Tag Archives: discharge

A Singular Honor

Happy New Year! Today, I found out that I would be the 4th ever recipient of the Certified Leader in Hospitalist Medicine designation. To be recognized as such, one has to complete three Leadership courses and a research project. The Leadership courses that are offered through the Society of Hospitalist Medicine (SHM) have had an enormous impact on my ability to lead my program. Courses cover leadership, finance, hospital finances, conflict resolution, negotiation, and many, many more. If anyone is interested in taking a leadership role in hospitalist medicine, these courses are a must. The research project must be approved by a review board and it is a very detailed process.
My project was to show that we can perform several interventions in a rural setting to decrease readmissions for four key diagnoses: CHF, MI, COPD exacerbations, and pneumonia. I chose this for our rural site at Wayne Memorial Hospital because I couldn’t find a single study regarding readmissions that was performed in a rural site, and thought that perhaps there would be other factors that affect readmission rates here versus an urban setting. As it turns out, we used four interventions: hiring four discharge coordinators to do bedside teaching & arrange follow-ups, etc., having the pharmacist perform medication reconciliation at the bedside prior to discharge, a home health visit on the 3rd day after discharge for everyone, and follow-up phone calls from both a pharmacist & discharge coordinator. The results were better than anticipated. Readmission rates fell over 34% over the one year study period, with CHF being the main diagnosis showing the statistical significance. As it turns out, being on ten or more meds at discharge was significant, and the home health intervention was also significant. No other variable turned out to make a difference, although I suspect having the coordinators make the follow-up appointments and phone calls had a large contribution to the decrease, although it couldn’t be shown statistically. As a result, we changed our approach to discharges and continued and expanded the coordinator role long-term. The bottom line is that we showed that research studies like this can be performed in a rural setting successfully, and I am very proud of this accomplishment. For the full details & discussion, look for the report soon on the SHM web site & eventually in the hospitalist literature where we hope to publish the entire project.
Having achieved this honor solidifies my place, and, more importantly, my program’s place as a leader in hospitalist medicine. When I started this company in 2006, I approached this with the idea that we can do things differently. I wanted to make a difference and become a leader for change. I wanted to make hospitals more efficient, safer, and of higher quality. Many hospitalist programs and companies are interested in profit margins and growth. I am as interested in profit as anyone, but that is not my focus at all. I fit well with the SHM because their goals mirror my own and they don’t provide just lip service. Their goal is to train the leaders of tomorrow who will help us transition from a fee-for-service mentality to a pay for performance model. I am proud to be a part of that change and perhaps a leader of this change by my example. Advanced Inpatient Medicine has adopted this goal which reflects my philosophy. If you are interested in making a difference & not just ‘working’ as a hospitalist, then come on and jump on board and be a part of something special. We are growing & can use the help.

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.