Program Performance Measurement

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.…

You May Have The Killer Med App. But My Hand Still Beats Yours.

Think about how many times per week you pull out your medical calculator to plug and play a Wells or CHADS-VASc score.  Twice?  Three times?  Now think about how many times you get pestered about readmissions--be it through case managers, hospital leaders, or through your paycheck.  Probably daily. You can use an app every day and think it's useful.  But it's the regs and invisible stuff that trumps what you got.  That's my "hand." I have written in the past about high impact readmission publications.  They may seem far removed from what you do in your everyday lives.  Maybe so.  But sometimes the audience for these articles are not frontline clinicians--even though their ability to transform your practice life may be more potent than what you would absorb and use from a familiar journal. Many of us have been carping for years about the post-discharge responsibility period for hospitals as…

Assumptions About Your Hospital Remaining In The Black Are Wrong. And You Better Listen To Who Is Saying So.

What does it mean to decrease the length of stay?  Perhaps you see it as your raison d'etre or a maybe checkbox on the To Do list. To your hospital, it implies efficiency, so they save money and get more with less.  Period. However, even if you achieve a level of increasing efficiency year after year, the hospital you work in, regrettably, will still have a margin (profit) problem.  I will tell you why. My concern stems from something I read published by the CBO.  Hospital-based providers will find it compelling. First, if you do not know what the CBO is or what they do, it is hard to grasp why what they say carries so much weight.  Once you are aware of the acronym, you will be amazed how frequent their name pops up in the news. (more…)

What I Did on My Summer Vacation

One of the best parts of my “job” as a more-or-less emeritus member of SHM’s Practice Analysis Committee is the chance to be involved up close and personal in the development, analysis, and reporting of the biannual State of Hospital Medicine (SoHM) survey. In fact, I’ve either led or been integrally involved in every SoHM survey since 2006, and that has enabled me to gain an extremely valuable perspective on how the specialty of hospital medicine has evolved over the last 10 years. During the last few weeks, I’ve been up to my eyeballs reviewing sections of the new 2016 survey report that were drafted – as was the case in 2014 – by Patrick Vulgamore, MPH, SHM staffer extraordinaire. While some of the data is still being analyzed, my excitement is growing about the new survey results. The State of Hospital Medicine Report will be available to the public…

The Last Days: Cash or Credit?

How often do you hear the following: the average senior utilizes  25% of their lifetime health spend during their last six months of life.  Too much. All that service use in such a concentrated period suggests possibilities. ICUs and inpatient care have great costs.  Our acute and post-acute institutions also do not hold up as models of efficient care delivery.  Most of them at least. What to do? I see the above observations as something akin to an emperor with no clothes. Because leaders with checkbooks have a focus on areas that will generate cost reductions, they seek opportunities they can wrap their arms around.  The more disadvantaged and disjointed ambulatory practices cause too many headaches.  Hospitals then seem like the right place.  Hospitalists and inpatient practitioners seem like the right people. The logic goes, with advanced directives and creative thinking, the right docs and facilities can make a dent…
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