Program Performance Measurement

The Medicaid Overhaul And How Hospitals And Its Providers Could Be Hardest Hit

Given the signs Paul Ryan, Speaker of the House, has flashed during his tenure, expect phase one of the health care financing overhaul to be heavily focused on Medicaid. The incoming administration aligns with this change (#6), as does the president-elect's choice of Tom Price for HHS Secretary.    This turn will have an impact on hospitals and something you should pay attention to.  You will see lots of press over the coming months, and you will hear the term Medicaid block grants.  You should have an opinion, especially if you work in a rural, safety net, urban, or academic medical center.  I would imagine that holds true for many of you. (more…)

Wow! A Two-fer

First I hear the American Board of Pediatrics ordains hospital medicine as a bonafide subspecialty. Then, for the adults among us, CMS issues a hospitalist specialty code.  No joke.  A specialty code--go live on April 3, 2017. This has been a laborious task and years in the making. Have a lookie: If you are scratching your head and wondering about the fuss, let me tell you the insights we will draw from the new knowledge and why it will advance our specialty.  For years, hospitalists got lumped with "generalists" when CMS, researchers, or insurance companies ventured to look at physician utilization patterns and service to the healthcare system. What was our individual and collective cost or contribution to a case?  Who understood.  Any interested party trying to untangle what a doc was producing during a hospital stay had only billing patterns, i.e., the percentage of inpatient codes one charged, to determine if…

What’s Under the Hood? Quick Look at Hospital Expenses

It's helpful to know where hospitals spend their money.  You might see a lot of technology and devices floating around the wards, but to keep the beds full, it's all about FTEs and human capital. Have a look at the figure below: Imagine the C-suite sitting down to make decisions regarding the upcoming annual budget.  While we might focus on the overuse of triple-lumen catheters or a high-risk case and legal costs, the executive decision makers think about personnel.  A hospital will burn approximately two-thirds of its spend on labor.  Medical and Pharma supplies, technology upgrades, keeping the lights on, repairs and maintenance all chip away at the coffers--but it's the employed manpower the first floor needs to think about and follow.  The battles hospital administration become embroiled in with organized labor always make headlines, but it's there leadership may find the greatest savings. The healthcare workforce has grown by leaps…

VIP Syndrome

I was reading a nice piece eulogizing David Bowie.  If you are a fan of his you know what a towering figure he was in the music world.  Given he died of cancer, I was also thinking about the docs involved in his care and their absolute pledge to him to guard his celebrity.  HIPPA aside, if you know the man or like his music, you must be in awe and most certainly, aimed to satisfy his expectations. If you work in a big town, you have probably seen your share of VIPs come and go into your facilities as well.  And you have also witnessed or partaken in the privileges accorded to them by request from above or out of your reverence. By VIPs, of course, I mean starting quarterbacks, lead singers, chairs of the board, and local luminaries and donors with deep pockets. I was curious about the…

Serious Upgrade for SHM’s 2016 State of Hospital Medicine Report

Great news! The long-anticipated 2016 State of Hospital Medicine (SoHM) Report was released last week to rave reviews. Pre-orders of the report blew away previous records, and that’s on top of the almost 600 hospital medicine groups (HMGs) that received free versions of the report as a result of participating in the survey. Again this year, the SoHM Report breaks down the latest statistics for a number of salary and workload benchmarks and a wide variety of HMG structural and operational characteristics that inform those two areas. I was privileged to be on a web conference last week in which SHM staffer extraordinaire Patrick Vulgamore, the primary writer/editor of the report, walked us through the enhanced online version. And I have to say it’s a massive upgrade to previous digital versions. Two extra-cool things about the new digital version: It is searchable. It can be accessed via a mobile app.…