Archive for September 2015

Will Nurses Be Part of the Answer to HM Sustainability?

by Leslie Flores
In my last post I suggested that in order for hospital medicine to be both financially and professionally sustainable, we need to figure out how hospitalists can see more patients each day while at the same time be more satisfied with their work. One possible approach to achieving this aim is to support physician hospitalists with less costly staff doing work not requiring a physician’s license or expertise. The most common skill mix diversification approach in Hospital Medicine Groups (HMGs) has been to add NPs and/or PAs to the team. SHM’s 2014 State of Hospital Medicine Report indicates that more than 65% of HMGs serving adults have one or more NP/PAs practicing in them. Over the last year or two, though, I’ve increasingly encountered the presence of nurses (usually RNs, though sometimes LPNs) in clinical roles supporting hospitalist practices. A few groups have incorporated nurses for years, but now more…
Leslie Flores is a founding partner at Nelson Flores Hospital Medicine Consultants, a consulting practice that has specialized in helping clients enhance the effectiveness and value of hospital medicine programs as well as those in other hospital-focused practice specialties since 20104. Ms. Flores began her career as a hospital executive, after receiving a BS degree in biological sciences at the University of California at Irvine and a Master’s in healthcare administration from the University of Minnesota. In addition to her leadership experience in hospital operations, business development, managed care and physician relations, she has provided consulting, training and leadership coaching services for hospitals, physician groups, and other healthcare organizations. Ms. Flores is an active speaker and writer on hospitalist practice management topics and serves on SHM’s Practice Analysis and Annual Meeting Committees. She serves as an informal advisor to SHM on practice management-related issues and helps to coordinate SHM’s bi-annual State of Hospital Medicine Survey.

SHM Media Highlights: September 10-24

by Brendon Shank
Expansive coverage of Journal of Hospital Medicine research, advance care planning, hospitalist spotlights, the transition to ICD-10 coding and disparities in Medicare readmission penalties received attention across local and national news outlets in this edition of media highlights. An article in the Journal of Hospital Medicine about a quick tool to diagnose delirium at the bedside has been receiving a higher than average amount of press pickup in multiple articles in both healthcare and mainstream media. Its Altmetric score puts it in the top five percent of all articles scored, and it is also popular on social media – including in a post from Dr. Burke Kealey on The Hospital Leader blog. Regional news outlets provided hospital medicine with additional exposure. A New York publication reviewed a Sarah Lawrence College seminar on end-of-life care discussions, including a mention of SHM and Government Relations Manager Joshua Lapps, who was among the team…
Brendon Shank is the Associate Vice President of the Society of Hospital Medicine and is a member of the PRSA Health Academy Executive Committee. You can find him on Twitter, @BShank.

A Better Understanding of Hospital Medicine

By: Monica Shah As I wrap up my research as an SHM student hospitalist scholar, I look back and think of all that I’ve learned. I am starting my second year of medical school with a whole new perspective on how hospital conditions affect patient outcomes. I know that, as a medical student and future physician, I will always be mindful of patient concerns. Now I have a better understanding of how maintaining good living conditions during hospitalization is an important part of treatment plans for patients for better overall functional recovery. Most importantly, I feel inspired by the numerous hospitalists I’ve encountered and the positive impact they make every day. I still remember the first day I started my project at the beginning of the summer. I recall being unsure of what to expect with hospital medicine research. One thing I learned throughout the summer is that hospital medicine…

Physician Assessment Gone Bad

  Some in our profession have begun to think hard about our future pay and incentives, especially given the vagueness of the recently passed MACRA legislation. MACRA replaced the SGR and put in place a model of compensation that in theory balances both physician accountability and just rewards for hard work.  The two MACRA tracks, the Merit-Based Incentive Payment System (MIPS) or the Alternative Payment Model (APM) are long on promise, however, but short on substance.  Read here for more (a brief and outstanding NEJM commentary). So much needs working out, and first among them requires us to deliver an appropriate means by which to assess physician achievement.  We have no functional framework to work off of and no history as a guide. How do you evaluate a provider when few valid instruments to measure performance exist? How do you reward a doctor for value when your metrics do not…

The Return of the Death Panel?

Few media flaps have left me as disappointed in us as a country as the vortex we allowed ourselves to be swept into around the “death panel” debate in 2009.   Initially I watched in stunned disbelief, later in anger and frustration as a logical and patient-centered proposal was slandered to the point that it was taken out of the Affordable Care Act, never to resurface until now. There has been recognition for years that we are failing our patients at the end of their lives – a most vulnerable time - delivering care that is not aligned with patients’ values, puts them through needless suffering, and, by the way, is super expensive. Thankfully, the Center for Medicare and Medicaid Service (CMS) is once again considering reimbursing physicians for these voluntary conversations between patients and providers. In our health care system, care can end up incredibly fragmented. The sicker the patient,…