Jane Jerrard

Next year, a new president will take the White House and likely will be the one to lead the United States toward much-needed healthcare reform. What does the near future hold? What should hospitalists know about each candidate’s healthcare policies and proposals? Here, a hospitalist and a government advocate for hospitalists each weigh in.

Are the Times a-Changin’?

Laura Allendorf, SHM’s senior adviser for advocacy and government affairs, keeps a close eye on healthcare legislation, values, and trends in Washington, D.C. She predicts that regardless of which candidate takes office in 2009, change is coming fast.

“Healthcare will definitely be a top priority for the new administration … regardless of who wins the White House,” she says. “There’s been an unprecedented level of discussion already. Congressional committees have already held hearings to prepare for changes next year. They’re laying the groundwork now.”

However, not everyone agrees that we’ll see healthcare reform so soon: Bradley Flansbaum, DO, MPH, chief of hospitalist section at Lenox Hill Hospital in New York City, believes other major issues, such as the slow economy and the war in Iraq, may take precedence.

“There are a lot of things on the agenda in Congress right now,” he points out. “I’m not sure how fast [healthcare reform] will really happen.” He says regardless of which man (Barack Obama or John McCain) wins, “he will have two or three top priorities as soon as he takes office—if healthcare reform is one of those priorities, some changes will happen.”

However, the business of Washington still can get in the way of a new administration. Dr. Flansbaum points to a House bill (HR 6331) that requests a delay in implementation of the Medicare competitive bidding program for durable medical equipment. “Lobbyists have sway over what legislators do in Washington, D.C.,” he notes. “Just because Obama or McCain come into office doesn’t mean those lobbyists will go away.”

Despite the forces against change, each candidate is touting major changes to healthcare access.

McCain and Tax Credits

Republican candidate McCain has released a healthcare plan based on instituting a federal tax credit to be used by individuals to purchase their own health insurance—regardless of whether they are covered (or can be covered) through an employer or through the non-group market.

His plan would replace a tax break for those who receive health insurance from their employers with a refundable tax credit of as much as $2,500 per individual and $5,000 per family, to be used for buying private coverage of their choice.

McCain’s plan proposes compensating physicians and hospitals based on performance, including tying Medicaid and Medicare reimbursements to results. His plan also includes ideas for containing healthcare spending by better treating chronic diseases, such as diabetes and heart disease.

“I believe that the best way to help small businesses and employers afford health care is not to increase government control of health care but to bring the rising cost of care under control and give people the option of having personal, portable health insurance,” McCain has said. He added that his proposal would allow individuals to retain their health insurance “even when they move or change jobs.”

Obama’s Funding Plan

Meanwhile, Democratic candidate Obama approaches the issue with a different solution. He proposes universal coverage through the following:

• The proposal would mandate all children have healthcare coverage, and would expand eligibility for Medicaid and SCHIP (State Children’s Health Insurance Program);
• A new public insurance program that would bridge the gap of the uninsured, covering Americans who don’t quality for Medicaid or SCHIP and have no access to coverage through their employer. The coverage would be similar to that offered to members of Congress; and
• A National Health Insurance Exchange to aid individuals and businesses that want to purchase private health insurance directly. Obama’s plan would require all employers to contribute toward health coverage for their employees or toward the cost of the public plan—all, that is, except small businesses who meet certain exemptions.

Congress Is the Decider

“McCain’s plan is, far and away, the more daring, and will present a greater shock to the system,” Dr. Flansbaum maintains. “It would probably lead to gridlock in Congress, because it would need bipartisan agreement to pass and I don’t think the Democrats would agree to it.” If, on the other hand, Obama wins the election, he would almost certainly have a sympathetic Democratic Congress to work with. “He’d have a greater chance of leading change along his lines,” predicts Dr. Flansbaum. “In this case, we might see a Massachusetts-esque plan.”

In either case, the candidate’s proposal may not become reality. “Folks have to remember, it’s Congress that has to come up with the plan” for reform, Allendorf cautions.

A strong president may carry some weight in this regard. “Like all presidents able to effect change, once [the 2009 electee] has the bully pulpit and can sway opinion, Congress should fall into line,” says Dr. Flansbaum. “There will be pressure to change things.”

That change, whatever shape it takes, is almost certain to include some belt-tightening for hospitals, he says. “You have to look at the facts: One-third of healthcare dollars are spent in hospitals … and the numbers given for waste in care in the system are upwards of 30%. You have to assume that hospitals are the logical place to cut.” Regardless of the election outcome, he cautions: “Hospitals will probably have to make painful cuts and changes. It’s going to happen at some point, though I’m not sure that Congress has the political will to push through any changes soon.”

Luckily, hospitalists are accustomed to continuous change and shifting policies, roles, and responsibilities. Their skills at adapting to changing conditions should serve them well in the post-election months. TH

Jane Jerrard is a medical writer based in Chicago.

Next year, a new president will take the White House and likely will be the one to lead the United States toward much-needed healthcare reform. What does the near future hold? What should hospitalists know about each candidate’s healthcare policies and proposals? Here, a hospitalist and a government advocate for hospitalists each weigh in.

Are the Times a-Changin’?

Laura Allendorf, SHM’s senior adviser for advocacy and government affairs, keeps a close eye on healthcare legislation, values, and trends in Washington, D.C. She predicts that regardless of which candidate takes office in 2009, change is coming fast.

“Healthcare will definitely be a top priority for the new administration … regardless of who wins the White House,” she says. “There’s been an unprecedented level of discussion already. Congressional committees have already held hearings to prepare for changes next year. They’re laying the groundwork now.”

However, not everyone agrees that we’ll see healthcare reform so soon: Bradley Flansbaum, DO, MPH, chief of hospitalist section at Lenox Hill Hospital in New York City, believes other major issues, such as the slow economy and the war in Iraq, may take precedence.

“There are a lot of things on the agenda in Congress right now,” he points out. “I’m not sure how fast [healthcare reform] will really happen.” He says regardless of which man (Barack Obama or John McCain) wins, “he will have two or three top priorities as soon as he takes office—if healthcare reform is one of those priorities, some changes will happen.”

However, the business of Washington still can get in the way of a new administration. Dr. Flansbaum points to a House bill (HR 6331) that requests a delay in implementation of the Medicare competitive bidding program for durable medical equipment. “Lobbyists have sway over what legislators do in Washington, D.C.,” he notes. “Just because Obama or McCain come into office doesn’t mean those lobbyists will go away.”

Despite the forces against change, each candidate is touting major changes to healthcare access.

McCain and Tax Credits

Republican candidate McCain has released a healthcare plan based on instituting a federal tax credit to be used by individuals to purchase their own health insurance—regardless of whether they are covered (or can be covered) through an employer or through the non-group market.

His plan would replace a tax break for those who receive health insurance from their employers with a refundable tax credit of as much as $2,500 per individual and $5,000 per family, to be used for buying private coverage of their choice.

McCain’s plan proposes compensating physicians and hospitals based on performance, including tying Medicaid and Medicare reimbursements to results. His plan also includes ideas for containing healthcare spending by better treating chronic diseases, such as diabetes and heart disease.

“I believe that the best way to help small businesses and employers afford health care is not to increase government control of health care but to bring the rising cost of care under control and give people the option of having personal, portable health insurance,” McCain has said. He added that his proposal would allow individuals to retain their health insurance “even when they move or change jobs.”

Obama’s Funding Plan

Meanwhile, Democratic candidate Obama approaches the issue with a different solution. He proposes universal coverage through the following:

• The proposal would mandate all children have healthcare coverage, and would expand eligibility for Medicaid and SCHIP (State Children’s Health Insurance Program);
• A new public insurance program that would bridge the gap of the uninsured, covering Americans who don’t quality for Medicaid or SCHIP and have no access to coverage through their employer. The coverage would be similar to that offered to members of Congress; and
• A National Health Insurance Exchange to aid individuals and businesses that want to purchase private health insurance directly. Obama’s plan would require all employers to contribute toward health coverage for their employees or toward the cost of the public plan—all, that is, except small businesses who meet certain exemptions.

Congress Is the Decider

“McCain’s plan is, far and away, the more daring, and will present a greater shock to the system,” Dr. Flansbaum maintains. “It would probably lead to gridlock in Congress, because it would need bipartisan agreement to pass and I don’t think the Democrats would agree to it.” If, on the other hand, Obama wins the election, he would almost certainly have a sympathetic Democratic Congress to work with. “He’d have a greater chance of leading change along his lines,” predicts Dr. Flansbaum. “In this case, we might see a Massachusetts-esque plan.”

In either case, the candidate’s proposal may not become reality. “Folks have to remember, it’s Congress that has to come up with the plan” for reform, Allendorf cautions.

A strong president may carry some weight in this regard. “Like all presidents able to effect change, once [the 2009 electee] has the bully pulpit and can sway opinion, Congress should fall into line,” says Dr. Flansbaum. “There will be pressure to change things.”

That change, whatever shape it takes, is almost certain to include some belt-tightening for hospitals, he says. “You have to look at the facts: One-third of healthcare dollars are spent in hospitals … and the numbers given for waste in care in the system are upwards of 30%. You have to assume that hospitals are the logical place to cut.” Regardless of the election outcome, he cautions: “Hospitals will probably have to make painful cuts and changes. It’s going to happen at some point, though I’m not sure that Congress has the political will to push through any changes soon.”

Luckily, hospitalists are accustomed to continuous change and shifting policies, roles, and responsibilities. Their skills at adapting to changing conditions should serve them well in the post-election months. TH

Jane Jerrard is a medical writer based in Chicago.

Next year, a new president will take the White House and likely will be the one to lead the United States toward much-needed healthcare reform. What does the near future hold? What should hospitalists know about each candidate’s healthcare policies and proposals? Here, a hospitalist and a government advocate for hospitalists each weigh in.

Are the Times a-Changin’?

Laura Allendorf, SHM’s senior adviser for advocacy and government affairs, keeps a close eye on healthcare legislation, values, and trends in Washington, D.C. She predicts that regardless of which candidate takes office in 2009, change is coming fast.

“Healthcare will definitely be a top priority for the new administration … regardless of who wins the White House,” she says. “There’s been an unprecedented level of discussion already. Congressional committees have already held hearings to prepare for changes next year. They’re laying the groundwork now.”

However, not everyone agrees that we’ll see healthcare reform so soon: Bradley Flansbaum, DO, MPH, chief of hospitalist section at Lenox Hill Hospital in New York City, believes other major issues, such as the slow economy and the war in Iraq, may take precedence.

“There are a lot of things on the agenda in Congress right now,” he points out. “I’m not sure how fast [healthcare reform] will really happen.” He says regardless of which man (Barack Obama or John McCain) wins, “he will have two or three top priorities as soon as he takes office—if healthcare reform is one of those priorities, some changes will happen.”

However, the business of Washington still can get in the way of a new administration. Dr. Flansbaum points to a House bill (HR 6331) that requests a delay in implementation of the Medicare competitive bidding program for durable medical equipment. “Lobbyists have sway over what legislators do in Washington, D.C.,” he notes. “Just because Obama or McCain come into office doesn’t mean those lobbyists will go away.”

Despite the forces against change, each candidate is touting major changes to healthcare access.

McCain and Tax Credits

Republican candidate McCain has released a healthcare plan based on instituting a federal tax credit to be used by individuals to purchase their own health insurance—regardless of whether they are covered (or can be covered) through an employer or through the non-group market.

His plan would replace a tax break for those who receive health insurance from their employers with a refundable tax credit of as much as $2,500 per individual and $5,000 per family, to be used for buying private coverage of their choice.

McCain’s plan proposes compensating physicians and hospitals based on performance, including tying Medicaid and Medicare reimbursements to results. His plan also includes ideas for containing healthcare spending by better treating chronic diseases, such as diabetes and heart disease.

“I believe that the best way to help small businesses and employers afford health care is not to increase government control of health care but to bring the rising cost of care under control and give people the option of having personal, portable health insurance,” McCain has said. He added that his proposal would allow individuals to retain their health insurance “even when they move or change jobs.”

Obama’s Funding Plan

Meanwhile, Democratic candidate Obama approaches the issue with a different solution. He proposes universal coverage through the following:

• The proposal would mandate all children have healthcare coverage, and would expand eligibility for Medicaid and SCHIP (State Children’s Health Insurance Program);
• A new public insurance program that would bridge the gap of the uninsured, covering Americans who don’t quality for Medicaid or SCHIP and have no access to coverage through their employer. The coverage would be similar to that offered to members of Congress; and
• A National Health Insurance Exchange to aid individuals and businesses that want to purchase private health insurance directly. Obama’s plan would require all employers to contribute toward health coverage for their employees or toward the cost of the public plan—all, that is, except small businesses who meet certain exemptions.

Congress Is the Decider

“McCain’s plan is, far and away, the more daring, and will present a greater shock to the system,” Dr. Flansbaum maintains. “It would probably lead to gridlock in Congress, because it would need bipartisan agreement to pass and I don’t think the Democrats would agree to it.” If, on the other hand, Obama wins the election, he would almost certainly have a sympathetic Democratic Congress to work with. “He’d have a greater chance of leading change along his lines,” predicts Dr. Flansbaum. “In this case, we might see a Massachusetts-esque plan.”

In either case, the candidate’s proposal may not become reality. “Folks have to remember, it’s Congress that has to come up with the plan” for reform, Allendorf cautions.

A strong president may carry some weight in this regard. “Like all presidents able to effect change, once [the 2009 electee] has the bully pulpit and can sway opinion, Congress should fall into line,” says Dr. Flansbaum. “There will be pressure to change things.”

That change, whatever shape it takes, is almost certain to include some belt-tightening for hospitals, he says. “You have to look at the facts: One-third of healthcare dollars are spent in hospitals … and the numbers given for waste in care in the system are upwards of 30%. You have to assume that hospitals are the logical place to cut.” Regardless of the election outcome, he cautions: “Hospitals will probably have to make painful cuts and changes. It’s going to happen at some point, though I’m not sure that Congress has the political will to push through any changes soon.”

Luckily, hospitalists are accustomed to continuous change and shifting policies, roles, and responsibilities. Their skills at adapting to changing conditions should serve them well in the post-election months. TH

Jane Jerrard is a medical writer based in Chicago.

A sour relationship with your immediate superior can ruin an otherwise fulfilling job. When you report to someone you continually disagree with or simply don’t understand, just showing up for work can become a misery. If you’re in a situation like this, don’t despair; there is a possible solution.

Power Struggle

Whether the conflict you feel with your boss is over care decisions, personal style, or scope of work, it really boils down to who gets control over your time and your patients.

“For physicians especially, autonomy is very important,” says Tosha B. Wetterneck, MD, associate professor of medicine at University of Wisconsin Hospital/Clinics in Madison. “Physicians are people who work hard, are very smart, and like to control what they do. There is obviously a lot of complexity and variation to the job, which adds to the workload. Plus, decision-making processes need to be happening all the time. This creates stress—and the way to control that stress is to have control over what they do.”

A hospitalist who continually butts heads with a superior over issues—or one who subjugates his or her opinion and decisions to the boss’s—is not likely to be satisfied with their job.

“Certainly, an individual’s autonomy is influenced by what they want to have control over and they’re allowed to have control over,” says Dr. Wetterneck. “If there’s a discrepancy between the two, that’s definitely going to have a negative effect on that hospitalist. If there’s a mismatch between what they want control over and what their boss wants, that’s going to be a problem.”

Manage Up

Russell L. Holman, MD, chief operating officer for Brentwood, Tenn.-based Cogent Healthcare and immediate past president of SHM, has worked his way through problems like this—both as the reportee and the boss. He worked out some particularly valuable lessons in a past job where, as medical director, he had trouble connecting with his boss.

“There seemed to be a tremendous communication gap, and there was a mismatch between what I felt was important and what my superior felt was important,” he recalls. “It seemed really hard to get on the same page.”

So he set out to solve the problem: “What I learned was that it’s not sufficient in a leadership role to just focus on who is reporting to you and manage in that direction,” says Dr. Holman. “No one ever tells you this, but you need to spend time managing up.”

Managing up primarily means initiating conversations to get information you need to better work with your boss.

“You need a clear understanding about the priorities and hot buttons of the person you’re reporting to, what they’re personally invested in, how they’re being managed, and what their incentives are,” advises Dr. Holman. “In my situation, I felt that I needed to understand my superior’s background—his career progression, areas of interest, things he felt were important in the organization.”

How do you uncover these facts? It’s simple: Request a one-on-one meeting with your superior and have a direct conversation where you ask those questions.

Next, continues Dr. Holman: “Have what I would call a translational conversation … ‘How do your priorities translate to me and my daily work?’ Again, ask this directly.”

But be warned. “This can be a very productive conversation, but it’s not an easy one to have,” he says. “The reason it’s hard is because whether you’re a frontline hospitalist or a group leader of some kind, you’re a highly educated, highly paid professional. Why would you want to redirect yourself to someone else’s priorities?”

That is the crux of the problem in working for a boss you don’t agree with—you need to relinquish some control to make the situation work.

“This may be difficult for some people but by giving up a little bit, you’ll get a much more productive relationship,” says Dr. Holman. “It also helps you understand how your daily work fits into the broader organizational vision, and you build political capital. You’ll build trust, respect, and equity. If there’s a project you want to engage in and you want support for it, you can trade on that equity.”

Learn their Style

Even as you’re practicing the art of managing up, you may face barriers in dealing with the boss. Consider whether it is a matter of understanding their personal and professional style.

“Maybe you’re just having trouble connecting,” Dr. Holman suggests. “Learn their style, how they communicate. Invest a little time to get a better understanding of their personality style. One way is to ask about their preferences—do they prefer e-mail, phone, or in-person conversations?—and to observe.”

You may discover that the boss is brusque with everyone, not just you, or that they don’t reply to your e-mails because they never check their in-box. The better you understand them, the less stress you’ll suffer from interactions.

The Last Resort

If you’re not getting along with your boss, or don’t like the answers you’re getting, should you consider going over their head to the next level up?

“The temptation may be to use workarounds or back channels—what I call leapfrogging—until you get the answer you want,” Dr. Holman says. “But there’s a lot of damage you can do in leapfrogging. I typically do not recommend that someone going over or around their supervisor unless the circumstances are egregious.”

Ultimately, if you’re still at odds with your boss and the conflict makes you unhappy with your job, you may need to consider finding a better environment.

“If your superior’s personal priorities are in conflict with yours, you owe it to both the boss and yourself to try to converse and reconcile those priorities,” says Dr. Holman. “You should still use the steps, but you may end up leaving anyway. [Managing up] doesn’t guarantee success, but it stacks the deck in your favor.”

He recalls an example where he was the superior to a dissatisfied hospitalist: “There was a hospitalist working for me who had a priority of working in an environment where he could use subjective judgment to make patient decisions. My priority was to standardize care as much as possible. The individual viewed [guidelines, checklists] as an encroachment on his autonomy. This came down to a very fundamental issue. I knew he’d be unhappy in this environment, and we agreed that he would be better off working for another group.”

Perhaps the best advice for coping with a difficult hospitalist-boss relationship is to avoid it in the first place. By recognizing what’s most important to you—what areas you need autonomy in—you can ask questions and perhaps negotiate during the interview or promotion stages. Dr. Wetterneck suggests that hospitalists take the control/autonomy survey included in the SHM white paper “A Challenge for a New Specialty: A White Paper on Hospitalist Career Satisfaction,” which she co-wrote. (The white paper is available under “Publications” on www.hospitalmedicine.org). TH

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

A sour relationship with your immediate superior can ruin an otherwise fulfilling job. When you report to someone you continually disagree with or simply don’t understand, just showing up for work can become a misery. If you’re in a situation like this, don’t despair; there is a possible solution.

Power Struggle

Whether the conflict you feel with your boss is over care decisions, personal style, or scope of work, it really boils down to who gets control over your time and your patients.

“For physicians especially, autonomy is very important,” says Tosha B. Wetterneck, MD, associate professor of medicine at University of Wisconsin Hospital/Clinics in Madison. “Physicians are people who work hard, are very smart, and like to control what they do. There is obviously a lot of complexity and variation to the job, which adds to the workload. Plus, decision-making processes need to be happening all the time. This creates stress—and the way to control that stress is to have control over what they do.”

A hospitalist who continually butts heads with a superior over issues—or one who subjugates his or her opinion and decisions to the boss’s—is not likely to be satisfied with their job.

“Certainly, an individual’s autonomy is influenced by what they want to have control over and they’re allowed to have control over,” says Dr. Wetterneck. “If there’s a discrepancy between the two, that’s definitely going to have a negative effect on that hospitalist. If there’s a mismatch between what they want control over and what their boss wants, that’s going to be a problem.”

Manage Up

Russell L. Holman, MD, chief operating officer for Brentwood, Tenn.-based Cogent Healthcare and immediate past president of SHM, has worked his way through problems like this—both as the reportee and the boss. He worked out some particularly valuable lessons in a past job where, as medical director, he had trouble connecting with his boss.

“There seemed to be a tremendous communication gap, and there was a mismatch between what I felt was important and what my superior felt was important,” he recalls. “It seemed really hard to get on the same page.”

So he set out to solve the problem: “What I learned was that it’s not sufficient in a leadership role to just focus on who is reporting to you and manage in that direction,” says Dr. Holman. “No one ever tells you this, but you need to spend time managing up.”

Managing up primarily means initiating conversations to get information you need to better work with your boss.

“You need a clear understanding about the priorities and hot buttons of the person you’re reporting to, what they’re personally invested in, how they’re being managed, and what their incentives are,” advises Dr. Holman. “In my situation, I felt that I needed to understand my superior’s background—his career progression, areas of interest, things he felt were important in the organization.”

How do you uncover these facts? It’s simple: Request a one-on-one meeting with your superior and have a direct conversation where you ask those questions.

Next, continues Dr. Holman: “Have what I would call a translational conversation … ‘How do your priorities translate to me and my daily work?’ Again, ask this directly.”

But be warned. “This can be a very productive conversation, but it’s not an easy one to have,” he says. “The reason it’s hard is because whether you’re a frontline hospitalist or a group leader of some kind, you’re a highly educated, highly paid professional. Why would you want to redirect yourself to someone else’s priorities?”

That is the crux of the problem in working for a boss you don’t agree with—you need to relinquish some control to make the situation work.

“This may be difficult for some people but by giving up a little bit, you’ll get a much more productive relationship,” says Dr. Holman. “It also helps you understand how your daily work fits into the broader organizational vision, and you build political capital. You’ll build trust, respect, and equity. If there’s a project you want to engage in and you want support for it, you can trade on that equity.”

Learn their Style

Even as you’re practicing the art of managing up, you may face barriers in dealing with the boss. Consider whether it is a matter of understanding their personal and professional style.

“Maybe you’re just having trouble connecting,” Dr. Holman suggests. “Learn their style, how they communicate. Invest a little time to get a better understanding of their personality style. One way is to ask about their preferences—do they prefer e-mail, phone, or in-person conversations?—and to observe.”

You may discover that the boss is brusque with everyone, not just you, or that they don’t reply to your e-mails because they never check their in-box. The better you understand them, the less stress you’ll suffer from interactions.

The Last Resort

If you’re not getting along with your boss, or don’t like the answers you’re getting, should you consider going over their head to the next level up?

“The temptation may be to use workarounds or back channels—what I call leapfrogging—until you get the answer you want,” Dr. Holman says. “But there’s a lot of damage you can do in leapfrogging. I typically do not recommend that someone going over or around their supervisor unless the circumstances are egregious.”

Ultimately, if you’re still at odds with your boss and the conflict makes you unhappy with your job, you may need to consider finding a better environment.

“If your superior’s personal priorities are in conflict with yours, you owe it to both the boss and yourself to try to converse and reconcile those priorities,” says Dr. Holman. “You should still use the steps, but you may end up leaving anyway. [Managing up] doesn’t guarantee success, but it stacks the deck in your favor.”

He recalls an example where he was the superior to a dissatisfied hospitalist: “There was a hospitalist working for me who had a priority of working in an environment where he could use subjective judgment to make patient decisions. My priority was to standardize care as much as possible. The individual viewed [guidelines, checklists] as an encroachment on his autonomy. This came down to a very fundamental issue. I knew he’d be unhappy in this environment, and we agreed that he would be better off working for another group.”

Perhaps the best advice for coping with a difficult hospitalist-boss relationship is to avoid it in the first place. By recognizing what’s most important to you—what areas you need autonomy in—you can ask questions and perhaps negotiate during the interview or promotion stages. Dr. Wetterneck suggests that hospitalists take the control/autonomy survey included in the SHM white paper “A Challenge for a New Specialty: A White Paper on Hospitalist Career Satisfaction,” which she co-wrote. (The white paper is available under “Publications” on www.hospitalmedicine.org). TH

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

A sour relationship with your immediate superior can ruin an otherwise fulfilling job. When you report to someone you continually disagree with or simply don’t understand, just showing up for work can become a misery. If you’re in a situation like this, don’t despair; there is a possible solution.

Power Struggle

Whether the conflict you feel with your boss is over care decisions, personal style, or scope of work, it really boils down to who gets control over your time and your patients.

“For physicians especially, autonomy is very important,” says Tosha B. Wetterneck, MD, associate professor of medicine at University of Wisconsin Hospital/Clinics in Madison. “Physicians are people who work hard, are very smart, and like to control what they do. There is obviously a lot of complexity and variation to the job, which adds to the workload. Plus, decision-making processes need to be happening all the time. This creates stress—and the way to control that stress is to have control over what they do.”

A hospitalist who continually butts heads with a superior over issues—or one who subjugates his or her opinion and decisions to the boss’s—is not likely to be satisfied with their job.

“Certainly, an individual’s autonomy is influenced by what they want to have control over and they’re allowed to have control over,” says Dr. Wetterneck. “If there’s a discrepancy between the two, that’s definitely going to have a negative effect on that hospitalist. If there’s a mismatch between what they want control over and what their boss wants, that’s going to be a problem.”

Manage Up

Russell L. Holman, MD, chief operating officer for Brentwood, Tenn.-based Cogent Healthcare and immediate past president of SHM, has worked his way through problems like this—both as the reportee and the boss. He worked out some particularly valuable lessons in a past job where, as medical director, he had trouble connecting with his boss.

“There seemed to be a tremendous communication gap, and there was a mismatch between what I felt was important and what my superior felt was important,” he recalls. “It seemed really hard to get on the same page.”

So he set out to solve the problem: “What I learned was that it’s not sufficient in a leadership role to just focus on who is reporting to you and manage in that direction,” says Dr. Holman. “No one ever tells you this, but you need to spend time managing up.”

Managing up primarily means initiating conversations to get information you need to better work with your boss.

“You need a clear understanding about the priorities and hot buttons of the person you’re reporting to, what they’re personally invested in, how they’re being managed, and what their incentives are,” advises Dr. Holman. “In my situation, I felt that I needed to understand my superior’s background—his career progression, areas of interest, things he felt were important in the organization.”

How do you uncover these facts? It’s simple: Request a one-on-one meeting with your superior and have a direct conversation where you ask those questions.

Next, continues Dr. Holman: “Have what I would call a translational conversation … ‘How do your priorities translate to me and my daily work?’ Again, ask this directly.”

But be warned. “This can be a very productive conversation, but it’s not an easy one to have,” he says. “The reason it’s hard is because whether you’re a frontline hospitalist or a group leader of some kind, you’re a highly educated, highly paid professional. Why would you want to redirect yourself to someone else’s priorities?”

That is the crux of the problem in working for a boss you don’t agree with—you need to relinquish some control to make the situation work.

“This may be difficult for some people but by giving up a little bit, you’ll get a much more productive relationship,” says Dr. Holman. “It also helps you understand how your daily work fits into the broader organizational vision, and you build political capital. You’ll build trust, respect, and equity. If there’s a project you want to engage in and you want support for it, you can trade on that equity.”

Learn their Style

Even as you’re practicing the art of managing up, you may face barriers in dealing with the boss. Consider whether it is a matter of understanding their personal and professional style.

“Maybe you’re just having trouble connecting,” Dr. Holman suggests. “Learn their style, how they communicate. Invest a little time to get a better understanding of their personality style. One way is to ask about their preferences—do they prefer e-mail, phone, or in-person conversations?—and to observe.”

You may discover that the boss is brusque with everyone, not just you, or that they don’t reply to your e-mails because they never check their in-box. The better you understand them, the less stress you’ll suffer from interactions.

The Last Resort

If you’re not getting along with your boss, or don’t like the answers you’re getting, should you consider going over their head to the next level up?

“The temptation may be to use workarounds or back channels—what I call leapfrogging—until you get the answer you want,” Dr. Holman says. “But there’s a lot of damage you can do in leapfrogging. I typically do not recommend that someone going over or around their supervisor unless the circumstances are egregious.”

Ultimately, if you’re still at odds with your boss and the conflict makes you unhappy with your job, you may need to consider finding a better environment.

“If your superior’s personal priorities are in conflict with yours, you owe it to both the boss and yourself to try to converse and reconcile those priorities,” says Dr. Holman. “You should still use the steps, but you may end up leaving anyway. [Managing up] doesn’t guarantee success, but it stacks the deck in your favor.”

He recalls an example where he was the superior to a dissatisfied hospitalist: “There was a hospitalist working for me who had a priority of working in an environment where he could use subjective judgment to make patient decisions. My priority was to standardize care as much as possible. The individual viewed [guidelines, checklists] as an encroachment on his autonomy. This came down to a very fundamental issue. I knew he’d be unhappy in this environment, and we agreed that he would be better off working for another group.”

Perhaps the best advice for coping with a difficult hospitalist-boss relationship is to avoid it in the first place. By recognizing what’s most important to you—what areas you need autonomy in—you can ask questions and perhaps negotiate during the interview or promotion stages. Dr. Wetterneck suggests that hospitalists take the control/autonomy survey included in the SHM white paper “A Challenge for a New Specialty: A White Paper on Hospitalist Career Satisfaction,” which she co-wrote. (The white paper is available under “Publications” on www.hospitalmedicine.org). TH

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

In April, the Centers for Medicare and Medicaid (CMS) published its proposed Inpatient Prospective Payment System (IPPS) rule for fiscal year 2009. The rule contains many important components, including additional categories of hospital-acquired conditions (HACs) that no longer will earn higher Medicare payment.

The good news is that under the proposed rule, Medicare payments to hospitals would increase by nearly $4 billion. However, the requirements to earn that are causing concern among some individuals and organizations, including SHM.

This year, CMS announced it would begin withholding additional payments for eight specific HACs, including some “never events”—a practice that won’t take effect until October (May 2008, p. 25). Now, the agency proposes to add nine more. Why double these restrictions so soon?

“I think it’s a combination of things,” says Gregory Maynard, MD, MSc, division chief of hospital medicine at the University of California, San Diego Medical Center. “Medicare is trying hard to find things that will improve quality and reduce costs, and there are many ways you can do both.”

CMS will pay the lesser Medicare Severity DRG (MS-DRG) amount if the complication was acquired at the hospital and the patient has no other complications or comorbidities.

“It’s not that Medicare won’t pay for the hospital stay—they won’t pay for that condition as a co-morbidity,” explains Dr. Maynard.

• The new HACs include:
• Surgical site infections following certain elective surgeries;
• Legionnaires’ disease;
• Glycemic control for diabetes;
• Iatrogenic pneumothorax;
• Delirium;
• Ventilator-associated pneumonia;
• Deep-vein thrombosis/pulmonary embolism (DVT/PE);
• Staphylococcus aureus septicemia; and
• Clostridium difficile-associated disease.

Unlike the original eight HACs, these proposed conditions are raising questions.

“The first round of conditions, such as objects left in during surgery, those are obvious and people can buy into them,” Dr. Maynard says. Regarding the proposed additions, he says, “Some of these are just out there.”

He singled out a couple of the new HACs. “DVT is a pet of mine, because we’ve done a lot of work in that area,’’ he notes. “We have good information about what patients are on when they develop DVTs or PEs, and we know that very, very few patients who do were neglected.”

As for C diff.-associated disease, he points out: “C diff.-associated diarrhea—that’s tough to totally avoid. In spite of a perfect process, it will still happen.”

SHM sent a letter to CMS regarding specific concerns with three HACs, stating: “SHM supports the CMS initiative to improve the quality of care for hospitalized patients by preventing avoidable hospital-acquired conditions as proposed in the Final Rule for fiscal year 2008. We have concerns about the conditions selected for FY 2009 and the potential for creating unintended consequences through the inclusion of these conditions.”

Dr. Maynard and others fear the new HACs will lead to the addition of processes and other expenses. “I can’t speak totally for SHM,” he says. “I know they support transparency—but you have to think carefully about the process of transparency. There are unintended consequences, like testing everyone who comes in the door for certain conditions, and even treating a condition that doesn’t need to be treated.”

In an April 28 post on his blog “Wachter’s World” (www.wachtersworld.org) Robert Wachter, MD, professor and associate chairman of the Department of Medicine at the University of California, San Francisco, says: “This new list is a case of too far, too fast. … I can’t argue with the premise—many of the [adverse events] on this list are no doubt partly preventable with more religious implementation of certain safety practices (for example, for C diff., avoiding unnecessary antibiotics and adhering to strict infection control practices with suspected cases). But they are nowhere near ready for prime time. Adoption of this new list will lead to all kinds of gaming, [present on admission] shenanigans, wasted effort on preventive strategies with no supportive evidence, and nasty unintended consequences.”

Too Many Measures?

The proposed rule also will significantly increase quality data reporting requirements for hospitals. The rule adds 43 quality measures to the existing 30, so hospitals would need to report on 73 measures to qualify for a full update to their FY 2009 payment rates. The new measures include:

• Surgical Care Improvement Project (one new measure);
• Hospital readmissions (three new measures);
• Nursing care (four new measures);
• Patient safety indicators developed by the Agency for Healthcare Research and Quality (AHRQ) (five new measures);
• Inpatient quality indicators by AHRQ (four new measures);
• Venous thromboembolism (six new measures);
• Stroke measures (five new measures); and
• Cardiac surgery measures (15 new measures).

Critics of the rule believe reporting on 73 measures is unreasonable—and perhaps impossible for smaller hospitals. In a statement released by the American Hospital Association (AHA), Nancy Foster, the AHA’s vice president for quality and patient safety. says, “… we are dismayed that CMS has proposed to add a long and confusing list of measures to those on which hospitals must report to get their full update.” Foster recommends CMS only include measures endorsed by the National Quality Forum as appropriate national standards and adopted by the Hospital Quality Alliance as useful for public reporting on hospital quality of care.

In the Middle

As with previous CMS programs and rules, the increased reporting requirements will mean a continued role for hospitalists.

“This will put hospitalists in the middle even more than they are now,” predicts Dr. Maynard. “It could be good—increasing their role of communicating and training hospital staff and leading quality improvement initiatives—or it could come down to a blame game. Hospitalists are taking care of half the patients in the hospital these days, so if something goes wrong, it may be seen as their fault.”

Read more about the proposed rule online at www.cms.hhs.gov. CMS will respond to comments in a final rule to be issued by Aug 1. TH

Jane Jerrard is a medical writer based in Chicago.

In April, the Centers for Medicare and Medicaid (CMS) published its proposed Inpatient Prospective Payment System (IPPS) rule for fiscal year 2009. The rule contains many important components, including additional categories of hospital-acquired conditions (HACs) that no longer will earn higher Medicare payment.

The good news is that under the proposed rule, Medicare payments to hospitals would increase by nearly $4 billion. However, the requirements to earn that are causing concern among some individuals and organizations, including SHM.

This year, CMS announced it would begin withholding additional payments for eight specific HACs, including some “never events”—a practice that won’t take effect until October (May 2008, p. 25). Now, the agency proposes to add nine more. Why double these restrictions so soon?

“I think it’s a combination of things,” says Gregory Maynard, MD, MSc, division chief of hospital medicine at the University of California, San Diego Medical Center. “Medicare is trying hard to find things that will improve quality and reduce costs, and there are many ways you can do both.”

CMS will pay the lesser Medicare Severity DRG (MS-DRG) amount if the complication was acquired at the hospital and the patient has no other complications or comorbidities.

“It’s not that Medicare won’t pay for the hospital stay—they won’t pay for that condition as a co-morbidity,” explains Dr. Maynard.

• The new HACs include:
• Surgical site infections following certain elective surgeries;
• Legionnaires’ disease;
• Glycemic control for diabetes;
• Iatrogenic pneumothorax;
• Delirium;
• Ventilator-associated pneumonia;
• Deep-vein thrombosis/pulmonary embolism (DVT/PE);
• Staphylococcus aureus septicemia; and
• Clostridium difficile-associated disease.

Unlike the original eight HACs, these proposed conditions are raising questions.

“The first round of conditions, such as objects left in during surgery, those are obvious and people can buy into them,” Dr. Maynard says. Regarding the proposed additions, he says, “Some of these are just out there.”

He singled out a couple of the new HACs. “DVT is a pet of mine, because we’ve done a lot of work in that area,’’ he notes. “We have good information about what patients are on when they develop DVTs or PEs, and we know that very, very few patients who do were neglected.”

As for C diff.-associated disease, he points out: “C diff.-associated diarrhea—that’s tough to totally avoid. In spite of a perfect process, it will still happen.”

SHM sent a letter to CMS regarding specific concerns with three HACs, stating: “SHM supports the CMS initiative to improve the quality of care for hospitalized patients by preventing avoidable hospital-acquired conditions as proposed in the Final Rule for fiscal year 2008. We have concerns about the conditions selected for FY 2009 and the potential for creating unintended consequences through the inclusion of these conditions.”

Dr. Maynard and others fear the new HACs will lead to the addition of processes and other expenses. “I can’t speak totally for SHM,” he says. “I know they support transparency—but you have to think carefully about the process of transparency. There are unintended consequences, like testing everyone who comes in the door for certain conditions, and even treating a condition that doesn’t need to be treated.”

In an April 28 post on his blog “Wachter’s World” (www.wachtersworld.org) Robert Wachter, MD, professor and associate chairman of the Department of Medicine at the University of California, San Francisco, says: “This new list is a case of too far, too fast. … I can’t argue with the premise—many of the [adverse events] on this list are no doubt partly preventable with more religious implementation of certain safety practices (for example, for C diff., avoiding unnecessary antibiotics and adhering to strict infection control practices with suspected cases). But they are nowhere near ready for prime time. Adoption of this new list will lead to all kinds of gaming, [present on admission] shenanigans, wasted effort on preventive strategies with no supportive evidence, and nasty unintended consequences.”

Too Many Measures?

The proposed rule also will significantly increase quality data reporting requirements for hospitals. The rule adds 43 quality measures to the existing 30, so hospitals would need to report on 73 measures to qualify for a full update to their FY 2009 payment rates. The new measures include:

• Surgical Care Improvement Project (one new measure);
• Hospital readmissions (three new measures);
• Nursing care (four new measures);
• Patient safety indicators developed by the Agency for Healthcare Research and Quality (AHRQ) (five new measures);
• Inpatient quality indicators by AHRQ (four new measures);
• Venous thromboembolism (six new measures);
• Stroke measures (five new measures); and
• Cardiac surgery measures (15 new measures).

Critics of the rule believe reporting on 73 measures is unreasonable—and perhaps impossible for smaller hospitals. In a statement released by the American Hospital Association (AHA), Nancy Foster, the AHA’s vice president for quality and patient safety. says, “… we are dismayed that CMS has proposed to add a long and confusing list of measures to those on which hospitals must report to get their full update.” Foster recommends CMS only include measures endorsed by the National Quality Forum as appropriate national standards and adopted by the Hospital Quality Alliance as useful for public reporting on hospital quality of care.

In the Middle

As with previous CMS programs and rules, the increased reporting requirements will mean a continued role for hospitalists.

“This will put hospitalists in the middle even more than they are now,” predicts Dr. Maynard. “It could be good—increasing their role of communicating and training hospital staff and leading quality improvement initiatives—or it could come down to a blame game. Hospitalists are taking care of half the patients in the hospital these days, so if something goes wrong, it may be seen as their fault.”

Read more about the proposed rule online at www.cms.hhs.gov. CMS will respond to comments in a final rule to be issued by Aug 1. TH

Jane Jerrard is a medical writer based in Chicago.

In April, the Centers for Medicare and Medicaid (CMS) published its proposed Inpatient Prospective Payment System (IPPS) rule for fiscal year 2009. The rule contains many important components, including additional categories of hospital-acquired conditions (HACs) that no longer will earn higher Medicare payment.

The good news is that under the proposed rule, Medicare payments to hospitals would increase by nearly $4 billion. However, the requirements to earn that are causing concern among some individuals and organizations, including SHM.

This year, CMS announced it would begin withholding additional payments for eight specific HACs, including some “never events”—a practice that won’t take effect until October (May 2008, p. 25). Now, the agency proposes to add nine more. Why double these restrictions so soon?

“I think it’s a combination of things,” says Gregory Maynard, MD, MSc, division chief of hospital medicine at the University of California, San Diego Medical Center. “Medicare is trying hard to find things that will improve quality and reduce costs, and there are many ways you can do both.”

CMS will pay the lesser Medicare Severity DRG (MS-DRG) amount if the complication was acquired at the hospital and the patient has no other complications or comorbidities.

“It’s not that Medicare won’t pay for the hospital stay—they won’t pay for that condition as a co-morbidity,” explains Dr. Maynard.

• The new HACs include:
• Surgical site infections following certain elective surgeries;
• Legionnaires’ disease;
• Glycemic control for diabetes;
• Iatrogenic pneumothorax;
• Delirium;
• Ventilator-associated pneumonia;
• Deep-vein thrombosis/pulmonary embolism (DVT/PE);
• Staphylococcus aureus septicemia; and
• Clostridium difficile-associated disease.

Unlike the original eight HACs, these proposed conditions are raising questions.

“The first round of conditions, such as objects left in during surgery, those are obvious and people can buy into them,” Dr. Maynard says. Regarding the proposed additions, he says, “Some of these are just out there.”

He singled out a couple of the new HACs. “DVT is a pet of mine, because we’ve done a lot of work in that area,’’ he notes. “We have good information about what patients are on when they develop DVTs or PEs, and we know that very, very few patients who do were neglected.”

As for C diff.-associated disease, he points out: “C diff.-associated diarrhea—that’s tough to totally avoid. In spite of a perfect process, it will still happen.”

SHM sent a letter to CMS regarding specific concerns with three HACs, stating: “SHM supports the CMS initiative to improve the quality of care for hospitalized patients by preventing avoidable hospital-acquired conditions as proposed in the Final Rule for fiscal year 2008. We have concerns about the conditions selected for FY 2009 and the potential for creating unintended consequences through the inclusion of these conditions.”

Dr. Maynard and others fear the new HACs will lead to the addition of processes and other expenses. “I can’t speak totally for SHM,” he says. “I know they support transparency—but you have to think carefully about the process of transparency. There are unintended consequences, like testing everyone who comes in the door for certain conditions, and even treating a condition that doesn’t need to be treated.”

In an April 28 post on his blog “Wachter’s World” (www.wachtersworld.org) Robert Wachter, MD, professor and associate chairman of the Department of Medicine at the University of California, San Francisco, says: “This new list is a case of too far, too fast. … I can’t argue with the premise—many of the [adverse events] on this list are no doubt partly preventable with more religious implementation of certain safety practices (for example, for C diff., avoiding unnecessary antibiotics and adhering to strict infection control practices with suspected cases). But they are nowhere near ready for prime time. Adoption of this new list will lead to all kinds of gaming, [present on admission] shenanigans, wasted effort on preventive strategies with no supportive evidence, and nasty unintended consequences.”

Too Many Measures?

The proposed rule also will significantly increase quality data reporting requirements for hospitals. The rule adds 43 quality measures to the existing 30, so hospitals would need to report on 73 measures to qualify for a full update to their FY 2009 payment rates. The new measures include:

• Surgical Care Improvement Project (one new measure);
• Hospital readmissions (three new measures);
• Nursing care (four new measures);
• Patient safety indicators developed by the Agency for Healthcare Research and Quality (AHRQ) (five new measures);
• Inpatient quality indicators by AHRQ (four new measures);
• Venous thromboembolism (six new measures);
• Stroke measures (five new measures); and
• Cardiac surgery measures (15 new measures).

Critics of the rule believe reporting on 73 measures is unreasonable—and perhaps impossible for smaller hospitals. In a statement released by the American Hospital Association (AHA), Nancy Foster, the AHA’s vice president for quality and patient safety. says, “… we are dismayed that CMS has proposed to add a long and confusing list of measures to those on which hospitals must report to get their full update.” Foster recommends CMS only include measures endorsed by the National Quality Forum as appropriate national standards and adopted by the Hospital Quality Alliance as useful for public reporting on hospital quality of care.

In the Middle

As with previous CMS programs and rules, the increased reporting requirements will mean a continued role for hospitalists.

“This will put hospitalists in the middle even more than they are now,” predicts Dr. Maynard. “It could be good—increasing their role of communicating and training hospital staff and leading quality improvement initiatives—or it could come down to a blame game. Hospitalists are taking care of half the patients in the hospital these days, so if something goes wrong, it may be seen as their fault.”

Read more about the proposed rule online at www.cms.hhs.gov. CMS will respond to comments in a final rule to be issued by Aug 1. TH

Jane Jerrard is a medical writer based in Chicago.

In today’s wide-open job market, hospitalists can pick a plum position anywhere in the United States. With promising opportunities in sunny Hawaii, bustling New York City, and everywhere in between—likely including your own hometown—the temptation to move to a warmer climate, kid-friendly small town, or bigger paycheck may be irresistible.

Michael-Anthony Williams, MD, chief medical officer for the Rocky Mountain Region of Sound Inpatient Physicians, has hired hospitalists who come to Denver from across the country.

“Market competition [for hospitalists] is definitely fierce and will remain so,” he says. “But no matter where you’re looking or what you’re searching for, you need to get a sense of the group you’ll be joining.”

Sameer Badlani, MD, hospitalist and instructor at the University of Chicago, agrees location should come second to the job itself. “You have to do a lot of introspection and decide what you’re looking for,” he cautions. “If you’re unhappy, ask yourself why a new job would be different.”

After taking this advice into account, consider the challenges and opportunities of starting life anew somewhere else.

Reasons to Relocate

Why think about moving in the first place?

“Money might be the biggest reason,” speculates Dr. Badlani. “The only way to make significantly more money is to become a partner in the practice. I’d say if you’re a hospitalist who’s relocating, you should definitely try to become a partner.”

Another reason to consider moving might be family reasons. “If a spouse gets a job offer in a different city, it’s easy for the hospitalist to move there and find a job,” Dr. Badlani points out. “With the economy the way it is, I think that more and more you’ll see spouses’ jobs influencing where hospitalists relocate.”

Some hospitalists move because they are drawn to a certain region or lifestyle. Dr. Williams says. “We certainly see people who target geography as playing a big role in their job search.”

If you fall into this category, be careful to do your research to discover the realities of your dream location.

“I’d advise that you make more than one trip to a place if you’ve never lived there before,” Dr. Badlani says. “See exactly what it means to live there. Visit the hospital medicine group more than once. Go out with a real estate agent and look at houses.”

Timing Is Everything

Once you’ve decided you are interested in moving—or have to move—get started with your location scouting and your job search.

“You should start looking [for a job] even earlier when you’re relocating,” Dr. Badlani advises. “And be sure to tell your supervisor that you’re thinking of relocating. This seems like a bad idea to some people, but it will be worse if you wait and give two weeks’ notice. That is unfair to your employer and your colleagues who will have to cover your work, and you will end up burning your bridges.” He recommends telling your current employer while interviewing for next year. If you’re already deep into your search, that should be about six or seven months in advance, he says.

“Your current employer will appreciate it, and they may even try to make some changes in order to keep you,” Dr. Badlani says.

Try to negotiate to keep your transition dates flexible. Your plans to move may not go as smoothly as you’d like. “Recently, we’ve seen a couple of people have a tough time selling their house before they move,” Dr. Williams says. “If you live in a tough real estate market, you might want to see if your new employer can be flexible on your start date.”

Consider Cost of Living

As you compare compensation offered by hospital medicine practices in different parts of the country—or even different parts of the same county—consider cost of living in each area.

“If you make $150,000 in Tulsa, Oklahoma, (then you need to make) $210,000 in Chicago,” Dr. Badlani says, who has worked in both cities. Cost of living, he adds, “can be misleading. Do your research and find out housing costs for the area. Online calculators only give approximations; make sure you compare housing in desirable areas of the city, not across the board.”

In addition, Dr. Badlani says, “If you choose a smaller town, it’s likely that you can get paid more—because they need you more—and live in a cheaper place. And you’ll find more opportunities in a smaller town because there are fewer doctors.”

The biggest challenge when comparing jobs is assessing the work required to make that salary, Dr. Williams adds. “Find out how many shifts per month you’ll work to earn it, and how many patients you’ll see per shift,” he suggests.

Relocation, Negotiation

Before you start negotiating a new contract, Dr. Badlani advises you first look at your current one to see what you’re walking away from.

“Every place has a golden handcuff,” he says. “The University of Chicago gives you three years before you’re fully vested in your retirement benefits; I know an Oklahoma hospital where it takes seven years. Leave before you’re vested and you could lose thousands of dollars in employer contributions. You have to ask, will your new job help you recover that quickly? Can you get a signing bonus that’s equal to all or most of what you’re walking away from, or the promise of a partnership? Try to mitigate that loss with other opportunities.

“Places like Kaiser Permanente offer money to help with a down payment for a house—that’s their version of a golden handcuff. If you stay in the job long enough, that becomes a free loan.”

Dr. Williams adds: “Will the group cover your moving expenses? That’s a lot of money. Also check on the state’s licensing fees and how long it will take to get your license—it varies greatly from state to state.”

While you’re interviewing, keep the negotiation process in mind: “I would never tell a recruiter or prospective employer all the reasons why I’m moving,” Dr. Badlani says. “You don’t want to show how interested you are. It’s a game you have to play. Be sure to say you’re looking at other opportunities and other towns.”

Finally, weigh your options against the rest of the market—and against what your peers are getting in terms of compensation and benefits.

“Talk to your friends and try to figure out what the best deal is,” Dr. Badlani says.

Although you can choose a hospitalist position anywhere in the country, the most important thing to consider is the group you’re joining. If it is not a good fit for your values and personality, then the state you’ve decided to move to will be one of discontent. TH

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

In today’s wide-open job market, hospitalists can pick a plum position anywhere in the United States. With promising opportunities in sunny Hawaii, bustling New York City, and everywhere in between—likely including your own hometown—the temptation to move to a warmer climate, kid-friendly small town, or bigger paycheck may be irresistible.

Michael-Anthony Williams, MD, chief medical officer for the Rocky Mountain Region of Sound Inpatient Physicians, has hired hospitalists who come to Denver from across the country.

“Market competition [for hospitalists] is definitely fierce and will remain so,” he says. “But no matter where you’re looking or what you’re searching for, you need to get a sense of the group you’ll be joining.”

Sameer Badlani, MD, hospitalist and instructor at the University of Chicago, agrees location should come second to the job itself. “You have to do a lot of introspection and decide what you’re looking for,” he cautions. “If you’re unhappy, ask yourself why a new job would be different.”

After taking this advice into account, consider the challenges and opportunities of starting life anew somewhere else.

Reasons to Relocate

Why think about moving in the first place?

“Money might be the biggest reason,” speculates Dr. Badlani. “The only way to make significantly more money is to become a partner in the practice. I’d say if you’re a hospitalist who’s relocating, you should definitely try to become a partner.”

Another reason to consider moving might be family reasons. “If a spouse gets a job offer in a different city, it’s easy for the hospitalist to move there and find a job,” Dr. Badlani points out. “With the economy the way it is, I think that more and more you’ll see spouses’ jobs influencing where hospitalists relocate.”

Some hospitalists move because they are drawn to a certain region or lifestyle. Dr. Williams says. “We certainly see people who target geography as playing a big role in their job search.”

If you fall into this category, be careful to do your research to discover the realities of your dream location.

“I’d advise that you make more than one trip to a place if you’ve never lived there before,” Dr. Badlani says. “See exactly what it means to live there. Visit the hospital medicine group more than once. Go out with a real estate agent and look at houses.”

Timing Is Everything

Once you’ve decided you are interested in moving—or have to move—get started with your location scouting and your job search.

“You should start looking [for a job] even earlier when you’re relocating,” Dr. Badlani advises. “And be sure to tell your supervisor that you’re thinking of relocating. This seems like a bad idea to some people, but it will be worse if you wait and give two weeks’ notice. That is unfair to your employer and your colleagues who will have to cover your work, and you will end up burning your bridges.” He recommends telling your current employer while interviewing for next year. If you’re already deep into your search, that should be about six or seven months in advance, he says.

“Your current employer will appreciate it, and they may even try to make some changes in order to keep you,” Dr. Badlani says.

Try to negotiate to keep your transition dates flexible. Your plans to move may not go as smoothly as you’d like. “Recently, we’ve seen a couple of people have a tough time selling their house before they move,” Dr. Williams says. “If you live in a tough real estate market, you might want to see if your new employer can be flexible on your start date.”

Consider Cost of Living

As you compare compensation offered by hospital medicine practices in different parts of the country—or even different parts of the same county—consider cost of living in each area.

“If you make $150,000 in Tulsa, Oklahoma, (then you need to make) $210,000 in Chicago,” Dr. Badlani says, who has worked in both cities. Cost of living, he adds, “can be misleading. Do your research and find out housing costs for the area. Online calculators only give approximations; make sure you compare housing in desirable areas of the city, not across the board.”

In addition, Dr. Badlani says, “If you choose a smaller town, it’s likely that you can get paid more—because they need you more—and live in a cheaper place. And you’ll find more opportunities in a smaller town because there are fewer doctors.”

The biggest challenge when comparing jobs is assessing the work required to make that salary, Dr. Williams adds. “Find out how many shifts per month you’ll work to earn it, and how many patients you’ll see per shift,” he suggests.

Relocation, Negotiation

Before you start negotiating a new contract, Dr. Badlani advises you first look at your current one to see what you’re walking away from.

“Every place has a golden handcuff,” he says. “The University of Chicago gives you three years before you’re fully vested in your retirement benefits; I know an Oklahoma hospital where it takes seven years. Leave before you’re vested and you could lose thousands of dollars in employer contributions. You have to ask, will your new job help you recover that quickly? Can you get a signing bonus that’s equal to all or most of what you’re walking away from, or the promise of a partnership? Try to mitigate that loss with other opportunities.

“Places like Kaiser Permanente offer money to help with a down payment for a house—that’s their version of a golden handcuff. If you stay in the job long enough, that becomes a free loan.”

Dr. Williams adds: “Will the group cover your moving expenses? That’s a lot of money. Also check on the state’s licensing fees and how long it will take to get your license—it varies greatly from state to state.”

While you’re interviewing, keep the negotiation process in mind: “I would never tell a recruiter or prospective employer all the reasons why I’m moving,” Dr. Badlani says. “You don’t want to show how interested you are. It’s a game you have to play. Be sure to say you’re looking at other opportunities and other towns.”

Finally, weigh your options against the rest of the market—and against what your peers are getting in terms of compensation and benefits.

“Talk to your friends and try to figure out what the best deal is,” Dr. Badlani says.

Although you can choose a hospitalist position anywhere in the country, the most important thing to consider is the group you’re joining. If it is not a good fit for your values and personality, then the state you’ve decided to move to will be one of discontent. TH

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

In today’s wide-open job market, hospitalists can pick a plum position anywhere in the United States. With promising opportunities in sunny Hawaii, bustling New York City, and everywhere in between—likely including your own hometown—the temptation to move to a warmer climate, kid-friendly small town, or bigger paycheck may be irresistible.

Michael-Anthony Williams, MD, chief medical officer for the Rocky Mountain Region of Sound Inpatient Physicians, has hired hospitalists who come to Denver from across the country.

“Market competition [for hospitalists] is definitely fierce and will remain so,” he says. “But no matter where you’re looking or what you’re searching for, you need to get a sense of the group you’ll be joining.”

Sameer Badlani, MD, hospitalist and instructor at the University of Chicago, agrees location should come second to the job itself. “You have to do a lot of introspection and decide what you’re looking for,” he cautions. “If you’re unhappy, ask yourself why a new job would be different.”

After taking this advice into account, consider the challenges and opportunities of starting life anew somewhere else.

Reasons to Relocate

Why think about moving in the first place?

“Money might be the biggest reason,” speculates Dr. Badlani. “The only way to make significantly more money is to become a partner in the practice. I’d say if you’re a hospitalist who’s relocating, you should definitely try to become a partner.”

Another reason to consider moving might be family reasons. “If a spouse gets a job offer in a different city, it’s easy for the hospitalist to move there and find a job,” Dr. Badlani points out. “With the economy the way it is, I think that more and more you’ll see spouses’ jobs influencing where hospitalists relocate.”

Some hospitalists move because they are drawn to a certain region or lifestyle. Dr. Williams says. “We certainly see people who target geography as playing a big role in their job search.”

If you fall into this category, be careful to do your research to discover the realities of your dream location.

“I’d advise that you make more than one trip to a place if you’ve never lived there before,” Dr. Badlani says. “See exactly what it means to live there. Visit the hospital medicine group more than once. Go out with a real estate agent and look at houses.”

Timing Is Everything

Once you’ve decided you are interested in moving—or have to move—get started with your location scouting and your job search.

“You should start looking [for a job] even earlier when you’re relocating,” Dr. Badlani advises. “And be sure to tell your supervisor that you’re thinking of relocating. This seems like a bad idea to some people, but it will be worse if you wait and give two weeks’ notice. That is unfair to your employer and your colleagues who will have to cover your work, and you will end up burning your bridges.” He recommends telling your current employer while interviewing for next year. If you’re already deep into your search, that should be about six or seven months in advance, he says.

“Your current employer will appreciate it, and they may even try to make some changes in order to keep you,” Dr. Badlani says.

Try to negotiate to keep your transition dates flexible. Your plans to move may not go as smoothly as you’d like. “Recently, we’ve seen a couple of people have a tough time selling their house before they move,” Dr. Williams says. “If you live in a tough real estate market, you might want to see if your new employer can be flexible on your start date.”

Consider Cost of Living

As you compare compensation offered by hospital medicine practices in different parts of the country—or even different parts of the same county—consider cost of living in each area.

“If you make $150,000 in Tulsa, Oklahoma, (then you need to make) $210,000 in Chicago,” Dr. Badlani says, who has worked in both cities. Cost of living, he adds, “can be misleading. Do your research and find out housing costs for the area. Online calculators only give approximations; make sure you compare housing in desirable areas of the city, not across the board.”

In addition, Dr. Badlani says, “If you choose a smaller town, it’s likely that you can get paid more—because they need you more—and live in a cheaper place. And you’ll find more opportunities in a smaller town because there are fewer doctors.”

The biggest challenge when comparing jobs is assessing the work required to make that salary, Dr. Williams adds. “Find out how many shifts per month you’ll work to earn it, and how many patients you’ll see per shift,” he suggests.

Relocation, Negotiation

Before you start negotiating a new contract, Dr. Badlani advises you first look at your current one to see what you’re walking away from.

“Every place has a golden handcuff,” he says. “The University of Chicago gives you three years before you’re fully vested in your retirement benefits; I know an Oklahoma hospital where it takes seven years. Leave before you’re vested and you could lose thousands of dollars in employer contributions. You have to ask, will your new job help you recover that quickly? Can you get a signing bonus that’s equal to all or most of what you’re walking away from, or the promise of a partnership? Try to mitigate that loss with other opportunities.

“Places like Kaiser Permanente offer money to help with a down payment for a house—that’s their version of a golden handcuff. If you stay in the job long enough, that becomes a free loan.”

Dr. Williams adds: “Will the group cover your moving expenses? That’s a lot of money. Also check on the state’s licensing fees and how long it will take to get your license—it varies greatly from state to state.”

While you’re interviewing, keep the negotiation process in mind: “I would never tell a recruiter or prospective employer all the reasons why I’m moving,” Dr. Badlani says. “You don’t want to show how interested you are. It’s a game you have to play. Be sure to say you’re looking at other opportunities and other towns.”

Finally, weigh your options against the rest of the market—and against what your peers are getting in terms of compensation and benefits.

“Talk to your friends and try to figure out what the best deal is,” Dr. Badlani says.

Although you can choose a hospitalist position anywhere in the country, the most important thing to consider is the group you’re joining. If it is not a good fit for your values and personality, then the state you’ve decided to move to will be one of discontent. TH

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

Have you seen what your discharged patients are saying about your hospital?

Now that patient satisfaction data is public, you can rest assured others are looking at how your facility stacks up against neighboring hospitals on doctor communication, pain management, and more.

As of late March, patient satisfaction information is available on the Centers for Medicare and Medicaid Services (CMS) Hospital Compare consumer Web site (www.hospital­compare.hhs.gov). This allows for a new level of transparency about the quality of care hospitals provide.

“This is an opportunity,” says Mark V. Williams, MD, director of the hospital medicine program at Northwestern University’s Feinberg School of Medicine in Chicago.

“Hospitalists ought to look up the information on their hospitals and, if they’re not doing well, go to their administrators and say they want to help bring those standings up.”

Satisfaction Defined

What is patient satisfaction? The Hospital Compare site terms this information “Survey of Patients’ Hospital Experiences” and offers a straight percentage of patient satisfaction for 10 areas, including these summary measures:

• How well nurses and doctors in the hospital communicated with the patient;
• How responsive hospital staff were to the patient’s needs;
• How well hospital staff helped the patient manage pain;
• How well the staff communicated with the patient about medicines; and
• Whether pertinent information was provided when the patient was discharged.

Additional items address the cleanliness and quietness of the patient’s room, as well as the patient’s overall rating of the hospital and whether the patient would recommend the hospital to others.

About the Survey

The CMS patient satisfaction percentages are compiled from hospital responses to the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). This is the first national, standardized, publicly reported survey of patients’ perspectives of hospital care.

Under CMS’ Reporting Hospital Quality Data Annual Payment Update program, hospitals subject to Inpatient Prospective Payment System (IPPS) payment provisions must collect and submit HCAHPS data to receive their full IPPS annual payment update. Other hospitals can voluntarily participate, but there is no incentive payment.

Hospitals administer the survey to a random sample of their adult Medicare patients (across medical conditions) anywhere from 48 hours to six weeks after discharge. They are allowed to conduct the survey by mail, telephone, mail with telephone follow-up, or active interactive voice recognition, and they either can integrate the HCAHPS questions with their own patient satisfaction survey or use HCAHPS by itself. Hospitals must survey patients throughout each month of the year.

CMS began reporting HCAHPS data in March on responses of patients discharged between October 2006 and June 2007. Results will be published quarterly and will comprise the most recent four quarters of data.

To the Rescue

Dr. Williams

How will this new aspect of transparency affect hospitalists?

“Hospitals are now going to be publicly exposed, as it were, and there will be increasing pressure on how to optimize these measures,” says Dr. Williams.

For this, they are likely to turn to their hospitalists. “Especially since hospitals spend so much money on supporting their hospital medicine programs, they’re going to want to see some return on that money in the form of improvement in these numbers.”

Although the data were added to Hospital Compare for the education of current and future patients, “I don’t think consumers look at this data at all,” Dr. Williams notes. “However, I think hospitals look at it, and they’ll use it to advertise [when they have impressive ratings on measures]. On these questions, hospitals are going to begin competing with each other.”

Hospitalists should be able to help their hospitals improve on specific ratings, just as they help with current quality and outcome measures.

“A lot of hospital medicine programs have already used patient satisfaction as a metric, with their own surveys,” Dr. Williams points out.

One patient satisfaction measure in particular can be addressed by hospitalists. “For HCAHPS, discharge is the component [with the lowest scores],” says Dr. Williams. “Obviously hospitalists can have a big impact on improving those numbers.”

Your own path to improving patient satisfaction is clear: Start by checking your hospital’s numbers on Hospital Compare—and remember those numbers can change quarterly. Consider how to boost satisfaction rates for some of those measures and get the buy-in you need to make changes that will bring the percentages up and keep them up. TH

Jane Jerrard is a medical writer based in Chicago.

Have you seen what your discharged patients are saying about your hospital?

Now that patient satisfaction data is public, you can rest assured others are looking at how your facility stacks up against neighboring hospitals on doctor communication, pain management, and more.

As of late March, patient satisfaction information is available on the Centers for Medicare and Medicaid Services (CMS) Hospital Compare consumer Web site (www.hospital­compare.hhs.gov). This allows for a new level of transparency about the quality of care hospitals provide.

“This is an opportunity,” says Mark V. Williams, MD, director of the hospital medicine program at Northwestern University’s Feinberg School of Medicine in Chicago.

“Hospitalists ought to look up the information on their hospitals and, if they’re not doing well, go to their administrators and say they want to help bring those standings up.”

Satisfaction Defined

What is patient satisfaction? The Hospital Compare site terms this information “Survey of Patients’ Hospital Experiences” and offers a straight percentage of patient satisfaction for 10 areas, including these summary measures:

• How well nurses and doctors in the hospital communicated with the patient;
• How responsive hospital staff were to the patient’s needs;
• How well hospital staff helped the patient manage pain;
• How well the staff communicated with the patient about medicines; and
• Whether pertinent information was provided when the patient was discharged.

Additional items address the cleanliness and quietness of the patient’s room, as well as the patient’s overall rating of the hospital and whether the patient would recommend the hospital to others.

About the Survey

The CMS patient satisfaction percentages are compiled from hospital responses to the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). This is the first national, standardized, publicly reported survey of patients’ perspectives of hospital care.

Under CMS’ Reporting Hospital Quality Data Annual Payment Update program, hospitals subject to Inpatient Prospective Payment System (IPPS) payment provisions must collect and submit HCAHPS data to receive their full IPPS annual payment update. Other hospitals can voluntarily participate, but there is no incentive payment.

Hospitals administer the survey to a random sample of their adult Medicare patients (across medical conditions) anywhere from 48 hours to six weeks after discharge. They are allowed to conduct the survey by mail, telephone, mail with telephone follow-up, or active interactive voice recognition, and they either can integrate the HCAHPS questions with their own patient satisfaction survey or use HCAHPS by itself. Hospitals must survey patients throughout each month of the year.

CMS began reporting HCAHPS data in March on responses of patients discharged between October 2006 and June 2007. Results will be published quarterly and will comprise the most recent four quarters of data.

To the Rescue

Dr. Williams

How will this new aspect of transparency affect hospitalists?

“Hospitals are now going to be publicly exposed, as it were, and there will be increasing pressure on how to optimize these measures,” says Dr. Williams.

For this, they are likely to turn to their hospitalists. “Especially since hospitals spend so much money on supporting their hospital medicine programs, they’re going to want to see some return on that money in the form of improvement in these numbers.”

Although the data were added to Hospital Compare for the education of current and future patients, “I don’t think consumers look at this data at all,” Dr. Williams notes. “However, I think hospitals look at it, and they’ll use it to advertise [when they have impressive ratings on measures]. On these questions, hospitals are going to begin competing with each other.”

Hospitalists should be able to help their hospitals improve on specific ratings, just as they help with current quality and outcome measures.

“A lot of hospital medicine programs have already used patient satisfaction as a metric, with their own surveys,” Dr. Williams points out.

One patient satisfaction measure in particular can be addressed by hospitalists. “For HCAHPS, discharge is the component [with the lowest scores],” says Dr. Williams. “Obviously hospitalists can have a big impact on improving those numbers.”

Your own path to improving patient satisfaction is clear: Start by checking your hospital’s numbers on Hospital Compare—and remember those numbers can change quarterly. Consider how to boost satisfaction rates for some of those measures and get the buy-in you need to make changes that will bring the percentages up and keep them up. TH

Jane Jerrard is a medical writer based in Chicago.

Have you seen what your discharged patients are saying about your hospital?

Now that patient satisfaction data is public, you can rest assured others are looking at how your facility stacks up against neighboring hospitals on doctor communication, pain management, and more.

As of late March, patient satisfaction information is available on the Centers for Medicare and Medicaid Services (CMS) Hospital Compare consumer Web site (www.hospital­compare.hhs.gov). This allows for a new level of transparency about the quality of care hospitals provide.

“This is an opportunity,” says Mark V. Williams, MD, director of the hospital medicine program at Northwestern University’s Feinberg School of Medicine in Chicago.

“Hospitalists ought to look up the information on their hospitals and, if they’re not doing well, go to their administrators and say they want to help bring those standings up.”

Satisfaction Defined

What is patient satisfaction? The Hospital Compare site terms this information “Survey of Patients’ Hospital Experiences” and offers a straight percentage of patient satisfaction for 10 areas, including these summary measures:

• How well nurses and doctors in the hospital communicated with the patient;
• How responsive hospital staff were to the patient’s needs;
• How well hospital staff helped the patient manage pain;
• How well the staff communicated with the patient about medicines; and
• Whether pertinent information was provided when the patient was discharged.

Additional items address the cleanliness and quietness of the patient’s room, as well as the patient’s overall rating of the hospital and whether the patient would recommend the hospital to others.

About the Survey

The CMS patient satisfaction percentages are compiled from hospital responses to the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). This is the first national, standardized, publicly reported survey of patients’ perspectives of hospital care.

Under CMS’ Reporting Hospital Quality Data Annual Payment Update program, hospitals subject to Inpatient Prospective Payment System (IPPS) payment provisions must collect and submit HCAHPS data to receive their full IPPS annual payment update. Other hospitals can voluntarily participate, but there is no incentive payment.

Hospitals administer the survey to a random sample of their adult Medicare patients (across medical conditions) anywhere from 48 hours to six weeks after discharge. They are allowed to conduct the survey by mail, telephone, mail with telephone follow-up, or active interactive voice recognition, and they either can integrate the HCAHPS questions with their own patient satisfaction survey or use HCAHPS by itself. Hospitals must survey patients throughout each month of the year.

CMS began reporting HCAHPS data in March on responses of patients discharged between October 2006 and June 2007. Results will be published quarterly and will comprise the most recent four quarters of data.

To the Rescue

Dr. Williams

How will this new aspect of transparency affect hospitalists?

“Hospitals are now going to be publicly exposed, as it were, and there will be increasing pressure on how to optimize these measures,” says Dr. Williams.

For this, they are likely to turn to their hospitalists. “Especially since hospitals spend so much money on supporting their hospital medicine programs, they’re going to want to see some return on that money in the form of improvement in these numbers.”

Although the data were added to Hospital Compare for the education of current and future patients, “I don’t think consumers look at this data at all,” Dr. Williams notes. “However, I think hospitals look at it, and they’ll use it to advertise [when they have impressive ratings on measures]. On these questions, hospitals are going to begin competing with each other.”

Hospitalists should be able to help their hospitals improve on specific ratings, just as they help with current quality and outcome measures.

“A lot of hospital medicine programs have already used patient satisfaction as a metric, with their own surveys,” Dr. Williams points out.

One patient satisfaction measure in particular can be addressed by hospitalists. “For HCAHPS, discharge is the component [with the lowest scores],” says Dr. Williams. “Obviously hospitalists can have a big impact on improving those numbers.”

Your own path to improving patient satisfaction is clear: Start by checking your hospital’s numbers on Hospital Compare—and remember those numbers can change quarterly. Consider how to boost satisfaction rates for some of those measures and get the buy-in you need to make changes that will bring the percentages up and keep them up. TH

Jane Jerrard is a medical writer based in Chicago.

If you’re early in your career as a hospitalist but plan to become a leader within your department or practice, you can start immediately.

Before your first assignment to take charge of a team or project, start “walking the walk.” In other words, exhibit leadership skills and traits on the job, in committees and in conversations, and you’ll draw attention to your potential for a chair position and position yourself for that first rung on the leadership ladder.

Demonstrate Key Skills

You don’t need a graduate-level class or a management textbook to practice some crucial leadership skills. Start at the most basic level: how you come across to everyone you interact with. Be on time, attend all meetings you are involved with, and come to those meetings prepared.

“Presenting yourself well is always good,” says Eric E. Howell MD, director of Collaborative Inpatient Medicine Service, Department of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, and course director for SHM’s Leadership Academy. “Speak clearly, be courteous and pleasant but not overly friendly, make eye contact … and one of my bosses once told me dress for your next job.” When you have an administrative meeting, change out of your dirty scrubs and into something businesslike.

As you perform your daily work, consider how you interact with other physicians and hospital staff.

“A hospitalist on a clinical team who is an effective communicator, who does things in a timely manner, is exhibiting leadership potential,” states Dr. Howell. “They’ll interact with their team, take quick, corrective action when necessary and give feedback in real-time in a way that’s not threatening.” As a director within a department of medicine, Dr. Howell chooses leaders regularly, and says, “That’s the first thing I look at when I’m looking for someone to fill a place on a committee.”

Ken Simone, DO, founder and president of Hospitalist and Practice Solutions in Brewer, Maine, agrees interaction with work teams is one place for an ambitious hospitalist to shine.

“Leaders have vision—and they create a common vision for the team,” he says. “They lead by example. A leader will work in the trenches and convey a positive attitude.”

Talk the Talk

As you practice basic leadership skills in your everyday work, you can take the next step. Develop and share your own opinions and insights on matters of quality improvement or standard processes and procedures.

“A hospitalist can display his or her leadership potential by sharing ideas and perspectives directly with the committee chair, department chiefs, chief medical officer or vice president of medical affairs, hospitalist clinical director, hospital CEO or COO,” Dr. Simone says. “It’s important for individuals seeking leadership positions to actively engage established leaders on the medical staff and in the medical community and share thoughts and ideas. True leaders are not afraid to take chances or expose themselves.”

Shine on Committees

Once you’ve earned a spot on one or more committees—or task forces or other official teams—you’ll have real opportunities to demonstrate your leadership potential.

“I’ll watch to see if the person participates,” says Dr. Howell of new committee members. “If you’re interested in leadership, you need to be a productive, active participant.”

There are many ways to be an active participant, even as a brand new committee member. “They may demonstrate their leadership skills by sharing their ideas during the meeting, by volunteering to spearhead an initiative that needs oversight, by chairing an ad hoc committee, by helping to facilitate the committee’s goals, or by sharing their experience in a similar situation,” Dr. Simone says. “They may also demonstrate their leadership abilities by being well prepared and informed on the agenda topics for the meeting.”

When you join committee discussions—or even discussions at a general staff meeting or departmental meeting—do your best to share insights and ideas rather than complaining.

“You must be able to express your views in an eloquent way,” instructs Dr. Howell. “If you disagree with [the chair or another committee member], you have to present another view or solution. Prove that you’re a problem-solver. This is a very useful trait and will show you as a potential leader.”

When an opportunity comes up to increase your participation, take it. “If you’re asked to help on a project that may be administrative or nonclinical, it’s important to say yes and to apply yourself to that project,” Dr. Howell says. “Do that, and people will think of you when it’s time to replace the chair of that committee.”

Training Helps

Although you don’t need formal training to start your leadership career, taking some steps can certainly help your cause.

“If you’re looking to advertise yourself as a leader, I like the people who have invested in themselves,” Dr. Howell says. “Those who have attended SHM’s Leadership Academy or otherwise taken efforts to improve themselves will stand out. It shows that they can be properly motivated, even if they don’t yet have the appropriate leadership skills.”

If you want to pursue leadership education—to gain important skills and to prove your motivation—Dr. Simone suggests you:

• Attend SHM Leadership Academy I and II;
• Attend hospitalist program management seminars;
• Attend business courses or complete an MBA program;
• Mentor with leaders within the hospital community;
• Participate in medical staff business and gain experience by exposure and participation; and/or
• Participate in your hospital’s medical staff leadership track if one exists.

Regardless of whether you decide to invest time and money into formal leadership training at this stage of your career, you can begin to position yourself as a leader by talking the talk and walking the walk.

“Involvement (e.g., attendance), active participation, preparation, and prudent risk-taking, to name a few examples, may be a recipe for success for aspiring young leaders,” summarizes Dr. Simone. TH

Jane Jerrard is a medical writer based in Chicago.

If you’re early in your career as a hospitalist but plan to become a leader within your department or practice, you can start immediately.

Before your first assignment to take charge of a team or project, start “walking the walk.” In other words, exhibit leadership skills and traits on the job, in committees and in conversations, and you’ll draw attention to your potential for a chair position and position yourself for that first rung on the leadership ladder.

Demonstrate Key Skills

You don’t need a graduate-level class or a management textbook to practice some crucial leadership skills. Start at the most basic level: how you come across to everyone you interact with. Be on time, attend all meetings you are involved with, and come to those meetings prepared.

“Presenting yourself well is always good,” says Eric E. Howell MD, director of Collaborative Inpatient Medicine Service, Department of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, and course director for SHM’s Leadership Academy. “Speak clearly, be courteous and pleasant but not overly friendly, make eye contact … and one of my bosses once told me dress for your next job.” When you have an administrative meeting, change out of your dirty scrubs and into something businesslike.

As you perform your daily work, consider how you interact with other physicians and hospital staff.

“A hospitalist on a clinical team who is an effective communicator, who does things in a timely manner, is exhibiting leadership potential,” states Dr. Howell. “They’ll interact with their team, take quick, corrective action when necessary and give feedback in real-time in a way that’s not threatening.” As a director within a department of medicine, Dr. Howell chooses leaders regularly, and says, “That’s the first thing I look at when I’m looking for someone to fill a place on a committee.”

Ken Simone, DO, founder and president of Hospitalist and Practice Solutions in Brewer, Maine, agrees interaction with work teams is one place for an ambitious hospitalist to shine.

“Leaders have vision—and they create a common vision for the team,” he says. “They lead by example. A leader will work in the trenches and convey a positive attitude.”

Talk the Talk

As you practice basic leadership skills in your everyday work, you can take the next step. Develop and share your own opinions and insights on matters of quality improvement or standard processes and procedures.

“A hospitalist can display his or her leadership potential by sharing ideas and perspectives directly with the committee chair, department chiefs, chief medical officer or vice president of medical affairs, hospitalist clinical director, hospital CEO or COO,” Dr. Simone says. “It’s important for individuals seeking leadership positions to actively engage established leaders on the medical staff and in the medical community and share thoughts and ideas. True leaders are not afraid to take chances or expose themselves.”

Shine on Committees

Once you’ve earned a spot on one or more committees—or task forces or other official teams—you’ll have real opportunities to demonstrate your leadership potential.

“I’ll watch to see if the person participates,” says Dr. Howell of new committee members. “If you’re interested in leadership, you need to be a productive, active participant.”

There are many ways to be an active participant, even as a brand new committee member. “They may demonstrate their leadership skills by sharing their ideas during the meeting, by volunteering to spearhead an initiative that needs oversight, by chairing an ad hoc committee, by helping to facilitate the committee’s goals, or by sharing their experience in a similar situation,” Dr. Simone says. “They may also demonstrate their leadership abilities by being well prepared and informed on the agenda topics for the meeting.”

When you join committee discussions—or even discussions at a general staff meeting or departmental meeting—do your best to share insights and ideas rather than complaining.

“You must be able to express your views in an eloquent way,” instructs Dr. Howell. “If you disagree with [the chair or another committee member], you have to present another view or solution. Prove that you’re a problem-solver. This is a very useful trait and will show you as a potential leader.”

When an opportunity comes up to increase your participation, take it. “If you’re asked to help on a project that may be administrative or nonclinical, it’s important to say yes and to apply yourself to that project,” Dr. Howell says. “Do that, and people will think of you when it’s time to replace the chair of that committee.”

Training Helps

Although you don’t need formal training to start your leadership career, taking some steps can certainly help your cause.

“If you’re looking to advertise yourself as a leader, I like the people who have invested in themselves,” Dr. Howell says. “Those who have attended SHM’s Leadership Academy or otherwise taken efforts to improve themselves will stand out. It shows that they can be properly motivated, even if they don’t yet have the appropriate leadership skills.”

If you want to pursue leadership education—to gain important skills and to prove your motivation—Dr. Simone suggests you:

• Attend SHM Leadership Academy I and II;
• Attend hospitalist program management seminars;
• Attend business courses or complete an MBA program;
• Mentor with leaders within the hospital community;
• Participate in medical staff business and gain experience by exposure and participation; and/or
• Participate in your hospital’s medical staff leadership track if one exists.

Regardless of whether you decide to invest time and money into formal leadership training at this stage of your career, you can begin to position yourself as a leader by talking the talk and walking the walk.

“Involvement (e.g., attendance), active participation, preparation, and prudent risk-taking, to name a few examples, may be a recipe for success for aspiring young leaders,” summarizes Dr. Simone. TH

Jane Jerrard is a medical writer based in Chicago.

If you’re early in your career as a hospitalist but plan to become a leader within your department or practice, you can start immediately.

Before your first assignment to take charge of a team or project, start “walking the walk.” In other words, exhibit leadership skills and traits on the job, in committees and in conversations, and you’ll draw attention to your potential for a chair position and position yourself for that first rung on the leadership ladder.

Demonstrate Key Skills

You don’t need a graduate-level class or a management textbook to practice some crucial leadership skills. Start at the most basic level: how you come across to everyone you interact with. Be on time, attend all meetings you are involved with, and come to those meetings prepared.

“Presenting yourself well is always good,” says Eric E. Howell MD, director of Collaborative Inpatient Medicine Service, Department of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, and course director for SHM’s Leadership Academy. “Speak clearly, be courteous and pleasant but not overly friendly, make eye contact … and one of my bosses once told me dress for your next job.” When you have an administrative meeting, change out of your dirty scrubs and into something businesslike.

As you perform your daily work, consider how you interact with other physicians and hospital staff.

“A hospitalist on a clinical team who is an effective communicator, who does things in a timely manner, is exhibiting leadership potential,” states Dr. Howell. “They’ll interact with their team, take quick, corrective action when necessary and give feedback in real-time in a way that’s not threatening.” As a director within a department of medicine, Dr. Howell chooses leaders regularly, and says, “That’s the first thing I look at when I’m looking for someone to fill a place on a committee.”

Ken Simone, DO, founder and president of Hospitalist and Practice Solutions in Brewer, Maine, agrees interaction with work teams is one place for an ambitious hospitalist to shine.

“Leaders have vision—and they create a common vision for the team,” he says. “They lead by example. A leader will work in the trenches and convey a positive attitude.”

Talk the Talk

As you practice basic leadership skills in your everyday work, you can take the next step. Develop and share your own opinions and insights on matters of quality improvement or standard processes and procedures.

“A hospitalist can display his or her leadership potential by sharing ideas and perspectives directly with the committee chair, department chiefs, chief medical officer or vice president of medical affairs, hospitalist clinical director, hospital CEO or COO,” Dr. Simone says. “It’s important for individuals seeking leadership positions to actively engage established leaders on the medical staff and in the medical community and share thoughts and ideas. True leaders are not afraid to take chances or expose themselves.”

Shine on Committees

Once you’ve earned a spot on one or more committees—or task forces or other official teams—you’ll have real opportunities to demonstrate your leadership potential.

“I’ll watch to see if the person participates,” says Dr. Howell of new committee members. “If you’re interested in leadership, you need to be a productive, active participant.”

There are many ways to be an active participant, even as a brand new committee member. “They may demonstrate their leadership skills by sharing their ideas during the meeting, by volunteering to spearhead an initiative that needs oversight, by chairing an ad hoc committee, by helping to facilitate the committee’s goals, or by sharing their experience in a similar situation,” Dr. Simone says. “They may also demonstrate their leadership abilities by being well prepared and informed on the agenda topics for the meeting.”

When you join committee discussions—or even discussions at a general staff meeting or departmental meeting—do your best to share insights and ideas rather than complaining.

“You must be able to express your views in an eloquent way,” instructs Dr. Howell. “If you disagree with [the chair or another committee member], you have to present another view or solution. Prove that you’re a problem-solver. This is a very useful trait and will show you as a potential leader.”

When an opportunity comes up to increase your participation, take it. “If you’re asked to help on a project that may be administrative or nonclinical, it’s important to say yes and to apply yourself to that project,” Dr. Howell says. “Do that, and people will think of you when it’s time to replace the chair of that committee.”

Training Helps

Although you don’t need formal training to start your leadership career, taking some steps can certainly help your cause.

“If you’re looking to advertise yourself as a leader, I like the people who have invested in themselves,” Dr. Howell says. “Those who have attended SHM’s Leadership Academy or otherwise taken efforts to improve themselves will stand out. It shows that they can be properly motivated, even if they don’t yet have the appropriate leadership skills.”

If you want to pursue leadership education—to gain important skills and to prove your motivation—Dr. Simone suggests you:

• Attend SHM Leadership Academy I and II;
• Attend hospitalist program management seminars;
• Attend business courses or complete an MBA program;
• Mentor with leaders within the hospital community;
• Participate in medical staff business and gain experience by exposure and participation; and/or
• Participate in your hospital’s medical staff leadership track if one exists.

Regardless of whether you decide to invest time and money into formal leadership training at this stage of your career, you can begin to position yourself as a leader by talking the talk and walking the walk.

“Involvement (e.g., attendance), active participation, preparation, and prudent risk-taking, to name a few examples, may be a recipe for success for aspiring young leaders,” summarizes Dr. Simone. TH

Jane Jerrard is a medical writer based in Chicago.

Gil Porat, MD

Many hospitalists face mysteries at work every day: a new admission’s enigmatic symptoms, inexplicable protocols for coding and other documentation—even the mystery of the missing chart.

One physician has created a much greater and more interesting mystery. Gil Porat, MD, a hospitalist with Colorado Springs Health Partners, just had his first novel, The Other Face of Murder, published by Alondra Press in April.

A Second Career

Dr. Porat worked on the novel steadily for years, starting during his residency. “I’ve been practicing medicine as a hospitalist for about five years now, so this novel has been a longer journey than medical school for me,” he admits.

His regular schedule, along with his dedication to writing, allowed him to finish the novel while working full time. “As a hospitalist, I work seven days on, seven days off, and that’s a terrific way to manage a second career,” explains Dr. Porat. “I spend my week off with my family—I have a wife and two boys—and on writing.”

Heavy Subject

The Other Face of Murder opens with a young physician stumbling across the corpse of his friend after hosting a dinner party. While it’s an entertaining mystery, the book also addresses deeper themes. As the physician investigates his friend’s untimely demise, he discovers not just “whodunit,” but ethical controversies behind the death.

“I did my residency in Oregon, which is the only state that has legalized physician-assisted suicide,” Dr. Porat notes. “The book discusses this, but it also discusses a lot of bioethical conundrums in medicine, including end-of-life care. It always disturbs physicians and staff to see a lot of suffering in end-of-life care; a big theme in the book is that we should be doing more palliative care [for these patients] and less intrusive care.”

Dr. Porat says he wrote the book for average mystery readers who may not be aware of these medical issues.

“My goal was to do more than just entertain; I wanted to teach some of the lessons that I’ve learned along the way,” he says. “Very little is heard in society regarding end-of-life issues. I hope this book will stimulate discussion about this in the general public.”

With his first published novel on the shelves, Dr. Porat has not taken a break. “I’m already working on a second book,” he says, “and that too will have a medical theme.” TH

Jane Jerrard is a medical writer based in Chicago.

Gil Porat, MD

Many hospitalists face mysteries at work every day: a new admission’s enigmatic symptoms, inexplicable protocols for coding and other documentation—even the mystery of the missing chart.

One physician has created a much greater and more interesting mystery. Gil Porat, MD, a hospitalist with Colorado Springs Health Partners, just had his first novel, The Other Face of Murder, published by Alondra Press in April.

A Second Career

Dr. Porat worked on the novel steadily for years, starting during his residency. “I’ve been practicing medicine as a hospitalist for about five years now, so this novel has been a longer journey than medical school for me,” he admits.

His regular schedule, along with his dedication to writing, allowed him to finish the novel while working full time. “As a hospitalist, I work seven days on, seven days off, and that’s a terrific way to manage a second career,” explains Dr. Porat. “I spend my week off with my family—I have a wife and two boys—and on writing.”

Heavy Subject

The Other Face of Murder opens with a young physician stumbling across the corpse of his friend after hosting a dinner party. While it’s an entertaining mystery, the book also addresses deeper themes. As the physician investigates his friend’s untimely demise, he discovers not just “whodunit,” but ethical controversies behind the death.

“I did my residency in Oregon, which is the only state that has legalized physician-assisted suicide,” Dr. Porat notes. “The book discusses this, but it also discusses a lot of bioethical conundrums in medicine, including end-of-life care. It always disturbs physicians and staff to see a lot of suffering in end-of-life care; a big theme in the book is that we should be doing more palliative care [for these patients] and less intrusive care.”

Dr. Porat says he wrote the book for average mystery readers who may not be aware of these medical issues.

“My goal was to do more than just entertain; I wanted to teach some of the lessons that I’ve learned along the way,” he says. “Very little is heard in society regarding end-of-life issues. I hope this book will stimulate discussion about this in the general public.”

With his first published novel on the shelves, Dr. Porat has not taken a break. “I’m already working on a second book,” he says, “and that too will have a medical theme.” TH

Jane Jerrard is a medical writer based in Chicago.

Gil Porat, MD

Many hospitalists face mysteries at work every day: a new admission’s enigmatic symptoms, inexplicable protocols for coding and other documentation—even the mystery of the missing chart.

One physician has created a much greater and more interesting mystery. Gil Porat, MD, a hospitalist with Colorado Springs Health Partners, just had his first novel, The Other Face of Murder, published by Alondra Press in April.

A Second Career

Dr. Porat worked on the novel steadily for years, starting during his residency. “I’ve been practicing medicine as a hospitalist for about five years now, so this novel has been a longer journey than medical school for me,” he admits.

His regular schedule, along with his dedication to writing, allowed him to finish the novel while working full time. “As a hospitalist, I work seven days on, seven days off, and that’s a terrific way to manage a second career,” explains Dr. Porat. “I spend my week off with my family—I have a wife and two boys—and on writing.”

Heavy Subject

The Other Face of Murder opens with a young physician stumbling across the corpse of his friend after hosting a dinner party. While it’s an entertaining mystery, the book also addresses deeper themes. As the physician investigates his friend’s untimely demise, he discovers not just “whodunit,” but ethical controversies behind the death.

“I did my residency in Oregon, which is the only state that has legalized physician-assisted suicide,” Dr. Porat notes. “The book discusses this, but it also discusses a lot of bioethical conundrums in medicine, including end-of-life care. It always disturbs physicians and staff to see a lot of suffering in end-of-life care; a big theme in the book is that we should be doing more palliative care [for these patients] and less intrusive care.”

Dr. Porat says he wrote the book for average mystery readers who may not be aware of these medical issues.

“My goal was to do more than just entertain; I wanted to teach some of the lessons that I’ve learned along the way,” he says. “Very little is heard in society regarding end-of-life issues. I hope this book will stimulate discussion about this in the general public.”

With his first published novel on the shelves, Dr. Porat has not taken a break. “I’m already working on a second book,” he says, “and that too will have a medical theme.” TH

Jane Jerrard is a medical writer based in Chicago.

State governments, private payors, Medicare, and hospitals have reached the same conclusion: Hospitals should not charge for preventable medical errors.

One of the latest entities to join this trend is Washington state. Early this year, healthcare associations there passed a resolution saying Washington healthcare providers no longer will charge for preventable hospital errors. The resolution applies to 28 “never events” published by the National Quality Forum (NQF). These are medical errors that clearly are identifiable, preventable, serious in their consequences for patients, and indicative of a real problem in the safety and credibility of a healthcare facility. (For a complete list of events, visit NQF’s Web site (www.qualityforum.org/pdf/news/prSeriousReportableEvents10-15-06.pdf).

Hospitals in Massachusetts, Minnesota, Pennsylvania, and Vermont have adopted similar policies. Private insurers Aetna, Wellpoint, and Blue Cross Blue Shield each are taking steps toward refusing payment for treatment resulting from serious medical errors in hospitals.

Amid these decisions, the American Hospital Association (AHA) released a quality advisory Feb. 12, recommending hospitals implement a no-charge policy for serious adverse errors.

“There’s certainly been a lot of conversation about aligning payment around outcomes,” says Nancy E. Foster, the AHA’s vice president for quality and patient safety policy. “Most of those conversations have focused on reward for doing the right thing, but there were certainly parts of those conversations based on the notion of who’s responsible and who pays when something that was preventable did happen.”

Even the federal government has gotten involved. Beginning in October, the Centers for Medicare and Medicaid Services (CMS) plans to no longer reimburse for specific preventable conditions.

CMS “Stop Payments”

If Congress approves Medicare’s plan, the CMS will not pay any extra-care costs for eight conditions unless they were present upon admission—and it prohibits hospitals from charging patients for such conditions. The conditions include three “never events”:

• Objects left in the body during surgery (“never event”);
• Air embolism (“never event”);
• Blood incompatibility (“never event”);
• Falls;
• Catheter-associated urinary tract infections;
• Pressure ulcers (decubitus ulcers);
• Vascular catheter-associated infection; and
• Surgical site infection after coronary artery bypass graft surgery (mediastinitis).

Next year, the CMS plans to add more conditions to the no-pay list. The most likely additions are ventilator-associated pneumonia, staphylococcus aureus septicemia, deep-vein thrombosis (DVT), and pulmonary embolism.

The CMS rule obviously directly affects hospital income, which will affect hospital processes and staff.

“As hospitalists, this affects us,” says Winthrop F. Whitcomb, MD, director of clinical performance improvement at Mercy Medical Center in Springfield, Mass., director of hospital medicine at Catholic Health East, and co-founder of SHM. “It’s another thing showcasing the value of hospitalists because we tend to document well. When a patient comes in with DVT or a pressure ulcer, we tend to document that, and that will help our hospitals.”

Other physicians may balk at hospital requests to amend or add to their notes to ensure payment, but, says Dr. Whitcomb: “Hospitalists understand the requirement for documentation. If you’re not a hospitalist, you may not be happy to be asked to change your documentation so that the hospital can get paid more, but we understand how important this is.”

Hospitals likely will continue to closely oversee physician documentation on Medicare patients.

“At our hospital, we [already] work with coders,” Dr. Whitcomb says. “I’ve heard of this more and more. They round with us now on every Medicare patient and review the charts. They actually write a formal note that prompts us to document accurately—they may ask us to amend that something was present on admission.” Dr. Whitcomb’s hospital has a paper-based system for this information; an electronic system will include this type of prompt. “Electronic prompts can be customized, but they can also be ignored; prompt fatigue is a big issue,” Dr. Whitcomb warns.

Another potential effect on hospitalists will be involvement in hospital efforts to prevent the eight conditions.

“The CMS change is definitely going to up the ante for quality improvement and patient safety work, no matter who undertakes it,” Dr. Whitcomb says. “It should expand opportunities for hospitalists to work in [quality improvement]. Hospitalists may end up leading teams to specifically address certain never events. The good news is, it gets right at the bottom line of the hospital, so nonclinicians like administrators in the financial office will immediately understand the importance of work like this.”

Leaving a sponge inside a patient is clearly a preventable medical error—but what about pressure ulcers? Or DVT?

In his “Wachter’s World” blog post of Feb. 11 (www.wachtersworld.org), Robert Wachter, MD, professor and associate chairman of the Department of Medicine at the University of California, San Francisco, addressed the CMS rule.

“For some of the events on the Medicare list, particularly the infections (such as catheter-related bloodstream infections), there is good evidence that the vast majority of events can be prevented,” Dr. Wachter wrote. “For others, such as pressure ulcers and falls, although some commonsensical practices have been widely promoted (particularly through IHI’s 5 Million Lives campaign), the evidence linking adherence to ‘prevention practices’ and reductions in adverse events is tenuous. These adverse events should stay off the list until the evidence is stronger.”

In spite of his misgivings, Dr. Wachter is a strong proponent of the trend toward nonpayment for preventable errors. “We’ve already seen hospitals putting far more resources into trying to prevent line infections, falls, and [pressure ulcers] than they were before,” he says. “And remember that the dollars at stake are relatively small. The extra payments for “Complicating Conditions” (CC) are not enormous, and many patients who have one CC have more than one; in which case, the hospital will still receive the extra payment even if the adverse event-related payment is denied. So, in essence the policy is creating an unusual amount of patient safety momentum for a relatively small displacement of dollars – a pretty clever trick.”

For more information on the CMS rule, read “Medicare’s decision to withhold payment for hospital errors: the devil is in the details,” by Dr. Wachter, Nancy Foster, and Adams Dudley, MD, in the February 2008 Joint Commission Journal of Quality and Patient Safety. TH

Jane Jerrard is a medical writer based in Chicago.

State governments, private payors, Medicare, and hospitals have reached the same conclusion: Hospitals should not charge for preventable medical errors.

One of the latest entities to join this trend is Washington state. Early this year, healthcare associations there passed a resolution saying Washington healthcare providers no longer will charge for preventable hospital errors. The resolution applies to 28 “never events” published by the National Quality Forum (NQF). These are medical errors that clearly are identifiable, preventable, serious in their consequences for patients, and indicative of a real problem in the safety and credibility of a healthcare facility. (For a complete list of events, visit NQF’s Web site (www.qualityforum.org/pdf/news/prSeriousReportableEvents10-15-06.pdf).

Hospitals in Massachusetts, Minnesota, Pennsylvania, and Vermont have adopted similar policies. Private insurers Aetna, Wellpoint, and Blue Cross Blue Shield each are taking steps toward refusing payment for treatment resulting from serious medical errors in hospitals.

Amid these decisions, the American Hospital Association (AHA) released a quality advisory Feb. 12, recommending hospitals implement a no-charge policy for serious adverse errors.

“There’s certainly been a lot of conversation about aligning payment around outcomes,” says Nancy E. Foster, the AHA’s vice president for quality and patient safety policy. “Most of those conversations have focused on reward for doing the right thing, but there were certainly parts of those conversations based on the notion of who’s responsible and who pays when something that was preventable did happen.”

Even the federal government has gotten involved. Beginning in October, the Centers for Medicare and Medicaid Services (CMS) plans to no longer reimburse for specific preventable conditions.

CMS “Stop Payments”

If Congress approves Medicare’s plan, the CMS will not pay any extra-care costs for eight conditions unless they were present upon admission—and it prohibits hospitals from charging patients for such conditions. The conditions include three “never events”:

• Objects left in the body during surgery (“never event”);
• Air embolism (“never event”);
• Blood incompatibility (“never event”);
• Falls;
• Catheter-associated urinary tract infections;
• Pressure ulcers (decubitus ulcers);
• Vascular catheter-associated infection; and
• Surgical site infection after coronary artery bypass graft surgery (mediastinitis).

Next year, the CMS plans to add more conditions to the no-pay list. The most likely additions are ventilator-associated pneumonia, staphylococcus aureus septicemia, deep-vein thrombosis (DVT), and pulmonary embolism.

The CMS rule obviously directly affects hospital income, which will affect hospital processes and staff.

“As hospitalists, this affects us,” says Winthrop F. Whitcomb, MD, director of clinical performance improvement at Mercy Medical Center in Springfield, Mass., director of hospital medicine at Catholic Health East, and co-founder of SHM. “It’s another thing showcasing the value of hospitalists because we tend to document well. When a patient comes in with DVT or a pressure ulcer, we tend to document that, and that will help our hospitals.”

Other physicians may balk at hospital requests to amend or add to their notes to ensure payment, but, says Dr. Whitcomb: “Hospitalists understand the requirement for documentation. If you’re not a hospitalist, you may not be happy to be asked to change your documentation so that the hospital can get paid more, but we understand how important this is.”

Hospitals likely will continue to closely oversee physician documentation on Medicare patients.

“At our hospital, we [already] work with coders,” Dr. Whitcomb says. “I’ve heard of this more and more. They round with us now on every Medicare patient and review the charts. They actually write a formal note that prompts us to document accurately—they may ask us to amend that something was present on admission.” Dr. Whitcomb’s hospital has a paper-based system for this information; an electronic system will include this type of prompt. “Electronic prompts can be customized, but they can also be ignored; prompt fatigue is a big issue,” Dr. Whitcomb warns.

Another potential effect on hospitalists will be involvement in hospital efforts to prevent the eight conditions.

“The CMS change is definitely going to up the ante for quality improvement and patient safety work, no matter who undertakes it,” Dr. Whitcomb says. “It should expand opportunities for hospitalists to work in [quality improvement]. Hospitalists may end up leading teams to specifically address certain never events. The good news is, it gets right at the bottom line of the hospital, so nonclinicians like administrators in the financial office will immediately understand the importance of work like this.”

Leaving a sponge inside a patient is clearly a preventable medical error—but what about pressure ulcers? Or DVT?

In his “Wachter’s World” blog post of Feb. 11 (www.wachtersworld.org), Robert Wachter, MD, professor and associate chairman of the Department of Medicine at the University of California, San Francisco, addressed the CMS rule.

“For some of the events on the Medicare list, particularly the infections (such as catheter-related bloodstream infections), there is good evidence that the vast majority of events can be prevented,” Dr. Wachter wrote. “For others, such as pressure ulcers and falls, although some commonsensical practices have been widely promoted (particularly through IHI’s 5 Million Lives campaign), the evidence linking adherence to ‘prevention practices’ and reductions in adverse events is tenuous. These adverse events should stay off the list until the evidence is stronger.”

In spite of his misgivings, Dr. Wachter is a strong proponent of the trend toward nonpayment for preventable errors. “We’ve already seen hospitals putting far more resources into trying to prevent line infections, falls, and [pressure ulcers] than they were before,” he says. “And remember that the dollars at stake are relatively small. The extra payments for “Complicating Conditions” (CC) are not enormous, and many patients who have one CC have more than one; in which case, the hospital will still receive the extra payment even if the adverse event-related payment is denied. So, in essence the policy is creating an unusual amount of patient safety momentum for a relatively small displacement of dollars – a pretty clever trick.”

For more information on the CMS rule, read “Medicare’s decision to withhold payment for hospital errors: the devil is in the details,” by Dr. Wachter, Nancy Foster, and Adams Dudley, MD, in the February 2008 Joint Commission Journal of Quality and Patient Safety. TH

Jane Jerrard is a medical writer based in Chicago.

State governments, private payors, Medicare, and hospitals have reached the same conclusion: Hospitals should not charge for preventable medical errors.

One of the latest entities to join this trend is Washington state. Early this year, healthcare associations there passed a resolution saying Washington healthcare providers no longer will charge for preventable hospital errors. The resolution applies to 28 “never events” published by the National Quality Forum (NQF). These are medical errors that clearly are identifiable, preventable, serious in their consequences for patients, and indicative of a real problem in the safety and credibility of a healthcare facility. (For a complete list of events, visit NQF’s Web site (www.qualityforum.org/pdf/news/prSeriousReportableEvents10-15-06.pdf).

Hospitals in Massachusetts, Minnesota, Pennsylvania, and Vermont have adopted similar policies. Private insurers Aetna, Wellpoint, and Blue Cross Blue Shield each are taking steps toward refusing payment for treatment resulting from serious medical errors in hospitals.

Amid these decisions, the American Hospital Association (AHA) released a quality advisory Feb. 12, recommending hospitals implement a no-charge policy for serious adverse errors.

“There’s certainly been a lot of conversation about aligning payment around outcomes,” says Nancy E. Foster, the AHA’s vice president for quality and patient safety policy. “Most of those conversations have focused on reward for doing the right thing, but there were certainly parts of those conversations based on the notion of who’s responsible and who pays when something that was preventable did happen.”

Even the federal government has gotten involved. Beginning in October, the Centers for Medicare and Medicaid Services (CMS) plans to no longer reimburse for specific preventable conditions.

CMS “Stop Payments”

If Congress approves Medicare’s plan, the CMS will not pay any extra-care costs for eight conditions unless they were present upon admission—and it prohibits hospitals from charging patients for such conditions. The conditions include three “never events”:

• Objects left in the body during surgery (“never event”);
• Air embolism (“never event”);
• Blood incompatibility (“never event”);
• Falls;
• Catheter-associated urinary tract infections;
• Pressure ulcers (decubitus ulcers);
• Vascular catheter-associated infection; and
• Surgical site infection after coronary artery bypass graft surgery (mediastinitis).

Next year, the CMS plans to add more conditions to the no-pay list. The most likely additions are ventilator-associated pneumonia, staphylococcus aureus septicemia, deep-vein thrombosis (DVT), and pulmonary embolism.

The CMS rule obviously directly affects hospital income, which will affect hospital processes and staff.

“As hospitalists, this affects us,” says Winthrop F. Whitcomb, MD, director of clinical performance improvement at Mercy Medical Center in Springfield, Mass., director of hospital medicine at Catholic Health East, and co-founder of SHM. “It’s another thing showcasing the value of hospitalists because we tend to document well. When a patient comes in with DVT or a pressure ulcer, we tend to document that, and that will help our hospitals.”

Other physicians may balk at hospital requests to amend or add to their notes to ensure payment, but, says Dr. Whitcomb: “Hospitalists understand the requirement for documentation. If you’re not a hospitalist, you may not be happy to be asked to change your documentation so that the hospital can get paid more, but we understand how important this is.”

Hospitals likely will continue to closely oversee physician documentation on Medicare patients.

“At our hospital, we [already] work with coders,” Dr. Whitcomb says. “I’ve heard of this more and more. They round with us now on every Medicare patient and review the charts. They actually write a formal note that prompts us to document accurately—they may ask us to amend that something was present on admission.” Dr. Whitcomb’s hospital has a paper-based system for this information; an electronic system will include this type of prompt. “Electronic prompts can be customized, but they can also be ignored; prompt fatigue is a big issue,” Dr. Whitcomb warns.

Another potential effect on hospitalists will be involvement in hospital efforts to prevent the eight conditions.

“The CMS change is definitely going to up the ante for quality improvement and patient safety work, no matter who undertakes it,” Dr. Whitcomb says. “It should expand opportunities for hospitalists to work in [quality improvement]. Hospitalists may end up leading teams to specifically address certain never events. The good news is, it gets right at the bottom line of the hospital, so nonclinicians like administrators in the financial office will immediately understand the importance of work like this.”

Leaving a sponge inside a patient is clearly a preventable medical error—but what about pressure ulcers? Or DVT?

In his “Wachter’s World” blog post of Feb. 11 (www.wachtersworld.org), Robert Wachter, MD, professor and associate chairman of the Department of Medicine at the University of California, San Francisco, addressed the CMS rule.

“For some of the events on the Medicare list, particularly the infections (such as catheter-related bloodstream infections), there is good evidence that the vast majority of events can be prevented,” Dr. Wachter wrote. “For others, such as pressure ulcers and falls, although some commonsensical practices have been widely promoted (particularly through IHI’s 5 Million Lives campaign), the evidence linking adherence to ‘prevention practices’ and reductions in adverse events is tenuous. These adverse events should stay off the list until the evidence is stronger.”

In spite of his misgivings, Dr. Wachter is a strong proponent of the trend toward nonpayment for preventable errors. “We’ve already seen hospitals putting far more resources into trying to prevent line infections, falls, and [pressure ulcers] than they were before,” he says. “And remember that the dollars at stake are relatively small. The extra payments for “Complicating Conditions” (CC) are not enormous, and many patients who have one CC have more than one; in which case, the hospital will still receive the extra payment even if the adverse event-related payment is denied. So, in essence the policy is creating an unusual amount of patient safety momentum for a relatively small displacement of dollars – a pretty clever trick.”

For more information on the CMS rule, read “Medicare’s decision to withhold payment for hospital errors: the devil is in the details,” by Dr. Wachter, Nancy Foster, and Adams Dudley, MD, in the February 2008 Joint Commission Journal of Quality and Patient Safety. TH

Jane Jerrard is a medical writer based in Chicago.

You may have had a mentor as a resident and possibly in your first year as a hospitalist, but don’t count out these valuable resources as you continue in your career. And don’t count out mentors who may come from other walks of life.

“It’s natural for physicians to look toward other physicians for guidance,” says Russell L. Holman, MD, chief operating officer for Cogent Healthcare, Nashville. “For physicians, including hospitalists, their natural inclination is to seek mentors who are physicians or have a similar training background. While there are many great physician mentors, you may be limiting yourself and missing opportunities that come from broader mentoring.”

Informal mentoring relationships are an excellent way to learn all sorts of leadership skills, from the subtle—like handling complains about a physician’s constant body odor—to hard skills, such as putting together a budget for your department or practice.

Management Mentors

Dr. Holman identified people at various stages in his career who could impart skills he sought, from a vice president of [human relations] for an integrated health system who steered him on personnel management and leadership development, to a carpenter-turned-attorney who helped him hone critical thinking skills.

“Talking to a mentor can show you the fresh side of new or old situations,” says Dr. Holman. “And you can feel comfortable telling them things that you wouldn’t tell anyone else. [When] you don’t work together, it provides a safe harbor to express ideas and opinions you normally wouldn’t.”

Mary Jo Gorman, MD, MBA, chief executive officer of Advanced ICU Care in St. Louis, Mo., agrees. “If you want someone to bounce ideas off of, try to find someone outside your organization,” she advises. She recommends physician organizations such as SHM: “Find someone who will listen, can keep their mouth shut and give you some honest feedback. For that reason, I’m a fan of professional coaches and career counselors. They provide an objective and unbiased audience and can suggest straightforward ways to manage sensitive issues.”

You also can find valuable mentors inside your workplace. “An often overlooked resource for hospitalist leaders is the other managers in their facilities,” says Dr. Gorman. “When I was a new manager, one of my mentors was the director of nursing. We could toss ideas back and forth, and she knew the politics and the personalities of the place, knew what mattered and what didn’t, and could steer me in the right direction.”

The managers and directors you work with, regardless of whether they’re physicians, are likely to have a lot of management experience, and can be resources for on-the-spot advice and guidance.

“Depending on the situation, even a chief operating officer or CEO of your hospital can give you good ideas and help you,” adds Dr. Gorman. “You’re a hospitalist; they’re supposed to be on your side. And they may be just five or 10 years older than you, but they have a lot of people management experience under their belts.”

They’re Everywhere

If you look beyond physicians and other healthcare professionals, finding an informal mentor is simply a matter of keeping your eyes and your mind open.

“You find a mentor by being in different situations,” Dr. Holman says. “Take advantage of getting to know people in different spheres, see what makes them tick that you can learn and apply to yourself.”

Consider all aspects of your life outside the workplace—your neighborhood, your church, your children’s school, any organizations you volunteer for, or social venues. Even your family—does anyone have management or business experience?

Keep your options open for learning from others, but if you have a specific area where you want to gain knowledge, you can search your circle of acquaintances to see who might be able to fill in that gap.

“Outside of healthcare, my personal accountant was a huge help,” says Dr. Gorman. “He sat down with me and helped me understand the financials I was supposed to do. You may have to pay for this service, but if you’re just asking for a few hours of their time and you have a good relationship, they’ll help you out.”

Regardless of what you want to learn, keep in mind that mentors can come in any shape and form. “A mentor can be someone younger than you, someone less well educated,” Dr. Holman points out. “What matters is when you recognize the value of the perspectives they bring.”

In fact, Dr. Holman says, he deliberately looks for people who are a little different from himself. “We tend to gravitate to those who are like us, but [in mentoring] this doesn’t lend itself to the greatest growth long-term,” he explains.

Make Mentoring Work

When you target someone as a potential mentor, it’s best to start with occasional questions and keep the relationship casual.

“My experience—and this is supported by literature—is that mentoring relationships are most solid when they form naturally,” Dr. Holman says. “The mentorship arena lends itself to flexibility and informal structure.”

Dr. Gorman agrees, suggesting that you not even mention “the M word.” “In my experience, asking someone flat out if they’ll be your mentor doesn’t really work,” Dr. Gorman says. “It sounds like a big commitment, and they shy away from it. Instead, I’d say just keep going back to the same people for guidance. Find those people who will listen to you and give you some help.”

Once you establish a mentoring relationship, try to find a way to return the favor—at least by being a good mentee.

“It’s particularly rewarding when mentoring is not one-sided, when each person has something to bring to the table,” Dr. Holman says. “Though it may be mostly one-sided, it’s good to be able to give some advice or counsel in return.”

Dr. Gorman adds that a good mentee either will act on advice or address why they didn’t. “No one likes to give advice just to see you blow it off, or head straight into a situation they warned you against,” she stresses. “Be respectful of their time, and be prepared when you present a problem. And be sure to thank them. You don’t have to send flowers or anything, just a verbal thank you for their time.”

No matter what stage your career is in, you can always pick up new skills and perspectives—particularly if you’re in a leadership position. Even if you feel you’re well established, finding new mentors can only make you better at what you do.

“You should always look for someone to learn from,” Dr. Gorman says. “They’re out there, no matter where you are or what you’re doing. Throw out some questions and see who you hit it off with, who gives you sound advice.” TH

Jane Jerrard writes “Public Policy” for The Hospitalist.

You may have had a mentor as a resident and possibly in your first year as a hospitalist, but don’t count out these valuable resources as you continue in your career. And don’t count out mentors who may come from other walks of life.

“It’s natural for physicians to look toward other physicians for guidance,” says Russell L. Holman, MD, chief operating officer for Cogent Healthcare, Nashville. “For physicians, including hospitalists, their natural inclination is to seek mentors who are physicians or have a similar training background. While there are many great physician mentors, you may be limiting yourself and missing opportunities that come from broader mentoring.”

Informal mentoring relationships are an excellent way to learn all sorts of leadership skills, from the subtle—like handling complains about a physician’s constant body odor—to hard skills, such as putting together a budget for your department or practice.

Management Mentors

Dr. Holman identified people at various stages in his career who could impart skills he sought, from a vice president of [human relations] for an integrated health system who steered him on personnel management and leadership development, to a carpenter-turned-attorney who helped him hone critical thinking skills.

“Talking to a mentor can show you the fresh side of new or old situations,” says Dr. Holman. “And you can feel comfortable telling them things that you wouldn’t tell anyone else. [When] you don’t work together, it provides a safe harbor to express ideas and opinions you normally wouldn’t.”

Mary Jo Gorman, MD, MBA, chief executive officer of Advanced ICU Care in St. Louis, Mo., agrees. “If you want someone to bounce ideas off of, try to find someone outside your organization,” she advises. She recommends physician organizations such as SHM: “Find someone who will listen, can keep their mouth shut and give you some honest feedback. For that reason, I’m a fan of professional coaches and career counselors. They provide an objective and unbiased audience and can suggest straightforward ways to manage sensitive issues.”

You also can find valuable mentors inside your workplace. “An often overlooked resource for hospitalist leaders is the other managers in their facilities,” says Dr. Gorman. “When I was a new manager, one of my mentors was the director of nursing. We could toss ideas back and forth, and she knew the politics and the personalities of the place, knew what mattered and what didn’t, and could steer me in the right direction.”

The managers and directors you work with, regardless of whether they’re physicians, are likely to have a lot of management experience, and can be resources for on-the-spot advice and guidance.

“Depending on the situation, even a chief operating officer or CEO of your hospital can give you good ideas and help you,” adds Dr. Gorman. “You’re a hospitalist; they’re supposed to be on your side. And they may be just five or 10 years older than you, but they have a lot of people management experience under their belts.”

They’re Everywhere

If you look beyond physicians and other healthcare professionals, finding an informal mentor is simply a matter of keeping your eyes and your mind open.

“You find a mentor by being in different situations,” Dr. Holman says. “Take advantage of getting to know people in different spheres, see what makes them tick that you can learn and apply to yourself.”

Consider all aspects of your life outside the workplace—your neighborhood, your church, your children’s school, any organizations you volunteer for, or social venues. Even your family—does anyone have management or business experience?

Keep your options open for learning from others, but if you have a specific area where you want to gain knowledge, you can search your circle of acquaintances to see who might be able to fill in that gap.

“Outside of healthcare, my personal accountant was a huge help,” says Dr. Gorman. “He sat down with me and helped me understand the financials I was supposed to do. You may have to pay for this service, but if you’re just asking for a few hours of their time and you have a good relationship, they’ll help you out.”

Regardless of what you want to learn, keep in mind that mentors can come in any shape and form. “A mentor can be someone younger than you, someone less well educated,” Dr. Holman points out. “What matters is when you recognize the value of the perspectives they bring.”

In fact, Dr. Holman says, he deliberately looks for people who are a little different from himself. “We tend to gravitate to those who are like us, but [in mentoring] this doesn’t lend itself to the greatest growth long-term,” he explains.

Make Mentoring Work

When you target someone as a potential mentor, it’s best to start with occasional questions and keep the relationship casual.

“My experience—and this is supported by literature—is that mentoring relationships are most solid when they form naturally,” Dr. Holman says. “The mentorship arena lends itself to flexibility and informal structure.”

Dr. Gorman agrees, suggesting that you not even mention “the M word.” “In my experience, asking someone flat out if they’ll be your mentor doesn’t really work,” Dr. Gorman says. “It sounds like a big commitment, and they shy away from it. Instead, I’d say just keep going back to the same people for guidance. Find those people who will listen to you and give you some help.”

Once you establish a mentoring relationship, try to find a way to return the favor—at least by being a good mentee.

“It’s particularly rewarding when mentoring is not one-sided, when each person has something to bring to the table,” Dr. Holman says. “Though it may be mostly one-sided, it’s good to be able to give some advice or counsel in return.”

Dr. Gorman adds that a good mentee either will act on advice or address why they didn’t. “No one likes to give advice just to see you blow it off, or head straight into a situation they warned you against,” she stresses. “Be respectful of their time, and be prepared when you present a problem. And be sure to thank them. You don’t have to send flowers or anything, just a verbal thank you for their time.”

No matter what stage your career is in, you can always pick up new skills and perspectives—particularly if you’re in a leadership position. Even if you feel you’re well established, finding new mentors can only make you better at what you do.

“You should always look for someone to learn from,” Dr. Gorman says. “They’re out there, no matter where you are or what you’re doing. Throw out some questions and see who you hit it off with, who gives you sound advice.” TH

Jane Jerrard writes “Public Policy” for The Hospitalist.

You may have had a mentor as a resident and possibly in your first year as a hospitalist, but don’t count out these valuable resources as you continue in your career. And don’t count out mentors who may come from other walks of life.

“It’s natural for physicians to look toward other physicians for guidance,” says Russell L. Holman, MD, chief operating officer for Cogent Healthcare, Nashville. “For physicians, including hospitalists, their natural inclination is to seek mentors who are physicians or have a similar training background. While there are many great physician mentors, you may be limiting yourself and missing opportunities that come from broader mentoring.”

Informal mentoring relationships are an excellent way to learn all sorts of leadership skills, from the subtle—like handling complains about a physician’s constant body odor—to hard skills, such as putting together a budget for your department or practice.

Management Mentors

Dr. Holman identified people at various stages in his career who could impart skills he sought, from a vice president of [human relations] for an integrated health system who steered him on personnel management and leadership development, to a carpenter-turned-attorney who helped him hone critical thinking skills.

“Talking to a mentor can show you the fresh side of new or old situations,” says Dr. Holman. “And you can feel comfortable telling them things that you wouldn’t tell anyone else. [When] you don’t work together, it provides a safe harbor to express ideas and opinions you normally wouldn’t.”

Mary Jo Gorman, MD, MBA, chief executive officer of Advanced ICU Care in St. Louis, Mo., agrees. “If you want someone to bounce ideas off of, try to find someone outside your organization,” she advises. She recommends physician organizations such as SHM: “Find someone who will listen, can keep their mouth shut and give you some honest feedback. For that reason, I’m a fan of professional coaches and career counselors. They provide an objective and unbiased audience and can suggest straightforward ways to manage sensitive issues.”

You also can find valuable mentors inside your workplace. “An often overlooked resource for hospitalist leaders is the other managers in their facilities,” says Dr. Gorman. “When I was a new manager, one of my mentors was the director of nursing. We could toss ideas back and forth, and she knew the politics and the personalities of the place, knew what mattered and what didn’t, and could steer me in the right direction.”

The managers and directors you work with, regardless of whether they’re physicians, are likely to have a lot of management experience, and can be resources for on-the-spot advice and guidance.

“Depending on the situation, even a chief operating officer or CEO of your hospital can give you good ideas and help you,” adds Dr. Gorman. “You’re a hospitalist; they’re supposed to be on your side. And they may be just five or 10 years older than you, but they have a lot of people management experience under their belts.”

They’re Everywhere

If you look beyond physicians and other healthcare professionals, finding an informal mentor is simply a matter of keeping your eyes and your mind open.

“You find a mentor by being in different situations,” Dr. Holman says. “Take advantage of getting to know people in different spheres, see what makes them tick that you can learn and apply to yourself.”

Consider all aspects of your life outside the workplace—your neighborhood, your church, your children’s school, any organizations you volunteer for, or social venues. Even your family—does anyone have management or business experience?

Keep your options open for learning from others, but if you have a specific area where you want to gain knowledge, you can search your circle of acquaintances to see who might be able to fill in that gap.

“Outside of healthcare, my personal accountant was a huge help,” says Dr. Gorman. “He sat down with me and helped me understand the financials I was supposed to do. You may have to pay for this service, but if you’re just asking for a few hours of their time and you have a good relationship, they’ll help you out.”

Regardless of what you want to learn, keep in mind that mentors can come in any shape and form. “A mentor can be someone younger than you, someone less well educated,” Dr. Holman points out. “What matters is when you recognize the value of the perspectives they bring.”

In fact, Dr. Holman says, he deliberately looks for people who are a little different from himself. “We tend to gravitate to those who are like us, but [in mentoring] this doesn’t lend itself to the greatest growth long-term,” he explains.

Make Mentoring Work

When you target someone as a potential mentor, it’s best to start with occasional questions and keep the relationship casual.

“My experience—and this is supported by literature—is that mentoring relationships are most solid when they form naturally,” Dr. Holman says. “The mentorship arena lends itself to flexibility and informal structure.”

Dr. Gorman agrees, suggesting that you not even mention “the M word.” “In my experience, asking someone flat out if they’ll be your mentor doesn’t really work,” Dr. Gorman says. “It sounds like a big commitment, and they shy away from it. Instead, I’d say just keep going back to the same people for guidance. Find those people who will listen to you and give you some help.”

Once you establish a mentoring relationship, try to find a way to return the favor—at least by being a good mentee.

“It’s particularly rewarding when mentoring is not one-sided, when each person has something to bring to the table,” Dr. Holman says. “Though it may be mostly one-sided, it’s good to be able to give some advice or counsel in return.”

Dr. Gorman adds that a good mentee either will act on advice or address why they didn’t. “No one likes to give advice just to see you blow it off, or head straight into a situation they warned you against,” she stresses. “Be respectful of their time, and be prepared when you present a problem. And be sure to thank them. You don’t have to send flowers or anything, just a verbal thank you for their time.”

No matter what stage your career is in, you can always pick up new skills and perspectives—particularly if you’re in a leadership position. Even if you feel you’re well established, finding new mentors can only make you better at what you do.

“You should always look for someone to learn from,” Dr. Gorman says. “They’re out there, no matter where you are or what you’re doing. Throw out some questions and see who you hit it off with, who gives you sound advice.” TH

Jane Jerrard writes “Public Policy” for The Hospitalist.

The best and brightest thinking from today’s hospitalists was on display in the poster presentations in San Diego. Of 265 abstracts submitted to the Research, Innovations and Clinical Vignettes (RIV) Competition, 195 were accepted for poster presentations.

“The quality and quantity of abstract submissions increases every year,” said Sylvia McKean, MD, course director of Hospital Medicine 2008.

Best in Show

“It’s been a banner year for the poster presentations,” said Jeffrey Greenwald, MD, hospital medicine unit director, Boston Medical Center, as he announced the winning abstracts during the President’s Lunch on April 5:

• Research: “Prevention of Hospital-Acquired Venous Thromboembolism: Prospective Validation of a VTE Risk Assessment Model and Protocol, Greg Maynard, MD, MSc, professor of clinical medicine and chief of the division of hospital medicine at the University of California, San Diego.
• Innovations: “Can Tissue Models Be Used to Teach Central Line Placement? Phase II of the Procedure Patient Safety Initiative (PPSI), Annie R. Harrington, MD, Cedars-Sinai Medical Center, Los Angeles; and
• Clinical Vignettes: “A Case of Salty Voluminous Urine, Twylla Tassava, MD, Saint Joseph Mercy Hospital, Ann Arbor, Mich.

Other Notable Works

Param Dedhia, MD, presented research he conducted with colleagues from Johns Hopkins Bayview Medical Center titled “Safe STEPS: Safe and Successful Transition of Elderly Patients.” The group developed an interdisciplinary, multifaceted intervention in this area, which included:

• A history and physical exam tailored to geriatric patients;
• A “fast facts fax” to communicate with the primary care physician;
• An interdisciplinary team worksheet for centralized input;
• A medical evaluation including a detailed review with the pharmacist; and?
• A pre-discharge appointment.

The results: A 15-question survey showed a 60% to 90% jump in patient satisfaction. A health assessment by self-report showed improvement as well, and the number of revisits and readmissions dropped from 10% to 3%.

“The Impact of Fragmentation of Hospitalist Care on Length of Stay and Post-Discharge Issues” was presented by Kenneth R. Epstein, MD, MBA, of IPC-The Hospitalist Company. Dr. Epstein and his colleagues used an observational study of data from IPC’s billing and clinical database on inpatient admissions with pneumonia with complications and heart failure and shock. They wanted to see if fragmented hospitalist care—care provided by more than one hospitalist—affected outcomes for these patients.

Using a fragmentation formula that included the number of days as an inpatient and the number of hospitalists who provided care, they found that for every 10% increase in fragmentation, the length of stay increased 0.45 days for pneumonia patients and 0.38 days for heart failure patients.

The country’s first fellowship for physician assistants (PA) specializing in hospital medicine was detailed in “The Mayo Clinic Arizona Post-Graduate PA Fellowship in Hospital Internal Medicine.” Kristen K. Will, MHPE, PA-C, co-program director of clinic’s PA Fellowship Program, outlined how her institution initiated the fellowship in October. The program will train one PA using hospital medicine-specific clinical rotations, didactic instruction, and teaching modules.

The best and brightest thinking from today’s hospitalists was on display in the poster presentations in San Diego. Of 265 abstracts submitted to the Research, Innovations and Clinical Vignettes (RIV) Competition, 195 were accepted for poster presentations.

“The quality and quantity of abstract submissions increases every year,” said Sylvia McKean, MD, course director of Hospital Medicine 2008.

Best in Show

“It’s been a banner year for the poster presentations,” said Jeffrey Greenwald, MD, hospital medicine unit director, Boston Medical Center, as he announced the winning abstracts during the President’s Lunch on April 5:

• Research: “Prevention of Hospital-Acquired Venous Thromboembolism: Prospective Validation of a VTE Risk Assessment Model and Protocol, Greg Maynard, MD, MSc, professor of clinical medicine and chief of the division of hospital medicine at the University of California, San Diego.
• Innovations: “Can Tissue Models Be Used to Teach Central Line Placement? Phase II of the Procedure Patient Safety Initiative (PPSI), Annie R. Harrington, MD, Cedars-Sinai Medical Center, Los Angeles; and
• Clinical Vignettes: “A Case of Salty Voluminous Urine, Twylla Tassava, MD, Saint Joseph Mercy Hospital, Ann Arbor, Mich.

Other Notable Works

Param Dedhia, MD, presented research he conducted with colleagues from Johns Hopkins Bayview Medical Center titled “Safe STEPS: Safe and Successful Transition of Elderly Patients.” The group developed an interdisciplinary, multifaceted intervention in this area, which included:

• A history and physical exam tailored to geriatric patients;
• A “fast facts fax” to communicate with the primary care physician;
• An interdisciplinary team worksheet for centralized input;
• A medical evaluation including a detailed review with the pharmacist; and?
• A pre-discharge appointment.

The results: A 15-question survey showed a 60% to 90% jump in patient satisfaction. A health assessment by self-report showed improvement as well, and the number of revisits and readmissions dropped from 10% to 3%.

“The Impact of Fragmentation of Hospitalist Care on Length of Stay and Post-Discharge Issues” was presented by Kenneth R. Epstein, MD, MBA, of IPC-The Hospitalist Company. Dr. Epstein and his colleagues used an observational study of data from IPC’s billing and clinical database on inpatient admissions with pneumonia with complications and heart failure and shock. They wanted to see if fragmented hospitalist care—care provided by more than one hospitalist—affected outcomes for these patients.

Using a fragmentation formula that included the number of days as an inpatient and the number of hospitalists who provided care, they found that for every 10% increase in fragmentation, the length of stay increased 0.45 days for pneumonia patients and 0.38 days for heart failure patients.

The country’s first fellowship for physician assistants (PA) specializing in hospital medicine was detailed in “The Mayo Clinic Arizona Post-Graduate PA Fellowship in Hospital Internal Medicine.” Kristen K. Will, MHPE, PA-C, co-program director of clinic’s PA Fellowship Program, outlined how her institution initiated the fellowship in October. The program will train one PA using hospital medicine-specific clinical rotations, didactic instruction, and teaching modules.

The best and brightest thinking from today’s hospitalists was on display in the poster presentations in San Diego. Of 265 abstracts submitted to the Research, Innovations and Clinical Vignettes (RIV) Competition, 195 were accepted for poster presentations.

“The quality and quantity of abstract submissions increases every year,” said Sylvia McKean, MD, course director of Hospital Medicine 2008.

Best in Show

“It’s been a banner year for the poster presentations,” said Jeffrey Greenwald, MD, hospital medicine unit director, Boston Medical Center, as he announced the winning abstracts during the President’s Lunch on April 5:

• Research: “Prevention of Hospital-Acquired Venous Thromboembolism: Prospective Validation of a VTE Risk Assessment Model and Protocol, Greg Maynard, MD, MSc, professor of clinical medicine and chief of the division of hospital medicine at the University of California, San Diego.
• Innovations: “Can Tissue Models Be Used to Teach Central Line Placement? Phase II of the Procedure Patient Safety Initiative (PPSI), Annie R. Harrington, MD, Cedars-Sinai Medical Center, Los Angeles; and
• Clinical Vignettes: “A Case of Salty Voluminous Urine, Twylla Tassava, MD, Saint Joseph Mercy Hospital, Ann Arbor, Mich.

Other Notable Works

Param Dedhia, MD, presented research he conducted with colleagues from Johns Hopkins Bayview Medical Center titled “Safe STEPS: Safe and Successful Transition of Elderly Patients.” The group developed an interdisciplinary, multifaceted intervention in this area, which included:

• A history and physical exam tailored to geriatric patients;
• A “fast facts fax” to communicate with the primary care physician;
• An interdisciplinary team worksheet for centralized input;
• A medical evaluation including a detailed review with the pharmacist; and?
• A pre-discharge appointment.

The results: A 15-question survey showed a 60% to 90% jump in patient satisfaction. A health assessment by self-report showed improvement as well, and the number of revisits and readmissions dropped from 10% to 3%.

“The Impact of Fragmentation of Hospitalist Care on Length of Stay and Post-Discharge Issues” was presented by Kenneth R. Epstein, MD, MBA, of IPC-The Hospitalist Company. Dr. Epstein and his colleagues used an observational study of data from IPC’s billing and clinical database on inpatient admissions with pneumonia with complications and heart failure and shock. They wanted to see if fragmented hospitalist care—care provided by more than one hospitalist—affected outcomes for these patients.

Using a fragmentation formula that included the number of days as an inpatient and the number of hospitalists who provided care, they found that for every 10% increase in fragmentation, the length of stay increased 0.45 days for pneumonia patients and 0.38 days for heart failure patients.

The country’s first fellowship for physician assistants (PA) specializing in hospital medicine was detailed in “The Mayo Clinic Arizona Post-Graduate PA Fellowship in Hospital Internal Medicine.” Kristen K. Will, MHPE, PA-C, co-program director of clinic’s PA Fellowship Program, outlined how her institution initiated the fellowship in October. The program will train one PA using hospital medicine-specific clinical rotations, didactic instruction, and teaching modules.