Program Performance Measurement

Who is the most productive hospitalist in the country? Guess what. It’s not you.

  Some of you might know CMS released our Part B productivity data earlier in 2014.  We have discussed on the policy side of SHM how we might use the data to learn about our field.  Unlike other specialties, we do not have a unique billing identifier.  Without the information, we cannot easily interrogate the database and view the patterns of the more than 40,000 hospital-based practitioners within our healthcare system.  The absence of such a feature creates gaps in our learning.  And as they say, you can't manage what you can't measure. We will acquire a unique code at some point, my conjecture, but until we do, we use inpatient-billing figures to assist in tagging physicians who practice hospital medicine. Most guess ambulatory docs do not bill greater than 25% of their codes on the hospital side, and as the hospitalist majority have their boards in IM or FP…

Hospital Doctors: We should never allow ourselves to become shift workers

Growing up, I had always associated shift work with blue-collar jobs - typically those jobs that didn’t require a degree or graduate education. Not that there’s anything wrong with those jobs (a lot of them are vital public services), but I never expected to one day be working in a job where I would see myself as a “shift worker,” or worse still one where I "clocked in and clocked out" at the start and finish of the day. Graduating from medical school and beginning a career in medicine, I surely had started a noble profession—a calling—where I was as far away from this as possible; in a position where I would receive autonomy and a certain degree of freedom. Now several years into a career in hospital medicine, I sometimes feel surprised at where my chosen specialty has found itself. I'm also surprised by how some of my peers view their own work schedules. Having…

“How do you know the two-midnight rule doesn’t deliver?” We just learned why.

93% of Hospitalist respondents rated observation policy as critical, but close to two-thirds were not confident in determining a patient's status. For several years, hospital-based practitioners have struggled with observation status, the two-midnight rule, and recovery audit mechanisms.  Doubly so because of the evolving regulations CMS continues to proffer.  Expect additional guidance as the workings (and vagaries) of the rule still plague patient admissions. We all toil with “medical necessity” and what the term means.  The linchpin of successfully implementing the rule hinges on deciphering that very term.  We look towards colleagues, administrators, and consultants for aid. However, after countless internal meetings, conference calls, and failed attempts in obtaining an instruction manual, we realized no one had answers.  Moreover, we at SHM did not know if members were coping and applying the rule in a consistent manner. (more…)

You think you know what predictive analytics means, huh?

  This month's Health Affairs dedicates itself to the subject of big data, a term in the news quite a bit these days.  If you think you know what big data implies, mainly dredging data sets to build the clinical decision support in your EMRs, you would be incorrect. We are talking much, much bigger. One article grabbed my attention, whose lead author practices both law and bioethics.  The piece delves into how information requires handling--legally, medically, entrepreneurially, and ethically.  I got way more out of reading the citation than I thought. To whet your appetite, think about the quote below: (more…)

It Takes a Village – Part I: What I learned from my in-laws’ Thanksgiving dinner

by Dr. Ryan Brown MD, FACP It seems like it was just yesterday that I first walked into Thanksgiving dinner at my in-laws’ and remembered thinking to myself, “What did I get myself into?” Coming from a very small family, I had never been exposed to the chaos that comes from letting 70 people loose in an elementary school cafeteria for dinner. Overwhelming, yes! But amazingly, when the food was ready, the chaos subsided and by the end of the night everyone was fed, happy, and ready to do it again! Even more amazing was the look of satisfaction on the organizers’ faces as they saw the happiness they created. Two decades later, I had that same feeling when I envisioned how 200 providers from 19 different facilities, separated by 400 miles and 2 different EMRs could all move in the same direction to achieve key quality initiatives. But then…
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