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Hospital Mortality Rate as Quality Measure. Tail Wags Dog.

Mar 3, 2015 | No Comments

I first became a mortality rate skeptic when Peter Pronovost’s piece, Using hospital mortality rates to judge hospital performance: a bad idea that just won’t go away, was published in BMJ five years ago. He and his co-author highlighted many of the pitfalls of using mortality rates to assess hospital quality. Similarly, in this months AHRQ Web M&M, Ian Scott, MBBS, MHA, MEd...

  • Workshopping the Elusive ECG
    Workshopping the Elusive ECG
    Mar 3, 2015 | No Comments

    By Dr. Moises Auron MD, FAAP, FACP, SFHM We were taught about it in medical school, then during residency, and we even have questions about it on the boards. Yet still, for a Pediatrician, the electrocardiogram (ECG) appears to be an elusive diagnostic test when it comes to a high degree of certainty on its normality. I usually get questions...

  • For Palliative Care Consultation, Timing is Everything
    For Palliative Care Consultation, Timing is Everything
    Mar 2, 2015 | No Comments

    by Dr. Jason Johanning MD, MS We as surgeons know that the timing of an intervention is an incredibly important decision.  Intervene too early and you expose the patient to potential unneeded risk.  Intervene too late and the disease process has already taken its toll. From a surgical perspective, palliative care consultation on the surgical patient can be looked at...

  • Bad to the Bone
    Bad to the Bone
    Feb 26, 2015 | No Comments

    I came to hospital medicine from the land of pulmonary/critical care. I had spent ten years dealing with septic shock, respiratory failure and acute renal failure. I had intubated, withdrawn life support, placed central lines, performed thoracenteses, and even placed a couple of chest tubes. I had changed tracheostomy tubes, I ran codes. In short I was a critical care...

  • 10 Scripts Never to Write
    10 Scripts Never to Write
    Feb 25, 2015 | No Comments

    by Dr. Charlie Reznikoff, MD A few months ago while attending the general medical floor I met a 60-year-old patient in a tragic situation. She was holding her household together — cooking for, cleaning up after, and parenting her granddaughters, managing the family finances, and trying to reform her two twenty-something daughters who preferred partying to raising their kids. One...

  • If Congress Plans on Fixing the RACs in 2015, They Need To Read This First!
    Feb 24, 2015 | No Comments

    The recent increase in observation stays has led to a surge in federal oversight and scrutiny.  We have covered the dispute on the blog before.  And yes, as the facilitators of the process, the recovery audit contractors (RACs) continue to receive the lion’s share of critical attention—especially with congress. In our attempts to resolve  the issue of appropriate in versus outpatient hospital stay designations,...

  • Value-based Payments: On the top of CMS’s List and Yours, Hospitalists
    Value-based Payments: On the top of CMS’s List and Yours, Hospitalists
    Feb 23, 2015 | No Comments

    The Department of Health and Human Services (HHS) announced a bold new goal to rapidly enhance the adoption of value-based reimbursement for all payors in the medical industry. The Medicare goal is to tie 30% of payments to ACOs or bundled payments by the end of 2016 and 50% by the end of 2018. HHS also set a goal to...

  • Hospital Growth: Time Check
    Feb 22, 2015 | No Comments

      Modern Healthcare has a nice piece out today examining the state of hospital growth and consolidation: Many hospitals across the country are reaching a crossroads. The median age of U.S. hospital buildings is rising, and new construction has dropped sharply, with capital going toward ambulatory-care facilities, physician hiring, information technology and telehealth. Mobile-health apps will become more prevalent over...

  • Accelerate Multistate Medical Licensure sans Redundancy
    Accelerate Multistate Medical Licensure sans Redundancy
    Feb 19, 2015 | 2 Comments

    by Deepak Asudani, MD, MPH, FHM If you aspire to relocate to another state, practice in multiple states, provide telemedicine or take on some per diem work, this should be of interest to you. As part of the feasibility study to bring forth Interstate Medical Licensure Compact, the Federation of State Medical Boards (FSMB) intends to “…develop a comprehensive process...

  • Facing up to the Challenges of Process Change in Healthcare
    Feb 17, 2015 | Comments Off

    by Dr. Luke Hansen MD, MHS “Why can’t everyone just do the right thing?” is a central question in American healthcare. Providers ask it of patients continually and increasingly in the era of the Triple Aim it is also a question the healthcare system is asking itself. How does one of the most advanced evidence production enterprises in the world...

  • If Your Hospital was The Ritz-Carlton, How High Would Your Patients Rate You?
    Feb 16, 2015 | 6 Comments

      I am a skeptic of the physician evaluation component of HCAHPS.  I suspect patients respond to hospital amenities, and better food, bigger TVs, and swankier lobbies have a halo effect—affecting how they assess not just the structural aspects of their care, but how they perceive their caregivers. You probably share my bias.  On an individual level, we can explain...

  • Hospitalists Rewarded for Choosing Wisely: A Win-Win-Win
    Feb 12, 2015 | Comments Off

    by Dr. John Bulger DO, MBA It has been two years since SHM unveiled its Choosing Wisely lists: 5 pediatric and 5 adult tests and treatments which hospitalist and their patients should question. SHM was quite eager at the time to play a role in the effort to create value by reducing cost and improving quality. In many ways, this...

  • Improving Care of Psychiatry Patients: Hospitalists My Kindred Soul
    Feb 11, 2015 | Comments Off

    by Dr. Kristen Sparks MD, MPH I am a psychiatric hospitalist. I didn’t necessarily intend to be, but after residency I gravitated to a large urban inpatient practice. Since then I’ve worked on inpatient psychiatry units in several states and New Zealand. It’s what I’m passionate about and can’t imagine doing anything else. Over the last several years I’ve been...

  • Flu: Treat Early, Late and Often? Thanks, CDC.
    Feb 10, 2015 | Comments Off

    by Dr. Weijen Chang MD FAAP, SFHM Recently, Dr. Tom Frieden, Director of the CDC, in response to criticism about the reduced efficacy of this season’s influenza vaccination has been prominently advocating use of antiviral medications (oseltamivir and zanamivir) for the treatment of influenza infections in adults and children. In short, his philosophy can be paraphrased as, “Treat early, treat...

  • I Fear This Might be My Last SHM Annual Meeting
    Feb 9, 2015 | 1 Comment

    by Randy J. Ferrance, DC, MD, FAAP, SFHM Let me say this first: I love being a hospitalist. I entered medical school as a primary care poster child, but from the first time I stepped onto the wards, I knew that was where I belonged. The acuity, the excitement, the gratification of admitting a patient who is nearly dead –...

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