QI Initiatives

NEW YORK—Hospitalists are poised to become key allies with hospital quality and safety officers nationwide, according to veteran hospitalist Jennifer Myers, MD, FHM, director of quality and safety education for Penn Medicine in Philadelphia.

Addressing hospitalists at the seventh annual Mid-Atlantic Hospital Medicine Symposium at Mount Sinai School of Medicine in New York, Dr. Myers said that while the challenges associated with quality improvement (QI) are many, HM leaders have the in-house relationships and respect to push the issue.

"There's really no other specialty more perfectly poised to lead this work," she told more than 180 symposium attendees Friday.

Dr. Myers, in an address titled "Enhancing Patient Safety," told The Hospitalist that HM leaders pursue three broad goals: to participate in QI programs already in place, to help create or foster a culture focused on addressing mistakes, and to teach those lessons to young physicians.

She urged physicians to actively report on mistakes and near misses, and earnestly address the processes that led to them. If a vehicle to discuss the mistakes doesn't exist at an institution, hospitalists can push to start one, she said. If a hospital doesn't have an electronic incident reporting system, a hospitalist can push to get one. "This is the goal," Dr. Myers added. "People coming to work and feeling they can be safe and report errors in the spirit of improvement."

She noted that many hospitalists already oversee quality and safety programs without any formal training. She recommended some of those physicians consider the Quality and Safety Educators Academy (QSEA), a three-day academy designed as a faculty development program and sponsored by SHM and the Alliance for Academic Internal Medicine (AAIM). The academy is March 7-9, 2013, in Tempe, Ariz.

NEW YORK—Hospitalists are poised to become key allies with hospital quality and safety officers nationwide, according to veteran hospitalist Jennifer Myers, MD, FHM, director of quality and safety education for Penn Medicine in Philadelphia.

Addressing hospitalists at the seventh annual Mid-Atlantic Hospital Medicine Symposium at Mount Sinai School of Medicine in New York, Dr. Myers said that while the challenges associated with quality improvement (QI) are many, HM leaders have the in-house relationships and respect to push the issue.

"There's really no other specialty more perfectly poised to lead this work," she told more than 180 symposium attendees Friday.

Dr. Myers, in an address titled "Enhancing Patient Safety," told The Hospitalist that HM leaders pursue three broad goals: to participate in QI programs already in place, to help create or foster a culture focused on addressing mistakes, and to teach those lessons to young physicians.

She urged physicians to actively report on mistakes and near misses, and earnestly address the processes that led to them. If a vehicle to discuss the mistakes doesn't exist at an institution, hospitalists can push to start one, she said. If a hospital doesn't have an electronic incident reporting system, a hospitalist can push to get one. "This is the goal," Dr. Myers added. "People coming to work and feeling they can be safe and report errors in the spirit of improvement."

She noted that many hospitalists already oversee quality and safety programs without any formal training. She recommended some of those physicians consider the Quality and Safety Educators Academy (QSEA), a three-day academy designed as a faculty development program and sponsored by SHM and the Alliance for Academic Internal Medicine (AAIM). The academy is March 7-9, 2013, in Tempe, Ariz.

NEW YORK—Hospitalists are poised to become key allies with hospital quality and safety officers nationwide, according to veteran hospitalist Jennifer Myers, MD, FHM, director of quality and safety education for Penn Medicine in Philadelphia.

Addressing hospitalists at the seventh annual Mid-Atlantic Hospital Medicine Symposium at Mount Sinai School of Medicine in New York, Dr. Myers said that while the challenges associated with quality improvement (QI) are many, HM leaders have the in-house relationships and respect to push the issue.

"There's really no other specialty more perfectly poised to lead this work," she told more than 180 symposium attendees Friday.

Dr. Myers, in an address titled "Enhancing Patient Safety," told The Hospitalist that HM leaders pursue three broad goals: to participate in QI programs already in place, to help create or foster a culture focused on addressing mistakes, and to teach those lessons to young physicians.

She urged physicians to actively report on mistakes and near misses, and earnestly address the processes that led to them. If a vehicle to discuss the mistakes doesn't exist at an institution, hospitalists can push to start one, she said. If a hospital doesn't have an electronic incident reporting system, a hospitalist can push to get one. "This is the goal," Dr. Myers added. "People coming to work and feeling they can be safe and report errors in the spirit of improvement."

She noted that many hospitalists already oversee quality and safety programs without any formal training. She recommended some of those physicians consider the Quality and Safety Educators Academy (QSEA), a three-day academy designed as a faculty development program and sponsored by SHM and the Alliance for Academic Internal Medicine (AAIM). The academy is March 7-9, 2013, in Tempe, Ariz.

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The new era of penalizing hospitals for higher-than-predicted 30-day avoidable readmissions rates has begun. Under the federal Hospital Readmissions Reduction Program, some calculate a hospital's excessive readmissions rate for each applicable condition.

Penalties for the current fiscal year—FY 2013, which began Oct. 1, 2012—will be based on discharges that occurred during the three-year period from July 1, 2008, to June 30, 2011, according to the program guidelines. For hospitals that don't improve, the penalty grows to a maximum 2% next year (FY14) and 3% in FY15.

Hospitalists are not penalized directly for readmissions, and many hospitalists are wondering about the extent to which they're responsible for a readmission after the patient leaves the hospital, notes Mark Williams, MD, FACP, MHM, chief of the division of hospital medicine at Northwestern University’s Feinberg School of Medicine in Chicago.

Dr. Williams is the principal investigator of SHM’s Project BOOST (Better Outcomes for Older Adults through Safe Transitions), one of several national quality initiatives that teach hospitals and other healthcare providers how to improve transitions of care through such techniques as patient coaching and community partnerships.

"These new penalties mean that hospitals will start talking to their physicians about readmissions, and looking for methods to incentivize the hospitalists to get involved in preventing them," Dr. Williams says.

The new era of penalizing hospitals for higher-than-predicted 30-day avoidable readmissions rates has begun. Under the federal Hospital Readmissions Reduction Program, some calculate a hospital's excessive readmissions rate for each applicable condition.

Penalties for the current fiscal year—FY 2013, which began Oct. 1, 2012—will be based on discharges that occurred during the three-year period from July 1, 2008, to June 30, 2011, according to the program guidelines. For hospitals that don't improve, the penalty grows to a maximum 2% next year (FY14) and 3% in FY15.

Hospitalists are not penalized directly for readmissions, and many hospitalists are wondering about the extent to which they're responsible for a readmission after the patient leaves the hospital, notes Mark Williams, MD, FACP, MHM, chief of the division of hospital medicine at Northwestern University’s Feinberg School of Medicine in Chicago.

Dr. Williams is the principal investigator of SHM’s Project BOOST (Better Outcomes for Older Adults through Safe Transitions), one of several national quality initiatives that teach hospitals and other healthcare providers how to improve transitions of care through such techniques as patient coaching and community partnerships.

"These new penalties mean that hospitals will start talking to their physicians about readmissions, and looking for methods to incentivize the hospitalists to get involved in preventing them," Dr. Williams says.

The new era of penalizing hospitals for higher-than-predicted 30-day avoidable readmissions rates has begun. Under the federal Hospital Readmissions Reduction Program, some calculate a hospital's excessive readmissions rate for each applicable condition.

Penalties for the current fiscal year—FY 2013, which began Oct. 1, 2012—will be based on discharges that occurred during the three-year period from July 1, 2008, to June 30, 2011, according to the program guidelines. For hospitals that don't improve, the penalty grows to a maximum 2% next year (FY14) and 3% in FY15.

Hospitalists are not penalized directly for readmissions, and many hospitalists are wondering about the extent to which they're responsible for a readmission after the patient leaves the hospital, notes Mark Williams, MD, FACP, MHM, chief of the division of hospital medicine at Northwestern University’s Feinberg School of Medicine in Chicago.

Dr. Williams is the principal investigator of SHM’s Project BOOST (Better Outcomes for Older Adults through Safe Transitions), one of several national quality initiatives that teach hospitals and other healthcare providers how to improve transitions of care through such techniques as patient coaching and community partnerships.

"These new penalties mean that hospitals will start talking to their physicians about readmissions, and looking for methods to incentivize the hospitalists to get involved in preventing them," Dr. Williams says.

Bringing a neurohospitalist service into an academic medical center can reduce neurological patients' length of stay (LOS) at the facility, according to a study in Neurology.

The retrospective cohort study, "Effect of a Neurohospitalist Service on Outcomes at an Academic Medical Center," found that the mean LOS dropped to 4.6 days while the neurohospitalist service was in place, compared with 6.3 days during the pre-neurohospitalist period. However, adding the service didn't significantly reduce the median cost of care delivery ($6,758 vs. $7,241; P=0.25) or in-hospital mortality rate (1.6% vs. 1.2%; P=0.61), the study noted.

Lead author Vanja Douglas, MD, health sciences assistant clinical professor in the department of neurology at the University of California at San Francisco (UCSF) School of Medicine, says the study's impact is limited by its single-center universe of data. The study was conducted at a UCSF Medical Center in October 2006, but Dr. Douglas hopes similar studies at other academic or community centers will replicate the findings.

"If the current model people have in place is not necessarily focused on outcomes like LOS and cost, then making a change to a neurohospitalist model is likely to positively affect those outcomes," says Dr. Douglas, editor in chief of The Neurohospitalist.

Investigators tracked administrative data starting 21 months before UCSF added a neurohospitalist service and 27 months after. The service was comprised of one neurohospitalist focused solely on inpatients, which allowed other staff neurologists to focus on consultative cases throughout the hospital. Dr. Douglas says as HM groups look to improve their scope of practice and bottom line, studies such as his can lay the groundwork to make the investment.

"A lot of the groups that contract with hospitals are interested in partnering with subspecialty hospitalists," Dr. Douglas adds. "A neurohospitalist model has the potential to work, and the potential to improve outcomes."

Bringing a neurohospitalist service into an academic medical center can reduce neurological patients' length of stay (LOS) at the facility, according to a study in Neurology.

The retrospective cohort study, "Effect of a Neurohospitalist Service on Outcomes at an Academic Medical Center," found that the mean LOS dropped to 4.6 days while the neurohospitalist service was in place, compared with 6.3 days during the pre-neurohospitalist period. However, adding the service didn't significantly reduce the median cost of care delivery ($6,758 vs. $7,241; P=0.25) or in-hospital mortality rate (1.6% vs. 1.2%; P=0.61), the study noted.

Lead author Vanja Douglas, MD, health sciences assistant clinical professor in the department of neurology at the University of California at San Francisco (UCSF) School of Medicine, says the study's impact is limited by its single-center universe of data. The study was conducted at a UCSF Medical Center in October 2006, but Dr. Douglas hopes similar studies at other academic or community centers will replicate the findings.

"If the current model people have in place is not necessarily focused on outcomes like LOS and cost, then making a change to a neurohospitalist model is likely to positively affect those outcomes," says Dr. Douglas, editor in chief of The Neurohospitalist.

Investigators tracked administrative data starting 21 months before UCSF added a neurohospitalist service and 27 months after. The service was comprised of one neurohospitalist focused solely on inpatients, which allowed other staff neurologists to focus on consultative cases throughout the hospital. Dr. Douglas says as HM groups look to improve their scope of practice and bottom line, studies such as his can lay the groundwork to make the investment.

"A lot of the groups that contract with hospitals are interested in partnering with subspecialty hospitalists," Dr. Douglas adds. "A neurohospitalist model has the potential to work, and the potential to improve outcomes."

Bringing a neurohospitalist service into an academic medical center can reduce neurological patients' length of stay (LOS) at the facility, according to a study in Neurology.

The retrospective cohort study, "Effect of a Neurohospitalist Service on Outcomes at an Academic Medical Center," found that the mean LOS dropped to 4.6 days while the neurohospitalist service was in place, compared with 6.3 days during the pre-neurohospitalist period. However, adding the service didn't significantly reduce the median cost of care delivery ($6,758 vs. $7,241; P=0.25) or in-hospital mortality rate (1.6% vs. 1.2%; P=0.61), the study noted.

Lead author Vanja Douglas, MD, health sciences assistant clinical professor in the department of neurology at the University of California at San Francisco (UCSF) School of Medicine, says the study's impact is limited by its single-center universe of data. The study was conducted at a UCSF Medical Center in October 2006, but Dr. Douglas hopes similar studies at other academic or community centers will replicate the findings.

"If the current model people have in place is not necessarily focused on outcomes like LOS and cost, then making a change to a neurohospitalist model is likely to positively affect those outcomes," says Dr. Douglas, editor in chief of The Neurohospitalist.

Investigators tracked administrative data starting 21 months before UCSF added a neurohospitalist service and 27 months after. The service was comprised of one neurohospitalist focused solely on inpatients, which allowed other staff neurologists to focus on consultative cases throughout the hospital. Dr. Douglas says as HM groups look to improve their scope of practice and bottom line, studies such as his can lay the groundwork to make the investment.

"A lot of the groups that contract with hospitals are interested in partnering with subspecialty hospitalists," Dr. Douglas adds. "A neurohospitalist model has the potential to work, and the potential to improve outcomes."

Hospitalists join SHM for lots of reasons, but the ability to network with hospitalists across the country is among the top motivators. In an emerging medical specialty, being able to collaborate and connect with peers is critical to career development and improving care.

Now, SHM has made connecting and collaborating easier than ever with Hospital Medicine Exchange (HMX), the first online community exclusively for hospitalists and hot topics in HM. Using HMX, hospitalists can start public discussions, post responses, and share files in one location.

For fast-moving issues, such as healthcare reform and hospitalist program management, HMX enables hospitalists to go straight to the source of some of the most important innovations: other hospitalists.

Using HMX is easy. Hospitalists log in to HMX using their SHM member username and password at HMXchange.org (automated assistance is available for those who don’t know their usernames or passwords). Once logged into HMX, hospitalists can browse communities, check out recent discussion threads, and update their profiles. Members can browse contacts to connect with thousands of other HMX users.

In addition to being the new home for conversations in hospital medicine, communities within HMX are replacing an array of legacy programs (e.g. the email listservs for practice management and SHM’s Leadership Academy alumni). HMX provides new flexibility not available in older systems like the listservs. Users can now opt into communities easily and decide how often they receive updates via email.

Conversation-Starters

Some hospitalists began collaborating with the HMX platform nearly a year ago. At the time, the platform was known as Higher Logic and supported SHM’s CODE-H, an educational program for hospital coding, along with SHM’s Hospital Value-Based Purchasing Toolkit (HVBP), a set of online resources and a community for hospitalists preparing their hospitals for value-based purchasing.

Patrick Torcson, MD, MMM, FACP, SFHM, led the HVBP community and sees the promise that HMX offers hospitalists. “It’s a nice synthesis of both content and resources because of the networking element,” he says. “It has a very real personal element as well.”

The HVBP community used HMX as equal parts educational session, networking, and library. Dr. Torcson and community members presented webinars, then followed up with discussions. Community members also shared resources about value-based purchasing through the discussion threads and the online library.

The immediate online interaction proved to be especially valuable when discussing a topic that was anything but static, he says.

“Because hospital value-based purchasing was unfolding over a timeline from [the Centers for Medicare & Medicaid Services (CMS)], we were able to add content as the program unfolded, including policy papers from Washington, webinars, and other relevant information,” Dr. Torcson explains. “For something like value-based purchasing, there’s no definitive source, so the collaboration was helpful. It’s true for a lot of topics in hospital medicine.

“To have a community tool like this that can accommodate for all the different inputs is really very valuable,” he adds.

HMX is a nice synthesis of both content and resources because of the networking element. It has a very real personal element as well.

—Patrick Torcson, MD, MMM, FACP, SFHM, chair, SHM’s Performance Measuring and Reporting Committee

Something for Every Member

In addition to a community for general issues affecting hospitalists, HMX also features specific communities designed to facilitate conversations on particular issues. As the communities evolve and conversations develop, SHM will add new communities.

Because so many hospitalists access the Internet from mobile devices, HMX is available for iPhones, iPads, and Android platforms through a third-party mobile application. Instructions for downloading and using the app are available at the HMX website.

SHM notified certain listserv users and others about the HMX introduction in August and September. Users quickly took to the new platform. Within a week of introducing HMX, nearly 100 hospitalists logged in for the first time.

The early interest in HMX isn’t surprising to Dr. Torcson, who says he “definitely” will use HMX in the future.

“It’s a great way to share best practices and case studies,” he says. “The personal dimension was really nice to connect so easily with the hospital medicine community. It’s nice to get the perspectives from other colleagues around the country and in different settings.”

Brendon Shank is SHM’s associate vice president of communications.

Hospitalists join SHM for lots of reasons, but the ability to network with hospitalists across the country is among the top motivators. In an emerging medical specialty, being able to collaborate and connect with peers is critical to career development and improving care.

Now, SHM has made connecting and collaborating easier than ever with Hospital Medicine Exchange (HMX), the first online community exclusively for hospitalists and hot topics in HM. Using HMX, hospitalists can start public discussions, post responses, and share files in one location.

For fast-moving issues, such as healthcare reform and hospitalist program management, HMX enables hospitalists to go straight to the source of some of the most important innovations: other hospitalists.

Using HMX is easy. Hospitalists log in to HMX using their SHM member username and password at HMXchange.org (automated assistance is available for those who don’t know their usernames or passwords). Once logged into HMX, hospitalists can browse communities, check out recent discussion threads, and update their profiles. Members can browse contacts to connect with thousands of other HMX users.

In addition to being the new home for conversations in hospital medicine, communities within HMX are replacing an array of legacy programs (e.g. the email listservs for practice management and SHM’s Leadership Academy alumni). HMX provides new flexibility not available in older systems like the listservs. Users can now opt into communities easily and decide how often they receive updates via email.

Conversation-Starters

Some hospitalists began collaborating with the HMX platform nearly a year ago. At the time, the platform was known as Higher Logic and supported SHM’s CODE-H, an educational program for hospital coding, along with SHM’s Hospital Value-Based Purchasing Toolkit (HVBP), a set of online resources and a community for hospitalists preparing their hospitals for value-based purchasing.

Patrick Torcson, MD, MMM, FACP, SFHM, led the HVBP community and sees the promise that HMX offers hospitalists. “It’s a nice synthesis of both content and resources because of the networking element,” he says. “It has a very real personal element as well.”

The HVBP community used HMX as equal parts educational session, networking, and library. Dr. Torcson and community members presented webinars, then followed up with discussions. Community members also shared resources about value-based purchasing through the discussion threads and the online library.

The immediate online interaction proved to be especially valuable when discussing a topic that was anything but static, he says.

“Because hospital value-based purchasing was unfolding over a timeline from [the Centers for Medicare & Medicaid Services (CMS)], we were able to add content as the program unfolded, including policy papers from Washington, webinars, and other relevant information,” Dr. Torcson explains. “For something like value-based purchasing, there’s no definitive source, so the collaboration was helpful. It’s true for a lot of topics in hospital medicine.

“To have a community tool like this that can accommodate for all the different inputs is really very valuable,” he adds.

HMX is a nice synthesis of both content and resources because of the networking element. It has a very real personal element as well.

—Patrick Torcson, MD, MMM, FACP, SFHM, chair, SHM’s Performance Measuring and Reporting Committee

Something for Every Member

In addition to a community for general issues affecting hospitalists, HMX also features specific communities designed to facilitate conversations on particular issues. As the communities evolve and conversations develop, SHM will add new communities.

Because so many hospitalists access the Internet from mobile devices, HMX is available for iPhones, iPads, and Android platforms through a third-party mobile application. Instructions for downloading and using the app are available at the HMX website.

SHM notified certain listserv users and others about the HMX introduction in August and September. Users quickly took to the new platform. Within a week of introducing HMX, nearly 100 hospitalists logged in for the first time.

The early interest in HMX isn’t surprising to Dr. Torcson, who says he “definitely” will use HMX in the future.

“It’s a great way to share best practices and case studies,” he says. “The personal dimension was really nice to connect so easily with the hospital medicine community. It’s nice to get the perspectives from other colleagues around the country and in different settings.”

Brendon Shank is SHM’s associate vice president of communications.

Hospitalists join SHM for lots of reasons, but the ability to network with hospitalists across the country is among the top motivators. In an emerging medical specialty, being able to collaborate and connect with peers is critical to career development and improving care.

Now, SHM has made connecting and collaborating easier than ever with Hospital Medicine Exchange (HMX), the first online community exclusively for hospitalists and hot topics in HM. Using HMX, hospitalists can start public discussions, post responses, and share files in one location.

For fast-moving issues, such as healthcare reform and hospitalist program management, HMX enables hospitalists to go straight to the source of some of the most important innovations: other hospitalists.

Using HMX is easy. Hospitalists log in to HMX using their SHM member username and password at HMXchange.org (automated assistance is available for those who don’t know their usernames or passwords). Once logged into HMX, hospitalists can browse communities, check out recent discussion threads, and update their profiles. Members can browse contacts to connect with thousands of other HMX users.

In addition to being the new home for conversations in hospital medicine, communities within HMX are replacing an array of legacy programs (e.g. the email listservs for practice management and SHM’s Leadership Academy alumni). HMX provides new flexibility not available in older systems like the listservs. Users can now opt into communities easily and decide how often they receive updates via email.

Conversation-Starters

Some hospitalists began collaborating with the HMX platform nearly a year ago. At the time, the platform was known as Higher Logic and supported SHM’s CODE-H, an educational program for hospital coding, along with SHM’s Hospital Value-Based Purchasing Toolkit (HVBP), a set of online resources and a community for hospitalists preparing their hospitals for value-based purchasing.

Patrick Torcson, MD, MMM, FACP, SFHM, led the HVBP community and sees the promise that HMX offers hospitalists. “It’s a nice synthesis of both content and resources because of the networking element,” he says. “It has a very real personal element as well.”

The HVBP community used HMX as equal parts educational session, networking, and library. Dr. Torcson and community members presented webinars, then followed up with discussions. Community members also shared resources about value-based purchasing through the discussion threads and the online library.

The immediate online interaction proved to be especially valuable when discussing a topic that was anything but static, he says.

“Because hospital value-based purchasing was unfolding over a timeline from [the Centers for Medicare & Medicaid Services (CMS)], we were able to add content as the program unfolded, including policy papers from Washington, webinars, and other relevant information,” Dr. Torcson explains. “For something like value-based purchasing, there’s no definitive source, so the collaboration was helpful. It’s true for a lot of topics in hospital medicine.

“To have a community tool like this that can accommodate for all the different inputs is really very valuable,” he adds.

HMX is a nice synthesis of both content and resources because of the networking element. It has a very real personal element as well.

—Patrick Torcson, MD, MMM, FACP, SFHM, chair, SHM’s Performance Measuring and Reporting Committee

Something for Every Member

In addition to a community for general issues affecting hospitalists, HMX also features specific communities designed to facilitate conversations on particular issues. As the communities evolve and conversations develop, SHM will add new communities.

Because so many hospitalists access the Internet from mobile devices, HMX is available for iPhones, iPads, and Android platforms through a third-party mobile application. Instructions for downloading and using the app are available at the HMX website.

SHM notified certain listserv users and others about the HMX introduction in August and September. Users quickly took to the new platform. Within a week of introducing HMX, nearly 100 hospitalists logged in for the first time.

The early interest in HMX isn’t surprising to Dr. Torcson, who says he “definitely” will use HMX in the future.

“It’s a great way to share best practices and case studies,” he says. “The personal dimension was really nice to connect so easily with the hospital medicine community. It’s nice to get the perspectives from other colleagues around the country and in different settings.”

Brendon Shank is SHM’s associate vice president of communications.

The healthcare market is saturated with fee-for-service reimbursement schemes. The Bureau of Labor Statistics estimates that 78% of employer-sponsored health insurance plans are some type of fee-for-service plan.¹ In Medicare, about 75% of beneficiaries use the traditional fee-for-service program.² Fee-for-service denotes that payments are made on individual services, billed separately, irrespective of outcome and, in some cases, necessity.

The physician value-based payment modifier (VBPM) is an initiative that will begin shifting Medicare reimbursement for physicians away from fee-for-service schemes and toward some type of pay-for-performance model.

For hospitalists, this will have a marked impact on HM practice and might have reverberating effects in the field itself.

Established under the 2008 Medicare Improvements for Patients and Providers Act (MIPPA) and expanded under the 2010 Affordable Care Act (ACA), the VBPM will be applied to all physicians by 2017.

The VBPM program is the physician version of hospital value-based purchasing; both are designed to move the basis of payment toward the quality of care delivered, not simply for the quantity of services rendered. By linking quality measurement with payment, the Centers for Medicare & Medicaid Services (CMS) hopes to start paying for value.

While legislation required the creation of pay-for-performance programs for physicians and hospitals, the design and implementation details have been delegated to CMS, part of the U.S. Department of Health and Human Services. Thus, CMS has oversight on the specifics of the program. These specifics are promulgated through the federal rulemaking process, which requires such agencies as CMS to seek input from the general public—as well as medical societies, including SHM—as rules are proposed and finalized. Generally, there is a 30- to 90-day period after a rule is proposed for public comment, after which a rule will be finalized.

For the VBPM and its performance period starting next year, the guidelines were published for public comment in a proposed rule for the fiscal-year 2013 Physician Fee Schedule. The final rule, which will provide more definitive guidance for hospitalists, is slated to come out in November.

Hospitalists should be cognizant of how quality measurements apply to their practice and find ways to participate in such quality measurement programs as the Physician Quality Reporting System (PQRS). PQRS will become the evaluative backbone of the VBPM. It is imperative that hospitalists stay abreast of these transformative changes in the healthcare system and work to ensure that their practice patterns, which fill critical gaps in patient care, are adequately represented in these changes.

Although legislation and legislative advocacy are undoubtedly important features of policymaking, participating in the federal rulemaking process is a vital tool for helping to shape healthcare. SHM actively pursues regulatory issues in order to advocate for hospitalists and their patients. The experiences and expertise of members are critical for SHM to be able to accurately represent the specialty.

By staying informed on health policy and being engaged with SHM, members can provide invaluable perspectives to help transform the field and revolutionize the healthcare system.

Josh Lapps is SHM's government relations specialist.

References

1. U.S. Bureau of Labor Statistics. Program Perspectives: fee-for-service plans. U.S. Bureau of Labor Statistics website. Available at: http://www.bls.gov/opub/perspectives/program_perspectives_vol2_issue5.pdf. Accessed Aug. 15, 2012.
2. The Henry J. Kaiser Family Foundation. Medicare at a glance. The Henry J. Kaiser Family Foundation website. Available at: http://www.kff.org/medicare/upload/1066_11.pdf. Accessed Aug. 29, 2012.

The healthcare market is saturated with fee-for-service reimbursement schemes. The Bureau of Labor Statistics estimates that 78% of employer-sponsored health insurance plans are some type of fee-for-service plan.¹ In Medicare, about 75% of beneficiaries use the traditional fee-for-service program.² Fee-for-service denotes that payments are made on individual services, billed separately, irrespective of outcome and, in some cases, necessity.

The physician value-based payment modifier (VBPM) is an initiative that will begin shifting Medicare reimbursement for physicians away from fee-for-service schemes and toward some type of pay-for-performance model.

For hospitalists, this will have a marked impact on HM practice and might have reverberating effects in the field itself.

Established under the 2008 Medicare Improvements for Patients and Providers Act (MIPPA) and expanded under the 2010 Affordable Care Act (ACA), the VBPM will be applied to all physicians by 2017.

The VBPM program is the physician version of hospital value-based purchasing; both are designed to move the basis of payment toward the quality of care delivered, not simply for the quantity of services rendered. By linking quality measurement with payment, the Centers for Medicare & Medicaid Services (CMS) hopes to start paying for value.

While legislation required the creation of pay-for-performance programs for physicians and hospitals, the design and implementation details have been delegated to CMS, part of the U.S. Department of Health and Human Services. Thus, CMS has oversight on the specifics of the program. These specifics are promulgated through the federal rulemaking process, which requires such agencies as CMS to seek input from the general public—as well as medical societies, including SHM—as rules are proposed and finalized. Generally, there is a 30- to 90-day period after a rule is proposed for public comment, after which a rule will be finalized.

For the VBPM and its performance period starting next year, the guidelines were published for public comment in a proposed rule for the fiscal-year 2013 Physician Fee Schedule. The final rule, which will provide more definitive guidance for hospitalists, is slated to come out in November.

Hospitalists should be cognizant of how quality measurements apply to their practice and find ways to participate in such quality measurement programs as the Physician Quality Reporting System (PQRS). PQRS will become the evaluative backbone of the VBPM. It is imperative that hospitalists stay abreast of these transformative changes in the healthcare system and work to ensure that their practice patterns, which fill critical gaps in patient care, are adequately represented in these changes.

Although legislation and legislative advocacy are undoubtedly important features of policymaking, participating in the federal rulemaking process is a vital tool for helping to shape healthcare. SHM actively pursues regulatory issues in order to advocate for hospitalists and their patients. The experiences and expertise of members are critical for SHM to be able to accurately represent the specialty.

By staying informed on health policy and being engaged with SHM, members can provide invaluable perspectives to help transform the field and revolutionize the healthcare system.

Josh Lapps is SHM's government relations specialist.

References

1. U.S. Bureau of Labor Statistics. Program Perspectives: fee-for-service plans. U.S. Bureau of Labor Statistics website. Available at: http://www.bls.gov/opub/perspectives/program_perspectives_vol2_issue5.pdf. Accessed Aug. 15, 2012.
2. The Henry J. Kaiser Family Foundation. Medicare at a glance. The Henry J. Kaiser Family Foundation website. Available at: http://www.kff.org/medicare/upload/1066_11.pdf. Accessed Aug. 29, 2012.

The healthcare market is saturated with fee-for-service reimbursement schemes. The Bureau of Labor Statistics estimates that 78% of employer-sponsored health insurance plans are some type of fee-for-service plan.¹ In Medicare, about 75% of beneficiaries use the traditional fee-for-service program.² Fee-for-service denotes that payments are made on individual services, billed separately, irrespective of outcome and, in some cases, necessity.

The physician value-based payment modifier (VBPM) is an initiative that will begin shifting Medicare reimbursement for physicians away from fee-for-service schemes and toward some type of pay-for-performance model.

For hospitalists, this will have a marked impact on HM practice and might have reverberating effects in the field itself.

Established under the 2008 Medicare Improvements for Patients and Providers Act (MIPPA) and expanded under the 2010 Affordable Care Act (ACA), the VBPM will be applied to all physicians by 2017.

The VBPM program is the physician version of hospital value-based purchasing; both are designed to move the basis of payment toward the quality of care delivered, not simply for the quantity of services rendered. By linking quality measurement with payment, the Centers for Medicare & Medicaid Services (CMS) hopes to start paying for value.

While legislation required the creation of pay-for-performance programs for physicians and hospitals, the design and implementation details have been delegated to CMS, part of the U.S. Department of Health and Human Services. Thus, CMS has oversight on the specifics of the program. These specifics are promulgated through the federal rulemaking process, which requires such agencies as CMS to seek input from the general public—as well as medical societies, including SHM—as rules are proposed and finalized. Generally, there is a 30- to 90-day period after a rule is proposed for public comment, after which a rule will be finalized.

For the VBPM and its performance period starting next year, the guidelines were published for public comment in a proposed rule for the fiscal-year 2013 Physician Fee Schedule. The final rule, which will provide more definitive guidance for hospitalists, is slated to come out in November.

Hospitalists should be cognizant of how quality measurements apply to their practice and find ways to participate in such quality measurement programs as the Physician Quality Reporting System (PQRS). PQRS will become the evaluative backbone of the VBPM. It is imperative that hospitalists stay abreast of these transformative changes in the healthcare system and work to ensure that their practice patterns, which fill critical gaps in patient care, are adequately represented in these changes.

Although legislation and legislative advocacy are undoubtedly important features of policymaking, participating in the federal rulemaking process is a vital tool for helping to shape healthcare. SHM actively pursues regulatory issues in order to advocate for hospitalists and their patients. The experiences and expertise of members are critical for SHM to be able to accurately represent the specialty.

By staying informed on health policy and being engaged with SHM, members can provide invaluable perspectives to help transform the field and revolutionize the healthcare system.

Josh Lapps is SHM's government relations specialist.

References

1. U.S. Bureau of Labor Statistics. Program Perspectives: fee-for-service plans. U.S. Bureau of Labor Statistics website. Available at: http://www.bls.gov/opub/perspectives/program_perspectives_vol2_issue5.pdf. Accessed Aug. 15, 2012.
2. The Henry J. Kaiser Family Foundation. Medicare at a glance. The Henry J. Kaiser Family Foundation website. Available at: http://www.kff.org/medicare/upload/1066_11.pdf. Accessed Aug. 29, 2012.

Tomorrow’s hospital will be increasingly oriented around quality and safety; today’s students must prepare to thrive in that environment.

That’s the philosophy behind SHM’s Quality and Safety Educators Academy (QSEA). Now in its second year, the two-and-a-half-day academy trains hospitalist educators to teach medical students and residents about quality and safety.

QSEA, co-hosted by SHM and the Alliance for Academic Internal Medicine, is March 7-9 at Tempe Mission Palms in Tempe, Ariz. Registration is now open at www.hospitalmedicine.org/qsea.

“In order to be successful, we must teach medical students and residents about these goals so that they incorporate them into their practice from day one,” says Jennifer S. Myers, MD, associate professor of clinical medicine, patient safety officer, and director of quality and safety education at the University of Pennsylvania’s Perelman School of Medicine in Philadelphia.

Progress in quality improvement (QI) and patient safety has been slow because many current physicians aren’t familiar with the materials, creating what Dr. Myers refers to as a “faculty development” gap. QSEA is the first and only academy designed to close that gap for hospitalist faculty by giving them specific knowledge, skills, a take-home toolkit, and a brand-new peer network of other quality-minded educators.

A major part of the academy is dedicated to the career trajectory of educators and, in Dr. Myers’ words, “how a hospitalist can be successful in making quality and safety education a career path.”

Despite the serious topics, she also is quick to point out that the academy is anything but dry.

“You have to experience it,” she says. “We have a ton of fun. You will leave with a new family.”

At the end of the inaugural QSEA, the faculty and course directors were so energized by the attendees that they formed a human pyramid. “It was a great moment,” she says.

Dr. Myers says she still enjoys receiving email from QSEA attendees about their new adventures in quality and safety education. “This makes it all worth it and why the QSEA team does this work,” she says.

Tomorrow’s hospital will be increasingly oriented around quality and safety; today’s students must prepare to thrive in that environment.

That’s the philosophy behind SHM’s Quality and Safety Educators Academy (QSEA). Now in its second year, the two-and-a-half-day academy trains hospitalist educators to teach medical students and residents about quality and safety.

QSEA, co-hosted by SHM and the Alliance for Academic Internal Medicine, is March 7-9 at Tempe Mission Palms in Tempe, Ariz. Registration is now open at www.hospitalmedicine.org/qsea.

“In order to be successful, we must teach medical students and residents about these goals so that they incorporate them into their practice from day one,” says Jennifer S. Myers, MD, associate professor of clinical medicine, patient safety officer, and director of quality and safety education at the University of Pennsylvania’s Perelman School of Medicine in Philadelphia.

Progress in quality improvement (QI) and patient safety has been slow because many current physicians aren’t familiar with the materials, creating what Dr. Myers refers to as a “faculty development” gap. QSEA is the first and only academy designed to close that gap for hospitalist faculty by giving them specific knowledge, skills, a take-home toolkit, and a brand-new peer network of other quality-minded educators.

A major part of the academy is dedicated to the career trajectory of educators and, in Dr. Myers’ words, “how a hospitalist can be successful in making quality and safety education a career path.”

Despite the serious topics, she also is quick to point out that the academy is anything but dry.

“You have to experience it,” she says. “We have a ton of fun. You will leave with a new family.”

At the end of the inaugural QSEA, the faculty and course directors were so energized by the attendees that they formed a human pyramid. “It was a great moment,” she says.

Dr. Myers says she still enjoys receiving email from QSEA attendees about their new adventures in quality and safety education. “This makes it all worth it and why the QSEA team does this work,” she says.

Tomorrow’s hospital will be increasingly oriented around quality and safety; today’s students must prepare to thrive in that environment.

That’s the philosophy behind SHM’s Quality and Safety Educators Academy (QSEA). Now in its second year, the two-and-a-half-day academy trains hospitalist educators to teach medical students and residents about quality and safety.

QSEA, co-hosted by SHM and the Alliance for Academic Internal Medicine, is March 7-9 at Tempe Mission Palms in Tempe, Ariz. Registration is now open at www.hospitalmedicine.org/qsea.

“In order to be successful, we must teach medical students and residents about these goals so that they incorporate them into their practice from day one,” says Jennifer S. Myers, MD, associate professor of clinical medicine, patient safety officer, and director of quality and safety education at the University of Pennsylvania’s Perelman School of Medicine in Philadelphia.

Progress in quality improvement (QI) and patient safety has been slow because many current physicians aren’t familiar with the materials, creating what Dr. Myers refers to as a “faculty development” gap. QSEA is the first and only academy designed to close that gap for hospitalist faculty by giving them specific knowledge, skills, a take-home toolkit, and a brand-new peer network of other quality-minded educators.

A major part of the academy is dedicated to the career trajectory of educators and, in Dr. Myers’ words, “how a hospitalist can be successful in making quality and safety education a career path.”

Despite the serious topics, she also is quick to point out that the academy is anything but dry.

“You have to experience it,” she says. “We have a ton of fun. You will leave with a new family.”

At the end of the inaugural QSEA, the faculty and course directors were so energized by the attendees that they formed a human pyramid. “It was a great moment,” she says.

Dr. Myers says she still enjoys receiving email from QSEA attendees about their new adventures in quality and safety education. “This makes it all worth it and why the QSEA team does this work,” she says.

Despite calls for board-certified intensivists to manage all critically ill patients, only a third of hospitalized ICU patients currently are seen by such a specialist—mostly because there are not enough of them to go around.^1,2 More and more hospitalists, especially those in community hospitals, are working in ICUs (see “The Critical-Care Debate,”). With the proper training, that can be a good thing for patients and hospitalists, according to a Research, Innovations, and Clinical Vignettes (RIV) abstract presented at HM12 in San Diego.³

Lead author and hospitalist Mark Krivopal, MD, SFHM, formerly with TeamHealth in California and now vice president and medical director of clinical integration and hospital medicine at Steward Health Care in Boston, outlined a program at California’s Lodi Memorial Hospital that identified a group of hospitalists who had experience in caring for critically ill patients and credentials to perform such procedures as central-line placements, intubations, and ventilator management. The select group of TeamHealth hospitalists completed a two-day “Fundamentals of Critical Care Support” course offered by the Society of Critical Care Medicine (www.sccm.org), then began covering the ICU in shifts from 7 a.m. to 7 p.m. The program was so successful early on that hospital administration requested that it expand to a 24-hour service.

An ICU hospitalist program needs to be a partnership, Dr. Krivopal says. Essential oversight at Lodi Memorial is provided by the hospital’s sole pulmonologist.

Preliminary data showed a 35% reduction in ventilator days and 22% reduction in ICU stays, Dr. Krivopal says. The hospital also reports high satisfaction from nurses and other staff. Additional metrics, such as cost savings and patient satisfaction, are under review.

“So long as the level of training is sufficient, this is an approach that definitely should be explored,” he says, adding that young internists have many of the skills needed for ICU work. “But if you don’t keep those skills up [with practice] after residency, you lose them.”

References

1. The Leapfrog Group. ICU physician staffing fact sheet. The Leapfrog Group website. Available at: http://www.leapfroggroup.org/media/file/Leapfrog-ICU_Physician_Staffing_Fact_Sheet.pdf. Accessed Aug. 29, 2012.
2. Health Resources & Services Administration. Report to Congress: The critical care workforce: a study of the supply and demand for critical care physicians. U.S. Department of Health & Human Services website. Available at: http://bhpr.hrsa.gov/healthworkforce/reports/studycriticalcarephys.pdf. Accessed Aug. 29, 2012.
3. Krivopal M, Hlaing M, Felber R, Himebaugh R. ICU hospitalist: a novel method of care for the critically ill patients in economically lean times. J Hosp Med. 2012;7(Suppl 2):192.

Despite calls for board-certified intensivists to manage all critically ill patients, only a third of hospitalized ICU patients currently are seen by such a specialist—mostly because there are not enough of them to go around.^1,2 More and more hospitalists, especially those in community hospitals, are working in ICUs (see “The Critical-Care Debate,”). With the proper training, that can be a good thing for patients and hospitalists, according to a Research, Innovations, and Clinical Vignettes (RIV) abstract presented at HM12 in San Diego.³

Lead author and hospitalist Mark Krivopal, MD, SFHM, formerly with TeamHealth in California and now vice president and medical director of clinical integration and hospital medicine at Steward Health Care in Boston, outlined a program at California’s Lodi Memorial Hospital that identified a group of hospitalists who had experience in caring for critically ill patients and credentials to perform such procedures as central-line placements, intubations, and ventilator management. The select group of TeamHealth hospitalists completed a two-day “Fundamentals of Critical Care Support” course offered by the Society of Critical Care Medicine (www.sccm.org), then began covering the ICU in shifts from 7 a.m. to 7 p.m. The program was so successful early on that hospital administration requested that it expand to a 24-hour service.

An ICU hospitalist program needs to be a partnership, Dr. Krivopal says. Essential oversight at Lodi Memorial is provided by the hospital’s sole pulmonologist.

Preliminary data showed a 35% reduction in ventilator days and 22% reduction in ICU stays, Dr. Krivopal says. The hospital also reports high satisfaction from nurses and other staff. Additional metrics, such as cost savings and patient satisfaction, are under review.

“So long as the level of training is sufficient, this is an approach that definitely should be explored,” he says, adding that young internists have many of the skills needed for ICU work. “But if you don’t keep those skills up [with practice] after residency, you lose them.”

References

1. The Leapfrog Group. ICU physician staffing fact sheet. The Leapfrog Group website. Available at: http://www.leapfroggroup.org/media/file/Leapfrog-ICU_Physician_Staffing_Fact_Sheet.pdf. Accessed Aug. 29, 2012.
2. Health Resources & Services Administration. Report to Congress: The critical care workforce: a study of the supply and demand for critical care physicians. U.S. Department of Health & Human Services website. Available at: http://bhpr.hrsa.gov/healthworkforce/reports/studycriticalcarephys.pdf. Accessed Aug. 29, 2012.
3. Krivopal M, Hlaing M, Felber R, Himebaugh R. ICU hospitalist: a novel method of care for the critically ill patients in economically lean times. J Hosp Med. 2012;7(Suppl 2):192.

Despite calls for board-certified intensivists to manage all critically ill patients, only a third of hospitalized ICU patients currently are seen by such a specialist—mostly because there are not enough of them to go around.^1,2 More and more hospitalists, especially those in community hospitals, are working in ICUs (see “The Critical-Care Debate,”). With the proper training, that can be a good thing for patients and hospitalists, according to a Research, Innovations, and Clinical Vignettes (RIV) abstract presented at HM12 in San Diego.³

Lead author and hospitalist Mark Krivopal, MD, SFHM, formerly with TeamHealth in California and now vice president and medical director of clinical integration and hospital medicine at Steward Health Care in Boston, outlined a program at California’s Lodi Memorial Hospital that identified a group of hospitalists who had experience in caring for critically ill patients and credentials to perform such procedures as central-line placements, intubations, and ventilator management. The select group of TeamHealth hospitalists completed a two-day “Fundamentals of Critical Care Support” course offered by the Society of Critical Care Medicine (www.sccm.org), then began covering the ICU in shifts from 7 a.m. to 7 p.m. The program was so successful early on that hospital administration requested that it expand to a 24-hour service.

An ICU hospitalist program needs to be a partnership, Dr. Krivopal says. Essential oversight at Lodi Memorial is provided by the hospital’s sole pulmonologist.

Preliminary data showed a 35% reduction in ventilator days and 22% reduction in ICU stays, Dr. Krivopal says. The hospital also reports high satisfaction from nurses and other staff. Additional metrics, such as cost savings and patient satisfaction, are under review.

“So long as the level of training is sufficient, this is an approach that definitely should be explored,” he says, adding that young internists have many of the skills needed for ICU work. “But if you don’t keep those skills up [with practice] after residency, you lose them.”

References

1. The Leapfrog Group. ICU physician staffing fact sheet. The Leapfrog Group website. Available at: http://www.leapfroggroup.org/media/file/Leapfrog-ICU_Physician_Staffing_Fact_Sheet.pdf. Accessed Aug. 29, 2012.
2. Health Resources & Services Administration. Report to Congress: The critical care workforce: a study of the supply and demand for critical care physicians. U.S. Department of Health & Human Services website. Available at: http://bhpr.hrsa.gov/healthworkforce/reports/studycriticalcarephys.pdf. Accessed Aug. 29, 2012.
3. Krivopal M, Hlaing M, Felber R, Himebaugh R. ICU hospitalist: a novel method of care for the critically ill patients in economically lean times. J Hosp Med. 2012;7(Suppl 2):192.