Public Policy

A Letter to My Patients

To my next patient: I often avoid putting my politics on my sleeve, as I don’t want that to get in the way of our relationship. I want you to know that I treat you as a fellow human being, no matter your race, gender, sexual orientation. With the election results, what will change about how I treat you at the bedside? Nothing. I may know about your criminal past. I see that tattoo underneath your gown. I hear your profanity-filled screed because you won’t get that MRI today. I know you don’t follow the treatment plan, that you are here illegally or that you are a refugee from another country. I will still care for you no matter what. It’s one of the blessed things we instill in each other in medicine. I saw someone like you recently: 28 years old, working hard, with 2 jobs, but neither provided…

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…

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…)
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