It’s the New Year, 2014, and it is time for Dr. Kealey’s waving of the hospitalist magic wand. If I had a magic wand, what would I instantly change about the life of hospitalists or the healthcare systems we work in? This is by no means an exhaustive list and certainly (and hopefully) reflects my own pet peeves. Now, Abracadabra!
SGR— Well, who wouldn’t wish this to go away? The Medicare Sustainable Growth Rate (SGR) formula, created in 1997 to control Medicare spending. By 2002 it started to work as the economy slowed and payments to doctors were set to begin falling. Of course Congress backed down then and has backed down each and every year creating last minute “patches” to prevent the cuts. Yeah for the patch! Long live the patch! Except each year, physicians’ fees are made part of a dastardly political game of chicken in Washington, raising anxiety levels in physicians everywhere. Our esteemed editor, Doctor Flansbaum, wrote recently on the current state of the SGR and the latest patch here. Read it and you will see why I am waving my magic wand to make it go away forever! Expelliarmus, Congress!
Post-Graduate Training— Our post-graduate training programs are still living in a pre-1996 world. Do you know any hospitalists who work 30 days straight with one guaranteed day off per week? Do you know any hospitalists who go to clinic one day a week letting their colleagues manage their patients in their absence? Not to say it’s all bad. I do like how the ACGME has incorporated more quality and safety work in the common program requirements and put a focus on systems based practice. Heading in the right direction for hospitalists, but still lagging behind the reality of real practice environments. I think Reparo is in order!
Scribes— ER docs have ’em. Hospitalists want ’em! My group at HealthPartners has been trialing scribes this past year. Early reports confirm what most ED’s find. Scribes don’t enhance productivity much, but greatly improve provider satisfaction. Even that is pretty important in a specialty where burnout is a risk and efficiency is key. Orchideous!
ICD-10— More than anything, I just want it to be done and in the rearview mirror. I think all the anxiety and fear is much worse than the actual thing. Hey, weren’t we all taught to be as specific and inclusive as possible in medical school? It’s just good medicine. I know, but what about the turtle bites, you say? Don’t know about you. Not something I deal with much. I am waving the magic wand now. Obliviate! Don’t worry; do your planning and October 1 will be a non-event.
Med Rec— Perhaps the safety and effectiveness challenge of our time and one we have spent the better part of a decade wrestling with. We sure have worked hard to become better record keepers and list makers, but we still are failing. It is time to figure out how to recruit our patients (who are the only true source of what medications enter their body) to help us solve this vexing problem. Scourgify!
That’s a start. There are way too many things to list. A hospitalists work is never done, right? I would love to hear from you things you could change in 2014 with your own magic wand.