Archive for April 2017

We Are Not Done Changing

Recently, the on-line version of JAMA published an original investigation entitled "Patient Mortality During Unannounced Accreditation Surveys at US Hospitals". The purpose of this investigation was to determine the effect of heightened vigilance during unannounced accreditation surveys on safety and quality of inpatient care. The authors found that there was a significant reduction in mortality in patients admitted during the week of surveys by The Joint Commission. The change was more significant in major teaching hospitals, where mortality fell from 6.41% to 5.93% during survey weeks, a 5.9% relative decrease. The positive effects of being monitored have been well documented in all kinds of arenas, such as hand washing and antibiotic stewardship. But mortality? This is an interesting outcome, especially considering a recent ordeal I went through with my dear sister-in-law. She was on vacation in a somewhat remote location and suffers from a chronic illness, which requires her to…

Building a Practice that People Want to be Part Of

As those of you who have followed my posts on this blog know, I’ve been spending a lot of time mulling over issues related to hospitalist job satisfaction and career sustainability. I’ve written about concrete things like re-thinking hospitalist work schedules and minimizing low-value interruptions, as well as more abstract concepts like assessing your group’s “gross happiness index.” My fascination with these issues and my concern about their potential impact on the specialty of hospital medicine eventually led John and me, as course directors, to the theme of this year’s practice management pre-course at HM17 – Practice Management Success Strategies: Building a Practice That People Want to Be Part Of. Perhaps, like me, you are interested in digging deeper into matters of career satisfaction and sustainability. Or perhaps you are simply focused on the more mundane struggle just to recruit and retain enough qualified providers for your group. In either…

SHM’s Eisenberg Award, Center for QI and More in HM News

SHM & Hospital Medicine in the News: March 30 – April 13, 2017 Check out the latest hospital medicine and SHM-related stories in mainstream and healthcare news. For the full stories, click on the links below: As a part of the I-PASS Study Group, SHM was awarded the Eisenberg Patient Safety and Quality Award for innovation at the national level. SHM’s Project BOOST (Better Outcomes by Optimizing Safe Transitions) was mentioned in a Healthcare IT News article on improving care transitions with technology. The State of Hospital Medicine Report was cited in an article discussing the benefits of nurse practitioners and physician assistants in hospital medicine groups. SHM members Read Pierce, MD, Efren Manjarrez, MD, SFHM and Joy Engblade, MD recommend five hospital committees for younger hospitalist colleagues in a Medscape Jenna Goldstein, Director of SHM’s Center for Quality Improvement, was quoted in an article highlighting SHM’s commitment to advancing…

A Need for Medicare Appeals Process Reform in Hospital Observation Care

by Ann Sheehy, MD, MS, FHM
By Ann M. Sheehy, MD, MS, FHM Concern has existed regarding Recovery Auditor enforcement of outpatient (observation) and inpatient status determinations. Scrutiny of the contingency fee-based Recovery Auditors, often called Recovery Audit Contractors (“RACs”), has prompted Congressional attention and Centers for Medicare & Medicaid Services (CMS) reforms. Although the impact of these changes is not fully known, there is bipartisan support for reform of the initial auditing step in the Medicare audit and appeals process. Congress and CMS must now turn their attention to reforming the 5-Level Medicare administrative appeals process that follows an initial audit and denial. Last year, the US Government Accountability Office (GAO) report Medicare Fee-for-Service: Opportunities Remain to Improve Appeals Process cited a 2000% increase in Level 3 inpatient appeals from 2010-2014. In response, CMS issued appeals reforms, including allowing senior attorneys to hear some Level 3 appeals and permitting the Medicare Appeals Council to set…
Ann Sheehy, MD, MS, FHM, is a physician and associate professor at the University of Wisconsin (UW) School of Medicine and Public Health. She received her MD and MS in Clinical Research from Mayo Medical School and Mayo Graduate School, respectively, in Rochester, Minnesota. She completed her residency in internal medicine at Johns Hopkins Hospital in Baltimore, Maryland in 2005. The same year, Dr. Sheehy joined the Division of Hospital Medicine as a Clinical Assistant Professor of Medicine at the University of Wisconsin School of Medicine and Public Health. In 2011, she became a Clinical Associate Professor of Medicine. Dr. Sheehy held the position of Interim Director, prior to being appointed Division of Hospital Medicine Director in 2012. Dr. Sheehy has a background in academic medicine, with emphasis on diabetes screening practices and care of inpatients with hyperglycemia, as well as health care disparities and the effect of health care policy on patient care in the hospital. Dr. Sheehy is a member of the Society of Hospital Medicine Public Policy committee, and serves as Vice President of the University of Wisconsin Hospital and Clinics (UWHC) Medical Board and is chair of the Credentials Committee. Dr. Sheehy is a two-time recipient of the Evans-Glassroth Department of Medicine Inpatient Teacher of the Year Award and has also been awarded the University of Wisconsin Internal Medicine Residency Professionalism Award. Dr. Sheehy is an active SHM member in the Public Policy Committee and has found herself on Capitol Hill multiple times, testifying before Congressional committees focused on the U.S. healthcare system, on behalf of hospitalists and SHM.

Overcoming a Continued Physician Shortage

Updated statistics from the Association of American Medical Colleges (AAMC) show that the United States will continue to face a physician shortage over the next decade, ranging from a conservative estimate of a shortfall of approximately 40,000 to a pessimistic estimate of about 105,000 by 2030. The statistics are based on modeling a variety of policy and health care scenarios over the next 10-20 years to determine what the physician workforce requirements will be compared to the expected pipeline. Although the current and projected healthcare landscape is complex, dynamic, and uncertain, every estimate projects a shortage that is significant enough to affect patient care in the United States. The US population is both growing and aging, which creates an ongoing need for hospitalists and hospital-based patient care; between 2015 and 2030, the US population aged 65 and older will increase by 55%. Hospitalist groups will not only be impacted by…
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