Posts by Danielle Scheurer

The Risk-Outcome-Experience Triad: Mortality Risk and HCAHPS

I had the pleasure of interviewing Mark Cowen, who is in the Department of Medicine and is the Chief of Clinical Decision Services at St. Joseph Mercy Hospital in Ann Arbor, MI. He and his team sought to analyze the relationship between patient’s admission risk of mortality and their ratings of hospitals on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. Their paper was recently published in the Journal of Hospital Medicine. How did you become interested in the relationship between mortality risk and HCAHPS? When our teams were thinking about how to organize our care to maximize our patient outcomes, we realized that the risk of mortality at admit was a high predictor of several poor patient outcomes (such as long length of stay and readmissions). At some point, we also had the notion that these may be the same patients that are providing lower scores…

Slow Down and Ask

We all knew her time was limited; recurrent metastatic glioblastoma at the age of 26. Surrounded by her husband and parents at all times, rounding on her was becoming more difficult for the team to endure. Each day she had a new limitation. First it was her inability to swallow food, then liquids, then her own secretions. Then it was urinary incontinence. Now it was relentless orthostatic hypotension. This was the worst for her. All of the past issues she handled with grace and strength, but this orthostatic hypotension made her unable to sit up or raise her head. As I explained how this was unlikely to get any better, and that we would need to plan for this going forward, this was the first tear I saw creep out of the corner of her right eye. Her family was still hopeful that the compassionate-use 4th line treatment that we…

Heterogeneity of Interdisciplinary Rounds

I had the pleasure of interviewing Surekha Bhamidipati, a hospitalist in the Department of Medicine at Christiana Care Health System. She and her team sought to analyze the current literature on the structure and outcomes of interdisciplinary rounds among hospitalized medicine patients, to determine the composition and impact of such rounds in her recent Journal of Hospital Medicine (JHM) paper, Structure and Outcomes of Inter-Disciplinary Rounds in Hospitalized Medicine Patients: A Systematic Review and Suggested Taxonomy. What is your background and how did you become interested in evaluating interdisciplinary rounds? I am a Faculty Hospitalist and completed my residency in Internal Medicine. I have been exposed and trained to participate in interdisciplinary rounding since Day#1 of my residency training. After my training, in my first job I also had the experience with very valuable bedside interdisciplinary rounding. Then in my current position, I found that we did interdisciplinary rounding, but…

Money back Guarantee!

We’ve all seen hundreds of commercials of companies advertising products and services with a money back guarantee. The Men’s Warehouse, for example, has been guaranteeing to men across the globe for over a decade, “You’re going to like the way you look; I guarantee it!” But to date, no one has made such a “guarantee” in the healthcare industry. Buying a suit is not exactly like getting your gallbladder removed. Geisinger Health System President and CEO, Dr. David Feinberg, is doing just that. Their health care system has developed an application, called the Geisinger ProvenExperience, which can be downloaded onto a smartphone. After a procedure, a patient is given a code for the condition that was treated. With that code, they can enter any feedback they have on the services provided; and then they can request a refund if they are not fully satisfied. Most remarkably, the request for a…

Hospitalists Bend the Cost Curve

The United States healthcare system continues to struggle with extremely high cost and variable quality of care. This year alone, the U.S. is projected to spend $2.8 trillion on healthcare, comprising approximately 18% of the entire U.S. gross domestic product (GDP); about 30% of that is spent within hospitals. This is more than Australia, Brazil, Canada, China, France, Germany, Italy, Japan, and the U.K. combined. This growth in cost is completely unsustainable and is threatening all aspects of the U.S. economy, as there is less to invest in infrastructure, education, and other public programs. Until the healthcare industry figures out how to measure cost, we will not be able to control it on a large scale. One methodology aimed at measuring the actual cost of care is the time-driven activity-based cost (TDABC) accounting method, by which patient time and activity is carefully measured, and cost attributed by time and resource…