John Nelson writes…

In my work with practices around the country, I’m struck by the wide variation in how each practice defines what constitutes full-time work.  This is a pretty big deal for reasons that are obvious and not so obvious.

Say you’re in a practice that defines full-time as 181 shifts annually.  The practice across town provides higher compensation and also requires 181 shifts annually.  The other practice gets a better deal, right?  (more…)

Robert Chang writes…

Stephen Jencks, Mark Williams and Eric Coleman recently published what some rightfully consider a landmark article in NEJM 2009 that discusses the readmission rates in the Medicare population.  Most of us have some awareness that the readmission rate is high although I doubt most would have empirically said 1 in 5.

Some significant proportion of these readmissions is preventable.  The Society of Hospital Medicine has collected a large number of resources in Project BOOST and hospitalists in our institution are eagerly participating.  We all can recollect patients that “if only”…perhaps they wouldn’t have had to return to the hospital.   (more…)

Rob Bessler writes…

When is the conversation going to switch to the rationing of care?

Everyone knows about all the costs in the system during the end stage of life. Should the government pay for this for everyone? (more…)

Rob Chang writes…

It’s the end of the year and evaluation time has come around again.

It’s a laborious process.  Self-assessments, peer assessments, nursing assessments, patient assessments, director assessments….  Thick stapled sheets of papers coated with numbers and ratings lay stacked and scattered across the lined dark carpet and desk in my office, each pile somehow representing the culmination of a year’s worth of effort.  The sheer amount of paperwork could likely reconstitute a small forest. (more…)

John Nelson writes…

Since SHM has began gathering data in 1997, the majority of hospitalists have shifted from a fixed, or “straight,” compensation, to a compensation method that includes a variable component based on performance.  Productivity, as measured in things like RVUs or encounters, is the most common variable element, but quality metrics used as a basis for a portion of compensation are rapidly gaining in popularity.

In late 2008, SHM’s Practice Analysis Committee conducted a survey focused on hospitalist turnover and participation in quality initiatives.  (more…)