Scope of Services

7-on/7-off Is Growing, but Will We Be Asked to Peel It back?

The new SHM/MGMA State of Hospital Medicine (SOHM) report has just been released and as always it is full of interesting nuggets about the way hospital medicine is practiced these days in our country. One fact/trend caught my eye. The number of 7-on/7-off scheduled programs is climbing. In the past two years, we have seen a rise from 41.9% in 2012 to now 53.8% of programs are working their schedule this way. I personally have always been a fan of win-win solutions and 7-on/7-off to me has been the mother of win-win solutions in hospital medicine. It’s a win for many doctors (but not all) in allowing blocks of time off to either focus on personal pursuits, or to manage your quality/safety/educational side of your job at your own pace and schedule. It’s a win for hospitals because it guarantees a steady presence of invested doctors ready to care for…

What’s going on?

I talk a lot with different physicians about integrating NP/PA providers into their practice.  I am frequently astonished by the level of reluctance, resistance and downright animosity from these physicians.  Many times a doctor will have a medical "horror story" with the NP/PA  playing  the  villain.  One bad encounter or event seems to  justify a complete rejection of the many positive attributes and contributions of these NP/PA providers, and negates the many studies that reveal comparable and safe care and outcomes.  Besides I have a few "horror stories" of my own, and guess who the villains are? I'm always mystified by this.  I practice in a very supportive environment.  This culture extends from the hospital leadership, both medical and nursing, which seems to understand what we do and values the care we provide, to my section leadership, to the consulting services, to the RNs I work with and most of…

Hospitalists Caught between a RAC and a Hard Place

by Melinda J. Johnson, MD, FHM, FACP The observation status problem has continued to grow both larger and worse. My hospitalist colleagues and I are caring for patients in hospital beds in the exact same way as other patients in the hospital, but we are told that we must give them the designation called observation status.  CMS recognizes observation status as outpatient care, like seeing a patient in a walk-in clinic. We don't "decide" to make a patient observation status.  When a patient is admitted to us, someone else (who is usually not a physician) has already decided the patient is observation status.  Hypothetically, we can write an order to change that status, but we are being watched very closely, and our decision to change the status will be challenged in (almost) a heartbeat.  We are being watched by people paid by our hospitals to make sure that no patient…

Lay Down Your Weapons

Maybe it's the way I was raised, to be polite and sensitive to others; I am a southern girl in so many ways, but I have been a southern expat for some time now weaned on Midwestern practicality. Recently the Nurse Practitioners Modernization Act was introduced in New York. As of January 1st, this law will allow nurse practitioners (NPs) with greater than 3,600 hours of experience to practice without a written practice agreement with a supervising physician. Seventeen states currently have no collaborative practice requirements with physicians. The idea behind this type of legislation is to improve or promote healthcare access for patients who may otherwise not be able to see a physician. The requirements are often viewed as a barrier to practice, as well as a disincentive to registered nurses (RNs) who otherwise would be motivated to pursue advanced certification. NPs easily argue that having to have a…

15 Patients a Day: Starling Curve or Sweet Spot?

2.2 micrometers. To generate maximal force, this is the perfect starting length of the sarcomere in the human heart.  Any more or less than this initial length and the force that the heart muscle can generate drops.  You all remember this as the basis for the Frank-Starling curve where just the right amount of tension (pre-load) is needed to generate optimal squeeze.    slidingfilament.webnode.com/applications/length-tension-relationship/Last month in JAMA, Elliott, et al published the results of an original investigation, Effect of Hospitalist Workload on the Quality and Efficiency of Care. The authors performed a retrospective cohort study of 20,041 admissions between 2008 and 2011 at Christiana and Wilmington Hospitals in Delaware. The patients were fully admitted (not observation) adult patients, excluding cardiology, oncology, and surgical patients. There was a mix of teaching and non-teaching services, as well as some ICU patients at one of the hospitals. Workload was derived from both RVU’s,…
12345...