Archive for November 2013

Moody’s hospital financial outlook still grim for 2014

Moody's Investors Service predicts the financial outlook for US not-for-profit hospitals will be no better in 2014 (and which has been negative since 2008). They expect hospitals will continue to see tight margins, as revenue will not keep up with expenses. Contributing factors to this revenue deficit include lower Medicare reimbursements, reductions in disproportionate share payments, and lower inpatient volumes (by heather at dhead inc). Uneven uptake in newly insured (via Medicaid or exchanges) will also be unpredictable and highly variable. Overall, for hospitalists, this will have to translate into a continued and fierce focus on Value (Quality / Cost) for all of us, to maintain feasible operating margins within our hospitals (Moody's summary).

Thank you for saving me!

My name is Burke Kealey and I am a hospitalist.  I am honored to be blogging for the Society and to have the opportunity to have a conversation with you about the healthcare system and how we work with and serve our patients.  Now a story: My patient "Sue" came in for a liver biopsy.  My job was to observe her overnight with a planned discharge in the morning.  She underwent the biopsy in the radiology suite and returned to the floor stable.  Her nurse called me urgently to the bedside an hour later as Sue was feeling dizzy and they were having trouble getting a good blood pressure. You all know what's next.  Stat Hgb 5, palpable blood pressure, fluid bolus, stat CT showing blood in the abdomen, and back to radiology for embolization.  I came by to see her afterwards and in her post-procedure haze, she opened her…

On Culture, Compassion, and Chronic Disease

You could say that being a doctor was in my blood.  My father is a small town family physician in Fergus Falls, Minnesota.  I watched him take care of patients and families from before birth to after death.  He did inpatient and outpatient care, seeing patients in clinic, admitting them to the hospital, and following them after discharge.  He maintained close connections to his patients, which I admired, and around the holidays there were often gifts of various home-canned treats.  Growing up, the two things that emerged for me were a love of science and a love of helping others.  It sounds cheesy, but this is what I said in my med school application, and they believed me (or at least let me in on other grounds). In my second year of med school I hatched a plan to delay graduation to study abroad.  With a vague notion of wanting…

International grads and what you might not know

Periodically, I love to tell a story of an encounter with an international medical graduate I worked with years ago.  While toiling as a ward attending at our county hospital at the start of another academic year, I had paired up with a newly arrived intern from Egypt.  A jovial guy who had years of practice experience under his belt, but none here in the U.S., he came to start his training in New York. He had reasonable clinical chops, but due to his short time in America, he lacked, shall we say, U.S. cultural competency.  He did not understand the nuance of our country's open-minded ways—and by open-minded, I don’t mean the red versus blue type. The vignette of our patient seemed simple: a middle-aged female with cellulitis of the lower extremity.  We discussed the case before entering the room, and I told my charge to go to it…