Archive for February 2018

Hospitals, Hospice and SNFs. The Big Deceit

"We Need Creative Solutions" When I read or hear the sentence above, I think of one thing and one thing only. The solution is long in coming, involves input from multiple parties, has no obvious fix, is costly--in either money or time, and we undergird it by a whopper of a collective action problem. How about getting to the actual point: "The problem we are trying to solve has no answer. We likely know the best course, and it's staring us in the face. We can spend the next few days, weeks, or months pretending we are unaware of it or we can take half a loaf now and get back to work." The above ran through my mind as I read a new hospital transitions study out in Annals of Internal Medicine. The findings were not unexpected, by me at least, but the response by those who do not…

Clerk, Scribe, Transporter, Data Manager… a.k.a. the Doctor

We grab some popcorn on the way in. Maybe a drink. The place is bustling, bright lights lead the way, and the kids grab all the new objects at each turn. Another fun Saturday night about to begin. At Target. Yep, spending the weekend evening strolling the aisles of a big box store: family fun at its finest. It is crowded. We are clearly not the only ones who think a night on the town with the kids translates into a stop and shop for milk and new socks. The excursion does have some highlights – in particular, the self-checkout process. The 9-year-old loves to scan the items, bag them, and use the credit card as though she were paying. These machines are enticing, with the promise of efficiency and a way to avoid any chatty cashier – particularly the ones that announce the items as they are scanned. “Hey…

Who Is Driving the Bus?

You are a hospitalist. Like all hospitalists, you struggle with the pace, the hours, the complexity of demands placed upon your clinical time, the dratted medical record, burnout. You sometimes feel the collaborative process with your consulting colleagues could be improved. You often feel that you are treated like a “glorified resident”, with consultants, or others, dictating the care to you. You resent that is seems you are there only to admit or discharge or cover the less appealing weekend and holiday shifts. These feelings are legitimate. They are also common. But allow me to ask: Are you driving the care? Are you owning the hospital space? Are you reaching out to communicate with your consultants? Are you discussing the case? Are you driving the bus? Because as a hospitalist, you can’t have it both ways. You can’t complain that you aren’t treated with the respect that I know your…

Risks and Rewards of Hospitalist Participation in New CMS Bundle Model

by Win Whitcomb, MD, MHM
By: Win Whitcomb, MD, MHM Hospitalist groups have been among the highest volume participants in Medicare’s Bundled Payments for Care Improvement (BPCI) demonstration project, initiating almost 200,000 episodes representing over $4.7B in spending since the model began1. On January 9, the Centers for Medicare and Medicaid Services (CMS) announced BPCI’s follow-on model, ‘BPCI Advanced’,2 which starts in October of this year and is slated to finish at year-end 2023. CMS intends for the program to qualify as an Advanced Alternative Payment Model (APM). As BPCI Advanced focuses on 29 common medical and surgical episodes involving an inpatient stay (it also includes three outpatient episodes) and the subsequent 90 day recovery period, it represents the first large scale opportunity for hospitalists to meet criteria for Advanced APM participation. Qualifying for the Advanced APM track of the Quality Payment Program – which involves meeting patient volume or payment thresholds3 - comes with a…
Author Win Whitcomb, MD, MHM is Chief Medical Officer of Remedy Partners. He is co-founder and past president of SHM. Email him at [email protected]