The Hospitalist

In our September issue, we look at SHM’s award-winning quality improvement (QI) programs in our cover story, “Mentored Implementation.” Dr. Mark Williams, professor of medicine at the University of Kentucky and principal investigator for SHM’s Project BOOST, outlines what mentored implementation really means and explains how site visits became a central feature. Dr. Gregory Maynard, director of the UC San Diego Center for Innovation and Improvement Science and senior vice president of SHM’s Center for Hospital Innovation and Improvement, talks about how mentored implementation of QI programs works. Also featured in this issue, we recap key sessions from the 2014 Pediatric Hospital Medicine conference held last month, and launch into part one of our two-part series on using electronic health record systems to reduce readmissions. This issue also features a write-up on The Hospitalist’s latest editorial award: an APEX Grand Award for Magazines, Journals, and Tabloids!

HM14 session co-presenter Dr. Katherine Hochman, of NYU Langone Medical Center, talks about how leaders come in all shapes and sizes and why she thinks patient safety is the core of hospital team development. Co-presenter Dr. Win Whitcomb, a hospitalist at Remedy Medical Partners, co-founder of SHM, and columnist for The Hospitalist newsmagazine, explains why mentorship is a key factor in career development and why who you follow offers insight into how you’ll lead. Fellow session presenter Dr. Thomas McIlraith, of Mercy Medical Group, discusses why understanding team dynamics is critically important in hospital medicine, and shares his experience with leadership early in his career.

An interview with SHM President Dr. Burke Kealey about his series of "President's Desk" columns. Dr. Kealey talks about how the hospital medicine movement arose and expands on the transformational nature of hospital medicine. Also in this issue, we provide a comprehensive look at medical decision making, focused on the ins and outs of turning decisions into the right codes for billing and ongoing. Dr. Christopher Moreland, a deaf teaching hospitalist at University Hospital at the University of Texas is profiled on our cover, and Team Hospitalist member Dr. Julie Fedderson tells us what drew her to the specialty. In addition, we offer a progress report of SHM’s performance assessment tool for hospital medicine groups. Our Key Clinical Question this month addresses hypontremia treatment and managment, and our In The Literature section features the latest in clinical literature.

Dr. Gupreet Dhaliwal, professor of medicine at the University of California at San Francisco, diagnosed two complex patient cases presented by Dr. Daniel Brotman, director of the hospitalist program at Johns Hopkins Hospital, at SHM's annual meeting in Las Vegas. Dr. Dhaliwal says while rare and challenging cases are appealing, diagnosing common problems presented by many cases is a great way to demonstrate thinking through a diagnosis. He also discusses how cognitive bias can work in a doctor’s favor. Dr. Brotman explains why the teamwork on problem solving that happens at these live sessions is one of their best features.

Dr. William Southern, chief of hospital medicine at Montefiore/Einstein in New York City, talks about how SCHOLAR was kicked off as a joint project of the Society of General Internal Medicine and Society of Hospital Medicine. Dr. Luci Leykum, associate professor of medicine and chief of the division of hospital medicine at the University of Texas at San Antonio, outlines the metrics of the project’s discoveries and talks about inherent challenges in academic HM programs. Dr. Greg Seymann, clinical professor and chief of the division of hospital medicine at the University of California at San Diego and chair of SHM’s Academic Advancement and Promotions task force, talks about other surprises the project revealed regarding definitions of success and shares some questions he hopes to explore in the SCHOLAR project’s next study.

This month, hospitalists react to the once-again delayed implementation of the coding classification system ICD-10. Robert Tennant, senior policy advisor at Medical Group Management Association, shares his organization’s perspective on the postponement. Dr. Amy Boutwell, a hospitalist at Newton-Wellesley Hospital and president of Collaborative Healthcare Strategies, discusses Medicare’s new hospital discharge rules and the opportunity they hold for hospitalists. Elsewhere in this issue, we have an update on SHM’s Leadership Academy scheduled for Nov. 3–6 in Honolulu, Hawaii, and the latest in clinical research, including a review of best practices for end-of-life care and when to suspect Kawasaki disease in infants.

Dr. Win Whitcomb, Dr. Edward Merrens, and Dr. Emily Mallin examine how Accountable Care Organizations (ACOs) improve quality care and focus on cost control. They also look at the challenges that are presented with ACOs, and emphasize the need for hospitalists’ support in order for ACOs to succeed.

This month in our issue, 10 medical specialty groups offer Choosing Wisely guidelines for hospitalists. Among them, Dr. Linda Cox notes why comprehensive pulmonary assessment, including spirometry, is important to diagnosing or ruling out asthma; and otolaryngologist Dr. Rahul Shah tells why hospitalists should stop routine radiographic imaging for patients who meet the diagnostic criteria for uncomplicated acute rhinosinusitis. Meanwhile, ABIM Foundation executive vice president and CEO Daniel Wolfson talks about why the Choosing Wisely campaign is not just another attempt at cost-containment. Also in this issue, legal advice for hospitalists on the intersection of social media and HIPAA rules, clinical practice guidelines on red blood cell transfusions, and our Key Clinical Question explores which patients should be screened for hepatitis C infection.

This month’s feature offers some perspective on how data analytics can inform medicine. Following up a presentation they prepared on the topic at HM14 in March, hospitalist David Meltzer, MD, and data scientist Rayid Ghani, both at the University of Chicago, discuss their interest in big data. Mr. Ghani expounds on what he sees as the social good inherent in analyzing large data sets that hospital medicine procures, and tells why he thinks data literacy should be required learning. Dr. Meltzer shares his observations about data infrastructure and collection in the hospital, while noting that using big data to solve riddles about public health and medical care is a practice that’s still in its infancy. Dr. Meltzer and Mr. Ghani also discuss their collaborative effort at the University of Chicago called Chicago LEARN—the Learning Effectiveness Advancement Research Network—which recently won a Patient-Centered Outcomes Research Institute grant.

This month’s feature looks at ways hospitalists can better engage with patients and how patients can make their concerns heard by hospital physicians. Patient Morgan Gleason recalls making a video of her complaints after a recent hospitalization that garnered more than 50,000 views on YouTube. Morgan talks about what led to making the video and aftereffects of posting the clip. Pediatric hospitalist Dr. Weijen Chang from the University of California at San Diego discusses who should lead the effort to hear the patients’ voices better and says patient surveys need to be answered by actual patients when possible. Dr. Bradley Monash from the University of California at San Francisco shares his views on how patients can get left out of the hospital conversation and suggests adding patients to the care team. Also, Beecher Grogan, founder of the non-profit, pediatric cancer-centered organization, Lucy’s Love Bus, talks about the disconnect between patients’ hospital experiences and physicians’ perception of it, and says a simple patient interview by physicians can go a long way.

Hospitalists discuss the importance of quality and safety initiatives, the impact of the Affordable Care Act, and the shift from fee-for-service to a population-based healthcare model. Dr. Michelle Mourad, director of quality and safety at University of California at San Francisco, tells us why getting involved in quality initiatives is a good move for hospitalists. Dr. Scott Gottlieb, a practicing physician and fellow at the American Enterprise Institute, lends insight into repercussions of reforms contained in the Affordable Care Act and shares why he sees a big risk in the ACA’s putting payment-reform risk only on providers. Dr. Ron Greeno, chief medical officer of Cogent Healthcare HMG and SHM Public Policy Committee Chair, talks about the value inherent in population-based healthcare and opportunities for hospitalists in that model. Also this month, we feature an in-depth report on SHM’s record-setting HM14 annual meeting, a look at accountable care units, and guest columnist Joe Courtney, a Congressman from Connecticut, weighs in on how his HR 1179 bill would help ease the three-midnight rule’s impact on patient care.

This month in our issue, we examine why hospitalists’ work experience and job skills make them naturals to join the executive ranks of hospital administration. Dr. Patrick Torcson, an internist and Chief Integration Officer at St. Tammany Parish Hospital in Covington, Louisiana, talks about why he joined the leadership track and his journey to the C-suite. Dr. Torcson says being able to think at a systems level, to put one’s ego aside, and to listen well are core qualities of good leadership, and that clinical credibility is the foundation of hospital medicine leadership. Also in this issue, we look at CMS’s again-delayed and controversial two-midnight rule, address the shortcomings of the designation “observation status” in our Policy Corner column, review the latest in clinical literature, and feature newly minted SHM President Burke Kealey’s first President’s Corner column on the social movement that is hospital medicine.

This month in our issue, we look at the challenges and rewards of global health work. Hospitalist Dr. Brett Hendel-Paterson, who participates in HealthPartners’ Travel and Tropical Medicine Center in St. Paul, Minnesota discusses how humility, curiosity, and hope are at the root of clinicians’ experiences in global health work, and the long-term commitment and social contract needed to do the job. Dr. Evan Lyon, head of the University of Chicago’s Global Hospital Medicine Fellowship program, shares how global health work has influenced his interactions with his patients. For those attending the Society of Hospital Medicine’s annual conference, HM14, we offer tips on using the HM14 In Hand mobile app to navigate the courses, events, and must-sees at this year’s convention. Also in this issue, we look at what makes a hospital medicine group effective, offer Dr. Win Whitcomb’s primer on the relative value unit and its place in the shift from volume-to-value reimbursement, look at CMS’s efforts to increase participation in the physician quality reporting system, and our Key Clinical Question covers which patients undergoing gastrointestinal endoscopic procedures should receive antibiotic prophylaxis.

This month’s feature looks at ways that hospitalists can better manage the flood, and flow, of eInformation in the hospital setting. Three hospitalists, Dr. Vineet Arora, Dr. Cheng-Kai Kao, and Dr. Roger Yu, offer advice on navigating the push and pull of information, forging a collaboration between clinicians and IT professionals to more effectively manage the flow of digital information, and building infrastructure to support eInformation management.

TThis month in our issue, we look at the challenges that healthcare reform in the U.S. poses for hospitalists and preview the Society of Hospital Medicine’s HM14 annual conference happening in Las Vegas at the Mandalay Bay Resort from March 24-27. First, noted healthcare futurist and HM14 keynote speaker, Dr. Ian Morrison, shares his thoughts on how healthcare reform and its revenue model, including changes under the Affordable Care Act, will impact hospitalists and the healthcare system. Next, Dr. Zubin Dumania, better known as ZoggMD and the founder of Turntable Health, offers tips on how HM14 attendees can avoid the stereotypical Las Vegas vacation and where to go for fun, good food, and entertainment post-session. Elsewhere in this issue, we examine how hospital pain management improves patient satisfaction scores with a team-management approach, provide career advice for first-time hospital medicine job seekers, review physician productivity compensation in the age of accountable care and value-based purchasing, and feature the latest in clinical literature.