Monthly Archives: May 2013

Blogging from SHM 2013

Returning to the annual national Society of Hospitalist Medicine conference always manages to reinvigorate and motivate me to continue to run the best Hospitalist programs in the region. I define best as most efficient, cost effective, and with the highest quality and patient satisfaction. Yesterday, Dr. Patrick Conway spoke about the ideal Hospitalist in 2014 and beyond as part of the opening remarks on day one. We have come a long way since Dr. Robert Wachter’s little group of inpatient physicians. The common theme of the entire meeting was summarized nicely by Dr. Conway: that all hospitalists must buy in to the concept that we need to be the drivers and the leaders in health care reform, that we need to embrace and become the leaders in effective change, and it is up to us at our individual hospitals to show everyone how to be more efficient, cost effective, and maximize the patient experience. Does this sound familiar? You may have just read almost those same words in AIM’s philosophy section on this web site. AIM embraces this challenge of being the best in all these areas.
Speaker number two of the morning was Dr. David Feinberg, CEO of the UCLA health system. Dr. Feinberg’s talk is one that i hope that all hospitalists can view on the SHM web site so we can all be reminded that it all starts with the patient. His title was ‘Healing Humankind One Patient at a Time’, and he spoke of never being satisfied and getting it right ‘all the time’. He mentioned that 85 out of 100 patients at UCLA give the hospital experience the highest rating, which he said made them the ‘cream of the crap’. He wanted to get it right 100% of the time. That’s no easy task, but I echo his statements, especially regarding mentally making every patient a family member and treating them like you would your own. I have used this same analogy when teaching students, and it works well.
There is some validation when I go to meetings like this that AIM remains way ahead of the curve in terms of the excellent care we provide. Our group remains committed to the team approach, a collaboration among the doctors, nurses, social workers, ancillary personnel and anyone else involved in patient care to create a unified system that minimizes risk, improves satisfaction, and controls costs. Now that the batteries have been recharged and I am satisfied that AIM remains among the best hospitalist groups out there, it’s time to leave Washington, DC and get back to work. I can’t wait to apply some things I learned this week to make us even better.

Reducing readmissions…oops!

     On April 15th, AIM just wrapped up one of its many QI projects, this one looking at decreasing readmission rates for four major diagnoses (MI, CHF, COPD, & pneumonia) through 4 specific interventions. It was a great project, involving many people over multiple disciplines. We added staff to provide more in depth discharge planning at the bedside. The pharmacists were involved making phone calls after discharge to go over med issues & also did med rec prior to discharge. Home health visits for every patient enrolled in the project also took place. So far, it looks like we will have reduced the rates of readmissions for CHF, MI, pneumonia, & COPD by about 25-30%!

    Here’s the rub: we didn’t do our hospital any favors & in fact, cost them revenue. The ‘problem’ was that our baseline readmission rates were not excessive, around the national average of 18% or so. We were never going to be hit with readmission penalties. What we did, basically, is cost our hospital business. So, was it the right thing to do? I don’t think there is anyone who wouldn’t agree that this project & these interventions were very good things to be doing. This is a prime example of just how difficult the transition from fee-for-service to pay-for-performance will be. Hospitals are not going to embrace these changes if it hurts the bottom line, no matter how much better it is for patient care. ACO’s & other programs are looking at improving the overall health of the population. In all of these models, the hospital is the cost center and the area to take the biggest hits. As a hospitalist, I have been thinking about the somewhat sad realization that if we succeed in these endeavors, then the need for hospitalists will diminish considerably. All for the greater good? Maybe. Then again, we are talking about government programs here. At the rate our government moves, I will be long retired before health care ever becomes that efficient. I hope we get there, though….eventually.