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Welcome to Day 2 of HM18!
I hope all of you enjoyed Day 1 as much as I did. The quality and variety of the presentations yesterday were stellar, and I am sure today will be the same.
The day begins with the Best of Research and Innovations, where the cream of the crop from the hundreds of submitted projects will be presented and recognized. Following that will be the Awards of Excellence, Society of Hospital Medicine’s annual celebration of the very best of our members for their years of stellar contributions in areas such as teaching, clinical excellence, and service to hospital medicine. You will be inspired by the accomplishments of our colleagues who are receiving these awards. They demonstrate to all of us how our specialty improves the health care delivered in our nation’s hospitals.
Our plenary speaker of the morning will be our very own Larry Wellikson, MD, MHM, who will give us his own perspectives on “Future Challenges for Hospital Medicine,” calling on his more than 2 decades of experience as the creative and accomplished CEO of SHM.
After the morning sessions, please join us for a real treat at noon when we have the honor of hearing from our visiting colleagues from the Japanese Society of Hospital General Medicine who will talk to us about hospital medicine in Japan. As much as we come to HM18 to learn from our U.S. colleagues who are doing extraordinary things here at home, this is a unique opportunity to learn from the leaders of one of our international partners how they are shaping the rapidly growing hospitalist movement in Japan.
That will be closely followed by the can’t-miss “Update in Hospital Medicine,” presented this year by Cindy Cooper, MD, and Barbara Slawski, MD, MS, SFHM. And especially important to our students, residents, and younger members, there is an evening session entitled, “Mastering the Job Interview,” a workshop for those who should always be looking to hone the nonclinical skills essential to long-term career success.
Like Day 1, this is a day chockfull of clinical and management presentations to meet everyone’s needs. There are too many to call out, but allow me to pick my personal favorite titles of the day, starting with “Waiting in Line for ‘It’s a Small World’ and Other Things We Do for No Reason” and “Let It Flow: CPAP, BIPAP, and High-Flow Oxygen.”
Yesterday kicked off HM18 with aplomb, and tomorrow we wrap up. So make the most of Day 2 today, and take advantage of the terrific work of our fellow hospitalists. During the breaks, visit the Exhibit Hall to explore, mingle, and thank our exhibitors for supporting our society and our conference.
Please stop by to greet the SHM staff who have made this conference another great success at the SHM Pavilion in the Exhibit Hall. While you’re there, take a chance to meet and chat with SHM board members who will be there throughout the conference.
Enjoy!
Dr. Greeno is president of the Society of Hospital Medicine and chief strategy officer at IPC Healthcare.
I hope all of you enjoyed Day 1 as much as I did. The quality and variety of the presentations yesterday were stellar, and I am sure today will be the same.
The day begins with the Best of Research and Innovations, where the cream of the crop from the hundreds of submitted projects will be presented and recognized. Following that will be the Awards of Excellence, Society of Hospital Medicine’s annual celebration of the very best of our members for their years of stellar contributions in areas such as teaching, clinical excellence, and service to hospital medicine. You will be inspired by the accomplishments of our colleagues who are receiving these awards. They demonstrate to all of us how our specialty improves the health care delivered in our nation’s hospitals.
Our plenary speaker of the morning will be our very own Larry Wellikson, MD, MHM, who will give us his own perspectives on “Future Challenges for Hospital Medicine,” calling on his more than 2 decades of experience as the creative and accomplished CEO of SHM.
After the morning sessions, please join us for a real treat at noon when we have the honor of hearing from our visiting colleagues from the Japanese Society of Hospital General Medicine who will talk to us about hospital medicine in Japan. As much as we come to HM18 to learn from our U.S. colleagues who are doing extraordinary things here at home, this is a unique opportunity to learn from the leaders of one of our international partners how they are shaping the rapidly growing hospitalist movement in Japan.
That will be closely followed by the can’t-miss “Update in Hospital Medicine,” presented this year by Cindy Cooper, MD, and Barbara Slawski, MD, MS, SFHM. And especially important to our students, residents, and younger members, there is an evening session entitled, “Mastering the Job Interview,” a workshop for those who should always be looking to hone the nonclinical skills essential to long-term career success.
Like Day 1, this is a day chockfull of clinical and management presentations to meet everyone’s needs. There are too many to call out, but allow me to pick my personal favorite titles of the day, starting with “Waiting in Line for ‘It’s a Small World’ and Other Things We Do for No Reason” and “Let It Flow: CPAP, BIPAP, and High-Flow Oxygen.”
Yesterday kicked off HM18 with aplomb, and tomorrow we wrap up. So make the most of Day 2 today, and take advantage of the terrific work of our fellow hospitalists. During the breaks, visit the Exhibit Hall to explore, mingle, and thank our exhibitors for supporting our society and our conference.
Please stop by to greet the SHM staff who have made this conference another great success at the SHM Pavilion in the Exhibit Hall. While you’re there, take a chance to meet and chat with SHM board members who will be there throughout the conference.
Enjoy!
Dr. Greeno is president of the Society of Hospital Medicine and chief strategy officer at IPC Healthcare.
I hope all of you enjoyed Day 1 as much as I did. The quality and variety of the presentations yesterday were stellar, and I am sure today will be the same.
The day begins with the Best of Research and Innovations, where the cream of the crop from the hundreds of submitted projects will be presented and recognized. Following that will be the Awards of Excellence, Society of Hospital Medicine’s annual celebration of the very best of our members for their years of stellar contributions in areas such as teaching, clinical excellence, and service to hospital medicine. You will be inspired by the accomplishments of our colleagues who are receiving these awards. They demonstrate to all of us how our specialty improves the health care delivered in our nation’s hospitals.
Our plenary speaker of the morning will be our very own Larry Wellikson, MD, MHM, who will give us his own perspectives on “Future Challenges for Hospital Medicine,” calling on his more than 2 decades of experience as the creative and accomplished CEO of SHM.
After the morning sessions, please join us for a real treat at noon when we have the honor of hearing from our visiting colleagues from the Japanese Society of Hospital General Medicine who will talk to us about hospital medicine in Japan. As much as we come to HM18 to learn from our U.S. colleagues who are doing extraordinary things here at home, this is a unique opportunity to learn from the leaders of one of our international partners how they are shaping the rapidly growing hospitalist movement in Japan.
That will be closely followed by the can’t-miss “Update in Hospital Medicine,” presented this year by Cindy Cooper, MD, and Barbara Slawski, MD, MS, SFHM. And especially important to our students, residents, and younger members, there is an evening session entitled, “Mastering the Job Interview,” a workshop for those who should always be looking to hone the nonclinical skills essential to long-term career success.
Like Day 1, this is a day chockfull of clinical and management presentations to meet everyone’s needs. There are too many to call out, but allow me to pick my personal favorite titles of the day, starting with “Waiting in Line for ‘It’s a Small World’ and Other Things We Do for No Reason” and “Let It Flow: CPAP, BIPAP, and High-Flow Oxygen.”
Yesterday kicked off HM18 with aplomb, and tomorrow we wrap up. So make the most of Day 2 today, and take advantage of the terrific work of our fellow hospitalists. During the breaks, visit the Exhibit Hall to explore, mingle, and thank our exhibitors for supporting our society and our conference.
Please stop by to greet the SHM staff who have made this conference another great success at the SHM Pavilion in the Exhibit Hall. While you’re there, take a chance to meet and chat with SHM board members who will be there throughout the conference.
Enjoy!
Dr. Greeno is president of the Society of Hospital Medicine and chief strategy officer at IPC Healthcare.
Tuesday’s satellite symposia schedule, information
Valuable Strategies to Reduce the Risk for and Clinical Impact of Hyperkalemia
7:30 – 9:30 p.m. – Canary Room 1-2
Dinner provided at 7:30 p.m.
Presenters: Biff F. Palmer, MD, professor of internal medicine, University of Texas Southwestern Medical Center, Dallas; Robert Toto, MD, associate dean, clinical and translational research, director, Center for Translational Medicine, UT Southwestern Medical Center, Dallas.
Overview: The goal of the case-based symposium is to highlight patients at increased risk of recurrent or sustained hyperkalemia and how these patients may be managed with evidence-based treatment so that they are able to continue renin-angiotensin-aldosterone system inhibitor therapy, if appropriate. The presenters will share their experiences in managing these patients, including suggestions for the hospitalist’s role in continued care.
Accreditation: This activity has been approved for AMA PRA Category 1 Credit(s)™. See final CE activity announcement for specific details.
This activity is supported by an educational grant from Relypsa Inc.
Hepatology News Tonight: Managing Complication of Cirrhosis
7:30 – 9:30 p.m. – Canary Room 3-4
Registration will be at 7:00 p.m.
Dinner provided at 7:30 p.m.
Presenters: Naoky Tsai, MD, clinical professor of medicine, John A. Burns School of Medicine, University of Hawaii, Manoa, Honolulu; Ashwani K. Singal MD, MS, associate professor of medicine and director of UAB Porphyria Center, division of gastroenterology and hepatology, University of Alabama at Birmingham.
Overview: This educational update will highlight the most clinically relevant advances in the management of patients with cirrhosis and hepatic encephalopathy (HE). The symposium will deliver emerging science and incorporate expert opinions on best practices for the diagnosis and management of patients with cirrhosis and HE.
Target audience: This activity has been designed to meet the educational needs of physicians, advanced practice providers, and allied health professionals who provide care for hospitalized patients with liver disease.
Learning objectives:
- Understand the complications and the consequences of chronic liver disease.
- Describe the economic, patient, and caregiver burdens associated with cirrhosis and HE.
- Demonstrate the ability to properly treat HE patients and prevent recurrence of disease.
Accredited by: Rehoboth McKindley Christian Health Care Services
Provided by: Chronic Liver Disease Foundation (CLDF)
Register: http://www.chronicliverdisease.org/
Supported by an educational grant from Salix Pharmaceuticals.
Valuable Strategies to Reduce the Risk for and Clinical Impact of Hyperkalemia
7:30 – 9:30 p.m. – Canary Room 1-2
Dinner provided at 7:30 p.m.
Presenters: Biff F. Palmer, MD, professor of internal medicine, University of Texas Southwestern Medical Center, Dallas; Robert Toto, MD, associate dean, clinical and translational research, director, Center for Translational Medicine, UT Southwestern Medical Center, Dallas.
Overview: The goal of the case-based symposium is to highlight patients at increased risk of recurrent or sustained hyperkalemia and how these patients may be managed with evidence-based treatment so that they are able to continue renin-angiotensin-aldosterone system inhibitor therapy, if appropriate. The presenters will share their experiences in managing these patients, including suggestions for the hospitalist’s role in continued care.
Accreditation: This activity has been approved for AMA PRA Category 1 Credit(s)™. See final CE activity announcement for specific details.
This activity is supported by an educational grant from Relypsa Inc.
Hepatology News Tonight: Managing Complication of Cirrhosis
7:30 – 9:30 p.m. – Canary Room 3-4
Registration will be at 7:00 p.m.
Dinner provided at 7:30 p.m.
Presenters: Naoky Tsai, MD, clinical professor of medicine, John A. Burns School of Medicine, University of Hawaii, Manoa, Honolulu; Ashwani K. Singal MD, MS, associate professor of medicine and director of UAB Porphyria Center, division of gastroenterology and hepatology, University of Alabama at Birmingham.
Overview: This educational update will highlight the most clinically relevant advances in the management of patients with cirrhosis and hepatic encephalopathy (HE). The symposium will deliver emerging science and incorporate expert opinions on best practices for the diagnosis and management of patients with cirrhosis and HE.
Target audience: This activity has been designed to meet the educational needs of physicians, advanced practice providers, and allied health professionals who provide care for hospitalized patients with liver disease.
Learning objectives:
- Understand the complications and the consequences of chronic liver disease.
- Describe the economic, patient, and caregiver burdens associated with cirrhosis and HE.
- Demonstrate the ability to properly treat HE patients and prevent recurrence of disease.
Accredited by: Rehoboth McKindley Christian Health Care Services
Provided by: Chronic Liver Disease Foundation (CLDF)
Register: http://www.chronicliverdisease.org/
Supported by an educational grant from Salix Pharmaceuticals.
Valuable Strategies to Reduce the Risk for and Clinical Impact of Hyperkalemia
7:30 – 9:30 p.m. – Canary Room 1-2
Dinner provided at 7:30 p.m.
Presenters: Biff F. Palmer, MD, professor of internal medicine, University of Texas Southwestern Medical Center, Dallas; Robert Toto, MD, associate dean, clinical and translational research, director, Center for Translational Medicine, UT Southwestern Medical Center, Dallas.
Overview: The goal of the case-based symposium is to highlight patients at increased risk of recurrent or sustained hyperkalemia and how these patients may be managed with evidence-based treatment so that they are able to continue renin-angiotensin-aldosterone system inhibitor therapy, if appropriate. The presenters will share their experiences in managing these patients, including suggestions for the hospitalist’s role in continued care.
Accreditation: This activity has been approved for AMA PRA Category 1 Credit(s)™. See final CE activity announcement for specific details.
This activity is supported by an educational grant from Relypsa Inc.
Hepatology News Tonight: Managing Complication of Cirrhosis
7:30 – 9:30 p.m. – Canary Room 3-4
Registration will be at 7:00 p.m.
Dinner provided at 7:30 p.m.
Presenters: Naoky Tsai, MD, clinical professor of medicine, John A. Burns School of Medicine, University of Hawaii, Manoa, Honolulu; Ashwani K. Singal MD, MS, associate professor of medicine and director of UAB Porphyria Center, division of gastroenterology and hepatology, University of Alabama at Birmingham.
Overview: This educational update will highlight the most clinically relevant advances in the management of patients with cirrhosis and hepatic encephalopathy (HE). The symposium will deliver emerging science and incorporate expert opinions on best practices for the diagnosis and management of patients with cirrhosis and HE.
Target audience: This activity has been designed to meet the educational needs of physicians, advanced practice providers, and allied health professionals who provide care for hospitalized patients with liver disease.
Learning objectives:
- Understand the complications and the consequences of chronic liver disease.
- Describe the economic, patient, and caregiver burdens associated with cirrhosis and HE.
- Demonstrate the ability to properly treat HE patients and prevent recurrence of disease.
Accredited by: Rehoboth McKindley Christian Health Care Services
Provided by: Chronic Liver Disease Foundation (CLDF)
Register: http://www.chronicliverdisease.org/
Supported by an educational grant from Salix Pharmaceuticals.
RIV plenary showcases best research
The best research in hospital medicine will be front and center today in the “Best of Research and Innovations in 2018” part of this morning’s plenary session.
New research also will figure prominently in the second “Clinical Vignettes Poster Competition” at lunchtime today.
During the plenary session, investigators will present the top-rated research among hundreds of submissions, said Ethan Cumbler, MD, FHM, chair of the Research, Innovations, Vignettes (RIV) competition and professor of medicine and medical director of the University of Colorado Acute Care Center for the Elderly, Denver, unit. Three independent, blinded reviewers chose the abstracts for oral presentation after rating them based on originality, scientific rigor, and importance to hospital medicine, he said. These oral presentations are meant not only to provide information to other hospitalists but also to inspire hospitalists to engage in research themselves.
“I think about it as a collective celebration of how far the field of hospital medicine has advanced in the last year and its potential moving forward,” Dr. Cumbler said. “My fundamental view is every hospitalist can and should be examining what they’re doing, thinking about how to do it better, and, by God, sharing it with the rest of us when they figure out that something can work better.”
Even as a veteran hospitalist, Dr. Cumbler said he still gets inspired by research presented in the RIV.
“When I see the RIV posters or come to hear the oral presentations, I get inspired, because I get to see what other people are doing in their local microenvironments, in their laboratories, in their hospitals,” he said. “And often I think ... ‘We could be doing stuff just that exciting.’ Often, it’s a chance to collaborate with the people whose work is inspiring you, or to take a great idea and run with it.”
At the Clinical Vignettes competition, research will focus on lessons learned from specific cases, Dr. Cumbler said.
“A typical clinical vignette would be a case presentation, maybe a diagnostic image or a description of the test that clinched the diagnosis, and then, most importantly, the lessons from that case, which are more widely applicable,” he said. “One of the things I love about Clinical Vignettes is it gives you a chance to highlight your best catches, but it also lets you, with humility, share your misses so that other people can learn from your experience.”
He said he hopes the sharing of research in formal oral presentations – and in the poster hall – continues to advance the hospital medicine literature.
“It’s come an incredible distance over the last 10 years, 15 years,” he said. “When I look at where we are heading next, I think it is into more multicenter research, multiple-institution quality improvement. I really see us graduating from proof-of-concept and pilot work into the kind of trials which answer questions – the big questions that face medicine.”
Best of Research and Innovations in 2018
8-9 a.m., Palms Ballroom
Clinical Vignettes #2
Poster Competition
12-1:30 p.m., Cypress Ballroom
The best research in hospital medicine will be front and center today in the “Best of Research and Innovations in 2018” part of this morning’s plenary session.
New research also will figure prominently in the second “Clinical Vignettes Poster Competition” at lunchtime today.
During the plenary session, investigators will present the top-rated research among hundreds of submissions, said Ethan Cumbler, MD, FHM, chair of the Research, Innovations, Vignettes (RIV) competition and professor of medicine and medical director of the University of Colorado Acute Care Center for the Elderly, Denver, unit. Three independent, blinded reviewers chose the abstracts for oral presentation after rating them based on originality, scientific rigor, and importance to hospital medicine, he said. These oral presentations are meant not only to provide information to other hospitalists but also to inspire hospitalists to engage in research themselves.
“I think about it as a collective celebration of how far the field of hospital medicine has advanced in the last year and its potential moving forward,” Dr. Cumbler said. “My fundamental view is every hospitalist can and should be examining what they’re doing, thinking about how to do it better, and, by God, sharing it with the rest of us when they figure out that something can work better.”
Even as a veteran hospitalist, Dr. Cumbler said he still gets inspired by research presented in the RIV.
“When I see the RIV posters or come to hear the oral presentations, I get inspired, because I get to see what other people are doing in their local microenvironments, in their laboratories, in their hospitals,” he said. “And often I think ... ‘We could be doing stuff just that exciting.’ Often, it’s a chance to collaborate with the people whose work is inspiring you, or to take a great idea and run with it.”
At the Clinical Vignettes competition, research will focus on lessons learned from specific cases, Dr. Cumbler said.
“A typical clinical vignette would be a case presentation, maybe a diagnostic image or a description of the test that clinched the diagnosis, and then, most importantly, the lessons from that case, which are more widely applicable,” he said. “One of the things I love about Clinical Vignettes is it gives you a chance to highlight your best catches, but it also lets you, with humility, share your misses so that other people can learn from your experience.”
He said he hopes the sharing of research in formal oral presentations – and in the poster hall – continues to advance the hospital medicine literature.
“It’s come an incredible distance over the last 10 years, 15 years,” he said. “When I look at where we are heading next, I think it is into more multicenter research, multiple-institution quality improvement. I really see us graduating from proof-of-concept and pilot work into the kind of trials which answer questions – the big questions that face medicine.”
Best of Research and Innovations in 2018
8-9 a.m., Palms Ballroom
Clinical Vignettes #2
Poster Competition
12-1:30 p.m., Cypress Ballroom
The best research in hospital medicine will be front and center today in the “Best of Research and Innovations in 2018” part of this morning’s plenary session.
New research also will figure prominently in the second “Clinical Vignettes Poster Competition” at lunchtime today.
During the plenary session, investigators will present the top-rated research among hundreds of submissions, said Ethan Cumbler, MD, FHM, chair of the Research, Innovations, Vignettes (RIV) competition and professor of medicine and medical director of the University of Colorado Acute Care Center for the Elderly, Denver, unit. Three independent, blinded reviewers chose the abstracts for oral presentation after rating them based on originality, scientific rigor, and importance to hospital medicine, he said. These oral presentations are meant not only to provide information to other hospitalists but also to inspire hospitalists to engage in research themselves.
“I think about it as a collective celebration of how far the field of hospital medicine has advanced in the last year and its potential moving forward,” Dr. Cumbler said. “My fundamental view is every hospitalist can and should be examining what they’re doing, thinking about how to do it better, and, by God, sharing it with the rest of us when they figure out that something can work better.”
Even as a veteran hospitalist, Dr. Cumbler said he still gets inspired by research presented in the RIV.
“When I see the RIV posters or come to hear the oral presentations, I get inspired, because I get to see what other people are doing in their local microenvironments, in their laboratories, in their hospitals,” he said. “And often I think ... ‘We could be doing stuff just that exciting.’ Often, it’s a chance to collaborate with the people whose work is inspiring you, or to take a great idea and run with it.”
At the Clinical Vignettes competition, research will focus on lessons learned from specific cases, Dr. Cumbler said.
“A typical clinical vignette would be a case presentation, maybe a diagnostic image or a description of the test that clinched the diagnosis, and then, most importantly, the lessons from that case, which are more widely applicable,” he said. “One of the things I love about Clinical Vignettes is it gives you a chance to highlight your best catches, but it also lets you, with humility, share your misses so that other people can learn from your experience.”
He said he hopes the sharing of research in formal oral presentations – and in the poster hall – continues to advance the hospital medicine literature.
“It’s come an incredible distance over the last 10 years, 15 years,” he said. “When I look at where we are heading next, I think it is into more multicenter research, multiple-institution quality improvement. I really see us graduating from proof-of-concept and pilot work into the kind of trials which answer questions – the big questions that face medicine.”
Best of Research and Innovations in 2018
8-9 a.m., Palms Ballroom
Clinical Vignettes #2
Poster Competition
12-1:30 p.m., Cypress Ballroom
Winners chosen at the SHM Clinical Vignettes competition
ORLANDO – Researchers presenting a case of starving ketoacidosis in a woman who was on a “Paleo” diet while breastfeeding won the Clinical Vignettes competition held Monday at HM18. The announcement capped a flurry of presenting and judging of posters on single cases that were captivating in both the stories they told and the lessons they taught.
The trainee award winner in the competition were presenters of a case of licorice-induced hypokalemia that, clinicians learned, was brought about by the drinking of an obscure kind of tea. The two others that made it into the final round of judging were on cases of syphilitic hepatitis and cardiac amyloidosis.
By chance, both of the winners highlighted dietary triggers, said Stephanie Sherman, MD, chair of the annual meeting’s clinical vignettes committee.
“The common themes in both of these were the importance of dietary history when interviewing patients,” Dr. Sherman said. “And then both had a beautiful review of the physiology that’s normal and how it gets broken in these situations.”
The Clinical Vignettes portion of the RIV competition, which also includes research and innovations categories, was separate this year because of space constraints, Dr. Sherman said.
Judges said they looked not only at how interesting and applicable each case was, but also the quality of the oral presentation and the poster’s visual appeal and clarity.
The ketoacidosis case, presented by Timothy Judson, MD, a resident at University of California, San Francisco, involved a 40-year-old woman who was previously healthy and had given birth 9 weeks earlier. Since the birth, the woman had been on a Paleo diet, a low-carbohydrate, ketogenic diet. She also was breastfeeding her newborn and continuing to breastfeed her 2-year-old son.
She presented with nonbilious, nonbloody emesis. On physical exam, she was found to be tachycardic, with diffuse tenderness of the abdomen. She was positive for ketones and had an elevated acetone level and elevated osmolar gap, the difference between the measured and calculated solutes in the serum.
Clinicians identified that low carbohydrate intake, high fat intake, and a high metabolic state, such as that brought on by breastfeeding, can contribute to ketoacidosis. She was treated with IV glucose-containing fluids, bicarbonate, fomepizole, and thiamine.
The case shows that patients should be warned about ketoacidosis risk when they start an ultra-low carbohydrate diet, especially if they are breastfeeding or lactating, Dr. Hudson said.
“Usually they’re safe, but they may not be if you’re in a high metabolic state,” he told judges.
“We take care of so many patients on a daily basis and we rarely get to tell their stories,” he said. “To be able to tell the story of the patients and give the learning points that we took away to others, I think is very rewarding.”
The winner of the trainee award, Maxwell Bressman, MD, a resident at Montefiore Medical Center in New York, presented the case of a 62-year-old woman with hypertension who had profound generalized weakness and an inability to walk.
“She actually came to the hospital because she couldn’t lift a cup of tea,” Dr. Bressman told judges.
Clinicians traced her problem to that very tea – a licorice-containing brew – after an ECG indicated hypokalemia. A breakdown product of licorice, glycyrrhizic acid, can prevent the breakdown of cortisol into cortisone, causing increased absorption of sodium in exchange for potassium, he explained.
“I really like interesting cases – it’s something I’ve thought about throughout medical school,” Dr. Bressman said. “It’s been incredibly fun. We have great cases at Montefiore. ... It’s taught me to think very broadly and with an expansive differential.”
ORLANDO – Researchers presenting a case of starving ketoacidosis in a woman who was on a “Paleo” diet while breastfeeding won the Clinical Vignettes competition held Monday at HM18. The announcement capped a flurry of presenting and judging of posters on single cases that were captivating in both the stories they told and the lessons they taught.
The trainee award winner in the competition were presenters of a case of licorice-induced hypokalemia that, clinicians learned, was brought about by the drinking of an obscure kind of tea. The two others that made it into the final round of judging were on cases of syphilitic hepatitis and cardiac amyloidosis.
By chance, both of the winners highlighted dietary triggers, said Stephanie Sherman, MD, chair of the annual meeting’s clinical vignettes committee.
“The common themes in both of these were the importance of dietary history when interviewing patients,” Dr. Sherman said. “And then both had a beautiful review of the physiology that’s normal and how it gets broken in these situations.”
The Clinical Vignettes portion of the RIV competition, which also includes research and innovations categories, was separate this year because of space constraints, Dr. Sherman said.
Judges said they looked not only at how interesting and applicable each case was, but also the quality of the oral presentation and the poster’s visual appeal and clarity.
The ketoacidosis case, presented by Timothy Judson, MD, a resident at University of California, San Francisco, involved a 40-year-old woman who was previously healthy and had given birth 9 weeks earlier. Since the birth, the woman had been on a Paleo diet, a low-carbohydrate, ketogenic diet. She also was breastfeeding her newborn and continuing to breastfeed her 2-year-old son.
She presented with nonbilious, nonbloody emesis. On physical exam, she was found to be tachycardic, with diffuse tenderness of the abdomen. She was positive for ketones and had an elevated acetone level and elevated osmolar gap, the difference between the measured and calculated solutes in the serum.
Clinicians identified that low carbohydrate intake, high fat intake, and a high metabolic state, such as that brought on by breastfeeding, can contribute to ketoacidosis. She was treated with IV glucose-containing fluids, bicarbonate, fomepizole, and thiamine.
The case shows that patients should be warned about ketoacidosis risk when they start an ultra-low carbohydrate diet, especially if they are breastfeeding or lactating, Dr. Hudson said.
“Usually they’re safe, but they may not be if you’re in a high metabolic state,” he told judges.
“We take care of so many patients on a daily basis and we rarely get to tell their stories,” he said. “To be able to tell the story of the patients and give the learning points that we took away to others, I think is very rewarding.”
The winner of the trainee award, Maxwell Bressman, MD, a resident at Montefiore Medical Center in New York, presented the case of a 62-year-old woman with hypertension who had profound generalized weakness and an inability to walk.
“She actually came to the hospital because she couldn’t lift a cup of tea,” Dr. Bressman told judges.
Clinicians traced her problem to that very tea – a licorice-containing brew – after an ECG indicated hypokalemia. A breakdown product of licorice, glycyrrhizic acid, can prevent the breakdown of cortisol into cortisone, causing increased absorption of sodium in exchange for potassium, he explained.
“I really like interesting cases – it’s something I’ve thought about throughout medical school,” Dr. Bressman said. “It’s been incredibly fun. We have great cases at Montefiore. ... It’s taught me to think very broadly and with an expansive differential.”
ORLANDO – Researchers presenting a case of starving ketoacidosis in a woman who was on a “Paleo” diet while breastfeeding won the Clinical Vignettes competition held Monday at HM18. The announcement capped a flurry of presenting and judging of posters on single cases that were captivating in both the stories they told and the lessons they taught.
The trainee award winner in the competition were presenters of a case of licorice-induced hypokalemia that, clinicians learned, was brought about by the drinking of an obscure kind of tea. The two others that made it into the final round of judging were on cases of syphilitic hepatitis and cardiac amyloidosis.
By chance, both of the winners highlighted dietary triggers, said Stephanie Sherman, MD, chair of the annual meeting’s clinical vignettes committee.
“The common themes in both of these were the importance of dietary history when interviewing patients,” Dr. Sherman said. “And then both had a beautiful review of the physiology that’s normal and how it gets broken in these situations.”
The Clinical Vignettes portion of the RIV competition, which also includes research and innovations categories, was separate this year because of space constraints, Dr. Sherman said.
Judges said they looked not only at how interesting and applicable each case was, but also the quality of the oral presentation and the poster’s visual appeal and clarity.
The ketoacidosis case, presented by Timothy Judson, MD, a resident at University of California, San Francisco, involved a 40-year-old woman who was previously healthy and had given birth 9 weeks earlier. Since the birth, the woman had been on a Paleo diet, a low-carbohydrate, ketogenic diet. She also was breastfeeding her newborn and continuing to breastfeed her 2-year-old son.
She presented with nonbilious, nonbloody emesis. On physical exam, she was found to be tachycardic, with diffuse tenderness of the abdomen. She was positive for ketones and had an elevated acetone level and elevated osmolar gap, the difference between the measured and calculated solutes in the serum.
Clinicians identified that low carbohydrate intake, high fat intake, and a high metabolic state, such as that brought on by breastfeeding, can contribute to ketoacidosis. She was treated with IV glucose-containing fluids, bicarbonate, fomepizole, and thiamine.
The case shows that patients should be warned about ketoacidosis risk when they start an ultra-low carbohydrate diet, especially if they are breastfeeding or lactating, Dr. Hudson said.
“Usually they’re safe, but they may not be if you’re in a high metabolic state,” he told judges.
“We take care of so many patients on a daily basis and we rarely get to tell their stories,” he said. “To be able to tell the story of the patients and give the learning points that we took away to others, I think is very rewarding.”
The winner of the trainee award, Maxwell Bressman, MD, a resident at Montefiore Medical Center in New York, presented the case of a 62-year-old woman with hypertension who had profound generalized weakness and an inability to walk.
“She actually came to the hospital because she couldn’t lift a cup of tea,” Dr. Bressman told judges.
Clinicians traced her problem to that very tea – a licorice-containing brew – after an ECG indicated hypokalemia. A breakdown product of licorice, glycyrrhizic acid, can prevent the breakdown of cortisol into cortisone, causing increased absorption of sodium in exchange for potassium, he explained.
“I really like interesting cases – it’s something I’ve thought about throughout medical school,” Dr. Bressman said. “It’s been incredibly fun. We have great cases at Montefiore. ... It’s taught me to think very broadly and with an expansive differential.”
REPORTING FROM HOSPITAL MEDICINE 2018
Video : The SHM Research Committee: Expanding the role and footprint of research in hospital medicine
ORLANDO – In a video interview, Stephanie Mueller, MD, SFHM, of Brigham and Women’s Hospital, Boston, discusses the scope and importance of the SHM Research Committee.
One of its most important roles is overseeing the yearly Scientific Abstract and Poster Competition, known as the Research, Innovations and Clinical Vignettes (RIV) portion of the annual conference, which brings the best of current research in hospital medicine, especially in the increasingly important area of value in patient care, to the members.
In discussing the work of the committee, Dr. Mueller – who is in her third year as a member – adds that they “are working to expand the research footprint within the Society of Hospital Medicine,” including implementing initiatives such as the VIP program, which is a visiting professorship in which junior and mid-level faculty can do an exchange program between institutions.
ORLANDO – In a video interview, Stephanie Mueller, MD, SFHM, of Brigham and Women’s Hospital, Boston, discusses the scope and importance of the SHM Research Committee.
One of its most important roles is overseeing the yearly Scientific Abstract and Poster Competition, known as the Research, Innovations and Clinical Vignettes (RIV) portion of the annual conference, which brings the best of current research in hospital medicine, especially in the increasingly important area of value in patient care, to the members.
In discussing the work of the committee, Dr. Mueller – who is in her third year as a member – adds that they “are working to expand the research footprint within the Society of Hospital Medicine,” including implementing initiatives such as the VIP program, which is a visiting professorship in which junior and mid-level faculty can do an exchange program between institutions.
ORLANDO – In a video interview, Stephanie Mueller, MD, SFHM, of Brigham and Women’s Hospital, Boston, discusses the scope and importance of the SHM Research Committee.
One of its most important roles is overseeing the yearly Scientific Abstract and Poster Competition, known as the Research, Innovations and Clinical Vignettes (RIV) portion of the annual conference, which brings the best of current research in hospital medicine, especially in the increasingly important area of value in patient care, to the members.
In discussing the work of the committee, Dr. Mueller – who is in her third year as a member – adds that they “are working to expand the research footprint within the Society of Hospital Medicine,” including implementing initiatives such as the VIP program, which is a visiting professorship in which junior and mid-level faculty can do an exchange program between institutions.
REPORTING FROM HOSPITAL MEDICINE 2018
SHM presidents: Innovate and avoid complacency
ORLANDO – In a time of tumult in American health care, hospital medicine can expect to see a reimagined – but not reduced – role, said the outgoing and current presidents of the Society of Hospital Medicine at Monday’s HM18 opening plenary.
Despite the many successes of the relatively young field of hospital medicine, there’s no room for complacency, said SHM’s immediate past president Ron Greeno, MD, MHM.
Dr. Greeno drew on his 25-year career in hospital medicine to frame past successes and upcoming challenges for hospital medicine in the 21st century.
As the profession defined itself and grew from the 1980s onward, “the model was challenged, and challenged significantly, mostly by our physician colleagues,” who either feared or didn’t understand the model, he said. All along, though, pioneers in hospital medicine were just trying “to figure out a way to take better care of patients in the hospital.”
The result, said Dr. Greeno, is that hospital medicine stands unique among physician specialties. “We as a specialty are in a very enviable position as we move into the post–health care reform era. More than any other specialty in the history of medicine, we are not expected to p
“Colleagues honor us by trusting us with their patients’ care … but we need to be aware that they are watching us and judging whether we are living up to our promises,” Dr. Greeno said. “So we need to be asking ourselves some tough questions. Perhaps we’re becoming too self-satisfied. Perhaps we are starting to believe our own press.”
Without an appetite for innovation as well as hard work, hospitalists could risk becoming “highly paid worker bees,” said Dr. Greeno.
“There are people who think this is happening. I know because I have talked to them while traveling around the country” as SHM president, he said. “I am not among that group. I think the best is yet to come … that we will become more integrated and have ever more impact and influence in the redesign of the U.S. health care system.”
More than anything, Dr. Greeno’s faith in the profession’s future is grounded in its human capital. Addressing the plenary attendees, he said, “You come here just to become better, to try to make things better. I see all of you who refuse to let the urgent get in the way of the important.”
In her first address as the new SHM president, Nasim Afsar, MD, SFHM, agreed that the people really do make the profession. “We will prevail because of our perseverance and our passion to be part of the solution for challenges in health care,” she said.
Dr. Afsar is chief ambulatory officer and chief medical officer for ACOs at UC Irvine Health. She said that earlier this year, she’d never felt more sure of her job security. Serving on the inpatient hospitalist service during the height of this year’s surging influenza season, Dr. Afsar saw a packed emergency department and a completely full house for her hospital. “We had to create a new hospitalist service” just to handle the volume, she said.
A sobering experience later that month, though, had her rethinking things. At a meeting of chief executive officers of health care systems, leaders spoke of hospitals transitioning from profit centers to cost centers. Some of the proposed innovations were startling: “When I heard talk of hospitals at home, and of virtual hospitals, I got a very different sense of our specialty,” said Dr. Afsar.
Still, she said, she’s confident there will be jobs for hospitalists in the future. “We can’t ignore the significant, irrefutable fact that has emerged: Value will prevail. And the only way to deliver that is population health management,” meaning the delivery of high value care at fair cost across the entire human lifespan, she said.
This call can be answered in two ways, said Dr. Afsar. “First, we have to define and deliver value for hospitalized patients every single day. Second, we have to look at what population health management means for our specialty.”
“I encourage us not to be confined by our names,” Dr. Afsar said. Rather, hospitalists will be defined by the attributes that they’ve become known for over the years: “Innovators. Problem solvers. Collaborators. Patient advocates.”
ORLANDO – In a time of tumult in American health care, hospital medicine can expect to see a reimagined – but not reduced – role, said the outgoing and current presidents of the Society of Hospital Medicine at Monday’s HM18 opening plenary.
Despite the many successes of the relatively young field of hospital medicine, there’s no room for complacency, said SHM’s immediate past president Ron Greeno, MD, MHM.
Dr. Greeno drew on his 25-year career in hospital medicine to frame past successes and upcoming challenges for hospital medicine in the 21st century.
As the profession defined itself and grew from the 1980s onward, “the model was challenged, and challenged significantly, mostly by our physician colleagues,” who either feared or didn’t understand the model, he said. All along, though, pioneers in hospital medicine were just trying “to figure out a way to take better care of patients in the hospital.”
The result, said Dr. Greeno, is that hospital medicine stands unique among physician specialties. “We as a specialty are in a very enviable position as we move into the post–health care reform era. More than any other specialty in the history of medicine, we are not expected to p
“Colleagues honor us by trusting us with their patients’ care … but we need to be aware that they are watching us and judging whether we are living up to our promises,” Dr. Greeno said. “So we need to be asking ourselves some tough questions. Perhaps we’re becoming too self-satisfied. Perhaps we are starting to believe our own press.”
Without an appetite for innovation as well as hard work, hospitalists could risk becoming “highly paid worker bees,” said Dr. Greeno.
“There are people who think this is happening. I know because I have talked to them while traveling around the country” as SHM president, he said. “I am not among that group. I think the best is yet to come … that we will become more integrated and have ever more impact and influence in the redesign of the U.S. health care system.”
More than anything, Dr. Greeno’s faith in the profession’s future is grounded in its human capital. Addressing the plenary attendees, he said, “You come here just to become better, to try to make things better. I see all of you who refuse to let the urgent get in the way of the important.”
In her first address as the new SHM president, Nasim Afsar, MD, SFHM, agreed that the people really do make the profession. “We will prevail because of our perseverance and our passion to be part of the solution for challenges in health care,” she said.
Dr. Afsar is chief ambulatory officer and chief medical officer for ACOs at UC Irvine Health. She said that earlier this year, she’d never felt more sure of her job security. Serving on the inpatient hospitalist service during the height of this year’s surging influenza season, Dr. Afsar saw a packed emergency department and a completely full house for her hospital. “We had to create a new hospitalist service” just to handle the volume, she said.
A sobering experience later that month, though, had her rethinking things. At a meeting of chief executive officers of health care systems, leaders spoke of hospitals transitioning from profit centers to cost centers. Some of the proposed innovations were startling: “When I heard talk of hospitals at home, and of virtual hospitals, I got a very different sense of our specialty,” said Dr. Afsar.
Still, she said, she’s confident there will be jobs for hospitalists in the future. “We can’t ignore the significant, irrefutable fact that has emerged: Value will prevail. And the only way to deliver that is population health management,” meaning the delivery of high value care at fair cost across the entire human lifespan, she said.
This call can be answered in two ways, said Dr. Afsar. “First, we have to define and deliver value for hospitalized patients every single day. Second, we have to look at what population health management means for our specialty.”
“I encourage us not to be confined by our names,” Dr. Afsar said. Rather, hospitalists will be defined by the attributes that they’ve become known for over the years: “Innovators. Problem solvers. Collaborators. Patient advocates.”
ORLANDO – In a time of tumult in American health care, hospital medicine can expect to see a reimagined – but not reduced – role, said the outgoing and current presidents of the Society of Hospital Medicine at Monday’s HM18 opening plenary.
Despite the many successes of the relatively young field of hospital medicine, there’s no room for complacency, said SHM’s immediate past president Ron Greeno, MD, MHM.
Dr. Greeno drew on his 25-year career in hospital medicine to frame past successes and upcoming challenges for hospital medicine in the 21st century.
As the profession defined itself and grew from the 1980s onward, “the model was challenged, and challenged significantly, mostly by our physician colleagues,” who either feared or didn’t understand the model, he said. All along, though, pioneers in hospital medicine were just trying “to figure out a way to take better care of patients in the hospital.”
The result, said Dr. Greeno, is that hospital medicine stands unique among physician specialties. “We as a specialty are in a very enviable position as we move into the post–health care reform era. More than any other specialty in the history of medicine, we are not expected to p
“Colleagues honor us by trusting us with their patients’ care … but we need to be aware that they are watching us and judging whether we are living up to our promises,” Dr. Greeno said. “So we need to be asking ourselves some tough questions. Perhaps we’re becoming too self-satisfied. Perhaps we are starting to believe our own press.”
Without an appetite for innovation as well as hard work, hospitalists could risk becoming “highly paid worker bees,” said Dr. Greeno.
“There are people who think this is happening. I know because I have talked to them while traveling around the country” as SHM president, he said. “I am not among that group. I think the best is yet to come … that we will become more integrated and have ever more impact and influence in the redesign of the U.S. health care system.”
More than anything, Dr. Greeno’s faith in the profession’s future is grounded in its human capital. Addressing the plenary attendees, he said, “You come here just to become better, to try to make things better. I see all of you who refuse to let the urgent get in the way of the important.”
In her first address as the new SHM president, Nasim Afsar, MD, SFHM, agreed that the people really do make the profession. “We will prevail because of our perseverance and our passion to be part of the solution for challenges in health care,” she said.
Dr. Afsar is chief ambulatory officer and chief medical officer for ACOs at UC Irvine Health. She said that earlier this year, she’d never felt more sure of her job security. Serving on the inpatient hospitalist service during the height of this year’s surging influenza season, Dr. Afsar saw a packed emergency department and a completely full house for her hospital. “We had to create a new hospitalist service” just to handle the volume, she said.
A sobering experience later that month, though, had her rethinking things. At a meeting of chief executive officers of health care systems, leaders spoke of hospitals transitioning from profit centers to cost centers. Some of the proposed innovations were startling: “When I heard talk of hospitals at home, and of virtual hospitals, I got a very different sense of our specialty,” said Dr. Afsar.
Still, she said, she’s confident there will be jobs for hospitalists in the future. “We can’t ignore the significant, irrefutable fact that has emerged: Value will prevail. And the only way to deliver that is population health management,” meaning the delivery of high value care at fair cost across the entire human lifespan, she said.
This call can be answered in two ways, said Dr. Afsar. “First, we have to define and deliver value for hospitalized patients every single day. Second, we have to look at what population health management means for our specialty.”
“I encourage us not to be confined by our names,” Dr. Afsar said. Rather, hospitalists will be defined by the attributes that they’ve become known for over the years: “Innovators. Problem solvers. Collaborators. Patient advocates.”
Hospitalists 'perfectly poised' to drive health care reform
ORLANDO – As dizzying as the alphabet soup of payment reform might seem – with its swirl of new incentives, alignments, and models – hospitalists should already be familiar with many of its main ideas, said keynote speaker Kate Goodrich, MD, director of the Center for Clinical Standards and Quality at the Centers for Medicare and Medicaid Services.
That makes hospitalists poised to help reform a U.S. health care system with the dubious pairing of staggering costs and poor outcomes, Dr. Goodrich told a packed ballroom on Monday at the annual meeting of the Society of Hospital Medicine.
Many of the measures involved in payment reform – with its Merit-Based Incentive Payment System (MIPS), Medicare Access and CHIP Reauthorization Act (MACRA), and Advanced Payment Models (APMs) – focus on outpatient and ambulatory care, Dr. Goodrich acknowledged. But it’s also about medical systems, she said.
“What do you focus on as hospitalists? Improving systems of care,” she said. “We focus on clinical care for our individual patient, but part of our job is also to think about it in terms of how do I improve the care across my hospital system?”
One aspect of reform that is most likely to directly affect hospitalists is the facility-based measurement part of the Quality Payment Program, slated to take effect in 2019. If participating in MIPS – the payment model in which clinicians can receive an increase or decrease in payments based on performance measured by data on quality, cost, and other factors – clinicians can choose to have their hospital’s quality measures count toward their MIPS quality score. The facility measurement was developed in part after conversations between CMS and SHM, Dr. Goodrich said.
“Many stakeholders are very excited about this possibility for a couple of reasons: No. 1, there would be absolutely no quality-reporting burden for you if you chose to do that,” she said. “No. 2, it really aligns the incentives between you and the hospital that you’re working in. Because, after all, we are all in this together. And some folks have felt like they aren’t always aligned with the incentives of the hospital that they are working with, or working for.”
Dr. Goodrich didn’t try to send a message that payment reform isn’t a challenge for hospitalists or anyone else – she called the new system “complicated” and said that “we are in a stage of fairly dramatic health system transformation.”
But she said there are steps hospitalists can take to make quality change – and necessary change – happen.
“First of all, of course, continue to provide high-quality patient care, focus on the patients in front of you, and lead the teams that you need in order to provide high-quality care,” she said.
Also, Dr. Goodrich said, hospitalists should learn to work more closely with their own hospital administrators and the post-acute facilities in their local communities.
“We have to figure out ways to collaborate with them and align the incentives across all of these systems of care,” she said. “Some of that comes top down from payers, but much of that can happen at the local level as well.”
Yet, she noted that she often senses trepidation.
“I always get the question: ‘Well, how do we do this? How do we make this change? It’s not something that we’re necessarily trained for,’ ” Dr. Goodrich said. “There are people out there who are doing this well. This is actually spreading across the country. So seek out those high-performers and learn from them. There’s a lot of learning networks out there that you can access to learn how to make some of these changes.”
ORLANDO – As dizzying as the alphabet soup of payment reform might seem – with its swirl of new incentives, alignments, and models – hospitalists should already be familiar with many of its main ideas, said keynote speaker Kate Goodrich, MD, director of the Center for Clinical Standards and Quality at the Centers for Medicare and Medicaid Services.
That makes hospitalists poised to help reform a U.S. health care system with the dubious pairing of staggering costs and poor outcomes, Dr. Goodrich told a packed ballroom on Monday at the annual meeting of the Society of Hospital Medicine.
Many of the measures involved in payment reform – with its Merit-Based Incentive Payment System (MIPS), Medicare Access and CHIP Reauthorization Act (MACRA), and Advanced Payment Models (APMs) – focus on outpatient and ambulatory care, Dr. Goodrich acknowledged. But it’s also about medical systems, she said.
“What do you focus on as hospitalists? Improving systems of care,” she said. “We focus on clinical care for our individual patient, but part of our job is also to think about it in terms of how do I improve the care across my hospital system?”
One aspect of reform that is most likely to directly affect hospitalists is the facility-based measurement part of the Quality Payment Program, slated to take effect in 2019. If participating in MIPS – the payment model in which clinicians can receive an increase or decrease in payments based on performance measured by data on quality, cost, and other factors – clinicians can choose to have their hospital’s quality measures count toward their MIPS quality score. The facility measurement was developed in part after conversations between CMS and SHM, Dr. Goodrich said.
“Many stakeholders are very excited about this possibility for a couple of reasons: No. 1, there would be absolutely no quality-reporting burden for you if you chose to do that,” she said. “No. 2, it really aligns the incentives between you and the hospital that you’re working in. Because, after all, we are all in this together. And some folks have felt like they aren’t always aligned with the incentives of the hospital that they are working with, or working for.”
Dr. Goodrich didn’t try to send a message that payment reform isn’t a challenge for hospitalists or anyone else – she called the new system “complicated” and said that “we are in a stage of fairly dramatic health system transformation.”
But she said there are steps hospitalists can take to make quality change – and necessary change – happen.
“First of all, of course, continue to provide high-quality patient care, focus on the patients in front of you, and lead the teams that you need in order to provide high-quality care,” she said.
Also, Dr. Goodrich said, hospitalists should learn to work more closely with their own hospital administrators and the post-acute facilities in their local communities.
“We have to figure out ways to collaborate with them and align the incentives across all of these systems of care,” she said. “Some of that comes top down from payers, but much of that can happen at the local level as well.”
Yet, she noted that she often senses trepidation.
“I always get the question: ‘Well, how do we do this? How do we make this change? It’s not something that we’re necessarily trained for,’ ” Dr. Goodrich said. “There are people out there who are doing this well. This is actually spreading across the country. So seek out those high-performers and learn from them. There’s a lot of learning networks out there that you can access to learn how to make some of these changes.”
ORLANDO – As dizzying as the alphabet soup of payment reform might seem – with its swirl of new incentives, alignments, and models – hospitalists should already be familiar with many of its main ideas, said keynote speaker Kate Goodrich, MD, director of the Center for Clinical Standards and Quality at the Centers for Medicare and Medicaid Services.
That makes hospitalists poised to help reform a U.S. health care system with the dubious pairing of staggering costs and poor outcomes, Dr. Goodrich told a packed ballroom on Monday at the annual meeting of the Society of Hospital Medicine.
Many of the measures involved in payment reform – with its Merit-Based Incentive Payment System (MIPS), Medicare Access and CHIP Reauthorization Act (MACRA), and Advanced Payment Models (APMs) – focus on outpatient and ambulatory care, Dr. Goodrich acknowledged. But it’s also about medical systems, she said.
“What do you focus on as hospitalists? Improving systems of care,” she said. “We focus on clinical care for our individual patient, but part of our job is also to think about it in terms of how do I improve the care across my hospital system?”
One aspect of reform that is most likely to directly affect hospitalists is the facility-based measurement part of the Quality Payment Program, slated to take effect in 2019. If participating in MIPS – the payment model in which clinicians can receive an increase or decrease in payments based on performance measured by data on quality, cost, and other factors – clinicians can choose to have their hospital’s quality measures count toward their MIPS quality score. The facility measurement was developed in part after conversations between CMS and SHM, Dr. Goodrich said.
“Many stakeholders are very excited about this possibility for a couple of reasons: No. 1, there would be absolutely no quality-reporting burden for you if you chose to do that,” she said. “No. 2, it really aligns the incentives between you and the hospital that you’re working in. Because, after all, we are all in this together. And some folks have felt like they aren’t always aligned with the incentives of the hospital that they are working with, or working for.”
Dr. Goodrich didn’t try to send a message that payment reform isn’t a challenge for hospitalists or anyone else – she called the new system “complicated” and said that “we are in a stage of fairly dramatic health system transformation.”
But she said there are steps hospitalists can take to make quality change – and necessary change – happen.
“First of all, of course, continue to provide high-quality patient care, focus on the patients in front of you, and lead the teams that you need in order to provide high-quality care,” she said.
Also, Dr. Goodrich said, hospitalists should learn to work more closely with their own hospital administrators and the post-acute facilities in their local communities.
“We have to figure out ways to collaborate with them and align the incentives across all of these systems of care,” she said. “Some of that comes top down from payers, but much of that can happen at the local level as well.”
Yet, she noted that she often senses trepidation.
“I always get the question: ‘Well, how do we do this? How do we make this change? It’s not something that we’re necessarily trained for,’ ” Dr. Goodrich said. “There are people out there who are doing this well. This is actually spreading across the country. So seek out those high-performers and learn from them. There’s a lot of learning networks out there that you can access to learn how to make some of these changes.”
Video: SHM President Nasim Afsar seeks an “unrelenting focus on delivering value”
ORLANDO – In a video interview, Nasim Afsar, MD, SFHM, details the career road that led her to the “tremendous honor” of becoming president of the Society of Hospital Medicine.
Having been on the board of directors for 6 years was a profound experience, according to Dr. Afsar, and now as president she looks to take what she has learned and focus on the future of the field.
When asked about her overall vision for the coming year for the Society, Dr. Afsar said that she is committed to “an unrelenting focus on delivering value to our patients, our institutions, and society, and the way we do that is through population health management.”
ORLANDO – In a video interview, Nasim Afsar, MD, SFHM, details the career road that led her to the “tremendous honor” of becoming president of the Society of Hospital Medicine.
Having been on the board of directors for 6 years was a profound experience, according to Dr. Afsar, and now as president she looks to take what she has learned and focus on the future of the field.
When asked about her overall vision for the coming year for the Society, Dr. Afsar said that she is committed to “an unrelenting focus on delivering value to our patients, our institutions, and society, and the way we do that is through population health management.”
ORLANDO – In a video interview, Nasim Afsar, MD, SFHM, details the career road that led her to the “tremendous honor” of becoming president of the Society of Hospital Medicine.
Having been on the board of directors for 6 years was a profound experience, according to Dr. Afsar, and now as president she looks to take what she has learned and focus on the future of the field.
When asked about her overall vision for the coming year for the Society, Dr. Afsar said that she is committed to “an unrelenting focus on delivering value to our patients, our institutions, and society, and the way we do that is through population health management.”
REPORTING FROM HOSPITAL MEDICINE 2018
Boosting bedside skills in hands-on session
A low faculty-to-learner ratio helped HM18 attendees get the most from their learning experience in the Sunday pre-conference course “Bedside Procedures for the Hospitalist.”
The pre-course blended live didactic teaching and hands-on training with simulators so participants could not only learn but also review and demonstrate techniques for many common invasive procedures hospitalists encounter in practice.
“Our goal is to make the entire bedside procedures pre-course a unique experience,” course codirector Alyssa Burkhart, MD, of the Billings (Mont.) Clinic, said in an interview before the session. 
“We carefully select the curriculum to create a program most relevant to the participants and their day-to-day work in patient care,” said Dr. Burkhart.
“The low faculty-to-learner ratio coupled with ample time to practice under expert guidance separates us from others. ... It’s a privilege to share our love of procedures with this year’s SHM participants,” said Dr. Burkhart, who comoderated the session with Joshua Lenchus, DO, SFHM, of the University of Miami.
An interactive focus on bedside procedures benefits novices and experienced clinicians, said Dr. Lenchus.
The simulation experience involved practice with ultrasound as well as anatomically representative training equipment.
“Our hope is that many hospitalists may once again find that spark of interest in performing more of their own procedures. The interactive sessions embedded within the pre-course are vital to the success of our program. Many other training sessions are didactics based. We strive to keep lecture time to a minimum so that small groups can learn from the expert facilitators,” Dr. Burkhart added.
“Ample hands-on practice time, interactive experience, and direct supervision separate our pre-course from other commercially available offerings,” Dr. Lenchus said.
The agenda kicked off with vascular and intraosseous access in the morning, followed by paracentesis, thoracentesis, lumbar puncture, and basic airway management, including the use of supraglottic devices.
Dr. Burkhart noted that the course included two separate practice sessions for vascular access because of the number of technical steps and potential complications. “Attendees typically wish to spend a considerable amount of time on vascular access,” she said. “The intraosseous access station and its exceptional trainers always receive very positive feedback.”
Dr. Burkhart and Dr. Lenchus had no financial conflicts to disclose.
A low faculty-to-learner ratio helped HM18 attendees get the most from their learning experience in the Sunday pre-conference course “Bedside Procedures for the Hospitalist.”
The pre-course blended live didactic teaching and hands-on training with simulators so participants could not only learn but also review and demonstrate techniques for many common invasive procedures hospitalists encounter in practice.
“Our goal is to make the entire bedside procedures pre-course a unique experience,” course codirector Alyssa Burkhart, MD, of the Billings (Mont.) Clinic, said in an interview before the session.
“We carefully select the curriculum to create a program most relevant to the participants and their day-to-day work in patient care,” said Dr. Burkhart.
“The low faculty-to-learner ratio coupled with ample time to practice under expert guidance separates us from others. ... It’s a privilege to share our love of procedures with this year’s SHM participants,” said Dr. Burkhart, who comoderated the session with Joshua Lenchus, DO, SFHM, of the University of Miami.
An interactive focus on bedside procedures benefits novices and experienced clinicians, said Dr. Lenchus.
The simulation experience involved practice with ultrasound as well as anatomically representative training equipment.
“Our hope is that many hospitalists may once again find that spark of interest in performing more of their own procedures. The interactive sessions embedded within the pre-course are vital to the success of our program. Many other training sessions are didactics based. We strive to keep lecture time to a minimum so that small groups can learn from the expert facilitators,” Dr. Burkhart added.
“Ample hands-on practice time, interactive experience, and direct supervision separate our pre-course from other commercially available offerings,” Dr. Lenchus said.
The agenda kicked off with vascular and intraosseous access in the morning, followed by paracentesis, thoracentesis, lumbar puncture, and basic airway management, including the use of supraglottic devices.
Dr. Burkhart noted that the course included two separate practice sessions for vascular access because of the number of technical steps and potential complications. “Attendees typically wish to spend a considerable amount of time on vascular access,” she said. “The intraosseous access station and its exceptional trainers always receive very positive feedback.”
Dr. Burkhart and Dr. Lenchus had no financial conflicts to disclose.
A low faculty-to-learner ratio helped HM18 attendees get the most from their learning experience in the Sunday pre-conference course “Bedside Procedures for the Hospitalist.”
The pre-course blended live didactic teaching and hands-on training with simulators so participants could not only learn but also review and demonstrate techniques for many common invasive procedures hospitalists encounter in practice.
“Our goal is to make the entire bedside procedures pre-course a unique experience,” course codirector Alyssa Burkhart, MD, of the Billings (Mont.) Clinic, said in an interview before the session.
“We carefully select the curriculum to create a program most relevant to the participants and their day-to-day work in patient care,” said Dr. Burkhart.
“The low faculty-to-learner ratio coupled with ample time to practice under expert guidance separates us from others. ... It’s a privilege to share our love of procedures with this year’s SHM participants,” said Dr. Burkhart, who comoderated the session with Joshua Lenchus, DO, SFHM, of the University of Miami.
An interactive focus on bedside procedures benefits novices and experienced clinicians, said Dr. Lenchus.
The simulation experience involved practice with ultrasound as well as anatomically representative training equipment.
“Our hope is that many hospitalists may once again find that spark of interest in performing more of their own procedures. The interactive sessions embedded within the pre-course are vital to the success of our program. Many other training sessions are didactics based. We strive to keep lecture time to a minimum so that small groups can learn from the expert facilitators,” Dr. Burkhart added.
“Ample hands-on practice time, interactive experience, and direct supervision separate our pre-course from other commercially available offerings,” Dr. Lenchus said.
The agenda kicked off with vascular and intraosseous access in the morning, followed by paracentesis, thoracentesis, lumbar puncture, and basic airway management, including the use of supraglottic devices.
Dr. Burkhart noted that the course included two separate practice sessions for vascular access because of the number of technical steps and potential complications. “Attendees typically wish to spend a considerable amount of time on vascular access,” she said. “The intraosseous access station and its exceptional trainers always receive very positive feedback.”
Dr. Burkhart and Dr. Lenchus had no financial conflicts to disclose.
Practical changes for improving practice management
An all-day HM18 pre-course – “Hospitalist Practice Management: How to Thrive in a Time of Intense Change” – for hospitalist leaders and practice administrators was all about practicality.
One of the goals of the session was to provide “quick, actionable interventions that attendees can implement right away, as well as alternatives for attendees to consider, which will require some work to employ,” said John Nelson, MD, MHM, a partner at Nelson Flores Hospital Medicine Consultants, La Quinta, Calif., the medical director of the Overlake Medical Center, Bellevue, Wash., and a course codirector and a faculty presenter.
Dr. Nelson pointed out that the hospitalist practice is a unique practice model. “We can’t effectively use the same approaches that other medical specialties use to ensure we have successful practices,” he said.
The pre-course, held Sunday before the official start of HM18, included more commentary and specifics than in past years about how to prosper in the rapidly changing health care landscape and how to reduce the chance of burnout.
Topics addressed included how to find, measure, and demonstrate value; how to incorporate different types of providers and clinical support staffing into a practice to support hospitalists; and how to recruit the right people and build a desirable culture.
The pre-course also covered effective roles for a variety of providers in a hospitalist group, including nurses, scribes, and coordinators, and delineated the benefits of providing telemedicine.
For group leaders and administrators in attendance, the session also shed light on how to interact with individual providers in their group and how to collaborate to build a healthy culture and practice, Ms. Flores said.
The day began with presentations that laid out valuable information and frameworks, including “A Tour of Survey Data: What It Does and Doesn’t Tell You” and “Defining and Measuring Value.” Sessions included six didactic lectures with a question-and-answer period, as well as what Dr. Nelson has dubbed “point/counterpoint” sessions in which faculty members debated particular issues, such as work scheduling models. During the last session, “Learning From Each Other,” participants shared with other attendees their own best practices in the areas covered.
Although there is no single best way to organize a hospitalist’s practice, the course provided lots of information and perspective to help listeners decide what is best for their practice.
“Even though we work in a stressful environment of constant change, hospitalists do have some control over their destiny, and there are things they can do to make hospitalist groups thrive in this challenging environment,” Ms. Flores concluded.
An all-day HM18 pre-course – “Hospitalist Practice Management: How to Thrive in a Time of Intense Change” – for hospitalist leaders and practice administrators was all about practicality.
One of the goals of the session was to provide “quick, actionable interventions that attendees can implement right away, as well as alternatives for attendees to consider, which will require some work to employ,” said John Nelson, MD, MHM, a partner at Nelson Flores Hospital Medicine Consultants, La Quinta, Calif., the medical director of the Overlake Medical Center, Bellevue, Wash., and a course codirector and a faculty presenter.
Dr. Nelson pointed out that the hospitalist practice is a unique practice model. “We can’t effectively use the same approaches that other medical specialties use to ensure we have successful practices,” he said.
The pre-course, held Sunday before the official start of HM18, included more commentary and specifics than in past years about how to prosper in the rapidly changing health care landscape and how to reduce the chance of burnout.
Topics addressed included how to find, measure, and demonstrate value; how to incorporate different types of providers and clinical support staffing into a practice to support hospitalists; and how to recruit the right people and build a desirable culture.
The pre-course also covered effective roles for a variety of providers in a hospitalist group, including nurses, scribes, and coordinators, and delineated the benefits of providing telemedicine.
For group leaders and administrators in attendance, the session also shed light on how to interact with individual providers in their group and how to collaborate to build a healthy culture and practice, Ms. Flores said.
The day began with presentations that laid out valuable information and frameworks, including “A Tour of Survey Data: What It Does and Doesn’t Tell You” and “Defining and Measuring Value.” Sessions included six didactic lectures with a question-and-answer period, as well as what Dr. Nelson has dubbed “point/counterpoint” sessions in which faculty members debated particular issues, such as work scheduling models. During the last session, “Learning From Each Other,” participants shared with other attendees their own best practices in the areas covered.
Although there is no single best way to organize a hospitalist’s practice, the course provided lots of information and perspective to help listeners decide what is best for their practice.
“Even though we work in a stressful environment of constant change, hospitalists do have some control over their destiny, and there are things they can do to make hospitalist groups thrive in this challenging environment,” Ms. Flores concluded.
An all-day HM18 pre-course – “Hospitalist Practice Management: How to Thrive in a Time of Intense Change” – for hospitalist leaders and practice administrators was all about practicality.
One of the goals of the session was to provide “quick, actionable interventions that attendees can implement right away, as well as alternatives for attendees to consider, which will require some work to employ,” said John Nelson, MD, MHM, a partner at Nelson Flores Hospital Medicine Consultants, La Quinta, Calif., the medical director of the Overlake Medical Center, Bellevue, Wash., and a course codirector and a faculty presenter.
Dr. Nelson pointed out that the hospitalist practice is a unique practice model. “We can’t effectively use the same approaches that other medical specialties use to ensure we have successful practices,” he said.
The pre-course, held Sunday before the official start of HM18, included more commentary and specifics than in past years about how to prosper in the rapidly changing health care landscape and how to reduce the chance of burnout.
Topics addressed included how to find, measure, and demonstrate value; how to incorporate different types of providers and clinical support staffing into a practice to support hospitalists; and how to recruit the right people and build a desirable culture.
The pre-course also covered effective roles for a variety of providers in a hospitalist group, including nurses, scribes, and coordinators, and delineated the benefits of providing telemedicine.
For group leaders and administrators in attendance, the session also shed light on how to interact with individual providers in their group and how to collaborate to build a healthy culture and practice, Ms. Flores said.
The day began with presentations that laid out valuable information and frameworks, including “A Tour of Survey Data: What It Does and Doesn’t Tell You” and “Defining and Measuring Value.” Sessions included six didactic lectures with a question-and-answer period, as well as what Dr. Nelson has dubbed “point/counterpoint” sessions in which faculty members debated particular issues, such as work scheduling models. During the last session, “Learning From Each Other,” participants shared with other attendees their own best practices in the areas covered.
Although there is no single best way to organize a hospitalist’s practice, the course provided lots of information and perspective to help listeners decide what is best for their practice.
“Even though we work in a stressful environment of constant change, hospitalists do have some control over their destiny, and there are things they can do to make hospitalist groups thrive in this challenging environment,” Ms. Flores concluded.