Innovations in Healthcare

A new study tracking the growth of advanced diagnostic imaging techniques found that the rate of growth for such tests is slowing dramatically, even as the total number of tests performed continues to grow.¹ Starting in 2007, the rate of growth dropped sharply to about 1% to 3% from more than 6% per year during the previous decade.

Frank Levy, PhD, professor of urban economics at Massachusetts Institute of Technology in Cambridge, Mass., and one of the study’s authors, suggests that the previous growth of the technology could have been partly attributable to such nonmedical factors as profitability for hospitals and fear of malpractice by physicians. The slowdown, Dr. Levy says, also might reflect increased pushback from insurers, recognition of the cost and waste issues, and growing concerns about radiation exposure.

“There are many medical reasons for using these procedures—and many nonmedical reasons,” Dr. Levy says. “To use healthcare resources more efficiently, you should make sure your reason for ordering these tests is medical.”

SHM is working on a short list of sometimes unnecessary but commonly performed medical procedures, which it plans to submit to the American Board of Internal Medicine’s Choosing Wisely campaign this fall. One of the tests being considered for this list is serial chest X-rays for hospitalized patients outside of the ICU who are clinically stable, says Wendy Nickel, associate vice president of SHM’s Center for Hospital Innovation and Improvement. Unnecessary imaging tests are both a safety and a waste issue, she adds.

In related news, a study in the Journal of the National Cancer Institute found that 95.9% of patients 65 and older who have Stage IV cancer received at least one high-cost advanced imaging procedure (e.g. PET or nuclear medicine), with their utilization rates rising more rapidly than for earlier stages of disease.² Such tests can lead to appropriate palliative measures but also can “distract patients from focusing on achievable end-of-life goals,” explain researchers from the Dana-Farber Cancer Institute in Boston.

References

1. Lee D, Levy F. The sharp slowdown in growth of medical imaging: an early analysis suggests combination of policies was the cause. Health Affairs website. Available at: http://www.healthaffairs.org/alert_link.php?url=http://content.healthaffairs.org/content/early/2012/07/24/hlthaff.2011.1034&t=h&id=1590. Accessed Aug. 29, 2012.
2. Hu YY, Kwok AC, Jiang W, et al. High-cost imaging in elderly patients with Stage IV cancer. J Natl Cancer Inst. 2012;104(15):1165-1173.

A new study tracking the growth of advanced diagnostic imaging techniques found that the rate of growth for such tests is slowing dramatically, even as the total number of tests performed continues to grow.¹ Starting in 2007, the rate of growth dropped sharply to about 1% to 3% from more than 6% per year during the previous decade.

Frank Levy, PhD, professor of urban economics at Massachusetts Institute of Technology in Cambridge, Mass., and one of the study’s authors, suggests that the previous growth of the technology could have been partly attributable to such nonmedical factors as profitability for hospitals and fear of malpractice by physicians. The slowdown, Dr. Levy says, also might reflect increased pushback from insurers, recognition of the cost and waste issues, and growing concerns about radiation exposure.

“There are many medical reasons for using these procedures—and many nonmedical reasons,” Dr. Levy says. “To use healthcare resources more efficiently, you should make sure your reason for ordering these tests is medical.”

SHM is working on a short list of sometimes unnecessary but commonly performed medical procedures, which it plans to submit to the American Board of Internal Medicine’s Choosing Wisely campaign this fall. One of the tests being considered for this list is serial chest X-rays for hospitalized patients outside of the ICU who are clinically stable, says Wendy Nickel, associate vice president of SHM’s Center for Hospital Innovation and Improvement. Unnecessary imaging tests are both a safety and a waste issue, she adds.

In related news, a study in the Journal of the National Cancer Institute found that 95.9% of patients 65 and older who have Stage IV cancer received at least one high-cost advanced imaging procedure (e.g. PET or nuclear medicine), with their utilization rates rising more rapidly than for earlier stages of disease.² Such tests can lead to appropriate palliative measures but also can “distract patients from focusing on achievable end-of-life goals,” explain researchers from the Dana-Farber Cancer Institute in Boston.

References

1. Lee D, Levy F. The sharp slowdown in growth of medical imaging: an early analysis suggests combination of policies was the cause. Health Affairs website. Available at: http://www.healthaffairs.org/alert_link.php?url=http://content.healthaffairs.org/content/early/2012/07/24/hlthaff.2011.1034&t=h&id=1590. Accessed Aug. 29, 2012.
2. Hu YY, Kwok AC, Jiang W, et al. High-cost imaging in elderly patients with Stage IV cancer. J Natl Cancer Inst. 2012;104(15):1165-1173.

A new study tracking the growth of advanced diagnostic imaging techniques found that the rate of growth for such tests is slowing dramatically, even as the total number of tests performed continues to grow.¹ Starting in 2007, the rate of growth dropped sharply to about 1% to 3% from more than 6% per year during the previous decade.

Frank Levy, PhD, professor of urban economics at Massachusetts Institute of Technology in Cambridge, Mass., and one of the study’s authors, suggests that the previous growth of the technology could have been partly attributable to such nonmedical factors as profitability for hospitals and fear of malpractice by physicians. The slowdown, Dr. Levy says, also might reflect increased pushback from insurers, recognition of the cost and waste issues, and growing concerns about radiation exposure.

“There are many medical reasons for using these procedures—and many nonmedical reasons,” Dr. Levy says. “To use healthcare resources more efficiently, you should make sure your reason for ordering these tests is medical.”

SHM is working on a short list of sometimes unnecessary but commonly performed medical procedures, which it plans to submit to the American Board of Internal Medicine’s Choosing Wisely campaign this fall. One of the tests being considered for this list is serial chest X-rays for hospitalized patients outside of the ICU who are clinically stable, says Wendy Nickel, associate vice president of SHM’s Center for Hospital Innovation and Improvement. Unnecessary imaging tests are both a safety and a waste issue, she adds.

In related news, a study in the Journal of the National Cancer Institute found that 95.9% of patients 65 and older who have Stage IV cancer received at least one high-cost advanced imaging procedure (e.g. PET or nuclear medicine), with their utilization rates rising more rapidly than for earlier stages of disease.² Such tests can lead to appropriate palliative measures but also can “distract patients from focusing on achievable end-of-life goals,” explain researchers from the Dana-Farber Cancer Institute in Boston.

References

1. Lee D, Levy F. The sharp slowdown in growth of medical imaging: an early analysis suggests combination of policies was the cause. Health Affairs website. Available at: http://www.healthaffairs.org/alert_link.php?url=http://content.healthaffairs.org/content/early/2012/07/24/hlthaff.2011.1034&t=h&id=1590. Accessed Aug. 29, 2012.
2. Hu YY, Kwok AC, Jiang W, et al. High-cost imaging in elderly patients with Stage IV cancer. J Natl Cancer Inst. 2012;104(15):1165-1173.

Amid the struggle to boost the country’s sagging critical-care workforce, experts have most commonly proposed creating a tiered or regionalized model of care, investing more in tele-ICU services, and augmenting the role of midlevel providers.

The University of Pittsburgh Medical Center, with 20 hospitals and roughly 500 ICU beds throughout its network, is adopting a regionalized healthcare delivery system. Some of the center’s most high-risk services, such as its big transplant programs, are centralized within the main university campus hospitals, as are about half of the ICU beds.

“In those hospitals, we’ve decided that we need 24/7 in-house, intensive-care attendings,” says Derek Angus, MD, the center’s chair of critical-care medicine. The doctors work with fellows and a rapidly growing expansion of midlevel providers.

In some of the smaller hospitals, however, some ICU patients are seen and managed by hospitalists. The medical center’s eventual goal is to be more systematic about the kinds of patients managed by intensivists as well as those managed by hospitalists. It’s a task made easier by the specialists’ close working relationship within the same department.

Dr. Angus believes telemedicine could help by providing a sort of mission control that can help track critically ill patients and those at risk of being admitted to ICUs across all 20 hospitals. He concedes, however, that telemedicine for ICU assistance has had mixed results in the medical literature, suggesting that a major key is working out the proper roles and responsibilities of those using the technology.

To improve the consistency of its own frontline providers, the Emory University Center for Critical Care in Atlanta developed a competency-based, critical-care training program for nurse practitioners (NPs) and physician assistants (PAs).

“It’s very clear that if you have a group of NP and PA providers who can do 90 percent of what the physician does, it really begins to unload the physician to focus on what I call the big-picture pieces of critical care,” says center director Timothy Buchman, PhD, MD.

That attending physician can be trained as a care executive to ensure well-coordinated care and to focus on any process that isn’t working well. “At a big academic health sciences center, that should probably be a critical-care physician,” Dr. Buchman notes. “But for the smaller community and regional hospitals that have a relatively less sick population, the person who will be well-positioned to oversee this nonphysician provider staff could well be a hospitalist who’s received additional guidance and training in critical care.”

For mild or moderate complexity of care, he says, the added training need not necessarily include a traditional two-year fellowship. Under a value-based system, sicker patients could be rapidly transferred to a higher level of care, and telemedicine could provide a “backstop” for providers in smaller hospitals who lack the training and experience of someone with a full critical-care fellowship.

Amid the struggle to boost the country’s sagging critical-care workforce, experts have most commonly proposed creating a tiered or regionalized model of care, investing more in tele-ICU services, and augmenting the role of midlevel providers.

The University of Pittsburgh Medical Center, with 20 hospitals and roughly 500 ICU beds throughout its network, is adopting a regionalized healthcare delivery system. Some of the center’s most high-risk services, such as its big transplant programs, are centralized within the main university campus hospitals, as are about half of the ICU beds.

“In those hospitals, we’ve decided that we need 24/7 in-house, intensive-care attendings,” says Derek Angus, MD, the center’s chair of critical-care medicine. The doctors work with fellows and a rapidly growing expansion of midlevel providers.

In some of the smaller hospitals, however, some ICU patients are seen and managed by hospitalists. The medical center’s eventual goal is to be more systematic about the kinds of patients managed by intensivists as well as those managed by hospitalists. It’s a task made easier by the specialists’ close working relationship within the same department.

Dr. Angus believes telemedicine could help by providing a sort of mission control that can help track critically ill patients and those at risk of being admitted to ICUs across all 20 hospitals. He concedes, however, that telemedicine for ICU assistance has had mixed results in the medical literature, suggesting that a major key is working out the proper roles and responsibilities of those using the technology.

To improve the consistency of its own frontline providers, the Emory University Center for Critical Care in Atlanta developed a competency-based, critical-care training program for nurse practitioners (NPs) and physician assistants (PAs).

“It’s very clear that if you have a group of NP and PA providers who can do 90 percent of what the physician does, it really begins to unload the physician to focus on what I call the big-picture pieces of critical care,” says center director Timothy Buchman, PhD, MD.

That attending physician can be trained as a care executive to ensure well-coordinated care and to focus on any process that isn’t working well. “At a big academic health sciences center, that should probably be a critical-care physician,” Dr. Buchman notes. “But for the smaller community and regional hospitals that have a relatively less sick population, the person who will be well-positioned to oversee this nonphysician provider staff could well be a hospitalist who’s received additional guidance and training in critical care.”

For mild or moderate complexity of care, he says, the added training need not necessarily include a traditional two-year fellowship. Under a value-based system, sicker patients could be rapidly transferred to a higher level of care, and telemedicine could provide a “backstop” for providers in smaller hospitals who lack the training and experience of someone with a full critical-care fellowship.

Amid the struggle to boost the country’s sagging critical-care workforce, experts have most commonly proposed creating a tiered or regionalized model of care, investing more in tele-ICU services, and augmenting the role of midlevel providers.

The University of Pittsburgh Medical Center, with 20 hospitals and roughly 500 ICU beds throughout its network, is adopting a regionalized healthcare delivery system. Some of the center’s most high-risk services, such as its big transplant programs, are centralized within the main university campus hospitals, as are about half of the ICU beds.

“In those hospitals, we’ve decided that we need 24/7 in-house, intensive-care attendings,” says Derek Angus, MD, the center’s chair of critical-care medicine. The doctors work with fellows and a rapidly growing expansion of midlevel providers.

In some of the smaller hospitals, however, some ICU patients are seen and managed by hospitalists. The medical center’s eventual goal is to be more systematic about the kinds of patients managed by intensivists as well as those managed by hospitalists. It’s a task made easier by the specialists’ close working relationship within the same department.

Dr. Angus believes telemedicine could help by providing a sort of mission control that can help track critically ill patients and those at risk of being admitted to ICUs across all 20 hospitals. He concedes, however, that telemedicine for ICU assistance has had mixed results in the medical literature, suggesting that a major key is working out the proper roles and responsibilities of those using the technology.

To improve the consistency of its own frontline providers, the Emory University Center for Critical Care in Atlanta developed a competency-based, critical-care training program for nurse practitioners (NPs) and physician assistants (PAs).

“It’s very clear that if you have a group of NP and PA providers who can do 90 percent of what the physician does, it really begins to unload the physician to focus on what I call the big-picture pieces of critical care,” says center director Timothy Buchman, PhD, MD.

That attending physician can be trained as a care executive to ensure well-coordinated care and to focus on any process that isn’t working well. “At a big academic health sciences center, that should probably be a critical-care physician,” Dr. Buchman notes. “But for the smaller community and regional hospitals that have a relatively less sick population, the person who will be well-positioned to oversee this nonphysician provider staff could well be a hospitalist who’s received additional guidance and training in critical care.”

For mild or moderate complexity of care, he says, the added training need not necessarily include a traditional two-year fellowship. Under a value-based system, sicker patients could be rapidly transferred to a higher level of care, and telemedicine could provide a “backstop” for providers in smaller hospitals who lack the training and experience of someone with a full critical-care fellowship.

An author of a report that estimates the national cost of unnecessary or wasteful healthcare at $750 billion per year hopes its findings will serve as a platform for hospitalists to spearhead improvements in healthcare delivery in the U.S.

The Institute of Medicine report, "Best Care at Lower Cost: The Path to Continuously Learning Health Care in America" [PDF], offers 10 broad recommendations that include reforming payment, adopting digital infrastructure, and simplifying transitional care. The paper was published earlier this month by a national committee of healthcare leaders, including Gary Kaplan, MD, FACP, FACMPE, FACPE, chairman and chief executive officer of Virginia Mason Health System in Seattle.

"The hospitalist is in a very unique position," Dr. Kaplan says. "They really are at the nexus of what we see as several of our key recommendations going forward."

In particular, Dr. Kaplan notes that healthcare delivery organizations should develop, implement, and fine-tune their "systems, engineering tools and process-improvement methods." Making such changes would help to "eliminate inefficiencies, remove unnecessary burdens on clinicians and staff, enhance patient experience, and improve patient health outcomes," he says.

"The hospitalists and the care teams with which the hospitalist connects are very critical to streamlining operations," Dr. Kaplan adds.

Many of the report's complaints about unnecessary testing, poor communication, and inefficient care delivery dovetail with the quality initiatives and practice-management improvements HM groups already push, Dr. Kaplan adds. To advance healthcare delivery's evolution, hospitalists should view the task of reform as an opportunity, not a challenge.

"There are very powerful opportunities for the hospitalist now to have great impact," he says. "To not just be the passive participants in a broken and dysfunctional system, but in many ways, [to be] one of the architects of an improved care system going forward."

An author of a report that estimates the national cost of unnecessary or wasteful healthcare at $750 billion per year hopes its findings will serve as a platform for hospitalists to spearhead improvements in healthcare delivery in the U.S.

The Institute of Medicine report, "Best Care at Lower Cost: The Path to Continuously Learning Health Care in America" [PDF], offers 10 broad recommendations that include reforming payment, adopting digital infrastructure, and simplifying transitional care. The paper was published earlier this month by a national committee of healthcare leaders, including Gary Kaplan, MD, FACP, FACMPE, FACPE, chairman and chief executive officer of Virginia Mason Health System in Seattle.

"The hospitalist is in a very unique position," Dr. Kaplan says. "They really are at the nexus of what we see as several of our key recommendations going forward."

In particular, Dr. Kaplan notes that healthcare delivery organizations should develop, implement, and fine-tune their "systems, engineering tools and process-improvement methods." Making such changes would help to "eliminate inefficiencies, remove unnecessary burdens on clinicians and staff, enhance patient experience, and improve patient health outcomes," he says.

"The hospitalists and the care teams with which the hospitalist connects are very critical to streamlining operations," Dr. Kaplan adds.

Many of the report's complaints about unnecessary testing, poor communication, and inefficient care delivery dovetail with the quality initiatives and practice-management improvements HM groups already push, Dr. Kaplan adds. To advance healthcare delivery's evolution, hospitalists should view the task of reform as an opportunity, not a challenge.

"There are very powerful opportunities for the hospitalist now to have great impact," he says. "To not just be the passive participants in a broken and dysfunctional system, but in many ways, [to be] one of the architects of an improved care system going forward."

An author of a report that estimates the national cost of unnecessary or wasteful healthcare at $750 billion per year hopes its findings will serve as a platform for hospitalists to spearhead improvements in healthcare delivery in the U.S.

The Institute of Medicine report, "Best Care at Lower Cost: The Path to Continuously Learning Health Care in America" [PDF], offers 10 broad recommendations that include reforming payment, adopting digital infrastructure, and simplifying transitional care. The paper was published earlier this month by a national committee of healthcare leaders, including Gary Kaplan, MD, FACP, FACMPE, FACPE, chairman and chief executive officer of Virginia Mason Health System in Seattle.

"The hospitalist is in a very unique position," Dr. Kaplan says. "They really are at the nexus of what we see as several of our key recommendations going forward."

In particular, Dr. Kaplan notes that healthcare delivery organizations should develop, implement, and fine-tune their "systems, engineering tools and process-improvement methods." Making such changes would help to "eliminate inefficiencies, remove unnecessary burdens on clinicians and staff, enhance patient experience, and improve patient health outcomes," he says.

"The hospitalists and the care teams with which the hospitalist connects are very critical to streamlining operations," Dr. Kaplan adds.

Many of the report's complaints about unnecessary testing, poor communication, and inefficient care delivery dovetail with the quality initiatives and practice-management improvements HM groups already push, Dr. Kaplan adds. To advance healthcare delivery's evolution, hospitalists should view the task of reform as an opportunity, not a challenge.

"There are very powerful opportunities for the hospitalist now to have great impact," he says. "To not just be the passive participants in a broken and dysfunctional system, but in many ways, [to be] one of the architects of an improved care system going forward."

Kerry Weiner, MD, acknowledges gaps in the continuity of care for many hospitalized patients, with the critical time being the first few days, or even hours, after leaving the hospital. The only provider who "really understands" what needs to happen next for the patient "is the hospitalist,” says Dr. Weiner, chief clinical officer for IPC The Hospitalist Co.

For the past decade, IPC has staffed a care-transitions call center at its corporate headquarters in North Hollywood, Calif. Twenty nurses, case managers, and patient representatives attempt to contact all patients discharged to home by IPC hospitalists within 48 to 72 hours.

According to data presented last December at an Institute for Healthcare Improvement national quality forum, IPC call centers reached out to nearly 350,000 patients discharged between October 2010 and September 2011. The calls were successful 30% of the time, and a fifth of the contacted patients needed an intervention. IPC calculates that those interventions prevented 1,782 avoidable readmissions.

According to Dr. Weiner, call center staff follow discharge instructions from the hospitalists using brief, customized, technology-driven reports. They focus on key points that could become health issues in the first few days after discharge.

IPC hopes to expand its care-transitions continuum, in part by prioritizing those patients who need to be called and reaching more of them, he adds.

Kerry Weiner, MD, acknowledges gaps in the continuity of care for many hospitalized patients, with the critical time being the first few days, or even hours, after leaving the hospital. The only provider who "really understands" what needs to happen next for the patient "is the hospitalist,” says Dr. Weiner, chief clinical officer for IPC The Hospitalist Co.

For the past decade, IPC has staffed a care-transitions call center at its corporate headquarters in North Hollywood, Calif. Twenty nurses, case managers, and patient representatives attempt to contact all patients discharged to home by IPC hospitalists within 48 to 72 hours.

According to data presented last December at an Institute for Healthcare Improvement national quality forum, IPC call centers reached out to nearly 350,000 patients discharged between October 2010 and September 2011. The calls were successful 30% of the time, and a fifth of the contacted patients needed an intervention. IPC calculates that those interventions prevented 1,782 avoidable readmissions.

According to Dr. Weiner, call center staff follow discharge instructions from the hospitalists using brief, customized, technology-driven reports. They focus on key points that could become health issues in the first few days after discharge.

IPC hopes to expand its care-transitions continuum, in part by prioritizing those patients who need to be called and reaching more of them, he adds.

Kerry Weiner, MD, acknowledges gaps in the continuity of care for many hospitalized patients, with the critical time being the first few days, or even hours, after leaving the hospital. The only provider who "really understands" what needs to happen next for the patient "is the hospitalist,” says Dr. Weiner, chief clinical officer for IPC The Hospitalist Co.

For the past decade, IPC has staffed a care-transitions call center at its corporate headquarters in North Hollywood, Calif. Twenty nurses, case managers, and patient representatives attempt to contact all patients discharged to home by IPC hospitalists within 48 to 72 hours.

According to data presented last December at an Institute for Healthcare Improvement national quality forum, IPC call centers reached out to nearly 350,000 patients discharged between October 2010 and September 2011. The calls were successful 30% of the time, and a fifth of the contacted patients needed an intervention. IPC calculates that those interventions prevented 1,782 avoidable readmissions.

According to Dr. Weiner, call center staff follow discharge instructions from the hospitalists using brief, customized, technology-driven reports. They focus on key points that could become health issues in the first few days after discharge.

IPC hopes to expand its care-transitions continuum, in part by prioritizing those patients who need to be called and reaching more of them, he adds.

Earlier this month CMS announced 17 additional awards under its Community-Based Care Transitions Program (CCTP), which now encompasses 200 acute-care hospitals and their hospitalists partnering with community agencies and coalitions to improve transitions of care in advance of the Oct. 1 start for excessive readmissions penalties. Innovative solutions to the readmissions dilemma are being tested at the local level by a variety of partnerships with hospitals and hospitalists.

For example, William C. Cook, DO, chief of hospital medicine for the Ohio Permanente Medical Group in Cleveland, is part of a community-wide quality coalition called Better Health Greater Cleveland, one of 17 such groups in the Robert Wood Johnson Foundation's Aligning Forces for Quality collaborative. The program includes 150 quality teams in 100 hospitals posting readmissions reductions and other quality metrics. Dr. Cook, who co-chairs Better Health's Steering Committee for Transitions of Care, is spearheading a transitions pilot with two local nursing homes.

"From the hospitalist perspective, our role is to make care transitions safe and predictable," Dr. Cook says. "The way I can contribute most to these transitions is by thinking ahead about what's going to happen next—and how do I prepare the patient and the next provider." One key step is taking time to complete the real-time discharge summary for each patient, he adds.

The idea, Dr. Cook explains, is to identify and communicate with collaborators across care settings so that the "coaching baton" can be passed in a manner that appears seamless to the patient.

Nearly a third of the 17 new CCTP sites participate in SHM's Project BOOST, including three hospitals in California and one each in Illinois and Pennsylvania. Project BOOST is accepting applications for its next round of sites through September.

Earlier this month CMS announced 17 additional awards under its Community-Based Care Transitions Program (CCTP), which now encompasses 200 acute-care hospitals and their hospitalists partnering with community agencies and coalitions to improve transitions of care in advance of the Oct. 1 start for excessive readmissions penalties. Innovative solutions to the readmissions dilemma are being tested at the local level by a variety of partnerships with hospitals and hospitalists.

For example, William C. Cook, DO, chief of hospital medicine for the Ohio Permanente Medical Group in Cleveland, is part of a community-wide quality coalition called Better Health Greater Cleveland, one of 17 such groups in the Robert Wood Johnson Foundation's Aligning Forces for Quality collaborative. The program includes 150 quality teams in 100 hospitals posting readmissions reductions and other quality metrics. Dr. Cook, who co-chairs Better Health's Steering Committee for Transitions of Care, is spearheading a transitions pilot with two local nursing homes.

"From the hospitalist perspective, our role is to make care transitions safe and predictable," Dr. Cook says. "The way I can contribute most to these transitions is by thinking ahead about what's going to happen next—and how do I prepare the patient and the next provider." One key step is taking time to complete the real-time discharge summary for each patient, he adds.

The idea, Dr. Cook explains, is to identify and communicate with collaborators across care settings so that the "coaching baton" can be passed in a manner that appears seamless to the patient.

Nearly a third of the 17 new CCTP sites participate in SHM's Project BOOST, including three hospitals in California and one each in Illinois and Pennsylvania. Project BOOST is accepting applications for its next round of sites through September.

Earlier this month CMS announced 17 additional awards under its Community-Based Care Transitions Program (CCTP), which now encompasses 200 acute-care hospitals and their hospitalists partnering with community agencies and coalitions to improve transitions of care in advance of the Oct. 1 start for excessive readmissions penalties. Innovative solutions to the readmissions dilemma are being tested at the local level by a variety of partnerships with hospitals and hospitalists.

For example, William C. Cook, DO, chief of hospital medicine for the Ohio Permanente Medical Group in Cleveland, is part of a community-wide quality coalition called Better Health Greater Cleveland, one of 17 such groups in the Robert Wood Johnson Foundation's Aligning Forces for Quality collaborative. The program includes 150 quality teams in 100 hospitals posting readmissions reductions and other quality metrics. Dr. Cook, who co-chairs Better Health's Steering Committee for Transitions of Care, is spearheading a transitions pilot with two local nursing homes.

"From the hospitalist perspective, our role is to make care transitions safe and predictable," Dr. Cook says. "The way I can contribute most to these transitions is by thinking ahead about what's going to happen next—and how do I prepare the patient and the next provider." One key step is taking time to complete the real-time discharge summary for each patient, he adds.

The idea, Dr. Cook explains, is to identify and communicate with collaborators across care settings so that the "coaching baton" can be passed in a manner that appears seamless to the patient.

Nearly a third of the 17 new CCTP sites participate in SHM's Project BOOST, including three hospitals in California and one each in Illinois and Pennsylvania. Project BOOST is accepting applications for its next round of sites through September.

The OB/GYN hospitalist field is growing, with at least 164 identified programs and 1,500 to 2,500 practitioners who spend all or part of their workweek in hospital labor and delivery departments. SHM and the American College of Obstetricians and Gynecologists helped birth the 90-member Society of OB/GYN Hospitalists in 2011, but it is now independent, says founding president Rob Olson, MD, an OB/GYN hospitalist practicing in Bellingham, Wash. The fledgling society is planning its second annual conference, Sept. 27-29 in Denver, with obstetric emergency simulation training, clinical lectures, and pearls from the experience of general hospitalist practice by HM pioneer John Nelson, MD, MHM.

Also known as laborists, these board-certified OB/GYN docs’ dedicated presence affords rapid on-site response to changes in patients’ conditions, Dr. Olson says. Laborists might cover nights and weekends, pick up unassigned patients, or cover for private obstetricians who are fully engaged. Laborists do not supplant the private practitioner’s role in delivering babies in the hospital, Dr. Olson says, “unless the private physician asks them to,” which, he adds, is happening more often.

Laborists typically are limited to labor and delivery services, although some also address gynecological cases in the ED. Most of the programs provide coverage 24/7, and invariably they are in facilities with medical hospitalists who might consult on medical complications for expectant mothers. One to two new programs open every month, Dr. Olson says, and his website lists 120 job openings. For information, visit www.ObGynHospitalist.com.

The OB/GYN hospitalist field is growing, with at least 164 identified programs and 1,500 to 2,500 practitioners who spend all or part of their workweek in hospital labor and delivery departments. SHM and the American College of Obstetricians and Gynecologists helped birth the 90-member Society of OB/GYN Hospitalists in 2011, but it is now independent, says founding president Rob Olson, MD, an OB/GYN hospitalist practicing in Bellingham, Wash. The fledgling society is planning its second annual conference, Sept. 27-29 in Denver, with obstetric emergency simulation training, clinical lectures, and pearls from the experience of general hospitalist practice by HM pioneer John Nelson, MD, MHM.

Also known as laborists, these board-certified OB/GYN docs’ dedicated presence affords rapid on-site response to changes in patients’ conditions, Dr. Olson says. Laborists might cover nights and weekends, pick up unassigned patients, or cover for private obstetricians who are fully engaged. Laborists do not supplant the private practitioner’s role in delivering babies in the hospital, Dr. Olson says, “unless the private physician asks them to,” which, he adds, is happening more often.

Laborists typically are limited to labor and delivery services, although some also address gynecological cases in the ED. Most of the programs provide coverage 24/7, and invariably they are in facilities with medical hospitalists who might consult on medical complications for expectant mothers. One to two new programs open every month, Dr. Olson says, and his website lists 120 job openings. For information, visit www.ObGynHospitalist.com.

The OB/GYN hospitalist field is growing, with at least 164 identified programs and 1,500 to 2,500 practitioners who spend all or part of their workweek in hospital labor and delivery departments. SHM and the American College of Obstetricians and Gynecologists helped birth the 90-member Society of OB/GYN Hospitalists in 2011, but it is now independent, says founding president Rob Olson, MD, an OB/GYN hospitalist practicing in Bellingham, Wash. The fledgling society is planning its second annual conference, Sept. 27-29 in Denver, with obstetric emergency simulation training, clinical lectures, and pearls from the experience of general hospitalist practice by HM pioneer John Nelson, MD, MHM.

Also known as laborists, these board-certified OB/GYN docs’ dedicated presence affords rapid on-site response to changes in patients’ conditions, Dr. Olson says. Laborists might cover nights and weekends, pick up unassigned patients, or cover for private obstetricians who are fully engaged. Laborists do not supplant the private practitioner’s role in delivering babies in the hospital, Dr. Olson says, “unless the private physician asks them to,” which, he adds, is happening more often.

Laborists typically are limited to labor and delivery services, although some also address gynecological cases in the ED. Most of the programs provide coverage 24/7, and invariably they are in facilities with medical hospitalists who might consult on medical complications for expectant mothers. One to two new programs open every month, Dr. Olson says, and his website lists 120 job openings. For information, visit www.ObGynHospitalist.com.

An interactive program to teach quality and leadership skills to internal-medicine residents at Mount Sinai School of Medicine in New York City—described in an Research, Innovations and Clinical Vignettes (RIV) poster presented at HM12 in San Diego—found that medical trainees are eager and willing to learn the skills that will be required from hospitalists in a reformed healthcare system.¹ Lead author Brian Markoff, MD, SFHM, associate chief of hospital medicine at Mount Sinai, says the Healthcare Leadership Track’s elective, one-month block in quality improvement (QI) and patient safety was established with four second-year residents in 2011-2012.

Along with didactic presentations, participants were offered novel structured learning exercises that included:

• Teaching a care-transitions module to interns;
• Proposing a new clinical pathway;
• Leading a conference on QI;
• Examining a hospital readmission for what went wrong;
• Pairing with a ward medical director;
• Conducting a mentored QI research project; and
• Participating in a book club.

All four participants from the first year “strongly agree that the block was highly relevant to their current and future careers,” Dr. Markoff says.

In their third year, the residents will have the opportunity to participate in one-month electives for leadership, teaching, and the business of medicine.

Six new second-year residents are joining the program, and longitudinal components span the program’s two years. “Most institutions that train residents have a lot of this activity going on,” he says. “Why not get house staff involved in experiential learning in these areas?”

Reference

1. Markoff B, Dunn A. Healthcare leadership track: a novel track to train leaders in inpatient medicine. Paper presented at: HM12, Society of Hospital Medicine annual meeting; April 1-4, 2012; San Diego.

An interactive program to teach quality and leadership skills to internal-medicine residents at Mount Sinai School of Medicine in New York City—described in an Research, Innovations and Clinical Vignettes (RIV) poster presented at HM12 in San Diego—found that medical trainees are eager and willing to learn the skills that will be required from hospitalists in a reformed healthcare system.¹ Lead author Brian Markoff, MD, SFHM, associate chief of hospital medicine at Mount Sinai, says the Healthcare Leadership Track’s elective, one-month block in quality improvement (QI) and patient safety was established with four second-year residents in 2011-2012.

Along with didactic presentations, participants were offered novel structured learning exercises that included:

• Teaching a care-transitions module to interns;
• Proposing a new clinical pathway;
• Leading a conference on QI;
• Examining a hospital readmission for what went wrong;
• Pairing with a ward medical director;
• Conducting a mentored QI research project; and
• Participating in a book club.

All four participants from the first year “strongly agree that the block was highly relevant to their current and future careers,” Dr. Markoff says.

In their third year, the residents will have the opportunity to participate in one-month electives for leadership, teaching, and the business of medicine.

Six new second-year residents are joining the program, and longitudinal components span the program’s two years. “Most institutions that train residents have a lot of this activity going on,” he says. “Why not get house staff involved in experiential learning in these areas?”

Reference

1. Markoff B, Dunn A. Healthcare leadership track: a novel track to train leaders in inpatient medicine. Paper presented at: HM12, Society of Hospital Medicine annual meeting; April 1-4, 2012; San Diego.

An interactive program to teach quality and leadership skills to internal-medicine residents at Mount Sinai School of Medicine in New York City—described in an Research, Innovations and Clinical Vignettes (RIV) poster presented at HM12 in San Diego—found that medical trainees are eager and willing to learn the skills that will be required from hospitalists in a reformed healthcare system.¹ Lead author Brian Markoff, MD, SFHM, associate chief of hospital medicine at Mount Sinai, says the Healthcare Leadership Track’s elective, one-month block in quality improvement (QI) and patient safety was established with four second-year residents in 2011-2012.

Along with didactic presentations, participants were offered novel structured learning exercises that included:

• Teaching a care-transitions module to interns;
• Proposing a new clinical pathway;
• Leading a conference on QI;
• Examining a hospital readmission for what went wrong;
• Pairing with a ward medical director;
• Conducting a mentored QI research project; and
• Participating in a book club.

All four participants from the first year “strongly agree that the block was highly relevant to their current and future careers,” Dr. Markoff says.

In their third year, the residents will have the opportunity to participate in one-month electives for leadership, teaching, and the business of medicine.

Six new second-year residents are joining the program, and longitudinal components span the program’s two years. “Most institutions that train residents have a lot of this activity going on,” he says. “Why not get house staff involved in experiential learning in these areas?”

Reference

1. Markoff B, Dunn A. Healthcare leadership track: a novel track to train leaders in inpatient medicine. Paper presented at: HM12, Society of Hospital Medicine annual meeting; April 1-4, 2012; San Diego.

Safer patients, improved quality of care, innovative uses of resources, increased job satisfaction: Those themes threaded their way through presentation after presentation at “Creating the Hospital of the Future: The Implications for Hospital-Focused Physician Practice,” a one-day meeting of hospitalist leaders and hospital administrators following the annual Health Forum/AHA Leadership Summit on July 21 in San Francisco.

The five-hour presentation to about 80 hospital CEOs, chief financial officers, and chief medical officers focused on the ever-expanding roles of subspecialty hospitalists and how subspecialty hospitalist programs can help administrators solve multiple challenges in an era of healthcare reform.

“When I started in 2007, I could only identify 15 hospitals in the United States with OB hospitalist programs. And now we know of 169, and the nation is adding one or two new programs a month,” says Rob Olson, MD, an OB/GYN hospitalistor “laborist”at PeaceHealth St. Joseph Medical Center in Bellingham, Wash., and editor of ObGynHospitalist.com. “If you think about it, if you can make it safer for women in labor, then duh! Why wouldn’t you want to do that?

“The finances work best at a hospital that delivers more than 2,000 babies a year. But many small hospitals, like those doing 800 or 1,000 deliveries a year, have programs because it makes it safer for women in labor,” he says. “Therefore, even though it might be more expensive at those lower numbers, it’s worth it. It’s the right thing to do.”

The July meeting was the second time SHM gathered stakeholders to discuss the growth of specialty hospitalists; a similar panel of experts convened last November in Las Vegas. Most at the San Francisco meeting recognized the upward trend in such HM-focused subspecialties as neurology, orthopedics, obstetrics, and general surgery, according to John Nelson, MD, MHM, organizer of the focused-practice meetings.

“Most people in healthcare feel like this is going to continue and intensify,” says Dr. Nelson, cofounder and past president of SHM, medical director of the hospitalist practice at Overlake Hospital Medical Center, Bellevue, Wash., and practice-management columnist for The Hospitalist. “There is consensus that each specialty can learn from the other about how they organize their practice and approach their work. There was consensus that we don’t have a lot of research data about what this means for things like cost of care, quality of care, patient experience, physician career longevity. So we need to encourage people to begin to study those things, and what this means for the stakeholders in healthcare.”

Dr. Likosky

Dr. Maa

Four subspecialty hospitalists—neurohospitalist David Likosky, MD, SFHM, surgicalist John Maa, MD, orthopedic hospitalist Kurt Ehlert, MD, and Dr. Olson, the laborist—took part in a 90-minute panel discussion in which they explained their practice models and fielded questions from the audience.

“My message was that there are a large number of people doing this now—we estimate there are between 600 and 700 neurohospitalists nationally—and that the model holds a lot of promise. There’s not a huge amount of data right now on outcomes and other metrics, but we’re starting to see that data,” said Dr. Likosky, medical director of the Evergreen Neuroscience Institute in Kirkland, Wash., and co-founder of the Neurohospitalist Society (neurohospitalistsociety.org). “The neurohospitalist model is a good solution to many of the problems that hospitals are facing now.”

Dr. Ehlert, director of orthopaedic services, Orthopeadic Hospitalists of New Bern (N.C.), and national orthopaedic medical director of Delphi of TEAMHealth, says subspecialty HM programs offer hospitals a “great chance of improving quality and patient safety over what they have currently, even if they have their emergency room covered.”

“I think hospitalists who are subspecialists in trauma can provide a bump up in productivity, safety, reliability,” he says. “Results will be better. I think it will be less expensive. [I told them] that there is an option out there that can benefit them in all of the various key ways that groups are looking at right now.”

Dr. Ehlert’s ortho-hospitalist group formed when the 300-bed hospital in New Bern encountered a manpower issue not unfamiliar to hospitals across the country. The bylaws of the medical staff allowed subspecialists to stop taking call when they turned 55, and four of the seven orthopedists aged out.

“Three doctors taking all the call is not really sustainable for them in their private practices,” Dr. Ehlert said. “So they looked at various options, came to us, and we started in December of 2009. It has been very successful, according to the administration. They love us being there. The emergency room is very happy with our responsiveness. I think our results have been very good.”

The new arrangement is a win-win, Dr. Ehlert says. The orthopedists are focused on their elective practices, and “they’re very happy with that. So their life is much better; their elective practice has actually gotten busier because they’re not having to leave space open for all the trauma from the ER. So I think all around it’s been very successful.”

The hospital has added a general surgery hospitalist program, which is doing well, too. “They’re much busier,” he says. “They’re really taking a load off the general surgeons in town.”

Dr. Maa, assistant professor and director of the surgical hospitalist program at University of California San Francisco Medical Center, says growth in his field is fueled by the ever-growing crises in emergency departments.

“Most hospitals critically depend on a general surgical service,” he said. “If you can’t keep a panel of general surgeons to take call, you’re probably going to have to close your emergency room.”

Dr. Maa, who founded UCSF’s surgical hospitalist program in 2005, explained how the terms “surgicalist” and “acute-care surgeon” have come to represent the concept of a dedicated emergency surgeon, whether it be in trauma or in general surgery. “It really does parallel the medical hospitalist model,” he says, adding that his field has had to overcome doubts about scheduling and patient safety.

“The danger in each of these specialty programs is to become too much of the silo mentality, to focus on their own discipline,” he adds. “We need to work across specialties, we need to collaborate, we need to find ways of utilizing the precious existing resources for emergency care, and make certain that the needs of society are met. Society places trust in doctors, hospital leaders, to build a system that will care for them when they need it. It’s our ethical obligation to design the safest, best system, with the resources that we have.”

Jason Carris is editor of The Hospitalist.

Safer patients, improved quality of care, innovative uses of resources, increased job satisfaction: Those themes threaded their way through presentation after presentation at “Creating the Hospital of the Future: The Implications for Hospital-Focused Physician Practice,” a one-day meeting of hospitalist leaders and hospital administrators following the annual Health Forum/AHA Leadership Summit on July 21 in San Francisco.

The five-hour presentation to about 80 hospital CEOs, chief financial officers, and chief medical officers focused on the ever-expanding roles of subspecialty hospitalists and how subspecialty hospitalist programs can help administrators solve multiple challenges in an era of healthcare reform.

“When I started in 2007, I could only identify 15 hospitals in the United States with OB hospitalist programs. And now we know of 169, and the nation is adding one or two new programs a month,” says Rob Olson, MD, an OB/GYN hospitalistor “laborist”at PeaceHealth St. Joseph Medical Center in Bellingham, Wash., and editor of ObGynHospitalist.com. “If you think about it, if you can make it safer for women in labor, then duh! Why wouldn’t you want to do that?

“The finances work best at a hospital that delivers more than 2,000 babies a year. But many small hospitals, like those doing 800 or 1,000 deliveries a year, have programs because it makes it safer for women in labor,” he says. “Therefore, even though it might be more expensive at those lower numbers, it’s worth it. It’s the right thing to do.”

The July meeting was the second time SHM gathered stakeholders to discuss the growth of specialty hospitalists; a similar panel of experts convened last November in Las Vegas. Most at the San Francisco meeting recognized the upward trend in such HM-focused subspecialties as neurology, orthopedics, obstetrics, and general surgery, according to John Nelson, MD, MHM, organizer of the focused-practice meetings.

“Most people in healthcare feel like this is going to continue and intensify,” says Dr. Nelson, cofounder and past president of SHM, medical director of the hospitalist practice at Overlake Hospital Medical Center, Bellevue, Wash., and practice-management columnist for The Hospitalist. “There is consensus that each specialty can learn from the other about how they organize their practice and approach their work. There was consensus that we don’t have a lot of research data about what this means for things like cost of care, quality of care, patient experience, physician career longevity. So we need to encourage people to begin to study those things, and what this means for the stakeholders in healthcare.”

Dr. Likosky

Dr. Maa

Four subspecialty hospitalists—neurohospitalist David Likosky, MD, SFHM, surgicalist John Maa, MD, orthopedic hospitalist Kurt Ehlert, MD, and Dr. Olson, the laborist—took part in a 90-minute panel discussion in which they explained their practice models and fielded questions from the audience.

“My message was that there are a large number of people doing this now—we estimate there are between 600 and 700 neurohospitalists nationally—and that the model holds a lot of promise. There’s not a huge amount of data right now on outcomes and other metrics, but we’re starting to see that data,” said Dr. Likosky, medical director of the Evergreen Neuroscience Institute in Kirkland, Wash., and co-founder of the Neurohospitalist Society (neurohospitalistsociety.org). “The neurohospitalist model is a good solution to many of the problems that hospitals are facing now.”

Dr. Ehlert, director of orthopaedic services, Orthopeadic Hospitalists of New Bern (N.C.), and national orthopaedic medical director of Delphi of TEAMHealth, says subspecialty HM programs offer hospitals a “great chance of improving quality and patient safety over what they have currently, even if they have their emergency room covered.”

“I think hospitalists who are subspecialists in trauma can provide a bump up in productivity, safety, reliability,” he says. “Results will be better. I think it will be less expensive. [I told them] that there is an option out there that can benefit them in all of the various key ways that groups are looking at right now.”

Dr. Ehlert’s ortho-hospitalist group formed when the 300-bed hospital in New Bern encountered a manpower issue not unfamiliar to hospitals across the country. The bylaws of the medical staff allowed subspecialists to stop taking call when they turned 55, and four of the seven orthopedists aged out.

“Three doctors taking all the call is not really sustainable for them in their private practices,” Dr. Ehlert said. “So they looked at various options, came to us, and we started in December of 2009. It has been very successful, according to the administration. They love us being there. The emergency room is very happy with our responsiveness. I think our results have been very good.”

The new arrangement is a win-win, Dr. Ehlert says. The orthopedists are focused on their elective practices, and “they’re very happy with that. So their life is much better; their elective practice has actually gotten busier because they’re not having to leave space open for all the trauma from the ER. So I think all around it’s been very successful.”

The hospital has added a general surgery hospitalist program, which is doing well, too. “They’re much busier,” he says. “They’re really taking a load off the general surgeons in town.”

Dr. Maa, assistant professor and director of the surgical hospitalist program at University of California San Francisco Medical Center, says growth in his field is fueled by the ever-growing crises in emergency departments.

“Most hospitals critically depend on a general surgical service,” he said. “If you can’t keep a panel of general surgeons to take call, you’re probably going to have to close your emergency room.”

Dr. Maa, who founded UCSF’s surgical hospitalist program in 2005, explained how the terms “surgicalist” and “acute-care surgeon” have come to represent the concept of a dedicated emergency surgeon, whether it be in trauma or in general surgery. “It really does parallel the medical hospitalist model,” he says, adding that his field has had to overcome doubts about scheduling and patient safety.

“The danger in each of these specialty programs is to become too much of the silo mentality, to focus on their own discipline,” he adds. “We need to work across specialties, we need to collaborate, we need to find ways of utilizing the precious existing resources for emergency care, and make certain that the needs of society are met. Society places trust in doctors, hospital leaders, to build a system that will care for them when they need it. It’s our ethical obligation to design the safest, best system, with the resources that we have.”

Jason Carris is editor of The Hospitalist.

Safer patients, improved quality of care, innovative uses of resources, increased job satisfaction: Those themes threaded their way through presentation after presentation at “Creating the Hospital of the Future: The Implications for Hospital-Focused Physician Practice,” a one-day meeting of hospitalist leaders and hospital administrators following the annual Health Forum/AHA Leadership Summit on July 21 in San Francisco.

The five-hour presentation to about 80 hospital CEOs, chief financial officers, and chief medical officers focused on the ever-expanding roles of subspecialty hospitalists and how subspecialty hospitalist programs can help administrators solve multiple challenges in an era of healthcare reform.

“When I started in 2007, I could only identify 15 hospitals in the United States with OB hospitalist programs. And now we know of 169, and the nation is adding one or two new programs a month,” says Rob Olson, MD, an OB/GYN hospitalistor “laborist”at PeaceHealth St. Joseph Medical Center in Bellingham, Wash., and editor of ObGynHospitalist.com. “If you think about it, if you can make it safer for women in labor, then duh! Why wouldn’t you want to do that?

“The finances work best at a hospital that delivers more than 2,000 babies a year. But many small hospitals, like those doing 800 or 1,000 deliveries a year, have programs because it makes it safer for women in labor,” he says. “Therefore, even though it might be more expensive at those lower numbers, it’s worth it. It’s the right thing to do.”

The July meeting was the second time SHM gathered stakeholders to discuss the growth of specialty hospitalists; a similar panel of experts convened last November in Las Vegas. Most at the San Francisco meeting recognized the upward trend in such HM-focused subspecialties as neurology, orthopedics, obstetrics, and general surgery, according to John Nelson, MD, MHM, organizer of the focused-practice meetings.

“Most people in healthcare feel like this is going to continue and intensify,” says Dr. Nelson, cofounder and past president of SHM, medical director of the hospitalist practice at Overlake Hospital Medical Center, Bellevue, Wash., and practice-management columnist for The Hospitalist. “There is consensus that each specialty can learn from the other about how they organize their practice and approach their work. There was consensus that we don’t have a lot of research data about what this means for things like cost of care, quality of care, patient experience, physician career longevity. So we need to encourage people to begin to study those things, and what this means for the stakeholders in healthcare.”

Dr. Likosky

Dr. Maa

Four subspecialty hospitalists—neurohospitalist David Likosky, MD, SFHM, surgicalist John Maa, MD, orthopedic hospitalist Kurt Ehlert, MD, and Dr. Olson, the laborist—took part in a 90-minute panel discussion in which they explained their practice models and fielded questions from the audience.

“My message was that there are a large number of people doing this now—we estimate there are between 600 and 700 neurohospitalists nationally—and that the model holds a lot of promise. There’s not a huge amount of data right now on outcomes and other metrics, but we’re starting to see that data,” said Dr. Likosky, medical director of the Evergreen Neuroscience Institute in Kirkland, Wash., and co-founder of the Neurohospitalist Society (neurohospitalistsociety.org). “The neurohospitalist model is a good solution to many of the problems that hospitals are facing now.”

Dr. Ehlert, director of orthopaedic services, Orthopeadic Hospitalists of New Bern (N.C.), and national orthopaedic medical director of Delphi of TEAMHealth, says subspecialty HM programs offer hospitals a “great chance of improving quality and patient safety over what they have currently, even if they have their emergency room covered.”

“I think hospitalists who are subspecialists in trauma can provide a bump up in productivity, safety, reliability,” he says. “Results will be better. I think it will be less expensive. [I told them] that there is an option out there that can benefit them in all of the various key ways that groups are looking at right now.”

Dr. Ehlert’s ortho-hospitalist group formed when the 300-bed hospital in New Bern encountered a manpower issue not unfamiliar to hospitals across the country. The bylaws of the medical staff allowed subspecialists to stop taking call when they turned 55, and four of the seven orthopedists aged out.

“Three doctors taking all the call is not really sustainable for them in their private practices,” Dr. Ehlert said. “So they looked at various options, came to us, and we started in December of 2009. It has been very successful, according to the administration. They love us being there. The emergency room is very happy with our responsiveness. I think our results have been very good.”

The new arrangement is a win-win, Dr. Ehlert says. The orthopedists are focused on their elective practices, and “they’re very happy with that. So their life is much better; their elective practice has actually gotten busier because they’re not having to leave space open for all the trauma from the ER. So I think all around it’s been very successful.”

The hospital has added a general surgery hospitalist program, which is doing well, too. “They’re much busier,” he says. “They’re really taking a load off the general surgeons in town.”

Dr. Maa, assistant professor and director of the surgical hospitalist program at University of California San Francisco Medical Center, says growth in his field is fueled by the ever-growing crises in emergency departments.

“Most hospitals critically depend on a general surgical service,” he said. “If you can’t keep a panel of general surgeons to take call, you’re probably going to have to close your emergency room.”

Dr. Maa, who founded UCSF’s surgical hospitalist program in 2005, explained how the terms “surgicalist” and “acute-care surgeon” have come to represent the concept of a dedicated emergency surgeon, whether it be in trauma or in general surgery. “It really does parallel the medical hospitalist model,” he says, adding that his field has had to overcome doubts about scheduling and patient safety.

“The danger in each of these specialty programs is to become too much of the silo mentality, to focus on their own discipline,” he adds. “We need to work across specialties, we need to collaborate, we need to find ways of utilizing the precious existing resources for emergency care, and make certain that the needs of society are met. Society places trust in doctors, hospital leaders, to build a system that will care for them when they need it. It’s our ethical obligation to design the safest, best system, with the resources that we have.”

Jason Carris is editor of The Hospitalist.

Although a recently released study of Medicare data uncovers little progress in reducing hospital readmissions, and the Oct. 1 deadline to implement CMS’ Hospital Readmissions Reduction Program looms, Carolyn Clancy, MD, director of the Agency for Healthcare Research and Quality (AHRQ), says she's not worried about the ability of America’s hospitalists to rise to the occasion and get a handle on the problem.

Dr. Clancy recently wrote a commentary outlining the government's approach to controlling readmissions, stating that taking aim at readmissions is 1) an integral component of its value-based purchasing program and 2) is an opportunity for improving hospital quality and patient safety.

"Hospitalists are often on the receiving end of hospitalizations resulting from poor coordination of care. I think it would be very exciting to be part of the solution," Dr. Clancy says. She says she observed firsthand during a recent hospital stay how hospitalists helped her to think about how she should care for herself after returning home. But her father suffered a needless rehospitalization when important information (how much Coumadin to take) was miscommunicated in a post-discharge follow-up phone call, causing him to start bleeding.

"Hospitalists who want to embrace the challenge will find a phenomenal amount of information on Innovations Exchange, where people from all over America are sharing their clinical innovations."

Dr. Clancy says she hopes AHRQ-supported tools and studies "will make it easier for hospitals to do the right thing."

Although a recently released study of Medicare data uncovers little progress in reducing hospital readmissions, and the Oct. 1 deadline to implement CMS’ Hospital Readmissions Reduction Program looms, Carolyn Clancy, MD, director of the Agency for Healthcare Research and Quality (AHRQ), says she's not worried about the ability of America’s hospitalists to rise to the occasion and get a handle on the problem.

Dr. Clancy recently wrote a commentary outlining the government's approach to controlling readmissions, stating that taking aim at readmissions is 1) an integral component of its value-based purchasing program and 2) is an opportunity for improving hospital quality and patient safety.

"Hospitalists are often on the receiving end of hospitalizations resulting from poor coordination of care. I think it would be very exciting to be part of the solution," Dr. Clancy says. She says she observed firsthand during a recent hospital stay how hospitalists helped her to think about how she should care for herself after returning home. But her father suffered a needless rehospitalization when important information (how much Coumadin to take) was miscommunicated in a post-discharge follow-up phone call, causing him to start bleeding.

"Hospitalists who want to embrace the challenge will find a phenomenal amount of information on Innovations Exchange, where people from all over America are sharing their clinical innovations."

Dr. Clancy says she hopes AHRQ-supported tools and studies "will make it easier for hospitals to do the right thing."

Although a recently released study of Medicare data uncovers little progress in reducing hospital readmissions, and the Oct. 1 deadline to implement CMS’ Hospital Readmissions Reduction Program looms, Carolyn Clancy, MD, director of the Agency for Healthcare Research and Quality (AHRQ), says she's not worried about the ability of America’s hospitalists to rise to the occasion and get a handle on the problem.

Dr. Clancy recently wrote a commentary outlining the government's approach to controlling readmissions, stating that taking aim at readmissions is 1) an integral component of its value-based purchasing program and 2) is an opportunity for improving hospital quality and patient safety.

"Hospitalists are often on the receiving end of hospitalizations resulting from poor coordination of care. I think it would be very exciting to be part of the solution," Dr. Clancy says. She says she observed firsthand during a recent hospital stay how hospitalists helped her to think about how she should care for herself after returning home. But her father suffered a needless rehospitalization when important information (how much Coumadin to take) was miscommunicated in a post-discharge follow-up phone call, causing him to start bleeding.

"Hospitalists who want to embrace the challenge will find a phenomenal amount of information on Innovations Exchange, where people from all over America are sharing their clinical innovations."

Dr. Clancy says she hopes AHRQ-supported tools and studies "will make it easier for hospitals to do the right thing."

Although Medicare's looming financial penalties for hospitals with excessive readmissions might seem like a blunt weapon, private health plans often have the flexibility to negotiate with partnering hospitals around incentives for readmissions prevention.

"We have arrangements with private insurance companies where we put at risk future compensation, based on achieving negotiated readmissions results," says Mark Carley, vice president of managed care and network development for Centura Health, a 13-hospital system in Colorado.

Payors, including United Healthcare, have developed their own readmissions programs and reporting mechanisms, although each program’s incentives are a little different, Carley says. Target rates are negotiated based on each hospital's readmissions in the previous 12-month period and national averages. The plan can also provide helpful data on its beneficiaries and other forms of assistance, because it wants to see the hospital hit the target, he adds. "If the target has been set too high, they may be willing to renegotiate."

But the plan doesn't tell the hospital how to reach that target.

"Where the complexity comes in is how we as a system implement internal policies and procedures to improve our care coordination, discharge processes, follow-up, and communication with downstream providers," says Carley. Centura Health's approach to readmissions has included close study of past performance data in search of opportunities for improvement, fine-tuning of the discharge planning process, and follow-up phone calls to patients and providers.

"In addition, we are working with post-acute providers to provide smoother transitions in the discharge process," he says.

Although Medicare's looming financial penalties for hospitals with excessive readmissions might seem like a blunt weapon, private health plans often have the flexibility to negotiate with partnering hospitals around incentives for readmissions prevention.

"We have arrangements with private insurance companies where we put at risk future compensation, based on achieving negotiated readmissions results," says Mark Carley, vice president of managed care and network development for Centura Health, a 13-hospital system in Colorado.

Payors, including United Healthcare, have developed their own readmissions programs and reporting mechanisms, although each program’s incentives are a little different, Carley says. Target rates are negotiated based on each hospital's readmissions in the previous 12-month period and national averages. The plan can also provide helpful data on its beneficiaries and other forms of assistance, because it wants to see the hospital hit the target, he adds. "If the target has been set too high, they may be willing to renegotiate."

But the plan doesn't tell the hospital how to reach that target.

"Where the complexity comes in is how we as a system implement internal policies and procedures to improve our care coordination, discharge processes, follow-up, and communication with downstream providers," says Carley. Centura Health's approach to readmissions has included close study of past performance data in search of opportunities for improvement, fine-tuning of the discharge planning process, and follow-up phone calls to patients and providers.

"In addition, we are working with post-acute providers to provide smoother transitions in the discharge process," he says.

Although Medicare's looming financial penalties for hospitals with excessive readmissions might seem like a blunt weapon, private health plans often have the flexibility to negotiate with partnering hospitals around incentives for readmissions prevention.

"We have arrangements with private insurance companies where we put at risk future compensation, based on achieving negotiated readmissions results," says Mark Carley, vice president of managed care and network development for Centura Health, a 13-hospital system in Colorado.

Payors, including United Healthcare, have developed their own readmissions programs and reporting mechanisms, although each program’s incentives are a little different, Carley says. Target rates are negotiated based on each hospital's readmissions in the previous 12-month period and national averages. The plan can also provide helpful data on its beneficiaries and other forms of assistance, because it wants to see the hospital hit the target, he adds. "If the target has been set too high, they may be willing to renegotiate."

But the plan doesn't tell the hospital how to reach that target.

"Where the complexity comes in is how we as a system implement internal policies and procedures to improve our care coordination, discharge processes, follow-up, and communication with downstream providers," says Carley. Centura Health's approach to readmissions has included close study of past performance data in search of opportunities for improvement, fine-tuning of the discharge planning process, and follow-up phone calls to patients and providers.

"In addition, we are working with post-acute providers to provide smoother transitions in the discharge process," he says.