Practice Management

The Institute for Healthcare Improvement (IHI) released its Triple Aim Initiative in 2008, challenging the healthcare industry to undergo extensive systematic change, with the following goals:¹

• Reduce the per capita cost of healthcare;
• Improve the patient experience of care, including quality and satisfaction; and
• Improve the health of populations.

The first two aims are difficult enough, but the third involves engaging and empowering patients and their families to take ownership of their own health and wellness. This is much more than just understanding what your diagnoses are and which medications to take; it is about getting and staying well. Keeping patients and their families well is a goal that has eluded the healthcare industry since before Hippocrates and is an extremely challenging one for hospitalists, whose time with patients is usually limited to an acute care hospital stay.

Naturally, when one industry cannot figure out how to do something well, another industry will develop a breakthrough innovation. Enter Apple Inc., which has officially moved into the health and wellness business. Apple Health is a new app that will share multiple inputs of patient information in a cloud platform called “HealthKit.” HealthKit will allow a user to view a personalized dashboard of health and fitness metrics, which conglomerates information from a myriad of different health and wellness apps, helping them “communicate” with one another.²

The breadth and choice of health and wellness apps available to users is astounding. In a five-minute browse through the app store on my iPhone, I found the following free options to help patients track and understand their health and wellness:

• MyPlate Calorie Tracker, Calorie Counter, and Fooducate help educate and monitor caloric intake.
• iTriage, WebMD, and Mango Health Medication Manager, which can answer questions about symptoms you may be experiencing, will save a list of medications, conditions, procedures, physicians, appointments, and more, and can help you manage your medications.
• Nexercise, MapMyRun, MapMyRide, MapMyFitness, Pacer, and Health Mate track physical activity.
• Fitness Buddy and Daily Workout allow users to view daily workout options and target muscle groups for appropriate exercises.
• ShopWell allows you to scan food labels and evaluate ingredients, calories, gluten, and so on in most store-bought food products.

What Apple proposes to do with its new HealthKit is coordinate the input of these types of apps to synthesize a patient’s health and wellness onto a single platform, which can be shared with caretakers and healthcare providers as needed. The company, as only Apple can, actually declared that its app might be “the beginning of a health revolution.”

A New Day

What HealthKit offers is truly unique from a data security standpoint, which will appeal to Orwellian paranoids. Traditionally, when customers use services such as Google or Yahoo, these services use your personal identity—gathered in pieces of data such as your location and your browsing histories—and then use that data to collect, store, or sell such information on their terms. But Apple promises to help manage health and wellness data on the users’ terms. The purpose is to enable easy but secure sharing of complex health information, which can be updated by users or by other devices. Apple has coordinated with other developers to import information to HealthKit from multiple platforms and devices (such as Nike+, Withings Scale, and Fitbit Flex), acting as a central repository of personalized information.

With this technology, it’s easy to envision hospitals, clinics, pharmacies, laboratories, and even insurers integrating bilaterally with any patient information housed on HealthKit, at the discretion of the user. Mayo Clinic, Cleveland Clinic, Kaiser Permanente, Stanford, UCLA, and Mount Sinai Hospital are all rumored to be working with Apple to figure out how to exchange relevant patient information to enhance the continuity of a patient’s care. In addition to these potential collaborators, electronic health record providers Epic Systems and Allscripts are rumored to be working with Apple in some sort of partnership.^3,4

Not only will HealthKit be a secure repository of information, but it will constantly monitor all the metrics and can be programmed to send alerts to key stakeholders, such as family members or healthcare providers, when any of the metrics veer outside predetermined boundaries.⁴

This “new revolution” in healthcare and wellness should prove extremely helpful to hospitalists, who are often caught in the crosshairs of disjointed patient care delivery systems, and patients who need someone (or something) to track their health and wellness. Imagine a late afternoon admission of a patient who knows exactly what medications she is taking, who can outline several months’ history of caloric intake, physical activity, and basic vital signs, who has an accurate and updated inventory of laboratory exams from other medical centers, and who has a list of all recent physicians and appointments. Although this may seem too good to be true, such an admission may not be too far in the future.

What would be even better is if a patient’s health and wellness tracking keeps him out of the hospital altogether. After all, an Apple a day keeps the doctors away.

Dr. Scheurer is a hospitalist and chief quality officer at the Medical University of South Carolina in Charleston. She is physician editor of The Hospitalist. Email her at scheured@musc.edu.

References

1. Institute for Healthcare Improvement. IHI Triple Aim Initiative. Available at: http://www.ihi.org/Engage/Initiatives/TripleAim/Pages/default.aspx. Accessed August 31, 2014.
2. Apple Inc. Healthkit information page. Available at: https://developer.apple.com/healthkit/. Accessed August 31, 2014.
3. The Advisory Board Company. Daily Briefing: Apple in talks with top hospitals to become ‘hub of health data.’ Available at: http://www.advisory.com/daily-briefing/2014/08/12/apple-in-talks-with-top-hospitals-to-become-hub-of-health-data. Accessed August 31, 2014.
4. Sullivan M. VentureBeat News. Apple announces HealthKit platform and new health app. Available at: http://venturebeat.com/2014/06/02/apple-announces-heath-kit-platform-and-health-app/. Accessed August 31, 2014.

The Institute for Healthcare Improvement (IHI) released its Triple Aim Initiative in 2008, challenging the healthcare industry to undergo extensive systematic change, with the following goals:¹

• Reduce the per capita cost of healthcare;
• Improve the patient experience of care, including quality and satisfaction; and
• Improve the health of populations.

The first two aims are difficult enough, but the third involves engaging and empowering patients and their families to take ownership of their own health and wellness. This is much more than just understanding what your diagnoses are and which medications to take; it is about getting and staying well. Keeping patients and their families well is a goal that has eluded the healthcare industry since before Hippocrates and is an extremely challenging one for hospitalists, whose time with patients is usually limited to an acute care hospital stay.

Naturally, when one industry cannot figure out how to do something well, another industry will develop a breakthrough innovation. Enter Apple Inc., which has officially moved into the health and wellness business. Apple Health is a new app that will share multiple inputs of patient information in a cloud platform called “HealthKit.” HealthKit will allow a user to view a personalized dashboard of health and fitness metrics, which conglomerates information from a myriad of different health and wellness apps, helping them “communicate” with one another.²

The breadth and choice of health and wellness apps available to users is astounding. In a five-minute browse through the app store on my iPhone, I found the following free options to help patients track and understand their health and wellness:

• MyPlate Calorie Tracker, Calorie Counter, and Fooducate help educate and monitor caloric intake.
• iTriage, WebMD, and Mango Health Medication Manager, which can answer questions about symptoms you may be experiencing, will save a list of medications, conditions, procedures, physicians, appointments, and more, and can help you manage your medications.
• Nexercise, MapMyRun, MapMyRide, MapMyFitness, Pacer, and Health Mate track physical activity.
• Fitness Buddy and Daily Workout allow users to view daily workout options and target muscle groups for appropriate exercises.
• ShopWell allows you to scan food labels and evaluate ingredients, calories, gluten, and so on in most store-bought food products.

What Apple proposes to do with its new HealthKit is coordinate the input of these types of apps to synthesize a patient’s health and wellness onto a single platform, which can be shared with caretakers and healthcare providers as needed. The company, as only Apple can, actually declared that its app might be “the beginning of a health revolution.”

A New Day

What HealthKit offers is truly unique from a data security standpoint, which will appeal to Orwellian paranoids. Traditionally, when customers use services such as Google or Yahoo, these services use your personal identity—gathered in pieces of data such as your location and your browsing histories—and then use that data to collect, store, or sell such information on their terms. But Apple promises to help manage health and wellness data on the users’ terms. The purpose is to enable easy but secure sharing of complex health information, which can be updated by users or by other devices. Apple has coordinated with other developers to import information to HealthKit from multiple platforms and devices (such as Nike+, Withings Scale, and Fitbit Flex), acting as a central repository of personalized information.

With this technology, it’s easy to envision hospitals, clinics, pharmacies, laboratories, and even insurers integrating bilaterally with any patient information housed on HealthKit, at the discretion of the user. Mayo Clinic, Cleveland Clinic, Kaiser Permanente, Stanford, UCLA, and Mount Sinai Hospital are all rumored to be working with Apple to figure out how to exchange relevant patient information to enhance the continuity of a patient’s care. In addition to these potential collaborators, electronic health record providers Epic Systems and Allscripts are rumored to be working with Apple in some sort of partnership.^3,4

Not only will HealthKit be a secure repository of information, but it will constantly monitor all the metrics and can be programmed to send alerts to key stakeholders, such as family members or healthcare providers, when any of the metrics veer outside predetermined boundaries.⁴

This “new revolution” in healthcare and wellness should prove extremely helpful to hospitalists, who are often caught in the crosshairs of disjointed patient care delivery systems, and patients who need someone (or something) to track their health and wellness. Imagine a late afternoon admission of a patient who knows exactly what medications she is taking, who can outline several months’ history of caloric intake, physical activity, and basic vital signs, who has an accurate and updated inventory of laboratory exams from other medical centers, and who has a list of all recent physicians and appointments. Although this may seem too good to be true, such an admission may not be too far in the future.

What would be even better is if a patient’s health and wellness tracking keeps him out of the hospital altogether. After all, an Apple a day keeps the doctors away.

Dr. Scheurer is a hospitalist and chief quality officer at the Medical University of South Carolina in Charleston. She is physician editor of The Hospitalist. Email her at scheured@musc.edu.

References

1. Institute for Healthcare Improvement. IHI Triple Aim Initiative. Available at: http://www.ihi.org/Engage/Initiatives/TripleAim/Pages/default.aspx. Accessed August 31, 2014.
2. Apple Inc. Healthkit information page. Available at: https://developer.apple.com/healthkit/. Accessed August 31, 2014.
3. The Advisory Board Company. Daily Briefing: Apple in talks with top hospitals to become ‘hub of health data.’ Available at: http://www.advisory.com/daily-briefing/2014/08/12/apple-in-talks-with-top-hospitals-to-become-hub-of-health-data. Accessed August 31, 2014.
4. Sullivan M. VentureBeat News. Apple announces HealthKit platform and new health app. Available at: http://venturebeat.com/2014/06/02/apple-announces-heath-kit-platform-and-health-app/. Accessed August 31, 2014.

The Institute for Healthcare Improvement (IHI) released its Triple Aim Initiative in 2008, challenging the healthcare industry to undergo extensive systematic change, with the following goals:¹

• Reduce the per capita cost of healthcare;
• Improve the patient experience of care, including quality and satisfaction; and
• Improve the health of populations.

The first two aims are difficult enough, but the third involves engaging and empowering patients and their families to take ownership of their own health and wellness. This is much more than just understanding what your diagnoses are and which medications to take; it is about getting and staying well. Keeping patients and their families well is a goal that has eluded the healthcare industry since before Hippocrates and is an extremely challenging one for hospitalists, whose time with patients is usually limited to an acute care hospital stay.

Naturally, when one industry cannot figure out how to do something well, another industry will develop a breakthrough innovation. Enter Apple Inc., which has officially moved into the health and wellness business. Apple Health is a new app that will share multiple inputs of patient information in a cloud platform called “HealthKit.” HealthKit will allow a user to view a personalized dashboard of health and fitness metrics, which conglomerates information from a myriad of different health and wellness apps, helping them “communicate” with one another.²

The breadth and choice of health and wellness apps available to users is astounding. In a five-minute browse through the app store on my iPhone, I found the following free options to help patients track and understand their health and wellness:

• MyPlate Calorie Tracker, Calorie Counter, and Fooducate help educate and monitor caloric intake.
• iTriage, WebMD, and Mango Health Medication Manager, which can answer questions about symptoms you may be experiencing, will save a list of medications, conditions, procedures, physicians, appointments, and more, and can help you manage your medications.
• Nexercise, MapMyRun, MapMyRide, MapMyFitness, Pacer, and Health Mate track physical activity.
• Fitness Buddy and Daily Workout allow users to view daily workout options and target muscle groups for appropriate exercises.
• ShopWell allows you to scan food labels and evaluate ingredients, calories, gluten, and so on in most store-bought food products.

What Apple proposes to do with its new HealthKit is coordinate the input of these types of apps to synthesize a patient’s health and wellness onto a single platform, which can be shared with caretakers and healthcare providers as needed. The company, as only Apple can, actually declared that its app might be “the beginning of a health revolution.”

A New Day

What HealthKit offers is truly unique from a data security standpoint, which will appeal to Orwellian paranoids. Traditionally, when customers use services such as Google or Yahoo, these services use your personal identity—gathered in pieces of data such as your location and your browsing histories—and then use that data to collect, store, or sell such information on their terms. But Apple promises to help manage health and wellness data on the users’ terms. The purpose is to enable easy but secure sharing of complex health information, which can be updated by users or by other devices. Apple has coordinated with other developers to import information to HealthKit from multiple platforms and devices (such as Nike+, Withings Scale, and Fitbit Flex), acting as a central repository of personalized information.

With this technology, it’s easy to envision hospitals, clinics, pharmacies, laboratories, and even insurers integrating bilaterally with any patient information housed on HealthKit, at the discretion of the user. Mayo Clinic, Cleveland Clinic, Kaiser Permanente, Stanford, UCLA, and Mount Sinai Hospital are all rumored to be working with Apple to figure out how to exchange relevant patient information to enhance the continuity of a patient’s care. In addition to these potential collaborators, electronic health record providers Epic Systems and Allscripts are rumored to be working with Apple in some sort of partnership.^3,4

Not only will HealthKit be a secure repository of information, but it will constantly monitor all the metrics and can be programmed to send alerts to key stakeholders, such as family members or healthcare providers, when any of the metrics veer outside predetermined boundaries.⁴

This “new revolution” in healthcare and wellness should prove extremely helpful to hospitalists, who are often caught in the crosshairs of disjointed patient care delivery systems, and patients who need someone (or something) to track their health and wellness. Imagine a late afternoon admission of a patient who knows exactly what medications she is taking, who can outline several months’ history of caloric intake, physical activity, and basic vital signs, who has an accurate and updated inventory of laboratory exams from other medical centers, and who has a list of all recent physicians and appointments. Although this may seem too good to be true, such an admission may not be too far in the future.

What would be even better is if a patient’s health and wellness tracking keeps him out of the hospital altogether. After all, an Apple a day keeps the doctors away.

Dr. Scheurer is a hospitalist and chief quality officer at the Medical University of South Carolina in Charleston. She is physician editor of The Hospitalist. Email her at scheured@musc.edu.

References

1. Institute for Healthcare Improvement. IHI Triple Aim Initiative. Available at: http://www.ihi.org/Engage/Initiatives/TripleAim/Pages/default.aspx. Accessed August 31, 2014.
2. Apple Inc. Healthkit information page. Available at: https://developer.apple.com/healthkit/. Accessed August 31, 2014.
3. The Advisory Board Company. Daily Briefing: Apple in talks with top hospitals to become ‘hub of health data.’ Available at: http://www.advisory.com/daily-briefing/2014/08/12/apple-in-talks-with-top-hospitals-to-become-hub-of-health-data. Accessed August 31, 2014.
4. Sullivan M. VentureBeat News. Apple announces HealthKit platform and new health app. Available at: http://venturebeat.com/2014/06/02/apple-announces-heath-kit-platform-and-health-app/. Accessed August 31, 2014.

“People don’t always remember what you say or even what you do, but they always remember how you made them feel.”—Maya Angelou

When SHM surveyed its members last year about why they had attended the annual meeting, the single most common response was to “be part of the hospital medicine movement.”

In the first three of my presidential columns, I talked about what that meant for the first 15 years of our specialty. HM’s rise occurred in the mid 1990s, during a time of despair in medicine, when pressures from rising costs and the new managed care industry upended the usual way of doing things, and then, around the turn of the century, amid a growing awareness that the care we had been delivering was wildly variable in quality—and often unsafe. Our field, created by members of the Baby Boomer generation, ultimately proved highly attractive to Generation X’ers, and our growth was accelerated by this new supply of young doctors. Fueled by the influx of dollars and attention brought on by the patient safety and quality movement, HM became the fastest growing medical specialty in history.

So, now we know what being part of the hospitalist movement meant before, but what does it mean today? Are the issues and drivers the same? I left my last column in 2006, with the partnership between the Institute for Healthcare Improvement (IHI), SHM, and six other key organizations to create the 5 Million Lives Campaign. It was an important year in several other ways, as what it meant to be a hospitalist began to change.

Enter the Millenials

In 2006 a new generation, the Millenials, born between 1985 and 2000, began entering medical schools across the country. This group, raised on a diet of positive reinforcement and cooperation, is characterized by confidence and a desire to work in teams. Born after the introduction of the Macintosh computer, Millenials are not just tech savvy; they have grown up in the world of social media and are digital media savvy. Even more than Gen X, Millenials strive for work-life balance. It almost seems this was a generation born and raised to be hospitalists!

Not only is their life philosophy different than the Boomers and X’ers before them, but their medical training has been unlike any before. From the moment they entered medical school, they were taught about patient quality and safety. To them, doctors aren’t the isolated pillars of strength and sole possessors of sacred knowledge that they used to be. They intuitively get that medicine is a team sport. In fact, most of the attendings on their ward rotations have been hospitalists.

Rise of Experience

In the early days of medicine, we as physicians understood that patients might not have the best experience, but that was just part of the deal, right? It’s just not supposed to be fun to be hospitalized—and sometimes you had to go through hell to get better. Those were the days of pure, unadulterated paternalism. We did things to patients to make them get better.

In the late 1970s, Irwin Press, PhD, began to study and lecture on patient satisfaction. In 1985, he joined forces with statistician Rod Ganey, PhD, to found Press Ganey Inc.¹ Patient experience as a concept began to enter the conversation of hospital administration, especially around the one-dimensional idea that better experience could contribute to the better financial health of an organization.

During the rise of the patient safety and quality movement in the late 1990s and early 2000s, our zeal to improve care led us to begin doing many things for patients. But a collateral idea began to rise in importance, too—the idea that a patient’s experience was critical to improving quality, not just a tool to attract more patients.

The entire national quality infrastructure I described in my last column (CMS, JCAHO, AHRQ, NQF) began to work on adding experience to the suite of measurements being developed. In 2006, CMS introduced the HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey. This was a set of questions designed to be used at all hospitals nationwide, a significant development, because there was now a national standard for patient experience that could be compared over time and across hospitals anywhere in the country.²

In 2007, all hospitals subject to the Inpatient Prospective Payment System—pretty much all hospitals except critical access hospitals—were required to submit their HCAHPS survey data or face up to a 2% penalty. In 2008, this experience data was released publicly for the first time.²

And, of course, the Patient Protection and Affordable Care Act of 2010 (ACA) included HCAHPS results in calculating Hospital Value-Based Purchasing payments.³

The Institute of Medicine, in laying out a vision for better healthcare in 2012, called for more involvement of patients and families.

We are even seeing organizations creating leadership positions solely focused on patient experience. The Cleveland Clinic created the first physician leadership position dedicated to patient experience in the country, appointing Bridget Duffy, MD, a hospitalist, as its first chief experience officer in 2010. In 2012, Sound Physicians became the first hospitalist company to create such a position, to which it appointed Mark Rudolph, MD. Who would have imagined this 10 years ago?

Life for hospitalists has changed dramatically from the early 1990s to the Millenials now entering our workforce. The forces guiding our work and stimulating our growth have evolved, but the overarching theme of the last twenty years has been improvement. When the medical world took a cold hard look at the care being delivered, we suddenly saw a world of opportunities for improvement.

I talked before about how the rise of the patient safety and quality movement coincided perfectly with the emergence of hospitalists. Here I told you about how patient experience emerged in prominence as we, collectively, in becoming aware of our quality deficits, gained newfound empathy for what patients were going through. This focus on patient experience again plays into our strength and the opportunity we have as a specialty.

In the December issue of The Hospitalist, the final column in this five-part series will examine how to put it all together as we move toward the future of the field. But first I’ll introduce one last factor, a problem that helped launch our field and is now the greatest threat to our success.

Dr. Kealey is SHM president and medical director of hospital specialties at HealthPartners Medical Group in St. Paul, Minn.

References

1. Press Ganey Associates, Inc. A spark ignited nearly three decades ago. Available at: http://www.pressganey.com/aboutUs/ourHistory.aspx. Accessed August 31, 2014.
2. Centers for Medicare and Medicaid Services. HCAHPS Fact Sheet. Available at: www.hcahpsonline.org. Accessed August 31, 2014.
3. American Hospital Association. Inpatient PPS. Available at: http://www.aha.org/advocacy-issues/medicare/ipps/index.shtml. Accessed August 31, 2014.

“People don’t always remember what you say or even what you do, but they always remember how you made them feel.”—Maya Angelou

When SHM surveyed its members last year about why they had attended the annual meeting, the single most common response was to “be part of the hospital medicine movement.”

In the first three of my presidential columns, I talked about what that meant for the first 15 years of our specialty. HM’s rise occurred in the mid 1990s, during a time of despair in medicine, when pressures from rising costs and the new managed care industry upended the usual way of doing things, and then, around the turn of the century, amid a growing awareness that the care we had been delivering was wildly variable in quality—and often unsafe. Our field, created by members of the Baby Boomer generation, ultimately proved highly attractive to Generation X’ers, and our growth was accelerated by this new supply of young doctors. Fueled by the influx of dollars and attention brought on by the patient safety and quality movement, HM became the fastest growing medical specialty in history.

So, now we know what being part of the hospitalist movement meant before, but what does it mean today? Are the issues and drivers the same? I left my last column in 2006, with the partnership between the Institute for Healthcare Improvement (IHI), SHM, and six other key organizations to create the 5 Million Lives Campaign. It was an important year in several other ways, as what it meant to be a hospitalist began to change.

Enter the Millenials

In 2006 a new generation, the Millenials, born between 1985 and 2000, began entering medical schools across the country. This group, raised on a diet of positive reinforcement and cooperation, is characterized by confidence and a desire to work in teams. Born after the introduction of the Macintosh computer, Millenials are not just tech savvy; they have grown up in the world of social media and are digital media savvy. Even more than Gen X, Millenials strive for work-life balance. It almost seems this was a generation born and raised to be hospitalists!

Not only is their life philosophy different than the Boomers and X’ers before them, but their medical training has been unlike any before. From the moment they entered medical school, they were taught about patient quality and safety. To them, doctors aren’t the isolated pillars of strength and sole possessors of sacred knowledge that they used to be. They intuitively get that medicine is a team sport. In fact, most of the attendings on their ward rotations have been hospitalists.

Rise of Experience

In the early days of medicine, we as physicians understood that patients might not have the best experience, but that was just part of the deal, right? It’s just not supposed to be fun to be hospitalized—and sometimes you had to go through hell to get better. Those were the days of pure, unadulterated paternalism. We did things to patients to make them get better.

In the late 1970s, Irwin Press, PhD, began to study and lecture on patient satisfaction. In 1985, he joined forces with statistician Rod Ganey, PhD, to found Press Ganey Inc.¹ Patient experience as a concept began to enter the conversation of hospital administration, especially around the one-dimensional idea that better experience could contribute to the better financial health of an organization.

During the rise of the patient safety and quality movement in the late 1990s and early 2000s, our zeal to improve care led us to begin doing many things for patients. But a collateral idea began to rise in importance, too—the idea that a patient’s experience was critical to improving quality, not just a tool to attract more patients.

The entire national quality infrastructure I described in my last column (CMS, JCAHO, AHRQ, NQF) began to work on adding experience to the suite of measurements being developed. In 2006, CMS introduced the HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey. This was a set of questions designed to be used at all hospitals nationwide, a significant development, because there was now a national standard for patient experience that could be compared over time and across hospitals anywhere in the country.²

In 2007, all hospitals subject to the Inpatient Prospective Payment System—pretty much all hospitals except critical access hospitals—were required to submit their HCAHPS survey data or face up to a 2% penalty. In 2008, this experience data was released publicly for the first time.²

And, of course, the Patient Protection and Affordable Care Act of 2010 (ACA) included HCAHPS results in calculating Hospital Value-Based Purchasing payments.³

The Institute of Medicine, in laying out a vision for better healthcare in 2012, called for more involvement of patients and families.

We are even seeing organizations creating leadership positions solely focused on patient experience. The Cleveland Clinic created the first physician leadership position dedicated to patient experience in the country, appointing Bridget Duffy, MD, a hospitalist, as its first chief experience officer in 2010. In 2012, Sound Physicians became the first hospitalist company to create such a position, to which it appointed Mark Rudolph, MD. Who would have imagined this 10 years ago?

Life for hospitalists has changed dramatically from the early 1990s to the Millenials now entering our workforce. The forces guiding our work and stimulating our growth have evolved, but the overarching theme of the last twenty years has been improvement. When the medical world took a cold hard look at the care being delivered, we suddenly saw a world of opportunities for improvement.

I talked before about how the rise of the patient safety and quality movement coincided perfectly with the emergence of hospitalists. Here I told you about how patient experience emerged in prominence as we, collectively, in becoming aware of our quality deficits, gained newfound empathy for what patients were going through. This focus on patient experience again plays into our strength and the opportunity we have as a specialty.

In the December issue of The Hospitalist, the final column in this five-part series will examine how to put it all together as we move toward the future of the field. But first I’ll introduce one last factor, a problem that helped launch our field and is now the greatest threat to our success.

Dr. Kealey is SHM president and medical director of hospital specialties at HealthPartners Medical Group in St. Paul, Minn.

References

1. Press Ganey Associates, Inc. A spark ignited nearly three decades ago. Available at: http://www.pressganey.com/aboutUs/ourHistory.aspx. Accessed August 31, 2014.
2. Centers for Medicare and Medicaid Services. HCAHPS Fact Sheet. Available at: www.hcahpsonline.org. Accessed August 31, 2014.
3. American Hospital Association. Inpatient PPS. Available at: http://www.aha.org/advocacy-issues/medicare/ipps/index.shtml. Accessed August 31, 2014.

“People don’t always remember what you say or even what you do, but they always remember how you made them feel.”—Maya Angelou

When SHM surveyed its members last year about why they had attended the annual meeting, the single most common response was to “be part of the hospital medicine movement.”

In the first three of my presidential columns, I talked about what that meant for the first 15 years of our specialty. HM’s rise occurred in the mid 1990s, during a time of despair in medicine, when pressures from rising costs and the new managed care industry upended the usual way of doing things, and then, around the turn of the century, amid a growing awareness that the care we had been delivering was wildly variable in quality—and often unsafe. Our field, created by members of the Baby Boomer generation, ultimately proved highly attractive to Generation X’ers, and our growth was accelerated by this new supply of young doctors. Fueled by the influx of dollars and attention brought on by the patient safety and quality movement, HM became the fastest growing medical specialty in history.

So, now we know what being part of the hospitalist movement meant before, but what does it mean today? Are the issues and drivers the same? I left my last column in 2006, with the partnership between the Institute for Healthcare Improvement (IHI), SHM, and six other key organizations to create the 5 Million Lives Campaign. It was an important year in several other ways, as what it meant to be a hospitalist began to change.

Enter the Millenials

In 2006 a new generation, the Millenials, born between 1985 and 2000, began entering medical schools across the country. This group, raised on a diet of positive reinforcement and cooperation, is characterized by confidence and a desire to work in teams. Born after the introduction of the Macintosh computer, Millenials are not just tech savvy; they have grown up in the world of social media and are digital media savvy. Even more than Gen X, Millenials strive for work-life balance. It almost seems this was a generation born and raised to be hospitalists!

Not only is their life philosophy different than the Boomers and X’ers before them, but their medical training has been unlike any before. From the moment they entered medical school, they were taught about patient quality and safety. To them, doctors aren’t the isolated pillars of strength and sole possessors of sacred knowledge that they used to be. They intuitively get that medicine is a team sport. In fact, most of the attendings on their ward rotations have been hospitalists.

Rise of Experience

In the early days of medicine, we as physicians understood that patients might not have the best experience, but that was just part of the deal, right? It’s just not supposed to be fun to be hospitalized—and sometimes you had to go through hell to get better. Those were the days of pure, unadulterated paternalism. We did things to patients to make them get better.

In the late 1970s, Irwin Press, PhD, began to study and lecture on patient satisfaction. In 1985, he joined forces with statistician Rod Ganey, PhD, to found Press Ganey Inc.¹ Patient experience as a concept began to enter the conversation of hospital administration, especially around the one-dimensional idea that better experience could contribute to the better financial health of an organization.

During the rise of the patient safety and quality movement in the late 1990s and early 2000s, our zeal to improve care led us to begin doing many things for patients. But a collateral idea began to rise in importance, too—the idea that a patient’s experience was critical to improving quality, not just a tool to attract more patients.

The entire national quality infrastructure I described in my last column (CMS, JCAHO, AHRQ, NQF) began to work on adding experience to the suite of measurements being developed. In 2006, CMS introduced the HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey. This was a set of questions designed to be used at all hospitals nationwide, a significant development, because there was now a national standard for patient experience that could be compared over time and across hospitals anywhere in the country.²

In 2007, all hospitals subject to the Inpatient Prospective Payment System—pretty much all hospitals except critical access hospitals—were required to submit their HCAHPS survey data or face up to a 2% penalty. In 2008, this experience data was released publicly for the first time.²

And, of course, the Patient Protection and Affordable Care Act of 2010 (ACA) included HCAHPS results in calculating Hospital Value-Based Purchasing payments.³

The Institute of Medicine, in laying out a vision for better healthcare in 2012, called for more involvement of patients and families.

We are even seeing organizations creating leadership positions solely focused on patient experience. The Cleveland Clinic created the first physician leadership position dedicated to patient experience in the country, appointing Bridget Duffy, MD, a hospitalist, as its first chief experience officer in 2010. In 2012, Sound Physicians became the first hospitalist company to create such a position, to which it appointed Mark Rudolph, MD. Who would have imagined this 10 years ago?

Life for hospitalists has changed dramatically from the early 1990s to the Millenials now entering our workforce. The forces guiding our work and stimulating our growth have evolved, but the overarching theme of the last twenty years has been improvement. When the medical world took a cold hard look at the care being delivered, we suddenly saw a world of opportunities for improvement.

I talked before about how the rise of the patient safety and quality movement coincided perfectly with the emergence of hospitalists. Here I told you about how patient experience emerged in prominence as we, collectively, in becoming aware of our quality deficits, gained newfound empathy for what patients were going through. This focus on patient experience again plays into our strength and the opportunity we have as a specialty.

In the December issue of The Hospitalist, the final column in this five-part series will examine how to put it all together as we move toward the future of the field. But first I’ll introduce one last factor, a problem that helped launch our field and is now the greatest threat to our success.

Dr. Kealey is SHM president and medical director of hospital specialties at HealthPartners Medical Group in St. Paul, Minn.

References

1. Press Ganey Associates, Inc. A spark ignited nearly three decades ago. Available at: http://www.pressganey.com/aboutUs/ourHistory.aspx. Accessed August 31, 2014.
2. Centers for Medicare and Medicaid Services. HCAHPS Fact Sheet. Available at: www.hcahpsonline.org. Accessed August 31, 2014.
3. American Hospital Association. Inpatient PPS. Available at: http://www.aha.org/advocacy-issues/medicare/ipps/index.shtml. Accessed August 31, 2014.

One of the toughest jobs of group management is teasing out the trends that will define HM in the future. In the past few years, hospitalist leaders have tried to forecast whether the growth in compensation would slow or even recede. Instead, median compensation nationwide climbed 17.7% between 2010 and 2014, telling

Dr. Landis that a specialty barely 20 years old still has room to grow.

“There’s a lot at stake here,” he says. “Our patients’ lives are at stake. A lot of our country’s resources are going into healthcare, and the hospital is a very expensive place to receive care, so we want to be delivering the best value.

“We’ve got to do a better job, The information [in the report] is there to help hospital medicine groups and hospitalists.”

IPC’s Taylor adds that trying to understand trends begins with noticing shifts before they become industry standards. He’s tracking two of those right now.

“We’re now seeing hospital stipends starting to be examined by the hospitals,” he says, noting that healthcare executives are asking if this is “a rational amount of money to be paying to support a program?

“We’re [also] starting to see a reversal in the trend of hospitals employing their own hospitalists, which gained quite a bit of steam about five years ago, but it seemed to start running out of steam. Now, from what we are seeing in the marketplace, it appears to be tipping back the other way, particularly with hospitals that have done the math, and they’re beginning to outsource.”

Whether those early warning signs become full-blown trends or not, Taylor says the best management approach is to measure as much information as possible moving forward. Having the SOHM’s baseline every other year is another piece of that information pie.

“It’s interesting data, but I think it’s going to be more interesting to me to see how that data looks three to four years from now, [to understand] if the trends we see or we believe we see beginning, continue,” he adds. “It will be interesting to see the impact of those two forces on the data.”—RQ

One of the toughest jobs of group management is teasing out the trends that will define HM in the future. In the past few years, hospitalist leaders have tried to forecast whether the growth in compensation would slow or even recede. Instead, median compensation nationwide climbed 17.7% between 2010 and 2014, telling

Dr. Landis that a specialty barely 20 years old still has room to grow.

“There’s a lot at stake here,” he says. “Our patients’ lives are at stake. A lot of our country’s resources are going into healthcare, and the hospital is a very expensive place to receive care, so we want to be delivering the best value.

“We’ve got to do a better job, The information [in the report] is there to help hospital medicine groups and hospitalists.”

IPC’s Taylor adds that trying to understand trends begins with noticing shifts before they become industry standards. He’s tracking two of those right now.

“We’re now seeing hospital stipends starting to be examined by the hospitals,” he says, noting that healthcare executives are asking if this is “a rational amount of money to be paying to support a program?

“We’re [also] starting to see a reversal in the trend of hospitals employing their own hospitalists, which gained quite a bit of steam about five years ago, but it seemed to start running out of steam. Now, from what we are seeing in the marketplace, it appears to be tipping back the other way, particularly with hospitals that have done the math, and they’re beginning to outsource.”

Whether those early warning signs become full-blown trends or not, Taylor says the best management approach is to measure as much information as possible moving forward. Having the SOHM’s baseline every other year is another piece of that information pie.

“It’s interesting data, but I think it’s going to be more interesting to me to see how that data looks three to four years from now, [to understand] if the trends we see or we believe we see beginning, continue,” he adds. “It will be interesting to see the impact of those two forces on the data.”—RQ

One of the toughest jobs of group management is teasing out the trends that will define HM in the future. In the past few years, hospitalist leaders have tried to forecast whether the growth in compensation would slow or even recede. Instead, median compensation nationwide climbed 17.7% between 2010 and 2014, telling

Dr. Landis that a specialty barely 20 years old still has room to grow.

“There’s a lot at stake here,” he says. “Our patients’ lives are at stake. A lot of our country’s resources are going into healthcare, and the hospital is a very expensive place to receive care, so we want to be delivering the best value.

“We’ve got to do a better job, The information [in the report] is there to help hospital medicine groups and hospitalists.”

IPC’s Taylor adds that trying to understand trends begins with noticing shifts before they become industry standards. He’s tracking two of those right now.

“We’re now seeing hospital stipends starting to be examined by the hospitals,” he says, noting that healthcare executives are asking if this is “a rational amount of money to be paying to support a program?

“We’re [also] starting to see a reversal in the trend of hospitals employing their own hospitalists, which gained quite a bit of steam about five years ago, but it seemed to start running out of steam. Now, from what we are seeing in the marketplace, it appears to be tipping back the other way, particularly with hospitals that have done the math, and they’re beginning to outsource.”

Whether those early warning signs become full-blown trends or not, Taylor says the best management approach is to measure as much information as possible moving forward. Having the SOHM’s baseline every other year is another piece of that information pie.

“It’s interesting data, but I think it’s going to be more interesting to me to see how that data looks three to four years from now, [to understand] if the trends we see or we believe we see beginning, continue,” he adds. “It will be interesting to see the impact of those two forces on the data.”—RQ

EDITOR’S NOTE: First in a series of reviews of the “Hospital Medicine: Current Concepts” series by members of Team Hospitalist.

According to the Advisory Board projections of inpatient service line volume through 2017, most service lines will experience a decrease. Those that are projected to increase include neurosurgery, vascular surgery, orthopedic surgery, and general surgery. It seems clear that the need for hospital medicine to engage in the care of the surgical patient is sure to grow.

That makes the publication of this book so prescient. As one in a series titled Hospital Medicine: Current Concepts, edited by Scott Flanders, MD, MHM, and Sanjay Saint, MD, MPH, this is a valuable contribution to hospitalist leaders, policymakers, and anyone routinely caring for the peri-operative patient.

Part one focuses on systems of care. The authors articulate the essential elements of developing a consultation service, a clinic, and a co-management program. Eric Siegal, MD, FHM, authors the second chapter, clearly delineating the important differences between a co-management program and a consultation program. He provides the reader with pearls as well as potential pitfalls.

The first eight chapters of this book will have a long shelf life; they deliver sound advice on quality and practice management in the peri-operative arena. Identifying elements of a successful program, engaging key stakeholders, and managing medications are all skills a hospitalist needs and will not change anytime soon. Anyone planning to build a consultation or co-management service will be well served by the guidance in part one.

The next three parts explore the assessment and management of various risks, post-operative care, and post-operative conditions. Although written by a veritable who’s who of hospital medicine and peri-operative medicine giants, some parts of these sections fall prey to the rapidly changing world of clinical care. For example, Chapter 9 provides a great review of the history of developing cardiac risk assessment tools for the patient undergoing noncardiac surgery. The chapter also reviews strategies to mitigate risk; however, it falls short by failing to discuss the Gupta risk score, which was developed over 200,000 cases, compared with about 4,000 for the revised cardiac risk index. That omission is likely a result of publication timing. Although the chapter does not call out the recent implications of scientific misconduct related to the Dutch peri-operative beta blocker trials, the authors’ conclusions on the use of beta blockers remains appropriate and could have been more timely if it had included a recent meta-analysis omitting the Dutch data.

Similarly, Chapter 10 provides an excellent review of the etiology and burden of peri-operative pulmonary complications. Relatively recent literature that updates previous guidelines, indicating the benefits of respiratory muscle training, is included; however, the recently completed IMPROVE trial was likely published too late for inclusion in this chapter. Thus the benefits of a low tidal volume/lung protective strategy in those at intermediate to high risk could be missed. Still, the clinical foundation provided by the chapters in parts two through four fill the void most of us experienced in training—namely, not learning how to care for the peri-operative patient.

Special sections on the bariatric and neurosurgical patient will be welcomed by those of us never trained in the care of such conditions.

Key Takeaways

As hospitalists become increasingly important in the care of surgical patients, this book will provide an excellent foundation for critical peri-operative concepts and tools.

The authors include specific recommendations that will help in the management of almost every surgical patient encountered. For example, the anticoagulation and glycemic control strategies are well written, as well as easy to understand and apply.

If you are a hospitalist group leader, this is a must read that will help define quality, scope of practice, and practice management issues we all struggle with.

Dr. Fitterman is vice chair of hospital medicine in the department of medicine North Shore-LIJ Health System and assistant professor of medicine at Hofstra North Shore-LIJ School of Medicine.

EDITOR’S NOTE: First in a series of reviews of the “Hospital Medicine: Current Concepts” series by members of Team Hospitalist.

According to the Advisory Board projections of inpatient service line volume through 2017, most service lines will experience a decrease. Those that are projected to increase include neurosurgery, vascular surgery, orthopedic surgery, and general surgery. It seems clear that the need for hospital medicine to engage in the care of the surgical patient is sure to grow.

That makes the publication of this book so prescient. As one in a series titled Hospital Medicine: Current Concepts, edited by Scott Flanders, MD, MHM, and Sanjay Saint, MD, MPH, this is a valuable contribution to hospitalist leaders, policymakers, and anyone routinely caring for the peri-operative patient.

Part one focuses on systems of care. The authors articulate the essential elements of developing a consultation service, a clinic, and a co-management program. Eric Siegal, MD, FHM, authors the second chapter, clearly delineating the important differences between a co-management program and a consultation program. He provides the reader with pearls as well as potential pitfalls.

The first eight chapters of this book will have a long shelf life; they deliver sound advice on quality and practice management in the peri-operative arena. Identifying elements of a successful program, engaging key stakeholders, and managing medications are all skills a hospitalist needs and will not change anytime soon. Anyone planning to build a consultation or co-management service will be well served by the guidance in part one.

The next three parts explore the assessment and management of various risks, post-operative care, and post-operative conditions. Although written by a veritable who’s who of hospital medicine and peri-operative medicine giants, some parts of these sections fall prey to the rapidly changing world of clinical care. For example, Chapter 9 provides a great review of the history of developing cardiac risk assessment tools for the patient undergoing noncardiac surgery. The chapter also reviews strategies to mitigate risk; however, it falls short by failing to discuss the Gupta risk score, which was developed over 200,000 cases, compared with about 4,000 for the revised cardiac risk index. That omission is likely a result of publication timing. Although the chapter does not call out the recent implications of scientific misconduct related to the Dutch peri-operative beta blocker trials, the authors’ conclusions on the use of beta blockers remains appropriate and could have been more timely if it had included a recent meta-analysis omitting the Dutch data.

Similarly, Chapter 10 provides an excellent review of the etiology and burden of peri-operative pulmonary complications. Relatively recent literature that updates previous guidelines, indicating the benefits of respiratory muscle training, is included; however, the recently completed IMPROVE trial was likely published too late for inclusion in this chapter. Thus the benefits of a low tidal volume/lung protective strategy in those at intermediate to high risk could be missed. Still, the clinical foundation provided by the chapters in parts two through four fill the void most of us experienced in training—namely, not learning how to care for the peri-operative patient.

Special sections on the bariatric and neurosurgical patient will be welcomed by those of us never trained in the care of such conditions.

Key Takeaways

As hospitalists become increasingly important in the care of surgical patients, this book will provide an excellent foundation for critical peri-operative concepts and tools.

The authors include specific recommendations that will help in the management of almost every surgical patient encountered. For example, the anticoagulation and glycemic control strategies are well written, as well as easy to understand and apply.

If you are a hospitalist group leader, this is a must read that will help define quality, scope of practice, and practice management issues we all struggle with.

Dr. Fitterman is vice chair of hospital medicine in the department of medicine North Shore-LIJ Health System and assistant professor of medicine at Hofstra North Shore-LIJ School of Medicine.

EDITOR’S NOTE: First in a series of reviews of the “Hospital Medicine: Current Concepts” series by members of Team Hospitalist.

According to the Advisory Board projections of inpatient service line volume through 2017, most service lines will experience a decrease. Those that are projected to increase include neurosurgery, vascular surgery, orthopedic surgery, and general surgery. It seems clear that the need for hospital medicine to engage in the care of the surgical patient is sure to grow.

That makes the publication of this book so prescient. As one in a series titled Hospital Medicine: Current Concepts, edited by Scott Flanders, MD, MHM, and Sanjay Saint, MD, MPH, this is a valuable contribution to hospitalist leaders, policymakers, and anyone routinely caring for the peri-operative patient.

Part one focuses on systems of care. The authors articulate the essential elements of developing a consultation service, a clinic, and a co-management program. Eric Siegal, MD, FHM, authors the second chapter, clearly delineating the important differences between a co-management program and a consultation program. He provides the reader with pearls as well as potential pitfalls.

The first eight chapters of this book will have a long shelf life; they deliver sound advice on quality and practice management in the peri-operative arena. Identifying elements of a successful program, engaging key stakeholders, and managing medications are all skills a hospitalist needs and will not change anytime soon. Anyone planning to build a consultation or co-management service will be well served by the guidance in part one.

The next three parts explore the assessment and management of various risks, post-operative care, and post-operative conditions. Although written by a veritable who’s who of hospital medicine and peri-operative medicine giants, some parts of these sections fall prey to the rapidly changing world of clinical care. For example, Chapter 9 provides a great review of the history of developing cardiac risk assessment tools for the patient undergoing noncardiac surgery. The chapter also reviews strategies to mitigate risk; however, it falls short by failing to discuss the Gupta risk score, which was developed over 200,000 cases, compared with about 4,000 for the revised cardiac risk index. That omission is likely a result of publication timing. Although the chapter does not call out the recent implications of scientific misconduct related to the Dutch peri-operative beta blocker trials, the authors’ conclusions on the use of beta blockers remains appropriate and could have been more timely if it had included a recent meta-analysis omitting the Dutch data.

Similarly, Chapter 10 provides an excellent review of the etiology and burden of peri-operative pulmonary complications. Relatively recent literature that updates previous guidelines, indicating the benefits of respiratory muscle training, is included; however, the recently completed IMPROVE trial was likely published too late for inclusion in this chapter. Thus the benefits of a low tidal volume/lung protective strategy in those at intermediate to high risk could be missed. Still, the clinical foundation provided by the chapters in parts two through four fill the void most of us experienced in training—namely, not learning how to care for the peri-operative patient.

Special sections on the bariatric and neurosurgical patient will be welcomed by those of us never trained in the care of such conditions.

Key Takeaways

As hospitalists become increasingly important in the care of surgical patients, this book will provide an excellent foundation for critical peri-operative concepts and tools.

The authors include specific recommendations that will help in the management of almost every surgical patient encountered. For example, the anticoagulation and glycemic control strategies are well written, as well as easy to understand and apply.

If you are a hospitalist group leader, this is a must read that will help define quality, scope of practice, and practice management issues we all struggle with.

Dr. Fitterman is vice chair of hospital medicine in the department of medicine North Shore-LIJ Health System and assistant professor of medicine at Hofstra North Shore-LIJ School of Medicine.

Engaging patients more effectively in their own treatment is becoming a growing focus for hospitals and hospitalists. The Wall Street Journal earlier this year described how hospitals are scoring patients on their “activation”—how engaged they are likely to be in their ongoing care and recovery—with measurement tools such as the Patient Activation Measure (www.insigniahealth.com/solutions/patient-activation-measure)—in order to customize their care through special coaching or other interventions.⁴ Information Week Healthcare notes that more hospitals are putting patient experience officers in the C-suite to help them learn how to treat patients more like valued customers.⁵

One of the country’s first chief experience officers (CXOs), James Merlino, MD, CXO for Cleveland Clinic, heads a department that hosts the annual Patient Experience Summit, which was held in Cleveland in May with co-sponsorship by the Society for Hospital Medicine and the American Hospital Association. It’s one thing to talk about how important patient experience is, Dr. Merlino told Information Week Healthcare. “But it’s another to hold people accountable for it.”

Larry Beresford is a freelance writer in Alameda, Calif.

References

1. Nagasako EM, Reidhead M, Waterman B, Dunagan WC. Adding socioeconomic data to hospital readmissions calculations may produce more useful results. Health Affair. 2014;33(5):786-791.
2. Hu J, Gonsahn MD, Nerenz DR. Socioeconomic status and readmissions: Evidence from an urban teaching hospital. Health Affair. 2014;33(5):778-785.
3. Hoyer EH, Needham DM, Atanelov L, Knox B, Friedman M, Brotman DJ. Association of impaired functional status at hospital discharge and subsequent rehospitalization. J Hosp Med. 2014;9(5):277–282.
4. Landro L. How doctors rate patients. The Wall Street Journal. March 31, 2014. Available at: http://online.wsj.com/news/articles/SB10001424052702304432604579473301109907412. Accessed July 31, 2014.
5. Diana A. Hospitals elevate patient satisfaction to the C-suite. Information Week Healthcare. March 24, 2014. Available at: http://www.informationweek.com/healthcare/leadership/ hospitals-elevate-patient-satisfaction-to-the-c-suite/d/d-id/1127860. Accessed July 31, 2014.
6. The Press Association. London trust now testing seriously ill patients for HIV. Nursing Times. May 8, 2014. Available at: http://www.nursingtimes.net/confirmation?rtn=%252fbarts-to-rollout-routine-hiv-testing-for-intensive-care-patients%252f5070642.article. Accessed July 31, 2014.
7. Pallin DJ, Espinola JA, Camargo CA Jr. US population aging and demand for inpatient services. J Hosp Med. 2014;9(3):193-196.

Engaging patients more effectively in their own treatment is becoming a growing focus for hospitals and hospitalists. The Wall Street Journal earlier this year described how hospitals are scoring patients on their “activation”—how engaged they are likely to be in their ongoing care and recovery—with measurement tools such as the Patient Activation Measure (www.insigniahealth.com/solutions/patient-activation-measure)—in order to customize their care through special coaching or other interventions.⁴ Information Week Healthcare notes that more hospitals are putting patient experience officers in the C-suite to help them learn how to treat patients more like valued customers.⁵

One of the country’s first chief experience officers (CXOs), James Merlino, MD, CXO for Cleveland Clinic, heads a department that hosts the annual Patient Experience Summit, which was held in Cleveland in May with co-sponsorship by the Society for Hospital Medicine and the American Hospital Association. It’s one thing to talk about how important patient experience is, Dr. Merlino told Information Week Healthcare. “But it’s another to hold people accountable for it.”

Larry Beresford is a freelance writer in Alameda, Calif.

References

1. Nagasako EM, Reidhead M, Waterman B, Dunagan WC. Adding socioeconomic data to hospital readmissions calculations may produce more useful results. Health Affair. 2014;33(5):786-791.
2. Hu J, Gonsahn MD, Nerenz DR. Socioeconomic status and readmissions: Evidence from an urban teaching hospital. Health Affair. 2014;33(5):778-785.
3. Hoyer EH, Needham DM, Atanelov L, Knox B, Friedman M, Brotman DJ. Association of impaired functional status at hospital discharge and subsequent rehospitalization. J Hosp Med. 2014;9(5):277–282.
4. Landro L. How doctors rate patients. The Wall Street Journal. March 31, 2014. Available at: http://online.wsj.com/news/articles/SB10001424052702304432604579473301109907412. Accessed July 31, 2014.
5. Diana A. Hospitals elevate patient satisfaction to the C-suite. Information Week Healthcare. March 24, 2014. Available at: http://www.informationweek.com/healthcare/leadership/ hospitals-elevate-patient-satisfaction-to-the-c-suite/d/d-id/1127860. Accessed July 31, 2014.
6. The Press Association. London trust now testing seriously ill patients for HIV. Nursing Times. May 8, 2014. Available at: http://www.nursingtimes.net/confirmation?rtn=%252fbarts-to-rollout-routine-hiv-testing-for-intensive-care-patients%252f5070642.article. Accessed July 31, 2014.
7. Pallin DJ, Espinola JA, Camargo CA Jr. US population aging and demand for inpatient services. J Hosp Med. 2014;9(3):193-196.

Engaging patients more effectively in their own treatment is becoming a growing focus for hospitals and hospitalists. The Wall Street Journal earlier this year described how hospitals are scoring patients on their “activation”—how engaged they are likely to be in their ongoing care and recovery—with measurement tools such as the Patient Activation Measure (www.insigniahealth.com/solutions/patient-activation-measure)—in order to customize their care through special coaching or other interventions.⁴ Information Week Healthcare notes that more hospitals are putting patient experience officers in the C-suite to help them learn how to treat patients more like valued customers.⁵

One of the country’s first chief experience officers (CXOs), James Merlino, MD, CXO for Cleveland Clinic, heads a department that hosts the annual Patient Experience Summit, which was held in Cleveland in May with co-sponsorship by the Society for Hospital Medicine and the American Hospital Association. It’s one thing to talk about how important patient experience is, Dr. Merlino told Information Week Healthcare. “But it’s another to hold people accountable for it.”

Larry Beresford is a freelance writer in Alameda, Calif.

References

1. Nagasako EM, Reidhead M, Waterman B, Dunagan WC. Adding socioeconomic data to hospital readmissions calculations may produce more useful results. Health Affair. 2014;33(5):786-791.
2. Hu J, Gonsahn MD, Nerenz DR. Socioeconomic status and readmissions: Evidence from an urban teaching hospital. Health Affair. 2014;33(5):778-785.
3. Hoyer EH, Needham DM, Atanelov L, Knox B, Friedman M, Brotman DJ. Association of impaired functional status at hospital discharge and subsequent rehospitalization. J Hosp Med. 2014;9(5):277–282.
4. Landro L. How doctors rate patients. The Wall Street Journal. March 31, 2014. Available at: http://online.wsj.com/news/articles/SB10001424052702304432604579473301109907412. Accessed July 31, 2014.
5. Diana A. Hospitals elevate patient satisfaction to the C-suite. Information Week Healthcare. March 24, 2014. Available at: http://www.informationweek.com/healthcare/leadership/ hospitals-elevate-patient-satisfaction-to-the-c-suite/d/d-id/1127860. Accessed July 31, 2014.
6. The Press Association. London trust now testing seriously ill patients for HIV. Nursing Times. May 8, 2014. Available at: http://www.nursingtimes.net/confirmation?rtn=%252fbarts-to-rollout-routine-hiv-testing-for-intensive-care-patients%252f5070642.article. Accessed July 31, 2014.
7. Pallin DJ, Espinola JA, Camargo CA Jr. US population aging and demand for inpatient services. J Hosp Med. 2014;9(3):193-196.

Following a successful pilot at The Royal London Hospital in Whitechapel, the Barts Health NHS Trust of the British National Health Service has begun routinely offering the blood test for HIV infection to all critical care patients served by the trust, aiming to get more HIV cases diagnosed earlier, thereby helping to stop the virus’ spread by those who don’t know they are infected. Fifty-two percent of 899 patients on the pilot critical care unit agreed to the test, three of whom tested positive for HIV, enabling their doctors to commence treatment.⁶

Patients on critical care units are receiving blood tests already, and the HIV test was presented as just one more test, albeit one with the potential to save lives and stop HIV transmission to partners, said Barts Health NHS Trust HIV medicine consultant Chloe Orkin, MD.

“People are still dying of HIV in the UK—but only because they test too late,” Dr. Orkin says.

The new policy at the UK’s largest regional health trust is in line with guidelines recommending the introduction of universal opt-out testing for HIV in critical care departments where local prevalence of the infection exceeds two per 1,000 individuals.

Larry Beresford is a freelance writer in Alameda, Calif.

Following a successful pilot at The Royal London Hospital in Whitechapel, the Barts Health NHS Trust of the British National Health Service has begun routinely offering the blood test for HIV infection to all critical care patients served by the trust, aiming to get more HIV cases diagnosed earlier, thereby helping to stop the virus’ spread by those who don’t know they are infected. Fifty-two percent of 899 patients on the pilot critical care unit agreed to the test, three of whom tested positive for HIV, enabling their doctors to commence treatment.⁶

Patients on critical care units are receiving blood tests already, and the HIV test was presented as just one more test, albeit one with the potential to save lives and stop HIV transmission to partners, said Barts Health NHS Trust HIV medicine consultant Chloe Orkin, MD.

“People are still dying of HIV in the UK—but only because they test too late,” Dr. Orkin says.

The new policy at the UK’s largest regional health trust is in line with guidelines recommending the introduction of universal opt-out testing for HIV in critical care departments where local prevalence of the infection exceeds two per 1,000 individuals.

Larry Beresford is a freelance writer in Alameda, Calif.

Following a successful pilot at The Royal London Hospital in Whitechapel, the Barts Health NHS Trust of the British National Health Service has begun routinely offering the blood test for HIV infection to all critical care patients served by the trust, aiming to get more HIV cases diagnosed earlier, thereby helping to stop the virus’ spread by those who don’t know they are infected. Fifty-two percent of 899 patients on the pilot critical care unit agreed to the test, three of whom tested positive for HIV, enabling their doctors to commence treatment.⁶

Patients on critical care units are receiving blood tests already, and the HIV test was presented as just one more test, albeit one with the potential to save lives and stop HIV transmission to partners, said Barts Health NHS Trust HIV medicine consultant Chloe Orkin, MD.

“People are still dying of HIV in the UK—but only because they test too late,” Dr. Orkin says.

The new policy at the UK’s largest regional health trust is in line with guidelines recommending the introduction of universal opt-out testing for HIV in critical care departments where local prevalence of the infection exceeds two per 1,000 individuals.

Larry Beresford is a freelance writer in Alameda, Calif.

72%

Total growth in hospital capacity needed by the year 2050, according to an analysis in the Journal of Hospital Medicine.⁷ The estimate is based on a predicted 67% increase in the annual number of hospitalizations—assuming that other factors such as age-specific hospitalization rates and lengths of stay do not change—and derived from U.S. Census Bureau projections that by 2050 the U.S. population will increase by 41%. Total U.S. hospital capacity has steadily decreased for the past three decades.

Larry Beresford is a freelance writer in Alameda, Calif.

72%

Total growth in hospital capacity needed by the year 2050, according to an analysis in the Journal of Hospital Medicine.⁷ The estimate is based on a predicted 67% increase in the annual number of hospitalizations—assuming that other factors such as age-specific hospitalization rates and lengths of stay do not change—and derived from U.S. Census Bureau projections that by 2050 the U.S. population will increase by 41%. Total U.S. hospital capacity has steadily decreased for the past three decades.

Larry Beresford is a freelance writer in Alameda, Calif.

72%

Total growth in hospital capacity needed by the year 2050, according to an analysis in the Journal of Hospital Medicine.⁷ The estimate is based on a predicted 67% increase in the annual number of hospitalizations—assuming that other factors such as age-specific hospitalization rates and lengths of stay do not change—and derived from U.S. Census Bureau projections that by 2050 the U.S. population will increase by 41%. Total U.S. hospital capacity has steadily decreased for the past three decades.

Larry Beresford is a freelance writer in Alameda, Calif.

Summary

Physicians suffer from “arrested development,” said Dr. Chiang, a hospitalist and chief of inpatient services at Boston Children’s Hospital, during a PHM2014 workshop on the basics of negotiation. Dr. Chiang was referring to the fact that in several professional realms, including negotiation, most physicians have not had the traditional experience of interviewing and negotiating for jobs after high school or college.

An understanding of several negotiation concepts can help the negotiator achieve an agreeable solution. Awareness of values and limits prior to the actual discussion or negotiation will increase the chance of a successful negotiation. Examples of some of these concepts are:

1. Best alternative to a negotiation agreement (BATNA). This is the course of action if negotiations fail. The negotiator should not accept a worse resolution than the BATNA.
2. Reservation value (RV). This is the lowest value a negotiator will accept in a deal.
3. Zone of possible agreement (ZOPA). This is the intellectual zone between two parties in a negotiation where an agreement can be reached.

The twin tasks of negotiation are a) learning about the true ZOPA in advance and b) determining how to influence the other person’s perception of this zone.

There are several negotiation methods and strategies of influence that can be used to support your position or goals. For example, status quo bias is very common. Addressing the specific reason a person is not willing to change from the status quo enables progress.

While it is important to advocate for one’s position, fairness is an important variable in reaching an agreement. Fairness often is not universally defined. Communication is essential in understanding each group’s position.

Summary

Physicians suffer from “arrested development,” said Dr. Chiang, a hospitalist and chief of inpatient services at Boston Children’s Hospital, during a PHM2014 workshop on the basics of negotiation. Dr. Chiang was referring to the fact that in several professional realms, including negotiation, most physicians have not had the traditional experience of interviewing and negotiating for jobs after high school or college.

An understanding of several negotiation concepts can help the negotiator achieve an agreeable solution. Awareness of values and limits prior to the actual discussion or negotiation will increase the chance of a successful negotiation. Examples of some of these concepts are:

1. Best alternative to a negotiation agreement (BATNA). This is the course of action if negotiations fail. The negotiator should not accept a worse resolution than the BATNA.
2. Reservation value (RV). This is the lowest value a negotiator will accept in a deal.
3. Zone of possible agreement (ZOPA). This is the intellectual zone between two parties in a negotiation where an agreement can be reached.

The twin tasks of negotiation are a) learning about the true ZOPA in advance and b) determining how to influence the other person’s perception of this zone.

There are several negotiation methods and strategies of influence that can be used to support your position or goals. For example, status quo bias is very common. Addressing the specific reason a person is not willing to change from the status quo enables progress.

While it is important to advocate for one’s position, fairness is an important variable in reaching an agreement. Fairness often is not universally defined. Communication is essential in understanding each group’s position.

Summary

Physicians suffer from “arrested development,” said Dr. Chiang, a hospitalist and chief of inpatient services at Boston Children’s Hospital, during a PHM2014 workshop on the basics of negotiation. Dr. Chiang was referring to the fact that in several professional realms, including negotiation, most physicians have not had the traditional experience of interviewing and negotiating for jobs after high school or college.

An understanding of several negotiation concepts can help the negotiator achieve an agreeable solution. Awareness of values and limits prior to the actual discussion or negotiation will increase the chance of a successful negotiation. Examples of some of these concepts are:

1. Best alternative to a negotiation agreement (BATNA). This is the course of action if negotiations fail. The negotiator should not accept a worse resolution than the BATNA.
2. Reservation value (RV). This is the lowest value a negotiator will accept in a deal.
3. Zone of possible agreement (ZOPA). This is the intellectual zone between two parties in a negotiation where an agreement can be reached.

The twin tasks of negotiation are a) learning about the true ZOPA in advance and b) determining how to influence the other person’s perception of this zone.

There are several negotiation methods and strategies of influence that can be used to support your position or goals. For example, status quo bias is very common. Addressing the specific reason a person is not willing to change from the status quo enables progress.

While it is important to advocate for one’s position, fairness is an important variable in reaching an agreement. Fairness often is not universally defined. Communication is essential in understanding each group’s position.

Dr. Hospitalist

I just read your article regarding billing. My supervising physician is a surgeon. She and I are both employed by the same hospital. Can she have me dictate the discharge summary before she signs off on it? Or does she have to dictate it because it is in the global post-op period and she is paid for the surgery? If she has me perform an inpatient consult one afternoon/evening, but she doesn't lay eyes on the patient until the following morning, can she bill for the initial consult? Or does she bill for the first subsequent consult? Where is the information to back up your responses, please?

—Concerned with Coding

Dr. Hospitalist responds:

You don’t say so, but I’m assuming you work as a physician assistant (PA) or a nurse practitioner (NP). Since you and your supervising physician are employed by the same hospital, I also assume your fees are assigned to the hospital and you are both considered members of the same “surgical group.”

Just so we’re all on the same page, let’s further define “global surgical” period. Even though there are three types of global surgical packages, they are all based on the number of expected post-operative days. In general, there are the zero- and 10-day post-op periods (for minor procedures) and the 90-day post-op period (for most major procedures). Almost all services, supplies, wound management, and follow-up visits related to the procedure are included in the global surgery payment.

The discharge summary also is part of the global surgery package. When your supervising physician co-signs and validates your note, she can bill as though she did the note herself as defined in the scope of practice and credentialing process at your hospital.

If allowed by your state and sanctioned by your hospital, you can bill separately; however, the global surgery payment would be decreased as per the Medicare Claims Processing Manual (Chapter 12, Sections 40 and 40.1-Physician/Nonphysician Practitioners), which states that “when a NP, PA, or CNS furnish services to a patient during a global surgical period, contractors shall determine the level of NP [nurse practitioner], PA [physician assistant], or CNS [clinical nurse specialist] involvement in furnishing part of the surgeon’s global surgical package consistent with their current practice of processing such claims.” The manual goes on to say that those NP, PA, or CNS services furnished are paid at 80% of the lesser of the actual charge or 85% of what a physician is paid under the Medicare Physician Fee Schedule.

Now you see why it’s more lucrative for the physician to bill than the NP/PA, especially if the extender is working under the “supervision” of the physician.

As I’m sure you’re aware, effective Jan. 1, 2010, the consultation codes were no longer recognized for Medicare Part B payment. Practitioners are directed to code patient evaluation and management (E/M) visits with E/M codes that represent where the visit occurs and identify the complexity of the visit performed.

Medicare directives are pretty clear that in order to bill for a visit, the physician or clinician must have a “face-to-face” encounter with the patient on the day of service billed. There is an opportunity for the physician and NP/PA from the same group practice to bill a split/shared E/M code under either unique physician identification number (UPIN), but the physician must still have a face-to-face encounter on the day of service or the bill must be submitted using the NP/PA’s UPIN (Medicare Claims Processing Manual, Chapter 12 – Physician/Nonphysician Practitioners. Section 30.6.1-Selection of Level of Evaluation and Management Service. Implemented: 01-04-10).

Therefore, in the situation that you describe, the supervising physician must bill for a subsequent visit E/M code.

Occasionally, teaching institutions with residents have formalized agreements with insurers that allow residents to see patients one day, with the attending physician allowed to bill for that day without seeing the patient. You should check with your group’s billing specialist to see if such arrangements have been made for your group.

After taking all this into consideration, however, I perceive the bigger issue as underlying tension or mistrust between you and the supervising physician. I suggest sitting down and having a conversation about scope of practice and expectations, and then you can better determine if you are the right person for that position.

Do you have a problem or concern that you’d like Dr. Hospitalist to address? Email your questions to drhospit@wiley.com.

Dr. Hospitalist

I just read your article regarding billing. My supervising physician is a surgeon. She and I are both employed by the same hospital. Can she have me dictate the discharge summary before she signs off on it? Or does she have to dictate it because it is in the global post-op period and she is paid for the surgery? If she has me perform an inpatient consult one afternoon/evening, but she doesn't lay eyes on the patient until the following morning, can she bill for the initial consult? Or does she bill for the first subsequent consult? Where is the information to back up your responses, please?

—Concerned with Coding

Dr. Hospitalist responds:

You don’t say so, but I’m assuming you work as a physician assistant (PA) or a nurse practitioner (NP). Since you and your supervising physician are employed by the same hospital, I also assume your fees are assigned to the hospital and you are both considered members of the same “surgical group.”

Just so we’re all on the same page, let’s further define “global surgical” period. Even though there are three types of global surgical packages, they are all based on the number of expected post-operative days. In general, there are the zero- and 10-day post-op periods (for minor procedures) and the 90-day post-op period (for most major procedures). Almost all services, supplies, wound management, and follow-up visits related to the procedure are included in the global surgery payment.

The discharge summary also is part of the global surgery package. When your supervising physician co-signs and validates your note, she can bill as though she did the note herself as defined in the scope of practice and credentialing process at your hospital.

If allowed by your state and sanctioned by your hospital, you can bill separately; however, the global surgery payment would be decreased as per the Medicare Claims Processing Manual (Chapter 12, Sections 40 and 40.1-Physician/Nonphysician Practitioners), which states that “when a NP, PA, or CNS furnish services to a patient during a global surgical period, contractors shall determine the level of NP [nurse practitioner], PA [physician assistant], or CNS [clinical nurse specialist] involvement in furnishing part of the surgeon’s global surgical package consistent with their current practice of processing such claims.” The manual goes on to say that those NP, PA, or CNS services furnished are paid at 80% of the lesser of the actual charge or 85% of what a physician is paid under the Medicare Physician Fee Schedule.

Now you see why it’s more lucrative for the physician to bill than the NP/PA, especially if the extender is working under the “supervision” of the physician.

As I’m sure you’re aware, effective Jan. 1, 2010, the consultation codes were no longer recognized for Medicare Part B payment. Practitioners are directed to code patient evaluation and management (E/M) visits with E/M codes that represent where the visit occurs and identify the complexity of the visit performed.

Medicare directives are pretty clear that in order to bill for a visit, the physician or clinician must have a “face-to-face” encounter with the patient on the day of service billed. There is an opportunity for the physician and NP/PA from the same group practice to bill a split/shared E/M code under either unique physician identification number (UPIN), but the physician must still have a face-to-face encounter on the day of service or the bill must be submitted using the NP/PA’s UPIN (Medicare Claims Processing Manual, Chapter 12 – Physician/Nonphysician Practitioners. Section 30.6.1-Selection of Level of Evaluation and Management Service. Implemented: 01-04-10).

Therefore, in the situation that you describe, the supervising physician must bill for a subsequent visit E/M code.

Occasionally, teaching institutions with residents have formalized agreements with insurers that allow residents to see patients one day, with the attending physician allowed to bill for that day without seeing the patient. You should check with your group’s billing specialist to see if such arrangements have been made for your group.

After taking all this into consideration, however, I perceive the bigger issue as underlying tension or mistrust between you and the supervising physician. I suggest sitting down and having a conversation about scope of practice and expectations, and then you can better determine if you are the right person for that position.

Do you have a problem or concern that you’d like Dr. Hospitalist to address? Email your questions to drhospit@wiley.com.

Dr. Hospitalist

I just read your article regarding billing. My supervising physician is a surgeon. She and I are both employed by the same hospital. Can she have me dictate the discharge summary before she signs off on it? Or does she have to dictate it because it is in the global post-op period and she is paid for the surgery? If she has me perform an inpatient consult one afternoon/evening, but she doesn't lay eyes on the patient until the following morning, can she bill for the initial consult? Or does she bill for the first subsequent consult? Where is the information to back up your responses, please?

—Concerned with Coding

Dr. Hospitalist responds:

You don’t say so, but I’m assuming you work as a physician assistant (PA) or a nurse practitioner (NP). Since you and your supervising physician are employed by the same hospital, I also assume your fees are assigned to the hospital and you are both considered members of the same “surgical group.”

Just so we’re all on the same page, let’s further define “global surgical” period. Even though there are three types of global surgical packages, they are all based on the number of expected post-operative days. In general, there are the zero- and 10-day post-op periods (for minor procedures) and the 90-day post-op period (for most major procedures). Almost all services, supplies, wound management, and follow-up visits related to the procedure are included in the global surgery payment.

The discharge summary also is part of the global surgery package. When your supervising physician co-signs and validates your note, she can bill as though she did the note herself as defined in the scope of practice and credentialing process at your hospital.

If allowed by your state and sanctioned by your hospital, you can bill separately; however, the global surgery payment would be decreased as per the Medicare Claims Processing Manual (Chapter 12, Sections 40 and 40.1-Physician/Nonphysician Practitioners), which states that “when a NP, PA, or CNS furnish services to a patient during a global surgical period, contractors shall determine the level of NP [nurse practitioner], PA [physician assistant], or CNS [clinical nurse specialist] involvement in furnishing part of the surgeon’s global surgical package consistent with their current practice of processing such claims.” The manual goes on to say that those NP, PA, or CNS services furnished are paid at 80% of the lesser of the actual charge or 85% of what a physician is paid under the Medicare Physician Fee Schedule.

Now you see why it’s more lucrative for the physician to bill than the NP/PA, especially if the extender is working under the “supervision” of the physician.

As I’m sure you’re aware, effective Jan. 1, 2010, the consultation codes were no longer recognized for Medicare Part B payment. Practitioners are directed to code patient evaluation and management (E/M) visits with E/M codes that represent where the visit occurs and identify the complexity of the visit performed.

Medicare directives are pretty clear that in order to bill for a visit, the physician or clinician must have a “face-to-face” encounter with the patient on the day of service billed. There is an opportunity for the physician and NP/PA from the same group practice to bill a split/shared E/M code under either unique physician identification number (UPIN), but the physician must still have a face-to-face encounter on the day of service or the bill must be submitted using the NP/PA’s UPIN (Medicare Claims Processing Manual, Chapter 12 – Physician/Nonphysician Practitioners. Section 30.6.1-Selection of Level of Evaluation and Management Service. Implemented: 01-04-10).

Therefore, in the situation that you describe, the supervising physician must bill for a subsequent visit E/M code.

Occasionally, teaching institutions with residents have formalized agreements with insurers that allow residents to see patients one day, with the attending physician allowed to bill for that day without seeing the patient. You should check with your group’s billing specialist to see if such arrangements have been made for your group.

After taking all this into consideration, however, I perceive the bigger issue as underlying tension or mistrust between you and the supervising physician. I suggest sitting down and having a conversation about scope of practice and expectations, and then you can better determine if you are the right person for that position.

Do you have a problem or concern that you’d like Dr. Hospitalist to address? Email your questions to drhospit@wiley.com.

Dr. Nelson

Dr. Nelson

I hope you’re already familiar with “The Key Principles and Characteristics of an Effective Hospital Medicine Group: An Assessment Guide for Hospitals and Hospitalists” [www.hospitalmedicine.org/keychar] and have spent at least a few minutes reviewing the list of 10 “principles” and 47 “characteristics” thought to be associated with effective hospital medicine groups (HMGs). (Full disclosure: I was one of the authors of the article published in February 2014 in the Journal of Hospital Medicine.) Most of us are very busy, so the temptation might be high to set the article aside and risk forgetting it. But I hope many in our field, both clinicians and administrators, will look at it more carefully. There are a number of ways you could use the guide to stimulate thinking or change in your practice.

Grading Our Specialty

I just returned from a meeting of about 10 hospitalist leaders from different organizations around the country. Attendees represented the diversity of our field, including hospital-employed HMGs, large hospitalist management companies, and academic programs. We spent a portion of the meeting discussing what grade we as a group would give the whole specialty of hospital medicine on each of the 10 “principles.” Essentially, we generated a report card for the U.S. hospitalist movement.

This wasn’t a rigorous scientific exercise; instead, it was a robust and thought-provoking discussion around what grade to assign. Opinions regarding the appropriate grade varied significantly, but a common theme was that our specialty really “owns” the importance of pursuing many or most of the principles listed in the article and is devoting time and resources to them even if many individual HMGs might have a long way to go to perform optimally.

For example, meeting attendees thought our field has for a long time worked diligently to “support care coordination across the care continuum” (Principle 6). No one thought that all HMGs do this optimally, but the consensus was that most HMGs have invested effort to do it well. And most were concerned that many HMGs still lack “adequate resources” (Principle 3) and sufficiently “engaged hospitalists” (Principle 2)—and that the former contributes to the latter.

The opinion of the hospitalist leaders who happened to attend the meeting where this conversation took place doesn’t represent the final word on how our specialty is performing, but I think all involved found value in having the conversation, hearing different perspectives about what we’re doing well and where we should focus energy and resources to improve.

Grading Your HM Group

You might want to do something similar within your own group, but make it more relevant by grading how your own practice performs on each of the 10 principles. You could do this on your own just to stimulate your thinking, or you could have each member of your HMG generate a report card of your group’s performance—then discuss where there is agreement or disagreement within the group.

You could structure this sort of individual or group assessment simply as an exercise to generate ideas and conversation about the practice, or your group could take a more formal approach and use it as part of a planning process to determine future practice management-related goals. I know of some groups that scheduled strategic planning meetings specifically to discuss which of the elements to make a priority.

Discussion Document for Leadership

In addition to using the article to generate conversation among hospitalists within your group, it can be a really valuable tool in guiding conversations with hospital leaders and the entity that employs the hospitalists. For example, you could use the article to generate or update the job description of the lead hospitalist or practice manager. Or during annual budgeting for the hospitalist practice, the guide could be used as a checklist to think about whether there are important areas that would benefit from more resources.

Of course, there is a risk that hospital leaders or those who employ the hospitalists could use the article primarily to criticize a hospitalist group and its leader for not already having excellent performance on every one of the principles and characteristics listed. That would be pretty unfortunate; there probably isn’t a single group that performs well on every domain, and the real value of the article is to “be aspirational, helping to raise the bar” for each HMG and our specialty as a whole.

And, as discussed in the article, an HMG doesn’t need to be a stellar performer on all 47 characteristics to be effective. Some of the characteristics listed in the article may not apply to all groups, so all involved in the management of any individual HMG should think about whether to set some aside when assessing their own group.

Where to Go from Here

The article is based on expert opinion, with the help of many more people than those listed as author, and I’m hopeful it will stimulate researchers to study some of these principles and characteristics. For many reasons, we will probably never have robust data, but I’d be happy for whatever we can get.

There is a pretty good chance that the evolution in the work we do and the nature of the hospital setting mean that the principles and characteristics may need to be revised periodically. I would love to know how they might be different in 10 or 20 years.

Dr. Nelson has been a practicing hospitalist since 1988. He is co-founder and past president of SHM, and principal in Nelson Flores Hospital Medicine Consultants. He is co-director for SHM’s “Best Practices in Managing a Hospital Medicine Program” course. Write to him at john.nelson@nelsonflores.com.

Dr. Nelson

Dr. Nelson

I hope you’re already familiar with “The Key Principles and Characteristics of an Effective Hospital Medicine Group: An Assessment Guide for Hospitals and Hospitalists” [www.hospitalmedicine.org/keychar] and have spent at least a few minutes reviewing the list of 10 “principles” and 47 “characteristics” thought to be associated with effective hospital medicine groups (HMGs). (Full disclosure: I was one of the authors of the article published in February 2014 in the Journal of Hospital Medicine.) Most of us are very busy, so the temptation might be high to set the article aside and risk forgetting it. But I hope many in our field, both clinicians and administrators, will look at it more carefully. There are a number of ways you could use the guide to stimulate thinking or change in your practice.

Grading Our Specialty

I just returned from a meeting of about 10 hospitalist leaders from different organizations around the country. Attendees represented the diversity of our field, including hospital-employed HMGs, large hospitalist management companies, and academic programs. We spent a portion of the meeting discussing what grade we as a group would give the whole specialty of hospital medicine on each of the 10 “principles.” Essentially, we generated a report card for the U.S. hospitalist movement.

This wasn’t a rigorous scientific exercise; instead, it was a robust and thought-provoking discussion around what grade to assign. Opinions regarding the appropriate grade varied significantly, but a common theme was that our specialty really “owns” the importance of pursuing many or most of the principles listed in the article and is devoting time and resources to them even if many individual HMGs might have a long way to go to perform optimally.

For example, meeting attendees thought our field has for a long time worked diligently to “support care coordination across the care continuum” (Principle 6). No one thought that all HMGs do this optimally, but the consensus was that most HMGs have invested effort to do it well. And most were concerned that many HMGs still lack “adequate resources” (Principle 3) and sufficiently “engaged hospitalists” (Principle 2)—and that the former contributes to the latter.

The opinion of the hospitalist leaders who happened to attend the meeting where this conversation took place doesn’t represent the final word on how our specialty is performing, but I think all involved found value in having the conversation, hearing different perspectives about what we’re doing well and where we should focus energy and resources to improve.

Grading Your HM Group

You might want to do something similar within your own group, but make it more relevant by grading how your own practice performs on each of the 10 principles. You could do this on your own just to stimulate your thinking, or you could have each member of your HMG generate a report card of your group’s performance—then discuss where there is agreement or disagreement within the group.

You could structure this sort of individual or group assessment simply as an exercise to generate ideas and conversation about the practice, or your group could take a more formal approach and use it as part of a planning process to determine future practice management-related goals. I know of some groups that scheduled strategic planning meetings specifically to discuss which of the elements to make a priority.

Discussion Document for Leadership

In addition to using the article to generate conversation among hospitalists within your group, it can be a really valuable tool in guiding conversations with hospital leaders and the entity that employs the hospitalists. For example, you could use the article to generate or update the job description of the lead hospitalist or practice manager. Or during annual budgeting for the hospitalist practice, the guide could be used as a checklist to think about whether there are important areas that would benefit from more resources.

Of course, there is a risk that hospital leaders or those who employ the hospitalists could use the article primarily to criticize a hospitalist group and its leader for not already having excellent performance on every one of the principles and characteristics listed. That would be pretty unfortunate; there probably isn’t a single group that performs well on every domain, and the real value of the article is to “be aspirational, helping to raise the bar” for each HMG and our specialty as a whole.

And, as discussed in the article, an HMG doesn’t need to be a stellar performer on all 47 characteristics to be effective. Some of the characteristics listed in the article may not apply to all groups, so all involved in the management of any individual HMG should think about whether to set some aside when assessing their own group.

Where to Go from Here

The article is based on expert opinion, with the help of many more people than those listed as author, and I’m hopeful it will stimulate researchers to study some of these principles and characteristics. For many reasons, we will probably never have robust data, but I’d be happy for whatever we can get.

There is a pretty good chance that the evolution in the work we do and the nature of the hospital setting mean that the principles and characteristics may need to be revised periodically. I would love to know how they might be different in 10 or 20 years.

Dr. Nelson has been a practicing hospitalist since 1988. He is co-founder and past president of SHM, and principal in Nelson Flores Hospital Medicine Consultants. He is co-director for SHM’s “Best Practices in Managing a Hospital Medicine Program” course. Write to him at john.nelson@nelsonflores.com.

Dr. Nelson

Dr. Nelson

I hope you’re already familiar with “The Key Principles and Characteristics of an Effective Hospital Medicine Group: An Assessment Guide for Hospitals and Hospitalists” [www.hospitalmedicine.org/keychar] and have spent at least a few minutes reviewing the list of 10 “principles” and 47 “characteristics” thought to be associated with effective hospital medicine groups (HMGs). (Full disclosure: I was one of the authors of the article published in February 2014 in the Journal of Hospital Medicine.) Most of us are very busy, so the temptation might be high to set the article aside and risk forgetting it. But I hope many in our field, both clinicians and administrators, will look at it more carefully. There are a number of ways you could use the guide to stimulate thinking or change in your practice.

Grading Our Specialty

I just returned from a meeting of about 10 hospitalist leaders from different organizations around the country. Attendees represented the diversity of our field, including hospital-employed HMGs, large hospitalist management companies, and academic programs. We spent a portion of the meeting discussing what grade we as a group would give the whole specialty of hospital medicine on each of the 10 “principles.” Essentially, we generated a report card for the U.S. hospitalist movement.

This wasn’t a rigorous scientific exercise; instead, it was a robust and thought-provoking discussion around what grade to assign. Opinions regarding the appropriate grade varied significantly, but a common theme was that our specialty really “owns” the importance of pursuing many or most of the principles listed in the article and is devoting time and resources to them even if many individual HMGs might have a long way to go to perform optimally.

For example, meeting attendees thought our field has for a long time worked diligently to “support care coordination across the care continuum” (Principle 6). No one thought that all HMGs do this optimally, but the consensus was that most HMGs have invested effort to do it well. And most were concerned that many HMGs still lack “adequate resources” (Principle 3) and sufficiently “engaged hospitalists” (Principle 2)—and that the former contributes to the latter.

The opinion of the hospitalist leaders who happened to attend the meeting where this conversation took place doesn’t represent the final word on how our specialty is performing, but I think all involved found value in having the conversation, hearing different perspectives about what we’re doing well and where we should focus energy and resources to improve.

Grading Your HM Group

You might want to do something similar within your own group, but make it more relevant by grading how your own practice performs on each of the 10 principles. You could do this on your own just to stimulate your thinking, or you could have each member of your HMG generate a report card of your group’s performance—then discuss where there is agreement or disagreement within the group.

You could structure this sort of individual or group assessment simply as an exercise to generate ideas and conversation about the practice, or your group could take a more formal approach and use it as part of a planning process to determine future practice management-related goals. I know of some groups that scheduled strategic planning meetings specifically to discuss which of the elements to make a priority.

Discussion Document for Leadership

In addition to using the article to generate conversation among hospitalists within your group, it can be a really valuable tool in guiding conversations with hospital leaders and the entity that employs the hospitalists. For example, you could use the article to generate or update the job description of the lead hospitalist or practice manager. Or during annual budgeting for the hospitalist practice, the guide could be used as a checklist to think about whether there are important areas that would benefit from more resources.

Of course, there is a risk that hospital leaders or those who employ the hospitalists could use the article primarily to criticize a hospitalist group and its leader for not already having excellent performance on every one of the principles and characteristics listed. That would be pretty unfortunate; there probably isn’t a single group that performs well on every domain, and the real value of the article is to “be aspirational, helping to raise the bar” for each HMG and our specialty as a whole.

And, as discussed in the article, an HMG doesn’t need to be a stellar performer on all 47 characteristics to be effective. Some of the characteristics listed in the article may not apply to all groups, so all involved in the management of any individual HMG should think about whether to set some aside when assessing their own group.

Where to Go from Here

The article is based on expert opinion, with the help of many more people than those listed as author, and I’m hopeful it will stimulate researchers to study some of these principles and characteristics. For many reasons, we will probably never have robust data, but I’d be happy for whatever we can get.

There is a pretty good chance that the evolution in the work we do and the nature of the hospital setting mean that the principles and characteristics may need to be revised periodically. I would love to know how they might be different in 10 or 20 years.

Dr. Nelson has been a practicing hospitalist since 1988. He is co-founder and past president of SHM, and principal in Nelson Flores Hospital Medicine Consultants. He is co-director for SHM’s “Best Practices in Managing a Hospital Medicine Program” course. Write to him at john.nelson@nelsonflores.com.