Archive for December 2013

Hospital admissions dipping

The Citi Research group found that November 2013 hospital admissions were the lowest they have been in a decade (~4-5% lower than 2012). This drop is probably multifactorial, but likely exacerbated by the Medicare implementation of the "two midnight" rule. As all hospitalists are now well aware, Medicare requires patients to be placed in "observation" status if the intended duration of the hospital stay is 1-2 midnights. We will continue to see how this new Medicare rule affects inpatient volumes over time (link to article).

Global Health Hospitalists: Strange but Noble Bedfellows

by Bob Wachter This post originally appeared on Wachter's World on December 19, 2013. As my Division of Hospital Medicine has grown – now to about 60 faculty – I spend part of my time figuring out what direction we should go in. At times, the path is obvious. It didn’t take Wayne Gretsky to recognize that we needed expertise in healthcare IT a decade ago, or in cost reduction more recently. The story of how we became the nation’s leading program for “global health hospitalists” is a very different tale. I’ve just returned from visiting our program in Haiti with three of our faculty members and two fellows, and so it seems like a good time to tell this story. Since we created our hospitalist program nearly two decades ago, we’ve pushed our faculty to find an area of interest beyond their clinical work. (Our former chair Lee Goldman,…

Global Health Hospitalists: Strange but Noble Bedfellows

As my Division of Hospital Medicine has grown – now to about 60 faculty – I spend part of my time figuring out what direction we should go in. At times, the path is obvious. It didn’t take Wayne Gretsky to recognize that we needed expertise in healthcare IT a decade ago, or in cost reduction more recently. The story of how we became the nation’s leading program for “global health hospitalists” is a very different tale. I’ve just returned from visiting our program in Haiti with three of our faculty members and two fellows, and so it seems like a good time to tell this story. Since we created our hospitalist program nearly two decades ago, we’ve pushed our faculty to find an area of interest beyond their clinical work. (Our former chair Lee Goldman, a cardiologist, dubbed these areas “diastole” and the name has stuck.) This has been…

What’s in a Number – Part I

119 – that’s one of my numbers. 3.5 - that’s another one. One hundred and nineteen months is the most recent estimate I could find for median survival for CLL.  Three and a half years is the most recent median time from diagnosis until the first treatment is needed. These numbers recently became “mine” after a diagnosis of chronic lymphocytic leukemia this past June.   But what do the numbers actually MEAN? First some context:  I was in Vietnam on a work trip when I noticed the cervical and axillary lymphadenopathy.  I ignored it for another month until a “curbside” with a friend and colleague who encouraged me to actually get it worked up. I was in the midst of a busy and stressful week on our academic hospitalist service, trying to do my best to teach, lead the team, care for patients, and move people through admission to discharge in…
12