Posts by Guest Post

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]

The Return of #JHMChat and Choosing Wisely

by Charlie M. Wray DO, MS
By: Charlie M. Wray DO, MS I’ll be honest – I can’t remember who won the 2012 Super Bowl, World Series or any other pop culture phenomenon*, but I do recall stumbling across something called Choosing Wisely® one afternoon while sitting in my clinic. With a burgeoning awareness that much of the care I was providing seemed superfluous and wasteful, the discovery that there was a group of physicians who shared this same sentiment was exciting! Five years in, the Choosing Wisely® campaign has published more than 500 specialty recommendations – with the Society of Hospital Medicine working on the upcoming version 2.0 (all are welcome to contribute!). Just as Choosing Wisely is gearing up for round 2, the Journal of Hospital Medicine’s (JHM) online journal club, #JHMChat, is rebooting as well! After a brief summer hiatus, we’re happy to announce that #JHMChat will be returning to discuss “Against Medical…
Charlie M. Wray DO, MS is an Assistant Professor of Medicine at the University of California, Francisco and the San Francisco VA Medical Center. He completed medical school at Western University – College of Osteopathic Medicine, residency at Loma Linda University Medical Center, and a Hospital Medicine Research Fellowship at The University of Chicago. Dr. Wray’s research interests are focused on inpatient care transitions, care fragmentation in the hospital setting, and overutilization of hospital resources. Additionally, he has strong interests in medical education, with specific focus in evidence-based medicine, the implementation of value-based care, and how learners negotiate medical uncertainty. Dr. Wray can often be found tweeting under @WrayCharles.

Why 7 On/7 Off Doesn’t Meet the Needs of Long-Stay Hospital Patients

by Lauren Doctoroff, MD
By: Lauren Doctoroff, MD Much has been written about the loss of the perspective of the primary care doctor for hospitalized patients and the impact on their hospitalization. However, few have reflected on the challenges posed by the 7 on/7 off hospitalist schedule for complicated long-stay patients. I have been a hospitalist for more than 10 years, and, for the past 3, I have been responsible for a complex patient strategy for my hospital. Having looked at the charts of hundreds of patients with long and complicated hospital stays, it is clear that there is an incompatibility between the on again/off again hospitalist schedule and the needs of these patients. With frequently changing providers, patients suffer not only from their own medical fluctuations, but also the changing plans of their providers. These are not the patients awaiting guardianship or insurance to allow for an adequate discharge plan. These are the…
Dr. Lauren Doctoroff is a hospitalist at the Beth Israel Deaconess Medical Center in Boston, Massachusetts. She completed medical school at the University of California at San Francisco in 2003, and a primary care internal medicine internship and residency at Massachusetts General Hospital in 2006. Her clinical responsibilities include hospitalist work on a teaching and a non-teaching service at the BIDMC. In addition, she was the founding medical director of the Healthcare Associates Post Discharge Clinic, a hospitalist-staffed, primary care-based post hospitalization clinic from 2009-2015. She also serves as the medical director of the PACT Transitional Care Program. As of 2015, she serves as the Medical Director for Utilization Management for the BIDMC, and chairs the Utilization Review Committee, and leads multiple initiatives on hospital utilization. She is a fellow of the Society of Hospital Medicine and serves on the SHM Public Policy Committee. She is an Assistant Professor at Harvard Medical School. Her academic interests include transitions in care and post discharge care, as well as hospital utilization particularly among patients with prolonged stays. She has published on post discharge care and outlier patients and has spoken locally and nationally on topics of transitions of care and post discharge care.

A Need for Medicare Appeals Process Reform in Hospital Observation Care

by Ann Sheehy, MD, MS, FHM
By Ann M. Sheehy, MD, MS, FHM Concern has existed regarding Recovery Auditor enforcement of outpatient (observation) and inpatient status determinations. Scrutiny of the contingency fee-based Recovery Auditors, often called Recovery Audit Contractors (“RACs”), has prompted Congressional attention and Centers for Medicare & Medicaid Services (CMS) reforms. Although the impact of these changes is not fully known, there is bipartisan support for reform of the initial auditing step in the Medicare audit and appeals process. Congress and CMS must now turn their attention to reforming the 5-Level Medicare administrative appeals process that follows an initial audit and denial. Last year, the US Government Accountability Office (GAO) report Medicare Fee-for-Service: Opportunities Remain to Improve Appeals Process cited a 2000% increase in Level 3 inpatient appeals from 2010-2014. In response, CMS issued appeals reforms, including allowing senior attorneys to hear some Level 3 appeals and permitting the Medicare Appeals Council to set…
Ann Sheehy, MD, MS, FHM, is a physician and associate professor at the University of Wisconsin (UW) School of Medicine and Public Health. She received her MD and MS in Clinical Research from Mayo Medical School and Mayo Graduate School, respectively, in Rochester, Minnesota. She completed her residency in internal medicine at Johns Hopkins Hospital in Baltimore, Maryland in 2005. The same year, Dr. Sheehy joined the Division of Hospital Medicine as a Clinical Assistant Professor of Medicine at the University of Wisconsin School of Medicine and Public Health. In 2011, she became a Clinical Associate Professor of Medicine. Dr. Sheehy held the position of Interim Director, prior to being appointed Division of Hospital Medicine Director in 2012. Dr. Sheehy has a background in academic medicine, with emphasis on diabetes screening practices and care of inpatients with hyperglycemia, as well as health care disparities and the effect of health care policy on patient care in the hospital. Dr. Sheehy is a member of the Society of Hospital Medicine Public Policy committee, and serves as Vice President of the University of Wisconsin Hospital and Clinics (UWHC) Medical Board and is chair of the Credentials Committee. Dr. Sheehy is a two-time recipient of the Evans-Glassroth Department of Medicine Inpatient Teacher of the Year Award and has also been awarded the University of Wisconsin Internal Medicine Residency Professionalism Award. Dr. Sheehy is an active SHM member in the Public Policy Committee and has found herself on Capitol Hill multiple times, testifying before Congressional committees focused on the U.S. healthcare system, on behalf of hospitalists and SHM.

Falling MOON Will Impact Hospitalists on March 8

by Bartho Caponi MD, FHM
Effective March 8, we have to deliver CMS’ Medicare Outpatient Observation Notice, the MOON, to all Medicare and Medicare Advantage patients hospitalized under observation status for 24 or more hours. This must happen within 36 hours of the observation order, even if eventually changed to inpatient status. A result of the well-intentioned NOTICE Act, the MOON is supposed to clarify when a patient is being observed rather than admitted (SHM has a useful FAQ for background). The MOON is a flawed document. For those not familiar, the MOON is a CMS-standardized document that hospitals have limited ability to edit. A point of contention for hospitalists, the first section states, “You’re a hospital outpatient receiving observation services. You are not an inpatient because:” followed by a blank field. The second section states, “Being an outpatient may affect what you pay in a hospital.” There are also specific delivery and receipt requirements,…
Bartho Caponi MD, FHM graduated from the University of Illinois at Rockford College of Medicine in 2005 and completed his internal medicine residency at the University of Wisconsin in 2008. He has been practicing hospital medicine at the University of Wisconsin since then, on teaching and non-teaching services. In 2012, Bart became a utilization review advisor, and has since served as UW Health's Medical Director for Case Management and Utilization Review. He has also been a member of SHM's Education Committee since 2013, and a member of the American College of Physician Advisors since 2015.