. But “don’t just attend the meetings. Be proactive.”

Choose your conferences wisely. For example, if you’re interested in leadership skills or a leadership position, consider SHM’s biannual Leadership Academy. “Not only is this a terrific learning opportunity, it’s a very strong networking environment,” says Russell L. Holman, MD, chief operating officer for Cogent Healthcare in Nashville, Tenn., and past president of SHM. “You’re sharing a room with 120 or 130 leaders or leaders-in-training.”

Dozens of annual conferences and courses are available for networking, including clinical CME courses offered by universities. “The American College of Physician Executives [ACPE] has advanced training courses not only in management, but in quality improvement and a variety of other interests,” Dr. Holman explains.

Networking at industry events may not have an immediate payoff, Dr. Arora warns. “You’re probably not going to land a job or land an opportunity at a meeting,” she says, “but you float your name and get to know people.”

Step 3: Let the Networking Begin

With your short speech ready to go, attend a conference or meeting with key industry leaders and simply approach influential individuals you’d like to meet.

“The way it’s done is even more important than where and when you do it,” Dr. Holman says. “You don’t want to come across as pushy, aggressive, or needy.” Simply introduce yourself with a handshake, rely on your elevator speech for a brief explanation, then give that person a chance to talk. Ask questions about how their career advanced, then ask if they know of any opportunities for you, he says.

If your initial conversation is rushed—say, you’re approaching a speaker after a presentation—keep your conversation brief. “At an event like an SHM meeting, it may be difficult to catch certain people,” Dr. Holman says. “If you can, at least shake their hand and exchange business cards, then follow up with an e-mail and ask for 15 minutes of their time. This is very acceptable; it happens to me all the time.”

Another key piece of advice: “Don’t ask them to contact you—you be the one to send an e-mail,” Dr. Holman says.

Step 4: Follow Up

Soon after the in-person meeting, send a follow-up e-mail. Carefully consider your subject line to ensure your message is read. Reference your encounter in the message (e.g., “We met after your presentation at the conference in Miami”) to remind the person who you are. Depending on your goals, you may ask for information to be forwarded, contacts for additional networking, or request a brief telephone conversation.

“A lot of speakers post their e-mail in their presentation,” Dr. Arora points out. “If you don’t get a chance to talk to them in person, send them a message after you get home. People love to get feedback. Comment on their presentation and introduce yourself that way.”

Hospitalists can strengthen their connections with an offer to reciprocate: “You want to be as helpful as you are helped,” Dr. Holman says. “End the conversation with the offer: ‘If there is any way that I can help you, let me know.’ ”

Set goals, practice your elevator speech, venture out and introduce yourself, and follow up.

These simple steps will help you in your networking efforts, and likely will help advance your career. TH

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

Networking is crucial to career advancement, no matter what your long-term goals are. Connecting with others in hospital medicine, general healthcare, and business can build your knowledge base, your support system, and your reputation. But how—and why—should hospitalists present themselves to the influential people they need to know?

The Need to Network

You may think it’s not necessary to expand your list of contacts within hospital medicine. Put another way, why bother to network? Vineet Arora, MD, MA, assistant professor of medicine at the Pritzker School of Medicine at University of Chicago, points to a paper, “Strength of Weak Ties,” published in the May 1973 American Journal of Sociology by sociologist Mark Granovetter. In the paper, he presents a social science theory that says “the people who are most helpful to you are those who you don’t know well,” Dr. Arora says. Granovetter’s theory suggests that in marketing or politics, the weak ties enable individuals to reach populations and audiences that are not accessible via strong ties.

“It’s not your friends or the people you know the best who are most likely to help you get a job,” Dr. Arora says. “Those people have already helped you as much as they can.” The main lesson here, she says, is to “think carefully about reaching outside your comfort zone. Introduce yourself to a stranger; it’s to your advantage to cultivate these weak ties.”

To increase your number of “weak ties” in hospital medicine, follow these simple steps:

Step 1: Establish Goals

Consider why you’re networking in order to focus your efforts and target your contacts. Are you looking for a new position? Do you want to transform yourself into the go-to hospitalist in a specific clinical area? Are you looking to learn leadership skills?

Once you’ve determined what you want to get out of networking—and it might be more than one goal—outline a brief elevator speech. It’s a one-minute explanation of who you are and what you’re interested in. It will prepare you to open a conversation with a stranger. “You should present yourself in a concise way,” Dr. Arora stresses. “State who you are and what your interests are.”

Step 2: Make a Plan

Once you know your goals and are able to state them clearly and eloquently, map out your networking strategy. You may simply keep this in the back of your mind for the short term, or you may specifically plan on attending events that will allow you to network with the appropriate people, such as hiring managers, experts in your area of interest, or HM movers and shakers.

“Figure out who the people are in your field of interest who are making waves, and go where they are,” Dr. Arora says. But “don’t just attend the meetings. Be proactive.”

Choose your conferences wisely. For example, if you’re interested in leadership skills or a leadership position, consider SHM’s biannual Leadership Academy. “Not only is this a terrific learning opportunity, it’s a very strong networking environment,” says Russell L. Holman, MD, chief operating officer for Cogent Healthcare in Nashville, Tenn., and past president of SHM. “You’re sharing a room with 120 or 130 leaders or leaders-in-training.”

Dozens of annual conferences and courses are available for networking, including clinical CME courses offered by universities. “The American College of Physician Executives [ACPE] has advanced training courses not only in management, but in quality improvement and a variety of other interests,” Dr. Holman explains.

Networking at industry events may not have an immediate payoff, Dr. Arora warns. “You’re probably not going to land a job or land an opportunity at a meeting,” she says, “but you float your name and get to know people.”

Step 3: Let the Networking Begin

With your short speech ready to go, attend a conference or meeting with key industry leaders and simply approach influential individuals you’d like to meet.

“The way it’s done is even more important than where and when you do it,” Dr. Holman says. “You don’t want to come across as pushy, aggressive, or needy.” Simply introduce yourself with a handshake, rely on your elevator speech for a brief explanation, then give that person a chance to talk. Ask questions about how their career advanced, then ask if they know of any opportunities for you, he says.

If your initial conversation is rushed—say, you’re approaching a speaker after a presentation—keep your conversation brief. “At an event like an SHM meeting, it may be difficult to catch certain people,” Dr. Holman says. “If you can, at least shake their hand and exchange business cards, then follow up with an e-mail and ask for 15 minutes of their time. This is very acceptable; it happens to me all the time.”

Another key piece of advice: “Don’t ask them to contact you—you be the one to send an e-mail,” Dr. Holman says.

Step 4: Follow Up

Soon after the in-person meeting, send a follow-up e-mail. Carefully consider your subject line to ensure your message is read. Reference your encounter in the message (e.g., “We met after your presentation at the conference in Miami”) to remind the person who you are. Depending on your goals, you may ask for information to be forwarded, contacts for additional networking, or request a brief telephone conversation.

“A lot of speakers post their e-mail in their presentation,” Dr. Arora points out. “If you don’t get a chance to talk to them in person, send them a message after you get home. People love to get feedback. Comment on their presentation and introduce yourself that way.”

Hospitalists can strengthen their connections with an offer to reciprocate: “You want to be as helpful as you are helped,” Dr. Holman says. “End the conversation with the offer: ‘If there is any way that I can help you, let me know.’ ”

Set goals, practice your elevator speech, venture out and introduce yourself, and follow up.

These simple steps will help you in your networking efforts, and likely will help advance your career. TH

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

Members of SHM's Public Policy Committee traveled to Capitol Hill for their fourth annual legislative visit last week and they found congressional representatives and staff more eager than ever to listen.

"With healthcare at the forefront of what's happening [in Congress] right now, the members of congress and their staffs were particularly interested in what we had to say," says committee member Felix Aguirre, MD, vice president of medical affairs for IPC: The Hospitalist Company in San Antonio. Specifically, the 13 committee members attended 35 Capitol Hill meetings and touted support for increased access to healthcare; delivery models to improve care coordination; and changes in payment methodologies that improve quality and value of healthcare, including consideration of alternative models, such as bundling payments for select conditions in hospitalized patients and physician value-based purchasing.

"The part that was noticeable [this year] was the elevation of the level of discussions we had," says committee member Gregory Seymann, MD, a hospitalist and associate clinical professor at the University of California San Diego School of Medicine. "We are now positioned to be influential … in healthcare matters that are obviously a big priority."

One of SHM's priorities is care transitions, and the committee brought legislators’ attention to SHM's Project BOOST (Better Outcomes for Older adults through Safe Transitions), a program designed to optimize transitions from the hospital to the home.

Mark V. Williams, MD, the project’s principal investigator, joined the committee and met with staff of key congressional committees, including the House Energy and Commerce Committee; the Senate Committee on Health, Education, Labor and Pensions; and the Senate Finance Committee. “I was impressed. They were all aware of the President's budget proposal to reduce rehospitalizations and understood how Project BOOST could help," Dr. Williams says. "They are excited about it and interested in data regarding its impact."

For more information about SHM’s public policy efforts, visit www.hospitalmedicine.org/Advocacy.

Members of SHM's Public Policy Committee traveled to Capitol Hill for their fourth annual legislative visit last week and they found congressional representatives and staff more eager than ever to listen.

"With healthcare at the forefront of what's happening [in Congress] right now, the members of congress and their staffs were particularly interested in what we had to say," says committee member Felix Aguirre, MD, vice president of medical affairs for IPC: The Hospitalist Company in San Antonio. Specifically, the 13 committee members attended 35 Capitol Hill meetings and touted support for increased access to healthcare; delivery models to improve care coordination; and changes in payment methodologies that improve quality and value of healthcare, including consideration of alternative models, such as bundling payments for select conditions in hospitalized patients and physician value-based purchasing.

"The part that was noticeable [this year] was the elevation of the level of discussions we had," says committee member Gregory Seymann, MD, a hospitalist and associate clinical professor at the University of California San Diego School of Medicine. "We are now positioned to be influential … in healthcare matters that are obviously a big priority."

One of SHM's priorities is care transitions, and the committee brought legislators’ attention to SHM's Project BOOST (Better Outcomes for Older adults through Safe Transitions), a program designed to optimize transitions from the hospital to the home.

Mark V. Williams, MD, the project’s principal investigator, joined the committee and met with staff of key congressional committees, including the House Energy and Commerce Committee; the Senate Committee on Health, Education, Labor and Pensions; and the Senate Finance Committee. “I was impressed. They were all aware of the President's budget proposal to reduce rehospitalizations and understood how Project BOOST could help," Dr. Williams says. "They are excited about it and interested in data regarding its impact."

For more information about SHM’s public policy efforts, visit www.hospitalmedicine.org/Advocacy.

Members of SHM's Public Policy Committee traveled to Capitol Hill for their fourth annual legislative visit last week and they found congressional representatives and staff more eager than ever to listen.

"With healthcare at the forefront of what's happening [in Congress] right now, the members of congress and their staffs were particularly interested in what we had to say," says committee member Felix Aguirre, MD, vice president of medical affairs for IPC: The Hospitalist Company in San Antonio. Specifically, the 13 committee members attended 35 Capitol Hill meetings and touted support for increased access to healthcare; delivery models to improve care coordination; and changes in payment methodologies that improve quality and value of healthcare, including consideration of alternative models, such as bundling payments for select conditions in hospitalized patients and physician value-based purchasing.

"The part that was noticeable [this year] was the elevation of the level of discussions we had," says committee member Gregory Seymann, MD, a hospitalist and associate clinical professor at the University of California San Diego School of Medicine. "We are now positioned to be influential … in healthcare matters that are obviously a big priority."

One of SHM's priorities is care transitions, and the committee brought legislators’ attention to SHM's Project BOOST (Better Outcomes for Older adults through Safe Transitions), a program designed to optimize transitions from the hospital to the home.

Mark V. Williams, MD, the project’s principal investigator, joined the committee and met with staff of key congressional committees, including the House Energy and Commerce Committee; the Senate Committee on Health, Education, Labor and Pensions; and the Senate Finance Committee. “I was impressed. They were all aware of the President's budget proposal to reduce rehospitalizations and understood how Project BOOST could help," Dr. Williams says. "They are excited about it and interested in data regarding its impact."

For more information about SHM’s public policy efforts, visit www.hospitalmedicine.org/Advocacy.

The economic stimulus bill that became law last week includes several items on SHM's healthcare policy wish list.

"It clearly hits some key issues," Eric Siegal, MD, chair of SHM's Public Policy Committee, says in regard to the American Recovery and Reinvestment Act. "This is a step in the right direction."

The $787 billion stimulus package includes:

• $1.1 billion for comparative effectiveness research (CER). Funding for CER is one of SHM's top policy priorities, says Laura Allendorf, SHM's senior advisor for advocacy and government affairs. CER examines the effectiveness of multiple therapies for specific medical conditions, or for a specific set of patients, to determine the best care options. "Funding for this is long overdue and key to healthcare reform," Dr. Siegal says. CER money will be split among the major players in this research, including the National Institutes of Health (NIH) and the Agency for Healthcare Research and Quality (AHRQ).
• A 34% increase in NIH funding. This includes $8.5 billion for research grants and programs that will allow for as many as 15,000 additional grants. "We know that an investment in biomedical research is an investment in the future of healthcare," says David Meltzer, MD, PhD, chair of SHM's Research Committee.
• $19 billion for health information technology. Incentives—and penalties—will target adoption of electronic health records by hospitals and office-based practices. "This will help improve patient safety, as well as care coordination," Allendorf says.

Other healthcare provisions in the package include an additional $86.6 billion in federal Medicaid funds, as well as temporary Medicaid coverage for the recently unemployed.

To keep up with public policy initiatives, check out SHM's advocacy portal.

The economic stimulus bill that became law last week includes several items on SHM's healthcare policy wish list.

"It clearly hits some key issues," Eric Siegal, MD, chair of SHM's Public Policy Committee, says in regard to the American Recovery and Reinvestment Act. "This is a step in the right direction."

The $787 billion stimulus package includes:

• $1.1 billion for comparative effectiveness research (CER). Funding for CER is one of SHM's top policy priorities, says Laura Allendorf, SHM's senior advisor for advocacy and government affairs. CER examines the effectiveness of multiple therapies for specific medical conditions, or for a specific set of patients, to determine the best care options. "Funding for this is long overdue and key to healthcare reform," Dr. Siegal says. CER money will be split among the major players in this research, including the National Institutes of Health (NIH) and the Agency for Healthcare Research and Quality (AHRQ).
• A 34% increase in NIH funding. This includes $8.5 billion for research grants and programs that will allow for as many as 15,000 additional grants. "We know that an investment in biomedical research is an investment in the future of healthcare," says David Meltzer, MD, PhD, chair of SHM's Research Committee.
• $19 billion for health information technology. Incentives—and penalties—will target adoption of electronic health records by hospitals and office-based practices. "This will help improve patient safety, as well as care coordination," Allendorf says.

Other healthcare provisions in the package include an additional $86.6 billion in federal Medicaid funds, as well as temporary Medicaid coverage for the recently unemployed.

To keep up with public policy initiatives, check out SHM's advocacy portal.

The economic stimulus bill that became law last week includes several items on SHM's healthcare policy wish list.

"It clearly hits some key issues," Eric Siegal, MD, chair of SHM's Public Policy Committee, says in regard to the American Recovery and Reinvestment Act. "This is a step in the right direction."

The $787 billion stimulus package includes:

• $1.1 billion for comparative effectiveness research (CER). Funding for CER is one of SHM's top policy priorities, says Laura Allendorf, SHM's senior advisor for advocacy and government affairs. CER examines the effectiveness of multiple therapies for specific medical conditions, or for a specific set of patients, to determine the best care options. "Funding for this is long overdue and key to healthcare reform," Dr. Siegal says. CER money will be split among the major players in this research, including the National Institutes of Health (NIH) and the Agency for Healthcare Research and Quality (AHRQ).
• A 34% increase in NIH funding. This includes $8.5 billion for research grants and programs that will allow for as many as 15,000 additional grants. "We know that an investment in biomedical research is an investment in the future of healthcare," says David Meltzer, MD, PhD, chair of SHM's Research Committee.
• $19 billion for health information technology. Incentives—and penalties—will target adoption of electronic health records by hospitals and office-based practices. "This will help improve patient safety, as well as care coordination," Allendorf says.

Other healthcare provisions in the package include an additional $86.6 billion in federal Medicaid funds, as well as temporary Medicaid coverage for the recently unemployed.

To keep up with public policy initiatives, check out SHM's advocacy portal.

Pediatric hospitalists are praising a new bill that expands the funding and scope of the State Children's Health Insurance Program (SCHIP), a program jointly funded by federal and state governments for children in families with incomes too high to qualify for Medicaid.

"Ideally, this will lead to better primary care, more immunizations, and disease prevention," says Jack Percelay, MD, MPH, a hospitalist at E.L.M.O. Pediatrics in New York City, Treasurer of SHM's board of directors, and a member of SHM's Public Policy Committee. Percelay foresees a twofold benefit of the new legislation: a likely decrease in uninsured pediatric patients using the ED and more fee recovery from patients who otherwise couldn't pay.

David Rappaport, MD, FAAP, a hospitalist at Alfred I. Dupont Hospital for Children in Wilmington, Del., agrees. "Children's health is more than the cuddly factor—it's a smart investment in healthcare," he says, explaining that paying for preventive measures in children, such as inoculations, can save on their healthcare costs in the future.

Signed by President Obama on Feb. 4, the bill reauthorizes SCHIP for four years and expands eligibility to children in families with incomes of up to three times the federal poverty level. It also covers legal immigrant pregnant women and children who have been in the country less than five years. The expansion will cover an additional 4 million children, raising the total to 11 million uninsured children enrolled in the program. Most of the $32.8 billion increase in federal funding for the program is to be covered by a 62-cent-per-pack increase in the federal cigarette tax.

Pediatric hospitalists are praising a new bill that expands the funding and scope of the State Children's Health Insurance Program (SCHIP), a program jointly funded by federal and state governments for children in families with incomes too high to qualify for Medicaid.

"Ideally, this will lead to better primary care, more immunizations, and disease prevention," says Jack Percelay, MD, MPH, a hospitalist at E.L.M.O. Pediatrics in New York City, Treasurer of SHM's board of directors, and a member of SHM's Public Policy Committee. Percelay foresees a twofold benefit of the new legislation: a likely decrease in uninsured pediatric patients using the ED and more fee recovery from patients who otherwise couldn't pay.

David Rappaport, MD, FAAP, a hospitalist at Alfred I. Dupont Hospital for Children in Wilmington, Del., agrees. "Children's health is more than the cuddly factor—it's a smart investment in healthcare," he says, explaining that paying for preventive measures in children, such as inoculations, can save on their healthcare costs in the future.

Signed by President Obama on Feb. 4, the bill reauthorizes SCHIP for four years and expands eligibility to children in families with incomes of up to three times the federal poverty level. It also covers legal immigrant pregnant women and children who have been in the country less than five years. The expansion will cover an additional 4 million children, raising the total to 11 million uninsured children enrolled in the program. Most of the $32.8 billion increase in federal funding for the program is to be covered by a 62-cent-per-pack increase in the federal cigarette tax.

Pediatric hospitalists are praising a new bill that expands the funding and scope of the State Children's Health Insurance Program (SCHIP), a program jointly funded by federal and state governments for children in families with incomes too high to qualify for Medicaid.

"Ideally, this will lead to better primary care, more immunizations, and disease prevention," says Jack Percelay, MD, MPH, a hospitalist at E.L.M.O. Pediatrics in New York City, Treasurer of SHM's board of directors, and a member of SHM's Public Policy Committee. Percelay foresees a twofold benefit of the new legislation: a likely decrease in uninsured pediatric patients using the ED and more fee recovery from patients who otherwise couldn't pay.

David Rappaport, MD, FAAP, a hospitalist at Alfred I. Dupont Hospital for Children in Wilmington, Del., agrees. "Children's health is more than the cuddly factor—it's a smart investment in healthcare," he says, explaining that paying for preventive measures in children, such as inoculations, can save on their healthcare costs in the future.

Signed by President Obama on Feb. 4, the bill reauthorizes SCHIP for four years and expands eligibility to children in families with incomes of up to three times the federal poverty level. It also covers legal immigrant pregnant women and children who have been in the country less than five years. The expansion will cover an additional 4 million children, raising the total to 11 million uninsured children enrolled in the program. Most of the $32.8 billion increase in federal funding for the program is to be covered by a 62-cent-per-pack increase in the federal cigarette tax.

Patient safety organizations, commonly referred to as PSOs, are about to take off. And when they do, PSOs should provide hospitalists with invaluable data on improving patient safety.

“PSOs are a great concept, but even though it’s been around since 2005, I haven’t seen it clinically,” says Janet Nagamine, RN, MD, hospitalist at Kaiser Permanente in Santa Clara, Calif., and chair of SHM’s Hospital Quality and Patient Safety Committee.

This calendar year, Nagamine and the rest of hospital medicine should start to see some movement—“PSO 1.0,” if you will.

Background

PSOs are public and private organizations approved by the Agency for Healthcare Research and Quality (AHRQ); they include such groups as Health Watch Inc., Human Performance Technology Group, and the Institute for Safe Medication Practices, which will collect, aggregate, and analyze data on patient safety events. Hospitals and other healthcare providers will voluntarily and confidentially report data. The ultimate goal is to advance changes in culture, processes, and systems to enhance patient safety.

PSOs grew out of the Patient Safety and Quality Improvement Act of 2005, which was a response to the Institute of Medicine’s landmark report “To Err Is Human: Building a Safer Health System.” But it wasn’t until last year that the U.S. Department of Health and Human Services issued a final rule outlining PSO requirements and procedures. The rule became effective Jan. 19, 2009.

AHRQ is responsible for coordinating the development of a set of common definitions and reporting formats, called common formats, for collecting the data. Eventually, AHRQ will create a network of patient safety databases to which PSOs, providers, and others can voluntarily contribute non-identifiable patient safety information. This network will serve as an interactive evidence-based management resource for providers, PSOs, and other entities. AHRQ will use data from the network to analyze national and regional statistics regarding patient safety events. Findings will be made public and will be included in AHRQ’s annual National Healthcare Quality Report.

IT Example

To date, the only comparable data-collection system is MedMarx, which compiles information on medication errors. The Joint Commission requires providers to supply a root-cause analysis on every Level 1 incident, “but that’s just scratching the surface of what occurs,” Dr. Nagamine says. “There are far many more Level 2 and Level 3 events with the same precursors, and that information would be very valuable.”

By collecting nationwide data on patient safety events, PSOs will be able to bridge the gaps in the reporting system and provide crucial patient safety information to the healthcare industry. “In general, the concept of aggregate information that allows us to compare events is incredibly important,” Dr. Nagamine says. “A hospitalist working in one hospital has only the information about events in that hospital, but 5,000 hospitals can provide more specific and actionable information. We just haven’t seen this operationalized yet.”

Dr. Nagamine uses a technology example to show the value PSOs could have in identifying patterns or problems that threaten patient safety: “Every hospital has a horror story of implementing a new information technology (IT) system, and we’re getting some very interesting feedback from hospitals about unintended consequences,” she says. “We’re hearing that patients are being hurt because of mistakes in systems—the use of dropdown menus (on computer screens) that don’t drop down far enough to reveal all options, or a screen where it’s easy to click the wrong item.”

Current systems might not allow problems like these to be highlighted. Even if staff knows of a problem, their hospital’s coding system might not allow them to detail it. “It may fall under ‘communications’ or ‘physician computerized order entry’ or something vague, so the data won’t show the specifics of what happened,” Dr. Nagamine points out. “If we had aggregate data on issues like this, we could address it. Right now, we just have word of mouth.”

An isolated event at a hospital is one thing, but similar data from around the nation is significant. “Drug companies or IT vendors confronted with (patterns) might make some changes,” she says. “That kind of data is powerful.”

Hospital Medicine on Board

When hospitals start reporting data to PSOs, where will hospitalists fit into the process? Hospitalists likely will be interviewed to answer some of the PSO’s questions, but they will not be the ones filling out the forms, Dr. Nagamine says. Hospitalists also will be among the ranks of healthcare professionals eagerly awaiting the release of the data. “The way that PSOs approach patient safety and quality—what’s near and dear to our hearts—is it gives us more data,” Dr. Nagamine says. This is crucial for hospitalists leading quality-improvement projects and similar tasks. “Without that data, it’s hard to get traction and movement. That data will help convince someone to invest more time and money in a particular problem area.”

Phase One: Participation

AHRQ has established a comprehensive Web site (www.pso.ahrq.gov) that includes information on the first draft of common formats for use with hospital inpatients. These are found on downloadable paper forms, available at the PSO Privacy Protection Center (PPC) Web site at www.psoppc.org/ web/patientsafety/paperforms.

“The forms are a first step,” Dr. Nagamine explains. “If we had these data points on every incident at every hospital, we’d know a lot more than we do now. We’d be able to harness that information.”

It will be a while before healthcare providers can search the data for patterns and possible solutions in patient safety, but the wait should be worth it. “You’ve got to start somewhere, and it’s not going to happen in one sweep,” Dr. Nagamine says. “This is simply a start. Hopefully, in a decade, we’ll have a lot more actionable information.” TH

Jane Jerrard is a medical writer based in Chicago.

Patient safety organizations, commonly referred to as PSOs, are about to take off. And when they do, PSOs should provide hospitalists with invaluable data on improving patient safety.

“PSOs are a great concept, but even though it’s been around since 2005, I haven’t seen it clinically,” says Janet Nagamine, RN, MD, hospitalist at Kaiser Permanente in Santa Clara, Calif., and chair of SHM’s Hospital Quality and Patient Safety Committee.

This calendar year, Nagamine and the rest of hospital medicine should start to see some movement—“PSO 1.0,” if you will.

Background

PSOs are public and private organizations approved by the Agency for Healthcare Research and Quality (AHRQ); they include such groups as Health Watch Inc., Human Performance Technology Group, and the Institute for Safe Medication Practices, which will collect, aggregate, and analyze data on patient safety events. Hospitals and other healthcare providers will voluntarily and confidentially report data. The ultimate goal is to advance changes in culture, processes, and systems to enhance patient safety.

PSOs grew out of the Patient Safety and Quality Improvement Act of 2005, which was a response to the Institute of Medicine’s landmark report “To Err Is Human: Building a Safer Health System.” But it wasn’t until last year that the U.S. Department of Health and Human Services issued a final rule outlining PSO requirements and procedures. The rule became effective Jan. 19, 2009.

AHRQ is responsible for coordinating the development of a set of common definitions and reporting formats, called common formats, for collecting the data. Eventually, AHRQ will create a network of patient safety databases to which PSOs, providers, and others can voluntarily contribute non-identifiable patient safety information. This network will serve as an interactive evidence-based management resource for providers, PSOs, and other entities. AHRQ will use data from the network to analyze national and regional statistics regarding patient safety events. Findings will be made public and will be included in AHRQ’s annual National Healthcare Quality Report.

IT Example

To date, the only comparable data-collection system is MedMarx, which compiles information on medication errors. The Joint Commission requires providers to supply a root-cause analysis on every Level 1 incident, “but that’s just scratching the surface of what occurs,” Dr. Nagamine says. “There are far many more Level 2 and Level 3 events with the same precursors, and that information would be very valuable.”

By collecting nationwide data on patient safety events, PSOs will be able to bridge the gaps in the reporting system and provide crucial patient safety information to the healthcare industry. “In general, the concept of aggregate information that allows us to compare events is incredibly important,” Dr. Nagamine says. “A hospitalist working in one hospital has only the information about events in that hospital, but 5,000 hospitals can provide more specific and actionable information. We just haven’t seen this operationalized yet.”

Dr. Nagamine uses a technology example to show the value PSOs could have in identifying patterns or problems that threaten patient safety: “Every hospital has a horror story of implementing a new information technology (IT) system, and we’re getting some very interesting feedback from hospitals about unintended consequences,” she says. “We’re hearing that patients are being hurt because of mistakes in systems—the use of dropdown menus (on computer screens) that don’t drop down far enough to reveal all options, or a screen where it’s easy to click the wrong item.”

Current systems might not allow problems like these to be highlighted. Even if staff knows of a problem, their hospital’s coding system might not allow them to detail it. “It may fall under ‘communications’ or ‘physician computerized order entry’ or something vague, so the data won’t show the specifics of what happened,” Dr. Nagamine points out. “If we had aggregate data on issues like this, we could address it. Right now, we just have word of mouth.”

An isolated event at a hospital is one thing, but similar data from around the nation is significant. “Drug companies or IT vendors confronted with (patterns) might make some changes,” she says. “That kind of data is powerful.”

Hospital Medicine on Board

When hospitals start reporting data to PSOs, where will hospitalists fit into the process? Hospitalists likely will be interviewed to answer some of the PSO’s questions, but they will not be the ones filling out the forms, Dr. Nagamine says. Hospitalists also will be among the ranks of healthcare professionals eagerly awaiting the release of the data. “The way that PSOs approach patient safety and quality—what’s near and dear to our hearts—is it gives us more data,” Dr. Nagamine says. This is crucial for hospitalists leading quality-improvement projects and similar tasks. “Without that data, it’s hard to get traction and movement. That data will help convince someone to invest more time and money in a particular problem area.”

Phase One: Participation

AHRQ has established a comprehensive Web site (www.pso.ahrq.gov) that includes information on the first draft of common formats for use with hospital inpatients. These are found on downloadable paper forms, available at the PSO Privacy Protection Center (PPC) Web site at www.psoppc.org/ web/patientsafety/paperforms.

“The forms are a first step,” Dr. Nagamine explains. “If we had these data points on every incident at every hospital, we’d know a lot more than we do now. We’d be able to harness that information.”

It will be a while before healthcare providers can search the data for patterns and possible solutions in patient safety, but the wait should be worth it. “You’ve got to start somewhere, and it’s not going to happen in one sweep,” Dr. Nagamine says. “This is simply a start. Hopefully, in a decade, we’ll have a lot more actionable information.” TH

Jane Jerrard is a medical writer based in Chicago.

Patient safety organizations, commonly referred to as PSOs, are about to take off. And when they do, PSOs should provide hospitalists with invaluable data on improving patient safety.

“PSOs are a great concept, but even though it’s been around since 2005, I haven’t seen it clinically,” says Janet Nagamine, RN, MD, hospitalist at Kaiser Permanente in Santa Clara, Calif., and chair of SHM’s Hospital Quality and Patient Safety Committee.

This calendar year, Nagamine and the rest of hospital medicine should start to see some movement—“PSO 1.0,” if you will.

Background

PSOs are public and private organizations approved by the Agency for Healthcare Research and Quality (AHRQ); they include such groups as Health Watch Inc., Human Performance Technology Group, and the Institute for Safe Medication Practices, which will collect, aggregate, and analyze data on patient safety events. Hospitals and other healthcare providers will voluntarily and confidentially report data. The ultimate goal is to advance changes in culture, processes, and systems to enhance patient safety.

PSOs grew out of the Patient Safety and Quality Improvement Act of 2005, which was a response to the Institute of Medicine’s landmark report “To Err Is Human: Building a Safer Health System.” But it wasn’t until last year that the U.S. Department of Health and Human Services issued a final rule outlining PSO requirements and procedures. The rule became effective Jan. 19, 2009.

AHRQ is responsible for coordinating the development of a set of common definitions and reporting formats, called common formats, for collecting the data. Eventually, AHRQ will create a network of patient safety databases to which PSOs, providers, and others can voluntarily contribute non-identifiable patient safety information. This network will serve as an interactive evidence-based management resource for providers, PSOs, and other entities. AHRQ will use data from the network to analyze national and regional statistics regarding patient safety events. Findings will be made public and will be included in AHRQ’s annual National Healthcare Quality Report.

IT Example

To date, the only comparable data-collection system is MedMarx, which compiles information on medication errors. The Joint Commission requires providers to supply a root-cause analysis on every Level 1 incident, “but that’s just scratching the surface of what occurs,” Dr. Nagamine says. “There are far many more Level 2 and Level 3 events with the same precursors, and that information would be very valuable.”

By collecting nationwide data on patient safety events, PSOs will be able to bridge the gaps in the reporting system and provide crucial patient safety information to the healthcare industry. “In general, the concept of aggregate information that allows us to compare events is incredibly important,” Dr. Nagamine says. “A hospitalist working in one hospital has only the information about events in that hospital, but 5,000 hospitals can provide more specific and actionable information. We just haven’t seen this operationalized yet.”

Dr. Nagamine uses a technology example to show the value PSOs could have in identifying patterns or problems that threaten patient safety: “Every hospital has a horror story of implementing a new information technology (IT) system, and we’re getting some very interesting feedback from hospitals about unintended consequences,” she says. “We’re hearing that patients are being hurt because of mistakes in systems—the use of dropdown menus (on computer screens) that don’t drop down far enough to reveal all options, or a screen where it’s easy to click the wrong item.”

Current systems might not allow problems like these to be highlighted. Even if staff knows of a problem, their hospital’s coding system might not allow them to detail it. “It may fall under ‘communications’ or ‘physician computerized order entry’ or something vague, so the data won’t show the specifics of what happened,” Dr. Nagamine points out. “If we had aggregate data on issues like this, we could address it. Right now, we just have word of mouth.”

An isolated event at a hospital is one thing, but similar data from around the nation is significant. “Drug companies or IT vendors confronted with (patterns) might make some changes,” she says. “That kind of data is powerful.”

Hospital Medicine on Board

When hospitals start reporting data to PSOs, where will hospitalists fit into the process? Hospitalists likely will be interviewed to answer some of the PSO’s questions, but they will not be the ones filling out the forms, Dr. Nagamine says. Hospitalists also will be among the ranks of healthcare professionals eagerly awaiting the release of the data. “The way that PSOs approach patient safety and quality—what’s near and dear to our hearts—is it gives us more data,” Dr. Nagamine says. This is crucial for hospitalists leading quality-improvement projects and similar tasks. “Without that data, it’s hard to get traction and movement. That data will help convince someone to invest more time and money in a particular problem area.”

Phase One: Participation

AHRQ has established a comprehensive Web site (www.pso.ahrq.gov) that includes information on the first draft of common formats for use with hospital inpatients. These are found on downloadable paper forms, available at the PSO Privacy Protection Center (PPC) Web site at www.psoppc.org/ web/patientsafety/paperforms.

“The forms are a first step,” Dr. Nagamine explains. “If we had these data points on every incident at every hospital, we’d know a lot more than we do now. We’d be able to harness that information.”

It will be a while before healthcare providers can search the data for patterns and possible solutions in patient safety, but the wait should be worth it. “You’ve got to start somewhere, and it’s not going to happen in one sweep,” Dr. Nagamine says. “This is simply a start. Hopefully, in a decade, we’ll have a lot more actionable information.” TH

Jane Jerrard is a medical writer based in Chicago.

Communication is an integral part of a hospitalist’s job: from admission interviews to conveying orders to nursing staff, communicating clearly and precisely is part of numerous best practices. When a hospitalist assumes a leadership role, however, the types and styles of communication change. A committee chair or department head must be aware of the messages they send—both literally and in the most general sense of the term. This transition to leadership can be tough.

“Physician communication is focused on clinical outcome. That’s easy for someone trained in medicine. But in leadership communication, there may not be a defined outcome,” says Timothy J. Keogh, PhD, assistant professor at The Citadel School of Business Administration in Charleston, S.C. “That’s a difficult switch from clinician to leader; maybe half of the problems a leader faces can’t be solved.”

Dr. Keogh and William F. Martin, PsyD, MPH, summarized their research data in “Managing Medical Groups: 21st Century Challenges and the Impact of Physician Leadership Styles,” published in the September-October 2004 issue of Journal of Medical Practice Management.

The Basics

The most basic communication skill a hospitalist leader should practice, according to Dr. Keogh, is “being less direct than [he or she] would like to be.” Dr. Keogh, who teaches communication skills as part of SHM’s Leadership Academy, says, “Data shows that physicians prefer to be more precise and cover topics quickly. In a leadership role, the initial part of the communication or conversation needs to be chattier. Some physicians believe that this uses up too much time, but, in fact, it doesn’t take that long and it’s a necessary step.” Acknowledge others’ need for connection by making eye contact, pausing, and exchanging quick pleasantries. “Leaders need to be able to say things in passing, greet people, et cetera,” Dr. Keogh stresses.

But what about in-depth communication?

Management Topics

If you supervise hospitalists, you can condense discussions of your expectations—at least compared with managers in business fields. “Physicians are skilled, well-trained individuals, so you don’t have to do so much of this,” Dr. Keogh says. “They have an internal sense of quality and you don’t really need to motivate them. It’s a matter of adjusting the edges.”

A hospitalist supervisor might need to address a situation in which a physician on the team has been disruptive or needs a disciplinary talk. In these instances, Dr. Keogh says, “The leader has to somehow collect data on what the hospitalist has displayed that doesn’t fit in with teamwork. The hard part is that the data is likely to be hearsay—what was said by whom, when. That’s management.”

For example, you might receive complaints from nursing staff of abrupt or rude behavior from a hospitalist. “Physicians may not think of this as data, but it is. What someone said or did, or gestured,” Dr. Keogh points out. “You have to be able to say, ‘Here’s what we know happened on this date. Help me understand what happened, because we have to change this. This behavior is not acceptable.’”

The key to all official management communication is to carefully consider how to frame the conversation and keep it flowing for both parties: Speak with hospitalists, not to them. Here is an example: “In a performance appraisal, one suggestion we make is to have a conversation about data,” Dr. Keogh explains. “Look at some numbers on quality assurance, patient load, or whatever you’re discussing. Do your homework and allow the other person to have a look at the data before you sit down with them. That’s a sign of respect.”

Styles of Communication

Dr. Keogh’s training for physician executives—including what he teaches at the Leadership Academy—is based on the personality profile system developed by Carlson Learning Company (now Inscape Publishing).1 The DiSC model outlines behavior or characteristic leadership preferences in four dimensions:

• Dominance (D): People who score high in this category have behavioral characteristics that include being motivated by control over tasks and work environment, directing others, and achieving specific stretch goals. In general, physician managers who score high on dominance tend to be results-focused, fast-paced, and value autonomy.
• Influence (I): People who score high in this category are motivated by interacting with others, giving and receiving immediate feedback, and acknowledging emotions as well as facts.
• Steadiness (S): People who score high in this category are motivated by job security, predictability, and clearly defined expectations.
• Conscientiousness (C): People who score high in this category are motivated by needing to be right, working alone, and preferring to work on tasks rather than dealing with people.

“This model provides groundwork for seeing that other people have different ways, different preferences of communicating,” Dr. Keogh says. In his own research, he says, he has found “nearly half of all physicians are some combination of time-sensitive and perfectionist,” meaning they fit the dominance style.

The trick to effective communication is learning to modify your style when necessary. Task-focused individuals must practice taking a minute for a greeting or a pleasantry, even if it initially goes against their routine. “Someone who is extremely outgoing and open can have trouble, too,” Dr. Keogh points out. “You can’t start a conversation with a lot of chit-chat, if you’re addressing someone who is direct. … That won’t work, either.”

The solution is to practice stepping outside of your normal communication style. “You can learn how to adjust your style, how to flex to others’ styles,” Dr. Keogh says. “Depending on whom you’re communicating with, you can mirror the style of the other person.” This helps to ensure that what you’re saying is received and understood.

Practicing new ways to communicate means making a fundamental shift in your behavior. It sounds difficult, but Dr. Keogh promises it’s not.

“The transition is not as hard as you think, because hospitalists have been trained to do patient interviews,” he says. “They’re skilled at observation and listening. In the transition to leadership, they sometimes forget that they have these skills and can use these to be a great leader.”” TH

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

Reference

1. Straw J. The 4-Dimensional Manager: DiSC Strategies for Managing Different People in the Best Ways. San Francisco: Berrett-Koehler Publishers, Inc.; 2002.

Communication is an integral part of a hospitalist’s job: from admission interviews to conveying orders to nursing staff, communicating clearly and precisely is part of numerous best practices. When a hospitalist assumes a leadership role, however, the types and styles of communication change. A committee chair or department head must be aware of the messages they send—both literally and in the most general sense of the term. This transition to leadership can be tough.

“Physician communication is focused on clinical outcome. That’s easy for someone trained in medicine. But in leadership communication, there may not be a defined outcome,” says Timothy J. Keogh, PhD, assistant professor at The Citadel School of Business Administration in Charleston, S.C. “That’s a difficult switch from clinician to leader; maybe half of the problems a leader faces can’t be solved.”

Dr. Keogh and William F. Martin, PsyD, MPH, summarized their research data in “Managing Medical Groups: 21st Century Challenges and the Impact of Physician Leadership Styles,” published in the September-October 2004 issue of Journal of Medical Practice Management.

The Basics

The most basic communication skill a hospitalist leader should practice, according to Dr. Keogh, is “being less direct than [he or she] would like to be.” Dr. Keogh, who teaches communication skills as part of SHM’s Leadership Academy, says, “Data shows that physicians prefer to be more precise and cover topics quickly. In a leadership role, the initial part of the communication or conversation needs to be chattier. Some physicians believe that this uses up too much time, but, in fact, it doesn’t take that long and it’s a necessary step.” Acknowledge others’ need for connection by making eye contact, pausing, and exchanging quick pleasantries. “Leaders need to be able to say things in passing, greet people, et cetera,” Dr. Keogh stresses.

But what about in-depth communication?

Management Topics

If you supervise hospitalists, you can condense discussions of your expectations—at least compared with managers in business fields. “Physicians are skilled, well-trained individuals, so you don’t have to do so much of this,” Dr. Keogh says. “They have an internal sense of quality and you don’t really need to motivate them. It’s a matter of adjusting the edges.”

A hospitalist supervisor might need to address a situation in which a physician on the team has been disruptive or needs a disciplinary talk. In these instances, Dr. Keogh says, “The leader has to somehow collect data on what the hospitalist has displayed that doesn’t fit in with teamwork. The hard part is that the data is likely to be hearsay—what was said by whom, when. That’s management.”

For example, you might receive complaints from nursing staff of abrupt or rude behavior from a hospitalist. “Physicians may not think of this as data, but it is. What someone said or did, or gestured,” Dr. Keogh points out. “You have to be able to say, ‘Here’s what we know happened on this date. Help me understand what happened, because we have to change this. This behavior is not acceptable.’”

The key to all official management communication is to carefully consider how to frame the conversation and keep it flowing for both parties: Speak with hospitalists, not to them. Here is an example: “In a performance appraisal, one suggestion we make is to have a conversation about data,” Dr. Keogh explains. “Look at some numbers on quality assurance, patient load, or whatever you’re discussing. Do your homework and allow the other person to have a look at the data before you sit down with them. That’s a sign of respect.”

Styles of Communication

Dr. Keogh’s training for physician executives—including what he teaches at the Leadership Academy—is based on the personality profile system developed by Carlson Learning Company (now Inscape Publishing).1 The DiSC model outlines behavior or characteristic leadership preferences in four dimensions:

• Dominance (D): People who score high in this category have behavioral characteristics that include being motivated by control over tasks and work environment, directing others, and achieving specific stretch goals. In general, physician managers who score high on dominance tend to be results-focused, fast-paced, and value autonomy.
• Influence (I): People who score high in this category are motivated by interacting with others, giving and receiving immediate feedback, and acknowledging emotions as well as facts.
• Steadiness (S): People who score high in this category are motivated by job security, predictability, and clearly defined expectations.
• Conscientiousness (C): People who score high in this category are motivated by needing to be right, working alone, and preferring to work on tasks rather than dealing with people.

“This model provides groundwork for seeing that other people have different ways, different preferences of communicating,” Dr. Keogh says. In his own research, he says, he has found “nearly half of all physicians are some combination of time-sensitive and perfectionist,” meaning they fit the dominance style.

The trick to effective communication is learning to modify your style when necessary. Task-focused individuals must practice taking a minute for a greeting or a pleasantry, even if it initially goes against their routine. “Someone who is extremely outgoing and open can have trouble, too,” Dr. Keogh points out. “You can’t start a conversation with a lot of chit-chat, if you’re addressing someone who is direct. … That won’t work, either.”

The solution is to practice stepping outside of your normal communication style. “You can learn how to adjust your style, how to flex to others’ styles,” Dr. Keogh says. “Depending on whom you’re communicating with, you can mirror the style of the other person.” This helps to ensure that what you’re saying is received and understood.

Practicing new ways to communicate means making a fundamental shift in your behavior. It sounds difficult, but Dr. Keogh promises it’s not.

“The transition is not as hard as you think, because hospitalists have been trained to do patient interviews,” he says. “They’re skilled at observation and listening. In the transition to leadership, they sometimes forget that they have these skills and can use these to be a great leader.”” TH

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

Reference

1. Straw J. The 4-Dimensional Manager: DiSC Strategies for Managing Different People in the Best Ways. San Francisco: Berrett-Koehler Publishers, Inc.; 2002.

Communication is an integral part of a hospitalist’s job: from admission interviews to conveying orders to nursing staff, communicating clearly and precisely is part of numerous best practices. When a hospitalist assumes a leadership role, however, the types and styles of communication change. A committee chair or department head must be aware of the messages they send—both literally and in the most general sense of the term. This transition to leadership can be tough.

“Physician communication is focused on clinical outcome. That’s easy for someone trained in medicine. But in leadership communication, there may not be a defined outcome,” says Timothy J. Keogh, PhD, assistant professor at The Citadel School of Business Administration in Charleston, S.C. “That’s a difficult switch from clinician to leader; maybe half of the problems a leader faces can’t be solved.”

Dr. Keogh and William F. Martin, PsyD, MPH, summarized their research data in “Managing Medical Groups: 21st Century Challenges and the Impact of Physician Leadership Styles,” published in the September-October 2004 issue of Journal of Medical Practice Management.

The Basics

The most basic communication skill a hospitalist leader should practice, according to Dr. Keogh, is “being less direct than [he or she] would like to be.” Dr. Keogh, who teaches communication skills as part of SHM’s Leadership Academy, says, “Data shows that physicians prefer to be more precise and cover topics quickly. In a leadership role, the initial part of the communication or conversation needs to be chattier. Some physicians believe that this uses up too much time, but, in fact, it doesn’t take that long and it’s a necessary step.” Acknowledge others’ need for connection by making eye contact, pausing, and exchanging quick pleasantries. “Leaders need to be able to say things in passing, greet people, et cetera,” Dr. Keogh stresses.

But what about in-depth communication?

Management Topics

If you supervise hospitalists, you can condense discussions of your expectations—at least compared with managers in business fields. “Physicians are skilled, well-trained individuals, so you don’t have to do so much of this,” Dr. Keogh says. “They have an internal sense of quality and you don’t really need to motivate them. It’s a matter of adjusting the edges.”

A hospitalist supervisor might need to address a situation in which a physician on the team has been disruptive or needs a disciplinary talk. In these instances, Dr. Keogh says, “The leader has to somehow collect data on what the hospitalist has displayed that doesn’t fit in with teamwork. The hard part is that the data is likely to be hearsay—what was said by whom, when. That’s management.”

For example, you might receive complaints from nursing staff of abrupt or rude behavior from a hospitalist. “Physicians may not think of this as data, but it is. What someone said or did, or gestured,” Dr. Keogh points out. “You have to be able to say, ‘Here’s what we know happened on this date. Help me understand what happened, because we have to change this. This behavior is not acceptable.’”

The key to all official management communication is to carefully consider how to frame the conversation and keep it flowing for both parties: Speak with hospitalists, not to them. Here is an example: “In a performance appraisal, one suggestion we make is to have a conversation about data,” Dr. Keogh explains. “Look at some numbers on quality assurance, patient load, or whatever you’re discussing. Do your homework and allow the other person to have a look at the data before you sit down with them. That’s a sign of respect.”

Styles of Communication

Dr. Keogh’s training for physician executives—including what he teaches at the Leadership Academy—is based on the personality profile system developed by Carlson Learning Company (now Inscape Publishing).1 The DiSC model outlines behavior or characteristic leadership preferences in four dimensions:

• Dominance (D): People who score high in this category have behavioral characteristics that include being motivated by control over tasks and work environment, directing others, and achieving specific stretch goals. In general, physician managers who score high on dominance tend to be results-focused, fast-paced, and value autonomy.
• Influence (I): People who score high in this category are motivated by interacting with others, giving and receiving immediate feedback, and acknowledging emotions as well as facts.
• Steadiness (S): People who score high in this category are motivated by job security, predictability, and clearly defined expectations.
• Conscientiousness (C): People who score high in this category are motivated by needing to be right, working alone, and preferring to work on tasks rather than dealing with people.

“This model provides groundwork for seeing that other people have different ways, different preferences of communicating,” Dr. Keogh says. In his own research, he says, he has found “nearly half of all physicians are some combination of time-sensitive and perfectionist,” meaning they fit the dominance style.

The trick to effective communication is learning to modify your style when necessary. Task-focused individuals must practice taking a minute for a greeting or a pleasantry, even if it initially goes against their routine. “Someone who is extremely outgoing and open can have trouble, too,” Dr. Keogh points out. “You can’t start a conversation with a lot of chit-chat, if you’re addressing someone who is direct. … That won’t work, either.”

The solution is to practice stepping outside of your normal communication style. “You can learn how to adjust your style, how to flex to others’ styles,” Dr. Keogh says. “Depending on whom you’re communicating with, you can mirror the style of the other person.” This helps to ensure that what you’re saying is received and understood.

Practicing new ways to communicate means making a fundamental shift in your behavior. It sounds difficult, but Dr. Keogh promises it’s not.

“The transition is not as hard as you think, because hospitalists have been trained to do patient interviews,” he says. “They’re skilled at observation and listening. In the transition to leadership, they sometimes forget that they have these skills and can use these to be a great leader.”” TH

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

Reference

1. Straw J. The 4-Dimensional Manager: DiSC Strategies for Managing Different People in the Best Ways. San Francisco: Berrett-Koehler Publishers, Inc.; 2002.

Physicians who count Medicare among their payers already know the government green-lighted a 1.1% increase in Medicare Part B payments to physicians last summer. The increase was made official by the Centers for Medicare and Medicaid Services (CMS) on Oct. 30, with the release of the Medicare Physician Fee Schedule Final Rule for fiscal year 2009. The Final Rule governs what services are reimbursed by Medicare, the reimbursement levels for those services, and other rules pertaining to Medicare. Many of these changes, additions, and deletions were dictated by the Medicare Improvements for Patients and Providers Act, or MIPPA. (See “MIPPA Matters,” December 2008, p. 18.)

The 2009 Final Rule not only makes official the short-term, 1.1% payment increase, it also marks significant increases in payments for inpatient evaluation and management services, higher bonuses for participation in the Physician Quality Reporting Initiative (PQRI), and new policies to help direct the future of healthcare.

Here is a look at a few of the key aspects of the Final Rule, of which you may not be aware:

Transparent Physicians

In a continued effort to make healthcare transparent, CMS will begin posting the names of physicians who successfully report through the 2009 PQRI on a physician compare Web site in 2010. (2007 and 2008 PQRI participants will not be included.) Just as the Hospital Compare site enables consumers to view data on facilities, this site will allow consumers to view data reported by individual doctors.

Although consumers may be interested in checking for information on their primary care physician, it is unlikely inpatients will check the site before agreeing to see a specific hospitalist. However, the Physician Compare site will have some impact on hospital medicine. “I think this is the beginning of physicians’ commitment to greater transparency,” says Eric Siegal, MD, chair of SHM’s Public Policy Committee. “In a very broad sense, physicians who agree to be listed on the Physician Compare site very clearly value transparency and quality of care. Their inclusion could be seen as a differentiator, though a small one.”

Another factor to consider regarding transparency: “Physician Compare is not just about patients,” Dr. Siegal points out. “Third-party payers will look at this, as well. If they’re looking for someone to help take care of their patients, this data might sway them in their decision.”

Telehealth and Inpatients

Medicare already reimburses for certain exchanges of medical information from off-site physicians or vendors via interactive electronic communications, also known as telehealth or telemedicine services. Under the 2009 Final Rule, CMS will create a new series of Healthcare Common Procedure Coding System (HCPCS) codes for follow-up inpatient telehealth consultations, allowing practitioners to bill for follow-up inpatient consultations delivered via telehealth.

These codes are intended for use by physicians or non-physician providers when an inpatient consultation is requested from an appropriate source, such as the patient’s attending physician. CMS emphasizes the codes are not intended for use in billing for the ongoing evaluation and management of a hospital inpatient.

E-prescribe Out of Reach

Much attention has been given to a new Medicare program, which promotes the widespread adoption of electronic prescribing (e-prescribing). Physicians who successfully participate in CMS’ Electronic Prescribing Incentive Program will earn an extra bonus; however, the program was designed for primary care programs and hospitalists are unlikely to be able to take advantage of this.

“We don’t even know if hospitalists will be able to participate,” Dr. Siegal explains. The only way a hospitalist can take part in the e-prescribing initiative is if the hospital already has an acceptable system. However, Dr. Siegal warns, “If you create a mandate requiring a system for medication reconciliation at discharge, and then require another, separate system for e-prescribing, you’ve got problems. The primary driver should be that the hospital’s system supports both. And as far as we can tell, most hospital systems don’t do this.”

In August, SHM and the American College of Emergency Physicians conducted a teleconference with CMS to voice concerns with the e-prescribe initiative. “What we wanted was an exception,” Dr. Siegal says. SHM’s concern: When CMS stops rewarding physicians for e-prescribing and begins to penalize those who don’t—currently scheduled for 2013—hospitalists who can’t participate will be penalized through their Medicare payments. The outcome of the meeting, Dr. Siegal says, is “CMS turned around and said ‘either you can participate or you can’t.’ But at least they are considering our points; they seem to understand them.”

The good news is there is time to work the problem out, “At the moment, while e-prescribing is all bonus and no penalty, there’s no urgency to address it,” Dr. Siegal says.

Patient Safety

The Final Rule also includes improvements to PQRI, which allows eligible professionals to report on 153 quality measures. Physicians who successfully report on cases during 2009 will be able to earn an incentive payment, which has been increased to 2% (up from 1.5% in 2008), of their total allowed charges for covered professional services.

“I hope that more hospitalists will get on board with this,” Dr. Siegal says. He believes PQRI will be around for a while, and any hospital medicine group waiting to see if it is worth investing in the program can safely do so. “My feeling is that there’s growing bi-partisan support for something like this. I think it’s here to stay,” Dr. Siegal says.

SHM’s Opinion Counts

One reason the Final Rule is especially hospitalist-friendly is because SHM submitted extensive comment on CMS’s proposals in August. “SHM had a fair amount to say, and there are things in the rule that dovetail with our comments,” Dr. Siegal explains. “Part of the challenge is picking which battles to fight; there is a lot covered in this rule. We ended up focusing on areas that were really important to us, and on items where we thought we had a unique voice where nobody else was going to articulate.”

The Final Rule is available at www.cms.hhs.gov/center/physician.asp under “CMS-1403-FC.” Fact sheets covering major provisions of the Final Rule are available at www.cms.hhs.gov/apps/media/ fact_sheets.asp. TH

Jane Jerrard is a medical writer based in Chicago.

Physicians who count Medicare among their payers already know the government green-lighted a 1.1% increase in Medicare Part B payments to physicians last summer. The increase was made official by the Centers for Medicare and Medicaid Services (CMS) on Oct. 30, with the release of the Medicare Physician Fee Schedule Final Rule for fiscal year 2009. The Final Rule governs what services are reimbursed by Medicare, the reimbursement levels for those services, and other rules pertaining to Medicare. Many of these changes, additions, and deletions were dictated by the Medicare Improvements for Patients and Providers Act, or MIPPA. (See “MIPPA Matters,” December 2008, p. 18.)

The 2009 Final Rule not only makes official the short-term, 1.1% payment increase, it also marks significant increases in payments for inpatient evaluation and management services, higher bonuses for participation in the Physician Quality Reporting Initiative (PQRI), and new policies to help direct the future of healthcare.

Here is a look at a few of the key aspects of the Final Rule, of which you may not be aware:

Transparent Physicians

In a continued effort to make healthcare transparent, CMS will begin posting the names of physicians who successfully report through the 2009 PQRI on a physician compare Web site in 2010. (2007 and 2008 PQRI participants will not be included.) Just as the Hospital Compare site enables consumers to view data on facilities, this site will allow consumers to view data reported by individual doctors.

Although consumers may be interested in checking for information on their primary care physician, it is unlikely inpatients will check the site before agreeing to see a specific hospitalist. However, the Physician Compare site will have some impact on hospital medicine. “I think this is the beginning of physicians’ commitment to greater transparency,” says Eric Siegal, MD, chair of SHM’s Public Policy Committee. “In a very broad sense, physicians who agree to be listed on the Physician Compare site very clearly value transparency and quality of care. Their inclusion could be seen as a differentiator, though a small one.”

Another factor to consider regarding transparency: “Physician Compare is not just about patients,” Dr. Siegal points out. “Third-party payers will look at this, as well. If they’re looking for someone to help take care of their patients, this data might sway them in their decision.”

Telehealth and Inpatients

Medicare already reimburses for certain exchanges of medical information from off-site physicians or vendors via interactive electronic communications, also known as telehealth or telemedicine services. Under the 2009 Final Rule, CMS will create a new series of Healthcare Common Procedure Coding System (HCPCS) codes for follow-up inpatient telehealth consultations, allowing practitioners to bill for follow-up inpatient consultations delivered via telehealth.

These codes are intended for use by physicians or non-physician providers when an inpatient consultation is requested from an appropriate source, such as the patient’s attending physician. CMS emphasizes the codes are not intended for use in billing for the ongoing evaluation and management of a hospital inpatient.

E-prescribe Out of Reach

Much attention has been given to a new Medicare program, which promotes the widespread adoption of electronic prescribing (e-prescribing). Physicians who successfully participate in CMS’ Electronic Prescribing Incentive Program will earn an extra bonus; however, the program was designed for primary care programs and hospitalists are unlikely to be able to take advantage of this.

“We don’t even know if hospitalists will be able to participate,” Dr. Siegal explains. The only way a hospitalist can take part in the e-prescribing initiative is if the hospital already has an acceptable system. However, Dr. Siegal warns, “If you create a mandate requiring a system for medication reconciliation at discharge, and then require another, separate system for e-prescribing, you’ve got problems. The primary driver should be that the hospital’s system supports both. And as far as we can tell, most hospital systems don’t do this.”

In August, SHM and the American College of Emergency Physicians conducted a teleconference with CMS to voice concerns with the e-prescribe initiative. “What we wanted was an exception,” Dr. Siegal says. SHM’s concern: When CMS stops rewarding physicians for e-prescribing and begins to penalize those who don’t—currently scheduled for 2013—hospitalists who can’t participate will be penalized through their Medicare payments. The outcome of the meeting, Dr. Siegal says, is “CMS turned around and said ‘either you can participate or you can’t.’ But at least they are considering our points; they seem to understand them.”

The good news is there is time to work the problem out, “At the moment, while e-prescribing is all bonus and no penalty, there’s no urgency to address it,” Dr. Siegal says.

Patient Safety

The Final Rule also includes improvements to PQRI, which allows eligible professionals to report on 153 quality measures. Physicians who successfully report on cases during 2009 will be able to earn an incentive payment, which has been increased to 2% (up from 1.5% in 2008), of their total allowed charges for covered professional services.

“I hope that more hospitalists will get on board with this,” Dr. Siegal says. He believes PQRI will be around for a while, and any hospital medicine group waiting to see if it is worth investing in the program can safely do so. “My feeling is that there’s growing bi-partisan support for something like this. I think it’s here to stay,” Dr. Siegal says.

SHM’s Opinion Counts

One reason the Final Rule is especially hospitalist-friendly is because SHM submitted extensive comment on CMS’s proposals in August. “SHM had a fair amount to say, and there are things in the rule that dovetail with our comments,” Dr. Siegal explains. “Part of the challenge is picking which battles to fight; there is a lot covered in this rule. We ended up focusing on areas that were really important to us, and on items where we thought we had a unique voice where nobody else was going to articulate.”

The Final Rule is available at www.cms.hhs.gov/center/physician.asp under “CMS-1403-FC.” Fact sheets covering major provisions of the Final Rule are available at www.cms.hhs.gov/apps/media/ fact_sheets.asp. TH

Jane Jerrard is a medical writer based in Chicago.

Physicians who count Medicare among their payers already know the government green-lighted a 1.1% increase in Medicare Part B payments to physicians last summer. The increase was made official by the Centers for Medicare and Medicaid Services (CMS) on Oct. 30, with the release of the Medicare Physician Fee Schedule Final Rule for fiscal year 2009. The Final Rule governs what services are reimbursed by Medicare, the reimbursement levels for those services, and other rules pertaining to Medicare. Many of these changes, additions, and deletions were dictated by the Medicare Improvements for Patients and Providers Act, or MIPPA. (See “MIPPA Matters,” December 2008, p. 18.)

The 2009 Final Rule not only makes official the short-term, 1.1% payment increase, it also marks significant increases in payments for inpatient evaluation and management services, higher bonuses for participation in the Physician Quality Reporting Initiative (PQRI), and new policies to help direct the future of healthcare.

Here is a look at a few of the key aspects of the Final Rule, of which you may not be aware:

Transparent Physicians

In a continued effort to make healthcare transparent, CMS will begin posting the names of physicians who successfully report through the 2009 PQRI on a physician compare Web site in 2010. (2007 and 2008 PQRI participants will not be included.) Just as the Hospital Compare site enables consumers to view data on facilities, this site will allow consumers to view data reported by individual doctors.

Although consumers may be interested in checking for information on their primary care physician, it is unlikely inpatients will check the site before agreeing to see a specific hospitalist. However, the Physician Compare site will have some impact on hospital medicine. “I think this is the beginning of physicians’ commitment to greater transparency,” says Eric Siegal, MD, chair of SHM’s Public Policy Committee. “In a very broad sense, physicians who agree to be listed on the Physician Compare site very clearly value transparency and quality of care. Their inclusion could be seen as a differentiator, though a small one.”

Another factor to consider regarding transparency: “Physician Compare is not just about patients,” Dr. Siegal points out. “Third-party payers will look at this, as well. If they’re looking for someone to help take care of their patients, this data might sway them in their decision.”

Telehealth and Inpatients

Medicare already reimburses for certain exchanges of medical information from off-site physicians or vendors via interactive electronic communications, also known as telehealth or telemedicine services. Under the 2009 Final Rule, CMS will create a new series of Healthcare Common Procedure Coding System (HCPCS) codes for follow-up inpatient telehealth consultations, allowing practitioners to bill for follow-up inpatient consultations delivered via telehealth.

These codes are intended for use by physicians or non-physician providers when an inpatient consultation is requested from an appropriate source, such as the patient’s attending physician. CMS emphasizes the codes are not intended for use in billing for the ongoing evaluation and management of a hospital inpatient.

E-prescribe Out of Reach

Much attention has been given to a new Medicare program, which promotes the widespread adoption of electronic prescribing (e-prescribing). Physicians who successfully participate in CMS’ Electronic Prescribing Incentive Program will earn an extra bonus; however, the program was designed for primary care programs and hospitalists are unlikely to be able to take advantage of this.

“We don’t even know if hospitalists will be able to participate,” Dr. Siegal explains. The only way a hospitalist can take part in the e-prescribing initiative is if the hospital already has an acceptable system. However, Dr. Siegal warns, “If you create a mandate requiring a system for medication reconciliation at discharge, and then require another, separate system for e-prescribing, you’ve got problems. The primary driver should be that the hospital’s system supports both. And as far as we can tell, most hospital systems don’t do this.”

In August, SHM and the American College of Emergency Physicians conducted a teleconference with CMS to voice concerns with the e-prescribe initiative. “What we wanted was an exception,” Dr. Siegal says. SHM’s concern: When CMS stops rewarding physicians for e-prescribing and begins to penalize those who don’t—currently scheduled for 2013—hospitalists who can’t participate will be penalized through their Medicare payments. The outcome of the meeting, Dr. Siegal says, is “CMS turned around and said ‘either you can participate or you can’t.’ But at least they are considering our points; they seem to understand them.”

The good news is there is time to work the problem out, “At the moment, while e-prescribing is all bonus and no penalty, there’s no urgency to address it,” Dr. Siegal says.

Patient Safety

The Final Rule also includes improvements to PQRI, which allows eligible professionals to report on 153 quality measures. Physicians who successfully report on cases during 2009 will be able to earn an incentive payment, which has been increased to 2% (up from 1.5% in 2008), of their total allowed charges for covered professional services.

“I hope that more hospitalists will get on board with this,” Dr. Siegal says. He believes PQRI will be around for a while, and any hospital medicine group waiting to see if it is worth investing in the program can safely do so. “My feeling is that there’s growing bi-partisan support for something like this. I think it’s here to stay,” Dr. Siegal says.

SHM’s Opinion Counts

One reason the Final Rule is especially hospitalist-friendly is because SHM submitted extensive comment on CMS’s proposals in August. “SHM had a fair amount to say, and there are things in the rule that dovetail with our comments,” Dr. Siegal explains. “Part of the challenge is picking which battles to fight; there is a lot covered in this rule. We ended up focusing on areas that were really important to us, and on items where we thought we had a unique voice where nobody else was going to articulate.”

The Final Rule is available at www.cms.hhs.gov/center/physician.asp under “CMS-1403-FC.” Fact sheets covering major provisions of the Final Rule are available at www.cms.hhs.gov/apps/media/ fact_sheets.asp. TH

Jane Jerrard is a medical writer based in Chicago.

Hospitalists routinely confront clinical, administrative, and ethical issues. Sometimes they face less-identifiable issues, such as office politics. Webster’s Dictionary defines office politics as “factional scheming for power and status within a group.” Wikipedia describes office politics as “the use of one’s individual or assigned power within an employing organization for the purpose of obtaining advantages beyond one’s legitimate authority.”

How much does office politics affect hospital medicine?

“Of course there is office politics in any work environment,” says Heather A. Harris, MD, former director of Eden Inpatient Services in Castro Valley, Calif., and currently splitting time as a hospitalist at the University of California San Francisco and the Palo Alto Medical Foundation. Dr. Harris, however, believes office politics is rare within hospital medicine because, “It is a young field and a growing field; everyone is growing together, so things tend to be pretty democratic. This is especially true of newer groups.”

Then again, there are times hospitalists find themselves embroiled in office politics. When this happens, what should you do?

Take the High Ground

Although she’s encountered few cases of office politics in her career, Dr. Harris’ general advice for hospitalists is, “First, recognize it, and then try to be a good team player.” Stay above the fray and try to tread carefully around political situations, especially if you’re a manager or informal leader.

Mary Jo Gorman, MD, MBA, CEO of Advanced ICU Care in St. Louis, and former SHM president, advises hospitalists and group directors to “take the high ground, no matter how frustrated you become.” She stresses discretion: “You can talk about it to your spouse, but if you’re a leader, you can’t even [comment on someone’s behavior] in front of your group. You never know, especially if you’re in a relatively small community, when you’re going to need someone’s support. You need to stay on good terms with people.” Dr. Gorman’s advice for leaders holds true for individuals hospitalists caught up in office politics.

Power Struggles

The role hospital medicine groups play as change agents probably is the main reason office politics may develop. “Any time you’re introducing a new concept that somebody feels threatened by, you’re going to incur some defensive maneuvers,” Dr. Gorman warns. “Whether you’re introducing a new hospital medicine group, or trying to change something, like the admissions process in the emergency room, you’re going to disrupt someone’s actions. Then you’ll find a whole broad range of reactions. And the more a person feels threatened, the more aggressive they’ll become.”

Based on her experiences establishing Eden Inpatient Services in 2003, Dr. Harris knows bringing a hospital medicine group into a hospital for the first time can be “a very political situation.” You can be stepping on personal, professional, and financial toes. “When you’re part of a new hospital medicine group … you’re potentially poised to take a lot of business away from people,” Dr. Harris explains. “It’s difficult to navigate those waters and build relationships” with physicians you’re consulting with and with primary care physicians. “In a way, this even extends to nurses,” she says. “You’re suddenly going to be working with them on patient care, and changing the way they work.” Dr. Harris encourages hospitalists to be aware of touchy situations, so as not to inadvertently fuel the fire of office politics. “Especially for young physicians just starting out, there can be a lack of recognition of other people’s feelings and turfs,” she cautions.

Hospitalists faced with an office issue should combine the cautionary approach with a willingness to work with people, even those who are engaging in office politics. “When you’re implementing a change, regardless of what it is, you need to identify who will think it’s a good thing and who will not,” Dr. Gorman advises. “You need to speak with individuals in the latter group, or choose others to speak to them, to garner their support.”

Take, for example, proposing a new project for your hospital’s Quality Improvement committee. A cautionary approach and team building will go a long way. “You’ve got to get to the people on the committee ahead of time, explain what you want to do, and get their feedback and support,” Dr. Gorman says. “If you find someone who opposes it, make sure you have enough support to override them. Or, better yet, find someone who can approach them on the topic, maybe their partner or another member of their group. This is a very practical approach.”

Identify Informal Leadership

When considering this inclusive approach, don’t forget the indirect leadership. “You may have a member of the medical staff who has some informal authority or power, maybe they have the most years of experience, or bring a lot of patients to the hospital, or maybe they are a member of the same group as someone in power,” Dr. Gorman says. “These informal leaders can create a lot of disturbance.”

To avoid problems, either direct or indirect, with these types of people, identify them early and make it a point to include them in the plan. “Usually, you know who holds informal power within your organization or the hospital,” Dr. Gorman says. “All you have to do is talk to them and explain what you’re doing. No one likes to be surprised. You might have to make some changes to accommodate their concerns.”

If this tactic fails and you still face opposition, you might have to weigh how important the opposition is. “You may decide to move ahead, even if you have to make changes and the project takes more time,” she says. “For physicians working in hospitals, we’re all used to instant results. You have to understand that process change takes time and you may have to take something bit by bit, and not get immediate results or responses.”

Be tactful about other professionals’ territories and feelings. Keep communication open and avoid springing surprises on stakeholders. Most importantly, stick to the high ground. These simple steps can help you stay far from the minefield known as office politics. TH

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

Hospitalists routinely confront clinical, administrative, and ethical issues. Sometimes they face less-identifiable issues, such as office politics. Webster’s Dictionary defines office politics as “factional scheming for power and status within a group.” Wikipedia describes office politics as “the use of one’s individual or assigned power within an employing organization for the purpose of obtaining advantages beyond one’s legitimate authority.”

How much does office politics affect hospital medicine?

“Of course there is office politics in any work environment,” says Heather A. Harris, MD, former director of Eden Inpatient Services in Castro Valley, Calif., and currently splitting time as a hospitalist at the University of California San Francisco and the Palo Alto Medical Foundation. Dr. Harris, however, believes office politics is rare within hospital medicine because, “It is a young field and a growing field; everyone is growing together, so things tend to be pretty democratic. This is especially true of newer groups.”

Then again, there are times hospitalists find themselves embroiled in office politics. When this happens, what should you do?

Take the High Ground

Although she’s encountered few cases of office politics in her career, Dr. Harris’ general advice for hospitalists is, “First, recognize it, and then try to be a good team player.” Stay above the fray and try to tread carefully around political situations, especially if you’re a manager or informal leader.

Mary Jo Gorman, MD, MBA, CEO of Advanced ICU Care in St. Louis, and former SHM president, advises hospitalists and group directors to “take the high ground, no matter how frustrated you become.” She stresses discretion: “You can talk about it to your spouse, but if you’re a leader, you can’t even [comment on someone’s behavior] in front of your group. You never know, especially if you’re in a relatively small community, when you’re going to need someone’s support. You need to stay on good terms with people.” Dr. Gorman’s advice for leaders holds true for individuals hospitalists caught up in office politics.

Power Struggles

The role hospital medicine groups play as change agents probably is the main reason office politics may develop. “Any time you’re introducing a new concept that somebody feels threatened by, you’re going to incur some defensive maneuvers,” Dr. Gorman warns. “Whether you’re introducing a new hospital medicine group, or trying to change something, like the admissions process in the emergency room, you’re going to disrupt someone’s actions. Then you’ll find a whole broad range of reactions. And the more a person feels threatened, the more aggressive they’ll become.”

Based on her experiences establishing Eden Inpatient Services in 2003, Dr. Harris knows bringing a hospital medicine group into a hospital for the first time can be “a very political situation.” You can be stepping on personal, professional, and financial toes. “When you’re part of a new hospital medicine group … you’re potentially poised to take a lot of business away from people,” Dr. Harris explains. “It’s difficult to navigate those waters and build relationships” with physicians you’re consulting with and with primary care physicians. “In a way, this even extends to nurses,” she says. “You’re suddenly going to be working with them on patient care, and changing the way they work.” Dr. Harris encourages hospitalists to be aware of touchy situations, so as not to inadvertently fuel the fire of office politics. “Especially for young physicians just starting out, there can be a lack of recognition of other people’s feelings and turfs,” she cautions.

Hospitalists faced with an office issue should combine the cautionary approach with a willingness to work with people, even those who are engaging in office politics. “When you’re implementing a change, regardless of what it is, you need to identify who will think it’s a good thing and who will not,” Dr. Gorman advises. “You need to speak with individuals in the latter group, or choose others to speak to them, to garner their support.”

Take, for example, proposing a new project for your hospital’s Quality Improvement committee. A cautionary approach and team building will go a long way. “You’ve got to get to the people on the committee ahead of time, explain what you want to do, and get their feedback and support,” Dr. Gorman says. “If you find someone who opposes it, make sure you have enough support to override them. Or, better yet, find someone who can approach them on the topic, maybe their partner or another member of their group. This is a very practical approach.”

Identify Informal Leadership

When considering this inclusive approach, don’t forget the indirect leadership. “You may have a member of the medical staff who has some informal authority or power, maybe they have the most years of experience, or bring a lot of patients to the hospital, or maybe they are a member of the same group as someone in power,” Dr. Gorman says. “These informal leaders can create a lot of disturbance.”

To avoid problems, either direct or indirect, with these types of people, identify them early and make it a point to include them in the plan. “Usually, you know who holds informal power within your organization or the hospital,” Dr. Gorman says. “All you have to do is talk to them and explain what you’re doing. No one likes to be surprised. You might have to make some changes to accommodate their concerns.”

If this tactic fails and you still face opposition, you might have to weigh how important the opposition is. “You may decide to move ahead, even if you have to make changes and the project takes more time,” she says. “For physicians working in hospitals, we’re all used to instant results. You have to understand that process change takes time and you may have to take something bit by bit, and not get immediate results or responses.”

Be tactful about other professionals’ territories and feelings. Keep communication open and avoid springing surprises on stakeholders. Most importantly, stick to the high ground. These simple steps can help you stay far from the minefield known as office politics. TH

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

Hospitalists routinely confront clinical, administrative, and ethical issues. Sometimes they face less-identifiable issues, such as office politics. Webster’s Dictionary defines office politics as “factional scheming for power and status within a group.” Wikipedia describes office politics as “the use of one’s individual or assigned power within an employing organization for the purpose of obtaining advantages beyond one’s legitimate authority.”

How much does office politics affect hospital medicine?

“Of course there is office politics in any work environment,” says Heather A. Harris, MD, former director of Eden Inpatient Services in Castro Valley, Calif., and currently splitting time as a hospitalist at the University of California San Francisco and the Palo Alto Medical Foundation. Dr. Harris, however, believes office politics is rare within hospital medicine because, “It is a young field and a growing field; everyone is growing together, so things tend to be pretty democratic. This is especially true of newer groups.”

Then again, there are times hospitalists find themselves embroiled in office politics. When this happens, what should you do?

Take the High Ground

Although she’s encountered few cases of office politics in her career, Dr. Harris’ general advice for hospitalists is, “First, recognize it, and then try to be a good team player.” Stay above the fray and try to tread carefully around political situations, especially if you’re a manager or informal leader.

Mary Jo Gorman, MD, MBA, CEO of Advanced ICU Care in St. Louis, and former SHM president, advises hospitalists and group directors to “take the high ground, no matter how frustrated you become.” She stresses discretion: “You can talk about it to your spouse, but if you’re a leader, you can’t even [comment on someone’s behavior] in front of your group. You never know, especially if you’re in a relatively small community, when you’re going to need someone’s support. You need to stay on good terms with people.” Dr. Gorman’s advice for leaders holds true for individuals hospitalists caught up in office politics.

Power Struggles

The role hospital medicine groups play as change agents probably is the main reason office politics may develop. “Any time you’re introducing a new concept that somebody feels threatened by, you’re going to incur some defensive maneuvers,” Dr. Gorman warns. “Whether you’re introducing a new hospital medicine group, or trying to change something, like the admissions process in the emergency room, you’re going to disrupt someone’s actions. Then you’ll find a whole broad range of reactions. And the more a person feels threatened, the more aggressive they’ll become.”

Based on her experiences establishing Eden Inpatient Services in 2003, Dr. Harris knows bringing a hospital medicine group into a hospital for the first time can be “a very political situation.” You can be stepping on personal, professional, and financial toes. “When you’re part of a new hospital medicine group … you’re potentially poised to take a lot of business away from people,” Dr. Harris explains. “It’s difficult to navigate those waters and build relationships” with physicians you’re consulting with and with primary care physicians. “In a way, this even extends to nurses,” she says. “You’re suddenly going to be working with them on patient care, and changing the way they work.” Dr. Harris encourages hospitalists to be aware of touchy situations, so as not to inadvertently fuel the fire of office politics. “Especially for young physicians just starting out, there can be a lack of recognition of other people’s feelings and turfs,” she cautions.

Hospitalists faced with an office issue should combine the cautionary approach with a willingness to work with people, even those who are engaging in office politics. “When you’re implementing a change, regardless of what it is, you need to identify who will think it’s a good thing and who will not,” Dr. Gorman advises. “You need to speak with individuals in the latter group, or choose others to speak to them, to garner their support.”

Take, for example, proposing a new project for your hospital’s Quality Improvement committee. A cautionary approach and team building will go a long way. “You’ve got to get to the people on the committee ahead of time, explain what you want to do, and get their feedback and support,” Dr. Gorman says. “If you find someone who opposes it, make sure you have enough support to override them. Or, better yet, find someone who can approach them on the topic, maybe their partner or another member of their group. This is a very practical approach.”

Identify Informal Leadership

When considering this inclusive approach, don’t forget the indirect leadership. “You may have a member of the medical staff who has some informal authority or power, maybe they have the most years of experience, or bring a lot of patients to the hospital, or maybe they are a member of the same group as someone in power,” Dr. Gorman says. “These informal leaders can create a lot of disturbance.”

To avoid problems, either direct or indirect, with these types of people, identify them early and make it a point to include them in the plan. “Usually, you know who holds informal power within your organization or the hospital,” Dr. Gorman says. “All you have to do is talk to them and explain what you’re doing. No one likes to be surprised. You might have to make some changes to accommodate their concerns.”

If this tactic fails and you still face opposition, you might have to weigh how important the opposition is. “You may decide to move ahead, even if you have to make changes and the project takes more time,” she says. “For physicians working in hospitals, we’re all used to instant results. You have to understand that process change takes time and you may have to take something bit by bit, and not get immediate results or responses.”

Be tactful about other professionals’ territories and feelings. Keep communication open and avoid springing surprises on stakeholders. Most importantly, stick to the high ground. These simple steps can help you stay far from the minefield known as office politics. TH

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