Jane Jerrard

A small Illinois hospital has joined the ranks of facilities—including its neighbors—in adding a hospital medicine (HM) program. The Genesis Medical Center, Illini Campus, in Silvas, Ill., began providing full-time hospitalist coverage on Dec. 1.

As the influx of hospitalists allowed local primary care physicians to stop making hospital visits, the Illini Campus rushed to fill the gap with its own HM program. "We were the last acute care hospital to implement a hospitalist program," says Chuck Bruhn, CEO of Illini Campus. "It had become a medical community issue."

Illini Campus, located near the Quad Cities on the western Illinois-eastern Iowa border, is a 149-bed facility with an average daily census of 50 to 55 patients. Its sister facility, the Genesis Medical Center in Davenport, Iowa, has had a successful hospital medicine program since 2005. Genesis' agreement with Cogent Healthcare, Inc., recently expanded to manage the program at Illini Campus, with round-the-clock coverage, including one full-time hospitalist.

Just two weeks after implementation, "the hospitalist program is growing much more rapidly than we had anticipated," Bruhn says. "They’re already covering a census of 14 patients a day. We're already talking about adding a physician extender."

Bruhn is pleased with the way the fledgling program has taken root. "We see it as a definite improvement, not only to quality and continuity of care, but to expediency of care. And the hospitalists provide additional support; they provide education to our clinical staff."

A small Illinois hospital has joined the ranks of facilities—including its neighbors—in adding a hospital medicine (HM) program. The Genesis Medical Center, Illini Campus, in Silvas, Ill., began providing full-time hospitalist coverage on Dec. 1.

As the influx of hospitalists allowed local primary care physicians to stop making hospital visits, the Illini Campus rushed to fill the gap with its own HM program. "We were the last acute care hospital to implement a hospitalist program," says Chuck Bruhn, CEO of Illini Campus. "It had become a medical community issue."

Illini Campus, located near the Quad Cities on the western Illinois-eastern Iowa border, is a 149-bed facility with an average daily census of 50 to 55 patients. Its sister facility, the Genesis Medical Center in Davenport, Iowa, has had a successful hospital medicine program since 2005. Genesis' agreement with Cogent Healthcare, Inc., recently expanded to manage the program at Illini Campus, with round-the-clock coverage, including one full-time hospitalist.

Just two weeks after implementation, "the hospitalist program is growing much more rapidly than we had anticipated," Bruhn says. "They’re already covering a census of 14 patients a day. We're already talking about adding a physician extender."

Bruhn is pleased with the way the fledgling program has taken root. "We see it as a definite improvement, not only to quality and continuity of care, but to expediency of care. And the hospitalists provide additional support; they provide education to our clinical staff."

A small Illinois hospital has joined the ranks of facilities—including its neighbors—in adding a hospital medicine (HM) program. The Genesis Medical Center, Illini Campus, in Silvas, Ill., began providing full-time hospitalist coverage on Dec. 1.

As the influx of hospitalists allowed local primary care physicians to stop making hospital visits, the Illini Campus rushed to fill the gap with its own HM program. "We were the last acute care hospital to implement a hospitalist program," says Chuck Bruhn, CEO of Illini Campus. "It had become a medical community issue."

Illini Campus, located near the Quad Cities on the western Illinois-eastern Iowa border, is a 149-bed facility with an average daily census of 50 to 55 patients. Its sister facility, the Genesis Medical Center in Davenport, Iowa, has had a successful hospital medicine program since 2005. Genesis' agreement with Cogent Healthcare, Inc., recently expanded to manage the program at Illini Campus, with round-the-clock coverage, including one full-time hospitalist.

Just two weeks after implementation, "the hospitalist program is growing much more rapidly than we had anticipated," Bruhn says. "They’re already covering a census of 14 patients a day. We're already talking about adding a physician extender."

Bruhn is pleased with the way the fledgling program has taken root. "We see it as a definite improvement, not only to quality and continuity of care, but to expediency of care. And the hospitalists provide additional support; they provide education to our clinical staff."

The Institute of Medicine (IOM) issued a report this month calling for limits to shifts worked by residents, a move that, if implemented, likely means more work for in-house hospitalists, according to one hospital medicine leader.

IOM recommends no change to the current maximum 80-hour workweek for residents, or to the maximum shift length of 30 hours. The report does, however, recommend residents only treat patients for up to 16 hours during their shift, down from the current recommendation of 24 hours. It also suggests residents take an uninterrupted five hours for a continuous sleep period between 10 p.m. and 8 a.m.

In 2003, the Accreditation Council for Graduate Medical Education restricted resident workweeks in order to protect patients and residents from unsafe conditions resulting from excessive fatigue. As mentioned in "While Residents Rest…" in The Hospitalist (August 2006), the resulting shift in workload stressed many hospitals relying on residents for coverage, and some believe it helped boost the need for hospitalists.

In teaching hospitals that follow the IOM recommendations, "I do think this work will go to hospitalists," says Sameer Badlani, MD, a hospitalist and instructor at the University of Chicago. "This is a good thing, in my opinion, as it will enhance the value a hospitalist program brings to an institution."

Dr. Badlani warns hospitals must be willing to help supplement additional costs to their hospitalist service.

The IOM report, "Resident Duty Hours: Enhancing Sleep, Supervision, and Safety," is available for purchase online, or you can download a report brief at www.iom.edu/CMS/3809/48553/60449.aspx.

The Institute of Medicine (IOM) issued a report this month calling for limits to shifts worked by residents, a move that, if implemented, likely means more work for in-house hospitalists, according to one hospital medicine leader.

IOM recommends no change to the current maximum 80-hour workweek for residents, or to the maximum shift length of 30 hours. The report does, however, recommend residents only treat patients for up to 16 hours during their shift, down from the current recommendation of 24 hours. It also suggests residents take an uninterrupted five hours for a continuous sleep period between 10 p.m. and 8 a.m.

In 2003, the Accreditation Council for Graduate Medical Education restricted resident workweeks in order to protect patients and residents from unsafe conditions resulting from excessive fatigue. As mentioned in "While Residents Rest…" in The Hospitalist (August 2006), the resulting shift in workload stressed many hospitals relying on residents for coverage, and some believe it helped boost the need for hospitalists.

In teaching hospitals that follow the IOM recommendations, "I do think this work will go to hospitalists," says Sameer Badlani, MD, a hospitalist and instructor at the University of Chicago. "This is a good thing, in my opinion, as it will enhance the value a hospitalist program brings to an institution."

Dr. Badlani warns hospitals must be willing to help supplement additional costs to their hospitalist service.

The IOM report, "Resident Duty Hours: Enhancing Sleep, Supervision, and Safety," is available for purchase online, or you can download a report brief at www.iom.edu/CMS/3809/48553/60449.aspx.

The Institute of Medicine (IOM) issued a report this month calling for limits to shifts worked by residents, a move that, if implemented, likely means more work for in-house hospitalists, according to one hospital medicine leader.

IOM recommends no change to the current maximum 80-hour workweek for residents, or to the maximum shift length of 30 hours. The report does, however, recommend residents only treat patients for up to 16 hours during their shift, down from the current recommendation of 24 hours. It also suggests residents take an uninterrupted five hours for a continuous sleep period between 10 p.m. and 8 a.m.

In 2003, the Accreditation Council for Graduate Medical Education restricted resident workweeks in order to protect patients and residents from unsafe conditions resulting from excessive fatigue. As mentioned in "While Residents Rest…" in The Hospitalist (August 2006), the resulting shift in workload stressed many hospitals relying on residents for coverage, and some believe it helped boost the need for hospitalists.

In teaching hospitals that follow the IOM recommendations, "I do think this work will go to hospitalists," says Sameer Badlani, MD, a hospitalist and instructor at the University of Chicago. "This is a good thing, in my opinion, as it will enhance the value a hospitalist program brings to an institution."

Dr. Badlani warns hospitals must be willing to help supplement additional costs to their hospitalist service.

The IOM report, "Resident Duty Hours: Enhancing Sleep, Supervision, and Safety," is available for purchase online, or you can download a report brief at www.iom.edu/CMS/3809/48553/60449.aspx.

Most hospitalists vividly recall Congress overriding President Bush’s July veto to avert a hefty, 10.6% cut in Medicare Part B payments to physicians. That memorable, last-minute save (instead of a pay cut, Congress increased Part B payments by 1.1%) was just a tiny part of some important legislation. The Medicare Improvements for Patients and Providers Act (MIPPA) includes myriad provisions addressing Medicare benefits, protections for low-income beneficiaries, changes for providers, data collection requirements for correcting healthcare disparities, and much more.

Hospitalists will be particularly interested in a handful of the provisions outlined in MIPPA, some of which impact them directly and others that will affect hospitals and clinical care, and still more whose outcomes remain to be seen.

For example, MIPPA is the legislation that extends the Physician Quality Reporting Initiative (PQRI) for two years, offering a bonus payment in 2009 and 2010 of 2% (up from 1.5%) of total Medicare allowed charges. It also directs the Centers for Medicare and Medicaid Services (CMS) to publicly post the list of providers who participate in the PQRI. (See “A Permanent PQRI” in the October 2008 issue of The Hospitalist.)

MIPPA also requires CMS to establish a program to promote widespread adoption of electronic prescribing, as outlined in “e-Prescription for Success?” in the September 2008 issue of The Hospitalist. Reporting on e-prescribing is not likely to apply to hospitalists, says Bradley Flansbaum, DO, MPH, chief of hospitalist section at Lenox Hill Hospital in New York City and a member of SHM’s Public Policy Committee. “Of course, it depends on whether the hospital uses it, but no one can say whether a hospitalist will get a benefit for reporting on e-prescribing,” he says.

Lucrative Changes to E&M Codes

One provision directly impacting hospitalists is MIPPA’s changes to payments for inpatient evaluation and management codes (E&M codes). According to Laura Allendorf, SHM’s senior advisor for advocacy and government affairs, this change will result in an estimated 3% average gain in total Medicare payments to hospitalists, or $5,000 to $6,000 annually—on top of the 1.1% payment update. (It’s important to note the final 2009 physician fee schedule, published in November, could change the overall impact for individual members.) E&M payments from some private payers also could increase, since many base their fees on Medicare’s fee schedule.

Quality Research Initiatives

MIPPA requires the establishment or continuation of several quality research initiatives, designed to help CMS determine new models of efficiency of care and cost efficiency.

One of these initiatives is Patient-Centered Medical Home (PCMH), a care model that facilitates partnerships between individual patients and their personal physicians, and when appropriate, the patient’s family. Care is facilitated by registries, information technology, health information exchange, and other means to assure patients get the indicated care when and where they need and want it in a culturally and linguistically appropriate manner. MIPPA grants new funding and expanded authority for CMS’ Medical Home Demonstration Project—if certain quality and/or savings targets are achieved.

“We’ve talked a bit about Patient-Centered Medical Home,” says Dr. Flansbaum of SHM’s Public Policy Committee. “From a political standpoint, it’s a feel-good agenda item with a lot of bipartisan support. The notion of this is here, but operationalizing it—getting it to work—is an entirely different story.” By definition, PCMH will revolve around primary care physicians, and the role and responsibilities of any hospitalists involved is yet unknown—as is the reimbursement model. “This is so far away right now, it’s a notion that needs to be turned into a theory that needs to be turned into a paradigm, to paraphrase Woody Allen,” Dr. Flansbaum says.

Another initiative greenlighted by MIPPA is comparative effectiveness research, or CER. It examines the effectiveness of different therapies for a specific medical condition, or for a specific set of patients, to determine the best option. It may involve comparing competing medications, or may analyze different treatment approaches such as surgery, devices, and drug therapies. MIPPA requires the Institute of Medicine report on best practices for the review of comparative effectiveness research and the development of clinical protocols.

“Obviously, the medical device companies and the pharmaceutical companies are against this,” Dr. Flansbaum says. “But it would be helpful for physicians, because it would give some guidance in certain gray-area treatments, such as: Is this drug appropriate in treating an end-stage cancer patient?” And as far as the nation’s health care system goes, he explains, “I think we need comparative effectiveness. We can’t continue as we are—on the net, we’re going broke—our current healthcare system can’t afford to keep going.”

Not the Only Game in Town

One interesting provision of MIPPA revokes “the unique authority of the Joint Commission to deem hospitals in compliance with the Medicare Conditions of Participation,” meaning hospital compliance is an open market—subject to approval from CMS, of course.

“The Joint Commission has been the gold standard for hospitals for a long, long time,” Dr. Flansbaum points out. “Now that they’ve opened that up, DNV (Det Norske Veritas Healthcare, Inc.) [for example], can compete with the Joint Commission to certify hospitals.”

What will this mean for hospitals? Probably not much in the short term. “I believe only 15 hospitals have DNV certifications, and that all of those also have a Joint Commission certification,” Dr. Flansbaum says, adding “[DNV and the Joint Commission] have a different approach; it’s like the ACT and the SAT. Both are used for college entrance exams, but the SAT is still mostly the gold standard, like the Joint Commission. But who knows? That could change … and if it does, well, competition is good.”

Some of the MIPPA provisions, such as the quality research initiatives, could end up shaping the future of healthcare. Others, such as the continuation of PQRI, may lead to new payment models for physicians.

Only time will tell which provisions will truly improve efficiency and costs—and which will impact hospital medicine in particular. TH

Jane Jerrard is a medical writer based in Chicago.

Most hospitalists vividly recall Congress overriding President Bush’s July veto to avert a hefty, 10.6% cut in Medicare Part B payments to physicians. That memorable, last-minute save (instead of a pay cut, Congress increased Part B payments by 1.1%) was just a tiny part of some important legislation. The Medicare Improvements for Patients and Providers Act (MIPPA) includes myriad provisions addressing Medicare benefits, protections for low-income beneficiaries, changes for providers, data collection requirements for correcting healthcare disparities, and much more.

Hospitalists will be particularly interested in a handful of the provisions outlined in MIPPA, some of which impact them directly and others that will affect hospitals and clinical care, and still more whose outcomes remain to be seen.

For example, MIPPA is the legislation that extends the Physician Quality Reporting Initiative (PQRI) for two years, offering a bonus payment in 2009 and 2010 of 2% (up from 1.5%) of total Medicare allowed charges. It also directs the Centers for Medicare and Medicaid Services (CMS) to publicly post the list of providers who participate in the PQRI. (See “A Permanent PQRI” in the October 2008 issue of The Hospitalist.)

MIPPA also requires CMS to establish a program to promote widespread adoption of electronic prescribing, as outlined in “e-Prescription for Success?” in the September 2008 issue of The Hospitalist. Reporting on e-prescribing is not likely to apply to hospitalists, says Bradley Flansbaum, DO, MPH, chief of hospitalist section at Lenox Hill Hospital in New York City and a member of SHM’s Public Policy Committee. “Of course, it depends on whether the hospital uses it, but no one can say whether a hospitalist will get a benefit for reporting on e-prescribing,” he says.

Lucrative Changes to E&M Codes

One provision directly impacting hospitalists is MIPPA’s changes to payments for inpatient evaluation and management codes (E&M codes). According to Laura Allendorf, SHM’s senior advisor for advocacy and government affairs, this change will result in an estimated 3% average gain in total Medicare payments to hospitalists, or $5,000 to $6,000 annually—on top of the 1.1% payment update. (It’s important to note the final 2009 physician fee schedule, published in November, could change the overall impact for individual members.) E&M payments from some private payers also could increase, since many base their fees on Medicare’s fee schedule.

Quality Research Initiatives

MIPPA requires the establishment or continuation of several quality research initiatives, designed to help CMS determine new models of efficiency of care and cost efficiency.

One of these initiatives is Patient-Centered Medical Home (PCMH), a care model that facilitates partnerships between individual patients and their personal physicians, and when appropriate, the patient’s family. Care is facilitated by registries, information technology, health information exchange, and other means to assure patients get the indicated care when and where they need and want it in a culturally and linguistically appropriate manner. MIPPA grants new funding and expanded authority for CMS’ Medical Home Demonstration Project—if certain quality and/or savings targets are achieved.

“We’ve talked a bit about Patient-Centered Medical Home,” says Dr. Flansbaum of SHM’s Public Policy Committee. “From a political standpoint, it’s a feel-good agenda item with a lot of bipartisan support. The notion of this is here, but operationalizing it—getting it to work—is an entirely different story.” By definition, PCMH will revolve around primary care physicians, and the role and responsibilities of any hospitalists involved is yet unknown—as is the reimbursement model. “This is so far away right now, it’s a notion that needs to be turned into a theory that needs to be turned into a paradigm, to paraphrase Woody Allen,” Dr. Flansbaum says.

Another initiative greenlighted by MIPPA is comparative effectiveness research, or CER. It examines the effectiveness of different therapies for a specific medical condition, or for a specific set of patients, to determine the best option. It may involve comparing competing medications, or may analyze different treatment approaches such as surgery, devices, and drug therapies. MIPPA requires the Institute of Medicine report on best practices for the review of comparative effectiveness research and the development of clinical protocols.

“Obviously, the medical device companies and the pharmaceutical companies are against this,” Dr. Flansbaum says. “But it would be helpful for physicians, because it would give some guidance in certain gray-area treatments, such as: Is this drug appropriate in treating an end-stage cancer patient?” And as far as the nation’s health care system goes, he explains, “I think we need comparative effectiveness. We can’t continue as we are—on the net, we’re going broke—our current healthcare system can’t afford to keep going.”

Not the Only Game in Town

One interesting provision of MIPPA revokes “the unique authority of the Joint Commission to deem hospitals in compliance with the Medicare Conditions of Participation,” meaning hospital compliance is an open market—subject to approval from CMS, of course.

“The Joint Commission has been the gold standard for hospitals for a long, long time,” Dr. Flansbaum points out. “Now that they’ve opened that up, DNV (Det Norske Veritas Healthcare, Inc.) [for example], can compete with the Joint Commission to certify hospitals.”

What will this mean for hospitals? Probably not much in the short term. “I believe only 15 hospitals have DNV certifications, and that all of those also have a Joint Commission certification,” Dr. Flansbaum says, adding “[DNV and the Joint Commission] have a different approach; it’s like the ACT and the SAT. Both are used for college entrance exams, but the SAT is still mostly the gold standard, like the Joint Commission. But who knows? That could change … and if it does, well, competition is good.”

Some of the MIPPA provisions, such as the quality research initiatives, could end up shaping the future of healthcare. Others, such as the continuation of PQRI, may lead to new payment models for physicians.

Only time will tell which provisions will truly improve efficiency and costs—and which will impact hospital medicine in particular. TH

Jane Jerrard is a medical writer based in Chicago.

Most hospitalists vividly recall Congress overriding President Bush’s July veto to avert a hefty, 10.6% cut in Medicare Part B payments to physicians. That memorable, last-minute save (instead of a pay cut, Congress increased Part B payments by 1.1%) was just a tiny part of some important legislation. The Medicare Improvements for Patients and Providers Act (MIPPA) includes myriad provisions addressing Medicare benefits, protections for low-income beneficiaries, changes for providers, data collection requirements for correcting healthcare disparities, and much more.

Hospitalists will be particularly interested in a handful of the provisions outlined in MIPPA, some of which impact them directly and others that will affect hospitals and clinical care, and still more whose outcomes remain to be seen.

For example, MIPPA is the legislation that extends the Physician Quality Reporting Initiative (PQRI) for two years, offering a bonus payment in 2009 and 2010 of 2% (up from 1.5%) of total Medicare allowed charges. It also directs the Centers for Medicare and Medicaid Services (CMS) to publicly post the list of providers who participate in the PQRI. (See “A Permanent PQRI” in the October 2008 issue of The Hospitalist.)

MIPPA also requires CMS to establish a program to promote widespread adoption of electronic prescribing, as outlined in “e-Prescription for Success?” in the September 2008 issue of The Hospitalist. Reporting on e-prescribing is not likely to apply to hospitalists, says Bradley Flansbaum, DO, MPH, chief of hospitalist section at Lenox Hill Hospital in New York City and a member of SHM’s Public Policy Committee. “Of course, it depends on whether the hospital uses it, but no one can say whether a hospitalist will get a benefit for reporting on e-prescribing,” he says.

Lucrative Changes to E&M Codes

One provision directly impacting hospitalists is MIPPA’s changes to payments for inpatient evaluation and management codes (E&M codes). According to Laura Allendorf, SHM’s senior advisor for advocacy and government affairs, this change will result in an estimated 3% average gain in total Medicare payments to hospitalists, or $5,000 to $6,000 annually—on top of the 1.1% payment update. (It’s important to note the final 2009 physician fee schedule, published in November, could change the overall impact for individual members.) E&M payments from some private payers also could increase, since many base their fees on Medicare’s fee schedule.

Quality Research Initiatives

MIPPA requires the establishment or continuation of several quality research initiatives, designed to help CMS determine new models of efficiency of care and cost efficiency.

One of these initiatives is Patient-Centered Medical Home (PCMH), a care model that facilitates partnerships between individual patients and their personal physicians, and when appropriate, the patient’s family. Care is facilitated by registries, information technology, health information exchange, and other means to assure patients get the indicated care when and where they need and want it in a culturally and linguistically appropriate manner. MIPPA grants new funding and expanded authority for CMS’ Medical Home Demonstration Project—if certain quality and/or savings targets are achieved.

“We’ve talked a bit about Patient-Centered Medical Home,” says Dr. Flansbaum of SHM’s Public Policy Committee. “From a political standpoint, it’s a feel-good agenda item with a lot of bipartisan support. The notion of this is here, but operationalizing it—getting it to work—is an entirely different story.” By definition, PCMH will revolve around primary care physicians, and the role and responsibilities of any hospitalists involved is yet unknown—as is the reimbursement model. “This is so far away right now, it’s a notion that needs to be turned into a theory that needs to be turned into a paradigm, to paraphrase Woody Allen,” Dr. Flansbaum says.

Another initiative greenlighted by MIPPA is comparative effectiveness research, or CER. It examines the effectiveness of different therapies for a specific medical condition, or for a specific set of patients, to determine the best option. It may involve comparing competing medications, or may analyze different treatment approaches such as surgery, devices, and drug therapies. MIPPA requires the Institute of Medicine report on best practices for the review of comparative effectiveness research and the development of clinical protocols.

“Obviously, the medical device companies and the pharmaceutical companies are against this,” Dr. Flansbaum says. “But it would be helpful for physicians, because it would give some guidance in certain gray-area treatments, such as: Is this drug appropriate in treating an end-stage cancer patient?” And as far as the nation’s health care system goes, he explains, “I think we need comparative effectiveness. We can’t continue as we are—on the net, we’re going broke—our current healthcare system can’t afford to keep going.”

Not the Only Game in Town

One interesting provision of MIPPA revokes “the unique authority of the Joint Commission to deem hospitals in compliance with the Medicare Conditions of Participation,” meaning hospital compliance is an open market—subject to approval from CMS, of course.

“The Joint Commission has been the gold standard for hospitals for a long, long time,” Dr. Flansbaum points out. “Now that they’ve opened that up, DNV (Det Norske Veritas Healthcare, Inc.) [for example], can compete with the Joint Commission to certify hospitals.”

What will this mean for hospitals? Probably not much in the short term. “I believe only 15 hospitals have DNV certifications, and that all of those also have a Joint Commission certification,” Dr. Flansbaum says, adding “[DNV and the Joint Commission] have a different approach; it’s like the ACT and the SAT. Both are used for college entrance exams, but the SAT is still mostly the gold standard, like the Joint Commission. But who knows? That could change … and if it does, well, competition is good.”

Some of the MIPPA provisions, such as the quality research initiatives, could end up shaping the future of healthcare. Others, such as the continuation of PQRI, may lead to new payment models for physicians.

Only time will tell which provisions will truly improve efficiency and costs—and which will impact hospital medicine in particular. TH

Jane Jerrard is a medical writer based in Chicago.

What are hospitalist leaders reading these days? What books, journals, and Web sites do they turn to—or recommend—for honing management skills, keeping up with industry trends, or generally staying sharp? In the January 2008 issue of The Hospitalist, four hospitalists in management positions shared their picks; here, three other leaders in the industry offer their “recommended reads.”

The President’s Picks

SHM President Patrick Cawley, MD, chief medical officer of the University of South Carolina Medical Center in Charleston, recommends a variety of resources for hospitalists in leadership positions and those who aspire to lead.

You're in Charge, Now What? The 8 Point Plan by Thomas J. Neff and James M. Citrin

“For any leader moving into a new position, this is an invaluable guide for the first six months,” Dr. Cawley says. “It was originally written for CEOs, but it works for any leadership role. Every time I have taken on a new leadership position, I have re-read it and learned something new.”

Competitive Advantage by Michael E. Porter

“This business reference classic details the underpinnings of today’s MBA programs,” Dr. Cawley explains. “The concepts of competitive advantage, value creation, and value chain are absolutes to anyone involved in strategic planning, and certainly for any hospitalist program which requires financial support.”

A Sense of Urgency by John P. Kotter

The newest book by a leading expert in change management, this book focuses on the first step of successful change. “All hospitalists who are interested in improving quality must understand the difference between false urgency and true urgency, since it is key to knowing which events can be used to successfully drive change,” Dr. Cawley states.

Getting Things Done by David Allen

“I’m always on a quest for better personal organization and time management skills,” Dr. Cawley admits. “GTD is one such method. Combine the book with the Microsoft Outlook tips and you’ll never look back.”

Harvard Business Review

“This is one of the few magazines I read cover to cover each month—Harvard Business Review is the business community’s equivalent of the New England Journal of Medicine,” Dr. Cawley says.

Hardwiring Excellence by Quint Studer

“Many hospitals across the nation have engaged the Studer Group to help improve leadership accountability and performance,” Dr. Cawley explains. “This book is the hospital version of Good to Great.”

Dr. Cawley adds, “for something really different … .”

The Prince by Machiavelli and The Politics of Life: 25 Rules for Survival in a Brutal and Manipulative World by Craig Crawford

“For any hospitalist who is part of a larger organization, and certainly for any leader, politics are a constant,” Dr. Cawley points out. “If you’re serious about understanding such motivations, you need to become not only a student of leadership, but one of politics, as well. The place to start is The Prince. Strive for the deeper understanding of Machiavelli and not the often quoted ‘ends justifies the means’ superficiality. Crawford’s book is the modern equivalent.”

A Pediatric Hospitalist Recommends…

Jack Percelay, MD, MPH, FAAP, E.L.M.O. Pediatrics, New York, also serves on SHM’s board of directors. He recommends reading these five resources:

Getting to Yes: Negotiating Agreement Without Giving In by Roger Fisher and William L. Ury

Dr. Percelay calls this book required reading, saying, “This is not new—it’s a core requirement for hospital medicine group leaders, hospitalists, or anyone who needs to negotiate for themselves.”

Hospitalists: A Guide to Building and Sustaining a Successful Program by Joseph A. Miller, John Nelson, MD, and Winthrop F. Whitcomb, MD

“This is a tremendously useful resource, if you’re having problems with your administration—if the C-suite doesn’t really ‘get’ hospitalists,” Dr. Percelay says. “It helps readers understand the philosophy behind a highly successful hospital medicine program. If you were going to convert a hospital executive to hospital medicine with one book, this is the book to give them. It’s very useful to know about for this reason.”

Crucial Conversations: Tools for Talking When Stakes are High and Crucial Confrontations by Kerry Patterson, Joseph Grenny, Ron McMillan and Al Switzler

“These books are more advanced and are targeted for those interested in developing their conflict resolution and leadership skills,” Dr. Percelay says. “They were recommended on the SHM practice management list serve, and they’re for both your personal and your professional life. These are the most useful leadership books I have read this year.”

The Cincinnati Children’s Hospital Pediatric Grand Rounds available at www.cincinnatichildrens. org/ed/cme/streaming-media/library/pgr/default.htm

“This is a pediatrics resource. Cincinnati Children’s Hospital has all of its grand rounds on the Web,” Dr. Percelay says. “For someone like me, who works in a community hospital and doesn’t have access to the latest and greatest research, this site provides free access to cutting edge, high-quality presentations. Some are very relevant to pediatric hospital medicine, and some presentations even offer free continuing medical education. Other hospitals do this, as well, but the Cincinnati site is the most user-friendly site I’ve found.”

Teaching Tools

Sylvia Cheney McKean, MD, medical director, Brigham and Women’s Hospital/Faulkner Hospitalist Service in Boston and SHM board member, uses several resources for dual purposes: to find the latest clinical information and to enhance and support her teaching.

PubMed available at www.ncbi.nlm. nih.gov/pubmed

The U.S. National Library of Medicine and the National Institutes of Health administer the PubMed site, which includes more than 18 million citations from MEDLINE and other life science journals for biomedical articles dating back to the 1950s. The site includes links to full text articles and other related resources.

“I find that most of my reading is through PubMed,” Dr. McKean says. “I get the latest, most up-to-date information. ... I generally proceed by first framing the question that needs to be answered and then looking for the best evidence. The key thing is to ask the right questions.”

American College of Physicians’ Medical Knowledge Self-Assessment Program (MKSAP) is available at www.acponline.org/products_services/ mksap/14.

“I find the ACP’s MKSAP syllabus very helpful for teaching and remaining updated,” Dr. McKean explains. “People use this to study for their boards, but it’s very helpful to teach residents ... and for viewing clinical problems.”

The Journal of Hospital Medicine

“I look at each issue cover to cover,” Dr. McKean says, “because it’s the most relevant journal of any out there. It has new research, professional development articles, and articles based on the Core Competencies of Hospital Medicine.”

SHM online research rooms available at www.hospitalmedicine.org

“SHM provides valuable resources that are being regularly updated for new hospitalists, hospitalist leaders and practicing hospitalists with the Core Competencies in Hospital Medicine as a framework,” Dr. McKean says. “There are new resource rooms coming out all the time, while the old ones are constantly updated. What I find most valuable is the quality improvement primer, a downloadable workbook which crosses all QI topics and gives physicians who have not had training in QI projects a framework to start their own … in their hospital.” TH

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

What are hospitalist leaders reading these days? What books, journals, and Web sites do they turn to—or recommend—for honing management skills, keeping up with industry trends, or generally staying sharp? In the January 2008 issue of The Hospitalist, four hospitalists in management positions shared their picks; here, three other leaders in the industry offer their “recommended reads.”

The President’s Picks

SHM President Patrick Cawley, MD, chief medical officer of the University of South Carolina Medical Center in Charleston, recommends a variety of resources for hospitalists in leadership positions and those who aspire to lead.

You're in Charge, Now What? The 8 Point Plan by Thomas J. Neff and James M. Citrin

“For any leader moving into a new position, this is an invaluable guide for the first six months,” Dr. Cawley says. “It was originally written for CEOs, but it works for any leadership role. Every time I have taken on a new leadership position, I have re-read it and learned something new.”

Competitive Advantage by Michael E. Porter

“This business reference classic details the underpinnings of today’s MBA programs,” Dr. Cawley explains. “The concepts of competitive advantage, value creation, and value chain are absolutes to anyone involved in strategic planning, and certainly for any hospitalist program which requires financial support.”

A Sense of Urgency by John P. Kotter

The newest book by a leading expert in change management, this book focuses on the first step of successful change. “All hospitalists who are interested in improving quality must understand the difference between false urgency and true urgency, since it is key to knowing which events can be used to successfully drive change,” Dr. Cawley states.

Getting Things Done by David Allen

“I’m always on a quest for better personal organization and time management skills,” Dr. Cawley admits. “GTD is one such method. Combine the book with the Microsoft Outlook tips and you’ll never look back.”

Harvard Business Review

“This is one of the few magazines I read cover to cover each month—Harvard Business Review is the business community’s equivalent of the New England Journal of Medicine,” Dr. Cawley says.

Hardwiring Excellence by Quint Studer

“Many hospitals across the nation have engaged the Studer Group to help improve leadership accountability and performance,” Dr. Cawley explains. “This book is the hospital version of Good to Great.”

Dr. Cawley adds, “for something really different … .”

The Prince by Machiavelli and The Politics of Life: 25 Rules for Survival in a Brutal and Manipulative World by Craig Crawford

“For any hospitalist who is part of a larger organization, and certainly for any leader, politics are a constant,” Dr. Cawley points out. “If you’re serious about understanding such motivations, you need to become not only a student of leadership, but one of politics, as well. The place to start is The Prince. Strive for the deeper understanding of Machiavelli and not the often quoted ‘ends justifies the means’ superficiality. Crawford’s book is the modern equivalent.”

A Pediatric Hospitalist Recommends…

Jack Percelay, MD, MPH, FAAP, E.L.M.O. Pediatrics, New York, also serves on SHM’s board of directors. He recommends reading these five resources:

Getting to Yes: Negotiating Agreement Without Giving In by Roger Fisher and William L. Ury

Dr. Percelay calls this book required reading, saying, “This is not new—it’s a core requirement for hospital medicine group leaders, hospitalists, or anyone who needs to negotiate for themselves.”

Hospitalists: A Guide to Building and Sustaining a Successful Program by Joseph A. Miller, John Nelson, MD, and Winthrop F. Whitcomb, MD

“This is a tremendously useful resource, if you’re having problems with your administration—if the C-suite doesn’t really ‘get’ hospitalists,” Dr. Percelay says. “It helps readers understand the philosophy behind a highly successful hospital medicine program. If you were going to convert a hospital executive to hospital medicine with one book, this is the book to give them. It’s very useful to know about for this reason.”

Crucial Conversations: Tools for Talking When Stakes are High and Crucial Confrontations by Kerry Patterson, Joseph Grenny, Ron McMillan and Al Switzler

“These books are more advanced and are targeted for those interested in developing their conflict resolution and leadership skills,” Dr. Percelay says. “They were recommended on the SHM practice management list serve, and they’re for both your personal and your professional life. These are the most useful leadership books I have read this year.”

The Cincinnati Children’s Hospital Pediatric Grand Rounds available at www.cincinnatichildrens. org/ed/cme/streaming-media/library/pgr/default.htm

“This is a pediatrics resource. Cincinnati Children’s Hospital has all of its grand rounds on the Web,” Dr. Percelay says. “For someone like me, who works in a community hospital and doesn’t have access to the latest and greatest research, this site provides free access to cutting edge, high-quality presentations. Some are very relevant to pediatric hospital medicine, and some presentations even offer free continuing medical education. Other hospitals do this, as well, but the Cincinnati site is the most user-friendly site I’ve found.”

Teaching Tools

Sylvia Cheney McKean, MD, medical director, Brigham and Women’s Hospital/Faulkner Hospitalist Service in Boston and SHM board member, uses several resources for dual purposes: to find the latest clinical information and to enhance and support her teaching.

PubMed available at www.ncbi.nlm. nih.gov/pubmed

The U.S. National Library of Medicine and the National Institutes of Health administer the PubMed site, which includes more than 18 million citations from MEDLINE and other life science journals for biomedical articles dating back to the 1950s. The site includes links to full text articles and other related resources.

“I find that most of my reading is through PubMed,” Dr. McKean says. “I get the latest, most up-to-date information. ... I generally proceed by first framing the question that needs to be answered and then looking for the best evidence. The key thing is to ask the right questions.”

American College of Physicians’ Medical Knowledge Self-Assessment Program (MKSAP) is available at www.acponline.org/products_services/ mksap/14.

“I find the ACP’s MKSAP syllabus very helpful for teaching and remaining updated,” Dr. McKean explains. “People use this to study for their boards, but it’s very helpful to teach residents ... and for viewing clinical problems.”

The Journal of Hospital Medicine

“I look at each issue cover to cover,” Dr. McKean says, “because it’s the most relevant journal of any out there. It has new research, professional development articles, and articles based on the Core Competencies of Hospital Medicine.”

SHM online research rooms available at www.hospitalmedicine.org

“SHM provides valuable resources that are being regularly updated for new hospitalists, hospitalist leaders and practicing hospitalists with the Core Competencies in Hospital Medicine as a framework,” Dr. McKean says. “There are new resource rooms coming out all the time, while the old ones are constantly updated. What I find most valuable is the quality improvement primer, a downloadable workbook which crosses all QI topics and gives physicians who have not had training in QI projects a framework to start their own … in their hospital.” TH

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

What are hospitalist leaders reading these days? What books, journals, and Web sites do they turn to—or recommend—for honing management skills, keeping up with industry trends, or generally staying sharp? In the January 2008 issue of The Hospitalist, four hospitalists in management positions shared their picks; here, three other leaders in the industry offer their “recommended reads.”

The President’s Picks

SHM President Patrick Cawley, MD, chief medical officer of the University of South Carolina Medical Center in Charleston, recommends a variety of resources for hospitalists in leadership positions and those who aspire to lead.

You're in Charge, Now What? The 8 Point Plan by Thomas J. Neff and James M. Citrin

“For any leader moving into a new position, this is an invaluable guide for the first six months,” Dr. Cawley says. “It was originally written for CEOs, but it works for any leadership role. Every time I have taken on a new leadership position, I have re-read it and learned something new.”

Competitive Advantage by Michael E. Porter

“This business reference classic details the underpinnings of today’s MBA programs,” Dr. Cawley explains. “The concepts of competitive advantage, value creation, and value chain are absolutes to anyone involved in strategic planning, and certainly for any hospitalist program which requires financial support.”

A Sense of Urgency by John P. Kotter

The newest book by a leading expert in change management, this book focuses on the first step of successful change. “All hospitalists who are interested in improving quality must understand the difference between false urgency and true urgency, since it is key to knowing which events can be used to successfully drive change,” Dr. Cawley states.

Getting Things Done by David Allen

“I’m always on a quest for better personal organization and time management skills,” Dr. Cawley admits. “GTD is one such method. Combine the book with the Microsoft Outlook tips and you’ll never look back.”

Harvard Business Review

“This is one of the few magazines I read cover to cover each month—Harvard Business Review is the business community’s equivalent of the New England Journal of Medicine,” Dr. Cawley says.

Hardwiring Excellence by Quint Studer

“Many hospitals across the nation have engaged the Studer Group to help improve leadership accountability and performance,” Dr. Cawley explains. “This book is the hospital version of Good to Great.”

Dr. Cawley adds, “for something really different … .”

The Prince by Machiavelli and The Politics of Life: 25 Rules for Survival in a Brutal and Manipulative World by Craig Crawford

“For any hospitalist who is part of a larger organization, and certainly for any leader, politics are a constant,” Dr. Cawley points out. “If you’re serious about understanding such motivations, you need to become not only a student of leadership, but one of politics, as well. The place to start is The Prince. Strive for the deeper understanding of Machiavelli and not the often quoted ‘ends justifies the means’ superficiality. Crawford’s book is the modern equivalent.”

A Pediatric Hospitalist Recommends…

Jack Percelay, MD, MPH, FAAP, E.L.M.O. Pediatrics, New York, also serves on SHM’s board of directors. He recommends reading these five resources:

Getting to Yes: Negotiating Agreement Without Giving In by Roger Fisher and William L. Ury

Dr. Percelay calls this book required reading, saying, “This is not new—it’s a core requirement for hospital medicine group leaders, hospitalists, or anyone who needs to negotiate for themselves.”

Hospitalists: A Guide to Building and Sustaining a Successful Program by Joseph A. Miller, John Nelson, MD, and Winthrop F. Whitcomb, MD

“This is a tremendously useful resource, if you’re having problems with your administration—if the C-suite doesn’t really ‘get’ hospitalists,” Dr. Percelay says. “It helps readers understand the philosophy behind a highly successful hospital medicine program. If you were going to convert a hospital executive to hospital medicine with one book, this is the book to give them. It’s very useful to know about for this reason.”

Crucial Conversations: Tools for Talking When Stakes are High and Crucial Confrontations by Kerry Patterson, Joseph Grenny, Ron McMillan and Al Switzler

“These books are more advanced and are targeted for those interested in developing their conflict resolution and leadership skills,” Dr. Percelay says. “They were recommended on the SHM practice management list serve, and they’re for both your personal and your professional life. These are the most useful leadership books I have read this year.”

The Cincinnati Children’s Hospital Pediatric Grand Rounds available at www.cincinnatichildrens. org/ed/cme/streaming-media/library/pgr/default.htm

“This is a pediatrics resource. Cincinnati Children’s Hospital has all of its grand rounds on the Web,” Dr. Percelay says. “For someone like me, who works in a community hospital and doesn’t have access to the latest and greatest research, this site provides free access to cutting edge, high-quality presentations. Some are very relevant to pediatric hospital medicine, and some presentations even offer free continuing medical education. Other hospitals do this, as well, but the Cincinnati site is the most user-friendly site I’ve found.”

Teaching Tools

Sylvia Cheney McKean, MD, medical director, Brigham and Women’s Hospital/Faulkner Hospitalist Service in Boston and SHM board member, uses several resources for dual purposes: to find the latest clinical information and to enhance and support her teaching.

PubMed available at www.ncbi.nlm. nih.gov/pubmed

The U.S. National Library of Medicine and the National Institutes of Health administer the PubMed site, which includes more than 18 million citations from MEDLINE and other life science journals for biomedical articles dating back to the 1950s. The site includes links to full text articles and other related resources.

“I find that most of my reading is through PubMed,” Dr. McKean says. “I get the latest, most up-to-date information. ... I generally proceed by first framing the question that needs to be answered and then looking for the best evidence. The key thing is to ask the right questions.”

American College of Physicians’ Medical Knowledge Self-Assessment Program (MKSAP) is available at www.acponline.org/products_services/ mksap/14.

“I find the ACP’s MKSAP syllabus very helpful for teaching and remaining updated,” Dr. McKean explains. “People use this to study for their boards, but it’s very helpful to teach residents ... and for viewing clinical problems.”

The Journal of Hospital Medicine

“I look at each issue cover to cover,” Dr. McKean says, “because it’s the most relevant journal of any out there. It has new research, professional development articles, and articles based on the Core Competencies of Hospital Medicine.”

SHM online research rooms available at www.hospitalmedicine.org

“SHM provides valuable resources that are being regularly updated for new hospitalists, hospitalist leaders and practicing hospitalists with the Core Competencies in Hospital Medicine as a framework,” Dr. McKean says. “There are new resource rooms coming out all the time, while the old ones are constantly updated. What I find most valuable is the quality improvement primer, a downloadable workbook which crosses all QI topics and gives physicians who have not had training in QI projects a framework to start their own … in their hospital.” TH

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

Beginning January 1, 2009, your on-the-job behavior—and that of other healthcare providers—will be held to a new standard. New Joint Commission standards include a requirement for healthcare organizations to create a code of conduct outlining acceptable and unacceptable behaviors for healthcare professionals, and to implement a process for managing problematic behavior. The reason for this unusual step is the belief that disruptive or intimidating behavior by physicians, nurses, and other healthcare workers has a negative impact on the quality of care.

“I think the standard shows that the Joint Commission is interested in behaviors within hospitals and other healthcare organizations, and how that affects quality of care, safety and the patient experience,” says Russell L. Holman, MD, immediate past president of SHM and chief operating officer for Cogent Healthcare, Nashville, Tenn. “By highlighting this as an area to be included in reviews and standards, it causes organizations to look for their own policies on disruptive behaviors.”

Here is a closer look at the new standard and how it might impact hospital medicine.

Not Physicians Only

The Joint Commission standard addresses “the problem of behaviors that threaten the performance of the healthcare team,” mentioning unprofessional behavior, specifically “intimidating and disruptive behaviors.” To many, this seems to target physicians. “In a hospital, there is an unwritten hierarchy, with physicians at the top,” Dr. Holman points out. “As such, some feel that different standards are applied to physician behaviors. For example, if a nurse or a pharmacist uses obscene language, they may be terminated. If a physician does this, they may receive feedback that the language was inappropriate.”

However, the Sentinel Event Alert released by the Joint Commission in July states, “While most formal research centers on intimidating and disruptive behaviors among physicians and nurses, there is evidence that these behaviors occur among other healthcare professionals, such as pharmacists, therapists, and support staff, as well as among administrators.” The alert does not single out physicians or any other healthcare profession regarding bad behaviors.

“I think the Joint Commission has been very clear in its intent that the standard applies equally to physicians and non-physicians,” Dr. Holman says.

When Hospitalists Cross the Line

How will this code of conduct standard affect hospitalists? Because of the nature of their work, they will be held to the standards of any hospital they work in. In the case of hospitalists who are directly employed by a hospital, the response should be straightforward. However, independent hospital medicine groups will have to work with their hospitals on behavior issues. First, these groups will need to decide whether they should have their own policies and procedures for code of conduct. “Hospital medicine groups need appropriate systems of identifying disruptive behavior, monitoring it, and taking any necessary actions to make sure the behavior is not continued,” Dr. Holman stresses.

Second, independent groups must communicate closely with the hospital when a behavior issue arises. “If you have a hospitalist who is not directly employed by the hospital, there is a dual responsibility for managing their disruptive behavior,” Dr. Holman says. “The hospital has medical staff standards, which are reflected in the medical staff bylaws and rules and regulations. These documents need to include policy and procedures around the incidence of disruptive physician behavior.”

But just because procedures are in place doesn’t mean the hospital will address a problem hospitalist. “This is where in practice, things can get a little fuzzy,” Dr. Holman admits. “The hospital may defer the responsibility for managing the physician to the employer. This is the scenario that has come up in hospital medicine.” He adds, “In my personal opinion, there is a dual responsibility. The hospital needs to apply its standard to all medical staff, regardless of specialty, tenure or employment status.” At the same time, the hospital medicine group/employer should have—and should implement—an approach to managing disruptive behavior.

“Different employers will have different capabilities,” Dr. Holman says. “For example, large, multi-specialty medical groups may have an infrastructure, including human resources professionals, risk managers and depth of medical and operational management, in place for dealing with disruptive behavior. … Small practices won’t have this. They may rely more heavily on the hospital’s infrastructure.”

Regardless of the hospital medicine group’s size and capabilities, it should promote two-way communication with the hospital regarding problems with individual hospitalists. “If an incident occurs in the hospital, the employer needs to know the details so they can follow up,” Dr. Holman says. “They have to be careful about sharing appropriate information, and protect all privacies. And they have to balance this communication with the fact that it doesn’t absolve one or the other from acting. There must be follow through from both parties, including disciplinary or corrective action as necessary.”

Defining “Disruptive”

One concern healthcare leaders—and the people they lead—may have is deciding the standard used in crafting a policy that specifies what types of behavior are unprofessional. “The challenge is defining disruptive behavior,” Dr. Holman says. “Of course, it can be very clear sometimes. But a surgeon throwing instruments in the operating room is different than someone who is a little bit outspoken.” Consider a hospitalist or other physician who’s in the habit of questioning authority; could this requirement lead to efforts to shut them down?

“Naturally, there is a degree of concern amongst physicians that this is a physician-directed standard, and that there may be a tough time distinguishing between the good faith criticisms of outspoken physicians and those who demonstrate physically threatening behavior,” Dr. Holman says.

The best way for hospitals, hospital medicine groups and other healthcare organizations to avoid this is to find established policies on this subject that are fair, carefully phrased and comprehensive, then customize one or more to their own specifications and distribute to all affected employees.

“I think these policies are nice to include in new physician orientations or training programs, so that physicians are aware of them,” Dr. Holman suggests.

For more information on the code of conduct standard, visit www.jointcommis-sion.org/SentinelEvents/SentinelEventAlert/sea_40.htm. TH

Jane Jerrard is a medical writer based in Chicago.

Beginning January 1, 2009, your on-the-job behavior—and that of other healthcare providers—will be held to a new standard. New Joint Commission standards include a requirement for healthcare organizations to create a code of conduct outlining acceptable and unacceptable behaviors for healthcare professionals, and to implement a process for managing problematic behavior. The reason for this unusual step is the belief that disruptive or intimidating behavior by physicians, nurses, and other healthcare workers has a negative impact on the quality of care.

“I think the standard shows that the Joint Commission is interested in behaviors within hospitals and other healthcare organizations, and how that affects quality of care, safety and the patient experience,” says Russell L. Holman, MD, immediate past president of SHM and chief operating officer for Cogent Healthcare, Nashville, Tenn. “By highlighting this as an area to be included in reviews and standards, it causes organizations to look for their own policies on disruptive behaviors.”

Here is a closer look at the new standard and how it might impact hospital medicine.

Not Physicians Only

The Joint Commission standard addresses “the problem of behaviors that threaten the performance of the healthcare team,” mentioning unprofessional behavior, specifically “intimidating and disruptive behaviors.” To many, this seems to target physicians. “In a hospital, there is an unwritten hierarchy, with physicians at the top,” Dr. Holman points out. “As such, some feel that different standards are applied to physician behaviors. For example, if a nurse or a pharmacist uses obscene language, they may be terminated. If a physician does this, they may receive feedback that the language was inappropriate.”

However, the Sentinel Event Alert released by the Joint Commission in July states, “While most formal research centers on intimidating and disruptive behaviors among physicians and nurses, there is evidence that these behaviors occur among other healthcare professionals, such as pharmacists, therapists, and support staff, as well as among administrators.” The alert does not single out physicians or any other healthcare profession regarding bad behaviors.

“I think the Joint Commission has been very clear in its intent that the standard applies equally to physicians and non-physicians,” Dr. Holman says.

When Hospitalists Cross the Line

How will this code of conduct standard affect hospitalists? Because of the nature of their work, they will be held to the standards of any hospital they work in. In the case of hospitalists who are directly employed by a hospital, the response should be straightforward. However, independent hospital medicine groups will have to work with their hospitals on behavior issues. First, these groups will need to decide whether they should have their own policies and procedures for code of conduct. “Hospital medicine groups need appropriate systems of identifying disruptive behavior, monitoring it, and taking any necessary actions to make sure the behavior is not continued,” Dr. Holman stresses.

Second, independent groups must communicate closely with the hospital when a behavior issue arises. “If you have a hospitalist who is not directly employed by the hospital, there is a dual responsibility for managing their disruptive behavior,” Dr. Holman says. “The hospital has medical staff standards, which are reflected in the medical staff bylaws and rules and regulations. These documents need to include policy and procedures around the incidence of disruptive physician behavior.”

But just because procedures are in place doesn’t mean the hospital will address a problem hospitalist. “This is where in practice, things can get a little fuzzy,” Dr. Holman admits. “The hospital may defer the responsibility for managing the physician to the employer. This is the scenario that has come up in hospital medicine.” He adds, “In my personal opinion, there is a dual responsibility. The hospital needs to apply its standard to all medical staff, regardless of specialty, tenure or employment status.” At the same time, the hospital medicine group/employer should have—and should implement—an approach to managing disruptive behavior.

“Different employers will have different capabilities,” Dr. Holman says. “For example, large, multi-specialty medical groups may have an infrastructure, including human resources professionals, risk managers and depth of medical and operational management, in place for dealing with disruptive behavior. … Small practices won’t have this. They may rely more heavily on the hospital’s infrastructure.”

Regardless of the hospital medicine group’s size and capabilities, it should promote two-way communication with the hospital regarding problems with individual hospitalists. “If an incident occurs in the hospital, the employer needs to know the details so they can follow up,” Dr. Holman says. “They have to be careful about sharing appropriate information, and protect all privacies. And they have to balance this communication with the fact that it doesn’t absolve one or the other from acting. There must be follow through from both parties, including disciplinary or corrective action as necessary.”

Defining “Disruptive”

One concern healthcare leaders—and the people they lead—may have is deciding the standard used in crafting a policy that specifies what types of behavior are unprofessional. “The challenge is defining disruptive behavior,” Dr. Holman says. “Of course, it can be very clear sometimes. But a surgeon throwing instruments in the operating room is different than someone who is a little bit outspoken.” Consider a hospitalist or other physician who’s in the habit of questioning authority; could this requirement lead to efforts to shut them down?

“Naturally, there is a degree of concern amongst physicians that this is a physician-directed standard, and that there may be a tough time distinguishing between the good faith criticisms of outspoken physicians and those who demonstrate physically threatening behavior,” Dr. Holman says.

The best way for hospitals, hospital medicine groups and other healthcare organizations to avoid this is to find established policies on this subject that are fair, carefully phrased and comprehensive, then customize one or more to their own specifications and distribute to all affected employees.

“I think these policies are nice to include in new physician orientations or training programs, so that physicians are aware of them,” Dr. Holman suggests.

For more information on the code of conduct standard, visit www.jointcommis-sion.org/SentinelEvents/SentinelEventAlert/sea_40.htm. TH

Jane Jerrard is a medical writer based in Chicago.

Beginning January 1, 2009, your on-the-job behavior—and that of other healthcare providers—will be held to a new standard. New Joint Commission standards include a requirement for healthcare organizations to create a code of conduct outlining acceptable and unacceptable behaviors for healthcare professionals, and to implement a process for managing problematic behavior. The reason for this unusual step is the belief that disruptive or intimidating behavior by physicians, nurses, and other healthcare workers has a negative impact on the quality of care.

“I think the standard shows that the Joint Commission is interested in behaviors within hospitals and other healthcare organizations, and how that affects quality of care, safety and the patient experience,” says Russell L. Holman, MD, immediate past president of SHM and chief operating officer for Cogent Healthcare, Nashville, Tenn. “By highlighting this as an area to be included in reviews and standards, it causes organizations to look for their own policies on disruptive behaviors.”

Here is a closer look at the new standard and how it might impact hospital medicine.

Not Physicians Only

The Joint Commission standard addresses “the problem of behaviors that threaten the performance of the healthcare team,” mentioning unprofessional behavior, specifically “intimidating and disruptive behaviors.” To many, this seems to target physicians. “In a hospital, there is an unwritten hierarchy, with physicians at the top,” Dr. Holman points out. “As such, some feel that different standards are applied to physician behaviors. For example, if a nurse or a pharmacist uses obscene language, they may be terminated. If a physician does this, they may receive feedback that the language was inappropriate.”

However, the Sentinel Event Alert released by the Joint Commission in July states, “While most formal research centers on intimidating and disruptive behaviors among physicians and nurses, there is evidence that these behaviors occur among other healthcare professionals, such as pharmacists, therapists, and support staff, as well as among administrators.” The alert does not single out physicians or any other healthcare profession regarding bad behaviors.

“I think the Joint Commission has been very clear in its intent that the standard applies equally to physicians and non-physicians,” Dr. Holman says.

When Hospitalists Cross the Line

How will this code of conduct standard affect hospitalists? Because of the nature of their work, they will be held to the standards of any hospital they work in. In the case of hospitalists who are directly employed by a hospital, the response should be straightforward. However, independent hospital medicine groups will have to work with their hospitals on behavior issues. First, these groups will need to decide whether they should have their own policies and procedures for code of conduct. “Hospital medicine groups need appropriate systems of identifying disruptive behavior, monitoring it, and taking any necessary actions to make sure the behavior is not continued,” Dr. Holman stresses.

Second, independent groups must communicate closely with the hospital when a behavior issue arises. “If you have a hospitalist who is not directly employed by the hospital, there is a dual responsibility for managing their disruptive behavior,” Dr. Holman says. “The hospital has medical staff standards, which are reflected in the medical staff bylaws and rules and regulations. These documents need to include policy and procedures around the incidence of disruptive physician behavior.”

But just because procedures are in place doesn’t mean the hospital will address a problem hospitalist. “This is where in practice, things can get a little fuzzy,” Dr. Holman admits. “The hospital may defer the responsibility for managing the physician to the employer. This is the scenario that has come up in hospital medicine.” He adds, “In my personal opinion, there is a dual responsibility. The hospital needs to apply its standard to all medical staff, regardless of specialty, tenure or employment status.” At the same time, the hospital medicine group/employer should have—and should implement—an approach to managing disruptive behavior.

“Different employers will have different capabilities,” Dr. Holman says. “For example, large, multi-specialty medical groups may have an infrastructure, including human resources professionals, risk managers and depth of medical and operational management, in place for dealing with disruptive behavior. … Small practices won’t have this. They may rely more heavily on the hospital’s infrastructure.”

Regardless of the hospital medicine group’s size and capabilities, it should promote two-way communication with the hospital regarding problems with individual hospitalists. “If an incident occurs in the hospital, the employer needs to know the details so they can follow up,” Dr. Holman says. “They have to be careful about sharing appropriate information, and protect all privacies. And they have to balance this communication with the fact that it doesn’t absolve one or the other from acting. There must be follow through from both parties, including disciplinary or corrective action as necessary.”

Defining “Disruptive”

One concern healthcare leaders—and the people they lead—may have is deciding the standard used in crafting a policy that specifies what types of behavior are unprofessional. “The challenge is defining disruptive behavior,” Dr. Holman says. “Of course, it can be very clear sometimes. But a surgeon throwing instruments in the operating room is different than someone who is a little bit outspoken.” Consider a hospitalist or other physician who’s in the habit of questioning authority; could this requirement lead to efforts to shut them down?

“Naturally, there is a degree of concern amongst physicians that this is a physician-directed standard, and that there may be a tough time distinguishing between the good faith criticisms of outspoken physicians and those who demonstrate physically threatening behavior,” Dr. Holman says.

The best way for hospitals, hospital medicine groups and other healthcare organizations to avoid this is to find established policies on this subject that are fair, carefully phrased and comprehensive, then customize one or more to their own specifications and distribute to all affected employees.

“I think these policies are nice to include in new physician orientations or training programs, so that physicians are aware of them,” Dr. Holman suggests.

For more information on the code of conduct standard, visit www.jointcommis-sion.org/SentinelEvents/SentinelEventAlert/sea_40.htm. TH

Jane Jerrard is a medical writer based in Chicago.

Hospitalists setting out on their careers are used to life as struggling students. Once they start earning a sizeable salary, they’re hit with some tough choices: How fast should they pay off medical school loans? Can they afford to give in to the temptation of an expensive reward? How much savings do they really need?

“It is a bit of a shock to start your first job as an attending physician,” says Margaret C. Fang, MD, MPH, assistant adjunct professor of medicine at the University of California Hospital Medicine Group. “Your bank account seems to grow so much faster!” No matter how big that account may seem, it can dwindle away every month if you don’t practice good money management skills.

Sameer Badlani, MD, hospitalist and instructor at the University of Chicago, is faculty advisor to a medical student interest group at his university called Money and Medicine. “It’s all about delayed gratification,” he says of the effect a physician’s salary has on a new hospitalist. “I say, just wait one year in your new job to see what your expenses are before you buy that big house or that expensive convertible.”

Do Your Research

Residents and early career hospitalists—and anyone who is having trouble saving some salary—would do well to tackle the subject of money management as if it were a clinical course. “What you do with your money deserves a lot of attention,” Dr. Fang says. “Vigilance about finances is important, but many physicians are not as prepared to deal with money management as they are to care for patients.”

When you’re about to start a job, find out the financial options before you’re faced with a mountain of forms and a heap of decisions. “When I started here, I had all this paperwork: I had to sign up for health insurance, disability, long-term disability, 401(k) and 403(b) plans, and more. It’s really daunting,” Dr. Fang says. “A little upfront research is important, so you can make good decisions about these things.”

When it comes to figuring out how much to contribute to retirement accounts, savings accounts and investments, consider enlisting some outside help. “Many institutions that hire young hospitalists offer financial counseling,” Dr. Fang points out. “I’ve done a lot of independent reading. But if your finances are more challenging—say you’re carrying a lot of debt—it’s reasonable to work with a financial consultant.”

Deal with Debt

Before you start investing your money, take a look at your debt. What to do with it—for instance, should you pay off all of your loans and bills—will be one of the most important decisions a new hospitalist will make.

“The first thing you should do is clear any credit card debt, because it carries such high interest rates,” Dr. Badlani advises. “Do this before investing in a Roth IRA or anything.”

As for student loans, “I recommend taking your time paying off fixed APR loans and federally subsidized loans,” Dr. Badlani says “These typically carry low interest and they are tax deductible. You’re better off investing your money in indexed mutual funds because the stock market averages an 8% to 10% return (long-term), versus loans that are maybe 6% interest, or 4% when you calculate the tax deduction.”

However, if your student loan comes from a private bank, it may carry a higher interest rate and variable APRs. In this case, says Dr. Badlani, “you need to pay off those loans first” or look into consolidating or refinancing high-interest student loans.

Build Your Savings

Once you’ve cleared or reduced any high-interest debt, it’s time to focus on saving some money—no matter how much you’re making. “Residents say they have no money to save,” Dr. Badlani says. “But you need to look at your lifestyle and look for what is called ‘the latte factor.’ If you work hard, you may feel you deserve a treat, so you buy a $4 latte every day—maybe two a day. If you work 27 days a month, this adds up to $200 a month or nearly $3,000 a year. If you put that money in your Roth IRA every year of your residency and your fellowship, that adds up to a cool $150,000—based on 8% to 9% annual return, compounded annually for 30 years and adjusted for investment fees.”

Starting a money market account or putting money in a certificate of deposit (CD) will keep it liquid. “You should have three to six months’ expenses, in case you lose your job or get sick,” Dr. Badlani says. “But be sure to put this ‘cushion money’ in a money market account, which these days are typically returning 3.5% APR versus regular checking accounts that offer a measly .25%, to offset inflation eating into your savings.”

Invest Early for Retirement

Residents and low-income hospitalists are in an excellent position to start investing for retirement. “While you’re a resident or intern, you most likely qualify for a Roth IRA,” Dr. Badlani explains. “This is the only time you’ll be able to invest in this. It’s a good choice for people with potential for increasing their income. Roth contributions are made after taxes and the account grows tax-free; you never have to pay tax on that money in retirement. For 2008, you’re eligible to contribute to a Roth IRA if you’re single or file as head of household with a modified adjusted gross income of below $114,000, or if you file jointly with income below $166,000.”

Another smart retirement investment for just about any hospitalist is employer-matched contributions. “If your employer will match your [retirement] contribution, that’s free money,” Dr. Badlani points out. “If you’re not taking advantage of that, you’re making a big mistake. Institutions will typically match up to about 5% of an employee’s contribution to a 401(k) or 403(b). Plus, by putting money in a retirement account, you’re reducing your tax burden.”

Online calculators can help you figure out how much to save—including matching funds—for a comfortable retirement. “The $1 million retirement has been the American dream for a long time, but that’s increased now to $1.5 to $1.8 million,” Dr. Badlani says. “But for a comfortable lifestyle and accounting for spiraling healthcare costs, I would recommend aiming for $5 million. That takes a lot of discipline over a long stretch of time.” He recommends the online calculator at www.dinkytown.net, which shows that a 29-year-old earning an annual income of $150,000 can retire at 65 with $5,868,264—if he or she contributes 15% to a 403(b) retirement account with a 5% employer match. “But you have to stick to this every month for the next 36 years,” Dr. Badlani warns. “That takes discipline.”

Regardless of how old you are or how much income you currently have, it’s wise to start practicing smart habits with spending, saving and investing your money. As Dr. Badlani says, “Good money habits last forever.” TH

Jane Jerrard also writes “Public Policy” for The Hospitalist.

Hospitalists setting out on their careers are used to life as struggling students. Once they start earning a sizeable salary, they’re hit with some tough choices: How fast should they pay off medical school loans? Can they afford to give in to the temptation of an expensive reward? How much savings do they really need?

“It is a bit of a shock to start your first job as an attending physician,” says Margaret C. Fang, MD, MPH, assistant adjunct professor of medicine at the University of California Hospital Medicine Group. “Your bank account seems to grow so much faster!” No matter how big that account may seem, it can dwindle away every month if you don’t practice good money management skills.

Sameer Badlani, MD, hospitalist and instructor at the University of Chicago, is faculty advisor to a medical student interest group at his university called Money and Medicine. “It’s all about delayed gratification,” he says of the effect a physician’s salary has on a new hospitalist. “I say, just wait one year in your new job to see what your expenses are before you buy that big house or that expensive convertible.”

Do Your Research

Residents and early career hospitalists—and anyone who is having trouble saving some salary—would do well to tackle the subject of money management as if it were a clinical course. “What you do with your money deserves a lot of attention,” Dr. Fang says. “Vigilance about finances is important, but many physicians are not as prepared to deal with money management as they are to care for patients.”

When you’re about to start a job, find out the financial options before you’re faced with a mountain of forms and a heap of decisions. “When I started here, I had all this paperwork: I had to sign up for health insurance, disability, long-term disability, 401(k) and 403(b) plans, and more. It’s really daunting,” Dr. Fang says. “A little upfront research is important, so you can make good decisions about these things.”

When it comes to figuring out how much to contribute to retirement accounts, savings accounts and investments, consider enlisting some outside help. “Many institutions that hire young hospitalists offer financial counseling,” Dr. Fang points out. “I’ve done a lot of independent reading. But if your finances are more challenging—say you’re carrying a lot of debt—it’s reasonable to work with a financial consultant.”

Deal with Debt

Before you start investing your money, take a look at your debt. What to do with it—for instance, should you pay off all of your loans and bills—will be one of the most important decisions a new hospitalist will make.

“The first thing you should do is clear any credit card debt, because it carries such high interest rates,” Dr. Badlani advises. “Do this before investing in a Roth IRA or anything.”

As for student loans, “I recommend taking your time paying off fixed APR loans and federally subsidized loans,” Dr. Badlani says “These typically carry low interest and they are tax deductible. You’re better off investing your money in indexed mutual funds because the stock market averages an 8% to 10% return (long-term), versus loans that are maybe 6% interest, or 4% when you calculate the tax deduction.”

However, if your student loan comes from a private bank, it may carry a higher interest rate and variable APRs. In this case, says Dr. Badlani, “you need to pay off those loans first” or look into consolidating or refinancing high-interest student loans.

Build Your Savings

Once you’ve cleared or reduced any high-interest debt, it’s time to focus on saving some money—no matter how much you’re making. “Residents say they have no money to save,” Dr. Badlani says. “But you need to look at your lifestyle and look for what is called ‘the latte factor.’ If you work hard, you may feel you deserve a treat, so you buy a $4 latte every day—maybe two a day. If you work 27 days a month, this adds up to $200 a month or nearly $3,000 a year. If you put that money in your Roth IRA every year of your residency and your fellowship, that adds up to a cool $150,000—based on 8% to 9% annual return, compounded annually for 30 years and adjusted for investment fees.”

Starting a money market account or putting money in a certificate of deposit (CD) will keep it liquid. “You should have three to six months’ expenses, in case you lose your job or get sick,” Dr. Badlani says. “But be sure to put this ‘cushion money’ in a money market account, which these days are typically returning 3.5% APR versus regular checking accounts that offer a measly .25%, to offset inflation eating into your savings.”

Invest Early for Retirement

Residents and low-income hospitalists are in an excellent position to start investing for retirement. “While you’re a resident or intern, you most likely qualify for a Roth IRA,” Dr. Badlani explains. “This is the only time you’ll be able to invest in this. It’s a good choice for people with potential for increasing their income. Roth contributions are made after taxes and the account grows tax-free; you never have to pay tax on that money in retirement. For 2008, you’re eligible to contribute to a Roth IRA if you’re single or file as head of household with a modified adjusted gross income of below $114,000, or if you file jointly with income below $166,000.”

Another smart retirement investment for just about any hospitalist is employer-matched contributions. “If your employer will match your [retirement] contribution, that’s free money,” Dr. Badlani points out. “If you’re not taking advantage of that, you’re making a big mistake. Institutions will typically match up to about 5% of an employee’s contribution to a 401(k) or 403(b). Plus, by putting money in a retirement account, you’re reducing your tax burden.”

Online calculators can help you figure out how much to save—including matching funds—for a comfortable retirement. “The $1 million retirement has been the American dream for a long time, but that’s increased now to $1.5 to $1.8 million,” Dr. Badlani says. “But for a comfortable lifestyle and accounting for spiraling healthcare costs, I would recommend aiming for $5 million. That takes a lot of discipline over a long stretch of time.” He recommends the online calculator at www.dinkytown.net, which shows that a 29-year-old earning an annual income of $150,000 can retire at 65 with $5,868,264—if he or she contributes 15% to a 403(b) retirement account with a 5% employer match. “But you have to stick to this every month for the next 36 years,” Dr. Badlani warns. “That takes discipline.”

Regardless of how old you are or how much income you currently have, it’s wise to start practicing smart habits with spending, saving and investing your money. As Dr. Badlani says, “Good money habits last forever.” TH

Jane Jerrard also writes “Public Policy” for The Hospitalist.

Hospitalists setting out on their careers are used to life as struggling students. Once they start earning a sizeable salary, they’re hit with some tough choices: How fast should they pay off medical school loans? Can they afford to give in to the temptation of an expensive reward? How much savings do they really need?

“It is a bit of a shock to start your first job as an attending physician,” says Margaret C. Fang, MD, MPH, assistant adjunct professor of medicine at the University of California Hospital Medicine Group. “Your bank account seems to grow so much faster!” No matter how big that account may seem, it can dwindle away every month if you don’t practice good money management skills.

Sameer Badlani, MD, hospitalist and instructor at the University of Chicago, is faculty advisor to a medical student interest group at his university called Money and Medicine. “It’s all about delayed gratification,” he says of the effect a physician’s salary has on a new hospitalist. “I say, just wait one year in your new job to see what your expenses are before you buy that big house or that expensive convertible.”

Do Your Research

Residents and early career hospitalists—and anyone who is having trouble saving some salary—would do well to tackle the subject of money management as if it were a clinical course. “What you do with your money deserves a lot of attention,” Dr. Fang says. “Vigilance about finances is important, but many physicians are not as prepared to deal with money management as they are to care for patients.”

When you’re about to start a job, find out the financial options before you’re faced with a mountain of forms and a heap of decisions. “When I started here, I had all this paperwork: I had to sign up for health insurance, disability, long-term disability, 401(k) and 403(b) plans, and more. It’s really daunting,” Dr. Fang says. “A little upfront research is important, so you can make good decisions about these things.”

When it comes to figuring out how much to contribute to retirement accounts, savings accounts and investments, consider enlisting some outside help. “Many institutions that hire young hospitalists offer financial counseling,” Dr. Fang points out. “I’ve done a lot of independent reading. But if your finances are more challenging—say you’re carrying a lot of debt—it’s reasonable to work with a financial consultant.”

Deal with Debt

Before you start investing your money, take a look at your debt. What to do with it—for instance, should you pay off all of your loans and bills—will be one of the most important decisions a new hospitalist will make.

“The first thing you should do is clear any credit card debt, because it carries such high interest rates,” Dr. Badlani advises. “Do this before investing in a Roth IRA or anything.”

As for student loans, “I recommend taking your time paying off fixed APR loans and federally subsidized loans,” Dr. Badlani says “These typically carry low interest and they are tax deductible. You’re better off investing your money in indexed mutual funds because the stock market averages an 8% to 10% return (long-term), versus loans that are maybe 6% interest, or 4% when you calculate the tax deduction.”

However, if your student loan comes from a private bank, it may carry a higher interest rate and variable APRs. In this case, says Dr. Badlani, “you need to pay off those loans first” or look into consolidating or refinancing high-interest student loans.

Build Your Savings

Once you’ve cleared or reduced any high-interest debt, it’s time to focus on saving some money—no matter how much you’re making. “Residents say they have no money to save,” Dr. Badlani says. “But you need to look at your lifestyle and look for what is called ‘the latte factor.’ If you work hard, you may feel you deserve a treat, so you buy a $4 latte every day—maybe two a day. If you work 27 days a month, this adds up to $200 a month or nearly $3,000 a year. If you put that money in your Roth IRA every year of your residency and your fellowship, that adds up to a cool $150,000—based on 8% to 9% annual return, compounded annually for 30 years and adjusted for investment fees.”

Starting a money market account or putting money in a certificate of deposit (CD) will keep it liquid. “You should have three to six months’ expenses, in case you lose your job or get sick,” Dr. Badlani says. “But be sure to put this ‘cushion money’ in a money market account, which these days are typically returning 3.5% APR versus regular checking accounts that offer a measly .25%, to offset inflation eating into your savings.”

Invest Early for Retirement

Residents and low-income hospitalists are in an excellent position to start investing for retirement. “While you’re a resident or intern, you most likely qualify for a Roth IRA,” Dr. Badlani explains. “This is the only time you’ll be able to invest in this. It’s a good choice for people with potential for increasing their income. Roth contributions are made after taxes and the account grows tax-free; you never have to pay tax on that money in retirement. For 2008, you’re eligible to contribute to a Roth IRA if you’re single or file as head of household with a modified adjusted gross income of below $114,000, or if you file jointly with income below $166,000.”

Another smart retirement investment for just about any hospitalist is employer-matched contributions. “If your employer will match your [retirement] contribution, that’s free money,” Dr. Badlani points out. “If you’re not taking advantage of that, you’re making a big mistake. Institutions will typically match up to about 5% of an employee’s contribution to a 401(k) or 403(b). Plus, by putting money in a retirement account, you’re reducing your tax burden.”

Online calculators can help you figure out how much to save—including matching funds—for a comfortable retirement. “The $1 million retirement has been the American dream for a long time, but that’s increased now to $1.5 to $1.8 million,” Dr. Badlani says. “But for a comfortable lifestyle and accounting for spiraling healthcare costs, I would recommend aiming for $5 million. That takes a lot of discipline over a long stretch of time.” He recommends the online calculator at www.dinkytown.net, which shows that a 29-year-old earning an annual income of $150,000 can retire at 65 with $5,868,264—if he or she contributes 15% to a 403(b) retirement account with a 5% employer match. “But you have to stick to this every month for the next 36 years,” Dr. Badlani warns. “That takes discipline.”

Regardless of how old you are or how much income you currently have, it’s wise to start practicing smart habits with spending, saving and investing your money. As Dr. Badlani says, “Good money habits last forever.” TH

Jane Jerrard also writes “Public Policy” for The Hospitalist.

Congress made history in July when it passed legislation that makes Medicare’s voluntary pay-for-reporting program permanent.

The program, the Physician Quality Reporting Initiative, or PQRI, which began in 2007 as a six-month trial and was continued through 2008, rewards physicians who successfully report on specific applicable quality measures with a cash bonus. The new bill, the Medicare Improvement for Patients and Providers Act (MIPPA), extends the Centers for Medicare and Medicaid (CMS) program beyond 2010.

“PQRI is now a permanent program, even though the details have only been provided through 2010,” says Michael Rapp, MD, of the CMS Office of Clinical Standards and Quality.

Here, is a look at PQRI past, present, and future, from a hospitalist’s point of view.

Pay-for-Performance Pilot Proves Worthwhile

In August, CMS released statistics on that first pay-for-reporting period. During the trial, 101,138 physicians submitted a quality-data code. Of those, 70,207 reported on at least one measure, and 56,722 earned a bonus.

Asked about those numbers, 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, says: “I think the folks at Medicare were pleased with that level of participation. This data helped convince them that the program should be permanent.”

What to Expect in 2009

The PQRI for 2009 is subject to revisions until the 2009 Physician Fee Schedule Final Rule is published sometime around Nov. 1. (Find the latest information on CMS Web site at www.cms.hhs.gov/pqri.) A number of proposed enhancements make it attractive and important to physicians, Dr. Torcson says.

CMS proposed 175 quality measures for physicians to report on, and MIPPA boosts payment for successful reporting of data on those measures. For 2009 and 2010, physicians who participate in the PQRI can earn an incentive payment of 2% (up from 1.5%) of their total allowed charges for Physician Fee Schedule (PFS) covered professional services.

However, except for a bigger check from CMS, hospitalists who currently report may not see much difference next year. “Overall, for hospitalists, PQRI will look pretty similar to 2007 and 2008,” Dr. Torcson warns. “The bonus is going to increase and the measures will be the same. That means that all of the background and education that SHM has provided on PQRI reporting remains relevant.”

One addition for 2009 is the use of patient registries to avoid claims systems for certain outpatient measures. “I don’t see the registry-reporting option being available to hospitalists in the short term,” Dr. Torcson says, “but it’s worth watching for the future.”

Beginning in 2009 and continuing through the next four years, Medicare also will provide incentive payments to eligible professionals who are successful electronic prescribers. (See the “Public Policy” article on p. 15 of the September 2008 The Hospitalist.) The e-prescribing measure in the 2008 PQRI will be removed for next year and used wholesale for a separate pay-for-reporting initiative pending changes from the Department of Health & Human Services. Unfortunately, none of the 2008 coding specifications for e-prescribing are available for hospitalist reporting.

“A lot of [the PQRI] measures have been created from the perspective of the cottage-industry model of an office-based private practice,” Dr. Torcson explains. “This 2008 (e-prescribing) measure was geared for an office-based physician practice—and the unforeseen consequence of the measure is that it’s not inclusive of patients being discharged from the hospital.”

Where Hospital Medicine Fits

By now, hospitalists should be resigned to the idea that many measures in PQRI don’t apply to their patients. However, SHM continues to work toward more inclusion for hospital-based physicians, by commenting on proposed rules and participating in the National Quality Forum and the American Medical Association’s Physician Consortium for Performance Improvement.

“We have been advocating for including performance measures for care processes, including transitions of care,” Dr. Torcson says. “This will probably come into play more in 2010 than 2009.”

SHM also has submitted comments on the proposed e-prescribing measures. Dr. Torcson says the organization is lobbying to make e-prescribing applicable to all hospital-based physicians, including ER doctors, and for discharged patients. “We want the whole process to harmonize with a comprehensive and safe discharge process that includes medication reconciliation,” he says.

To Report or Not to Report?

Regardless of whether lobbying efforts succeed in making more reporting applicable to hospital medicine, should groups start reporting in 2009? “It’s going to be a tough decision,” Dr. Torcson admits. “There’s a pretty significant investment in time and infrastructure to set this up. For the groups I know, the return on investment was negative.” In other words, PQRI does not pay for itself in a hospital medicine setting.

He says any hospital medicine group that wants to report should have in place a computerized system, and be willing to start slowly. “I’m convinced that it’s going to take an electronic coding/documentation system, as well as designated support staff within the hospital medicine group to pull it off,” he says. “This almost requires a full-time person.”

Dr. Torcson recommends starting with the reporting of three or four measures. “If you’re using a manual process or a homegrown system,” he says, “then the fewer measures the better, in terms of doing PQRI right to reach the 80% threshold.”

If you’re interested in reporting under the 2009 PQRI, go to SHM’s Web site at www.hospitalmedicine.org/ and type “PQRI 2008” into the advanced search bar. The article, “Information on PQRI 2008,” from May 17, 2007, provides important details about the program, including which measures apply to hospitalists. TH

Jane Jerrard is a medical writer based in Chicago.

Congress made history in July when it passed legislation that makes Medicare’s voluntary pay-for-reporting program permanent.

The program, the Physician Quality Reporting Initiative, or PQRI, which began in 2007 as a six-month trial and was continued through 2008, rewards physicians who successfully report on specific applicable quality measures with a cash bonus. The new bill, the Medicare Improvement for Patients and Providers Act (MIPPA), extends the Centers for Medicare and Medicaid (CMS) program beyond 2010.

“PQRI is now a permanent program, even though the details have only been provided through 2010,” says Michael Rapp, MD, of the CMS Office of Clinical Standards and Quality.

Here, is a look at PQRI past, present, and future, from a hospitalist’s point of view.

Pay-for-Performance Pilot Proves Worthwhile

In August, CMS released statistics on that first pay-for-reporting period. During the trial, 101,138 physicians submitted a quality-data code. Of those, 70,207 reported on at least one measure, and 56,722 earned a bonus.

Asked about those numbers, 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, says: “I think the folks at Medicare were pleased with that level of participation. This data helped convince them that the program should be permanent.”

What to Expect in 2009

The PQRI for 2009 is subject to revisions until the 2009 Physician Fee Schedule Final Rule is published sometime around Nov. 1. (Find the latest information on CMS Web site at www.cms.hhs.gov/pqri.) A number of proposed enhancements make it attractive and important to physicians, Dr. Torcson says.

CMS proposed 175 quality measures for physicians to report on, and MIPPA boosts payment for successful reporting of data on those measures. For 2009 and 2010, physicians who participate in the PQRI can earn an incentive payment of 2% (up from 1.5%) of their total allowed charges for Physician Fee Schedule (PFS) covered professional services.

However, except for a bigger check from CMS, hospitalists who currently report may not see much difference next year. “Overall, for hospitalists, PQRI will look pretty similar to 2007 and 2008,” Dr. Torcson warns. “The bonus is going to increase and the measures will be the same. That means that all of the background and education that SHM has provided on PQRI reporting remains relevant.”

One addition for 2009 is the use of patient registries to avoid claims systems for certain outpatient measures. “I don’t see the registry-reporting option being available to hospitalists in the short term,” Dr. Torcson says, “but it’s worth watching for the future.”

Beginning in 2009 and continuing through the next four years, Medicare also will provide incentive payments to eligible professionals who are successful electronic prescribers. (See the “Public Policy” article on p. 15 of the September 2008 The Hospitalist.) The e-prescribing measure in the 2008 PQRI will be removed for next year and used wholesale for a separate pay-for-reporting initiative pending changes from the Department of Health & Human Services. Unfortunately, none of the 2008 coding specifications for e-prescribing are available for hospitalist reporting.

“A lot of [the PQRI] measures have been created from the perspective of the cottage-industry model of an office-based private practice,” Dr. Torcson explains. “This 2008 (e-prescribing) measure was geared for an office-based physician practice—and the unforeseen consequence of the measure is that it’s not inclusive of patients being discharged from the hospital.”

Where Hospital Medicine Fits

By now, hospitalists should be resigned to the idea that many measures in PQRI don’t apply to their patients. However, SHM continues to work toward more inclusion for hospital-based physicians, by commenting on proposed rules and participating in the National Quality Forum and the American Medical Association’s Physician Consortium for Performance Improvement.

“We have been advocating for including performance measures for care processes, including transitions of care,” Dr. Torcson says. “This will probably come into play more in 2010 than 2009.”

SHM also has submitted comments on the proposed e-prescribing measures. Dr. Torcson says the organization is lobbying to make e-prescribing applicable to all hospital-based physicians, including ER doctors, and for discharged patients. “We want the whole process to harmonize with a comprehensive and safe discharge process that includes medication reconciliation,” he says.

To Report or Not to Report?

Regardless of whether lobbying efforts succeed in making more reporting applicable to hospital medicine, should groups start reporting in 2009? “It’s going to be a tough decision,” Dr. Torcson admits. “There’s a pretty significant investment in time and infrastructure to set this up. For the groups I know, the return on investment was negative.” In other words, PQRI does not pay for itself in a hospital medicine setting.

He says any hospital medicine group that wants to report should have in place a computerized system, and be willing to start slowly. “I’m convinced that it’s going to take an electronic coding/documentation system, as well as designated support staff within the hospital medicine group to pull it off,” he says. “This almost requires a full-time person.”

Dr. Torcson recommends starting with the reporting of three or four measures. “If you’re using a manual process or a homegrown system,” he says, “then the fewer measures the better, in terms of doing PQRI right to reach the 80% threshold.”

If you’re interested in reporting under the 2009 PQRI, go to SHM’s Web site at www.hospitalmedicine.org/ and type “PQRI 2008” into the advanced search bar. The article, “Information on PQRI 2008,” from May 17, 2007, provides important details about the program, including which measures apply to hospitalists. TH

Jane Jerrard is a medical writer based in Chicago.

Congress made history in July when it passed legislation that makes Medicare’s voluntary pay-for-reporting program permanent.

The program, the Physician Quality Reporting Initiative, or PQRI, which began in 2007 as a six-month trial and was continued through 2008, rewards physicians who successfully report on specific applicable quality measures with a cash bonus. The new bill, the Medicare Improvement for Patients and Providers Act (MIPPA), extends the Centers for Medicare and Medicaid (CMS) program beyond 2010.

“PQRI is now a permanent program, even though the details have only been provided through 2010,” says Michael Rapp, MD, of the CMS Office of Clinical Standards and Quality.

Here, is a look at PQRI past, present, and future, from a hospitalist’s point of view.

Pay-for-Performance Pilot Proves Worthwhile

In August, CMS released statistics on that first pay-for-reporting period. During the trial, 101,138 physicians submitted a quality-data code. Of those, 70,207 reported on at least one measure, and 56,722 earned a bonus.

Asked about those numbers, 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, says: “I think the folks at Medicare were pleased with that level of participation. This data helped convince them that the program should be permanent.”

What to Expect in 2009

The PQRI for 2009 is subject to revisions until the 2009 Physician Fee Schedule Final Rule is published sometime around Nov. 1. (Find the latest information on CMS Web site at www.cms.hhs.gov/pqri.) A number of proposed enhancements make it attractive and important to physicians, Dr. Torcson says.

CMS proposed 175 quality measures for physicians to report on, and MIPPA boosts payment for successful reporting of data on those measures. For 2009 and 2010, physicians who participate in the PQRI can earn an incentive payment of 2% (up from 1.5%) of their total allowed charges for Physician Fee Schedule (PFS) covered professional services.

However, except for a bigger check from CMS, hospitalists who currently report may not see much difference next year. “Overall, for hospitalists, PQRI will look pretty similar to 2007 and 2008,” Dr. Torcson warns. “The bonus is going to increase and the measures will be the same. That means that all of the background and education that SHM has provided on PQRI reporting remains relevant.”

One addition for 2009 is the use of patient registries to avoid claims systems for certain outpatient measures. “I don’t see the registry-reporting option being available to hospitalists in the short term,” Dr. Torcson says, “but it’s worth watching for the future.”

Beginning in 2009 and continuing through the next four years, Medicare also will provide incentive payments to eligible professionals who are successful electronic prescribers. (See the “Public Policy” article on p. 15 of the September 2008 The Hospitalist.) The e-prescribing measure in the 2008 PQRI will be removed for next year and used wholesale for a separate pay-for-reporting initiative pending changes from the Department of Health & Human Services. Unfortunately, none of the 2008 coding specifications for e-prescribing are available for hospitalist reporting.

“A lot of [the PQRI] measures have been created from the perspective of the cottage-industry model of an office-based private practice,” Dr. Torcson explains. “This 2008 (e-prescribing) measure was geared for an office-based physician practice—and the unforeseen consequence of the measure is that it’s not inclusive of patients being discharged from the hospital.”

Where Hospital Medicine Fits

By now, hospitalists should be resigned to the idea that many measures in PQRI don’t apply to their patients. However, SHM continues to work toward more inclusion for hospital-based physicians, by commenting on proposed rules and participating in the National Quality Forum and the American Medical Association’s Physician Consortium for Performance Improvement.

“We have been advocating for including performance measures for care processes, including transitions of care,” Dr. Torcson says. “This will probably come into play more in 2010 than 2009.”

SHM also has submitted comments on the proposed e-prescribing measures. Dr. Torcson says the organization is lobbying to make e-prescribing applicable to all hospital-based physicians, including ER doctors, and for discharged patients. “We want the whole process to harmonize with a comprehensive and safe discharge process that includes medication reconciliation,” he says.

To Report or Not to Report?

Regardless of whether lobbying efforts succeed in making more reporting applicable to hospital medicine, should groups start reporting in 2009? “It’s going to be a tough decision,” Dr. Torcson admits. “There’s a pretty significant investment in time and infrastructure to set this up. For the groups I know, the return on investment was negative.” In other words, PQRI does not pay for itself in a hospital medicine setting.

He says any hospital medicine group that wants to report should have in place a computerized system, and be willing to start slowly. “I’m convinced that it’s going to take an electronic coding/documentation system, as well as designated support staff within the hospital medicine group to pull it off,” he says. “This almost requires a full-time person.”

Dr. Torcson recommends starting with the reporting of three or four measures. “If you’re using a manual process or a homegrown system,” he says, “then the fewer measures the better, in terms of doing PQRI right to reach the 80% threshold.”

If you’re interested in reporting under the 2009 PQRI, go to SHM’s Web site at www.hospitalmedicine.org/ and type “PQRI 2008” into the advanced search bar. The article, “Information on PQRI 2008,” from May 17, 2007, provides important details about the program, including which measures apply to hospitalists. TH

Jane Jerrard is a medical writer based in Chicago.

You’re unhappy with your workload or schedule.

Your spouse has been transferred to a different state.

You simply want a change of scenery.

Regardless of the reason, you’re looking for a new job. In hospital medicine, how and when is it appropriate to give notice? To maintain good relations with your current employer now and in the future, make sure you consider your departure from both sides of the desk.

Timing is Everything

Before you start skimming classified ads and phoning friends in the field to ask about job openings, consider how much time your employer needs to fill your position.

“When you’re thinking about leaving a group, you have to realize that the timing for getting your replacement is longer than you might think,” says Heather A. Harris, MD, a hospitalist who splits her time between the University of California, San Francisco and the Palo Alto Medical Foundation. “The traditional two-week notice in other jobs is tough for most [hospital medicine] groups to handle—unless it’s a really big group or already overstaffed, which is never the case.”

Dr. Harris, who hired many hospitalists when she was director of Eden Inpatient Services, Eden Medical Center, Castro Valley, Calif., recommends giving a minimum of two months notice. “That gives your group time to figure out what to do,” she says. “Otherwise, you’re putting the entire group in a bind.”

Other physicians suggest an even longer timeframe. “My preference would be that a hospitalist give me no less than six months notification,” says Fred A. McCurdy, MD, PhD, MBA, associate dean for faculty development, Texas Tech University Health Sciences Center at Amarillo. “That’s a best-case scenario for finding a replacement. It could take longer than that.”

The issue is workload for the doctors left behind: “The other hospitalists are going to have to cover the slack in the meantime,” Dr. Harris points out. “Keep that in mind when you’re giving notice; you’re putting everyone else in a position where they have to cover the work.”

A lengthy timeframe actually could dovetail with your own transition. “You’ll have to get credentialed at that new hospital,” Dr. Harris says. “It’s important to realize when you get that job offer that group might want you to start the next day, but you have to wait until the credentialing process is complete.” Depending on the hospital, that could take as long as three months.

It’s important to know the specifics of your new hospital’s credential process. “You don’t want to leave a job before you have the means to enter a new job,” Dr. McCurdy warns. “Make sure you understand when you can actually start the work.”

Meanwhile, your current employer will need time to move your replacement through the same process. “Some hospitals are slower than others,” Dr. Harris says, “but even if I have a hospitalist in mind who’s available to start right away, they won’t be able to step in until the hospital’s credentialing is complete.”

Speak Up

When you decide to leave a job, tell your immediate supervisor directly and be open about your job search. “Ideally, the person who is leaving would sit down with me and tell me their intention to leave, where they intend to go, and the circumstances of their leaving,” Dr. McCurdy says. “I don’t want to hear about it third hand or through the grapevine, and I don’t want to find out that it’s some sort of negotiating tactic.”

If you want a new job because you’re unhappy with the one you have, consider whether the issues causing your discontent can be rectified. Dr. McCurdy says he would make every effort to keep a hospitalist in his group. “Obviously, there are some things I can’t help with,” he says. “I can’t change the weather, I can’t change the school systems, but I might be able to help with work issues.”

Build Bridges, Don’t Burn Them

It should go without saying that once you officially give notice, you should make every effort to maintain good relations with your employer and colleagues, by continuing to do your job well and remaining an active, positive member of your group, Dr. Harris says. This is particularly important if you stay in the same geographic area.

“There is a lot of fluidity in hospital medicine; people move from place to place,” she says. “It’s a small community and people know each other.”

If you feel comfortable doing so, offer to help your old employer find your replacement. Dr. McCurdy asks departing physicians for this favor. “I’d ask if they know someone who would be a good fit here,” he says. “The hospitalist community is small and pretty cohesive, so they may know someone.” Helping fill your position is a great way to stay connected and to show your good will toward the group.

If your employer asks you to stay a few weeks longer than you planned, consider whether you can jockey your upcoming start date to accommodate the request—but not at the price of being unhappy or risking your new job. “I might try to get someone to stay on a bit longer, but I’m not going to twist their arm if they aren’t interested,” Dr. McCurdy says. “It’s better to be without a physician than to have a disgruntled one.”

When you decide to move on to a new job, remember that you have a long career ahead of you. Be thoughtful and professional about how and when you leave. This small consideration can help maintain your reputation and connections for years to come. TH

Jane Jerrard also writes “Public Policy” for The Hospitalist.

You’re unhappy with your workload or schedule.

Your spouse has been transferred to a different state.

You simply want a change of scenery.

Regardless of the reason, you’re looking for a new job. In hospital medicine, how and when is it appropriate to give notice? To maintain good relations with your current employer now and in the future, make sure you consider your departure from both sides of the desk.

Timing is Everything

Before you start skimming classified ads and phoning friends in the field to ask about job openings, consider how much time your employer needs to fill your position.

“When you’re thinking about leaving a group, you have to realize that the timing for getting your replacement is longer than you might think,” says Heather A. Harris, MD, a hospitalist who splits her time between the University of California, San Francisco and the Palo Alto Medical Foundation. “The traditional two-week notice in other jobs is tough for most [hospital medicine] groups to handle—unless it’s a really big group or already overstaffed, which is never the case.”

Dr. Harris, who hired many hospitalists when she was director of Eden Inpatient Services, Eden Medical Center, Castro Valley, Calif., recommends giving a minimum of two months notice. “That gives your group time to figure out what to do,” she says. “Otherwise, you’re putting the entire group in a bind.”

Other physicians suggest an even longer timeframe. “My preference would be that a hospitalist give me no less than six months notification,” says Fred A. McCurdy, MD, PhD, MBA, associate dean for faculty development, Texas Tech University Health Sciences Center at Amarillo. “That’s a best-case scenario for finding a replacement. It could take longer than that.”

The issue is workload for the doctors left behind: “The other hospitalists are going to have to cover the slack in the meantime,” Dr. Harris points out. “Keep that in mind when you’re giving notice; you’re putting everyone else in a position where they have to cover the work.”

A lengthy timeframe actually could dovetail with your own transition. “You’ll have to get credentialed at that new hospital,” Dr. Harris says. “It’s important to realize when you get that job offer that group might want you to start the next day, but you have to wait until the credentialing process is complete.” Depending on the hospital, that could take as long as three months.

It’s important to know the specifics of your new hospital’s credential process. “You don’t want to leave a job before you have the means to enter a new job,” Dr. McCurdy warns. “Make sure you understand when you can actually start the work.”

Meanwhile, your current employer will need time to move your replacement through the same process. “Some hospitals are slower than others,” Dr. Harris says, “but even if I have a hospitalist in mind who’s available to start right away, they won’t be able to step in until the hospital’s credentialing is complete.”

Speak Up

When you decide to leave a job, tell your immediate supervisor directly and be open about your job search. “Ideally, the person who is leaving would sit down with me and tell me their intention to leave, where they intend to go, and the circumstances of their leaving,” Dr. McCurdy says. “I don’t want to hear about it third hand or through the grapevine, and I don’t want to find out that it’s some sort of negotiating tactic.”

If you want a new job because you’re unhappy with the one you have, consider whether the issues causing your discontent can be rectified. Dr. McCurdy says he would make every effort to keep a hospitalist in his group. “Obviously, there are some things I can’t help with,” he says. “I can’t change the weather, I can’t change the school systems, but I might be able to help with work issues.”

Build Bridges, Don’t Burn Them

It should go without saying that once you officially give notice, you should make every effort to maintain good relations with your employer and colleagues, by continuing to do your job well and remaining an active, positive member of your group, Dr. Harris says. This is particularly important if you stay in the same geographic area.

“There is a lot of fluidity in hospital medicine; people move from place to place,” she says. “It’s a small community and people know each other.”

If you feel comfortable doing so, offer to help your old employer find your replacement. Dr. McCurdy asks departing physicians for this favor. “I’d ask if they know someone who would be a good fit here,” he says. “The hospitalist community is small and pretty cohesive, so they may know someone.” Helping fill your position is a great way to stay connected and to show your good will toward the group.

If your employer asks you to stay a few weeks longer than you planned, consider whether you can jockey your upcoming start date to accommodate the request—but not at the price of being unhappy or risking your new job. “I might try to get someone to stay on a bit longer, but I’m not going to twist their arm if they aren’t interested,” Dr. McCurdy says. “It’s better to be without a physician than to have a disgruntled one.”

When you decide to move on to a new job, remember that you have a long career ahead of you. Be thoughtful and professional about how and when you leave. This small consideration can help maintain your reputation and connections for years to come. TH

Jane Jerrard also writes “Public Policy” for The Hospitalist.

You’re unhappy with your workload or schedule.

Your spouse has been transferred to a different state.

You simply want a change of scenery.

Regardless of the reason, you’re looking for a new job. In hospital medicine, how and when is it appropriate to give notice? To maintain good relations with your current employer now and in the future, make sure you consider your departure from both sides of the desk.

Timing is Everything

Before you start skimming classified ads and phoning friends in the field to ask about job openings, consider how much time your employer needs to fill your position.

“When you’re thinking about leaving a group, you have to realize that the timing for getting your replacement is longer than you might think,” says Heather A. Harris, MD, a hospitalist who splits her time between the University of California, San Francisco and the Palo Alto Medical Foundation. “The traditional two-week notice in other jobs is tough for most [hospital medicine] groups to handle—unless it’s a really big group or already overstaffed, which is never the case.”

Dr. Harris, who hired many hospitalists when she was director of Eden Inpatient Services, Eden Medical Center, Castro Valley, Calif., recommends giving a minimum of two months notice. “That gives your group time to figure out what to do,” she says. “Otherwise, you’re putting the entire group in a bind.”

Other physicians suggest an even longer timeframe. “My preference would be that a hospitalist give me no less than six months notification,” says Fred A. McCurdy, MD, PhD, MBA, associate dean for faculty development, Texas Tech University Health Sciences Center at Amarillo. “That’s a best-case scenario for finding a replacement. It could take longer than that.”

The issue is workload for the doctors left behind: “The other hospitalists are going to have to cover the slack in the meantime,” Dr. Harris points out. “Keep that in mind when you’re giving notice; you’re putting everyone else in a position where they have to cover the work.”

A lengthy timeframe actually could dovetail with your own transition. “You’ll have to get credentialed at that new hospital,” Dr. Harris says. “It’s important to realize when you get that job offer that group might want you to start the next day, but you have to wait until the credentialing process is complete.” Depending on the hospital, that could take as long as three months.

It’s important to know the specifics of your new hospital’s credential process. “You don’t want to leave a job before you have the means to enter a new job,” Dr. McCurdy warns. “Make sure you understand when you can actually start the work.”

Meanwhile, your current employer will need time to move your replacement through the same process. “Some hospitals are slower than others,” Dr. Harris says, “but even if I have a hospitalist in mind who’s available to start right away, they won’t be able to step in until the hospital’s credentialing is complete.”

Speak Up

When you decide to leave a job, tell your immediate supervisor directly and be open about your job search. “Ideally, the person who is leaving would sit down with me and tell me their intention to leave, where they intend to go, and the circumstances of their leaving,” Dr. McCurdy says. “I don’t want to hear about it third hand or through the grapevine, and I don’t want to find out that it’s some sort of negotiating tactic.”

If you want a new job because you’re unhappy with the one you have, consider whether the issues causing your discontent can be rectified. Dr. McCurdy says he would make every effort to keep a hospitalist in his group. “Obviously, there are some things I can’t help with,” he says. “I can’t change the weather, I can’t change the school systems, but I might be able to help with work issues.”

Build Bridges, Don’t Burn Them

It should go without saying that once you officially give notice, you should make every effort to maintain good relations with your employer and colleagues, by continuing to do your job well and remaining an active, positive member of your group, Dr. Harris says. This is particularly important if you stay in the same geographic area.

“There is a lot of fluidity in hospital medicine; people move from place to place,” she says. “It’s a small community and people know each other.”

If you feel comfortable doing so, offer to help your old employer find your replacement. Dr. McCurdy asks departing physicians for this favor. “I’d ask if they know someone who would be a good fit here,” he says. “The hospitalist community is small and pretty cohesive, so they may know someone.” Helping fill your position is a great way to stay connected and to show your good will toward the group.

If your employer asks you to stay a few weeks longer than you planned, consider whether you can jockey your upcoming start date to accommodate the request—but not at the price of being unhappy or risking your new job. “I might try to get someone to stay on a bit longer, but I’m not going to twist their arm if they aren’t interested,” Dr. McCurdy says. “It’s better to be without a physician than to have a disgruntled one.”

When you decide to move on to a new job, remember that you have a long career ahead of you. Be thoughtful and professional about how and when you leave. This small consideration can help maintain your reputation and connections for years to come. TH

Jane Jerrard also writes “Public Policy” for The Hospitalist.

CMS has taken up the e-prescribing torch. In July, the agency announced a preliminary program to promote widespread adoption of electronic prescribing.

E-prescribing is a natural goal for CMS; it has been proven to improve quality of care, reduce medication errors, increase efficiency, and lower administrative costs. Kerry Weems, the acting CMS administrator, says an all-electronic prescribing system could save Medicare as much as $156 million over five years—largely through improved quality care.

Though details on the e-prescribing plan are not yet decided, CMS has revealed that beginning in 2009 (and for the next four years) it will provide incentive payments to physicians who are “successful electronic prescribers.”

Details to Be Determined

The e-prescribing plan will be included in the Physician Quality Reporting Initiative (PQRI), with guidelines included in the 2009 PQRI. (How the new plan will work with the current PQRI e-prescribing measure is one of the unknown details.)

Weems says CMS will use its standard rule-making process to shape the e-prescribing plan. Therefore, details of the incentives program will not be available until this fall, when Medicare releases its final rule on the 2009 physician fee schedule. According to Weems, the 2009 fee schedule and PQRI will clarify some murkiness. “They will be specific about what constitutes e-prescribing, including the extent and reporting of what needs to be done through PQRI,” he says.

Rewards, Then Possible Punishments

Physicians can start reporting on e-prescribing Jan. 1, and those who do will reap the benefits. Patrick Conway, MD, MSc, a hospitalist, an assistant professor at Cincinnati Children’s Hospital Medical Center, and a 2007-2008 White House Fellow working in the Department of Health and Human Services (HHS), says initial discussions about promoting e-prescribing included talk of an incentive-based plan.

“It’s my opinion that, for physicians, it’s beneficial to start with a reward or carrot rather than a punishment,” he says. “And generally, CMS has approached physician programs with this method—like the PQRI.”

The current plan’s outlines indicates that in 2009 and 2010, physicians who successfully report on e-prescribing will receive an incentive payment of up to 2% of their total Medicare allowed charges, matching the maximum bonus they can earn under the regular PQRI. Payment will be additive, so a physician can earn up to 4% (2% for PQRI and 2% for e-prescribing.)

The e-prescribing incentive will drop to 1% in 2011 and 2012, and to 0.5% incentive payment in 2013. After 2013, the carrot is replaced with a stick, and those who do not use e-prescribing will suffer a reduction in payment.

Cost Concerns

CMS estimates the cost of adopting e-prescribing will be approximately $3,000 per individual prescriber. This includes equipment, training, and program maintenance. That can add up to a sizeable expense—particularly for small groups. For that reason, the agency promises a built-in hardship exemption for small practices and others who prove they cannot afford to adopt e-prescribing.

Also, some funding is available: Dr. Conway says CMS has a financial-incentive program for electronic health records, many of which include e-prescribing. “The CMS Electronic Health Records Demonstration is a $150 million program that will provide funds to 1,200 physician practices to adopt this technology,” he says. “They’re currently recruiting practices.” Details on the demonstration are available at www.cms.hhs.gov/DemoProjectsEvalRpts/.

Will Hospitalists Participate?

Until details of the e-prescribing program are published, no one can say whether the plan will encompass hospitalists. However, Dr. Conway says, “I think this plan is conceptually relevant to hospitalists: It’s possible that hospitalists will be able to participate in the current plan. We don’t know yet. But CMS will continue to push forward on initiatives that increase quality and decrease costs, including e-prescribing. They’ll support electronic health records, whether this particular initiative applies to hospitals or not.”

Even if it turns out hospital medicine groups can’t reap incentive payments from the new plan, Dr. Conway hopes they still will adopt the technology. “Computerized physician order entry (CPOE) and e-prescribing have the potential to decrease errors and increase the quality of care,” he says. “Therefore, I would encourage hospitals and hospitalists to implement electronic health records with computerized order entry and e-prescribing when possible.”

He says the real benefit to hospitals seeking to improve quality and reduce error is not the electronic transmission of prescriptions to the pharmacy, but CPOE. “Most evidence of increased quality is around computerized physician order entry, which includes decision support at the time of the order,” he points out. “One could argue that you could have an incentive for hospitals that utilize CPOE, but I have no idea if CMS will pursue that.”

Next Steps

On Oct. 6-7 CMS will host a conference on the complete e-prescribing plan for pharmacists and physicians in Boston. For details, check the CMS site at www.cms.hhs.gov/eprescribing or www.cms.hhs.gov/pqri.

Dr. Conway thinks the meeting is a good next step for CMS. “I believe it’s very important to engage frontline providers and stakeholders, so the concept of holding a conference to ensure the design of the program is understood, and to get buy-in from the people participating, is a wise choice,” he says.

In the next few months, physicians likely will be inundated with information on e-prescribing processes under the CMS plan. Stay abreast of the latest information through the CMS Web site and, if it turns out, hospitalists can actively participate in the plan, through the SHM Web site at www.hospitalmedicine.org. TH

Jane Jerrard is a medical writer based in Chicago.

CMS has taken up the e-prescribing torch. In July, the agency announced a preliminary program to promote widespread adoption of electronic prescribing.

E-prescribing is a natural goal for CMS; it has been proven to improve quality of care, reduce medication errors, increase efficiency, and lower administrative costs. Kerry Weems, the acting CMS administrator, says an all-electronic prescribing system could save Medicare as much as $156 million over five years—largely through improved quality care.

Though details on the e-prescribing plan are not yet decided, CMS has revealed that beginning in 2009 (and for the next four years) it will provide incentive payments to physicians who are “successful electronic prescribers.”

Details to Be Determined

The e-prescribing plan will be included in the Physician Quality Reporting Initiative (PQRI), with guidelines included in the 2009 PQRI. (How the new plan will work with the current PQRI e-prescribing measure is one of the unknown details.)

Weems says CMS will use its standard rule-making process to shape the e-prescribing plan. Therefore, details of the incentives program will not be available until this fall, when Medicare releases its final rule on the 2009 physician fee schedule. According to Weems, the 2009 fee schedule and PQRI will clarify some murkiness. “They will be specific about what constitutes e-prescribing, including the extent and reporting of what needs to be done through PQRI,” he says.

Rewards, Then Possible Punishments

Physicians can start reporting on e-prescribing Jan. 1, and those who do will reap the benefits. Patrick Conway, MD, MSc, a hospitalist, an assistant professor at Cincinnati Children’s Hospital Medical Center, and a 2007-2008 White House Fellow working in the Department of Health and Human Services (HHS), says initial discussions about promoting e-prescribing included talk of an incentive-based plan.

“It’s my opinion that, for physicians, it’s beneficial to start with a reward or carrot rather than a punishment,” he says. “And generally, CMS has approached physician programs with this method—like the PQRI.”

The current plan’s outlines indicates that in 2009 and 2010, physicians who successfully report on e-prescribing will receive an incentive payment of up to 2% of their total Medicare allowed charges, matching the maximum bonus they can earn under the regular PQRI. Payment will be additive, so a physician can earn up to 4% (2% for PQRI and 2% for e-prescribing.)

The e-prescribing incentive will drop to 1% in 2011 and 2012, and to 0.5% incentive payment in 2013. After 2013, the carrot is replaced with a stick, and those who do not use e-prescribing will suffer a reduction in payment.

Cost Concerns

CMS estimates the cost of adopting e-prescribing will be approximately $3,000 per individual prescriber. This includes equipment, training, and program maintenance. That can add up to a sizeable expense—particularly for small groups. For that reason, the agency promises a built-in hardship exemption for small practices and others who prove they cannot afford to adopt e-prescribing.

Also, some funding is available: Dr. Conway says CMS has a financial-incentive program for electronic health records, many of which include e-prescribing. “The CMS Electronic Health Records Demonstration is a $150 million program that will provide funds to 1,200 physician practices to adopt this technology,” he says. “They’re currently recruiting practices.” Details on the demonstration are available at www.cms.hhs.gov/DemoProjectsEvalRpts/.

Will Hospitalists Participate?

Until details of the e-prescribing program are published, no one can say whether the plan will encompass hospitalists. However, Dr. Conway says, “I think this plan is conceptually relevant to hospitalists: It’s possible that hospitalists will be able to participate in the current plan. We don’t know yet. But CMS will continue to push forward on initiatives that increase quality and decrease costs, including e-prescribing. They’ll support electronic health records, whether this particular initiative applies to hospitals or not.”

Even if it turns out hospital medicine groups can’t reap incentive payments from the new plan, Dr. Conway hopes they still will adopt the technology. “Computerized physician order entry (CPOE) and e-prescribing have the potential to decrease errors and increase the quality of care,” he says. “Therefore, I would encourage hospitals and hospitalists to implement electronic health records with computerized order entry and e-prescribing when possible.”

He says the real benefit to hospitals seeking to improve quality and reduce error is not the electronic transmission of prescriptions to the pharmacy, but CPOE. “Most evidence of increased quality is around computerized physician order entry, which includes decision support at the time of the order,” he points out. “One could argue that you could have an incentive for hospitals that utilize CPOE, but I have no idea if CMS will pursue that.”

Next Steps

On Oct. 6-7 CMS will host a conference on the complete e-prescribing plan for pharmacists and physicians in Boston. For details, check the CMS site at www.cms.hhs.gov/eprescribing or www.cms.hhs.gov/pqri.

Dr. Conway thinks the meeting is a good next step for CMS. “I believe it’s very important to engage frontline providers and stakeholders, so the concept of holding a conference to ensure the design of the program is understood, and to get buy-in from the people participating, is a wise choice,” he says.

In the next few months, physicians likely will be inundated with information on e-prescribing processes under the CMS plan. Stay abreast of the latest information through the CMS Web site and, if it turns out, hospitalists can actively participate in the plan, through the SHM Web site at www.hospitalmedicine.org. TH

Jane Jerrard is a medical writer based in Chicago.

CMS has taken up the e-prescribing torch. In July, the agency announced a preliminary program to promote widespread adoption of electronic prescribing.

E-prescribing is a natural goal for CMS; it has been proven to improve quality of care, reduce medication errors, increase efficiency, and lower administrative costs. Kerry Weems, the acting CMS administrator, says an all-electronic prescribing system could save Medicare as much as $156 million over five years—largely through improved quality care.

Though details on the e-prescribing plan are not yet decided, CMS has revealed that beginning in 2009 (and for the next four years) it will provide incentive payments to physicians who are “successful electronic prescribers.”

Details to Be Determined

The e-prescribing plan will be included in the Physician Quality Reporting Initiative (PQRI), with guidelines included in the 2009 PQRI. (How the new plan will work with the current PQRI e-prescribing measure is one of the unknown details.)

Weems says CMS will use its standard rule-making process to shape the e-prescribing plan. Therefore, details of the incentives program will not be available until this fall, when Medicare releases its final rule on the 2009 physician fee schedule. According to Weems, the 2009 fee schedule and PQRI will clarify some murkiness. “They will be specific about what constitutes e-prescribing, including the extent and reporting of what needs to be done through PQRI,” he says.

Rewards, Then Possible Punishments

Physicians can start reporting on e-prescribing Jan. 1, and those who do will reap the benefits. Patrick Conway, MD, MSc, a hospitalist, an assistant professor at Cincinnati Children’s Hospital Medical Center, and a 2007-2008 White House Fellow working in the Department of Health and Human Services (HHS), says initial discussions about promoting e-prescribing included talk of an incentive-based plan.

“It’s my opinion that, for physicians, it’s beneficial to start with a reward or carrot rather than a punishment,” he says. “And generally, CMS has approached physician programs with this method—like the PQRI.”

The current plan’s outlines indicates that in 2009 and 2010, physicians who successfully report on e-prescribing will receive an incentive payment of up to 2% of their total Medicare allowed charges, matching the maximum bonus they can earn under the regular PQRI. Payment will be additive, so a physician can earn up to 4% (2% for PQRI and 2% for e-prescribing.)

The e-prescribing incentive will drop to 1% in 2011 and 2012, and to 0.5% incentive payment in 2013. After 2013, the carrot is replaced with a stick, and those who do not use e-prescribing will suffer a reduction in payment.

Cost Concerns

CMS estimates the cost of adopting e-prescribing will be approximately $3,000 per individual prescriber. This includes equipment, training, and program maintenance. That can add up to a sizeable expense—particularly for small groups. For that reason, the agency promises a built-in hardship exemption for small practices and others who prove they cannot afford to adopt e-prescribing.

Also, some funding is available: Dr. Conway says CMS has a financial-incentive program for electronic health records, many of which include e-prescribing. “The CMS Electronic Health Records Demonstration is a $150 million program that will provide funds to 1,200 physician practices to adopt this technology,” he says. “They’re currently recruiting practices.” Details on the demonstration are available at www.cms.hhs.gov/DemoProjectsEvalRpts/.

Will Hospitalists Participate?

Until details of the e-prescribing program are published, no one can say whether the plan will encompass hospitalists. However, Dr. Conway says, “I think this plan is conceptually relevant to hospitalists: It’s possible that hospitalists will be able to participate in the current plan. We don’t know yet. But CMS will continue to push forward on initiatives that increase quality and decrease costs, including e-prescribing. They’ll support electronic health records, whether this particular initiative applies to hospitals or not.”

Even if it turns out hospital medicine groups can’t reap incentive payments from the new plan, Dr. Conway hopes they still will adopt the technology. “Computerized physician order entry (CPOE) and e-prescribing have the potential to decrease errors and increase the quality of care,” he says. “Therefore, I would encourage hospitals and hospitalists to implement electronic health records with computerized order entry and e-prescribing when possible.”

He says the real benefit to hospitals seeking to improve quality and reduce error is not the electronic transmission of prescriptions to the pharmacy, but CPOE. “Most evidence of increased quality is around computerized physician order entry, which includes decision support at the time of the order,” he points out. “One could argue that you could have an incentive for hospitals that utilize CPOE, but I have no idea if CMS will pursue that.”

Next Steps

On Oct. 6-7 CMS will host a conference on the complete e-prescribing plan for pharmacists and physicians in Boston. For details, check the CMS site at www.cms.hhs.gov/eprescribing or www.cms.hhs.gov/pqri.

Dr. Conway thinks the meeting is a good next step for CMS. “I believe it’s very important to engage frontline providers and stakeholders, so the concept of holding a conference to ensure the design of the program is understood, and to get buy-in from the people participating, is a wise choice,” he says.

In the next few months, physicians likely will be inundated with information on e-prescribing processes under the CMS plan. Stay abreast of the latest information through the CMS Web site and, if it turns out, hospitalists can actively participate in the plan, through the SHM Web site at www.hospitalmedicine.org. TH

Jane Jerrard is a medical writer based in Chicago.

If you’re in an HM leadership position, don’t be surprised if you’re asked to be a mentor for a less-experienced hospitalist. Why should you voluntarily spend valuable time sharing your guidance and advice? Because to lead is to mentor, and when you dive into the process it rewards all parties involved.

To Lead Is to Mentor

Whether you were just promoted or you’re a leadership veteran approached for the first time by an eager new hospitalist, don’t hesitate to add mentoring to your schedule and responsibilities.

“When you start out as a leader, you get where you want to go by being a mentor,” says Eric E. Howell, MD, director of Collaborative Inpatient Medicine Service, Department of Medicine, Johns Hopkins Bayview Medical Center, Baltimore and faculty for SHM’s Leadership Academy. “You gather disciples, as it were, who will then see you as a leader and support you as a good leadership choice.”

Not only that, but mentoring can add to your skill set as a leader, says Joan C. Faro, MD, FACP, MBA, chief medical officer at John T. Mather Memorial Hospital, Port Jefferson, N.Y. “If you’re interested in developing leadership skills, it’s one of those things you need to do, and do well. If you can’t mentor, then you really can’t lead.”

Plus, when you mentor, you get to feel the reward inherent in helping a young physician whose shoes you once filled. “It’s like raising a kid,” says Dr. Faro. “You want to do a good job because you want to see someone succeed.” This is especially true for mentoring relationships within your HM group.

That means fully flushing out the program and dedicating the time necessary to make it a success. “If you are the de facto leader of a group, you have some obligation to people interested in career development,” says Dr. Howell. “I think it’s part of the job to help advance those people.”

The Ground Rules

Any new mentoring arrangement should start with a discussion of expectations, responsibilities, time frames, and communication. What are the mentee’s expectations for the relationship? How much time can you, the mentor, offer?

Whether the arrangement is formal (a director mentoring a new hire) or casual (an established hospitalist asking a conference speaker for a long-distance mentoring relationship), ground rules are important, Dr. Howell insists. “The mentoring relationship can be established informally, but it’s worthwhile to set some rules on responsibilities: How is the feedback going to come, how frank and honest do you want to be, when should we meet? …Rules will depend on the relationship and on the individuals involved.”

If nothing else, agree to how frequently you will meet or speak. “It could be quarterly or it could be weekly,” says Dr. Howell. “Face time is important, but e-mail and phone calls will work, too, as long as you’ve established some ground rules about this. If the mentee expects a face-to-face meeting and you’re e-mailing your answers, that could be a problem. So you need to establish how you’re going to communicate.”

Those meetings can add up to a sizeable commitment. How much time, exactly, should a new mentor expect to devote to this aspect of leadership? “It varies widely,” Dr. Howell admits. “But I will say that many younger mentees require much more time than older mentors expect. If they’re struggling or haven’t found their stride yet, it can require several hours a week, which is a lot for a busy person’s schedule. But many relationships can be handled weekly or monthly.”

Dr. Faro, who has mentored many hospitalists within her organization, says, “You need to build the relationship; you need enough contact time so that you can understand each other.” For her, that amounts to 40 to 50 hours of getting-to-know-you time, she says. “After that, maybe an hour a week.”

Tailor Mentoring

Dr. Faro tailors her guidance to the personality, capabilities, and level of independence of each person she mentors—hence her lengthy initial time frame.

“You need to start with setting up a clear set of goals and outcomes,” she says. “They really need to know what they’re doing and why they’re doing it. So, set up a plan with specific time frames. It’s your job to determine how independent they are; you may end up giving them goals rather than them stating what they’re going to do.”

For example, she might tell one mentee to develop an order set for patients with syncope, and expect a document by an agreed-upon deadline. She might give another individual the same assignment, but walk that person through each step—within reason. “You can’t do it for them, or they’re not going to learn,” she maintains.

Each completed task is met with constructive criticism. How well was the task done? Did the physician leave out anything? If Dr. Faro senses that more guidance is necessary, she steps up her level of involvement.

What Makes a Successful Mentor?

Dr. Faro understands the mentor/mentee process because she’s been part of it for so long. How can you get to that point? Simply agreeing to be a mentor and having regular meetings with your mentee doesn’t necessarily mean you’re doing a good job.

“Good mentors probably listen more than they talk,” explains Dr. Howell. “For many people, if they can talk it out, they will reach their own conclusions and that’s much more powerful than being told something. That ‘Aha!’ moment is a big career moment.”

He also believes strong mentors can give even non-hospitalists helpful career advice. “Good mentors are able to step out of their own shoes and look at the unique situation of the other person, and give advice tailored to that situation,” he explains. “You have to be altruistic in your mentoring; you can’t do it for your own needs.”

Successful mentors also understand their mentees. For example, mentees in leadership positions should receive advice about how to invest in themselves and their careers. “I always recommend SHM’s Leadership Academy, as well as several books, including Getting to Yes and Good to Great to improve themselves as leaders,” says Dr. Howell.

Finally, a mentor who does the job well understands when the relationship isn’t working. If this is the case, “be up-front and honest, and if possible, point that person to another mentor,” Dr. Howell says. “If you can introduce them and get them started, that’s best. You can also share a mentee with someone else; you can each handle different areas. I have many different mentors in different areas. It’s more productive that way.” TH

Jane Jerrard also writes “Public Policy” for The Hospitalist.

If you’re in an HM leadership position, don’t be surprised if you’re asked to be a mentor for a less-experienced hospitalist. Why should you voluntarily spend valuable time sharing your guidance and advice? Because to lead is to mentor, and when you dive into the process it rewards all parties involved.

To Lead Is to Mentor

Whether you were just promoted or you’re a leadership veteran approached for the first time by an eager new hospitalist, don’t hesitate to add mentoring to your schedule and responsibilities.

“When you start out as a leader, you get where you want to go by being a mentor,” says Eric E. Howell, MD, director of Collaborative Inpatient Medicine Service, Department of Medicine, Johns Hopkins Bayview Medical Center, Baltimore and faculty for SHM’s Leadership Academy. “You gather disciples, as it were, who will then see you as a leader and support you as a good leadership choice.”

Not only that, but mentoring can add to your skill set as a leader, says Joan C. Faro, MD, FACP, MBA, chief medical officer at John T. Mather Memorial Hospital, Port Jefferson, N.Y. “If you’re interested in developing leadership skills, it’s one of those things you need to do, and do well. If you can’t mentor, then you really can’t lead.”

Plus, when you mentor, you get to feel the reward inherent in helping a young physician whose shoes you once filled. “It’s like raising a kid,” says Dr. Faro. “You want to do a good job because you want to see someone succeed.” This is especially true for mentoring relationships within your HM group.

That means fully flushing out the program and dedicating the time necessary to make it a success. “If you are the de facto leader of a group, you have some obligation to people interested in career development,” says Dr. Howell. “I think it’s part of the job to help advance those people.”

The Ground Rules

Any new mentoring arrangement should start with a discussion of expectations, responsibilities, time frames, and communication. What are the mentee’s expectations for the relationship? How much time can you, the mentor, offer?

Whether the arrangement is formal (a director mentoring a new hire) or casual (an established hospitalist asking a conference speaker for a long-distance mentoring relationship), ground rules are important, Dr. Howell insists. “The mentoring relationship can be established informally, but it’s worthwhile to set some rules on responsibilities: How is the feedback going to come, how frank and honest do you want to be, when should we meet? …Rules will depend on the relationship and on the individuals involved.”

If nothing else, agree to how frequently you will meet or speak. “It could be quarterly or it could be weekly,” says Dr. Howell. “Face time is important, but e-mail and phone calls will work, too, as long as you’ve established some ground rules about this. If the mentee expects a face-to-face meeting and you’re e-mailing your answers, that could be a problem. So you need to establish how you’re going to communicate.”

Those meetings can add up to a sizeable commitment. How much time, exactly, should a new mentor expect to devote to this aspect of leadership? “It varies widely,” Dr. Howell admits. “But I will say that many younger mentees require much more time than older mentors expect. If they’re struggling or haven’t found their stride yet, it can require several hours a week, which is a lot for a busy person’s schedule. But many relationships can be handled weekly or monthly.”

Dr. Faro, who has mentored many hospitalists within her organization, says, “You need to build the relationship; you need enough contact time so that you can understand each other.” For her, that amounts to 40 to 50 hours of getting-to-know-you time, she says. “After that, maybe an hour a week.”

Tailor Mentoring

Dr. Faro tailors her guidance to the personality, capabilities, and level of independence of each person she mentors—hence her lengthy initial time frame.

“You need to start with setting up a clear set of goals and outcomes,” she says. “They really need to know what they’re doing and why they’re doing it. So, set up a plan with specific time frames. It’s your job to determine how independent they are; you may end up giving them goals rather than them stating what they’re going to do.”

For example, she might tell one mentee to develop an order set for patients with syncope, and expect a document by an agreed-upon deadline. She might give another individual the same assignment, but walk that person through each step—within reason. “You can’t do it for them, or they’re not going to learn,” she maintains.

Each completed task is met with constructive criticism. How well was the task done? Did the physician leave out anything? If Dr. Faro senses that more guidance is necessary, she steps up her level of involvement.

What Makes a Successful Mentor?

Dr. Faro understands the mentor/mentee process because she’s been part of it for so long. How can you get to that point? Simply agreeing to be a mentor and having regular meetings with your mentee doesn’t necessarily mean you’re doing a good job.

“Good mentors probably listen more than they talk,” explains Dr. Howell. “For many people, if they can talk it out, they will reach their own conclusions and that’s much more powerful than being told something. That ‘Aha!’ moment is a big career moment.”

He also believes strong mentors can give even non-hospitalists helpful career advice. “Good mentors are able to step out of their own shoes and look at the unique situation of the other person, and give advice tailored to that situation,” he explains. “You have to be altruistic in your mentoring; you can’t do it for your own needs.”

Successful mentors also understand their mentees. For example, mentees in leadership positions should receive advice about how to invest in themselves and their careers. “I always recommend SHM’s Leadership Academy, as well as several books, including Getting to Yes and Good to Great to improve themselves as leaders,” says Dr. Howell.

Finally, a mentor who does the job well understands when the relationship isn’t working. If this is the case, “be up-front and honest, and if possible, point that person to another mentor,” Dr. Howell says. “If you can introduce them and get them started, that’s best. You can also share a mentee with someone else; you can each handle different areas. I have many different mentors in different areas. It’s more productive that way.” TH

Jane Jerrard also writes “Public Policy” for The Hospitalist.

If you’re in an HM leadership position, don’t be surprised if you’re asked to be a mentor for a less-experienced hospitalist. Why should you voluntarily spend valuable time sharing your guidance and advice? Because to lead is to mentor, and when you dive into the process it rewards all parties involved.

To Lead Is to Mentor

Whether you were just promoted or you’re a leadership veteran approached for the first time by an eager new hospitalist, don’t hesitate to add mentoring to your schedule and responsibilities.

“When you start out as a leader, you get where you want to go by being a mentor,” says Eric E. Howell, MD, director of Collaborative Inpatient Medicine Service, Department of Medicine, Johns Hopkins Bayview Medical Center, Baltimore and faculty for SHM’s Leadership Academy. “You gather disciples, as it were, who will then see you as a leader and support you as a good leadership choice.”

Not only that, but mentoring can add to your skill set as a leader, says Joan C. Faro, MD, FACP, MBA, chief medical officer at John T. Mather Memorial Hospital, Port Jefferson, N.Y. “If you’re interested in developing leadership skills, it’s one of those things you need to do, and do well. If you can’t mentor, then you really can’t lead.”

Plus, when you mentor, you get to feel the reward inherent in helping a young physician whose shoes you once filled. “It’s like raising a kid,” says Dr. Faro. “You want to do a good job because you want to see someone succeed.” This is especially true for mentoring relationships within your HM group.

That means fully flushing out the program and dedicating the time necessary to make it a success. “If you are the de facto leader of a group, you have some obligation to people interested in career development,” says Dr. Howell. “I think it’s part of the job to help advance those people.”

The Ground Rules

Any new mentoring arrangement should start with a discussion of expectations, responsibilities, time frames, and communication. What are the mentee’s expectations for the relationship? How much time can you, the mentor, offer?

Whether the arrangement is formal (a director mentoring a new hire) or casual (an established hospitalist asking a conference speaker for a long-distance mentoring relationship), ground rules are important, Dr. Howell insists. “The mentoring relationship can be established informally, but it’s worthwhile to set some rules on responsibilities: How is the feedback going to come, how frank and honest do you want to be, when should we meet? …Rules will depend on the relationship and on the individuals involved.”

If nothing else, agree to how frequently you will meet or speak. “It could be quarterly or it could be weekly,” says Dr. Howell. “Face time is important, but e-mail and phone calls will work, too, as long as you’ve established some ground rules about this. If the mentee expects a face-to-face meeting and you’re e-mailing your answers, that could be a problem. So you need to establish how you’re going to communicate.”

Those meetings can add up to a sizeable commitment. How much time, exactly, should a new mentor expect to devote to this aspect of leadership? “It varies widely,” Dr. Howell admits. “But I will say that many younger mentees require much more time than older mentors expect. If they’re struggling or haven’t found their stride yet, it can require several hours a week, which is a lot for a busy person’s schedule. But many relationships can be handled weekly or monthly.”

Dr. Faro, who has mentored many hospitalists within her organization, says, “You need to build the relationship; you need enough contact time so that you can understand each other.” For her, that amounts to 40 to 50 hours of getting-to-know-you time, she says. “After that, maybe an hour a week.”

Tailor Mentoring

Dr. Faro tailors her guidance to the personality, capabilities, and level of independence of each person she mentors—hence her lengthy initial time frame.

“You need to start with setting up a clear set of goals and outcomes,” she says. “They really need to know what they’re doing and why they’re doing it. So, set up a plan with specific time frames. It’s your job to determine how independent they are; you may end up giving them goals rather than them stating what they’re going to do.”

For example, she might tell one mentee to develop an order set for patients with syncope, and expect a document by an agreed-upon deadline. She might give another individual the same assignment, but walk that person through each step—within reason. “You can’t do it for them, or they’re not going to learn,” she maintains.

Each completed task is met with constructive criticism. How well was the task done? Did the physician leave out anything? If Dr. Faro senses that more guidance is necessary, she steps up her level of involvement.

What Makes a Successful Mentor?

Dr. Faro understands the mentor/mentee process because she’s been part of it for so long. How can you get to that point? Simply agreeing to be a mentor and having regular meetings with your mentee doesn’t necessarily mean you’re doing a good job.

“Good mentors probably listen more than they talk,” explains Dr. Howell. “For many people, if they can talk it out, they will reach their own conclusions and that’s much more powerful than being told something. That ‘Aha!’ moment is a big career moment.”

He also believes strong mentors can give even non-hospitalists helpful career advice. “Good mentors are able to step out of their own shoes and look at the unique situation of the other person, and give advice tailored to that situation,” he explains. “You have to be altruistic in your mentoring; you can’t do it for your own needs.”

Successful mentors also understand their mentees. For example, mentees in leadership positions should receive advice about how to invest in themselves and their careers. “I always recommend SHM’s Leadership Academy, as well as several books, including Getting to Yes and Good to Great to improve themselves as leaders,” says Dr. Howell.

Finally, a mentor who does the job well understands when the relationship isn’t working. If this is the case, “be up-front and honest, and if possible, point that person to another mentor,” Dr. Howell says. “If you can introduce them and get them started, that’s best. You can also share a mentee with someone else; you can each handle different areas. I have many different mentors in different areas. It’s more productive that way.” TH

Jane Jerrard also writes “Public Policy” for The Hospitalist.