How Often Do You Ask This (Ineffective) Question?

How often do we get complacent with knowledge?  We hear the same thing over and over, and the message becomes lore.  Drink eight ounces of water per day or turkey makes you drowsy—not only do we as docs believe it but we tell family members and patients the same. I came across a new study in CMAJ that fractures another piece of lore we hold fast. And not only should this study put the kibosh on it, but also upends a practice (a patient question) that teachers from eons past have instructed us to use over and over and over.  The question has intuitive appeal, is easy to gestalt, and has a universal understanding.  Non-physicians and laypeople can grasp what the answer implies without any difficulty.  (more…)

Building a Practice that People Want to be Part Of

As those of you who have followed my posts on this blog know, I’ve been spending a lot of time mulling over issues related to hospitalist job satisfaction and career sustainability. I’ve written about concrete things like re-thinking hospitalist work schedules and minimizing low-value interruptions, as well as more abstract concepts like assessing your group’s “gross happiness index.” My fascination with these issues and my concern about their potential impact on the specialty of hospital medicine eventually led John and me, as course directors, to the theme of this year’s practice management pre-course at HM17 – Practice Management Success Strategies: Building a Practice That People Want to Be Part Of. Perhaps, like me, you are interested in digging deeper into matters of career satisfaction and sustainability. Or perhaps you are simply focused on the more mundane struggle just to recruit and retain enough qualified providers for your group. In either…

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.

Should Resource Overutilization Be Considered an Adverse Event?

We have all seen the Choosing Wisely lists and the new “Things We Do for No Reason” section in the Journal of Hospital Medicine. We have heard a lot about common areas of overuse in hospitals. Sure, there have been some success stories of hospitalists leading projects to decrease an area of overuse, but when you get down to it, have we really done much to not just recognize overuse but to actually decrease it? Think about the patient safety movement over the last two decades. Telling horrifying stories of wrong-limb surgeries may have caught headlines, but that did not do much to stop the problem from still happening. The medical world had to shift our thinking from one of individual blame to recognizing the role of systems and environments in creating these problems. We had to put structures in place, such as safety review committees and mandated processes for…

The Nursing Home Get Out of Jail Card (“We Don’t Want Our Patient Back”). It’s Now Adios.

The Centers for Medicare & Medicaid Services (CMS) has not updated its rules ("conditions for participation") for nursing homes in twenty-five years. Late last year they finally did. Many of the changes will have an impact on the daily lives of NH residents but are far removed from hospital medicine.  Think a resident's ability to pick their own roommate and have all hours visitors.  However, there are a few changes that intersect with HM, and a notable one will affect how you respond to a frequently encountered roadblock long-term care facilities sometimes throw our way. First, though, some of the changes CMS finalized.  With SHM members now moving into the post-acute and LTC realm, several have real relevance (I only cite a sliver of them): (more…)