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Quality Summit Produces Plan
Somebody oughta fix that. I’m sure you’ve heard that phrase from friends or relatives lamenting their recent visit to a hospital.
My grandmother will use just about any opportunity to inform me that hospitals make people sicker. I’ve tried to explain that her perspective is skewed. After all, a lot of her friends were pretty sick before they entered the hospital. But “it’s that place” she vows. “They oughta change it.” Fortunately for me, my grandmother still hasn’t figured out what I do professionally, so I’m not considered part of “they.” I let her rant to my husband, since he has the letters MD after his name.
The truth, as you know, is many hospital medicine physicians and their teams are working their tails off trying to improve inpatient care. Much like my grandmother, hospital administrators haven’t identified who the “they” (change agents) are or what exactly the “it” (practices and systems that lead to suboptimal care) is that needs to be changed. It often is unclear how quality improvement initiatives affect the bottom line or which initiatives will ultimately improve outcomes. Today, a considerable amount of improvement efforts depend on the good will and perseverance of a few champions working with minimal institutional support.
The Hospital Quality and Patient Safety Committee (HQPSC) and SHM leadership recently convened a summit to define a vision for the optimal hospital stay and determine how to best train and support hospitalists as leaders and change agents.
The HQPSC and summit participants concluded SHM is, and should be, a national leader in quality improvement efforts including aspects of education, clinical care, and political advocacy for the hospital setting. To that end, the following strategy recently was submitted by the HQPSC and approved by the SHM Board of Directors to promote development of local, regional, and national infrastructures that support quality and patient safety:
Advance a national quality agenda for hospitals and hospitalists.
- Create a task force reporting to the HQPSC that partners with stakeholders to define the “ideal hospital stay” and promote quality improvement;
- Inform federal accrediting and policy-making groups about the effect of current quality measures and changes required to better support the “ideal hospital stay”;
- Advocate for the alignment of reimbursement practices that reward providers and institutions that demonstrate value and translate these practices into improved quality and patient safety;
- Establish an Acute Care Collaborative (ACC) comprising national organizations representing nurses, pharmacists, case managers, social workers, and other allied medical professionals. The ACC might be expanded to include other key physician groups (e.g., emergency physicians, geriatricians, intensivists); and
- Determine what other key national organizations are doing in quality improvement (QI) and look for opportunities for SHM to partner in these efforts.
Develop educational programs and technical support tools for all practicing hospitalists (entry level to QI leaders) engaged in quality improvement efforts.
- Delineate entry-level and advanced quality improvement offerings. Develop offerings specifically for advanced level participants;
- Expand mentored implementation programs to accommodate more participants and assess the need for other types of programs that provide longitudinal support or coaching;
- Expand current offerings, including resource rooms, mentored implementation, and expert training sessions, to other disease states, system processes, and special populations with attention to coordinating this with SHM’s The Core Competencies in Hospital Medicine: A Framework for Curriculum Development;
- Assess the need for new instructional modalities to reach a broader audience (e.g., Web based self-study modules); and
- Promote QI training in medical school, residency, and fellowship programs. Promote systems-based practice and QI throughout the continuum of education. This would include programs that engage medical students, residents, and fellows as well as the development of performance improvement modules (PIMs) for the American Board of Internal Medicine.
Improves the perceived value of implementing and sustaining QI efforts, and hospitalist leadership of those efforts.
- Advocate directly to the C-suites of hospitals to facilitate alignment of incentives that support hospitalists leading quality initiatives;
- Conduct a survey to quantify resources needed for hospitalists to successfully lead quality initiatives and develop safety programs. Develop a white paper based on survey results and distribute it to the C-suite;
- Encourage QI research that creates evidence and outcomes that can influence C-suites to commit adequate resources to QI activities;
- Explore opportunities to use existing local and national infrastructures to promote a more proactive and evidence-based approach to quality and safety rather than reactive and compliance-oriented quality projects; and
- Create a monthly column in The Hospitalist spotlighting QI efforts and assign staff to recruit submissions of “improvement stories” for the Web site.
Evaluate effectiveness of SHM’s current QI resources, educational offerings. SHM needs to assess its current offerings to understand and improve their effectiveness. Process and impact data are needed to obtain external money to create or sustain QI offerings.
- Create robust evaluations and collect better data to assess use and impact of resource rooms, quality precourses, and other SHM offerings.
Promote and support hospitalists as quality improvement experts. Contribute to the “new science” of quality improvement.
- Partner with the Research Committee to define and publish key areas in need of future research related to quality improvement. Advocate to granting agencies to put out RFPs that will help define the ideal hospital stay and support SHM’s research agenda;
- Partner with federal agencies to assess the value of current performance measures and facilitate development of more reliable and meaningful measures;
- Develop trainings for hospitalists on the methods and science of quality improvement research;
- Partner with the Research Committee to develop a research network; and
- Seek money to support demonstration projects that support our quality agenda.
Another goal, to promote development and adoption of health information technology and decision support tools that advance quality and patient safety, recently was discussed by the HQPSC and will be integrated into the next stage of planning.
Next Steps
SHM has an impressive history of working with its members to develop and implement quality initiatives. Our programs have helped reduce rates of venous thromboembolisms, improve glycemic control, and improve the discharge process. Our highly praised online resource rooms provide free tutorials in QI and implementation guides for specific interventions.
More than 250 healthcare professionals have completed our QI pre-course and more than one thousand hospitalists have completed our leadership programs. This momentum, combined with the acceleration of national interest in quality and patient safety, brings an unprecedented opportunity for SHM to advance hospital medicine, promote the highest quality care for our patients, and position hospitalists to be leaders in transforming hospital care.
During the next year, HQPSC will be translating this strategy into specific activities. SHM staff, HQPSC, and other members are developing additional training programs and technical tools.
If you are interested in becoming more involved in SHM’s quality initiatives, please contact me at tbudnitz@hospitalmedicine.org.
If you have a QI success story to share, please consider submission to the Improvement Stories section of the online Resource Rooms or The Hospitalist.
I thank all of you who are part of the “they” who are working tirelessly with SHM to fix “it.” Together we can move mountains, or something more impervious like healthcare systems and performance measures.
Somebody oughta fix that. I’m sure you’ve heard that phrase from friends or relatives lamenting their recent visit to a hospital.
My grandmother will use just about any opportunity to inform me that hospitals make people sicker. I’ve tried to explain that her perspective is skewed. After all, a lot of her friends were pretty sick before they entered the hospital. But “it’s that place” she vows. “They oughta change it.” Fortunately for me, my grandmother still hasn’t figured out what I do professionally, so I’m not considered part of “they.” I let her rant to my husband, since he has the letters MD after his name.
The truth, as you know, is many hospital medicine physicians and their teams are working their tails off trying to improve inpatient care. Much like my grandmother, hospital administrators haven’t identified who the “they” (change agents) are or what exactly the “it” (practices and systems that lead to suboptimal care) is that needs to be changed. It often is unclear how quality improvement initiatives affect the bottom line or which initiatives will ultimately improve outcomes. Today, a considerable amount of improvement efforts depend on the good will and perseverance of a few champions working with minimal institutional support.
The Hospital Quality and Patient Safety Committee (HQPSC) and SHM leadership recently convened a summit to define a vision for the optimal hospital stay and determine how to best train and support hospitalists as leaders and change agents.
The HQPSC and summit participants concluded SHM is, and should be, a national leader in quality improvement efforts including aspects of education, clinical care, and political advocacy for the hospital setting. To that end, the following strategy recently was submitted by the HQPSC and approved by the SHM Board of Directors to promote development of local, regional, and national infrastructures that support quality and patient safety:
Advance a national quality agenda for hospitals and hospitalists.
- Create a task force reporting to the HQPSC that partners with stakeholders to define the “ideal hospital stay” and promote quality improvement;
- Inform federal accrediting and policy-making groups about the effect of current quality measures and changes required to better support the “ideal hospital stay”;
- Advocate for the alignment of reimbursement practices that reward providers and institutions that demonstrate value and translate these practices into improved quality and patient safety;
- Establish an Acute Care Collaborative (ACC) comprising national organizations representing nurses, pharmacists, case managers, social workers, and other allied medical professionals. The ACC might be expanded to include other key physician groups (e.g., emergency physicians, geriatricians, intensivists); and
- Determine what other key national organizations are doing in quality improvement (QI) and look for opportunities for SHM to partner in these efforts.
Develop educational programs and technical support tools for all practicing hospitalists (entry level to QI leaders) engaged in quality improvement efforts.
- Delineate entry-level and advanced quality improvement offerings. Develop offerings specifically for advanced level participants;
- Expand mentored implementation programs to accommodate more participants and assess the need for other types of programs that provide longitudinal support or coaching;
- Expand current offerings, including resource rooms, mentored implementation, and expert training sessions, to other disease states, system processes, and special populations with attention to coordinating this with SHM’s The Core Competencies in Hospital Medicine: A Framework for Curriculum Development;
- Assess the need for new instructional modalities to reach a broader audience (e.g., Web based self-study modules); and
- Promote QI training in medical school, residency, and fellowship programs. Promote systems-based practice and QI throughout the continuum of education. This would include programs that engage medical students, residents, and fellows as well as the development of performance improvement modules (PIMs) for the American Board of Internal Medicine.
Improves the perceived value of implementing and sustaining QI efforts, and hospitalist leadership of those efforts.
- Advocate directly to the C-suites of hospitals to facilitate alignment of incentives that support hospitalists leading quality initiatives;
- Conduct a survey to quantify resources needed for hospitalists to successfully lead quality initiatives and develop safety programs. Develop a white paper based on survey results and distribute it to the C-suite;
- Encourage QI research that creates evidence and outcomes that can influence C-suites to commit adequate resources to QI activities;
- Explore opportunities to use existing local and national infrastructures to promote a more proactive and evidence-based approach to quality and safety rather than reactive and compliance-oriented quality projects; and
- Create a monthly column in The Hospitalist spotlighting QI efforts and assign staff to recruit submissions of “improvement stories” for the Web site.
Evaluate effectiveness of SHM’s current QI resources, educational offerings. SHM needs to assess its current offerings to understand and improve their effectiveness. Process and impact data are needed to obtain external money to create or sustain QI offerings.
- Create robust evaluations and collect better data to assess use and impact of resource rooms, quality precourses, and other SHM offerings.
Promote and support hospitalists as quality improvement experts. Contribute to the “new science” of quality improvement.
- Partner with the Research Committee to define and publish key areas in need of future research related to quality improvement. Advocate to granting agencies to put out RFPs that will help define the ideal hospital stay and support SHM’s research agenda;
- Partner with federal agencies to assess the value of current performance measures and facilitate development of more reliable and meaningful measures;
- Develop trainings for hospitalists on the methods and science of quality improvement research;
- Partner with the Research Committee to develop a research network; and
- Seek money to support demonstration projects that support our quality agenda.
Another goal, to promote development and adoption of health information technology and decision support tools that advance quality and patient safety, recently was discussed by the HQPSC and will be integrated into the next stage of planning.
Next Steps
SHM has an impressive history of working with its members to develop and implement quality initiatives. Our programs have helped reduce rates of venous thromboembolisms, improve glycemic control, and improve the discharge process. Our highly praised online resource rooms provide free tutorials in QI and implementation guides for specific interventions.
More than 250 healthcare professionals have completed our QI pre-course and more than one thousand hospitalists have completed our leadership programs. This momentum, combined with the acceleration of national interest in quality and patient safety, brings an unprecedented opportunity for SHM to advance hospital medicine, promote the highest quality care for our patients, and position hospitalists to be leaders in transforming hospital care.
During the next year, HQPSC will be translating this strategy into specific activities. SHM staff, HQPSC, and other members are developing additional training programs and technical tools.
If you are interested in becoming more involved in SHM’s quality initiatives, please contact me at tbudnitz@hospitalmedicine.org.
If you have a QI success story to share, please consider submission to the Improvement Stories section of the online Resource Rooms or The Hospitalist.
I thank all of you who are part of the “they” who are working tirelessly with SHM to fix “it.” Together we can move mountains, or something more impervious like healthcare systems and performance measures.
Somebody oughta fix that. I’m sure you’ve heard that phrase from friends or relatives lamenting their recent visit to a hospital.
My grandmother will use just about any opportunity to inform me that hospitals make people sicker. I’ve tried to explain that her perspective is skewed. After all, a lot of her friends were pretty sick before they entered the hospital. But “it’s that place” she vows. “They oughta change it.” Fortunately for me, my grandmother still hasn’t figured out what I do professionally, so I’m not considered part of “they.” I let her rant to my husband, since he has the letters MD after his name.
The truth, as you know, is many hospital medicine physicians and their teams are working their tails off trying to improve inpatient care. Much like my grandmother, hospital administrators haven’t identified who the “they” (change agents) are or what exactly the “it” (practices and systems that lead to suboptimal care) is that needs to be changed. It often is unclear how quality improvement initiatives affect the bottom line or which initiatives will ultimately improve outcomes. Today, a considerable amount of improvement efforts depend on the good will and perseverance of a few champions working with minimal institutional support.
The Hospital Quality and Patient Safety Committee (HQPSC) and SHM leadership recently convened a summit to define a vision for the optimal hospital stay and determine how to best train and support hospitalists as leaders and change agents.
The HQPSC and summit participants concluded SHM is, and should be, a national leader in quality improvement efforts including aspects of education, clinical care, and political advocacy for the hospital setting. To that end, the following strategy recently was submitted by the HQPSC and approved by the SHM Board of Directors to promote development of local, regional, and national infrastructures that support quality and patient safety:
Advance a national quality agenda for hospitals and hospitalists.
- Create a task force reporting to the HQPSC that partners with stakeholders to define the “ideal hospital stay” and promote quality improvement;
- Inform federal accrediting and policy-making groups about the effect of current quality measures and changes required to better support the “ideal hospital stay”;
- Advocate for the alignment of reimbursement practices that reward providers and institutions that demonstrate value and translate these practices into improved quality and patient safety;
- Establish an Acute Care Collaborative (ACC) comprising national organizations representing nurses, pharmacists, case managers, social workers, and other allied medical professionals. The ACC might be expanded to include other key physician groups (e.g., emergency physicians, geriatricians, intensivists); and
- Determine what other key national organizations are doing in quality improvement (QI) and look for opportunities for SHM to partner in these efforts.
Develop educational programs and technical support tools for all practicing hospitalists (entry level to QI leaders) engaged in quality improvement efforts.
- Delineate entry-level and advanced quality improvement offerings. Develop offerings specifically for advanced level participants;
- Expand mentored implementation programs to accommodate more participants and assess the need for other types of programs that provide longitudinal support or coaching;
- Expand current offerings, including resource rooms, mentored implementation, and expert training sessions, to other disease states, system processes, and special populations with attention to coordinating this with SHM’s The Core Competencies in Hospital Medicine: A Framework for Curriculum Development;
- Assess the need for new instructional modalities to reach a broader audience (e.g., Web based self-study modules); and
- Promote QI training in medical school, residency, and fellowship programs. Promote systems-based practice and QI throughout the continuum of education. This would include programs that engage medical students, residents, and fellows as well as the development of performance improvement modules (PIMs) for the American Board of Internal Medicine.
Improves the perceived value of implementing and sustaining QI efforts, and hospitalist leadership of those efforts.
- Advocate directly to the C-suites of hospitals to facilitate alignment of incentives that support hospitalists leading quality initiatives;
- Conduct a survey to quantify resources needed for hospitalists to successfully lead quality initiatives and develop safety programs. Develop a white paper based on survey results and distribute it to the C-suite;
- Encourage QI research that creates evidence and outcomes that can influence C-suites to commit adequate resources to QI activities;
- Explore opportunities to use existing local and national infrastructures to promote a more proactive and evidence-based approach to quality and safety rather than reactive and compliance-oriented quality projects; and
- Create a monthly column in The Hospitalist spotlighting QI efforts and assign staff to recruit submissions of “improvement stories” for the Web site.
Evaluate effectiveness of SHM’s current QI resources, educational offerings. SHM needs to assess its current offerings to understand and improve their effectiveness. Process and impact data are needed to obtain external money to create or sustain QI offerings.
- Create robust evaluations and collect better data to assess use and impact of resource rooms, quality precourses, and other SHM offerings.
Promote and support hospitalists as quality improvement experts. Contribute to the “new science” of quality improvement.
- Partner with the Research Committee to define and publish key areas in need of future research related to quality improvement. Advocate to granting agencies to put out RFPs that will help define the ideal hospital stay and support SHM’s research agenda;
- Partner with federal agencies to assess the value of current performance measures and facilitate development of more reliable and meaningful measures;
- Develop trainings for hospitalists on the methods and science of quality improvement research;
- Partner with the Research Committee to develop a research network; and
- Seek money to support demonstration projects that support our quality agenda.
Another goal, to promote development and adoption of health information technology and decision support tools that advance quality and patient safety, recently was discussed by the HQPSC and will be integrated into the next stage of planning.
Next Steps
SHM has an impressive history of working with its members to develop and implement quality initiatives. Our programs have helped reduce rates of venous thromboembolisms, improve glycemic control, and improve the discharge process. Our highly praised online resource rooms provide free tutorials in QI and implementation guides for specific interventions.
More than 250 healthcare professionals have completed our QI pre-course and more than one thousand hospitalists have completed our leadership programs. This momentum, combined with the acceleration of national interest in quality and patient safety, brings an unprecedented opportunity for SHM to advance hospital medicine, promote the highest quality care for our patients, and position hospitalists to be leaders in transforming hospital care.
During the next year, HQPSC will be translating this strategy into specific activities. SHM staff, HQPSC, and other members are developing additional training programs and technical tools.
If you are interested in becoming more involved in SHM’s quality initiatives, please contact me at tbudnitz@hospitalmedicine.org.
If you have a QI success story to share, please consider submission to the Improvement Stories section of the online Resource Rooms or The Hospitalist.
I thank all of you who are part of the “they” who are working tirelessly with SHM to fix “it.” Together we can move mountains, or something more impervious like healthcare systems and performance measures.
Mission in D.C.
SHM’s Public Policy Committee (PPC) has been monitoring federal legislation and regulations affecting hospital medicine and recommending appropriate action by the Society. Over the past several months, the PPC has been engaged in a variety of initiatives.
Physician Payment (Part B)
One of lawmakers’ top priorities in 2007 was addressing pending cuts in Medicare payments to physicians. Under the flawed sustainable growth rate (SGR) formula, Part B Medicare payments were to be reduced by 10% in 2008 and by an additional 5% in January 2009. SHM is working to influence the debate.
Chapter Summaries
Montana
Nashville
The Nashville chapter met Sept. 13 for a roundtable discussion on challenges in the management of hospitalist programs. Eleven hospitalist physicians attended, including five medical directors who represented five area hospitalist programs:
- Kimberly Bell, MD, HCA/Centennial Medical Center, Nashville;
- Rizwan Faisal, MD, Horizon Medical Center, Dickson;
- Randal Rampp, MD, River Park Hospital, McMinnville;
- James Snyder, MD, St. Thomas Hospital, Nashville; and
- James Tedesco, MD, Summit Medical Associates, Hermitage.
These medical directors de-scribed their programs and how they manage variation in daily patient volume, plan for staffing needs, and recruiting. They also discussed jeopardy plans, physician extenders, how to attract new applicants, and incentive plans.
As Congress began to consider legislation on physician payment reform, SHM quickly launched a comprehensive grassroots campaign to stop the cuts. In an e-mail to 7,745 hospitalists, PPC Chair Eric Siegal, MD, director of the hospital medicine program, Cogent Healthcare, Nashville, Tenn., urged members to contact their lawmakers using SHM’s online advocacy tool, Capwiz. Several issues of the e-newsletter also reminded members to write their representatives in support of two years of positive updates. As the congressional session came to a close, SHM members had sent a record 800 messages to their lawmakers urging them to block the pending reductions.
Then, in a letter to the chairs of the Ways and Means and Energy and Commerce committees, SHM commented on key provisions of draft Medicare legislation, expressing appreciation for the inclusion of language averting the scheduled cuts. SHM voiced concern about provisions of the bill that would reconfigure the Medicare payment formula into six service-specific categories with their own expenditure targets and conversion rates, in an effort to control volume of services. The letter also urged Congress to continue to provide funding for voluntary participation in the Physician Quality Reporting Initiative (PQRI) in 2008.
SHM also joined 130 state and national medical societies to urge Senate Majority Leader Harry Reid, D-Nev., to include two years of positive Medicare physician payment updates in pending legislation that would reauthorize the State Children’s Health Insurance Program. The letter underscored the importance of Congress acting sooner rather than later to reverse the cuts. “Temporary Congressional interventions to prevent past cuts, while necessary, have not kept up with increases in medical practice costs and have pushed the cost of fixing the problem to future years, making a meaningful long-term resolution more and more expensive,” the letter read. “Physician payment rates are about the same today as they were in 2001, while practice costs have increased nearly 20% and will increase another 20% over next nine years, according to the government’s conservative Medicare Economic Index (MEI).”
Last fall, two PPC members, Eric Howell, MD, from Maryland, and Greg Seymann, MD, from California, visited members of their congressional delegation on Capitol Hill. Dr. Howell is director of Collaborative Inpatient Medicine Service, Department of Medicine, Johns Hopkins Bayview Medical Center, Baltimore. Dr. Seymann is associate clinical professor, University of California, San Diego School of Medicine, Division of Hospital Medicine. During their meetings, Drs. Howell and Seymann voiced support for legislation to avert the Medicare cuts and discussed other elements of SHM’s quality-centered legislative agenda, emphasizing the role of hospitalists in improving the quality of care provided in America’s hospitals.
Hospital Payment (Part A)
SHM joined the American Hospital Association in opposition to a provision in the fiscal year 2008 Medicare inpatient prospective payment system, a proposed rule that would have cut Medicare payment for hospital services in fiscal year 2008.
The Centers for Medicare and Medicaid Services (CMS) sought to reduce hospital payments by 2.4% in 2008 and 2009 based on the assumption that hospitals will adjust coding practices to receive higher payments as a result of proposed changes in the payment system designed to account more fully for patients’ severity of illness.
This proposed “behavioral offset” would have cut $24 billion over five years from payments to hospitals. Congress enacted legislation in September that significantly reduces the cuts hospitals face in the next two years.
Quality Reporting
Together with the Performance and Standards Task Force (PSTF), PPC and staff have posted educational material on our Web site and made other resources available to SHM members to help them determine whether or not they should participate in the PQRI, which began July 1.
For example, SHM sponsored a nationwide call with CMS on the “Nuts and Bolts of Applying the PQRI to Your Hospital Medicine Practice.” Staff have since surveyed the SHM members who participated in this members-only call to learn more about what led them to participate or not to participate in the program. Those participating were asked for information on their experiences to help inform our policy on the initiative.
PPC and the PSTF also collaborated on comments to CMS on the 2008 proposed physician payment rule that dealt with the PQRI and submitted comments to CMS staff on the draft feedback report that PQRI participating physicians and other health professionals will receive upon completion of the 2007 program.
In other action, at the PPC’s recommendation, SHM endorsed legislation that would authorize federal funding for the development and testing of inpatient pediatric quality measures. When it comes to measuring and reporting on healthcare quality, children’s measures lag far behind those for adult care. The Children’s Health Care Quality Act (S. 1226/H.R. 2723) would address this disparity.
FY 2008 Appropriations
SHM continues to call on Congress to increase funding for the Agency for Health Care Research and Quality (AHRQ) in view of the important role the agency plays in supporting quality improvement and patient safety initiatives.
Our efforts are paying off. Legislation approved by the House of Representatives and by the Senate Appropriations Committee would boost AHRQ funding in FY 2008 by $10 million to $329 million, the first increase for the agency in several years. SHM members sent 100 messages to Capitol Hill in support of increased spending for AHRQ. Research Committee Chair Andrew Auerbach, MD, visited with legislative staff Sept. 17 to advocate for greater funding for AHRQ and the creation of a new Center for Comparative Effectiveness Research within the agency. Dr. Auerbach is assistant professor of medicine in residence at the University of California, San Francisco.
At press time, Congress had not taken final action on FY 2008 appropriations for AHRQ.
The PPC keeps you informed about our legislative and regulatory activities through monthly updates posted via the SHM Web site, The Hospitalist, and our e-newsletter. SHM letters to Congress and CMS are on the SHM Web site as well. Depending on the issue, you might also get an e-mail urging you to visit our legislative action center at www.hospitalmedicine.org/beheard and contact your members of Congress. We depend on your involvement in the legislative process to be effective in Washington. We appreciate your feedback. You can reach me at lallendorf@hospitalmedicine.org.
SHM’s Public Policy Committee (PPC) has been monitoring federal legislation and regulations affecting hospital medicine and recommending appropriate action by the Society. Over the past several months, the PPC has been engaged in a variety of initiatives.
Physician Payment (Part B)
One of lawmakers’ top priorities in 2007 was addressing pending cuts in Medicare payments to physicians. Under the flawed sustainable growth rate (SGR) formula, Part B Medicare payments were to be reduced by 10% in 2008 and by an additional 5% in January 2009. SHM is working to influence the debate.
Chapter Summaries
Montana
Nashville
The Nashville chapter met Sept. 13 for a roundtable discussion on challenges in the management of hospitalist programs. Eleven hospitalist physicians attended, including five medical directors who represented five area hospitalist programs:
- Kimberly Bell, MD, HCA/Centennial Medical Center, Nashville;
- Rizwan Faisal, MD, Horizon Medical Center, Dickson;
- Randal Rampp, MD, River Park Hospital, McMinnville;
- James Snyder, MD, St. Thomas Hospital, Nashville; and
- James Tedesco, MD, Summit Medical Associates, Hermitage.
These medical directors de-scribed their programs and how they manage variation in daily patient volume, plan for staffing needs, and recruiting. They also discussed jeopardy plans, physician extenders, how to attract new applicants, and incentive plans.
As Congress began to consider legislation on physician payment reform, SHM quickly launched a comprehensive grassroots campaign to stop the cuts. In an e-mail to 7,745 hospitalists, PPC Chair Eric Siegal, MD, director of the hospital medicine program, Cogent Healthcare, Nashville, Tenn., urged members to contact their lawmakers using SHM’s online advocacy tool, Capwiz. Several issues of the e-newsletter also reminded members to write their representatives in support of two years of positive updates. As the congressional session came to a close, SHM members had sent a record 800 messages to their lawmakers urging them to block the pending reductions.
Then, in a letter to the chairs of the Ways and Means and Energy and Commerce committees, SHM commented on key provisions of draft Medicare legislation, expressing appreciation for the inclusion of language averting the scheduled cuts. SHM voiced concern about provisions of the bill that would reconfigure the Medicare payment formula into six service-specific categories with their own expenditure targets and conversion rates, in an effort to control volume of services. The letter also urged Congress to continue to provide funding for voluntary participation in the Physician Quality Reporting Initiative (PQRI) in 2008.
SHM also joined 130 state and national medical societies to urge Senate Majority Leader Harry Reid, D-Nev., to include two years of positive Medicare physician payment updates in pending legislation that would reauthorize the State Children’s Health Insurance Program. The letter underscored the importance of Congress acting sooner rather than later to reverse the cuts. “Temporary Congressional interventions to prevent past cuts, while necessary, have not kept up with increases in medical practice costs and have pushed the cost of fixing the problem to future years, making a meaningful long-term resolution more and more expensive,” the letter read. “Physician payment rates are about the same today as they were in 2001, while practice costs have increased nearly 20% and will increase another 20% over next nine years, according to the government’s conservative Medicare Economic Index (MEI).”
Last fall, two PPC members, Eric Howell, MD, from Maryland, and Greg Seymann, MD, from California, visited members of their congressional delegation on Capitol Hill. Dr. Howell is director of Collaborative Inpatient Medicine Service, Department of Medicine, Johns Hopkins Bayview Medical Center, Baltimore. Dr. Seymann is associate clinical professor, University of California, San Diego School of Medicine, Division of Hospital Medicine. During their meetings, Drs. Howell and Seymann voiced support for legislation to avert the Medicare cuts and discussed other elements of SHM’s quality-centered legislative agenda, emphasizing the role of hospitalists in improving the quality of care provided in America’s hospitals.
Hospital Payment (Part A)
SHM joined the American Hospital Association in opposition to a provision in the fiscal year 2008 Medicare inpatient prospective payment system, a proposed rule that would have cut Medicare payment for hospital services in fiscal year 2008.
The Centers for Medicare and Medicaid Services (CMS) sought to reduce hospital payments by 2.4% in 2008 and 2009 based on the assumption that hospitals will adjust coding practices to receive higher payments as a result of proposed changes in the payment system designed to account more fully for patients’ severity of illness.
This proposed “behavioral offset” would have cut $24 billion over five years from payments to hospitals. Congress enacted legislation in September that significantly reduces the cuts hospitals face in the next two years.
Quality Reporting
Together with the Performance and Standards Task Force (PSTF), PPC and staff have posted educational material on our Web site and made other resources available to SHM members to help them determine whether or not they should participate in the PQRI, which began July 1.
For example, SHM sponsored a nationwide call with CMS on the “Nuts and Bolts of Applying the PQRI to Your Hospital Medicine Practice.” Staff have since surveyed the SHM members who participated in this members-only call to learn more about what led them to participate or not to participate in the program. Those participating were asked for information on their experiences to help inform our policy on the initiative.
PPC and the PSTF also collaborated on comments to CMS on the 2008 proposed physician payment rule that dealt with the PQRI and submitted comments to CMS staff on the draft feedback report that PQRI participating physicians and other health professionals will receive upon completion of the 2007 program.
In other action, at the PPC’s recommendation, SHM endorsed legislation that would authorize federal funding for the development and testing of inpatient pediatric quality measures. When it comes to measuring and reporting on healthcare quality, children’s measures lag far behind those for adult care. The Children’s Health Care Quality Act (S. 1226/H.R. 2723) would address this disparity.
FY 2008 Appropriations
SHM continues to call on Congress to increase funding for the Agency for Health Care Research and Quality (AHRQ) in view of the important role the agency plays in supporting quality improvement and patient safety initiatives.
Our efforts are paying off. Legislation approved by the House of Representatives and by the Senate Appropriations Committee would boost AHRQ funding in FY 2008 by $10 million to $329 million, the first increase for the agency in several years. SHM members sent 100 messages to Capitol Hill in support of increased spending for AHRQ. Research Committee Chair Andrew Auerbach, MD, visited with legislative staff Sept. 17 to advocate for greater funding for AHRQ and the creation of a new Center for Comparative Effectiveness Research within the agency. Dr. Auerbach is assistant professor of medicine in residence at the University of California, San Francisco.
At press time, Congress had not taken final action on FY 2008 appropriations for AHRQ.
The PPC keeps you informed about our legislative and regulatory activities through monthly updates posted via the SHM Web site, The Hospitalist, and our e-newsletter. SHM letters to Congress and CMS are on the SHM Web site as well. Depending on the issue, you might also get an e-mail urging you to visit our legislative action center at www.hospitalmedicine.org/beheard and contact your members of Congress. We depend on your involvement in the legislative process to be effective in Washington. We appreciate your feedback. You can reach me at lallendorf@hospitalmedicine.org.
SHM’s Public Policy Committee (PPC) has been monitoring federal legislation and regulations affecting hospital medicine and recommending appropriate action by the Society. Over the past several months, the PPC has been engaged in a variety of initiatives.
Physician Payment (Part B)
One of lawmakers’ top priorities in 2007 was addressing pending cuts in Medicare payments to physicians. Under the flawed sustainable growth rate (SGR) formula, Part B Medicare payments were to be reduced by 10% in 2008 and by an additional 5% in January 2009. SHM is working to influence the debate.
Chapter Summaries
Montana
Nashville
The Nashville chapter met Sept. 13 for a roundtable discussion on challenges in the management of hospitalist programs. Eleven hospitalist physicians attended, including five medical directors who represented five area hospitalist programs:
- Kimberly Bell, MD, HCA/Centennial Medical Center, Nashville;
- Rizwan Faisal, MD, Horizon Medical Center, Dickson;
- Randal Rampp, MD, River Park Hospital, McMinnville;
- James Snyder, MD, St. Thomas Hospital, Nashville; and
- James Tedesco, MD, Summit Medical Associates, Hermitage.
These medical directors de-scribed their programs and how they manage variation in daily patient volume, plan for staffing needs, and recruiting. They also discussed jeopardy plans, physician extenders, how to attract new applicants, and incentive plans.
As Congress began to consider legislation on physician payment reform, SHM quickly launched a comprehensive grassroots campaign to stop the cuts. In an e-mail to 7,745 hospitalists, PPC Chair Eric Siegal, MD, director of the hospital medicine program, Cogent Healthcare, Nashville, Tenn., urged members to contact their lawmakers using SHM’s online advocacy tool, Capwiz. Several issues of the e-newsletter also reminded members to write their representatives in support of two years of positive updates. As the congressional session came to a close, SHM members had sent a record 800 messages to their lawmakers urging them to block the pending reductions.
Then, in a letter to the chairs of the Ways and Means and Energy and Commerce committees, SHM commented on key provisions of draft Medicare legislation, expressing appreciation for the inclusion of language averting the scheduled cuts. SHM voiced concern about provisions of the bill that would reconfigure the Medicare payment formula into six service-specific categories with their own expenditure targets and conversion rates, in an effort to control volume of services. The letter also urged Congress to continue to provide funding for voluntary participation in the Physician Quality Reporting Initiative (PQRI) in 2008.
SHM also joined 130 state and national medical societies to urge Senate Majority Leader Harry Reid, D-Nev., to include two years of positive Medicare physician payment updates in pending legislation that would reauthorize the State Children’s Health Insurance Program. The letter underscored the importance of Congress acting sooner rather than later to reverse the cuts. “Temporary Congressional interventions to prevent past cuts, while necessary, have not kept up with increases in medical practice costs and have pushed the cost of fixing the problem to future years, making a meaningful long-term resolution more and more expensive,” the letter read. “Physician payment rates are about the same today as they were in 2001, while practice costs have increased nearly 20% and will increase another 20% over next nine years, according to the government’s conservative Medicare Economic Index (MEI).”
Last fall, two PPC members, Eric Howell, MD, from Maryland, and Greg Seymann, MD, from California, visited members of their congressional delegation on Capitol Hill. Dr. Howell is director of Collaborative Inpatient Medicine Service, Department of Medicine, Johns Hopkins Bayview Medical Center, Baltimore. Dr. Seymann is associate clinical professor, University of California, San Diego School of Medicine, Division of Hospital Medicine. During their meetings, Drs. Howell and Seymann voiced support for legislation to avert the Medicare cuts and discussed other elements of SHM’s quality-centered legislative agenda, emphasizing the role of hospitalists in improving the quality of care provided in America’s hospitals.
Hospital Payment (Part A)
SHM joined the American Hospital Association in opposition to a provision in the fiscal year 2008 Medicare inpatient prospective payment system, a proposed rule that would have cut Medicare payment for hospital services in fiscal year 2008.
The Centers for Medicare and Medicaid Services (CMS) sought to reduce hospital payments by 2.4% in 2008 and 2009 based on the assumption that hospitals will adjust coding practices to receive higher payments as a result of proposed changes in the payment system designed to account more fully for patients’ severity of illness.
This proposed “behavioral offset” would have cut $24 billion over five years from payments to hospitals. Congress enacted legislation in September that significantly reduces the cuts hospitals face in the next two years.
Quality Reporting
Together with the Performance and Standards Task Force (PSTF), PPC and staff have posted educational material on our Web site and made other resources available to SHM members to help them determine whether or not they should participate in the PQRI, which began July 1.
For example, SHM sponsored a nationwide call with CMS on the “Nuts and Bolts of Applying the PQRI to Your Hospital Medicine Practice.” Staff have since surveyed the SHM members who participated in this members-only call to learn more about what led them to participate or not to participate in the program. Those participating were asked for information on their experiences to help inform our policy on the initiative.
PPC and the PSTF also collaborated on comments to CMS on the 2008 proposed physician payment rule that dealt with the PQRI and submitted comments to CMS staff on the draft feedback report that PQRI participating physicians and other health professionals will receive upon completion of the 2007 program.
In other action, at the PPC’s recommendation, SHM endorsed legislation that would authorize federal funding for the development and testing of inpatient pediatric quality measures. When it comes to measuring and reporting on healthcare quality, children’s measures lag far behind those for adult care. The Children’s Health Care Quality Act (S. 1226/H.R. 2723) would address this disparity.
FY 2008 Appropriations
SHM continues to call on Congress to increase funding for the Agency for Health Care Research and Quality (AHRQ) in view of the important role the agency plays in supporting quality improvement and patient safety initiatives.
Our efforts are paying off. Legislation approved by the House of Representatives and by the Senate Appropriations Committee would boost AHRQ funding in FY 2008 by $10 million to $329 million, the first increase for the agency in several years. SHM members sent 100 messages to Capitol Hill in support of increased spending for AHRQ. Research Committee Chair Andrew Auerbach, MD, visited with legislative staff Sept. 17 to advocate for greater funding for AHRQ and the creation of a new Center for Comparative Effectiveness Research within the agency. Dr. Auerbach is assistant professor of medicine in residence at the University of California, San Francisco.
At press time, Congress had not taken final action on FY 2008 appropriations for AHRQ.
The PPC keeps you informed about our legislative and regulatory activities through monthly updates posted via the SHM Web site, The Hospitalist, and our e-newsletter. SHM letters to Congress and CMS are on the SHM Web site as well. Depending on the issue, you might also get an e-mail urging you to visit our legislative action center at www.hospitalmedicine.org/beheard and contact your members of Congress. We depend on your involvement in the legislative process to be effective in Washington. We appreciate your feedback. You can reach me at lallendorf@hospitalmedicine.org.
SHM Behind the Scenes
Remember the classic episod-es of “Star Trek” where a new cast member went on a mission? Chances were that guy would be the one to fall off a cliff or get zapped with a laser gun and would not make it back safely to the starship Enterprise.
Recently I was in a meeting focused on what happens when older adults are discharged from the hospital. I thought to myself: “Those are the patients wearing the red uniforms. But what if we could make the experience of older adults more like that of Spock and Captain Kirk, where luck and good preparation are on their side and the data to make informed decisions follow them everywhere?”
The transition of patients in and out of the hospital has become a key patient-safety concern. Patients frequently arrive at the hospital with incomplete medical histories and uncertain or missing medication lists. During a typical hospitalization, patients receive less than optimal preparation before their discharge and often leave the hospital without a clear understanding of how to care for themselves, identify new symptoms that require immediate medical attention, or take their medications. Further, it is often unclear whom patients should call with questions while they are in “the white space”—that time period between hospital discharge and follow-up care. Do they call the hospital? The hospitalist? Their primary care physician? Their cardiologist?
Safety related to transitions of care is a concern frequently raised about the hospital medicine movement. The use of hospitalists forces physician discontinuity at admission and discharge. However, SHM plans to make discharge planning an issue that brings hospitalists and hospital medicine the greatest praise. SHM is taking a clear, proactive leadership role to define safe transitions, create toolkits for hospitals to improve their current transition practices, and develop technical assistance programs to build quality improvement capacity at local institutions.
Safe Transitions
SHM is participating in two major initiatives to define safe transitions. As a member of the American Board of Internal Medicine (ABIM) Foundation Stepping Up To The Plate Initiative (SUTTP), we are helping to develop sets of principles of and standards for safe and effective transitions.
SHM also co-chaired a Transitions of Care Consensus Conference (TOCCC) in partnership with the American College of Physicians and Society of General Internal Medicine. The TOCCC further reviewed the work of the SUTTP conference and focused more specifically on issues that arise as patients transfer in and out of the hospital.
In these meetings and others, SHM’s messages were clear:
- Improvements in transitions are needed now, and shouldn’t wait for other movements such as creation of medical homes or national electronic medical records to become a reality;
- Safe transitions require teams of medical professionals on both sides of the transfer and patients and their families working together;
- Patients and their families/ caregivers must be included and prepared for transfers of care;
- Better information on patient history and medications needs to follow patients into the hospital; and
- A small subset of information from the care plan, or transition record, should follow patients through each transfer, and be made available to them in lay terms.
Both the SUTTP and TOCCC documents are under review for endorsement by multiple medical professional societies. SHM is pursuing the development of related performance measures for safe care transitions.
Technical Assistance
SHM has for years distinguished its educational offerings by offering “implementation education.” We focus on translating best practices into actual practices. To that end, with generous support from the John A. Hartford Foundation, we are developing a discharge planning toolkit.
The toolkit will provide a step-wise approach to plan, implement, and evaluate interventions to improve discharge planning. The toolkit will help quality teams establish goals, garner internal support for interventions, educate support staff, and evaluate their results.
The interventional approaches and tools are focused on:
- Improving communication among sending and receiving physicians;
- Better preparing patients for post-discharge medication management and other self-care; and
- Facilitating follow-up care and transfer of patient information.
On Sept. 7, SHM convened an advisory board in Chicago to review and provide feedback on our proposed interventional strategies, technical support offerings, and evaluation plan. An impressive group of key stakeholders attended, including:
- Representatives from major payer groups such as the Centers for Medicare and Medicaid Services, Blue Cross Blue Shield, and Kaiser Permanente;
- Professional societies including the American Geriatrics Society, the Society of General Internal Medicine, the Case Management Society of America, and the American Society of Health System Pharmacists.
- Representation from the John A. Hartford Foundation, patient advocates from The Families and Health Care Project, and leaders and practicing professionals in nursing, social work, case management, patient advocacy, geriatrics, primary care, quality improvement and, of course, hospital medicine.
While not at the September meeting, the advisory board also includes representatives from the Agency for Healthcare Research and Quality and the Joint Commission.
The advisory board provided valuable feedback on SHM’s proposed toolkit and applauded our efforts to lead teams to make substantial local hospital improvements. Participants also had the opportunity to share existing resources and strategize opportunities to encourage wide-scale adoption of the toolkit. In February the advisory board plans to reconvene to review the completed toolkit.
SHM is developing training opportunities for institutions adopting the toolkit, designed to meet the full spectrum of technical assistance needs. The full toolkit will be available free on SHM’s Web site in the spring. At the April 2008 SHM Annual Meeting in San Diego, quality teams can participate in a daylong pre-course on general quality improvement principles and hands-on application of the toolkit.
In May, SHM will begin reviewing applications for sites wishing to participate in the yearlong mentoring program or a more intensive short-term, on-site consultant service. For more information on these technical assistance programs, visit the SHM Web site at www.hospitalmedicine.org and select the “Quality Improvement” link, then “Current Initiatives.”
We hope you and your institution will join our journey into the white space to improve discharge planning and help our patients “live long and prosper.” TH
Remember the classic episod-es of “Star Trek” where a new cast member went on a mission? Chances were that guy would be the one to fall off a cliff or get zapped with a laser gun and would not make it back safely to the starship Enterprise.
Recently I was in a meeting focused on what happens when older adults are discharged from the hospital. I thought to myself: “Those are the patients wearing the red uniforms. But what if we could make the experience of older adults more like that of Spock and Captain Kirk, where luck and good preparation are on their side and the data to make informed decisions follow them everywhere?”
The transition of patients in and out of the hospital has become a key patient-safety concern. Patients frequently arrive at the hospital with incomplete medical histories and uncertain or missing medication lists. During a typical hospitalization, patients receive less than optimal preparation before their discharge and often leave the hospital without a clear understanding of how to care for themselves, identify new symptoms that require immediate medical attention, or take their medications. Further, it is often unclear whom patients should call with questions while they are in “the white space”—that time period between hospital discharge and follow-up care. Do they call the hospital? The hospitalist? Their primary care physician? Their cardiologist?
Safety related to transitions of care is a concern frequently raised about the hospital medicine movement. The use of hospitalists forces physician discontinuity at admission and discharge. However, SHM plans to make discharge planning an issue that brings hospitalists and hospital medicine the greatest praise. SHM is taking a clear, proactive leadership role to define safe transitions, create toolkits for hospitals to improve their current transition practices, and develop technical assistance programs to build quality improvement capacity at local institutions.
Safe Transitions
SHM is participating in two major initiatives to define safe transitions. As a member of the American Board of Internal Medicine (ABIM) Foundation Stepping Up To The Plate Initiative (SUTTP), we are helping to develop sets of principles of and standards for safe and effective transitions.
SHM also co-chaired a Transitions of Care Consensus Conference (TOCCC) in partnership with the American College of Physicians and Society of General Internal Medicine. The TOCCC further reviewed the work of the SUTTP conference and focused more specifically on issues that arise as patients transfer in and out of the hospital.
In these meetings and others, SHM’s messages were clear:
- Improvements in transitions are needed now, and shouldn’t wait for other movements such as creation of medical homes or national electronic medical records to become a reality;
- Safe transitions require teams of medical professionals on both sides of the transfer and patients and their families working together;
- Patients and their families/ caregivers must be included and prepared for transfers of care;
- Better information on patient history and medications needs to follow patients into the hospital; and
- A small subset of information from the care plan, or transition record, should follow patients through each transfer, and be made available to them in lay terms.
Both the SUTTP and TOCCC documents are under review for endorsement by multiple medical professional societies. SHM is pursuing the development of related performance measures for safe care transitions.
Technical Assistance
SHM has for years distinguished its educational offerings by offering “implementation education.” We focus on translating best practices into actual practices. To that end, with generous support from the John A. Hartford Foundation, we are developing a discharge planning toolkit.
The toolkit will provide a step-wise approach to plan, implement, and evaluate interventions to improve discharge planning. The toolkit will help quality teams establish goals, garner internal support for interventions, educate support staff, and evaluate their results.
The interventional approaches and tools are focused on:
- Improving communication among sending and receiving physicians;
- Better preparing patients for post-discharge medication management and other self-care; and
- Facilitating follow-up care and transfer of patient information.
On Sept. 7, SHM convened an advisory board in Chicago to review and provide feedback on our proposed interventional strategies, technical support offerings, and evaluation plan. An impressive group of key stakeholders attended, including:
- Representatives from major payer groups such as the Centers for Medicare and Medicaid Services, Blue Cross Blue Shield, and Kaiser Permanente;
- Professional societies including the American Geriatrics Society, the Society of General Internal Medicine, the Case Management Society of America, and the American Society of Health System Pharmacists.
- Representation from the John A. Hartford Foundation, patient advocates from The Families and Health Care Project, and leaders and practicing professionals in nursing, social work, case management, patient advocacy, geriatrics, primary care, quality improvement and, of course, hospital medicine.
While not at the September meeting, the advisory board also includes representatives from the Agency for Healthcare Research and Quality and the Joint Commission.
The advisory board provided valuable feedback on SHM’s proposed toolkit and applauded our efforts to lead teams to make substantial local hospital improvements. Participants also had the opportunity to share existing resources and strategize opportunities to encourage wide-scale adoption of the toolkit. In February the advisory board plans to reconvene to review the completed toolkit.
SHM is developing training opportunities for institutions adopting the toolkit, designed to meet the full spectrum of technical assistance needs. The full toolkit will be available free on SHM’s Web site in the spring. At the April 2008 SHM Annual Meeting in San Diego, quality teams can participate in a daylong pre-course on general quality improvement principles and hands-on application of the toolkit.
In May, SHM will begin reviewing applications for sites wishing to participate in the yearlong mentoring program or a more intensive short-term, on-site consultant service. For more information on these technical assistance programs, visit the SHM Web site at www.hospitalmedicine.org and select the “Quality Improvement” link, then “Current Initiatives.”
We hope you and your institution will join our journey into the white space to improve discharge planning and help our patients “live long and prosper.” TH
Remember the classic episod-es of “Star Trek” where a new cast member went on a mission? Chances were that guy would be the one to fall off a cliff or get zapped with a laser gun and would not make it back safely to the starship Enterprise.
Recently I was in a meeting focused on what happens when older adults are discharged from the hospital. I thought to myself: “Those are the patients wearing the red uniforms. But what if we could make the experience of older adults more like that of Spock and Captain Kirk, where luck and good preparation are on their side and the data to make informed decisions follow them everywhere?”
The transition of patients in and out of the hospital has become a key patient-safety concern. Patients frequently arrive at the hospital with incomplete medical histories and uncertain or missing medication lists. During a typical hospitalization, patients receive less than optimal preparation before their discharge and often leave the hospital without a clear understanding of how to care for themselves, identify new symptoms that require immediate medical attention, or take their medications. Further, it is often unclear whom patients should call with questions while they are in “the white space”—that time period between hospital discharge and follow-up care. Do they call the hospital? The hospitalist? Their primary care physician? Their cardiologist?
Safety related to transitions of care is a concern frequently raised about the hospital medicine movement. The use of hospitalists forces physician discontinuity at admission and discharge. However, SHM plans to make discharge planning an issue that brings hospitalists and hospital medicine the greatest praise. SHM is taking a clear, proactive leadership role to define safe transitions, create toolkits for hospitals to improve their current transition practices, and develop technical assistance programs to build quality improvement capacity at local institutions.
Safe Transitions
SHM is participating in two major initiatives to define safe transitions. As a member of the American Board of Internal Medicine (ABIM) Foundation Stepping Up To The Plate Initiative (SUTTP), we are helping to develop sets of principles of and standards for safe and effective transitions.
SHM also co-chaired a Transitions of Care Consensus Conference (TOCCC) in partnership with the American College of Physicians and Society of General Internal Medicine. The TOCCC further reviewed the work of the SUTTP conference and focused more specifically on issues that arise as patients transfer in and out of the hospital.
In these meetings and others, SHM’s messages were clear:
- Improvements in transitions are needed now, and shouldn’t wait for other movements such as creation of medical homes or national electronic medical records to become a reality;
- Safe transitions require teams of medical professionals on both sides of the transfer and patients and their families working together;
- Patients and their families/ caregivers must be included and prepared for transfers of care;
- Better information on patient history and medications needs to follow patients into the hospital; and
- A small subset of information from the care plan, or transition record, should follow patients through each transfer, and be made available to them in lay terms.
Both the SUTTP and TOCCC documents are under review for endorsement by multiple medical professional societies. SHM is pursuing the development of related performance measures for safe care transitions.
Technical Assistance
SHM has for years distinguished its educational offerings by offering “implementation education.” We focus on translating best practices into actual practices. To that end, with generous support from the John A. Hartford Foundation, we are developing a discharge planning toolkit.
The toolkit will provide a step-wise approach to plan, implement, and evaluate interventions to improve discharge planning. The toolkit will help quality teams establish goals, garner internal support for interventions, educate support staff, and evaluate their results.
The interventional approaches and tools are focused on:
- Improving communication among sending and receiving physicians;
- Better preparing patients for post-discharge medication management and other self-care; and
- Facilitating follow-up care and transfer of patient information.
On Sept. 7, SHM convened an advisory board in Chicago to review and provide feedback on our proposed interventional strategies, technical support offerings, and evaluation plan. An impressive group of key stakeholders attended, including:
- Representatives from major payer groups such as the Centers for Medicare and Medicaid Services, Blue Cross Blue Shield, and Kaiser Permanente;
- Professional societies including the American Geriatrics Society, the Society of General Internal Medicine, the Case Management Society of America, and the American Society of Health System Pharmacists.
- Representation from the John A. Hartford Foundation, patient advocates from The Families and Health Care Project, and leaders and practicing professionals in nursing, social work, case management, patient advocacy, geriatrics, primary care, quality improvement and, of course, hospital medicine.
While not at the September meeting, the advisory board also includes representatives from the Agency for Healthcare Research and Quality and the Joint Commission.
The advisory board provided valuable feedback on SHM’s proposed toolkit and applauded our efforts to lead teams to make substantial local hospital improvements. Participants also had the opportunity to share existing resources and strategize opportunities to encourage wide-scale adoption of the toolkit. In February the advisory board plans to reconvene to review the completed toolkit.
SHM is developing training opportunities for institutions adopting the toolkit, designed to meet the full spectrum of technical assistance needs. The full toolkit will be available free on SHM’s Web site in the spring. At the April 2008 SHM Annual Meeting in San Diego, quality teams can participate in a daylong pre-course on general quality improvement principles and hands-on application of the toolkit.
In May, SHM will begin reviewing applications for sites wishing to participate in the yearlong mentoring program or a more intensive short-term, on-site consultant service. For more information on these technical assistance programs, visit the SHM Web site at www.hospitalmedicine.org and select the “Quality Improvement” link, then “Current Initiatives.”
We hope you and your institution will join our journey into the white space to improve discharge planning and help our patients “live long and prosper.” TH