JAMA released a theme issue today, and the spotlight shines on readmissions.  I will weigh in on the findings shortly as the issue contains a good deal of material.  However, our own Mark Williams writes the featured commentary and I will let him cue the release:  

Would you like to read about some good policy, but bad execution?  Browse on.

On the physician side of the ledger, we trust that observation units, i.e., geographic weigh stations to determine fitness of admission or discharge, are a good thing.  Earlier discharge, focused resource use, possibly less exposure to hospital badness—all winning strategies to improve efficiency.  What is the problem then?  From todays WSJ:

With the financial pressures hospitals are facing due to decreases in health care compensation, the RAC, etc,  and the changes in healthcare architecture coming with ACOs, there will continued pressure on hospitalist programs to cut costs and decrease staffing while improving our quality of care.  I truly believe we need all the information we can get to know where we stand as hospitalists and to help us plan for what’s to come. We need this so we can best serve the institutions where we work and the hospitalists we work with.  The SHM and MGMA surveys on hospital medicine are out and we need to fill them in.  Here is how: 

The August 2nd citation, Association of Hospitalist Care With Medical Utilization After Discharge: Evidence of Cost Shift From a Cohort Study, generated an enormous amount of attention.The response was significant, and many of the letters published are worth reading (in particular, Dan Brotman’s).  

The scary things we do could teach us a thing or two.

It’s been a tough week… month… quarter.  Well, it hasn’t been easy lately.  I’ve seen people and families shaken to their core, but that’s common at work.

No big deal.  I can handle it… until I find myself shaken, scared, broken, crying, and finally praying about the terrible things that are happening all around me.  Why does it take us so long to admit how frail we really are?  How much do we have to go through to admit that we are fallible, that we seek the easy lie rather than the hard truth?

Some of you might have caught this ad campaign recently launched by the AMA:

Are your hospitalists so busy that they’re hurting the bottom line?

It’s been a crazy summer!  Our census has nearly doubled over the past six months, but we’ve sustained that growth with no increase in personnel.

I’ve faced days with twenty patients to start the day and much more to do before.  But my perspective is decidedly different than it was a mere five years ago.  I used to see the high census as a long day ahead, but one that would ultimately benefit the hospital and hospitalist alike.  Sure, I was happy to make the extra money!

Things have changed…

Transitions, schmanzitions, potato, tomato, ACO, PHO, let’s call the whole thing……really complicated.  Is anyone getting it right? Well, Jim Henson did….(check out this clip).

For the past 3 months I have been working on a project that aspires to understand the link between the hospitalist/inpatient team and the PCP/ patient centered medical home. In particular, we want to understand the barriers to effective, closed-loop, timely communication between these two entities at the point of transition from inpatient to post-acute-care setting.  We have held a think tank, consulted with leading experts in the field, and have started to amass some data in order to understand how we hospitalists can be more integrated with the primary care team especially in settings where that relationship does not otherwise exist.

We have asked hospitalists to take this brief survey about their perspectives: (please click here to answer 10 simple questions and then return to my post).

What do you think?  Well, click here to see where you fall in the distribution.

By and large, I believe hospitalists want to own the discharge and many would agree that this may be the most important part of  complex inpatient care. Let’s face it, for those of us who have done this for a while, we understand the importance of the nicely packaged discharge. I am a 42 year old hospitalist and actually completed a PRIMARY CARE residency. I practiced outpatient medicine. Like many of my contemporaries, we understand the concept of the medical home.  But what about the new generation of hospitalists? How do they establish rapport and empathy with their colleagues in the medical neighborhood without having experienced the slings and arrows of Primary Care for themselves? Take a peek at this AHRQ white paper to learn more about PCMH.

The work our specialty has done in the quality and safety domain, especially around transitions, has been important and transformative.  Yet, I would like to suggest, perhaps challenge, to us that the heavy lifting for care transitions  lies in establishing a strong and meaningful relationship  with the patient centered medical home (whatever that may look like in your neighborhood, please tell us).

I am fearful that if we do not take the lead in establishing a robust partnership with the medical home, we may lose an opportunity to truly innovate during this critical moment in our history.

If you are currently working with a liaison in the medical home, kudos to you. If you are not, it may be prime time to reach out to the medical directors of your referring practices. Creating that meaningful relationship with your patients’ medical neighborhood will serve you and your patients well.

Is anyone out there willing to share some stories about how they have either
successfully or unsuccessfully partnered with the PCMH in their neighborhood?

I handed in my resignation.  Change! Loss!  I will miss the radiologists, the nurses, the cardiologists, nephrologists, neurologists, the women who work in the cafeteria, the maintenance guys, the women who clean the floors, the IT guys, the residents, my beloved secretary, and my wonderful hospitalist docs.