Posts by Burke Kealey

What If Observation Status Worked in the Real World?

I have been reading SHM’s recent White Paper on Observation Status and getting depressed about the implications for our patients and our care.  I don’t enjoy having conversations with patients and family explaining how in spite of them being in an actual hospital bed, and sleeping in an actual hospital room (ok, maybe not sleeping so well), and getting all care that modern medicine can deliver, their status has been deemed to be “observation,” AKA, not a “real” hospital admission. You see a “real” hospital admission is one in which everything that is happening to you in observation status still happens (you know, the bed, the upstairs room, the care, etc.), but a doctor has been forced to give an educated guess, ummm gut call, umm cough cough… about how long you will be in the hospital. Then it occurred to me that maybe we could turn this around?  This…

US News Medical Admissions Blog Profiles Hospitalists: All Press is Good Press, Right?

We are clearly in the mainstream!  The Medical School Admissions Doctor blog sponsored by US News and World Report profiled hospital medicine this week in a post entitled, “Get to Know a Day in the Life of a Hospitalist.”  I admit, I had never seen this blog before, but after reviewing the article written by Sylvia Morris, a former hospitalist at Emory, I took the opportunity to peruse other articles in the blog history. The article about a day in the life of a hospitalist is part of a series where they are trying to capture the day-to-day aspects of being a certain type of specialist. Other entries I saw were covering primary care physicians, OB/Gyn, and nocturnists. I also noticed that their target audience is pre-med students and they focus on giving advice on how to get into medical school and showing what life could be like as a…

Should Doctors Work for Hospitals?

A recent article in The Atlantic  posited this very question and mostly points out the ills of this arrangement.  The article points to data from the American Hospital Association showing that the number of physicians employed by hospitals grew by 34% between 2000 and 2010. The article points out financial reasons that hospitals want to employ doctors.  To avoid any illegality, or just the plain ‘ol effort, of persuading doctors to send patients back to their facilities to garner market share, but also to capture the higher facility fees that go along with visits and procedures done on campus, hospitals have been revisiting the trend from the early 90’s managed care era and snatching up practices.  Additionally, capturing this market share gives hospitals greater leverage when negotiating with payers. But does this apply to hospitalists?  For sure the purchasing trend mirrors that of other types of doctors.  Our own data from our annual SHM/MGMA…

15 Patients a Day: Starling Curve or Sweet Spot?

2.2 micrometers. To generate maximal force, this is the perfect starting length of the sarcomere in the human heart.  Any more or less than this initial length and the force that the heart muscle can generate drops.  You all remember this as the basis for the Frank-Starling curve where just the right amount of tension (pre-load) is needed to generate optimal squeeze.    slidingfilament.webnode.com/applications/length-tension-relationship/Last month in JAMA, Elliott, et al published the results of an original investigation, Effect of Hospitalist Workload on the Quality and Efficiency of Care. The authors performed a retrospective cohort study of 20,041 admissions between 2008 and 2011 at Christiana and Wilmington Hospitals in Delaware. The patients were fully admitted (not observation) adult patients, excluding cardiology, oncology, and surgical patients. There was a mix of teaching and non-teaching services, as well as some ICU patients at one of the hospitals. Workload was derived from both RVU’s,…

A View from the Podium

Speech? Check! Slides? Check! Selfie? Check! I had the great honor to address our membership a few weeks ago in Las Vegas at HM 14.  For those of you who have never had the chance to speak before a huge ballroom filled with over 3,000 of your closest friends and colleagues, I recommend it - there's nothing better to get you focused on the issues at hand and to come to terms with your own self-doubts. We finished out HM14 at 3603 attendees.  This is 924 total attendees over our previous registration record.  Either we have a bunch of party animals who were ready to hit Las Vegas en masse or we have an enthusiastic membership who knows that our annual meetings are the place to learn, network, polish skills, and get reenergized for another year. I know, I know, both is the right answer. Over the course of my…