Posts by Guest Post

A GIF Is Worth 3000 Words: Introducing #VisualAbstract for #JHMChat

by Charlie M. Wray, DO, MS
If you’re like most hospitalists, your day usually starts around dawn (or dusk, for our nocturnal colleagues). After arriving at the hospital and quickly receiving sign out on your patients, you down the last bit of coffee and rush off to spend a morning on the wards. As you’re getting into a rhythm, the charge nurse on 3C grabs you as you walk by and lets you know that Mr. Sanchez’s son arrived and would like an update. BEEP. BEEP. BEEP: “Mrs. Jones wants to know when she can eat.” Just as you head her way, the cardiology fellow sees you and wants to discuss the follow-up plan on Mr. Aldridge… By 3PM, you’ve grabbed a quick bite to eat, and you’re likely leading the Patient Safety Committee meeting (while still fielding intermittent pages, of course). By early evening, you’re placing a few last minute orders and putting out small…
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.

A Renewed Call to Overhaul Hospital Observation Care

by Ann Sheehy, MD, MS, FHM
By Ann M. Sheehy, MD, MS, FHM In response to concerns about Medicare beneficiary out-of-pocket financial risk, Congress unanimously passed the NOTICE Act, which President Obama signed into law August 5, 2015. This law states that all Medicare beneficiaries hospitalized for 24 hours or more as outpatients under observation must to be notified in writing that they are outpatients “…not later than 36 hours after the time such individual begins receiving such services…”, as well as the associated “…implications for cost-sharing…”. Last month, the Centers for Medicare & Medicaid Services (CMS) released the final Medicare Outpatient Observation Notice (MOON) that hospitals will start delivering to patients no later than March 8, 2017 to comply with the law. Patients or their representative must sign the form to acknowledge receipt. There is no doubt transparency is important, and patients should be informed when hospitalized as outpatients instead of as inpatients. But the…
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.

The Best Way to Die?

by David Brabeck, MD, FACP
By David Brabeck, MD, FACP Medicine can be a strange business. Trainees are often thrust into situations involving life and death in which there is often little formal education for end of life experiences. Moreover, relatively few have personally experienced family members or loved ones dying. The population of the United States is aging and palliative care is a growing field. Despite this, formal medical school education regarding palliative care and hospice is quite varied and often inadequate. A recent review in the journal Medical Education reported that medical schools’ curriculums include between two hours and several weeks of training for end-of-life issues. With limited training in this area, residents and supervising attendings are often left to experiential education to guide them in their communication and medical decision making when a patient is close to dying. These can be difficult waters to navigate when futility of care and patient’s wishes…
David Brabeck, MD, FACP is Associate Program Director, Internal Medicine Residency, in the Departments of Hospital Medicine/General Internal Medicine at Lahey Hospital and Medical Center in Burlington, MA. He can be reached at [email protected]

Legacy from the Dying to the Living

by Jamie Yao
By: Jamie Yao Jamie is a fourth year medical student at the University of California, San Francisco entering into the field of internal medicine. She shares how her recent experience on a palliative care rotation at Moffitt Hospital in San Francisco, CA inspired her to express her feelings through poetry. Many of the moments on my palliative care rotation, such as the ones described in the poem, were inspiring. One that particularly resonates is when I had the opportunity to facilitate and witness the video chat exchange between one of our patients and his family, including his young children. It was simultaneously joyful and heartbreaking to see the love shared between him, his fiancee, and children. It was one of the many examples I encountered of the interactions between patients and their loved ones, who were often the crux of what patients derived meaning from in their lives. "Legacy from…
Jamie Yao is a fourth year UCSF medical student entering the field of internal medicine. Prior to medical school, she majored in Microbiology, Immunology, and Molecular Genetics at UCLA and completed a year of AmeriCorps with Hudson River HealthCare in Peekskill, New York. During her time on a palliative care elective at Moffitt Cancer Center, she had the privilege of working with and learning from an interprofessional team that showed her the varied ways that providers can care for patients. After being incredibly impacted by the patients she met and the vulnerability, resilience and love that they shared with her and their loved ones, she wrote her reflections in the poem, "Legacy from the Dying to the Living."

A Quick Lesson on Bundled Payments

by John Nelson, MD, MHM
By: John Nelson, MD, MHM The Centers for Medicare & Medicaid Services (CMS) has too many new payment models for a practicing doctor to keep up with them all. But there are three that I think are most important for hospitalists to know something about: hospital value-based purchasing, MACRA-related models, and bundled payments. Here, I’ll focus on the latter, which unlike the first two, influences payment to both hospitals and physicians (as well as other providers). Bundles for Different Diagnoses Bundled payment programs are the most visible of CMS’s episode payment models (EPMs). There are currently voluntary bundle models (called Bundled Payments for Care Improvement, or BPCI) across many different diagnoses. And in some locales, there is a mandatory bundle program for hip and knee replacements that began in March 2016 (called Comprehensive Care for Joint Replacement, or CCJR or just CJR). These programs are set to expand significantly in the next few years.…
John Nelson, MD, MHM has been a practicing hospitalist since 1988. He is co-founder and past president of SHM, and principal in Nelson Flores Hospital Medicine Consultants. He is co-director for SHM’s “Best Practices in Managing a Hospital Medicine Program” course. Write to him at [email protected]