Archive for October 2016

Next on #JHMChat: Ideas from Residents to Root Out Routine Labs

While the saying goes, “you can’t teach an old dog new tricks”, I think we all assume you can teach a new dog new tricks… or at least all of us in medical education believe this! However, new research in the Journal of Hospital Medicine highlights that maybe the old dog is the key to the puzzle after all. In the case of routine labs, a practice that has already been called into question by the Society of Hospital Medicine’s Choosing Wisely list, the majority of medicine and surgery residents at University of Pennsylvania admitted that they engaged in unnecessary ordering of inpatient labs, with over a third of them occurring on a daily basis! Why is this so hard to change? Not surprisingly, one of the key culprits was it was hard-to-break habit. However, several of the top reasons were also related to the “old dog”, also known as…

MACRA, Enhanced PA Care Models & SHM Members in Hospital Medicine News

SHM & Hospital Medicine in the News: October 13 – 27, 2016 Check out the latest hospital medicine and SHM-related stories in mainstream and healthcare-centric news. For the full stories, click on the links below: Following the release of the final MACRA rule, medical professionals and policy experts alike are poring over the 2400-page document and extracting some of the high-level points. Recent research finds that expanding the role of hospitalist advanced practice providers achieves similar clinical outcomes at a lower cost. A mainstream media piece debunks the notion that hospitalists compete with primary care providers and demonstrates how they act in coordination with them to enhance care of hospitalized patients. Drs. Brad Flansbaum, Ron Greeno and John Nelson were tapped for an interview with Medscape to discuss what hospitalists need to know about accountable care organizations. Two stories placed Drs. Brian Harte and Bob Wachter in the spotlight for…

A Quick Lesson on Bundled Payments

by John Nelson, MD, MHM
By: John Nelson, MD, MHM The Centers for Medicare & Medicaid Services (CMS) has too many new payment models for a practicing doctor to keep up with them all. But there are three that I think are most important for hospitalists to know something about: hospital value-based purchasing, MACRA-related models, and bundled payments. Here, I’ll focus on the latter, which unlike the first two, influences payment to both hospitals and physicians (as well as other providers). Bundles for Different Diagnoses Bundled payment programs are the most visible of CMS’s episode payment models (EPMs). There are currently voluntary bundle models (called Bundled Payments for Care Improvement, or BPCI) across many different diagnoses. And in some locales, there is a mandatory bundle program for hip and knee replacements that began in March 2016 (called Comprehensive Care for Joint Replacement, or CCJR or just CJR). These programs are set to expand significantly in the next few years.…
John Nelson, MD, MHM has been a practicing hospitalist since 1988. He is co-founder and past president of SHM, and principal in Nelson Flores Hospital Medicine Consultants. He is co-director for SHM’s “Best Practices in Managing a Hospital Medicine Program” course. Write to him at [email protected]

The ABIM Has New Plans for MOC and Wants Your Opinion. Give It to ‘Em!

  We have more details on what the ABIM is considering regarding changes to the Maintenance of Certification (MOC) process since they last announced some very high-level ideas in the spring. The ABIM is now requesting feedback through a member survey on some proposed options to update its controversial MOC process. Specifically, they are outlining two main alternatives to the current 10-year high-stakes, high-prep, high-anxiety MOC exam: a 5-year pathway and a 2-year pathway. The chart below from the ABIM blog hits the key points. The email to the membership with the survey link attached goes into more depth about what each proposal could entail but also adds some things not shown in the table, the most key of which is that both of these options would be “low stakes”. Specifically, they call out the fact that “if you don’t do well on one assessment, you will not lose your certification”. This, if…

VIP Syndrome

I was reading a nice piece eulogizing David Bowie.  If you are a fan of his you know what a towering figure he was in the music world.  Given he died of cancer, I was also thinking about the docs involved in his care and their absolute pledge to him to guard his celebrity.  HIPPA aside, if you know the man or like his music, you must be in awe and most certainly, aimed to satisfy his expectations. If you work in a big town, you have probably seen your share of VIPs come and go into your facilities as well.  And you have also witnessed or partaken in the privileges accorded to them by request from above or out of your reverence. By VIPs, of course, I mean starting quarterbacks, lead singers, chairs of the board, and local luminaries and donors with deep pockets. I was curious about the…
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