Posts by Guest Post

Pay for Performance: How Prisoners Presaged CMS Changes

by Dr. Greg Seymann
by: Greg Seymann, Chair of SHM’s Performance Measurement and Reporting Committee In England in the mid 1800’s, the concept that government had a duty to provide for the public health was taking shape under the leadership of Edwin Chadwick. At one point in his career, Chadwick struggled to improve staggeringly high mortality rates on British ships transporting prisoners to the Australian colonies. Various interventions, including dietary modifications, onboard medical staff, and even exercise programs, failed to reduce death rates below 50%. Chadwick’s mentor, the utilitarian philosopher Jeremy Bentham, suggested a change in the contract with the ships’ captains. Instead of paying for the number of passengers boarding the ship in London, they would pay for the number who got off alive in Australia. In the two years that followed, Chadwick found that mortality rates dropped to 5%, and the precedent to apply “pay for performance” incentives to improving health outcomes…
Dr. Greg Seymann is a hospitalist and Vice Chief for Academic Affairs at the University of California, San Diego Division of Hospital Medicine. He is a longstanding member and current chair of SHM’s Performance Measurement and Reporting Committee.

Perioperative Care: Evolving Role for Hospitalists

by Dr. Rachel Thompson, MPH, SFHM
by Rachel E. Thompson, MD, MPH, SFHM With healthcare evolving from volume to value and from episodes of care to care for populations, many are looking at how to redesign our expensive surgical care models. Nearly a quarter of all hospitalizations in the United States are for a surgical procedure, and these are twice as costly as medical hospitalizations. This January, CMS rolled out the first official bundled payment program for joint replacement at 75 hospitals. Anesthesiologists are increasingly becoming involved earlier in the perioperative process and looking to be a primary player in building the Perioperative Surgical Home. Currently, 87% of hospitalists actively engage in co-management of surgical patients. Hospitalists are integral to the perioperative process—assessing risk for medical complications, planning for perioperative care, developing programs aimed at risk reduction for preventable complications and early identification and intervention for unavoidable complications and guiding quality improvement efforts, including planning for…
Dr. Rachel Thompson, MPH, SFHM currently serves as an Associate Professor in the Department of Medicine at the University of Nebraska Medical Center, where she has been recruited to lead the new Section of Hospital Medicine. She earned her bachelor's degree from Amherst College summa cum laude. She completed medical school and residency at the University of Washington. In 2014, she completed her the University of Washington’s Executive MPH and in 2015 she completed the University of Washington Certificate Program in Patient Safety and Quality. Prior to being recruited to the University of Nebraska Medical Center, Dr. Thompson founded the Medicine Consult Service in 2003 at Harborview Medical in Seattle, King County’s safety-net hospital and the region’s Level I trauma center. She developed the Medicine Operative Consult Service that provides comprehensive perioperative care for high-risk patients. She has significant experience with program development, education and in quality and safety. You can follow Dr. Thompson on twitter @RThomsponMD.

Non-invasive Imaging & Inpatient Cardiac Stress Testing

by Dr. Rumman Langah
By Rumman Langah, MD, FACP, FHM Being trained and board-certified in nuclear medicine and nuclear cardiology, non-invasive imaging and cardiac stress testing has been an area of profound interest to me. As practicing hospitalists, we usually get called from our colleagues in emergency department to admit patients presenting with chest pain (possible angina or angina equivalent). Most of the time, we end up admitting patients for observation and inpatient stress testing without a clear understanding of the risk stratification process and the choice of stress test, if indicated. At Hospital Medicine 2016 in San Diego, I will discuss the risk stratification process, provide a brief review of the available stress test modalities considering their strengths and limitations, and assist you to choose the most appropriate stress test for your patient. You will also find this presentation useful to recognize a particular stress test’s accuracy to rule out obstructive coronary artery…
Dr. Rumman Langah graduated from King Edward Medical University, Lahore, Pakistan, and completed his internal medicine residency at East Tennessee State University, followed by nuclear medicine residency at Medical University of South Carolina. He is board certified in internal medicine, nuclear medicine and nuclear cardiology. He joined Emory's Division of Hospital Medicine in 2009 as clinical faculty. Dr. Langah is an Assistant Professor of Medicine and a clinical faculty member in the Division of Hospital Medicine. He serves as Medical Director of Emory University Hospital Progressive Care Unit (PCU) and Site Director of M3 Student Clerkship. His other major responsibilities include Co-chair EDHM CPC committee, leader EDHM Quality Council COPD Working group, Site Representative and member of EDHM Education Council, member of J. Willis Hurst Internal Medicine residency Core Faculty, member of Residency Clinical Competency Committee, member of Division of Hospital medicine Faculty Development Steering Committee, member of GA ACP Hospitalist and member of GA ACP CME/education committees. He received the 2014 Director’s award for excellence at Emory University Hospital and 2015 Division Education Award. He has mentored several students, residents, associate providers and peer faculty for poster presentations.

Do You Speak Surgeon-ese?

by Dr. Kurt Pfeifer MD, FACP, FHM
Kurt Pfeifer, MD, FACP, FHM Does the phrase “medical clearance” make your skin crawl? Perioperative medicine continues to be a growing part of the practice of hospitalists everywhere, yet for many this is an area they feel uncomfortable with. Never fear! Hospital Medicine 2016 has more perioperative medicine educational offerings than ever! On Sunday, March 6 the all-day Perioperative Medicine precourse (Spy Into the World of Perioperative Medicine) provides an overview of all major aspects of the field, from the basics to the controversies. Speaking of controversies, watch Steven Cohn and me duke it out over hotly contested perioperative topics in The Great Debate – Controversies in Perioperative Medicine on March 9th at 8:45 am. For a sweeping update of all things periop, check out Paul Grant’s Update in Perioperative and Consultative Medicine on March 9th at 7:40 am. Have you ever wondered what goes on in the OR when…
Dr. Kurt Pfeifer MD, FACP, FHM completed medical school and Internal Medicine residency at the Medical College of Wisconsin prior to serving there as chief resident. He subsequently joined the faculty of the Medical College of Wisconsin and served as Associate Program Director for the Internal Medicine Residency for nine years. He is currently the director of the preoperative evaluation clinic at the Froedtert and Medical College Eye Institute and a course director in MCW’s Discovery Curriculum. His clinical and scholarly activities focus primarily on perioperative and consultative medicine, medical education and career development. Dr. Pfeifer has co-authored over 300 student and resident abstracts, case reports and national presentations and has written and lectured extensively on perioperative medicine and medical education. He is also Associate Editor for two innovative, online learning portals - shmConsults.com, an online curriculum for perioperative and consultative medicine, and ClinicalAccess, a point-of-care evidence-based medicine search engine.

Getting Permission to Die

by Rachel Deming
by Rachel Deming When I first met Ms. G. she told me she was in such pain that she wanted to die. She had a nice life, a full life, and her pain was just unbearable, she told me. "I have to stay strong for my children, however," she said. "They want to see me, so I have to keep fighting, keep bearing this pain for them." Over the next week, I saw Ms. G. many more times. Sometimes she was in good spirits, and other times she would cry in pain, pleading to make it stop. One afternoon when she was feeling better, she asked if she could tell me her story. She told me that she had a great story, a story that was worth sharing. She grew up in the Philippines; as a young woman she worked at the U.S. air force base as a cleaner. While…
Rachel Deming is a fourth year medical student at University of California, San Francisco School of Medicine. She has a B.A. in Human Biology from Stanford University. Before applying to medical school, she taught high school science in Oakland, CA. Rachel is currently applying for pediatric residency programs  for next year, and has a special interest in palliative care, as well as medical education.
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