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Meet The Villain of Hospital Costs: The Chargemaster

Jul 30, 2015 | 4 Comments

by Christopher Moriates, MD Author of Understanding Value-Based Healthcare* The hospital chargemaster has become nearly a household term, following its turn as the villain in highly publicized features in Time magazine, The New York Times, and the The Daily Show. Nobody seems to like the chargemaster. But what exactly is it and how does it relate to hospital costs? The...

  • Reimagining the Sounds of the Hospital: Theory to Practice
    Reimagining the Sounds of the Hospital: Theory to Practice
    Jul 29, 2015 | No Comments

    By Mimi Zander During my undergraduate studies at Rutgers University, I studied English, women’s and gender studies, and literary theory. As part of The Institute for Women’s Leadership Scholars Program, during class discussions, we would circle back to the idea of bridging theory and practice. The first step is identifying the problem. The next step is to discuss, research, and...

  • Hospitalists Rise, Medicare Falls
    Hospitalists Rise, Medicare Falls
    Jul 28, 2015 | 7 Comments

    Sorta. A new study out today in JAMA you will want to know about: How has Medicare done on the inpatient side from 1999-2013? Medicare all-cause mortality?  DOWN

  • What’s Wrong with Our “Big Data” on the Wards?
    Jul 23, 2015 | No Comments

    by Frank Zadravecz, MPH Across industries, Big Data is widely believed to offer a higher form of intelligence and knowledge that can generate insights that were previously impossible. However, the current cacophony of patient alarms we experience on the wards is not as informative for medical providers as we would hope. Are these alarms adding noise to otherwise informative Big...

  • Hey Hospitalists, Let’s Have a Conversation about “The Conversation”
    Jul 17, 2015 | Comments Off on Hey Hospitalists, Let’s Have a Conversation about “The Conversation”

    by Howard Epstein, MD, FHM Last week, the Center for Medicare and Medicaid Services (CMS) – the nation’s largest payer of healthcare services and the 800 pound gorilla in setting medical necessity and coverage policies – announced a proposal to begin paying for goals of care and advance care planning (ACP) discussions between medical providers and patients. Sound familiar? It...

  • Yes.  I have a problem with mortality rates!
    Yes. I have a problem with mortality rates!
    Jul 16, 2015 | Comments Off on Yes. I have a problem with mortality rates!

    I have always had a bugaboo with mortality rates.  It is a clunky standard. We need death measures to serve as precise tools for quality improvement and hospital performance.  If a hospital has a standardized mortality rate of 3%, you can assume only a small percentage of individuals suffered their fate due to medical error.  People have cancer.  People have...

  • Improving Patient Care as a Trainee
    Jul 14, 2015 | 1 Comment

    by Monica Shah Patient safety has always been a priority for me, but it is only recently that I became aware of the many issues that threaten quality of care for patients. As a medical student, I vividly remember shadowing at the hospital and being shocked at what I saw. I walked through patient rooms and heard loud beeps going...

  • Super-Utilizers: Will they be buying or renting beds?
    Jul 12, 2015 | 7 Comments

    Costs in health care tend to concentrate in the domains of the few (think 80/20 rule).  As it goes for chronically ill community dwellers, the same applies to frequent flyers in the ER.  You may have heard of the term super-utilizers. Those individuals present week after week with innumerable complaints, sometimes pedestrian, sometimes critical–always finding themselves back on the ward for...

  • The War That No One Wins
    The War That No One Wins
    Jul 9, 2015 | Comments Off on The War That No One Wins

    My uncle just died.  He was my mother’s brother,  an irascible blowhard, a mercurial bit of a family dictator with a soft spot for small children. He had the unfortunately common clinical course of catastrophic illness followed by steadfast decline into the heartbreaking oblivion of dementia. This dementia was of a steep descent and his daily life was reduced to...

  • The First Two Years – Pathways and Patient Outcomes
    Jul 8, 2015 | Comments Off on The First Two Years – Pathways and Patient Outcomes

    By Frank Zadravecz, MPH The first two years of our medical curriculum are an introduction to the human body’s normal and pathophysiology, and an attempt to untangle the complex pathways involved in the interactions between self and non-self. We hope to make connections between our physical exam findings and the physiologic pathways we have at our educational foundation. We begin...

  • If You Are a Doctor, You Are a Teacher.
    If You Are a Doctor, You Are a Teacher.
    Jul 7, 2015 | 2 Comments

    To hold him who has taught me this art as equal to my parents and to live my life in partnership with him, and if he is in need of money to give him a share of mine, and to regard his offspring as equal to my brothers in male lineage and to teach them this art—if they desire to...

  • Readmits and ER Docs: Looks Like They Need Their Own Special Penalty Box
    Readmits and ER Docs: Looks Like They Need Their Own Special Penalty Box
    Jul 5, 2015 | 2 Comments

    We have conditioned ourselves to think of readmits in three domains: care transitions (us), patient factors, and community determinants.  Guess what?  I will give you number four.  ER docs.  A new study in JHM looked at the role ERs, and ER physicians play in fee for service Medicare readmissions. The investigators looked at four years of data from Texas hospitals (2008-11),...

  • Settling In
    Settling In
    Jul 2, 2015 | Comments Off on Settling In

    I am coming up on my two year anniversary. Not my wedding anniversary (soon to be 15 years – thanks Maia!), but two years since I joined the ranks of the patients. It was two years ago this week that my day was interrupted by a page from my internist saying, “I don’t know how to tell you this, Brett,...

  • Do Hospitalists Need Paid Time Off?
    Jun 30, 2015 | 7 Comments

    by Leslie Flores, MHA, SFHM Does paid time off (PTO) make sense for physicians like hospitalists and ED docs who are largely shift workers? I guess it depends on your perspective, though I have some definite opinions of my own. But before sharing my thoughts on the value of PTO for hospitalists, it might be instructive to understand a bit...

  • A Chat with Dr. Greg Hall from Project Protect
    Jun 25, 2015 | Comments Off on A Chat with Dr. Greg Hall from Project Protect

    by Dr. Ian Jenkins MD I recently had the opportunity to serve as a mentor for Project Protect, an initiative of the Health Research & Education Trust (HRET) that paired rising stars in quality and infection prevention with mentors from several organizations, including the Society of Hospital Medicine (SHM). Mentees worked on Catheter Associated Urinary Tract Infection (CAUTI) prevention in...

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