Archive for July 2015

Meet The Villain of Hospital Costs: The Chargemaster

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 first step is to understand basic hospital accounting terms including “costs,” “charges,” “prices,” and “reimbursement”: [caption id="attachment_12969" align="aligncenter" width="980"] Figure from: Moriates, Arora, Shah. Understanding Value-Based Healthcare. New York, New York: Mcgraw-Hill, 2015.[/caption] The chargemaster (also known as the charge description master or “CDM”) is the list of charges for the tens of thousands of billable items at a given hospital – sort of like a menu at a restaurant, but one that is very long and includes reams of inscrutable acronyms and abbreviations. The chargemaster contains the itemized charge…

Reimagining the Sounds of the Hospital: Theory to Practice

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 theorize about the problem. Finally, we need to leave our safe academic bubble and enact the solutions that we colorfully described to each other and our professors. I am finding this framework to be enormously helpful in unpacking the work I am doing at The Children's Hospital of Philadelphia (CHOP) as part of the Society of Hospital Medicine's Student Scholars program. My work at CHOP tackles step one and two in a scientifically rigorous way: identify alarm fatigue in our hospital and determine how it occurs on our floors. What…

Hospitalists Rise, Medicare Falls

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 (more…)

What’s Wrong with Our “Big Data” on the Wards?

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 Data? In the June 2015 issue of The Hospitalist, Karen Appold highlights the unique position that hospitalists hold in the fight against the overwhelming number of alarms generated by patient bedside monitors. In an interview with Ms. Appold, Vladmir Cadet of the ECRI Institute frames alarm load in the context of our current healthcare system, and suggests that alarm fatigue has become an enterprise-wide issue potentially due to sector-wide implementation of error-prone systems. The presence of non-specific alarm settings on our wards hints that alarm mismanagement may be rooted deeper…

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 should. This is the same, seemingly no-brainer proposal that in 2009 was stricken from the eventually approved Patient Protection and Affordable Care Act (PPACA, AKA the ACA, AKA “Obamacare”) in response to the intentional and patently false accusations of government run “death panels” in the hopes of salvaging some measure of bipartisan support. As we all know, the bill eventually passed the following year without a single Republican voting in favor in either the House or Senate – and without funding for ACP sessions! This is not the first attempt…
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