Scope of Services

CMS, SHM, and the Two-Midnight Rule

We ended the chat and we all felt lost. I am referring to SHM's recent CMS conference call concerning the two-midnight rule.  We wanted to clarify the vague nature in how CMS defines medical necessity—the linchpin of how the rule operates.  (more…)

Super Bowl & State of Hospital Medicine

by Dr. William "Tex" Landis, FHM It’s Super Bowl time and that means it's time to complete the State of Hospital Medicine Survey, the biennial survey of hospitalist practices.  Discussions abound about who is the best football quarter back.  Is it Peyton Manning, Russell Wilson, Tom Brady, or somebody else?  What are the stats?  What does each individual and team do well?  How do they stack up against one another?  How will championship caliber football teams perform?  Who will be the MVP? This time of year, as hospitalists, we should be even more concerned about the performance of our hospital care teams.  The State of Hospital Medicine Survey helps us gather information about the specialty of hospital medicine so that we can compare our performance to other hospitalist groups.  What is the best source of information to help us perform successfully?  While I am not going to come down on…

Observation units and who $aves

This week, JAMA IM released a nice study profiling patients on observation status for the years 2010-11.  While only involving one site, the large sample and thorough accounting of data enhances our knowledge of the growing obs trend. (more…)

Trends come in threes

All things come in threes, or so they say. In my time in practice, I have cared for many undocumented adults. Usually Latino, young, and male, their issues reduce into two categories: injuries related to work (construction and food service) and uncontrolled flares of chronic conditions (diabetes and asthma). Occasionally, I also care for desperate folks in need of dialysis, transplants, or continued mechanical ventilation. Difficulty understates the latter category. (more…)

An average hospital is…..?

A quick post on something we do not think about often. We look at the world through our own professional lens.  If you toil at a big urban hospital, your sphere of interest encompasses GME, training, research, and safety net care.  Conversely, if you work at a small, rural hospital, you concentrate on ER and ward coverage, adequacy of services, and connectivity to neighboring facilities and unavailable technology. (more…)