Jane Jerrard

Those responsible for teaching hospital medicine to residents and medical students had an unprecedented opportunity to become students for the day and learn from top teachers in the field.

An important new addition to the all-day precourses was the “Teaching Hospitalist Educators (THE) Course: What Clinical Teachers in Hospital Medicine Need to Know.” The session was presented by Jeffrey Wiese, MD, FACP, associate professor of medicine at Tulane University Health Sciences Center in New Orleans, and Mark Williams, MD, director of the hospital medicine program at Northwestern University’s Feinberg School of Medicine in Chicago.

“This pre-course was developed in response to requests from [SHM’s] Education Committee,” said Sylvia McKean, MD, chair of SHM’s Annual Meeting Committee. “It fold[s] in the best suggestions for hospitalist educators. It’s designed to shift those hospitalists who are responsible for education away from knowledge-only [teaching] and toward a performance-based focus.”

The pre-course used SHM’s The Core Competencies in Hospital Medicine as a framework to provide a competency-based model of physician education, one that emphasizes performance-based competencies such as procedures, practice-based learning, and “people skills.” This model can be adapted to teaching residents and students at the bedside as well as in conference rooms and large lecture halls.

“It went beyond curriculum,” said attendee Kevin O’Leary, MD. “It inspired people to think creatively about their own curriculum at home … it was an enlightened teaching model.”

The more than 85 hospitalist educators who attended the pre-course were asked to start a networking group to be called the SHM Educator Network, which will exchange resources and curriculum.

“The goal is for people to share talking points and generate additional tools,” Dr. Williams said. “There are lots of new faculty” teaching hospital medicine across the country. “They need training and they need resources.”

Those responsible for teaching hospital medicine to residents and medical students had an unprecedented opportunity to become students for the day and learn from top teachers in the field.

An important new addition to the all-day precourses was the “Teaching Hospitalist Educators (THE) Course: What Clinical Teachers in Hospital Medicine Need to Know.” The session was presented by Jeffrey Wiese, MD, FACP, associate professor of medicine at Tulane University Health Sciences Center in New Orleans, and Mark Williams, MD, director of the hospital medicine program at Northwestern University’s Feinberg School of Medicine in Chicago.

“This pre-course was developed in response to requests from [SHM’s] Education Committee,” said Sylvia McKean, MD, chair of SHM’s Annual Meeting Committee. “It fold[s] in the best suggestions for hospitalist educators. It’s designed to shift those hospitalists who are responsible for education away from knowledge-only [teaching] and toward a performance-based focus.”

The pre-course used SHM’s The Core Competencies in Hospital Medicine as a framework to provide a competency-based model of physician education, one that emphasizes performance-based competencies such as procedures, practice-based learning, and “people skills.” This model can be adapted to teaching residents and students at the bedside as well as in conference rooms and large lecture halls.

“It went beyond curriculum,” said attendee Kevin O’Leary, MD. “It inspired people to think creatively about their own curriculum at home … it was an enlightened teaching model.”

The more than 85 hospitalist educators who attended the pre-course were asked to start a networking group to be called the SHM Educator Network, which will exchange resources and curriculum.

“The goal is for people to share talking points and generate additional tools,” Dr. Williams said. “There are lots of new faculty” teaching hospital medicine across the country. “They need training and they need resources.”

Those responsible for teaching hospital medicine to residents and medical students had an unprecedented opportunity to become students for the day and learn from top teachers in the field.

An important new addition to the all-day precourses was the “Teaching Hospitalist Educators (THE) Course: What Clinical Teachers in Hospital Medicine Need to Know.” The session was presented by Jeffrey Wiese, MD, FACP, associate professor of medicine at Tulane University Health Sciences Center in New Orleans, and Mark Williams, MD, director of the hospital medicine program at Northwestern University’s Feinberg School of Medicine in Chicago.

“This pre-course was developed in response to requests from [SHM’s] Education Committee,” said Sylvia McKean, MD, chair of SHM’s Annual Meeting Committee. “It fold[s] in the best suggestions for hospitalist educators. It’s designed to shift those hospitalists who are responsible for education away from knowledge-only [teaching] and toward a performance-based focus.”

The pre-course used SHM’s The Core Competencies in Hospital Medicine as a framework to provide a competency-based model of physician education, one that emphasizes performance-based competencies such as procedures, practice-based learning, and “people skills.” This model can be adapted to teaching residents and students at the bedside as well as in conference rooms and large lecture halls.

“It went beyond curriculum,” said attendee Kevin O’Leary, MD. “It inspired people to think creatively about their own curriculum at home … it was an enlightened teaching model.”

The more than 85 hospitalist educators who attended the pre-course were asked to start a networking group to be called the SHM Educator Network, which will exchange resources and curriculum.

“The goal is for people to share talking points and generate additional tools,” Dr. Williams said. “There are lots of new faculty” teaching hospital medicine across the country. “They need training and they need resources.”

Couldn’t make it to a session you wanted to attend? Missed the meeting entirely?

This at-a-glance wrap-up provides some highlights from several key sessions:

Clinical Tracks

Key session: “The How, When and Why of Comanagement” presented by Eric M. Siegal, MD, regional medical director, Cogent Healthcare, Madison, Wis.

Take-away points: Co-management does not always result in better or more efficient care. Common arguments in favor of having hospitalists involved, such as improved outcomes and leveraging scarce specialist resources, each have a counter-argument that should be carefully considered.

In assuming co-management of orthopedic or neurosurgical patients, Dr. Siegal points out: “We’re managing patients we were never trained to manage. Subspecialties know how to do this type of care. Why step in, learn new skills, and practice them on living patients?”

Dr. Siegal summarized his concerns with some clear caveats: “Be rigorous about defining your co-management responsibilities; admit that some patients don’t need us; concentrate on leveraging your own scarce resources; and recognize that it’s sometimes better for a surgeon to see his or her patient.”

If and when you do assume co-management responsibilities, he advised, ask questions, including “Why are we being asked to participate?” “Will we make a difference?” and “What might we screw up?”

Key session: “Nosocomial Infections and Resistant Organisms” presented by James Pile, MD, FACP, Case Western Reserve University/MetroHealth Medical Center, Cleveland, Ohio

Take-away points: Dr. Pile’s presentation began with the evolving topic of methicillin-resistant Staph aureus (MRSA). He traced the evolution of nosocomial and community-associated strains of MRSA and detailed the ongoing shifts in the distribution of community-associated MRSA (CA-MRSA). Particular attention was given to the ongoing movement of CA-MRSA out of the community and into the hospital setting, the recent emergence of multidrug resistant CA-MRSA on the East and West coasts, and MRSA colonization.

He also touched on the emerging understanding that vancomycin is a less-than-ideal treatment for serious MRSA infections, and outlined the potential utility of alternative agents old and new. He then addressed catheter-related bloodstream infections, including optimal diagnostic methods, evidence-based methods of prevention, and treatment strategies.

He stressed that the still-underutilized therapeutic modality of antibiotic lock therapy clearly appears to increase the likelihood of successfully salvaging infected catheters, and discussed the fact the responsible pathogen helps inform the decision to remove or retain an infected catheter. He closed by pointing out that revised guidelines for the treatment of catheter-related bloodstream infections from the Infectious Diseases Society of America should be released shortly.

Operational Track

Key session: “Designing Compensation and Bonus Plans to Drive Desired Behaviors” presented by Rachel M. George, MD, MBA, Cogent Healthcare, Department of Pediatrics at SUNY Downstate Medical Center, Brooklyn, N.Y.; Winthrop Whitcomb, MD, Mercy Medical Center in Springfield, Mass.; and John Bulger DO, FACOI, FACP, Geisinger Health System in Pennsylvania.

Take-away points: Dr. Whitcomb discussed compensation for community-based hospital medicine programs that reward both an individual’s productivity—based on RVUs, charges or cash—and quality measures met, which will directly improve quality.

Dr. Bolger believes hospitalists at a large academic teaching center should have the ability to affect their compensation; therefore, those who contribute more should be compensated more. His institution uses a base-incentive plan that rewards for core values including teaching, innovation, and quality.

Dr. George of the multistate hospital medicine program Cogent Healthcare discussed her organization’s compensation plan of a base salary plus a bonus of approximately 20% of salary for incentives.

Academic Track

Key session: “Keys to a Successful Academic Hospitalist Program” presented by Robert M. Wachter, MD, University of California, San Francisco; Brian P. Lucas, MD, MS, Cook County Hospital, Chicago; and Adrienne L. Bennett, MD, PhD, Ohio State University Medical Center, Columbus.

Take-away points: These academic hospitalist leaders stressed research in this session. Research is critical to the success of hospital medicine. You can support research by building research expertise among your staff and creating (or borrowing) an infrastructure for research. Get your entire group involved, with the goal of producing at least two scholarly works a year. Invite other subspecialists and institutions to participate in your research. You also must offer salary support for dedicated scholarship time.

Quality Track

Key session: “Improving Quality and Safety during Transitions of Care” presented by Eric Coleman, MD, MPH, University of Colorado, Denver; Jeffrey Greenwald, MD, Boston University Medical Campus; Lakshmi Halasyamani, MD, St. Joseph Mercy Medical Center, Ann Arbor, Mich.; and Mark V. Williams, MD, Northwestern University’s Feinberg School of Medicine in Chicago.

Take-away points: Retitled “BOOSTing Care Transitions,” this session focused on problems with discharging patients and outlined Project BOOST: Better Outcomes for Older adults through Safe Transitions. The BOOST toolkit includes resources for identifying high-risk patients; preparation for the patient and caregiver including follow-up plans; and a discharge summary communication. Specific tools include GRATE, a Geriatric Risk Adjusted Transition Evaluation; a 6P Risk Scale to be used on admit and discharge; a Risk Adjusted Checklist; and GAP, Geriatric Assessment of Preparedness for on admit, near discharge and at discharge. The toolkit is available online in the SHM Resource Rooms at www.hospitalmedicine.org.

Pediatric Track

Key session: “Surveys Say ... Current Reports on Pediatric Hospitalist Workload and Compensation” presented by Jack Percelay, MD, MPH, FAAP, ELMO Pediatrics, Livingston, N.J., and David Zipes, MD, FAAP, St. Vincent Children’s Hospital, Indianapolis, Ind.

Take-away points: Relevant data from the “Society of Hospital Medicine 2007-08 Survey: The Authoritative Source on the State of the Hospitalist Movement” were reviewed, with many caveats noted as the pediatric portion still is being analyzed. Pediatric hospitalists make less money than their adult-patient counterparts, with a total compensation of $144,600 compared with $183,900. They reported fewer patient encounters and work fewer hours overall. These differences are subject to closer examination. “Is this really a decrease in productivity and the work that we do, or does this reflect the fact that virtually no ‘private practice hospitalists’ responded?” Dr. Percelay asked.

Key session: “Clinical Pathways on a Budget” presented by Steve Narang, MD, Our Lady of the Lake Regional Medical Center, Baton Rouge, La.

Take-away points: To help fill the gap in information on pediatric care, Dr. Narang designed a clinical pathway for admitting an increasing number of pediatric patients with skin and soft-tissue infection (abscess) based on evidence and expert opinion. This pathway was shared with 100 pediatric providers in Louisiana. The results of implementing the pathway in his institution showed a reduction in other, less efficient treatments and tests, a 25% decrease in length of stay for these patients and a 20% decrease in cost—both in three years.

Couldn’t make it to a session you wanted to attend? Missed the meeting entirely?

This at-a-glance wrap-up provides some highlights from several key sessions:

Clinical Tracks

Key session: “The How, When and Why of Comanagement” presented by Eric M. Siegal, MD, regional medical director, Cogent Healthcare, Madison, Wis.

Take-away points: Co-management does not always result in better or more efficient care. Common arguments in favor of having hospitalists involved, such as improved outcomes and leveraging scarce specialist resources, each have a counter-argument that should be carefully considered.

In assuming co-management of orthopedic or neurosurgical patients, Dr. Siegal points out: “We’re managing patients we were never trained to manage. Subspecialties know how to do this type of care. Why step in, learn new skills, and practice them on living patients?”

Dr. Siegal summarized his concerns with some clear caveats: “Be rigorous about defining your co-management responsibilities; admit that some patients don’t need us; concentrate on leveraging your own scarce resources; and recognize that it’s sometimes better for a surgeon to see his or her patient.”

If and when you do assume co-management responsibilities, he advised, ask questions, including “Why are we being asked to participate?” “Will we make a difference?” and “What might we screw up?”

Key session: “Nosocomial Infections and Resistant Organisms” presented by James Pile, MD, FACP, Case Western Reserve University/MetroHealth Medical Center, Cleveland, Ohio

Take-away points: Dr. Pile’s presentation began with the evolving topic of methicillin-resistant Staph aureus (MRSA). He traced the evolution of nosocomial and community-associated strains of MRSA and detailed the ongoing shifts in the distribution of community-associated MRSA (CA-MRSA). Particular attention was given to the ongoing movement of CA-MRSA out of the community and into the hospital setting, the recent emergence of multidrug resistant CA-MRSA on the East and West coasts, and MRSA colonization.

He also touched on the emerging understanding that vancomycin is a less-than-ideal treatment for serious MRSA infections, and outlined the potential utility of alternative agents old and new. He then addressed catheter-related bloodstream infections, including optimal diagnostic methods, evidence-based methods of prevention, and treatment strategies.

He stressed that the still-underutilized therapeutic modality of antibiotic lock therapy clearly appears to increase the likelihood of successfully salvaging infected catheters, and discussed the fact the responsible pathogen helps inform the decision to remove or retain an infected catheter. He closed by pointing out that revised guidelines for the treatment of catheter-related bloodstream infections from the Infectious Diseases Society of America should be released shortly.

Operational Track

Key session: “Designing Compensation and Bonus Plans to Drive Desired Behaviors” presented by Rachel M. George, MD, MBA, Cogent Healthcare, Department of Pediatrics at SUNY Downstate Medical Center, Brooklyn, N.Y.; Winthrop Whitcomb, MD, Mercy Medical Center in Springfield, Mass.; and John Bulger DO, FACOI, FACP, Geisinger Health System in Pennsylvania.

Take-away points: Dr. Whitcomb discussed compensation for community-based hospital medicine programs that reward both an individual’s productivity—based on RVUs, charges or cash—and quality measures met, which will directly improve quality.

Dr. Bolger believes hospitalists at a large academic teaching center should have the ability to affect their compensation; therefore, those who contribute more should be compensated more. His institution uses a base-incentive plan that rewards for core values including teaching, innovation, and quality.

Dr. George of the multistate hospital medicine program Cogent Healthcare discussed her organization’s compensation plan of a base salary plus a bonus of approximately 20% of salary for incentives.

Academic Track

Key session: “Keys to a Successful Academic Hospitalist Program” presented by Robert M. Wachter, MD, University of California, San Francisco; Brian P. Lucas, MD, MS, Cook County Hospital, Chicago; and Adrienne L. Bennett, MD, PhD, Ohio State University Medical Center, Columbus.

Take-away points: These academic hospitalist leaders stressed research in this session. Research is critical to the success of hospital medicine. You can support research by building research expertise among your staff and creating (or borrowing) an infrastructure for research. Get your entire group involved, with the goal of producing at least two scholarly works a year. Invite other subspecialists and institutions to participate in your research. You also must offer salary support for dedicated scholarship time.

Quality Track

Key session: “Improving Quality and Safety during Transitions of Care” presented by Eric Coleman, MD, MPH, University of Colorado, Denver; Jeffrey Greenwald, MD, Boston University Medical Campus; Lakshmi Halasyamani, MD, St. Joseph Mercy Medical Center, Ann Arbor, Mich.; and Mark V. Williams, MD, Northwestern University’s Feinberg School of Medicine in Chicago.

Take-away points: Retitled “BOOSTing Care Transitions,” this session focused on problems with discharging patients and outlined Project BOOST: Better Outcomes for Older adults through Safe Transitions. The BOOST toolkit includes resources for identifying high-risk patients; preparation for the patient and caregiver including follow-up plans; and a discharge summary communication. Specific tools include GRATE, a Geriatric Risk Adjusted Transition Evaluation; a 6P Risk Scale to be used on admit and discharge; a Risk Adjusted Checklist; and GAP, Geriatric Assessment of Preparedness for on admit, near discharge and at discharge. The toolkit is available online in the SHM Resource Rooms at www.hospitalmedicine.org.

Pediatric Track

Key session: “Surveys Say ... Current Reports on Pediatric Hospitalist Workload and Compensation” presented by Jack Percelay, MD, MPH, FAAP, ELMO Pediatrics, Livingston, N.J., and David Zipes, MD, FAAP, St. Vincent Children’s Hospital, Indianapolis, Ind.

Take-away points: Relevant data from the “Society of Hospital Medicine 2007-08 Survey: The Authoritative Source on the State of the Hospitalist Movement” were reviewed, with many caveats noted as the pediatric portion still is being analyzed. Pediatric hospitalists make less money than their adult-patient counterparts, with a total compensation of $144,600 compared with $183,900. They reported fewer patient encounters and work fewer hours overall. These differences are subject to closer examination. “Is this really a decrease in productivity and the work that we do, or does this reflect the fact that virtually no ‘private practice hospitalists’ responded?” Dr. Percelay asked.

Key session: “Clinical Pathways on a Budget” presented by Steve Narang, MD, Our Lady of the Lake Regional Medical Center, Baton Rouge, La.

Take-away points: To help fill the gap in information on pediatric care, Dr. Narang designed a clinical pathway for admitting an increasing number of pediatric patients with skin and soft-tissue infection (abscess) based on evidence and expert opinion. This pathway was shared with 100 pediatric providers in Louisiana. The results of implementing the pathway in his institution showed a reduction in other, less efficient treatments and tests, a 25% decrease in length of stay for these patients and a 20% decrease in cost—both in three years.

Couldn’t make it to a session you wanted to attend? Missed the meeting entirely?

This at-a-glance wrap-up provides some highlights from several key sessions:

Clinical Tracks

Key session: “The How, When and Why of Comanagement” presented by Eric M. Siegal, MD, regional medical director, Cogent Healthcare, Madison, Wis.

Take-away points: Co-management does not always result in better or more efficient care. Common arguments in favor of having hospitalists involved, such as improved outcomes and leveraging scarce specialist resources, each have a counter-argument that should be carefully considered.

In assuming co-management of orthopedic or neurosurgical patients, Dr. Siegal points out: “We’re managing patients we were never trained to manage. Subspecialties know how to do this type of care. Why step in, learn new skills, and practice them on living patients?”

Dr. Siegal summarized his concerns with some clear caveats: “Be rigorous about defining your co-management responsibilities; admit that some patients don’t need us; concentrate on leveraging your own scarce resources; and recognize that it’s sometimes better for a surgeon to see his or her patient.”

If and when you do assume co-management responsibilities, he advised, ask questions, including “Why are we being asked to participate?” “Will we make a difference?” and “What might we screw up?”

Key session: “Nosocomial Infections and Resistant Organisms” presented by James Pile, MD, FACP, Case Western Reserve University/MetroHealth Medical Center, Cleveland, Ohio

Take-away points: Dr. Pile’s presentation began with the evolving topic of methicillin-resistant Staph aureus (MRSA). He traced the evolution of nosocomial and community-associated strains of MRSA and detailed the ongoing shifts in the distribution of community-associated MRSA (CA-MRSA). Particular attention was given to the ongoing movement of CA-MRSA out of the community and into the hospital setting, the recent emergence of multidrug resistant CA-MRSA on the East and West coasts, and MRSA colonization.

He also touched on the emerging understanding that vancomycin is a less-than-ideal treatment for serious MRSA infections, and outlined the potential utility of alternative agents old and new. He then addressed catheter-related bloodstream infections, including optimal diagnostic methods, evidence-based methods of prevention, and treatment strategies.

He stressed that the still-underutilized therapeutic modality of antibiotic lock therapy clearly appears to increase the likelihood of successfully salvaging infected catheters, and discussed the fact the responsible pathogen helps inform the decision to remove or retain an infected catheter. He closed by pointing out that revised guidelines for the treatment of catheter-related bloodstream infections from the Infectious Diseases Society of America should be released shortly.

Operational Track

Key session: “Designing Compensation and Bonus Plans to Drive Desired Behaviors” presented by Rachel M. George, MD, MBA, Cogent Healthcare, Department of Pediatrics at SUNY Downstate Medical Center, Brooklyn, N.Y.; Winthrop Whitcomb, MD, Mercy Medical Center in Springfield, Mass.; and John Bulger DO, FACOI, FACP, Geisinger Health System in Pennsylvania.

Take-away points: Dr. Whitcomb discussed compensation for community-based hospital medicine programs that reward both an individual’s productivity—based on RVUs, charges or cash—and quality measures met, which will directly improve quality.

Dr. Bolger believes hospitalists at a large academic teaching center should have the ability to affect their compensation; therefore, those who contribute more should be compensated more. His institution uses a base-incentive plan that rewards for core values including teaching, innovation, and quality.

Dr. George of the multistate hospital medicine program Cogent Healthcare discussed her organization’s compensation plan of a base salary plus a bonus of approximately 20% of salary for incentives.

Academic Track

Key session: “Keys to a Successful Academic Hospitalist Program” presented by Robert M. Wachter, MD, University of California, San Francisco; Brian P. Lucas, MD, MS, Cook County Hospital, Chicago; and Adrienne L. Bennett, MD, PhD, Ohio State University Medical Center, Columbus.

Take-away points: These academic hospitalist leaders stressed research in this session. Research is critical to the success of hospital medicine. You can support research by building research expertise among your staff and creating (or borrowing) an infrastructure for research. Get your entire group involved, with the goal of producing at least two scholarly works a year. Invite other subspecialists and institutions to participate in your research. You also must offer salary support for dedicated scholarship time.

Quality Track

Key session: “Improving Quality and Safety during Transitions of Care” presented by Eric Coleman, MD, MPH, University of Colorado, Denver; Jeffrey Greenwald, MD, Boston University Medical Campus; Lakshmi Halasyamani, MD, St. Joseph Mercy Medical Center, Ann Arbor, Mich.; and Mark V. Williams, MD, Northwestern University’s Feinberg School of Medicine in Chicago.

Take-away points: Retitled “BOOSTing Care Transitions,” this session focused on problems with discharging patients and outlined Project BOOST: Better Outcomes for Older adults through Safe Transitions. The BOOST toolkit includes resources for identifying high-risk patients; preparation for the patient and caregiver including follow-up plans; and a discharge summary communication. Specific tools include GRATE, a Geriatric Risk Adjusted Transition Evaluation; a 6P Risk Scale to be used on admit and discharge; a Risk Adjusted Checklist; and GAP, Geriatric Assessment of Preparedness for on admit, near discharge and at discharge. The toolkit is available online in the SHM Resource Rooms at www.hospitalmedicine.org.

Pediatric Track

Key session: “Surveys Say ... Current Reports on Pediatric Hospitalist Workload and Compensation” presented by Jack Percelay, MD, MPH, FAAP, ELMO Pediatrics, Livingston, N.J., and David Zipes, MD, FAAP, St. Vincent Children’s Hospital, Indianapolis, Ind.

Take-away points: Relevant data from the “Society of Hospital Medicine 2007-08 Survey: The Authoritative Source on the State of the Hospitalist Movement” were reviewed, with many caveats noted as the pediatric portion still is being analyzed. Pediatric hospitalists make less money than their adult-patient counterparts, with a total compensation of $144,600 compared with $183,900. They reported fewer patient encounters and work fewer hours overall. These differences are subject to closer examination. “Is this really a decrease in productivity and the work that we do, or does this reflect the fact that virtually no ‘private practice hospitalists’ responded?” Dr. Percelay asked.

Key session: “Clinical Pathways on a Budget” presented by Steve Narang, MD, Our Lady of the Lake Regional Medical Center, Baton Rouge, La.

Take-away points: To help fill the gap in information on pediatric care, Dr. Narang designed a clinical pathway for admitting an increasing number of pediatric patients with skin and soft-tissue infection (abscess) based on evidence and expert opinion. This pathway was shared with 100 pediatric providers in Louisiana. The results of implementing the pathway in his institution showed a reduction in other, less efficient treatments and tests, a 25% decrease in length of stay for these patients and a 20% decrease in cost—both in three years.

A new educational track at Hospital Medicine 2008 offered the latest evidence-based data on controversial issues hospitalists routinely face—all in a shortened time frame called Rapid Fire.

“The Rapid Fire track is very exciting,” said Sylvia McKean, MD, course director of the meeting. “The purpose is basically to help hospitalists when they’re on the front lines with the key questions that come up. The sessions are 35 minutes each, and they’re more direct, with applicable content that’s designed to provide attendees with rapid bursts of information and to address specific questions. Each course is very clinical and very relevant to [working hospitalists].”

The Rapid Fire track proved popular with attendees; each topic drew a packed house.

“This is a great idea—it’s like a mini-session,” said attendee Randy Hobbs, MD, of Aurora Hospital PC in Buffalo, N.Y. “They did a great job choosing the questions. These are things we use every day.”

Ten topics were covered in Rapid Fire, two per session hour. Each answered multiple questions submitted in advance by the Annual Meeting Committee, and each used the highest level of medical evidence available. Key points from each include:

“Controversies in Critical Care”: David Schulman, MD, MPH, chief of pulmonary and critical care medicine at Emory University Hospital in Atlanta, outlined treatment options for high-risk patients with ventilator-acquired pneumonia. His advise: Include a cephalosporin with antipseudomonal activity; imipenem or meropenem; beta-lactam and a beta-lactamase inhibitor plus anantipseudomonal fluoroquinolone or aminoglycoside; and add vancomycin or linezolid if methicillin-resistant staphylococcus aureus is of high incidence.

“Clot Controversies: Thrombolysis and VTE Prophylaxis”: “Prophylaxis has to do with diligence, not which drug we give them,” said Timothy Morris, MD, University of California, San Diego. “Declare the risk and contraindication for each patient and mark whether you’re going to prophylax, and it can make a huge difference” when a patient is admitted, he advised.

“Controversies in Transfusion Medicine”: Studies indicate careful assessment of the necessity of transfusion for each patient is crucial, said Jeffrey Carson, MD, Robert Wood Johnson Medical School in New Brunswick, N.J. Pending additional research, current data suggest that a restrictive transfusion trigger (7 g/dL) should be used.

“Acute Coronary Syndrome Trials and Tribulations”: Can you trust troponins? Will Southern, MD, MS, of Weiler Division Hospital of Montefiore Medical Center in New York City, said the following combinations have good outcomes:

• Prolonged chest pain and normal troponin;
• Normal ECG and normal troponin in a young nondiabetic patient without prior coronary artery disease; and
• Normal troponin and atypical symptoms in the same patient type.

“Management of Anticoagulant-Related Bleeding Complications”: Amir Jaffer, MD, University of Miami Hospital, cited a study that recommended the following treatment for unfractionated or low molecular weight heparin-related bleeding:

• 1 mg of protamine for every 100 units of heparin;
• No greater than 50 mg of protamine at one time; and
• Infusion should not exceed 5 mg/min.

“Acute Renal Failure Prophylaxis, Med Dosing and Acute Management”: James Paparello, MD, of Northwestern University, reviewed medications used in kidney disease. For example, nonsteroidal anti-inflammatory drugs (NSAIDS) can push a patient with marginal glomerular filtration rate into acute renal failure. In dialysis, NSAIDS carry a bleeding risk.

“Perioperative Cardiac Guide-lines”: “Preoperative evaluation should focus on the clinical presentation of disease, exercise tolerance, and extent of surgery,” said Lee Fleisher, MD, University of Pennsylvania Health System in Philadelphia. “Testing should be reserved for patients with a poor exercise tolerance undergoing vascular surgery with risk factors if the results may impact care.”

“Ischemic Stroke Diagnosis and Management”: All patients who suffer a transient ischemic attack or ischemic stroke should get the following, summarized Galen Henderson, MD, Brigham and Women’s Hospital:

• Brain and neurovascular imaging;
• Blood glucose and serum electrolytes;
• Complete blood count with platelets;
• Prothrombin time/partial thromboplastin/international normalized ratio;
• A 12-lead EKG and Holter monitoring;
• Transthoracic echocardiogram/ transesophageal echcardiogram; and
• Supplemental oxygen fever reduction and lipids.

“Common Endocrine Problems for the Hospitalist”: “Regardless of a prior history of diabetes, keep glucose at 80-110 mg/dl for better outcomes,” advised Jordan Geller, MD, of the Endocrinology Department at Cedars-Sinai Medical Center in Los Angeles.

“New Practices in ACLS”: Jason Persoff, MD, of the Mayo Clinic in Jacksonville, Fla., reviewed new studies showing that the best course for basic life support is to begin chest compressions immediately, pushing hard and pumping fast. Focus on this, not bag-valve-mask or intubation, to save more lives.

A new educational track at Hospital Medicine 2008 offered the latest evidence-based data on controversial issues hospitalists routinely face—all in a shortened time frame called Rapid Fire.

“The Rapid Fire track is very exciting,” said Sylvia McKean, MD, course director of the meeting. “The purpose is basically to help hospitalists when they’re on the front lines with the key questions that come up. The sessions are 35 minutes each, and they’re more direct, with applicable content that’s designed to provide attendees with rapid bursts of information and to address specific questions. Each course is very clinical and very relevant to [working hospitalists].”

The Rapid Fire track proved popular with attendees; each topic drew a packed house.

“This is a great idea—it’s like a mini-session,” said attendee Randy Hobbs, MD, of Aurora Hospital PC in Buffalo, N.Y. “They did a great job choosing the questions. These are things we use every day.”

Ten topics were covered in Rapid Fire, two per session hour. Each answered multiple questions submitted in advance by the Annual Meeting Committee, and each used the highest level of medical evidence available. Key points from each include:

“Controversies in Critical Care”: David Schulman, MD, MPH, chief of pulmonary and critical care medicine at Emory University Hospital in Atlanta, outlined treatment options for high-risk patients with ventilator-acquired pneumonia. His advise: Include a cephalosporin with antipseudomonal activity; imipenem or meropenem; beta-lactam and a beta-lactamase inhibitor plus anantipseudomonal fluoroquinolone or aminoglycoside; and add vancomycin or linezolid if methicillin-resistant staphylococcus aureus is of high incidence.

“Clot Controversies: Thrombolysis and VTE Prophylaxis”: “Prophylaxis has to do with diligence, not which drug we give them,” said Timothy Morris, MD, University of California, San Diego. “Declare the risk and contraindication for each patient and mark whether you’re going to prophylax, and it can make a huge difference” when a patient is admitted, he advised.

“Controversies in Transfusion Medicine”: Studies indicate careful assessment of the necessity of transfusion for each patient is crucial, said Jeffrey Carson, MD, Robert Wood Johnson Medical School in New Brunswick, N.J. Pending additional research, current data suggest that a restrictive transfusion trigger (7 g/dL) should be used.

“Acute Coronary Syndrome Trials and Tribulations”: Can you trust troponins? Will Southern, MD, MS, of Weiler Division Hospital of Montefiore Medical Center in New York City, said the following combinations have good outcomes:

• Prolonged chest pain and normal troponin;
• Normal ECG and normal troponin in a young nondiabetic patient without prior coronary artery disease; and
• Normal troponin and atypical symptoms in the same patient type.

“Management of Anticoagulant-Related Bleeding Complications”: Amir Jaffer, MD, University of Miami Hospital, cited a study that recommended the following treatment for unfractionated or low molecular weight heparin-related bleeding:

• 1 mg of protamine for every 100 units of heparin;
• No greater than 50 mg of protamine at one time; and
• Infusion should not exceed 5 mg/min.

“Acute Renal Failure Prophylaxis, Med Dosing and Acute Management”: James Paparello, MD, of Northwestern University, reviewed medications used in kidney disease. For example, nonsteroidal anti-inflammatory drugs (NSAIDS) can push a patient with marginal glomerular filtration rate into acute renal failure. In dialysis, NSAIDS carry a bleeding risk.

“Perioperative Cardiac Guide-lines”: “Preoperative evaluation should focus on the clinical presentation of disease, exercise tolerance, and extent of surgery,” said Lee Fleisher, MD, University of Pennsylvania Health System in Philadelphia. “Testing should be reserved for patients with a poor exercise tolerance undergoing vascular surgery with risk factors if the results may impact care.”

“Ischemic Stroke Diagnosis and Management”: All patients who suffer a transient ischemic attack or ischemic stroke should get the following, summarized Galen Henderson, MD, Brigham and Women’s Hospital:

• Brain and neurovascular imaging;
• Blood glucose and serum electrolytes;
• Complete blood count with platelets;
• Prothrombin time/partial thromboplastin/international normalized ratio;
• A 12-lead EKG and Holter monitoring;
• Transthoracic echocardiogram/ transesophageal echcardiogram; and
• Supplemental oxygen fever reduction and lipids.

“Common Endocrine Problems for the Hospitalist”: “Regardless of a prior history of diabetes, keep glucose at 80-110 mg/dl for better outcomes,” advised Jordan Geller, MD, of the Endocrinology Department at Cedars-Sinai Medical Center in Los Angeles.

“New Practices in ACLS”: Jason Persoff, MD, of the Mayo Clinic in Jacksonville, Fla., reviewed new studies showing that the best course for basic life support is to begin chest compressions immediately, pushing hard and pumping fast. Focus on this, not bag-valve-mask or intubation, to save more lives.

A new educational track at Hospital Medicine 2008 offered the latest evidence-based data on controversial issues hospitalists routinely face—all in a shortened time frame called Rapid Fire.

“The Rapid Fire track is very exciting,” said Sylvia McKean, MD, course director of the meeting. “The purpose is basically to help hospitalists when they’re on the front lines with the key questions that come up. The sessions are 35 minutes each, and they’re more direct, with applicable content that’s designed to provide attendees with rapid bursts of information and to address specific questions. Each course is very clinical and very relevant to [working hospitalists].”

The Rapid Fire track proved popular with attendees; each topic drew a packed house.

“This is a great idea—it’s like a mini-session,” said attendee Randy Hobbs, MD, of Aurora Hospital PC in Buffalo, N.Y. “They did a great job choosing the questions. These are things we use every day.”

Ten topics were covered in Rapid Fire, two per session hour. Each answered multiple questions submitted in advance by the Annual Meeting Committee, and each used the highest level of medical evidence available. Key points from each include:

“Controversies in Critical Care”: David Schulman, MD, MPH, chief of pulmonary and critical care medicine at Emory University Hospital in Atlanta, outlined treatment options for high-risk patients with ventilator-acquired pneumonia. His advise: Include a cephalosporin with antipseudomonal activity; imipenem or meropenem; beta-lactam and a beta-lactamase inhibitor plus anantipseudomonal fluoroquinolone or aminoglycoside; and add vancomycin or linezolid if methicillin-resistant staphylococcus aureus is of high incidence.

“Clot Controversies: Thrombolysis and VTE Prophylaxis”: “Prophylaxis has to do with diligence, not which drug we give them,” said Timothy Morris, MD, University of California, San Diego. “Declare the risk and contraindication for each patient and mark whether you’re going to prophylax, and it can make a huge difference” when a patient is admitted, he advised.

“Controversies in Transfusion Medicine”: Studies indicate careful assessment of the necessity of transfusion for each patient is crucial, said Jeffrey Carson, MD, Robert Wood Johnson Medical School in New Brunswick, N.J. Pending additional research, current data suggest that a restrictive transfusion trigger (7 g/dL) should be used.

“Acute Coronary Syndrome Trials and Tribulations”: Can you trust troponins? Will Southern, MD, MS, of Weiler Division Hospital of Montefiore Medical Center in New York City, said the following combinations have good outcomes:

• Prolonged chest pain and normal troponin;
• Normal ECG and normal troponin in a young nondiabetic patient without prior coronary artery disease; and
• Normal troponin and atypical symptoms in the same patient type.

“Management of Anticoagulant-Related Bleeding Complications”: Amir Jaffer, MD, University of Miami Hospital, cited a study that recommended the following treatment for unfractionated or low molecular weight heparin-related bleeding:

• 1 mg of protamine for every 100 units of heparin;
• No greater than 50 mg of protamine at one time; and
• Infusion should not exceed 5 mg/min.

“Acute Renal Failure Prophylaxis, Med Dosing and Acute Management”: James Paparello, MD, of Northwestern University, reviewed medications used in kidney disease. For example, nonsteroidal anti-inflammatory drugs (NSAIDS) can push a patient with marginal glomerular filtration rate into acute renal failure. In dialysis, NSAIDS carry a bleeding risk.

“Perioperative Cardiac Guide-lines”: “Preoperative evaluation should focus on the clinical presentation of disease, exercise tolerance, and extent of surgery,” said Lee Fleisher, MD, University of Pennsylvania Health System in Philadelphia. “Testing should be reserved for patients with a poor exercise tolerance undergoing vascular surgery with risk factors if the results may impact care.”

“Ischemic Stroke Diagnosis and Management”: All patients who suffer a transient ischemic attack or ischemic stroke should get the following, summarized Galen Henderson, MD, Brigham and Women’s Hospital:

• Brain and neurovascular imaging;
• Blood glucose and serum electrolytes;
• Complete blood count with platelets;
• Prothrombin time/partial thromboplastin/international normalized ratio;
• A 12-lead EKG and Holter monitoring;
• Transthoracic echocardiogram/ transesophageal echcardiogram; and
• Supplemental oxygen fever reduction and lipids.

“Common Endocrine Problems for the Hospitalist”: “Regardless of a prior history of diabetes, keep glucose at 80-110 mg/dl for better outcomes,” advised Jordan Geller, MD, of the Endocrinology Department at Cedars-Sinai Medical Center in Los Angeles.

“New Practices in ACLS”: Jason Persoff, MD, of the Mayo Clinic in Jacksonville, Fla., reviewed new studies showing that the best course for basic life support is to begin chest compressions immediately, pushing hard and pumping fast. Focus on this, not bag-valve-mask or intubation, to save more lives.

Attendees at Hospital Medicine 2008 were the first to hear the results of the latest SHM survey of hospitalists, learning that hospitalist pay is up, roughly one-third of hospitalist leaders don’t know their groups’ expenses or fee revenues, and that financial support has grown substantially.

The society’s biannual survey of U.S. hospital medicine groups went to 1,700 of an estimated 2,200 groups in 2007. SHM Senior Vice President Joseph Miller and Burke Kealey, MD, chair of SHM’s Benchmarks Committee (which designed the survey) presented the findings from the “Society of Hospital Medicine 2007-08 Survey: The Authoritative Source on the State of the Hospitalist Movement.”

“Our purpose is to provide a snapshot of hospital medicine at a moment in time for hospitalists and hospital medicine groups,” Miller said. “I think this is the best SHM survey ever conducted.”

Survey Basics

The survey drew a 24% response rate, gleaning information from 440 hospital medicine groups representing 3,242 individual hospitalists, as well as summary data from a separate survey sent to the nation’s largest hospital medicine groups. “We think it adds to the richness of the data,” explained Miller.

All data were collected between September and December 2007 and reflects information for the previous 12 months. Miller was careful to note that RVU values changed midway through that period.

Hospital medicine still is a young specialty, but, Miller said, “I think we’re seeing a growing experience base.” The median age of hospitalists is 37, with 3.7 years of mean experience. For leaders, the median age is 41, with 6.7 years of experience.

The State of HMGs

Today’s hospital medicine groups are growing, and so is the financial support they receive from hospitals.

“There has been significant growth in the number of [full-time employees] in hospital medicine groups,” Miller said. Since the previous survey two years ago, there is a 31% mean growth in groups. “We’re seeing fewer new groups, with more growth coming from the established groups” More groups are using nurse practitioners and/or physician assistants, up from 29% to 38%.

As for the leadership of the hospital medicine groups, the survey revealed some serious knowledge gaps. “Thirty-five to 37% of leaders did not know the finances of their groups,” Miller pointed out. This percentage—up somewhat from two years ago—could not answer survey questions on their group’s expenses or fee revenue.

The numbers of those who know where their money comes from show that hospitals (or partner institutions) are supplying more financial support now. A whopping 91% of responding programs receive money, with the total mean amount exceeding $97,000 per full-time physician. “This has increased substantially since the last survey,” Miller said.

Productivity and Pay

To ensure clarity of data, the survey breaks down compensation and productivity information for hospitalists into four separate groups: those who treat adult patients; those who treat pediatric patients; those who treat both; and nurse practitioners and physician assistants. In the session, Dr. Kealey covered only the first group.

He pointed out the strong correlation between the number of hours worked and higher productivity, and between higher productivity and higher compensation.

“Encounters have remained relatively flat,” he said. (They are down just 4% from the previous survey.) “But total compensation has increased by 13%.” In other words, hospitalists are working about the same amount they were two years ago, but are making more money—on average, $193,000.

Of the survey respondents, 25.3% are paid by straight salary; 6.1% are paid based on productivity, and the remainder earn a mix of salary and bonus.

Productivity figures show hospitalist experience pays off: Experienced hospitalists have more encounters in the same number of hours than their less-experienced counterparts. They also have higher compensation.

Another disturbing trend among hospitalist leaders is that they put in about as many clinical hours as nonleaders. “This indicates that they may not have enough time to lead,” Dr. Kealey said.

The survey included information on 106 respondents who are nocturnists. These night workers have significantly fewer encounters, and work slightly fewer hours for slightly less money. Dr. Kealey noted that “when you cover nights, your productivity drops. This is good to know if you’re thinking about adding night coverage in your practice.”

The complete survey results should be available sometime in May, and information will be posted on the SHM Web site at www.hospitalmedicine.org.

Attendees at Hospital Medicine 2008 were the first to hear the results of the latest SHM survey of hospitalists, learning that hospitalist pay is up, roughly one-third of hospitalist leaders don’t know their groups’ expenses or fee revenues, and that financial support has grown substantially.

The society’s biannual survey of U.S. hospital medicine groups went to 1,700 of an estimated 2,200 groups in 2007. SHM Senior Vice President Joseph Miller and Burke Kealey, MD, chair of SHM’s Benchmarks Committee (which designed the survey) presented the findings from the “Society of Hospital Medicine 2007-08 Survey: The Authoritative Source on the State of the Hospitalist Movement.”

“Our purpose is to provide a snapshot of hospital medicine at a moment in time for hospitalists and hospital medicine groups,” Miller said. “I think this is the best SHM survey ever conducted.”

Survey Basics

The survey drew a 24% response rate, gleaning information from 440 hospital medicine groups representing 3,242 individual hospitalists, as well as summary data from a separate survey sent to the nation’s largest hospital medicine groups. “We think it adds to the richness of the data,” explained Miller.

All data were collected between September and December 2007 and reflects information for the previous 12 months. Miller was careful to note that RVU values changed midway through that period.

Hospital medicine still is a young specialty, but, Miller said, “I think we’re seeing a growing experience base.” The median age of hospitalists is 37, with 3.7 years of mean experience. For leaders, the median age is 41, with 6.7 years of experience.

The State of HMGs

Today’s hospital medicine groups are growing, and so is the financial support they receive from hospitals.

“There has been significant growth in the number of [full-time employees] in hospital medicine groups,” Miller said. Since the previous survey two years ago, there is a 31% mean growth in groups. “We’re seeing fewer new groups, with more growth coming from the established groups” More groups are using nurse practitioners and/or physician assistants, up from 29% to 38%.

As for the leadership of the hospital medicine groups, the survey revealed some serious knowledge gaps. “Thirty-five to 37% of leaders did not know the finances of their groups,” Miller pointed out. This percentage—up somewhat from two years ago—could not answer survey questions on their group’s expenses or fee revenue.

The numbers of those who know where their money comes from show that hospitals (or partner institutions) are supplying more financial support now. A whopping 91% of responding programs receive money, with the total mean amount exceeding $97,000 per full-time physician. “This has increased substantially since the last survey,” Miller said.

Productivity and Pay

To ensure clarity of data, the survey breaks down compensation and productivity information for hospitalists into four separate groups: those who treat adult patients; those who treat pediatric patients; those who treat both; and nurse practitioners and physician assistants. In the session, Dr. Kealey covered only the first group.

He pointed out the strong correlation between the number of hours worked and higher productivity, and between higher productivity and higher compensation.

“Encounters have remained relatively flat,” he said. (They are down just 4% from the previous survey.) “But total compensation has increased by 13%.” In other words, hospitalists are working about the same amount they were two years ago, but are making more money—on average, $193,000.

Of the survey respondents, 25.3% are paid by straight salary; 6.1% are paid based on productivity, and the remainder earn a mix of salary and bonus.

Productivity figures show hospitalist experience pays off: Experienced hospitalists have more encounters in the same number of hours than their less-experienced counterparts. They also have higher compensation.

Another disturbing trend among hospitalist leaders is that they put in about as many clinical hours as nonleaders. “This indicates that they may not have enough time to lead,” Dr. Kealey said.

The survey included information on 106 respondents who are nocturnists. These night workers have significantly fewer encounters, and work slightly fewer hours for slightly less money. Dr. Kealey noted that “when you cover nights, your productivity drops. This is good to know if you’re thinking about adding night coverage in your practice.”

The complete survey results should be available sometime in May, and information will be posted on the SHM Web site at www.hospitalmedicine.org.

Attendees at Hospital Medicine 2008 were the first to hear the results of the latest SHM survey of hospitalists, learning that hospitalist pay is up, roughly one-third of hospitalist leaders don’t know their groups’ expenses or fee revenues, and that financial support has grown substantially.

The society’s biannual survey of U.S. hospital medicine groups went to 1,700 of an estimated 2,200 groups in 2007. SHM Senior Vice President Joseph Miller and Burke Kealey, MD, chair of SHM’s Benchmarks Committee (which designed the survey) presented the findings from the “Society of Hospital Medicine 2007-08 Survey: The Authoritative Source on the State of the Hospitalist Movement.”

“Our purpose is to provide a snapshot of hospital medicine at a moment in time for hospitalists and hospital medicine groups,” Miller said. “I think this is the best SHM survey ever conducted.”

Survey Basics

The survey drew a 24% response rate, gleaning information from 440 hospital medicine groups representing 3,242 individual hospitalists, as well as summary data from a separate survey sent to the nation’s largest hospital medicine groups. “We think it adds to the richness of the data,” explained Miller.

All data were collected between September and December 2007 and reflects information for the previous 12 months. Miller was careful to note that RVU values changed midway through that period.

Hospital medicine still is a young specialty, but, Miller said, “I think we’re seeing a growing experience base.” The median age of hospitalists is 37, with 3.7 years of mean experience. For leaders, the median age is 41, with 6.7 years of experience.

The State of HMGs

Today’s hospital medicine groups are growing, and so is the financial support they receive from hospitals.

“There has been significant growth in the number of [full-time employees] in hospital medicine groups,” Miller said. Since the previous survey two years ago, there is a 31% mean growth in groups. “We’re seeing fewer new groups, with more growth coming from the established groups” More groups are using nurse practitioners and/or physician assistants, up from 29% to 38%.

As for the leadership of the hospital medicine groups, the survey revealed some serious knowledge gaps. “Thirty-five to 37% of leaders did not know the finances of their groups,” Miller pointed out. This percentage—up somewhat from two years ago—could not answer survey questions on their group’s expenses or fee revenue.

The numbers of those who know where their money comes from show that hospitals (or partner institutions) are supplying more financial support now. A whopping 91% of responding programs receive money, with the total mean amount exceeding $97,000 per full-time physician. “This has increased substantially since the last survey,” Miller said.

Productivity and Pay

To ensure clarity of data, the survey breaks down compensation and productivity information for hospitalists into four separate groups: those who treat adult patients; those who treat pediatric patients; those who treat both; and nurse practitioners and physician assistants. In the session, Dr. Kealey covered only the first group.

He pointed out the strong correlation between the number of hours worked and higher productivity, and between higher productivity and higher compensation.

“Encounters have remained relatively flat,” he said. (They are down just 4% from the previous survey.) “But total compensation has increased by 13%.” In other words, hospitalists are working about the same amount they were two years ago, but are making more money—on average, $193,000.

Of the survey respondents, 25.3% are paid by straight salary; 6.1% are paid based on productivity, and the remainder earn a mix of salary and bonus.

Productivity figures show hospitalist experience pays off: Experienced hospitalists have more encounters in the same number of hours than their less-experienced counterparts. They also have higher compensation.

Another disturbing trend among hospitalist leaders is that they put in about as many clinical hours as nonleaders. “This indicates that they may not have enough time to lead,” Dr. Kealey said.

The survey included information on 106 respondents who are nocturnists. These night workers have significantly fewer encounters, and work slightly fewer hours for slightly less money. Dr. Kealey noted that “when you cover nights, your productivity drops. This is good to know if you’re thinking about adding night coverage in your practice.”

The complete survey results should be available sometime in May, and information will be posted on the SHM Web site at www.hospitalmedicine.org.

Three healthcare visionaries inspired attendees of SHM’s Annual Meeting with unique views of the future of U.S. healthcare and the role hospitalists can play in shaping a new model of efficient, high-quality care.

Meeting attendees were galvanized April 4 by Donald M. Berwick, MD, MPP, president and CEO of the Institute for Healthcare Improvement (IHI) and architect of the “100,000 Lives” and “5 Million Lives” campaigns. In his opening-day address “Improving Healthcare Quality and Value: Hospitalists and the Quality Revolution,” Dr. Berwick pointed out that physicians react to care problems by working harder and harder—but that the real solution must come from big-picture changes. Like his 12-year-old Subaru Outback, Dr. Berwick emphasized: “You have a top speed, and you can’t go beyond that. The system has to depend on interdependency, not on [individual] heroism.”

After setting the stage with data highlighting healthcare’s disparities and underperformance, Dr. Berwick unveiled the Triple Aim, a proposal that would fundamentally change U.S. healthcare. The Triple Aim goes beyond standard quality improvement and the concept of universal healthcare to target three areas: population health (preventive measures), experience of care (safety, efficiency, patient-centered care), and per-capita cost.

“We need to create a system that provides better care to all populations and controls the inflation of costs,” Dr. Berwick stressed. He said giant steps are needed to pursue the Triple Aim, including continued transparency, public health interventions, coordination of care, universal access, a financial management system, and an organization or consortium to act as integrator.

“There’s no question in my mind that hospitalists can participate,” said Dr. Berwick. “Can you help with Triple Aim? I’m not sure. You have to decide [your role]. Do you want to be contributors?”

From audience reaction, the answer seemed to be a resounding “yes.”

“His comments about the systemwide process versus a single doctor really rang true,” said attendee Arpi Bekmezian, MD, a pediatric hospitalist at University of California, Los Angeles. “Changing the system is the key to improving quality in a hospital because it’s such a large, crazy, intense institution.”

“Pimp My Ride” Care

On April 5, author, consultant, and healthcare futurist Ian Morrison, PhD, provided a thought-provoking look at healthcare flaws in “Hospitalists and the Future of Healthcare: The Quest for Value for All Americans.” Dr. Morrison terms our system “Pimp My Ride” healthcare. “We’re adding unbelievable amounts of technology on a frame that’s tired, old, and ineffective,” he asserted.

Dr. Morrison warned that Americans have worse health than their counterparts in other industrialized countries, and this trend is going to get worse.

“We have coming at us over the next two decades a triple tsunami of chronic care needs that will overwhelm our current health system,” he warned: obesity and its related conditions, cancer as a chronic condition, and depression. He pointed out that hospitalists must see a lot of hypertensive, obese, non-compliant, and diabetic patients. “When you see [these] patients, you’re seeing the failure of primary care,” he said.

The bottom line, according to Dr. Morrison, is progress will take great effort—and hospitalists can lead the charge: “Systems of healthcare need to be continually improved to deliver greater value. This will require clinical skills, process skills, the use of cutting-edge information technology and clinical technology. You’re right at the heart of that. We need new models of safer, more reliable, higher quality, more cost-effective care, and I think your profession can make a central contribution to that.”

Wachter’s “Mega-trends”

As is traditional at SHM meetings, Bob Wachter wrapped up the meeting with his insights on the present and future of hospital medicine. Dr. Wachter, who coined the term “hospitalist,” presented “Whipsawed: Can Hospitalists Survive in the Face of Co-Management, Non-Teaching Services, Transparency and the Reality of Perpetual Change.”

Dr. Wachter sees six “mega-trends” affecting hospital medicine:

1. Quality and value issues: “Even if payer pay-for-performance stalls out, local programs will grow,” he predicted. “When transparency increases, your CMO will start asking for accountability from the hospital medicine program. There will likely be a bonus scheme attached to this.”

2. Patient safety: “The emergence of state reporting systems is huge,” Wachter said. “I’m not sure if that’s good or not.” One key shift is the National Quality Forum’s list of 28 “never events,” or errors that are clearly identifiable, preventable, and serious for patients. “You’ll start to see more pressure from state bureaucrats on this.”

3. Information technology: The downside of enhanced technology, Wachter believes, is that “IT leads to dislocation of medicine. The physician relationships that are formed while we’re on the floor are gone.” Doctors can now complete their notes at home or in their office.

4. Co-management: There is massive growth in opportunities for co-managing patients. Dr. Wachter sees this as inevitable: “Don’t bother trying to not own it. It’s going to happen.”

5. ACGME regulations for teaching institutions: “We’ve seen the end of using residents as a cheap labor pools,” Dr. Wachter said. “Now academic hospitals have to figure out how to be like community hospitals.”

6. Work force issues: Tremendous growth requires comprehensive changes to how business is done. “Thriving now takes a new set of skills: leadership, change management, team building, and the skill to say ‘No’ or ‘Yes, if you can …’ ” said Dr. Wachter. Sharing those skills with your clinical hospitalists is imperative, he stressed: “Now, leadership and innovation must be everyone’s job. Your practice must become a bureaucracy.”

There is good news, Dr. Wachter stressed: “We’re in the driver’s seat. We can demand” what we need to survive and thrive.

Three healthcare visionaries inspired attendees of SHM’s Annual Meeting with unique views of the future of U.S. healthcare and the role hospitalists can play in shaping a new model of efficient, high-quality care.

Meeting attendees were galvanized April 4 by Donald M. Berwick, MD, MPP, president and CEO of the Institute for Healthcare Improvement (IHI) and architect of the “100,000 Lives” and “5 Million Lives” campaigns. In his opening-day address “Improving Healthcare Quality and Value: Hospitalists and the Quality Revolution,” Dr. Berwick pointed out that physicians react to care problems by working harder and harder—but that the real solution must come from big-picture changes. Like his 12-year-old Subaru Outback, Dr. Berwick emphasized: “You have a top speed, and you can’t go beyond that. The system has to depend on interdependency, not on [individual] heroism.”

After setting the stage with data highlighting healthcare’s disparities and underperformance, Dr. Berwick unveiled the Triple Aim, a proposal that would fundamentally change U.S. healthcare. The Triple Aim goes beyond standard quality improvement and the concept of universal healthcare to target three areas: population health (preventive measures), experience of care (safety, efficiency, patient-centered care), and per-capita cost.

“We need to create a system that provides better care to all populations and controls the inflation of costs,” Dr. Berwick stressed. He said giant steps are needed to pursue the Triple Aim, including continued transparency, public health interventions, coordination of care, universal access, a financial management system, and an organization or consortium to act as integrator.

“There’s no question in my mind that hospitalists can participate,” said Dr. Berwick. “Can you help with Triple Aim? I’m not sure. You have to decide [your role]. Do you want to be contributors?”

From audience reaction, the answer seemed to be a resounding “yes.”

“His comments about the systemwide process versus a single doctor really rang true,” said attendee Arpi Bekmezian, MD, a pediatric hospitalist at University of California, Los Angeles. “Changing the system is the key to improving quality in a hospital because it’s such a large, crazy, intense institution.”

“Pimp My Ride” Care

On April 5, author, consultant, and healthcare futurist Ian Morrison, PhD, provided a thought-provoking look at healthcare flaws in “Hospitalists and the Future of Healthcare: The Quest for Value for All Americans.” Dr. Morrison terms our system “Pimp My Ride” healthcare. “We’re adding unbelievable amounts of technology on a frame that’s tired, old, and ineffective,” he asserted.

Dr. Morrison warned that Americans have worse health than their counterparts in other industrialized countries, and this trend is going to get worse.

“We have coming at us over the next two decades a triple tsunami of chronic care needs that will overwhelm our current health system,” he warned: obesity and its related conditions, cancer as a chronic condition, and depression. He pointed out that hospitalists must see a lot of hypertensive, obese, non-compliant, and diabetic patients. “When you see [these] patients, you’re seeing the failure of primary care,” he said.

The bottom line, according to Dr. Morrison, is progress will take great effort—and hospitalists can lead the charge: “Systems of healthcare need to be continually improved to deliver greater value. This will require clinical skills, process skills, the use of cutting-edge information technology and clinical technology. You’re right at the heart of that. We need new models of safer, more reliable, higher quality, more cost-effective care, and I think your profession can make a central contribution to that.”

Wachter’s “Mega-trends”

As is traditional at SHM meetings, Bob Wachter wrapped up the meeting with his insights on the present and future of hospital medicine. Dr. Wachter, who coined the term “hospitalist,” presented “Whipsawed: Can Hospitalists Survive in the Face of Co-Management, Non-Teaching Services, Transparency and the Reality of Perpetual Change.”

Dr. Wachter sees six “mega-trends” affecting hospital medicine:

1. Quality and value issues: “Even if payer pay-for-performance stalls out, local programs will grow,” he predicted. “When transparency increases, your CMO will start asking for accountability from the hospital medicine program. There will likely be a bonus scheme attached to this.”

2. Patient safety: “The emergence of state reporting systems is huge,” Wachter said. “I’m not sure if that’s good or not.” One key shift is the National Quality Forum’s list of 28 “never events,” or errors that are clearly identifiable, preventable, and serious for patients. “You’ll start to see more pressure from state bureaucrats on this.”

3. Information technology: The downside of enhanced technology, Wachter believes, is that “IT leads to dislocation of medicine. The physician relationships that are formed while we’re on the floor are gone.” Doctors can now complete their notes at home or in their office.

4. Co-management: There is massive growth in opportunities for co-managing patients. Dr. Wachter sees this as inevitable: “Don’t bother trying to not own it. It’s going to happen.”

5. ACGME regulations for teaching institutions: “We’ve seen the end of using residents as a cheap labor pools,” Dr. Wachter said. “Now academic hospitals have to figure out how to be like community hospitals.”

6. Work force issues: Tremendous growth requires comprehensive changes to how business is done. “Thriving now takes a new set of skills: leadership, change management, team building, and the skill to say ‘No’ or ‘Yes, if you can …’ ” said Dr. Wachter. Sharing those skills with your clinical hospitalists is imperative, he stressed: “Now, leadership and innovation must be everyone’s job. Your practice must become a bureaucracy.”

There is good news, Dr. Wachter stressed: “We’re in the driver’s seat. We can demand” what we need to survive and thrive.

Three healthcare visionaries inspired attendees of SHM’s Annual Meeting with unique views of the future of U.S. healthcare and the role hospitalists can play in shaping a new model of efficient, high-quality care.

Meeting attendees were galvanized April 4 by Donald M. Berwick, MD, MPP, president and CEO of the Institute for Healthcare Improvement (IHI) and architect of the “100,000 Lives” and “5 Million Lives” campaigns. In his opening-day address “Improving Healthcare Quality and Value: Hospitalists and the Quality Revolution,” Dr. Berwick pointed out that physicians react to care problems by working harder and harder—but that the real solution must come from big-picture changes. Like his 12-year-old Subaru Outback, Dr. Berwick emphasized: “You have a top speed, and you can’t go beyond that. The system has to depend on interdependency, not on [individual] heroism.”

After setting the stage with data highlighting healthcare’s disparities and underperformance, Dr. Berwick unveiled the Triple Aim, a proposal that would fundamentally change U.S. healthcare. The Triple Aim goes beyond standard quality improvement and the concept of universal healthcare to target three areas: population health (preventive measures), experience of care (safety, efficiency, patient-centered care), and per-capita cost.

“We need to create a system that provides better care to all populations and controls the inflation of costs,” Dr. Berwick stressed. He said giant steps are needed to pursue the Triple Aim, including continued transparency, public health interventions, coordination of care, universal access, a financial management system, and an organization or consortium to act as integrator.

“There’s no question in my mind that hospitalists can participate,” said Dr. Berwick. “Can you help with Triple Aim? I’m not sure. You have to decide [your role]. Do you want to be contributors?”

From audience reaction, the answer seemed to be a resounding “yes.”

“His comments about the systemwide process versus a single doctor really rang true,” said attendee Arpi Bekmezian, MD, a pediatric hospitalist at University of California, Los Angeles. “Changing the system is the key to improving quality in a hospital because it’s such a large, crazy, intense institution.”

“Pimp My Ride” Care

On April 5, author, consultant, and healthcare futurist Ian Morrison, PhD, provided a thought-provoking look at healthcare flaws in “Hospitalists and the Future of Healthcare: The Quest for Value for All Americans.” Dr. Morrison terms our system “Pimp My Ride” healthcare. “We’re adding unbelievable amounts of technology on a frame that’s tired, old, and ineffective,” he asserted.

Dr. Morrison warned that Americans have worse health than their counterparts in other industrialized countries, and this trend is going to get worse.

“We have coming at us over the next two decades a triple tsunami of chronic care needs that will overwhelm our current health system,” he warned: obesity and its related conditions, cancer as a chronic condition, and depression. He pointed out that hospitalists must see a lot of hypertensive, obese, non-compliant, and diabetic patients. “When you see [these] patients, you’re seeing the failure of primary care,” he said.

The bottom line, according to Dr. Morrison, is progress will take great effort—and hospitalists can lead the charge: “Systems of healthcare need to be continually improved to deliver greater value. This will require clinical skills, process skills, the use of cutting-edge information technology and clinical technology. You’re right at the heart of that. We need new models of safer, more reliable, higher quality, more cost-effective care, and I think your profession can make a central contribution to that.”

Wachter’s “Mega-trends”

As is traditional at SHM meetings, Bob Wachter wrapped up the meeting with his insights on the present and future of hospital medicine. Dr. Wachter, who coined the term “hospitalist,” presented “Whipsawed: Can Hospitalists Survive in the Face of Co-Management, Non-Teaching Services, Transparency and the Reality of Perpetual Change.”

Dr. Wachter sees six “mega-trends” affecting hospital medicine:

1. Quality and value issues: “Even if payer pay-for-performance stalls out, local programs will grow,” he predicted. “When transparency increases, your CMO will start asking for accountability from the hospital medicine program. There will likely be a bonus scheme attached to this.”

2. Patient safety: “The emergence of state reporting systems is huge,” Wachter said. “I’m not sure if that’s good or not.” One key shift is the National Quality Forum’s list of 28 “never events,” or errors that are clearly identifiable, preventable, and serious for patients. “You’ll start to see more pressure from state bureaucrats on this.”

3. Information technology: The downside of enhanced technology, Wachter believes, is that “IT leads to dislocation of medicine. The physician relationships that are formed while we’re on the floor are gone.” Doctors can now complete their notes at home or in their office.

4. Co-management: There is massive growth in opportunities for co-managing patients. Dr. Wachter sees this as inevitable: “Don’t bother trying to not own it. It’s going to happen.”

5. ACGME regulations for teaching institutions: “We’ve seen the end of using residents as a cheap labor pools,” Dr. Wachter said. “Now academic hospitals have to figure out how to be like community hospitals.”

6. Work force issues: Tremendous growth requires comprehensive changes to how business is done. “Thriving now takes a new set of skills: leadership, change management, team building, and the skill to say ‘No’ or ‘Yes, if you can …’ ” said Dr. Wachter. Sharing those skills with your clinical hospitalists is imperative, he stressed: “Now, leadership and innovation must be everyone’s job. Your practice must become a bureaucracy.”

There is good news, Dr. Wachter stressed: “We’re in the driver’s seat. We can demand” what we need to survive and thrive.

SAN DIEGO—Eleven years ago, about 100 physicians gathered in San Diego for a meeting of the National Association of Inpatient Physicians (NAIP). The term “hospitalist” had been coined only two years earlier for a fledgling specialty.

Fast forward to April 3, when NAIP—now SHM—returned to this city with 1,600 attendees for the largest gathering of hospitalists to date. This meeting, Hospital Medicine 2008, showcased a multitude of the society’s newest and boldest efforts.

Hot-off-the-presses data from the Society of Hospital Medicine 2007-2008 Survey were unveiled, showing hospitalists are getting paid more to do roughly the same amount of work they’d been doing. SHM also announced an upcoming Fellowship in Hospital Medicine credential, to be the first designation of commitment to the field. While handing over the reins to his successor Patrick J. Cawley, MD, outgoing SHM President Rusty Holman, MD, announced the development of a Hospital Care Collaborative that will foster cooperation among hospitalists, critical care nurses, pharmacists, and other hospital medicine stakeholders.

Attendees flocked to SHM’s new Rapid Fire clinical track for evidence-based answers to common question, delivered at a breakneck pace. For the first time, an award for Team Approaches in Quality Improvement was among those bestowed at the President’s Lunch. The winning project, “Optimizing Prevention of Hospital-Acquired Venous Thromboembolism,” was the creation of a team from the University of California, San Diego led by Gregory Maynard, MD, professor of clinical medicine and chief of the division of hospital medicine.

The future of our healthcare system and the role hospital medicine will play were uppermost on the minds of keynote speakers Don Berwick, MD, of the Institute for Healthcare Improvement (IHI), healthcare futurist Ian Morrison, PhD, and Robert Wachter, MD, each of whom peered into their crystal balls to give hospitalists glimpses of the challenges and opportunities they might expect. Each urged hospitalists to assert their place in the forefront of reimagining the U.S. care system and claim a leading role in whatever system that might be.

A First Time for Everything

The meeting produced many firsts in the educational content provided, thanks to SHM’s Annual Meeting Committee, led by course director Sylvia McKean, MD.

“We did change some things,” Dr. McKean said. “We had a call for proposals for speakers and sessions, and picked up a session in the operational track, in the clinical track and in Rapid Fire. We got a tremendous response to this, and this was the first time we’d ever had an open call like that.”

Several of the all-day pre-courses were revamped or entirely new. Also new was the Rapid Fire track, which provided answers to dilemmas in critical care, perioperative cardiac, care and more—all in rapid bursts of information.

There also were more special-interest forums, offering an opportunity for all subsets under the tent of hospital medicine—from geriatric hospitalists to women hospitalists to rural hospitalists—to network and compare notes.

Another opportunity to network for those with strong lungs was the inaugural SHM Fun Run early April 5. Participants ran a 5K course along San Diego’s waterfront.

SHM Announces Firsts

At the President’s Lunch on April 5, SHM leaders unveiled plans for several initiatives that will continue to foster and improve hospital medicine.

Dr. Holman outlined recent SHM successes and introduced upcoming initiatives. Successes include the society’s policy and advocacy agenda. SHM members generated 1,700 letters to Congress in 2007 through the online Legislative Action Center and added their voices to a successful lobby to postpone a 10.1% physician pay cut by Medicare last year. He also discussed his appearance at a Senate roundtable March 6 on Capitol Hill to discuss Medicare’s value-based purchasing of hospital care.

SHM is also front and center regarding transitions of care, and has been charged with developing transition quality measures for consideration in reporting initiatives.

As for future initiatives, Dr. Holman told attendees about SHM’s plan for a Hospital Care Collaborative. The society will partner with national organizations in allied health, including the American Association of Critical-Care Nurses and the American Society of Health-System Pharmacists. All will work together on common policies and implementation strategies.

The society also will provide more resources for hospitalist leaders. “SHM wants to be positioned to support leadership training,” Dr. Holman noted. “We have a multiyear plan” that includes creating core competencies for hospital medicine leadership, a possible leadership certification, a mentoring program, and leadership coaching.

SHM CEO Larry Wellikson, MD, summed up the tremendous growth of hospital medicine: “We’re large and in charge, and we’re only going to get bigger.” He elaborated on progress made on SHM initiatives that will enhance this growth, including:

• Continued monitoring of the first official certification for hospital medicine, the American Board of Internal Medicine (ABIM)-approved Focused Recognition for Hospital Medicine;
• Creation of the first designation of commitment to the practice of hospital medicine: the SHM Fellowship in Hospital Medicine (FHM) credential. A Senior Fellowship in Hospital Medicine and a Master in Hospital Medicine will also be available. Information and applications will be available this fall, and all SHM members can apply;
• Continued use of new media to educate and inform members; and
• One- or two-day regional educational forums across the U.S.

Dr. Cawley, chief medical officer of Medical University of South Carolina Medical Center in Charleston, closed the President’s Lunch by echoing the speakers’ message for hospitalists. “Change is in the air,” he asserted, recalling the last time healthcare was poised for big change, when President Clinton was prepared to overhaul the system in 1993. “The difference between 1993 and 2008 is you—it’s hospitalists,” Dr. Cawley urged. “You are the guiding team” for change.

Also during Saturday’s luncheon, outgoing SHM board members Bill Atchley, MD, and Mary Jo Gorman, MD, were honored for their six years of service.

Focus on the Future

Hospital Medicine 2008 was firmly focused on the future: the future of American healthcare, the future of hospital medicine, and what hospitalists will and should do to further their specialty. These themes surfaced again and again in the plenaries, in breakout sessions, and in casual hallway conversations.

Drs. Berwick and Morrison stirred up attendees with their morning addresses and had them debating the state of healthcare. Dr. Wachter, professor and associate chairman, department of medicine, and chief of the medical service, University of California, San Francisco, offered his unique perspective by taking Drs. Berwick and Morrison’s 35,000-foot-view and bringing it down to the day-to-day work of hospitalists. The creator of the popular healthcare blog “Wachter’s World” (www.wachtersworld. org) suggested “megatrends” hospitalists might expect to see, including:

• The growth of local pay-for-performance (bonuses based on performance) and state reporting systems, and a shift toward outcome measurement as opposed to process measures;
• The power of public reporting, driven by the “simple embarrassment of highlighting underperformers”;
• Zero tolerance for “disruptive” physicians;
• Ever-increasing hospitalist-surgical comanagement; and
• IT-induced “dislocation” of medicine as computerization decreases the need for physical presence, as well as the emergence of IT haves and have-nots.

Jane Jerrard, a Chicago-based medical journalist, writes the “Public Policy” and “Career Development” departments for The Hospitalist and has covered the SHM Annual Meeting the past three years.

SAN DIEGO—Eleven years ago, about 100 physicians gathered in San Diego for a meeting of the National Association of Inpatient Physicians (NAIP). The term “hospitalist” had been coined only two years earlier for a fledgling specialty.

Fast forward to April 3, when NAIP—now SHM—returned to this city with 1,600 attendees for the largest gathering of hospitalists to date. This meeting, Hospital Medicine 2008, showcased a multitude of the society’s newest and boldest efforts.

Hot-off-the-presses data from the Society of Hospital Medicine 2007-2008 Survey were unveiled, showing hospitalists are getting paid more to do roughly the same amount of work they’d been doing. SHM also announced an upcoming Fellowship in Hospital Medicine credential, to be the first designation of commitment to the field. While handing over the reins to his successor Patrick J. Cawley, MD, outgoing SHM President Rusty Holman, MD, announced the development of a Hospital Care Collaborative that will foster cooperation among hospitalists, critical care nurses, pharmacists, and other hospital medicine stakeholders.

Attendees flocked to SHM’s new Rapid Fire clinical track for evidence-based answers to common question, delivered at a breakneck pace. For the first time, an award for Team Approaches in Quality Improvement was among those bestowed at the President’s Lunch. The winning project, “Optimizing Prevention of Hospital-Acquired Venous Thromboembolism,” was the creation of a team from the University of California, San Diego led by Gregory Maynard, MD, professor of clinical medicine and chief of the division of hospital medicine.

The future of our healthcare system and the role hospital medicine will play were uppermost on the minds of keynote speakers Don Berwick, MD, of the Institute for Healthcare Improvement (IHI), healthcare futurist Ian Morrison, PhD, and Robert Wachter, MD, each of whom peered into their crystal balls to give hospitalists glimpses of the challenges and opportunities they might expect. Each urged hospitalists to assert their place in the forefront of reimagining the U.S. care system and claim a leading role in whatever system that might be.

A First Time for Everything

The meeting produced many firsts in the educational content provided, thanks to SHM’s Annual Meeting Committee, led by course director Sylvia McKean, MD.

“We did change some things,” Dr. McKean said. “We had a call for proposals for speakers and sessions, and picked up a session in the operational track, in the clinical track and in Rapid Fire. We got a tremendous response to this, and this was the first time we’d ever had an open call like that.”

Several of the all-day pre-courses were revamped or entirely new. Also new was the Rapid Fire track, which provided answers to dilemmas in critical care, perioperative cardiac, care and more—all in rapid bursts of information.

There also were more special-interest forums, offering an opportunity for all subsets under the tent of hospital medicine—from geriatric hospitalists to women hospitalists to rural hospitalists—to network and compare notes.

Another opportunity to network for those with strong lungs was the inaugural SHM Fun Run early April 5. Participants ran a 5K course along San Diego’s waterfront.

SHM Announces Firsts

At the President’s Lunch on April 5, SHM leaders unveiled plans for several initiatives that will continue to foster and improve hospital medicine.

Dr. Holman outlined recent SHM successes and introduced upcoming initiatives. Successes include the society’s policy and advocacy agenda. SHM members generated 1,700 letters to Congress in 2007 through the online Legislative Action Center and added their voices to a successful lobby to postpone a 10.1% physician pay cut by Medicare last year. He also discussed his appearance at a Senate roundtable March 6 on Capitol Hill to discuss Medicare’s value-based purchasing of hospital care.

SHM is also front and center regarding transitions of care, and has been charged with developing transition quality measures for consideration in reporting initiatives.

As for future initiatives, Dr. Holman told attendees about SHM’s plan for a Hospital Care Collaborative. The society will partner with national organizations in allied health, including the American Association of Critical-Care Nurses and the American Society of Health-System Pharmacists. All will work together on common policies and implementation strategies.

The society also will provide more resources for hospitalist leaders. “SHM wants to be positioned to support leadership training,” Dr. Holman noted. “We have a multiyear plan” that includes creating core competencies for hospital medicine leadership, a possible leadership certification, a mentoring program, and leadership coaching.

SHM CEO Larry Wellikson, MD, summed up the tremendous growth of hospital medicine: “We’re large and in charge, and we’re only going to get bigger.” He elaborated on progress made on SHM initiatives that will enhance this growth, including:

• Continued monitoring of the first official certification for hospital medicine, the American Board of Internal Medicine (ABIM)-approved Focused Recognition for Hospital Medicine;
• Creation of the first designation of commitment to the practice of hospital medicine: the SHM Fellowship in Hospital Medicine (FHM) credential. A Senior Fellowship in Hospital Medicine and a Master in Hospital Medicine will also be available. Information and applications will be available this fall, and all SHM members can apply;
• Continued use of new media to educate and inform members; and
• One- or two-day regional educational forums across the U.S.

Dr. Cawley, chief medical officer of Medical University of South Carolina Medical Center in Charleston, closed the President’s Lunch by echoing the speakers’ message for hospitalists. “Change is in the air,” he asserted, recalling the last time healthcare was poised for big change, when President Clinton was prepared to overhaul the system in 1993. “The difference between 1993 and 2008 is you—it’s hospitalists,” Dr. Cawley urged. “You are the guiding team” for change.

Also during Saturday’s luncheon, outgoing SHM board members Bill Atchley, MD, and Mary Jo Gorman, MD, were honored for their six years of service.

Focus on the Future

Hospital Medicine 2008 was firmly focused on the future: the future of American healthcare, the future of hospital medicine, and what hospitalists will and should do to further their specialty. These themes surfaced again and again in the plenaries, in breakout sessions, and in casual hallway conversations.

Drs. Berwick and Morrison stirred up attendees with their morning addresses and had them debating the state of healthcare. Dr. Wachter, professor and associate chairman, department of medicine, and chief of the medical service, University of California, San Francisco, offered his unique perspective by taking Drs. Berwick and Morrison’s 35,000-foot-view and bringing it down to the day-to-day work of hospitalists. The creator of the popular healthcare blog “Wachter’s World” (www.wachtersworld. org) suggested “megatrends” hospitalists might expect to see, including:

• The growth of local pay-for-performance (bonuses based on performance) and state reporting systems, and a shift toward outcome measurement as opposed to process measures;
• The power of public reporting, driven by the “simple embarrassment of highlighting underperformers”;
• Zero tolerance for “disruptive” physicians;
• Ever-increasing hospitalist-surgical comanagement; and
• IT-induced “dislocation” of medicine as computerization decreases the need for physical presence, as well as the emergence of IT haves and have-nots.

Jane Jerrard, a Chicago-based medical journalist, writes the “Public Policy” and “Career Development” departments for The Hospitalist and has covered the SHM Annual Meeting the past three years.

SAN DIEGO—Eleven years ago, about 100 physicians gathered in San Diego for a meeting of the National Association of Inpatient Physicians (NAIP). The term “hospitalist” had been coined only two years earlier for a fledgling specialty.

Fast forward to April 3, when NAIP—now SHM—returned to this city with 1,600 attendees for the largest gathering of hospitalists to date. This meeting, Hospital Medicine 2008, showcased a multitude of the society’s newest and boldest efforts.

Hot-off-the-presses data from the Society of Hospital Medicine 2007-2008 Survey were unveiled, showing hospitalists are getting paid more to do roughly the same amount of work they’d been doing. SHM also announced an upcoming Fellowship in Hospital Medicine credential, to be the first designation of commitment to the field. While handing over the reins to his successor Patrick J. Cawley, MD, outgoing SHM President Rusty Holman, MD, announced the development of a Hospital Care Collaborative that will foster cooperation among hospitalists, critical care nurses, pharmacists, and other hospital medicine stakeholders.

Attendees flocked to SHM’s new Rapid Fire clinical track for evidence-based answers to common question, delivered at a breakneck pace. For the first time, an award for Team Approaches in Quality Improvement was among those bestowed at the President’s Lunch. The winning project, “Optimizing Prevention of Hospital-Acquired Venous Thromboembolism,” was the creation of a team from the University of California, San Diego led by Gregory Maynard, MD, professor of clinical medicine and chief of the division of hospital medicine.

The future of our healthcare system and the role hospital medicine will play were uppermost on the minds of keynote speakers Don Berwick, MD, of the Institute for Healthcare Improvement (IHI), healthcare futurist Ian Morrison, PhD, and Robert Wachter, MD, each of whom peered into their crystal balls to give hospitalists glimpses of the challenges and opportunities they might expect. Each urged hospitalists to assert their place in the forefront of reimagining the U.S. care system and claim a leading role in whatever system that might be.

A First Time for Everything

The meeting produced many firsts in the educational content provided, thanks to SHM’s Annual Meeting Committee, led by course director Sylvia McKean, MD.

“We did change some things,” Dr. McKean said. “We had a call for proposals for speakers and sessions, and picked up a session in the operational track, in the clinical track and in Rapid Fire. We got a tremendous response to this, and this was the first time we’d ever had an open call like that.”

Several of the all-day pre-courses were revamped or entirely new. Also new was the Rapid Fire track, which provided answers to dilemmas in critical care, perioperative cardiac, care and more—all in rapid bursts of information.

There also were more special-interest forums, offering an opportunity for all subsets under the tent of hospital medicine—from geriatric hospitalists to women hospitalists to rural hospitalists—to network and compare notes.

Another opportunity to network for those with strong lungs was the inaugural SHM Fun Run early April 5. Participants ran a 5K course along San Diego’s waterfront.

SHM Announces Firsts

At the President’s Lunch on April 5, SHM leaders unveiled plans for several initiatives that will continue to foster and improve hospital medicine.

Dr. Holman outlined recent SHM successes and introduced upcoming initiatives. Successes include the society’s policy and advocacy agenda. SHM members generated 1,700 letters to Congress in 2007 through the online Legislative Action Center and added their voices to a successful lobby to postpone a 10.1% physician pay cut by Medicare last year. He also discussed his appearance at a Senate roundtable March 6 on Capitol Hill to discuss Medicare’s value-based purchasing of hospital care.

SHM is also front and center regarding transitions of care, and has been charged with developing transition quality measures for consideration in reporting initiatives.

As for future initiatives, Dr. Holman told attendees about SHM’s plan for a Hospital Care Collaborative. The society will partner with national organizations in allied health, including the American Association of Critical-Care Nurses and the American Society of Health-System Pharmacists. All will work together on common policies and implementation strategies.

The society also will provide more resources for hospitalist leaders. “SHM wants to be positioned to support leadership training,” Dr. Holman noted. “We have a multiyear plan” that includes creating core competencies for hospital medicine leadership, a possible leadership certification, a mentoring program, and leadership coaching.

SHM CEO Larry Wellikson, MD, summed up the tremendous growth of hospital medicine: “We’re large and in charge, and we’re only going to get bigger.” He elaborated on progress made on SHM initiatives that will enhance this growth, including:

• Continued monitoring of the first official certification for hospital medicine, the American Board of Internal Medicine (ABIM)-approved Focused Recognition for Hospital Medicine;
• Creation of the first designation of commitment to the practice of hospital medicine: the SHM Fellowship in Hospital Medicine (FHM) credential. A Senior Fellowship in Hospital Medicine and a Master in Hospital Medicine will also be available. Information and applications will be available this fall, and all SHM members can apply;
• Continued use of new media to educate and inform members; and
• One- or two-day regional educational forums across the U.S.

Dr. Cawley, chief medical officer of Medical University of South Carolina Medical Center in Charleston, closed the President’s Lunch by echoing the speakers’ message for hospitalists. “Change is in the air,” he asserted, recalling the last time healthcare was poised for big change, when President Clinton was prepared to overhaul the system in 1993. “The difference between 1993 and 2008 is you—it’s hospitalists,” Dr. Cawley urged. “You are the guiding team” for change.

Also during Saturday’s luncheon, outgoing SHM board members Bill Atchley, MD, and Mary Jo Gorman, MD, were honored for their six years of service.

Focus on the Future

Hospital Medicine 2008 was firmly focused on the future: the future of American healthcare, the future of hospital medicine, and what hospitalists will and should do to further their specialty. These themes surfaced again and again in the plenaries, in breakout sessions, and in casual hallway conversations.

Drs. Berwick and Morrison stirred up attendees with their morning addresses and had them debating the state of healthcare. Dr. Wachter, professor and associate chairman, department of medicine, and chief of the medical service, University of California, San Francisco, offered his unique perspective by taking Drs. Berwick and Morrison’s 35,000-foot-view and bringing it down to the day-to-day work of hospitalists. The creator of the popular healthcare blog “Wachter’s World” (www.wachtersworld. org) suggested “megatrends” hospitalists might expect to see, including:

• The growth of local pay-for-performance (bonuses based on performance) and state reporting systems, and a shift toward outcome measurement as opposed to process measures;
• The power of public reporting, driven by the “simple embarrassment of highlighting underperformers”;
• Zero tolerance for “disruptive” physicians;
• Ever-increasing hospitalist-surgical comanagement; and
• IT-induced “dislocation” of medicine as computerization decreases the need for physical presence, as well as the emergence of IT haves and have-nots.

Jane Jerrard, a Chicago-based medical journalist, writes the “Public Policy” and “Career Development” departments for The Hospitalist and has covered the SHM Annual Meeting the past three years.

The current pay-for-reporting program from the Centers for Medicare and Medicaid (CMS) seems tailor-made for hospitalists. Here’s a look at the voluntary Physician Quality Reporting Initiative (PQRI) program, and why and how hospitalists are—and are not—participating.

CMS has revised the reporting program that began as a six-month trial in 2007. The current PQRI runs the full calendar year for 2008 and includes 119 quality measures—11 of which hospitalists can report on. Detailed specifications for the measures are available on the CMS Web site at www.cms.hhs.gov.

The earnings in this pay-for-reporting program remain the same as 2007: Physicians who successfully report on measures can earn a bonus payment equal to 1.5% of their total Medicare-allowed charges. Some hospitalists have collected their bonus for participating in the 2007 trial; it’s likely more will participate this year.

CMS has yet to release data on participation in the 2007 PQRI trial or this year’s initiative. However, SHM has urged hospitalists to participate, and many are. During a national, SHM-sponsored conference call with CMS in summer 2007, approximately 20% of the 160 hospitalists participating in the call responded to a follow-up survey. Almost half of all respondents indicated they planned to participate in PQRI reporting.

“That percentage comes from a select group of hospitalists who were highly interested in the PQRI,” points out Patrick J. Torcson, MD, MMM, FACP, director of hospital medicine at St. Tammany Parish Hospital in Covington, La.

Unlike many specialists, hospitalists are finding reporting to be a straightforward process. “For hospitalists, PQRI reporting on specific measures harmonizes nicely with workflow,” says Dr. Torcson. “Most applicable measures take place during admission or discharge. Documentation and reporting for PQRI can take place during these times.”

Report on Reporting

At St. Tammany, Dr. Torcson’s eight-hospitalist team is participating in PQRI. Although you need only to report on three measures to qualify for a bonus payment from the program, “we’re actually reporting on the full list of [hospitalist-applicable] measures,” Dr. Torcson says. It’s up to each St. Tammany hospitalist to remember to report on the 11 measures.

“Support for [reporting] really comes down to physician memory,” says Dr. Torcson. “Long term, this is going to have to be part of an electronic system, with decision support and billing capability from an electronic health record.”

In spite of the added step of PQRI reporting, Dr. Torcson says, “we’ve had an enthusiastic response from our hospitalists.” The payoff for the hospital medicine program and the hospital is yet to be seen. “You hope that PQRI performance reporting will result in improved quality of care,” henotes.

But many physicians—including hospitalists—are not participating in PQRI.

“It comes down to different practice models,” explains Dr. Torcson. “But for many physicians, a major reason not to participate is that they’re taking a wait-­and-see approach. They’re waiting to see if this is just the latest flavor of the month, and think it’s not worth investing time and effort until it proves otherwise.”

Gregory B. Seymann, MD, associate clinical professor, University of California, San Diego (UCSD) School of Medicine, Division of Hospital Medicine, is a member of SHM’s Public Policy Committee and says he was disappointed his group is unable to participate in PQRI.

“I work for UCSD, where our hospitalist group is one of many, many subspecialty groups that work out of our hospital,” he explains “We do a lot of QI work, and we were certainly interested in participating in PQRI.” However, the hospital uses an electronic billing system incompatible with reporting on the measures. The software could be upgraded for about $15,000, says Dr. Seymann, but hospital administration sees no return on the investment.

“The cost wouldn’t match the increase in revenues because besides hospital medicine, there aren’t a lot of other subspecialties that would be interested in participating,” explains Dr. Seymann. “As much as I wanted our group to participate, I can’t fully fault UCSD on this decision on business grounds. They want to see some stability in [the decision to continue PQRI] before they invest.”

In the meantime, the orthopedics group at UCSD has invested in reporting. They are tracking PQRI measures on paper and reporting to CMS, and they’ll ultimately be able to show the administration whether the bonus per physician might add up to the cost of the necessary billing-system upgrade.

Beyond 2008

Everyone involved—not just UCSD—is asking: Is PQRI here to stay? That decision rests with federal lawmakers. At the end of this year, Congress must vote on whether to extend the program—and no one can guarantee whether that will happen.

“The chairs of the Senate Finance Committee have been tremendously supportive of the PQRI,” says Dr. Torcson. “There is a lot of political will behind this right now. [PQRI supporters in Congress] want better quality in healthcare for better pay.”

This year’s election will have a major impact on this decision: “A change in administration will definitely factor in,” warns Dr. Torcson. “The 2008 Medicare Physician Payment Update seemed to divide along party lines. Republicans were somewhat supportive, and Democrats didn’t seem to support it. It’s not quite that simple, but that was a general pattern.”

The best advice for physicians invested or interested in investing in PQRI is to keep an eye on the November election results and the Senate Finance Committee to find out what 2009 and beyond will look like for PQRI or other CMS pay-for-reporting initiatives.

Too Late to Participate?

Although the PQRI began Jan. 1, there is no enrollment process; physicians can start reporting any time during the year. However, participants reporting on three measures report in at least 80% of the instances in which those measures are reportable—that means all year—in order to qualify for a bonus. If you begin reporting this far into the year, you’re not likely to reach that threshold and earn your bonus.

“Starting late in the year could affect reaching that threshold, but it’s never too late to start the practice and process of reporting,” says Dr. Torcson. “You can still make that commitment to performance reporting. Even if you don’t get the 1.5% bonus, you get the benefit of getting started in the important practice of performance reporting.”

Read more about the PQRI on SHM’s Web site (www.hospitalmedicine.org). TH

Jane Jerrard has written for The Hospitalist since 2005.

The current pay-for-reporting program from the Centers for Medicare and Medicaid (CMS) seems tailor-made for hospitalists. Here’s a look at the voluntary Physician Quality Reporting Initiative (PQRI) program, and why and how hospitalists are—and are not—participating.

CMS has revised the reporting program that began as a six-month trial in 2007. The current PQRI runs the full calendar year for 2008 and includes 119 quality measures—11 of which hospitalists can report on. Detailed specifications for the measures are available on the CMS Web site at www.cms.hhs.gov.

The earnings in this pay-for-reporting program remain the same as 2007: Physicians who successfully report on measures can earn a bonus payment equal to 1.5% of their total Medicare-allowed charges. Some hospitalists have collected their bonus for participating in the 2007 trial; it’s likely more will participate this year.

CMS has yet to release data on participation in the 2007 PQRI trial or this year’s initiative. However, SHM has urged hospitalists to participate, and many are. During a national, SHM-sponsored conference call with CMS in summer 2007, approximately 20% of the 160 hospitalists participating in the call responded to a follow-up survey. Almost half of all respondents indicated they planned to participate in PQRI reporting.

“That percentage comes from a select group of hospitalists who were highly interested in the PQRI,” points out Patrick J. Torcson, MD, MMM, FACP, director of hospital medicine at St. Tammany Parish Hospital in Covington, La.

Unlike many specialists, hospitalists are finding reporting to be a straightforward process. “For hospitalists, PQRI reporting on specific measures harmonizes nicely with workflow,” says Dr. Torcson. “Most applicable measures take place during admission or discharge. Documentation and reporting for PQRI can take place during these times.”

Report on Reporting

At St. Tammany, Dr. Torcson’s eight-hospitalist team is participating in PQRI. Although you need only to report on three measures to qualify for a bonus payment from the program, “we’re actually reporting on the full list of [hospitalist-applicable] measures,” Dr. Torcson says. It’s up to each St. Tammany hospitalist to remember to report on the 11 measures.

“Support for [reporting] really comes down to physician memory,” says Dr. Torcson. “Long term, this is going to have to be part of an electronic system, with decision support and billing capability from an electronic health record.”

In spite of the added step of PQRI reporting, Dr. Torcson says, “we’ve had an enthusiastic response from our hospitalists.” The payoff for the hospital medicine program and the hospital is yet to be seen. “You hope that PQRI performance reporting will result in improved quality of care,” henotes.

But many physicians—including hospitalists—are not participating in PQRI.

“It comes down to different practice models,” explains Dr. Torcson. “But for many physicians, a major reason not to participate is that they’re taking a wait-­and-see approach. They’re waiting to see if this is just the latest flavor of the month, and think it’s not worth investing time and effort until it proves otherwise.”

Gregory B. Seymann, MD, associate clinical professor, University of California, San Diego (UCSD) School of Medicine, Division of Hospital Medicine, is a member of SHM’s Public Policy Committee and says he was disappointed his group is unable to participate in PQRI.

“I work for UCSD, where our hospitalist group is one of many, many subspecialty groups that work out of our hospital,” he explains “We do a lot of QI work, and we were certainly interested in participating in PQRI.” However, the hospital uses an electronic billing system incompatible with reporting on the measures. The software could be upgraded for about $15,000, says Dr. Seymann, but hospital administration sees no return on the investment.

“The cost wouldn’t match the increase in revenues because besides hospital medicine, there aren’t a lot of other subspecialties that would be interested in participating,” explains Dr. Seymann. “As much as I wanted our group to participate, I can’t fully fault UCSD on this decision on business grounds. They want to see some stability in [the decision to continue PQRI] before they invest.”

In the meantime, the orthopedics group at UCSD has invested in reporting. They are tracking PQRI measures on paper and reporting to CMS, and they’ll ultimately be able to show the administration whether the bonus per physician might add up to the cost of the necessary billing-system upgrade.

Beyond 2008

Everyone involved—not just UCSD—is asking: Is PQRI here to stay? That decision rests with federal lawmakers. At the end of this year, Congress must vote on whether to extend the program—and no one can guarantee whether that will happen.

“The chairs of the Senate Finance Committee have been tremendously supportive of the PQRI,” says Dr. Torcson. “There is a lot of political will behind this right now. [PQRI supporters in Congress] want better quality in healthcare for better pay.”

This year’s election will have a major impact on this decision: “A change in administration will definitely factor in,” warns Dr. Torcson. “The 2008 Medicare Physician Payment Update seemed to divide along party lines. Republicans were somewhat supportive, and Democrats didn’t seem to support it. It’s not quite that simple, but that was a general pattern.”

The best advice for physicians invested or interested in investing in PQRI is to keep an eye on the November election results and the Senate Finance Committee to find out what 2009 and beyond will look like for PQRI or other CMS pay-for-reporting initiatives.

Too Late to Participate?

Although the PQRI began Jan. 1, there is no enrollment process; physicians can start reporting any time during the year. However, participants reporting on three measures report in at least 80% of the instances in which those measures are reportable—that means all year—in order to qualify for a bonus. If you begin reporting this far into the year, you’re not likely to reach that threshold and earn your bonus.

“Starting late in the year could affect reaching that threshold, but it’s never too late to start the practice and process of reporting,” says Dr. Torcson. “You can still make that commitment to performance reporting. Even if you don’t get the 1.5% bonus, you get the benefit of getting started in the important practice of performance reporting.”

Read more about the PQRI on SHM’s Web site (www.hospitalmedicine.org). TH

Jane Jerrard has written for The Hospitalist since 2005.

The current pay-for-reporting program from the Centers for Medicare and Medicaid (CMS) seems tailor-made for hospitalists. Here’s a look at the voluntary Physician Quality Reporting Initiative (PQRI) program, and why and how hospitalists are—and are not—participating.

CMS has revised the reporting program that began as a six-month trial in 2007. The current PQRI runs the full calendar year for 2008 and includes 119 quality measures—11 of which hospitalists can report on. Detailed specifications for the measures are available on the CMS Web site at www.cms.hhs.gov.

The earnings in this pay-for-reporting program remain the same as 2007: Physicians who successfully report on measures can earn a bonus payment equal to 1.5% of their total Medicare-allowed charges. Some hospitalists have collected their bonus for participating in the 2007 trial; it’s likely more will participate this year.

CMS has yet to release data on participation in the 2007 PQRI trial or this year’s initiative. However, SHM has urged hospitalists to participate, and many are. During a national, SHM-sponsored conference call with CMS in summer 2007, approximately 20% of the 160 hospitalists participating in the call responded to a follow-up survey. Almost half of all respondents indicated they planned to participate in PQRI reporting.

“That percentage comes from a select group of hospitalists who were highly interested in the PQRI,” points out Patrick J. Torcson, MD, MMM, FACP, director of hospital medicine at St. Tammany Parish Hospital in Covington, La.

Unlike many specialists, hospitalists are finding reporting to be a straightforward process. “For hospitalists, PQRI reporting on specific measures harmonizes nicely with workflow,” says Dr. Torcson. “Most applicable measures take place during admission or discharge. Documentation and reporting for PQRI can take place during these times.”

Report on Reporting

At St. Tammany, Dr. Torcson’s eight-hospitalist team is participating in PQRI. Although you need only to report on three measures to qualify for a bonus payment from the program, “we’re actually reporting on the full list of [hospitalist-applicable] measures,” Dr. Torcson says. It’s up to each St. Tammany hospitalist to remember to report on the 11 measures.

“Support for [reporting] really comes down to physician memory,” says Dr. Torcson. “Long term, this is going to have to be part of an electronic system, with decision support and billing capability from an electronic health record.”

In spite of the added step of PQRI reporting, Dr. Torcson says, “we’ve had an enthusiastic response from our hospitalists.” The payoff for the hospital medicine program and the hospital is yet to be seen. “You hope that PQRI performance reporting will result in improved quality of care,” henotes.

But many physicians—including hospitalists—are not participating in PQRI.

“It comes down to different practice models,” explains Dr. Torcson. “But for many physicians, a major reason not to participate is that they’re taking a wait-­and-see approach. They’re waiting to see if this is just the latest flavor of the month, and think it’s not worth investing time and effort until it proves otherwise.”

Gregory B. Seymann, MD, associate clinical professor, University of California, San Diego (UCSD) School of Medicine, Division of Hospital Medicine, is a member of SHM’s Public Policy Committee and says he was disappointed his group is unable to participate in PQRI.

“I work for UCSD, where our hospitalist group is one of many, many subspecialty groups that work out of our hospital,” he explains “We do a lot of QI work, and we were certainly interested in participating in PQRI.” However, the hospital uses an electronic billing system incompatible with reporting on the measures. The software could be upgraded for about $15,000, says Dr. Seymann, but hospital administration sees no return on the investment.

“The cost wouldn’t match the increase in revenues because besides hospital medicine, there aren’t a lot of other subspecialties that would be interested in participating,” explains Dr. Seymann. “As much as I wanted our group to participate, I can’t fully fault UCSD on this decision on business grounds. They want to see some stability in [the decision to continue PQRI] before they invest.”

In the meantime, the orthopedics group at UCSD has invested in reporting. They are tracking PQRI measures on paper and reporting to CMS, and they’ll ultimately be able to show the administration whether the bonus per physician might add up to the cost of the necessary billing-system upgrade.

Beyond 2008

Everyone involved—not just UCSD—is asking: Is PQRI here to stay? That decision rests with federal lawmakers. At the end of this year, Congress must vote on whether to extend the program—and no one can guarantee whether that will happen.

“The chairs of the Senate Finance Committee have been tremendously supportive of the PQRI,” says Dr. Torcson. “There is a lot of political will behind this right now. [PQRI supporters in Congress] want better quality in healthcare for better pay.”

This year’s election will have a major impact on this decision: “A change in administration will definitely factor in,” warns Dr. Torcson. “The 2008 Medicare Physician Payment Update seemed to divide along party lines. Republicans were somewhat supportive, and Democrats didn’t seem to support it. It’s not quite that simple, but that was a general pattern.”

The best advice for physicians invested or interested in investing in PQRI is to keep an eye on the November election results and the Senate Finance Committee to find out what 2009 and beyond will look like for PQRI or other CMS pay-for-reporting initiatives.

Too Late to Participate?

Although the PQRI began Jan. 1, there is no enrollment process; physicians can start reporting any time during the year. However, participants reporting on three measures report in at least 80% of the instances in which those measures are reportable—that means all year—in order to qualify for a bonus. If you begin reporting this far into the year, you’re not likely to reach that threshold and earn your bonus.

“Starting late in the year could affect reaching that threshold, but it’s never too late to start the practice and process of reporting,” says Dr. Torcson. “You can still make that commitment to performance reporting. Even if you don’t get the 1.5% bonus, you get the benefit of getting started in the important practice of performance reporting.”

Read more about the PQRI on SHM’s Web site (www.hospitalmedicine.org). TH

Jane Jerrard has written for The Hospitalist since 2005.

By putting a little time and effort into your presentation skills, you can become more persuasive and effective in your day-to-day job—and even advance your career and reputation.

For hospitalists, with their often-heavy committee load and frequent formal or informal teaching conversations, addressing groups is part of the job.

“At the end of the day, hospitalists are advocates—whether for quality improvement or patient-care issues,” says Jeffrey Wiese, MD, FACP, associate professor of medicine at Tulane University Health Sciences Center in New Orleans, associate chairman of medicine, director of the Tulane Internal Medicine Residency Program, and associate director of student programs, internal medicine. “And most of their advocacy efforts [are] going to be person-to-person, verbal discussions, where their passion and conviction can come through.”

Even if you’re never asked to present at a national meeting, you are likely to address a lot of committees, teams, and task forces in your career.

“It’s important to realize that people’s time is valuable in committee meetings,” stresses Dr. Wiese. “You have to be able to speak clearly, concisely, and to the point to make your case effectively.”

Learn by Listening

If you haven’t had much experience addressing groups or you feel your presentation skills are lacking, there are simple steps to become comfortable—even accomplished—at speaking.

“Most effective speakers are partly born but mostly made,” says Robert Wachter, MD, co-founder of SHM, frequent keynote speaker and professor and associate chairman of the Department of Medicine at the University of California, San Francisco.

Becoming an effective speaker may require formal training, perhaps from a course or a book. But one step every aspiring speaker can easily take is to listen to other speakers—a lot of them.

While working on his own presentation skills, Dr. Wachter says: “I learned to be a shameless mimic and thief. Even now, when I hear a good lecture, I always ask myself what that person did really well, and can I do that, too. And when I hear a crummy speaker, I wonder what I would tell them to them improve.”

Dr. Wiese does the same thing. “My strategy is to learn from every talk I sit in on,” he says. “Watch how the speaker is performing—not just at medical meetings, but also on TV. In this election year there are a lot of opportunities to listen to speeches. Note good speakers’ cadence, pitch and tone, and borrow from them.”

Simple Secrets

Effective speaking is built on some basic tenets. “There are fundamental skills that most speakers don’t use—you’d be surprised how basic these skills are,” says Dr. Wiese. These basics include:

Practice makes perfect: No matter how confident you are of your material, practice. Whether you’ll teach, speak to a quality-improvement committee or address a national group, make an outline and run through your speech. “There’s no talk I give without at least sitting down an hour beforehand to think through what I’m going to say,” says Dr. Wiese.

Give it all you’ve got: “When you’re asked to address a group, you have to convince yourself that this is the most important talk you’ve ever given,” stresses Dr. Wiese. “Your belief in this will give you the passion and commitment to your topic that comes out in how you speak.”

Start strong: Getting your audience’s interest and attention immediately is crucial.

“Engaging the audience successfully in the first one to three minutes is unbelievably important because unless you get them to care enough to listen at the outset, you’ve lost them for the rest of the talk,” he says. He believes only about one in 100 speakers do this well. “I assume the audience is not really with me and that I need to actively engage them—and I make sure they know enough to care about the topic. I start with the reasonable assumption that I know more and care more about my topic than they do. Make sure you give them enough background to get them started.”

Fledgling speakers can try capturing their audience’s attention by starting with a joke, story, dramatic anecdote, or shocking data. Starting your presentation with a bang, says Dr. Wachter, “is a learnable skill, and it’s a lot easier when you’re addressing a small group of people you know.”

Spice up dry information: If you’re stuck with a topic you fear is too boring to engage, find a “hook” to draw the audience in. Dr. Wachter suggests, “When you explain facts, use analogy and metaphors, and use graphics only when appropriate,” he suggests.

Find your voice: A tricky thing for new speakers is controlling their voice and using it to maintain interest. Avoid using a monotone—a common effect of reading from notes or slides.

“It’s important to work on your cadence and on the pitch and tone of your voice,” advises Dr. Wiese. “I think speaking is similar to music. Music has rest notes for a reason: to augment what you just said and to set up what you’re about to say. Try replacing the “ums” and “uhs” you use while you’re thinking about what to say next with silence. The audience will be riveted.”

Go easy on the PowerPoint: Don’t rely on your slides or flipchart to influence or engage your audience. Make eye contact with individuals and in a small group; touch a shoulder or two. “The truth is that most people use PowerPoint slides because they didn’t practice their talk,” says Dr. Wiese. “Turn away from your slides and talk person to person—you’ll be much more compelling.”

Speaking Opportunities

For an ambitious hospitalist, opportunities are abundant. “Find the residency director at the nearest program and tell them you’d like to give a conference for free,” Dr. Wiese recommends. “I guarantee this will get you 20 or 30 offers.”

He says national and regional organizations are great opportunities to get involved. “All it really takes is to attend the meetings, find the people doing the talks and tell them that you want an opportunity to hone your speaking skills,” he notes.

If you’re convinced that practicing your speaking skills will help you influence committees, enhance your reputation and improve your career possibilities, then take Dr. Wiese’s advice and get ready to launch your speaking career. TH

Jane Jerrard writes “Public Policy” for The Hospitalist.

By putting a little time and effort into your presentation skills, you can become more persuasive and effective in your day-to-day job—and even advance your career and reputation.

For hospitalists, with their often-heavy committee load and frequent formal or informal teaching conversations, addressing groups is part of the job.

“At the end of the day, hospitalists are advocates—whether for quality improvement or patient-care issues,” says Jeffrey Wiese, MD, FACP, associate professor of medicine at Tulane University Health Sciences Center in New Orleans, associate chairman of medicine, director of the Tulane Internal Medicine Residency Program, and associate director of student programs, internal medicine. “And most of their advocacy efforts [are] going to be person-to-person, verbal discussions, where their passion and conviction can come through.”

Even if you’re never asked to present at a national meeting, you are likely to address a lot of committees, teams, and task forces in your career.

“It’s important to realize that people’s time is valuable in committee meetings,” stresses Dr. Wiese. “You have to be able to speak clearly, concisely, and to the point to make your case effectively.”

Learn by Listening

If you haven’t had much experience addressing groups or you feel your presentation skills are lacking, there are simple steps to become comfortable—even accomplished—at speaking.

“Most effective speakers are partly born but mostly made,” says Robert Wachter, MD, co-founder of SHM, frequent keynote speaker and professor and associate chairman of the Department of Medicine at the University of California, San Francisco.

Becoming an effective speaker may require formal training, perhaps from a course or a book. But one step every aspiring speaker can easily take is to listen to other speakers—a lot of them.

While working on his own presentation skills, Dr. Wachter says: “I learned to be a shameless mimic and thief. Even now, when I hear a good lecture, I always ask myself what that person did really well, and can I do that, too. And when I hear a crummy speaker, I wonder what I would tell them to them improve.”

Dr. Wiese does the same thing. “My strategy is to learn from every talk I sit in on,” he says. “Watch how the speaker is performing—not just at medical meetings, but also on TV. In this election year there are a lot of opportunities to listen to speeches. Note good speakers’ cadence, pitch and tone, and borrow from them.”

Simple Secrets

Effective speaking is built on some basic tenets. “There are fundamental skills that most speakers don’t use—you’d be surprised how basic these skills are,” says Dr. Wiese. These basics include:

Practice makes perfect: No matter how confident you are of your material, practice. Whether you’ll teach, speak to a quality-improvement committee or address a national group, make an outline and run through your speech. “There’s no talk I give without at least sitting down an hour beforehand to think through what I’m going to say,” says Dr. Wiese.

Give it all you’ve got: “When you’re asked to address a group, you have to convince yourself that this is the most important talk you’ve ever given,” stresses Dr. Wiese. “Your belief in this will give you the passion and commitment to your topic that comes out in how you speak.”

Start strong: Getting your audience’s interest and attention immediately is crucial.

“Engaging the audience successfully in the first one to three minutes is unbelievably important because unless you get them to care enough to listen at the outset, you’ve lost them for the rest of the talk,” he says. He believes only about one in 100 speakers do this well. “I assume the audience is not really with me and that I need to actively engage them—and I make sure they know enough to care about the topic. I start with the reasonable assumption that I know more and care more about my topic than they do. Make sure you give them enough background to get them started.”

Fledgling speakers can try capturing their audience’s attention by starting with a joke, story, dramatic anecdote, or shocking data. Starting your presentation with a bang, says Dr. Wachter, “is a learnable skill, and it’s a lot easier when you’re addressing a small group of people you know.”

Spice up dry information: If you’re stuck with a topic you fear is too boring to engage, find a “hook” to draw the audience in. Dr. Wachter suggests, “When you explain facts, use analogy and metaphors, and use graphics only when appropriate,” he suggests.

Find your voice: A tricky thing for new speakers is controlling their voice and using it to maintain interest. Avoid using a monotone—a common effect of reading from notes or slides.

“It’s important to work on your cadence and on the pitch and tone of your voice,” advises Dr. Wiese. “I think speaking is similar to music. Music has rest notes for a reason: to augment what you just said and to set up what you’re about to say. Try replacing the “ums” and “uhs” you use while you’re thinking about what to say next with silence. The audience will be riveted.”

Go easy on the PowerPoint: Don’t rely on your slides or flipchart to influence or engage your audience. Make eye contact with individuals and in a small group; touch a shoulder or two. “The truth is that most people use PowerPoint slides because they didn’t practice their talk,” says Dr. Wiese. “Turn away from your slides and talk person to person—you’ll be much more compelling.”

Speaking Opportunities

For an ambitious hospitalist, opportunities are abundant. “Find the residency director at the nearest program and tell them you’d like to give a conference for free,” Dr. Wiese recommends. “I guarantee this will get you 20 or 30 offers.”

He says national and regional organizations are great opportunities to get involved. “All it really takes is to attend the meetings, find the people doing the talks and tell them that you want an opportunity to hone your speaking skills,” he notes.

If you’re convinced that practicing your speaking skills will help you influence committees, enhance your reputation and improve your career possibilities, then take Dr. Wiese’s advice and get ready to launch your speaking career. TH

Jane Jerrard writes “Public Policy” for The Hospitalist.

By putting a little time and effort into your presentation skills, you can become more persuasive and effective in your day-to-day job—and even advance your career and reputation.

For hospitalists, with their often-heavy committee load and frequent formal or informal teaching conversations, addressing groups is part of the job.

“At the end of the day, hospitalists are advocates—whether for quality improvement or patient-care issues,” says Jeffrey Wiese, MD, FACP, associate professor of medicine at Tulane University Health Sciences Center in New Orleans, associate chairman of medicine, director of the Tulane Internal Medicine Residency Program, and associate director of student programs, internal medicine. “And most of their advocacy efforts [are] going to be person-to-person, verbal discussions, where their passion and conviction can come through.”

Even if you’re never asked to present at a national meeting, you are likely to address a lot of committees, teams, and task forces in your career.

“It’s important to realize that people’s time is valuable in committee meetings,” stresses Dr. Wiese. “You have to be able to speak clearly, concisely, and to the point to make your case effectively.”

Learn by Listening

If you haven’t had much experience addressing groups or you feel your presentation skills are lacking, there are simple steps to become comfortable—even accomplished—at speaking.

“Most effective speakers are partly born but mostly made,” says Robert Wachter, MD, co-founder of SHM, frequent keynote speaker and professor and associate chairman of the Department of Medicine at the University of California, San Francisco.

Becoming an effective speaker may require formal training, perhaps from a course or a book. But one step every aspiring speaker can easily take is to listen to other speakers—a lot of them.

While working on his own presentation skills, Dr. Wachter says: “I learned to be a shameless mimic and thief. Even now, when I hear a good lecture, I always ask myself what that person did really well, and can I do that, too. And when I hear a crummy speaker, I wonder what I would tell them to them improve.”

Dr. Wiese does the same thing. “My strategy is to learn from every talk I sit in on,” he says. “Watch how the speaker is performing—not just at medical meetings, but also on TV. In this election year there are a lot of opportunities to listen to speeches. Note good speakers’ cadence, pitch and tone, and borrow from them.”

Simple Secrets

Effective speaking is built on some basic tenets. “There are fundamental skills that most speakers don’t use—you’d be surprised how basic these skills are,” says Dr. Wiese. These basics include:

Practice makes perfect: No matter how confident you are of your material, practice. Whether you’ll teach, speak to a quality-improvement committee or address a national group, make an outline and run through your speech. “There’s no talk I give without at least sitting down an hour beforehand to think through what I’m going to say,” says Dr. Wiese.

Give it all you’ve got: “When you’re asked to address a group, you have to convince yourself that this is the most important talk you’ve ever given,” stresses Dr. Wiese. “Your belief in this will give you the passion and commitment to your topic that comes out in how you speak.”

Start strong: Getting your audience’s interest and attention immediately is crucial.

“Engaging the audience successfully in the first one to three minutes is unbelievably important because unless you get them to care enough to listen at the outset, you’ve lost them for the rest of the talk,” he says. He believes only about one in 100 speakers do this well. “I assume the audience is not really with me and that I need to actively engage them—and I make sure they know enough to care about the topic. I start with the reasonable assumption that I know more and care more about my topic than they do. Make sure you give them enough background to get them started.”

Fledgling speakers can try capturing their audience’s attention by starting with a joke, story, dramatic anecdote, or shocking data. Starting your presentation with a bang, says Dr. Wachter, “is a learnable skill, and it’s a lot easier when you’re addressing a small group of people you know.”

Spice up dry information: If you’re stuck with a topic you fear is too boring to engage, find a “hook” to draw the audience in. Dr. Wachter suggests, “When you explain facts, use analogy and metaphors, and use graphics only when appropriate,” he suggests.

Find your voice: A tricky thing for new speakers is controlling their voice and using it to maintain interest. Avoid using a monotone—a common effect of reading from notes or slides.

“It’s important to work on your cadence and on the pitch and tone of your voice,” advises Dr. Wiese. “I think speaking is similar to music. Music has rest notes for a reason: to augment what you just said and to set up what you’re about to say. Try replacing the “ums” and “uhs” you use while you’re thinking about what to say next with silence. The audience will be riveted.”

Go easy on the PowerPoint: Don’t rely on your slides or flipchart to influence or engage your audience. Make eye contact with individuals and in a small group; touch a shoulder or two. “The truth is that most people use PowerPoint slides because they didn’t practice their talk,” says Dr. Wiese. “Turn away from your slides and talk person to person—you’ll be much more compelling.”

Speaking Opportunities

For an ambitious hospitalist, opportunities are abundant. “Find the residency director at the nearest program and tell them you’d like to give a conference for free,” Dr. Wiese recommends. “I guarantee this will get you 20 or 30 offers.”

He says national and regional organizations are great opportunities to get involved. “All it really takes is to attend the meetings, find the people doing the talks and tell them that you want an opportunity to hone your speaking skills,” he notes.

If you’re convinced that practicing your speaking skills will help you influence committees, enhance your reputation and improve your career possibilities, then take Dr. Wiese’s advice and get ready to launch your speaking career. TH

Jane Jerrard writes “Public Policy” for The Hospitalist.

SHM had a seat at the table at a high-level roundtable meeting March 6 in Washington, D.C., to discuss Medicare’s value-based purchasing of hospital care.

SHM President Russell Holman, MD, chief operating officer for Cogent Healthcare, Nashville, participated in the roundtable convened by Senate Finance Committee Chairman Max Baucus, D-Mont., and ranking member Chuck Grassley, R-Iowa. The roundtable included representatives from 22 public and private healthcare organizations, including SHM, the American Hospital Association, and National Quality Forum.

“SHM was one of only two physician organizations participating,” points out Laura Allendorf, SHM’s senior adviser for advocacy and government affairs. “That is very significant. I think [our inclusion] is a testament to our growing presence, our advocacy efforts and our willingness to help representatives with healthcare issues like value-based purchasing.”

The Proposed Plan

At the roundtable, representatives from the Centers for Medicare and Medicaid Services (CMS), the Medicare Payment Advisory Commission (MedPAC), and the Government Accountability Office (GAO) presented an overview of the report that CMS submitted to Congress in November, which outlines a hospital value-based purchasing program. The plan is designed to meet CMS’ objective of “transforming Medicare from a passive payer of claims to an active purchaser of care.” It builds on the existing framework of the current pay-for-reporting program, Reporting Hospital Quality Data for Annual Payment Update, but more closely links hospital Medicare payments to performance.

Dr. Holman is well versed in the plan; he and members of SHM’s Public Policy Committee, who were in Washington for annual visits to Capitol Hill, had just met with CMS’s Chief Medical Officer Tom Valuck, MD.

“That same morning, Tom Valuck had spent an hour and a half briefing Public Policy Committee members on Medicare’s value-based purchasing plan,” says Allendorf. “I’d lined up that meeting before the roundtable was set up.”

A transition to CMS’s proposed value-based purchasing plan, or VBP, would probably occur over three years. Under the plan, a percentage of the hospital’s diagnosis related group (DRG) payment would rely on the hospital’s performance on a specific set of measures. Although the report is comprehensive, details on implementation, incentives, and more must be made final.

Public reporting of quality measures remains a key part of the plan; quality of care information would be available to patients through the CMS Hospital Compare site at www.medicare.gov. A PDF of the CMS report to Congress is available at www.cms.hhs.gov/center/hospital.asp.

Support For Harmonization

After the formal presentation on the VBP plan, roundtable moderator John Inglehart, founding editor of Health Affairs, asked a series of questions directed at specific segments of the group, targeting issues surrounding the plan’s quality measures, performance standards, incentives, and plan implementation.

Dr. Holman was asked to comment on how CMS could ensure that hospital measures and physician measures become more aligned.

“The measures that each party are asked to report in terms of Part B of Medicare are somewhat different and can lead to confusion and people working at cross purposes,” Dr. Holman explains. “This adds complexity to a system that’s already too complex. In my statement, I said that what we call harmonization [of reporting measures] is a very important step for CMS to take, so that physicians and hospitals are required to measure and report the same thing. The more we can move toward outcome measures, as well as efficiency and patient experience measures, the more harmonization we’ll have. Focusing on outcomes creates a common goal.”

Dr. Holman continued his comments to the roundtable by using an example of harmonization at the heart of hospital medicine: transitions of care. “I let the group know that SHM is working on a number of initiatives regarding care transitions,” he says. “Transitions of care require the whole system to come together; it’s a great way to help galvanize all the stakeholders toward that shared goal.”

In his written statement, Dr. Holman elaborated on SHM’s efforts regarding transitions of care and pushed for an alignment of CMS quality measures and incentives for physicians with those for hospitals.

Air of Excitement

Although they had many concerns about implementation, the roundtable participants were enthusiastic about the plan. “There was a fabulous give-and-take on issues regarding implementation,” says Allendorf.

Dr. Holman stayed after the meeting to discuss the proceedings with other participants. “All in all, the informal comments I heard after the meeting were that this was the most exciting moment they’d had in 30-plus years in healthcare,” he notes. “This marks a substantial change in the payment system, which has always been seen as a barrier to quality.”

What’s Next

The ball is now in the court of Sens. Baucus and Grassley, who will use the roundtable input to draft legislation that would make the necessary statutory changes in time for CMS to implement the plan by fiscal year 2009, or Oct. 1, as mandated by the Deficit Reduction Act (DRA) of 2005.

“I think they’ll be back in touch with [SHM] as they develop the plan,” Allendorf predicts. After the legislation has been submitted, it’s up to Congress to act. “Everything depends on whether any Medicare legislation moves this year, and no one know whether that will happen,” she says.

Whatever final form the CMS plan takes, the future looks bright for value-based purchasing—and for SHM’s continued involvement.

“This roundtable was an excellent opportunity for SHM to develop a relationship with CMS, and to link to the Senate Finance Committee,” Dr. Holman asserts. “My hope is that those relationships will bear fruit over time, and that we can continue to work with those entities, as well as the other roundtable participants, to propose and develop measures over time, and to bring alignment between hospital measures and physician measures.”

Jane Jerrard is a medical writer based in Chicago.

Read More Online

For more information on the roundtable, including Dr. Holman’s written statement and others, as well as a recorded Webcast, visit Sen. Baucus’ Web site at www.senate.gov/~finance/sitepages/VBProundtable030408.htm. TH

SHM had a seat at the table at a high-level roundtable meeting March 6 in Washington, D.C., to discuss Medicare’s value-based purchasing of hospital care.

SHM President Russell Holman, MD, chief operating officer for Cogent Healthcare, Nashville, participated in the roundtable convened by Senate Finance Committee Chairman Max Baucus, D-Mont., and ranking member Chuck Grassley, R-Iowa. The roundtable included representatives from 22 public and private healthcare organizations, including SHM, the American Hospital Association, and National Quality Forum.

“SHM was one of only two physician organizations participating,” points out Laura Allendorf, SHM’s senior adviser for advocacy and government affairs. “That is very significant. I think [our inclusion] is a testament to our growing presence, our advocacy efforts and our willingness to help representatives with healthcare issues like value-based purchasing.”

The Proposed Plan

At the roundtable, representatives from the Centers for Medicare and Medicaid Services (CMS), the Medicare Payment Advisory Commission (MedPAC), and the Government Accountability Office (GAO) presented an overview of the report that CMS submitted to Congress in November, which outlines a hospital value-based purchasing program. The plan is designed to meet CMS’ objective of “transforming Medicare from a passive payer of claims to an active purchaser of care.” It builds on the existing framework of the current pay-for-reporting program, Reporting Hospital Quality Data for Annual Payment Update, but more closely links hospital Medicare payments to performance.

Dr. Holman is well versed in the plan; he and members of SHM’s Public Policy Committee, who were in Washington for annual visits to Capitol Hill, had just met with CMS’s Chief Medical Officer Tom Valuck, MD.

“That same morning, Tom Valuck had spent an hour and a half briefing Public Policy Committee members on Medicare’s value-based purchasing plan,” says Allendorf. “I’d lined up that meeting before the roundtable was set up.”

A transition to CMS’s proposed value-based purchasing plan, or VBP, would probably occur over three years. Under the plan, a percentage of the hospital’s diagnosis related group (DRG) payment would rely on the hospital’s performance on a specific set of measures. Although the report is comprehensive, details on implementation, incentives, and more must be made final.

Public reporting of quality measures remains a key part of the plan; quality of care information would be available to patients through the CMS Hospital Compare site at www.medicare.gov. A PDF of the CMS report to Congress is available at www.cms.hhs.gov/center/hospital.asp.

Support For Harmonization

After the formal presentation on the VBP plan, roundtable moderator John Inglehart, founding editor of Health Affairs, asked a series of questions directed at specific segments of the group, targeting issues surrounding the plan’s quality measures, performance standards, incentives, and plan implementation.

Dr. Holman was asked to comment on how CMS could ensure that hospital measures and physician measures become more aligned.

“The measures that each party are asked to report in terms of Part B of Medicare are somewhat different and can lead to confusion and people working at cross purposes,” Dr. Holman explains. “This adds complexity to a system that’s already too complex. In my statement, I said that what we call harmonization [of reporting measures] is a very important step for CMS to take, so that physicians and hospitals are required to measure and report the same thing. The more we can move toward outcome measures, as well as efficiency and patient experience measures, the more harmonization we’ll have. Focusing on outcomes creates a common goal.”

Dr. Holman continued his comments to the roundtable by using an example of harmonization at the heart of hospital medicine: transitions of care. “I let the group know that SHM is working on a number of initiatives regarding care transitions,” he says. “Transitions of care require the whole system to come together; it’s a great way to help galvanize all the stakeholders toward that shared goal.”

In his written statement, Dr. Holman elaborated on SHM’s efforts regarding transitions of care and pushed for an alignment of CMS quality measures and incentives for physicians with those for hospitals.

Air of Excitement

Although they had many concerns about implementation, the roundtable participants were enthusiastic about the plan. “There was a fabulous give-and-take on issues regarding implementation,” says Allendorf.

Dr. Holman stayed after the meeting to discuss the proceedings with other participants. “All in all, the informal comments I heard after the meeting were that this was the most exciting moment they’d had in 30-plus years in healthcare,” he notes. “This marks a substantial change in the payment system, which has always been seen as a barrier to quality.”

What’s Next

The ball is now in the court of Sens. Baucus and Grassley, who will use the roundtable input to draft legislation that would make the necessary statutory changes in time for CMS to implement the plan by fiscal year 2009, or Oct. 1, as mandated by the Deficit Reduction Act (DRA) of 2005.

“I think they’ll be back in touch with [SHM] as they develop the plan,” Allendorf predicts. After the legislation has been submitted, it’s up to Congress to act. “Everything depends on whether any Medicare legislation moves this year, and no one know whether that will happen,” she says.

Whatever final form the CMS plan takes, the future looks bright for value-based purchasing—and for SHM’s continued involvement.

“This roundtable was an excellent opportunity for SHM to develop a relationship with CMS, and to link to the Senate Finance Committee,” Dr. Holman asserts. “My hope is that those relationships will bear fruit over time, and that we can continue to work with those entities, as well as the other roundtable participants, to propose and develop measures over time, and to bring alignment between hospital measures and physician measures.”

Jane Jerrard is a medical writer based in Chicago.

Read More Online

For more information on the roundtable, including Dr. Holman’s written statement and others, as well as a recorded Webcast, visit Sen. Baucus’ Web site at www.senate.gov/~finance/sitepages/VBProundtable030408.htm. TH

SHM had a seat at the table at a high-level roundtable meeting March 6 in Washington, D.C., to discuss Medicare’s value-based purchasing of hospital care.

SHM President Russell Holman, MD, chief operating officer for Cogent Healthcare, Nashville, participated in the roundtable convened by Senate Finance Committee Chairman Max Baucus, D-Mont., and ranking member Chuck Grassley, R-Iowa. The roundtable included representatives from 22 public and private healthcare organizations, including SHM, the American Hospital Association, and National Quality Forum.

“SHM was one of only two physician organizations participating,” points out Laura Allendorf, SHM’s senior adviser for advocacy and government affairs. “That is very significant. I think [our inclusion] is a testament to our growing presence, our advocacy efforts and our willingness to help representatives with healthcare issues like value-based purchasing.”

The Proposed Plan

At the roundtable, representatives from the Centers for Medicare and Medicaid Services (CMS), the Medicare Payment Advisory Commission (MedPAC), and the Government Accountability Office (GAO) presented an overview of the report that CMS submitted to Congress in November, which outlines a hospital value-based purchasing program. The plan is designed to meet CMS’ objective of “transforming Medicare from a passive payer of claims to an active purchaser of care.” It builds on the existing framework of the current pay-for-reporting program, Reporting Hospital Quality Data for Annual Payment Update, but more closely links hospital Medicare payments to performance.

Dr. Holman is well versed in the plan; he and members of SHM’s Public Policy Committee, who were in Washington for annual visits to Capitol Hill, had just met with CMS’s Chief Medical Officer Tom Valuck, MD.

“That same morning, Tom Valuck had spent an hour and a half briefing Public Policy Committee members on Medicare’s value-based purchasing plan,” says Allendorf. “I’d lined up that meeting before the roundtable was set up.”

A transition to CMS’s proposed value-based purchasing plan, or VBP, would probably occur over three years. Under the plan, a percentage of the hospital’s diagnosis related group (DRG) payment would rely on the hospital’s performance on a specific set of measures. Although the report is comprehensive, details on implementation, incentives, and more must be made final.

Public reporting of quality measures remains a key part of the plan; quality of care information would be available to patients through the CMS Hospital Compare site at www.medicare.gov. A PDF of the CMS report to Congress is available at www.cms.hhs.gov/center/hospital.asp.

Support For Harmonization

After the formal presentation on the VBP plan, roundtable moderator John Inglehart, founding editor of Health Affairs, asked a series of questions directed at specific segments of the group, targeting issues surrounding the plan’s quality measures, performance standards, incentives, and plan implementation.

Dr. Holman was asked to comment on how CMS could ensure that hospital measures and physician measures become more aligned.

“The measures that each party are asked to report in terms of Part B of Medicare are somewhat different and can lead to confusion and people working at cross purposes,” Dr. Holman explains. “This adds complexity to a system that’s already too complex. In my statement, I said that what we call harmonization [of reporting measures] is a very important step for CMS to take, so that physicians and hospitals are required to measure and report the same thing. The more we can move toward outcome measures, as well as efficiency and patient experience measures, the more harmonization we’ll have. Focusing on outcomes creates a common goal.”

Dr. Holman continued his comments to the roundtable by using an example of harmonization at the heart of hospital medicine: transitions of care. “I let the group know that SHM is working on a number of initiatives regarding care transitions,” he says. “Transitions of care require the whole system to come together; it’s a great way to help galvanize all the stakeholders toward that shared goal.”

In his written statement, Dr. Holman elaborated on SHM’s efforts regarding transitions of care and pushed for an alignment of CMS quality measures and incentives for physicians with those for hospitals.

Air of Excitement

Although they had many concerns about implementation, the roundtable participants were enthusiastic about the plan. “There was a fabulous give-and-take on issues regarding implementation,” says Allendorf.

Dr. Holman stayed after the meeting to discuss the proceedings with other participants. “All in all, the informal comments I heard after the meeting were that this was the most exciting moment they’d had in 30-plus years in healthcare,” he notes. “This marks a substantial change in the payment system, which has always been seen as a barrier to quality.”

What’s Next

The ball is now in the court of Sens. Baucus and Grassley, who will use the roundtable input to draft legislation that would make the necessary statutory changes in time for CMS to implement the plan by fiscal year 2009, or Oct. 1, as mandated by the Deficit Reduction Act (DRA) of 2005.

“I think they’ll be back in touch with [SHM] as they develop the plan,” Allendorf predicts. After the legislation has been submitted, it’s up to Congress to act. “Everything depends on whether any Medicare legislation moves this year, and no one know whether that will happen,” she says.

Whatever final form the CMS plan takes, the future looks bright for value-based purchasing—and for SHM’s continued involvement.

“This roundtable was an excellent opportunity for SHM to develop a relationship with CMS, and to link to the Senate Finance Committee,” Dr. Holman asserts. “My hope is that those relationships will bear fruit over time, and that we can continue to work with those entities, as well as the other roundtable participants, to propose and develop measures over time, and to bring alignment between hospital measures and physician measures.”

Jane Jerrard is a medical writer based in Chicago.

Read More Online

For more information on the roundtable, including Dr. Holman’s written statement and others, as well as a recorded Webcast, visit Sen. Baucus’ Web site at www.senate.gov/~finance/sitepages/VBProundtable030408.htm. TH

An increase in uninsured patients who show up in emergency departments (EDs), physician specialty shortages, and a physician population unwilling to take call all have led to a now-common practice: hospitals pay physician-specialists for on-call coverage of their EDs.

Though essential for providing adequate emergency care, this hospital-physician arrangement can violate anti-kickback laws. But recently, one hospital’s payments to on-call physicians was given an official federal stamp of approval. What does this official statement mean for hospital medicine groups and the hospitalists they employ?

Origins of the Opinion

In September 2007, the Office of the Inspector General (OIG) issued an advisory opinion that a hospital that pays physicians for providing on-call and indigent care services in the ED does not violate the federal anti-kickback statute.

An unnamed medical center requested the opinion and submitted details on the comprehensive, detailed program it had created to ensure coverage of the ED.

The hospital’s program includes varied payment structures for staff physicians based on their participation in an on-call schedule for the ED and provision of inpatient follow-up care to patients seen while on call, among other actions.

The program applies to 18 specialties including hospitalists, and all participating physicians receive a per-diem payment for each on-call day.

Lou Glaser, partner at law firm of Sonnenschein Nath & Rosenthal, LLP, in Chicago, wrote the request.

“In this particular case, the hospital extended the program to nearly every specialty on the staff,” he explains. “Few hospitals have gone that far. But my client wanted to ensure that this program was appropriate and, if questioned, wanted to be able to say that they did everything possible to set up an appropriate program. They also, to the extent that if the OIG said no, wanted to be able to tell their physicians that they tried everything possible” to set up a fair payment system.

Ron Greeno, MD, FCCP, chief medical officer at Cogent Healthcare in Irvine, Calif., and a member of SHM’s Public Policy Committee, is surprised the opinion was requested.

“It came out of the blue,” he says. “We weren’t worrying about it.” He believes the shortage of physicians willing to provide on-call care in the ED—particularly to uninsured patients—forces hospitals to create similar payment structures.

“The opinion basically says the OIG doesn’t frown on the current practice,” Dr. Greeno says. “There’s no reason they would—and if they did, it would mean a staffing crisis for all hospitals.” Part of this potential crisis includes care for uninsured patients, for which the hospital isn’t compensated.

Uninsured Patients

A pivotal point in the OIG opinion and in the problems hospitals have with ED on-call staffing is payment for care of uninsured patients—especially those who require an on-call physician at the ED in the middle of the night.

“My client wanted a solution to this, a solution that ensured their indigent patients would receive care from all necessary specialties,” says Glaser.

The payment program created by Glaser’s client hospitals was structured to include care for indigent patients. “The OIG latched on to that for a number of reasons,” says Glaser. “But basically it shows that physicians are being paid for something that they would not otherwise be paid for.”

Effect on Hospitalists

Though the OIG opinion doesn’t change status quo for most, it provides valuable guidance on what the government considers an acceptable plan for covering on-call shortages. Criteria outlined in the opinion include:

• There must be a clear, demonstrated need for the on-call service;
• Participating physicians would otherwise be un- or under-compensated for a meaningful portion of their work, such as caring for uninsured admissions;
• Participating physicians deliver defined added value such as better outcomes, or participation in quality initiatives; and
• Reimbursement reflects market value.

Because most hospitalists are employed by or supported by the hospital for which they are on call, they are entirely exempt from anti-kickback issues. Therefore, the OIG opinion won’t affect their on-call payments.

“The opinion obviously isn’t geared toward any specialty,” Glaser points out. “In fact, the OIG noted that the hospital could not select specific groups and try to steer money toward those. That said, hospitalists are in a slightly different position than other medical staff. They maintain their practice at the hospital, and depend on that for their volume and income.”

If your hospital medicine group is not supported primarily by the hospital, how can you ensure your on-call payments are legally acceptable?

First, have a lawyer review your arrangements. While the onus for staying within the bounds of the law is on hospitals, it’s important for every hospital medicine group to have local legal experts examine their current or proposed payment structure for on-call and indigent care.

“Any time a hospital gives money to a doctor, [he or she] is subject to scrutiny,” says Dr. Greeno. “This has to be legally vetted.”

Second, document your own payment system. “There was a great deal of discussion in the request for opinion on how the hospital established its payment structure,” says Glaser. “The opinion shows the importance of having a well-documented process for establishing the rates to be paid, and showing that that’s fair.”

You can start your review of your own payment program by downloading a comprehensive overview of the OIG advisory opinion at SHM’s Web site, www.hospitalmedicine.org.

“For most of us who have been minding their p’s and q’s, [the opinion] doesn’t require any changes,” Dr. Greeno stresses. However, hospital medicine directors should stay on the safe side and check any on-call payment programs you might be participating in. TH

Jane Jerrard has written for The Hospitalist since 2005.

An increase in uninsured patients who show up in emergency departments (EDs), physician specialty shortages, and a physician population unwilling to take call all have led to a now-common practice: hospitals pay physician-specialists for on-call coverage of their EDs.

Though essential for providing adequate emergency care, this hospital-physician arrangement can violate anti-kickback laws. But recently, one hospital’s payments to on-call physicians was given an official federal stamp of approval. What does this official statement mean for hospital medicine groups and the hospitalists they employ?

Origins of the Opinion

In September 2007, the Office of the Inspector General (OIG) issued an advisory opinion that a hospital that pays physicians for providing on-call and indigent care services in the ED does not violate the federal anti-kickback statute.

An unnamed medical center requested the opinion and submitted details on the comprehensive, detailed program it had created to ensure coverage of the ED.

The hospital’s program includes varied payment structures for staff physicians based on their participation in an on-call schedule for the ED and provision of inpatient follow-up care to patients seen while on call, among other actions.

The program applies to 18 specialties including hospitalists, and all participating physicians receive a per-diem payment for each on-call day.

Lou Glaser, partner at law firm of Sonnenschein Nath & Rosenthal, LLP, in Chicago, wrote the request.

“In this particular case, the hospital extended the program to nearly every specialty on the staff,” he explains. “Few hospitals have gone that far. But my client wanted to ensure that this program was appropriate and, if questioned, wanted to be able to say that they did everything possible to set up an appropriate program. They also, to the extent that if the OIG said no, wanted to be able to tell their physicians that they tried everything possible” to set up a fair payment system.

Ron Greeno, MD, FCCP, chief medical officer at Cogent Healthcare in Irvine, Calif., and a member of SHM’s Public Policy Committee, is surprised the opinion was requested.

“It came out of the blue,” he says. “We weren’t worrying about it.” He believes the shortage of physicians willing to provide on-call care in the ED—particularly to uninsured patients—forces hospitals to create similar payment structures.

“The opinion basically says the OIG doesn’t frown on the current practice,” Dr. Greeno says. “There’s no reason they would—and if they did, it would mean a staffing crisis for all hospitals.” Part of this potential crisis includes care for uninsured patients, for which the hospital isn’t compensated.

Uninsured Patients

A pivotal point in the OIG opinion and in the problems hospitals have with ED on-call staffing is payment for care of uninsured patients—especially those who require an on-call physician at the ED in the middle of the night.

“My client wanted a solution to this, a solution that ensured their indigent patients would receive care from all necessary specialties,” says Glaser.

The payment program created by Glaser’s client hospitals was structured to include care for indigent patients. “The OIG latched on to that for a number of reasons,” says Glaser. “But basically it shows that physicians are being paid for something that they would not otherwise be paid for.”

Effect on Hospitalists

Though the OIG opinion doesn’t change status quo for most, it provides valuable guidance on what the government considers an acceptable plan for covering on-call shortages. Criteria outlined in the opinion include:

• There must be a clear, demonstrated need for the on-call service;
• Participating physicians would otherwise be un- or under-compensated for a meaningful portion of their work, such as caring for uninsured admissions;
• Participating physicians deliver defined added value such as better outcomes, or participation in quality initiatives; and
• Reimbursement reflects market value.

Because most hospitalists are employed by or supported by the hospital for which they are on call, they are entirely exempt from anti-kickback issues. Therefore, the OIG opinion won’t affect their on-call payments.

“The opinion obviously isn’t geared toward any specialty,” Glaser points out. “In fact, the OIG noted that the hospital could not select specific groups and try to steer money toward those. That said, hospitalists are in a slightly different position than other medical staff. They maintain their practice at the hospital, and depend on that for their volume and income.”

If your hospital medicine group is not supported primarily by the hospital, how can you ensure your on-call payments are legally acceptable?

First, have a lawyer review your arrangements. While the onus for staying within the bounds of the law is on hospitals, it’s important for every hospital medicine group to have local legal experts examine their current or proposed payment structure for on-call and indigent care.

“Any time a hospital gives money to a doctor, [he or she] is subject to scrutiny,” says Dr. Greeno. “This has to be legally vetted.”

Second, document your own payment system. “There was a great deal of discussion in the request for opinion on how the hospital established its payment structure,” says Glaser. “The opinion shows the importance of having a well-documented process for establishing the rates to be paid, and showing that that’s fair.”

You can start your review of your own payment program by downloading a comprehensive overview of the OIG advisory opinion at SHM’s Web site, www.hospitalmedicine.org.

“For most of us who have been minding their p’s and q’s, [the opinion] doesn’t require any changes,” Dr. Greeno stresses. However, hospital medicine directors should stay on the safe side and check any on-call payment programs you might be participating in. TH

Jane Jerrard has written for The Hospitalist since 2005.

An increase in uninsured patients who show up in emergency departments (EDs), physician specialty shortages, and a physician population unwilling to take call all have led to a now-common practice: hospitals pay physician-specialists for on-call coverage of their EDs.

Though essential for providing adequate emergency care, this hospital-physician arrangement can violate anti-kickback laws. But recently, one hospital’s payments to on-call physicians was given an official federal stamp of approval. What does this official statement mean for hospital medicine groups and the hospitalists they employ?

Origins of the Opinion

In September 2007, the Office of the Inspector General (OIG) issued an advisory opinion that a hospital that pays physicians for providing on-call and indigent care services in the ED does not violate the federal anti-kickback statute.

An unnamed medical center requested the opinion and submitted details on the comprehensive, detailed program it had created to ensure coverage of the ED.

The hospital’s program includes varied payment structures for staff physicians based on their participation in an on-call schedule for the ED and provision of inpatient follow-up care to patients seen while on call, among other actions.

The program applies to 18 specialties including hospitalists, and all participating physicians receive a per-diem payment for each on-call day.

Lou Glaser, partner at law firm of Sonnenschein Nath & Rosenthal, LLP, in Chicago, wrote the request.

“In this particular case, the hospital extended the program to nearly every specialty on the staff,” he explains. “Few hospitals have gone that far. But my client wanted to ensure that this program was appropriate and, if questioned, wanted to be able to say that they did everything possible to set up an appropriate program. They also, to the extent that if the OIG said no, wanted to be able to tell their physicians that they tried everything possible” to set up a fair payment system.

Ron Greeno, MD, FCCP, chief medical officer at Cogent Healthcare in Irvine, Calif., and a member of SHM’s Public Policy Committee, is surprised the opinion was requested.

“It came out of the blue,” he says. “We weren’t worrying about it.” He believes the shortage of physicians willing to provide on-call care in the ED—particularly to uninsured patients—forces hospitals to create similar payment structures.

“The opinion basically says the OIG doesn’t frown on the current practice,” Dr. Greeno says. “There’s no reason they would—and if they did, it would mean a staffing crisis for all hospitals.” Part of this potential crisis includes care for uninsured patients, for which the hospital isn’t compensated.

Uninsured Patients

A pivotal point in the OIG opinion and in the problems hospitals have with ED on-call staffing is payment for care of uninsured patients—especially those who require an on-call physician at the ED in the middle of the night.

“My client wanted a solution to this, a solution that ensured their indigent patients would receive care from all necessary specialties,” says Glaser.

The payment program created by Glaser’s client hospitals was structured to include care for indigent patients. “The OIG latched on to that for a number of reasons,” says Glaser. “But basically it shows that physicians are being paid for something that they would not otherwise be paid for.”

Effect on Hospitalists

Though the OIG opinion doesn’t change status quo for most, it provides valuable guidance on what the government considers an acceptable plan for covering on-call shortages. Criteria outlined in the opinion include:

• There must be a clear, demonstrated need for the on-call service;
• Participating physicians would otherwise be un- or under-compensated for a meaningful portion of their work, such as caring for uninsured admissions;
• Participating physicians deliver defined added value such as better outcomes, or participation in quality initiatives; and
• Reimbursement reflects market value.

Because most hospitalists are employed by or supported by the hospital for which they are on call, they are entirely exempt from anti-kickback issues. Therefore, the OIG opinion won’t affect their on-call payments.

“The opinion obviously isn’t geared toward any specialty,” Glaser points out. “In fact, the OIG noted that the hospital could not select specific groups and try to steer money toward those. That said, hospitalists are in a slightly different position than other medical staff. They maintain their practice at the hospital, and depend on that for their volume and income.”

If your hospital medicine group is not supported primarily by the hospital, how can you ensure your on-call payments are legally acceptable?

First, have a lawyer review your arrangements. While the onus for staying within the bounds of the law is on hospitals, it’s important for every hospital medicine group to have local legal experts examine their current or proposed payment structure for on-call and indigent care.

“Any time a hospital gives money to a doctor, [he or she] is subject to scrutiny,” says Dr. Greeno. “This has to be legally vetted.”

Second, document your own payment system. “There was a great deal of discussion in the request for opinion on how the hospital established its payment structure,” says Glaser. “The opinion shows the importance of having a well-documented process for establishing the rates to be paid, and showing that that’s fair.”

You can start your review of your own payment program by downloading a comprehensive overview of the OIG advisory opinion at SHM’s Web site, www.hospitalmedicine.org.

“For most of us who have been minding their p’s and q’s, [the opinion] doesn’t require any changes,” Dr. Greeno stresses. However, hospital medicine directors should stay on the safe side and check any on-call payment programs you might be participating in. TH

Jane Jerrard has written for The Hospitalist since 2005.