Posts by Burke Kealey

“We got it wrong. We are sorry.”

I saw this in my inbox this week and immediately I thought it must be from Pete Carroll, coach of the Super Bowl losing Seattle Seahawks, apologizing for one of the stupidest calls ever in the history of coaching. His call was to throw the ball from the 1 yard line instead of punch into the end zone behind their thundering “Beastmode” running back, Marshawn Lynch. You all saw what happened. The ball was intercepted, essentially ending the game and preserving a harrowing victory for the New England Patriots in Super Bowl XLIX. Or, maybe it was from Left Shark. Left Shark was Katy Perry’s bumbling dancer in an otherwise shining Super Bowl half-time show for the ages. Left Shark looked as if he was having trouble remembering his routine. Right Shark and Katy were crisp and sharp and made Left Shark look very, very bad. But, alas I opened it…

Focused Practice in Hospital Medicine: Reflections on Procrastination and the Teamwork Effectiveness Assessment Module

The great procrastinator. That’s what I call myself sometimes. I last re-certified for the ABIM board certificate in 2005. That was under the old system of every ten year renewals (but not the really old system of never having to renew). At the time one needed 100 total points and to pass the general internal medicine test. I waited until the last calendar year and then within a few months in early 2005, I did a patient survey module one week while on service, handing out patient surveys to every patient I saw, and then went to a Wake Forest MOC course where I completed four modules within 4 days. Boom, all my points done with only the test standing in my way. I put in a few months of brushing up on outpatient medicine with Med-Study study guides (which I highly recommend, no conflict of interest here, I paid…

Surgical Co-management, The Global Package, and Consciously Uncoupling

There is an upcoming Medicare rule that will go into effect in two phases beginning in 2017 that has a lot of surgeons and hospitalists concerned about the direction of peri-operative care and surgical co-management. [caption id="attachment_11629" align="alignright" width="200"] source: www.imnotobsessed.com[/caption] Medicare’s proposal apes the words of Gwyneth Paltrow when describing her divorce from now ex-husband Chris Martin of Coldplay, “Consciously Uncoupling.” An awesome euphemism to describe the schism and separation of that annoying celebrity couple. It is also a great term to describe what CMS is moving forward with in relation to the Global Surgical Fee, or “the Global Package.” We hospitalists may know of this system of bundling, but don’t really live in that world today. We have heard plenty about how payment systems of the future will be moving toward bundling, but to see one un-bundling seems at odds with the general trend. In today's world, the…

7-on/7-off Is Growing, but Will We Be Asked to Peel It back?

The new SHM/MGMA State of Hospital Medicine (SOHM) report has just been released and as always it is full of interesting nuggets about the way hospital medicine is practiced these days in our country. One fact/trend caught my eye. The number of 7-on/7-off scheduled programs is climbing. In the past two years, we have seen a rise from 41.9% in 2012 to now 53.8% of programs are working their schedule this way. I personally have always been a fan of win-win solutions and 7-on/7-off to me has been the mother of win-win solutions in hospital medicine. It’s a win for many doctors (but not all) in allowing blocks of time off to either focus on personal pursuits, or to manage your quality/safety/educational side of your job at your own pace and schedule. It’s a win for hospitals because it guarantees a steady presence of invested doctors ready to care for…

JHM Review: Scope of Practice for NPs/PAs in the Hospitalist Team

In this week’s blog post, I have the pleasure of interviewing Anand Kartha, MD, MS from the Boston VA who is the lead author on a paper that just came out in the Journal of Hospital Medicine this week, “Nurse Practitioner and Physician Assistant Scope of Practice in 118 Acute Care Hospitals.”  Anand and his research team attempted to look at, in this first study, the scope of practice of PAs and NPs in the inpatient setting.  They also explored outcome measures that could be affected by the presence of PAs and NPs.  This is a great first look at how these practitioners work today and has some potential implications for the workforce of the future in hospital medicine. 1.  Why did the research team decide to study APPs who work in hospital medicine and specialty services all in one bucket?  Do you plan to study them separately? The reason we…