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Hospital Medicine Advocates Aid in Securing $10 Million for National Quality Forum
Hospitalists on the Hill
WHEN: May 16, 2013
WHERE: Washington, D.C.
HOW: Register today at www.hospitalmedicine2013.org/onthehill Space is limited.
The American Taxpayer Relief Act, which was signed into law Jan. 3 to stave off the fiscal cliff, contained a little-mentioned provision that reauthorized $10 million in Medicare funding for the National Quality Forum (NQF). Hospitalists, taking on the role of policy advocates, helped secure this reauthorization and score a victory for national quality-improvement (QI) efforts.
The NQF is a nonprofit organization established to create consensus around national priorities and measures for performing reporting and improvement in healthcare. It receives funding through a variety of sources ranging from public funds, private organizations and membership dues. Since 2009, it has received $10 million annually from a U.S. Department of Health and Human Services contract. That contract, a significant portion of NQF funding, was set to end in 2012.
The Stand for Quality coalition, composed of healthcare organizations supportive of the NQF, helps ensure that Congress sustains funding and support of performance measurement reporting and QI. SHM historically has been a strong proponent of the NQF, pitching in at the start of Stand for Quality four years ago this month. As it became clear that the federal contract for the NQF was not likely to be renewed by Congress for the 2013 calendar year, the member organizations of Stand for Quality were asked to step up to the plate in any way they could.
Jumping at the opportunity to assist, SHM linked hospitalists to their members of Congress in support of the NQF. Through members of SHM's Public Policy and Performance Measurement and Reporting committees, SHM connected with congressional offices and urged them to join a sign-on letter from the office of U.S. Sen. Mark Begich (D-Alaska) office in support of continued NQF funding. Letters between members of Congress are a way that legislators internally lobby on behalf of a particular issue. Hearing from their constituents can help persuade a legislator to act.
Sharing professional expertise also can inform a legislator's decisions. SHM members have a wealth of specialized knowledge and experiences that greatly benefit health policy discussions. In December 2012, SHM was asked to join NQF staffers and several other organizations on Capitol Hill for visits with select members of Congress, including several physician-legislators. These meetings were designed to raise the profile of the important work NQF is doing for QI and to make sure that NQF funding was not forgotten in any debt deal.
Mangla Gulati, MD, FACP, FHM, a hospitalist and SHM member, participated in these visits on behalf of hospital medicine and provided much-needed physician input on the importance of NQF's work.
The benefits of in-person visits are mutual: Members of Congress learn more about the real-life effects of a particular policy and, according to Dr. Gulati, "the visits to the Hill were a very valuable experience and shed a whole new light on the challenges we face in medicine."
Taken together, these advocacy tactics—coalition-building, contacting congressional offices, and in-person visits in Washington—were crucial to securing NQF's funding reauthorization and are critical tools for the advocacy work at SHM. The most concrete and impactful advocacy includes positioning hospitalists on the front line and sharing their perspectives and experiences with policymakers and their staffs.
We hope you'll heed this call and join SHM in Washington, D.C., May 16 for Hospitalists on the Hill, part of SHM's annual meeting. For more information and to register, go to www.hospitalmedicine2013.org/onthehill.
Joshua Lapps is SHM's government relations specialist.
Hospitalists on the Hill
WHEN: May 16, 2013
WHERE: Washington, D.C.
HOW: Register today at www.hospitalmedicine2013.org/onthehill Space is limited.
The American Taxpayer Relief Act, which was signed into law Jan. 3 to stave off the fiscal cliff, contained a little-mentioned provision that reauthorized $10 million in Medicare funding for the National Quality Forum (NQF). Hospitalists, taking on the role of policy advocates, helped secure this reauthorization and score a victory for national quality-improvement (QI) efforts.
The NQF is a nonprofit organization established to create consensus around national priorities and measures for performing reporting and improvement in healthcare. It receives funding through a variety of sources ranging from public funds, private organizations and membership dues. Since 2009, it has received $10 million annually from a U.S. Department of Health and Human Services contract. That contract, a significant portion of NQF funding, was set to end in 2012.
The Stand for Quality coalition, composed of healthcare organizations supportive of the NQF, helps ensure that Congress sustains funding and support of performance measurement reporting and QI. SHM historically has been a strong proponent of the NQF, pitching in at the start of Stand for Quality four years ago this month. As it became clear that the federal contract for the NQF was not likely to be renewed by Congress for the 2013 calendar year, the member organizations of Stand for Quality were asked to step up to the plate in any way they could.
Jumping at the opportunity to assist, SHM linked hospitalists to their members of Congress in support of the NQF. Through members of SHM's Public Policy and Performance Measurement and Reporting committees, SHM connected with congressional offices and urged them to join a sign-on letter from the office of U.S. Sen. Mark Begich (D-Alaska) office in support of continued NQF funding. Letters between members of Congress are a way that legislators internally lobby on behalf of a particular issue. Hearing from their constituents can help persuade a legislator to act.
Sharing professional expertise also can inform a legislator's decisions. SHM members have a wealth of specialized knowledge and experiences that greatly benefit health policy discussions. In December 2012, SHM was asked to join NQF staffers and several other organizations on Capitol Hill for visits with select members of Congress, including several physician-legislators. These meetings were designed to raise the profile of the important work NQF is doing for QI and to make sure that NQF funding was not forgotten in any debt deal.
Mangla Gulati, MD, FACP, FHM, a hospitalist and SHM member, participated in these visits on behalf of hospital medicine and provided much-needed physician input on the importance of NQF's work.
The benefits of in-person visits are mutual: Members of Congress learn more about the real-life effects of a particular policy and, according to Dr. Gulati, "the visits to the Hill were a very valuable experience and shed a whole new light on the challenges we face in medicine."
Taken together, these advocacy tactics—coalition-building, contacting congressional offices, and in-person visits in Washington—were crucial to securing NQF's funding reauthorization and are critical tools for the advocacy work at SHM. The most concrete and impactful advocacy includes positioning hospitalists on the front line and sharing their perspectives and experiences with policymakers and their staffs.
We hope you'll heed this call and join SHM in Washington, D.C., May 16 for Hospitalists on the Hill, part of SHM's annual meeting. For more information and to register, go to www.hospitalmedicine2013.org/onthehill.
Joshua Lapps is SHM's government relations specialist.
Hospitalists on the Hill
WHEN: May 16, 2013
WHERE: Washington, D.C.
HOW: Register today at www.hospitalmedicine2013.org/onthehill Space is limited.
The American Taxpayer Relief Act, which was signed into law Jan. 3 to stave off the fiscal cliff, contained a little-mentioned provision that reauthorized $10 million in Medicare funding for the National Quality Forum (NQF). Hospitalists, taking on the role of policy advocates, helped secure this reauthorization and score a victory for national quality-improvement (QI) efforts.
The NQF is a nonprofit organization established to create consensus around national priorities and measures for performing reporting and improvement in healthcare. It receives funding through a variety of sources ranging from public funds, private organizations and membership dues. Since 2009, it has received $10 million annually from a U.S. Department of Health and Human Services contract. That contract, a significant portion of NQF funding, was set to end in 2012.
The Stand for Quality coalition, composed of healthcare organizations supportive of the NQF, helps ensure that Congress sustains funding and support of performance measurement reporting and QI. SHM historically has been a strong proponent of the NQF, pitching in at the start of Stand for Quality four years ago this month. As it became clear that the federal contract for the NQF was not likely to be renewed by Congress for the 2013 calendar year, the member organizations of Stand for Quality were asked to step up to the plate in any way they could.
Jumping at the opportunity to assist, SHM linked hospitalists to their members of Congress in support of the NQF. Through members of SHM's Public Policy and Performance Measurement and Reporting committees, SHM connected with congressional offices and urged them to join a sign-on letter from the office of U.S. Sen. Mark Begich (D-Alaska) office in support of continued NQF funding. Letters between members of Congress are a way that legislators internally lobby on behalf of a particular issue. Hearing from their constituents can help persuade a legislator to act.
Sharing professional expertise also can inform a legislator's decisions. SHM members have a wealth of specialized knowledge and experiences that greatly benefit health policy discussions. In December 2012, SHM was asked to join NQF staffers and several other organizations on Capitol Hill for visits with select members of Congress, including several physician-legislators. These meetings were designed to raise the profile of the important work NQF is doing for QI and to make sure that NQF funding was not forgotten in any debt deal.
Mangla Gulati, MD, FACP, FHM, a hospitalist and SHM member, participated in these visits on behalf of hospital medicine and provided much-needed physician input on the importance of NQF's work.
The benefits of in-person visits are mutual: Members of Congress learn more about the real-life effects of a particular policy and, according to Dr. Gulati, "the visits to the Hill were a very valuable experience and shed a whole new light on the challenges we face in medicine."
Taken together, these advocacy tactics—coalition-building, contacting congressional offices, and in-person visits in Washington—were crucial to securing NQF's funding reauthorization and are critical tools for the advocacy work at SHM. The most concrete and impactful advocacy includes positioning hospitalists on the front line and sharing their perspectives and experiences with policymakers and their staffs.
We hope you'll heed this call and join SHM in Washington, D.C., May 16 for Hospitalists on the Hill, part of SHM's annual meeting. For more information and to register, go to www.hospitalmedicine2013.org/onthehill.
Joshua Lapps is SHM's government relations specialist.
We Welcome the Newest SHM Members
- D. Davis, MD, Alabama
- V. Palabindala, Alabama
- V. Do, Arizona
- G. Khera, MD, Arizona
- A. Afrashteh, MD, California
- P. Alegarbes, California
- J. Close, California
- B. Davis, DO , California
- J. Eng, MD, California
- C. Liao, MD, California
- A. Manoharan, MBBS, California
- K. Martinez, California
- K. Mothkuri, MD, California
- M. Ochner, MD, MPH, California
- T. Ososkova, MD, California
- H. Selke, MD, California
- M. Sethi, MD, California
- S. Sonti, MD, California
- C. Tsay, California
- D. Virnich, MD, MBA, California
- A. Montoya, FNP, Colorado
- J. Nickelsen, MD, Colorado
- V. Kota, MD, Connecticut
- S. Kim, MD, Delaware
- N. Serafimova, MD, Delaware
- S. Brulte, MD, Florida
- A. Camacho, AN P, Florida
- E. Carter, MD, Florida
- C. Cesa, MD, Florida
- K. Eaton, PA-C, Florida
- N. Harris, MD, Florida
- T. Jones, MD, Florida
- A. Karmand, MD, Florida
- A. Laila, MD, Florida
- M. Lane, MD, Florida
- L. Leisch, MD, Florida
- V. Ngo, MD, Florida
- H. Patel, DO , Florida
- M. Pop, MD, Florida
- A. Rahman, MD, Florida
- J. Whynot, MD, Florida
- P. Amene, MBBS, Georgia
- A. Bawa, MD, Georgia
- J. Dee, Georgia
- C. Henritz, DO , Georgia
- Y. Imran, MD, Georgia
- J. Mikell, MD, Georgia
- D. Nagarajan, MD, Georgia
- L. Porter, MD, Georgia
- K. Thykeson, MD, Idaho
- C. Beveridge, Illinois
- R. Helfrich, MD, Illinois
- R. Kellum, MD, Illinois
- T. Mahmood, MD, Illinois
- D. Patel, MD, Illinois
- M. Regala, MD, Illinois
- H. Sandhu, MD, Illinois
- U. Tekin, MD, Illinois
- D. Azad, MD, FACP, MPH, Indiana
- J. Light, MD, Indiana
- P. Marpu, MD, Indiana
- N. Paul, ACNP, Indiana
- C. Bowers, MD, Kansas
- L. Fanucchi, MD, MPH, Kentucky
- S. Kad, MD, FACP, MPH, MS, USAR , Kentucky
- D. Davis, MD, Alabama
- V. Palabindala, Alabama
- V. Do, Arizona
- G. Khera, MD, Arizona
- A. Afrashteh, MD, California
- P. Alegarbes, California
- J. Close, California
- B. Davis, DO , California
- J. Eng, MD, California
- C. Liao, MD, California
- A. Manoharan, MBBS, California
- K. Martinez, California
- K. Mothkuri, MD, California
- M. Ochner, MD, MPH, California
- T. Ososkova, MD, California
- H. Selke, MD, California
- M. Sethi, MD, California
- S. Sonti, MD, California
- C. Tsay, California
- D. Virnich, MD, MBA, California
- A. Montoya, FNP, Colorado
- J. Nickelsen, MD, Colorado
- V. Kota, MD, Connecticut
- S. Kim, MD, Delaware
- N. Serafimova, MD, Delaware
- S. Brulte, MD, Florida
- A. Camacho, AN P, Florida
- E. Carter, MD, Florida
- C. Cesa, MD, Florida
- K. Eaton, PA-C, Florida
- N. Harris, MD, Florida
- T. Jones, MD, Florida
- A. Karmand, MD, Florida
- A. Laila, MD, Florida
- M. Lane, MD, Florida
- L. Leisch, MD, Florida
- V. Ngo, MD, Florida
- H. Patel, DO , Florida
- M. Pop, MD, Florida
- A. Rahman, MD, Florida
- J. Whynot, MD, Florida
- P. Amene, MBBS, Georgia
- A. Bawa, MD, Georgia
- J. Dee, Georgia
- C. Henritz, DO , Georgia
- Y. Imran, MD, Georgia
- J. Mikell, MD, Georgia
- D. Nagarajan, MD, Georgia
- L. Porter, MD, Georgia
- K. Thykeson, MD, Idaho
- C. Beveridge, Illinois
- R. Helfrich, MD, Illinois
- R. Kellum, MD, Illinois
- T. Mahmood, MD, Illinois
- D. Patel, MD, Illinois
- M. Regala, MD, Illinois
- H. Sandhu, MD, Illinois
- U. Tekin, MD, Illinois
- D. Azad, MD, FACP, MPH, Indiana
- J. Light, MD, Indiana
- P. Marpu, MD, Indiana
- N. Paul, ACNP, Indiana
- C. Bowers, MD, Kansas
- L. Fanucchi, MD, MPH, Kentucky
- S. Kad, MD, FACP, MPH, MS, USAR , Kentucky
- D. Davis, MD, Alabama
- V. Palabindala, Alabama
- V. Do, Arizona
- G. Khera, MD, Arizona
- A. Afrashteh, MD, California
- P. Alegarbes, California
- J. Close, California
- B. Davis, DO , California
- J. Eng, MD, California
- C. Liao, MD, California
- A. Manoharan, MBBS, California
- K. Martinez, California
- K. Mothkuri, MD, California
- M. Ochner, MD, MPH, California
- T. Ososkova, MD, California
- H. Selke, MD, California
- M. Sethi, MD, California
- S. Sonti, MD, California
- C. Tsay, California
- D. Virnich, MD, MBA, California
- A. Montoya, FNP, Colorado
- J. Nickelsen, MD, Colorado
- V. Kota, MD, Connecticut
- S. Kim, MD, Delaware
- N. Serafimova, MD, Delaware
- S. Brulte, MD, Florida
- A. Camacho, AN P, Florida
- E. Carter, MD, Florida
- C. Cesa, MD, Florida
- K. Eaton, PA-C, Florida
- N. Harris, MD, Florida
- T. Jones, MD, Florida
- A. Karmand, MD, Florida
- A. Laila, MD, Florida
- M. Lane, MD, Florida
- L. Leisch, MD, Florida
- V. Ngo, MD, Florida
- H. Patel, DO , Florida
- M. Pop, MD, Florida
- A. Rahman, MD, Florida
- J. Whynot, MD, Florida
- P. Amene, MBBS, Georgia
- A. Bawa, MD, Georgia
- J. Dee, Georgia
- C. Henritz, DO , Georgia
- Y. Imran, MD, Georgia
- J. Mikell, MD, Georgia
- D. Nagarajan, MD, Georgia
- L. Porter, MD, Georgia
- K. Thykeson, MD, Idaho
- C. Beveridge, Illinois
- R. Helfrich, MD, Illinois
- R. Kellum, MD, Illinois
- T. Mahmood, MD, Illinois
- D. Patel, MD, Illinois
- M. Regala, MD, Illinois
- H. Sandhu, MD, Illinois
- U. Tekin, MD, Illinois
- D. Azad, MD, FACP, MPH, Indiana
- J. Light, MD, Indiana
- P. Marpu, MD, Indiana
- N. Paul, ACNP, Indiana
- C. Bowers, MD, Kansas
- L. Fanucchi, MD, MPH, Kentucky
- S. Kad, MD, FACP, MPH, MS, USAR , Kentucky
HMX Term of the Month: Achievement Points
Awarded to a hospital by comparing an individual hospital’s performance measure rates during a certain period with all hospitals’ rates during the baseline period.
Awarded to a hospital by comparing an individual hospital’s performance measure rates during a certain period with all hospitals’ rates during the baseline period.
Awarded to a hospital by comparing an individual hospital’s performance measure rates during a certain period with all hospitals’ rates during the baseline period.
Fellow in Hospital Medicine Spotlight: Katherine Hochman, MD, MBA, FHM
Dr. Hochman is assistant chief of medicine service and director of the hospitalist program at New York University Medical Center (NYUMC) in New York City. She is a clinical assistant professor at New York University School of Medicine. She earned her Fellow in Hospital Medicine designation in 2008.
Undergraduate education: University of Pennsylvania, Philadelphia.
Medical school: University of Miami Miller School of Medicine.
Notable: In 2004, Dr. Hochman was the first and only hospitalist at NYUMC. Today, there are 23.5 hospitalists in the program, thanks to her work in founding the NYU Hospitalist Group. Although she and her team struggled with recruiting hospitalists to work nights and weekends, her directorship of the NYU Hospitalist Scholars program, which combines clinical work and research mentorship, has helped the group attract physicians for those shifts.
As director, she and other hospitalists have created the NYC Hospitalist Directors’ Consortium, which meets regularly through SHM. Dr. Hochman has mentored and passed on her hospitalist passion to dozens of graduate students, residents, and post-doctoral fellows. As a result of her mentorship and dedication to education, she was awarded the 2003 Firm Chief Award for Outstanding Medical Student Teaching and the 2005 NYU Teacher of the Year Award.
FYI: A mother of three, Dr. Hochman still finds time to follow her passion for museum visits. Her favorite haunt is the Museum of Modern Art. She has even staged innovative team-building events using themed museum tours. She also coaches an indoor soccer club.
Quotable: "The SHM fellowship is an important distinction for me. It shows a continued commitment to the field of hospital medicine."
Dr. Hochman is assistant chief of medicine service and director of the hospitalist program at New York University Medical Center (NYUMC) in New York City. She is a clinical assistant professor at New York University School of Medicine. She earned her Fellow in Hospital Medicine designation in 2008.
Undergraduate education: University of Pennsylvania, Philadelphia.
Medical school: University of Miami Miller School of Medicine.
Notable: In 2004, Dr. Hochman was the first and only hospitalist at NYUMC. Today, there are 23.5 hospitalists in the program, thanks to her work in founding the NYU Hospitalist Group. Although she and her team struggled with recruiting hospitalists to work nights and weekends, her directorship of the NYU Hospitalist Scholars program, which combines clinical work and research mentorship, has helped the group attract physicians for those shifts.
As director, she and other hospitalists have created the NYC Hospitalist Directors’ Consortium, which meets regularly through SHM. Dr. Hochman has mentored and passed on her hospitalist passion to dozens of graduate students, residents, and post-doctoral fellows. As a result of her mentorship and dedication to education, she was awarded the 2003 Firm Chief Award for Outstanding Medical Student Teaching and the 2005 NYU Teacher of the Year Award.
FYI: A mother of three, Dr. Hochman still finds time to follow her passion for museum visits. Her favorite haunt is the Museum of Modern Art. She has even staged innovative team-building events using themed museum tours. She also coaches an indoor soccer club.
Quotable: "The SHM fellowship is an important distinction for me. It shows a continued commitment to the field of hospital medicine."
Dr. Hochman is assistant chief of medicine service and director of the hospitalist program at New York University Medical Center (NYUMC) in New York City. She is a clinical assistant professor at New York University School of Medicine. She earned her Fellow in Hospital Medicine designation in 2008.
Undergraduate education: University of Pennsylvania, Philadelphia.
Medical school: University of Miami Miller School of Medicine.
Notable: In 2004, Dr. Hochman was the first and only hospitalist at NYUMC. Today, there are 23.5 hospitalists in the program, thanks to her work in founding the NYU Hospitalist Group. Although she and her team struggled with recruiting hospitalists to work nights and weekends, her directorship of the NYU Hospitalist Scholars program, which combines clinical work and research mentorship, has helped the group attract physicians for those shifts.
As director, she and other hospitalists have created the NYC Hospitalist Directors’ Consortium, which meets regularly through SHM. Dr. Hochman has mentored and passed on her hospitalist passion to dozens of graduate students, residents, and post-doctoral fellows. As a result of her mentorship and dedication to education, she was awarded the 2003 Firm Chief Award for Outstanding Medical Student Teaching and the 2005 NYU Teacher of the Year Award.
FYI: A mother of three, Dr. Hochman still finds time to follow her passion for museum visits. Her favorite haunt is the Museum of Modern Art. She has even staged innovative team-building events using themed museum tours. She also coaches an indoor soccer club.
Quotable: "The SHM fellowship is an important distinction for me. It shows a continued commitment to the field of hospital medicine."
Is Your Hospital Medicine Group a Good Candidate for Project BOOST?
Does your team have:
- Eagerness to improve their discharge processes and reduce unnecessary readmissions and avoidable adverse events in the post-discharge period?
- A multidisciplinary team in place capable of working collaboratively to redesign existing care processes?
- A dedicated leader to manage the process of tailoring the BOOST intervention to your site’s needs and implementing BOOST?
- Support of at least one executive sponsor who can meet with the team monthly?
- Access to data support personnel needed to collect baseline and post-implementation data?
Does your team have:
- Eagerness to improve their discharge processes and reduce unnecessary readmissions and avoidable adverse events in the post-discharge period?
- A multidisciplinary team in place capable of working collaboratively to redesign existing care processes?
- A dedicated leader to manage the process of tailoring the BOOST intervention to your site’s needs and implementing BOOST?
- Support of at least one executive sponsor who can meet with the team monthly?
- Access to data support personnel needed to collect baseline and post-implementation data?
Does your team have:
- Eagerness to improve their discharge processes and reduce unnecessary readmissions and avoidable adverse events in the post-discharge period?
- A multidisciplinary team in place capable of working collaboratively to redesign existing care processes?
- A dedicated leader to manage the process of tailoring the BOOST intervention to your site’s needs and implementing BOOST?
- Support of at least one executive sponsor who can meet with the team monthly?
- Access to data support personnel needed to collect baseline and post-implementation data?
Soaring Medicare Costs for Unplanned Hospitalizations Underscore Need to Reduce Readmissions
- According to research published in the New England Journal of Medicine, about 1 in 5 hospitalized Medicare beneficiaries were readmitted within 30 days after discharge. Unplanned rehospitalizations cost Medicare $17.4 billion in 2004.
- The Project BOOST toolkit has been downloaded more than 4,000 times.
- Project BOOST has been implemented at more than 150 sites nationwide.
- Early data from six sites that have implemented Project BOOST reveal a reduction in 30-day readmission rates to 11.2% from 14.2%, as well as a 21% reduction in 30-day, all-cause readmission rates.
Source: www.hospitalmedicine.org
- According to research published in the New England Journal of Medicine, about 1 in 5 hospitalized Medicare beneficiaries were readmitted within 30 days after discharge. Unplanned rehospitalizations cost Medicare $17.4 billion in 2004.
- The Project BOOST toolkit has been downloaded more than 4,000 times.
- Project BOOST has been implemented at more than 150 sites nationwide.
- Early data from six sites that have implemented Project BOOST reveal a reduction in 30-day readmission rates to 11.2% from 14.2%, as well as a 21% reduction in 30-day, all-cause readmission rates.
Source: www.hospitalmedicine.org
- According to research published in the New England Journal of Medicine, about 1 in 5 hospitalized Medicare beneficiaries were readmitted within 30 days after discharge. Unplanned rehospitalizations cost Medicare $17.4 billion in 2004.
- The Project BOOST toolkit has been downloaded more than 4,000 times.
- Project BOOST has been implemented at more than 150 sites nationwide.
- Early data from six sites that have implemented Project BOOST reveal a reduction in 30-day readmission rates to 11.2% from 14.2%, as well as a 21% reduction in 30-day, all-cause readmission rates.
Source: www.hospitalmedicine.org
Hospitalists Urged to Help Reduce 30-Day Readmission Rate
For hospitals across the country, 2013 is the year to address readmissions and find practical solutions. In January, the Journal of the American Medical Association dedicated
an entire issue to the vexing problem of hospital readmissions. In his audio summary of the issue, JAMA editor Howard Bauchner, MD, notes that it “came together organically,” based on increased submissions and attention to 30-day readmissions.
Among nearly a dozen articles focused on readmissions, discharge, and transitions of care, Project BOOST principal investigator Mark V. Williams, MD, FACP, MHM, makes the case for a community-based approach in an editorial titled “A Requirement to Reduce Readmissions: Take Care of the Patient, Not Just the Disease.” In the piece, he advocates for “broad patient-centered approaches that engage all members of a care team, especially front-line clinicians and use proven quality-improvement [QI] methods.” He goes on to link the concepts to the principles taught by Project BOOST.
After all, readmissions are expensive, and not just for hospitals, which is why private insurers and the Centers for Medicare & Medicaid Services (CMS) are investing resources to improve discharge processes, reduce readmissions, and reduce costs.
Many adverse events that happen after discharge are predictable using assessment tools and methods in the Project BOOST program, Dr. Williams says. Hospitalists can—and should, according to many—improve the system to protect patients.
And while systemwide change doesn’t happen overnight, it does have to start somewhere, as leaders at the 150-plus Project BOOST sites nationwide can attest Now is the time to begin planning to join the Project BOOST 2013 cohort. Applications will be accepted through this summer; training will begin in the fall. But participation is limited, and successful applicants often need time to prepare their applications, which must include letters of support from a site executive and the development of a multidisciplinary team. For more information, visit www.hospitalmedicine.org/boost.
Brendon Shank is SHM’s associate vice president of communications.
For hospitals across the country, 2013 is the year to address readmissions and find practical solutions. In January, the Journal of the American Medical Association dedicated
an entire issue to the vexing problem of hospital readmissions. In his audio summary of the issue, JAMA editor Howard Bauchner, MD, notes that it “came together organically,” based on increased submissions and attention to 30-day readmissions.
Among nearly a dozen articles focused on readmissions, discharge, and transitions of care, Project BOOST principal investigator Mark V. Williams, MD, FACP, MHM, makes the case for a community-based approach in an editorial titled “A Requirement to Reduce Readmissions: Take Care of the Patient, Not Just the Disease.” In the piece, he advocates for “broad patient-centered approaches that engage all members of a care team, especially front-line clinicians and use proven quality-improvement [QI] methods.” He goes on to link the concepts to the principles taught by Project BOOST.
After all, readmissions are expensive, and not just for hospitals, which is why private insurers and the Centers for Medicare & Medicaid Services (CMS) are investing resources to improve discharge processes, reduce readmissions, and reduce costs.
Many adverse events that happen after discharge are predictable using assessment tools and methods in the Project BOOST program, Dr. Williams says. Hospitalists can—and should, according to many—improve the system to protect patients.
And while systemwide change doesn’t happen overnight, it does have to start somewhere, as leaders at the 150-plus Project BOOST sites nationwide can attest Now is the time to begin planning to join the Project BOOST 2013 cohort. Applications will be accepted through this summer; training will begin in the fall. But participation is limited, and successful applicants often need time to prepare their applications, which must include letters of support from a site executive and the development of a multidisciplinary team. For more information, visit www.hospitalmedicine.org/boost.
Brendon Shank is SHM’s associate vice president of communications.
For hospitals across the country, 2013 is the year to address readmissions and find practical solutions. In January, the Journal of the American Medical Association dedicated
an entire issue to the vexing problem of hospital readmissions. In his audio summary of the issue, JAMA editor Howard Bauchner, MD, notes that it “came together organically,” based on increased submissions and attention to 30-day readmissions.
Among nearly a dozen articles focused on readmissions, discharge, and transitions of care, Project BOOST principal investigator Mark V. Williams, MD, FACP, MHM, makes the case for a community-based approach in an editorial titled “A Requirement to Reduce Readmissions: Take Care of the Patient, Not Just the Disease.” In the piece, he advocates for “broad patient-centered approaches that engage all members of a care team, especially front-line clinicians and use proven quality-improvement [QI] methods.” He goes on to link the concepts to the principles taught by Project BOOST.
After all, readmissions are expensive, and not just for hospitals, which is why private insurers and the Centers for Medicare & Medicaid Services (CMS) are investing resources to improve discharge processes, reduce readmissions, and reduce costs.
Many adverse events that happen after discharge are predictable using assessment tools and methods in the Project BOOST program, Dr. Williams says. Hospitalists can—and should, according to many—improve the system to protect patients.
And while systemwide change doesn’t happen overnight, it does have to start somewhere, as leaders at the 150-plus Project BOOST sites nationwide can attest Now is the time to begin planning to join the Project BOOST 2013 cohort. Applications will be accepted through this summer; training will begin in the fall. But participation is limited, and successful applicants often need time to prepare their applications, which must include letters of support from a site executive and the development of a multidisciplinary team. For more information, visit www.hospitalmedicine.org/boost.
Brendon Shank is SHM’s associate vice president of communications.
Shaun Frost: Why Hospital Patients' Expectations Should Dictate Their Care
It is difficult to disagree that patients and their families deserve to be satisfied with the care they receive, and furthermore that a satisfying care experience is the foundation upon which the ability to heal is based. Mention the subject of patient satisfaction, however, to care providers, and prepare for many to respond negatively. For most, this frustration likely stems from the challenges associated with satisfaction measurement, and the application of this measurement to provider performance reporting and reimbursement. Perhaps by focusing so intently on quantifying how happy patients are with their care, we have distracted ourselves from the real goal of creating patient experiences that enable optimal healing.
In some respects, healthcare’s preoccupation with satisfaction measurements seems analogous to administering a final examination before teaching the course material. If so, at this juncture, it would be prudent to back up and examine the curriculum required to master the subject matter necessary to perform well on the test. To this end, it is necessary to:
Identify the contributors to a satisfying patient experience, and Focus specifically on understanding patient expectations.
Expectation Examination
An essential reading on the subject of patient experience and satisfaction is a July/August 2005 article in The Hospitalist titled “Patient Satisfaction: the Hospitalist’s Role,” in which Patrick J. Torcson, MD, MMM, FACP, SFHM, introduces “The First Law of Service.”1 According to this law, satisfaction can be mathematically defined as equal to patients’ perceptions of the care they received minus their expectations for that care (satisfaction=perception–expectation). Accordingly, if perception meets or exceeds expectation, an associated degree of satisfaction will be generated.
Both perceptions and expectations can be affected to create satisfaction. Remodeling a hospital lobby is an example of an effort to primarily influence patient perception. When considering efforts to influence patient expectations, it is useful to think of universal versus individual patient requirements, needs, desires, values, and goals. Examples of universal patient expectations (meaning expectations held by all or a majority of patients) would include receiving warm meals at scheduled times, having call lights answered in a timely manner, understanding the side effects of medications, and receiving instructions at the time of discharge. Examples of individual patient expectations (meaning expectations that are personally held by individual patients because of reasons unique to individual circumstances not common to everyone) would be need for low-cost medications due to economic hardship, prioritization of functional improvement versus pain elimination, and tolerance of treatment-related side effects.
It might be fair to say that in its pursuit to create satisfying patient experiences, our healthcare system has focused more on influencing perception and universal patient expectations than it has on addressing unique, personally held patient interests. In the future, we should attend more diligently to individual expectations. By doing so, patients will be better engaged, providers will be better informed, and satisfaction will follow.
Shared Decision-Making
You wouldn’t think of retaining a real estate agent to assist you in purchasing a home without informing that person about your personal needs. In order to satisfy you, the agent must understand what you expect in regard to such issues as price, square footage, yard size, community amenities, school district, proximity to work, etc. Just as your needs in shopping for a home can only be met by considering your personal expectations, your patient’s needs can only be met by understanding their individual healthcare requirements.
Unfortunately, understanding an individual patient’s expectations about their healthcare is more challenging than outlining a list of requirements for their ideal home. Although the reasons for this are multiple (see “Barriers to Understanding Patient Expectations,” left), the solution in large part rests in the application of shared decision-making (SDM).
SDM is defined as a collaborative communication process between provider and patient intended to help the patient decide among multiple acceptable healthcare choices in accordance with their preferences and values. SDM has been demonstrated to positively impact patient satisfaction, as well as care quality, resource utilization, and healthcare costs. A cornerstone feature of SDM is the use of decision aids to assist patients in identifying their personal healthcare expectations while simultaneously educating them about how those expectations apply to care plan options. Decision aids also benefit care providers by creating a standardized framework by which to solicit patients’ input regarding their preferences. When navigated appropriately, SDM balances the clinician’s expertise and knowledge with the patient’s goals and values.
Recent investigations into the application of SDM to HM practice have touted its effectiveness (e.g. when applied to low-risk chest pain evaluations) and questioned the creation of unintended negative consequences (e.g. on hospital resource consumption and affordability).2,3 Despite limited data in the HM setting, several literature reviews examining the effectiveness of SDM across various care sites consistently linked it to greater patient satisfaction.4
It is important to realize that policymakers are lauding the promise of SDM and incorporating its use into rules, regulations, and funding opportunities. For example, the Centers for Medicare & Medicaid Services (CMS) requires SDM to participate in its accountable-care organization (ACO) programs, and several states recently have enacted legislation to promote SDM. Expect thus to experience future pressure to apply SDM in your hospitalist practice. Organizations dedicated to the advancement of SDM include the Society for Participatory Medicine, the Informed Medical Decisions Foundation, the Society for Medical Decision Making, and the Mayo Clinic. More information and resources are available on their websites.
Conclusions
Satisfaction surveys are tools for measuring the quality of patient care experiences. Although satisfaction surveying is an inexact science, and the application of survey results to performance evaluation is challenging, we must remember that the goal is to optimize patient experience. Necessary in the creation of a satisfying patient experience is a robust understanding of patient expectations. SDM is a promising communication strategy that can help both providers and patients better identify the personally held values and goals that determine patient care expectations.
Dr. Frost is president of SHM.
References
- Torcson, P. Patient satisfaction: the hospitalist’s role. The Hospitalist website. Available at: http://www.the-hospitalist.org/details/article/256805/Patient_Satisfaction_the_Hospitalists_Role.html. Accessed Jan. 30, 2013.
- Hess E, et al. The chest pain choice decision aid. A randomized trial. Circ Cardiovasc Qual Outcomes. 2012;5:251-259.
- Tak, HJ, Meltzer, D. Effect of patient preference in medical decision-making on inpatient care [abstract]. J Hosp Med. 2012;7(Suppl 2):91.
- Hostetter, M, Klein S. Helping patients make better treatment choices with decision aids. The Commonwealth Fund website. Available at: http://www.commonwealthfund.org/Newsletters/Quality-Matters/2012/October-November/In-Focus.aspx. Accessed Jan. 30, 2013.
It is difficult to disagree that patients and their families deserve to be satisfied with the care they receive, and furthermore that a satisfying care experience is the foundation upon which the ability to heal is based. Mention the subject of patient satisfaction, however, to care providers, and prepare for many to respond negatively. For most, this frustration likely stems from the challenges associated with satisfaction measurement, and the application of this measurement to provider performance reporting and reimbursement. Perhaps by focusing so intently on quantifying how happy patients are with their care, we have distracted ourselves from the real goal of creating patient experiences that enable optimal healing.
In some respects, healthcare’s preoccupation with satisfaction measurements seems analogous to administering a final examination before teaching the course material. If so, at this juncture, it would be prudent to back up and examine the curriculum required to master the subject matter necessary to perform well on the test. To this end, it is necessary to:
Identify the contributors to a satisfying patient experience, and Focus specifically on understanding patient expectations.
Expectation Examination
An essential reading on the subject of patient experience and satisfaction is a July/August 2005 article in The Hospitalist titled “Patient Satisfaction: the Hospitalist’s Role,” in which Patrick J. Torcson, MD, MMM, FACP, SFHM, introduces “The First Law of Service.”1 According to this law, satisfaction can be mathematically defined as equal to patients’ perceptions of the care they received minus their expectations for that care (satisfaction=perception–expectation). Accordingly, if perception meets or exceeds expectation, an associated degree of satisfaction will be generated.
Both perceptions and expectations can be affected to create satisfaction. Remodeling a hospital lobby is an example of an effort to primarily influence patient perception. When considering efforts to influence patient expectations, it is useful to think of universal versus individual patient requirements, needs, desires, values, and goals. Examples of universal patient expectations (meaning expectations held by all or a majority of patients) would include receiving warm meals at scheduled times, having call lights answered in a timely manner, understanding the side effects of medications, and receiving instructions at the time of discharge. Examples of individual patient expectations (meaning expectations that are personally held by individual patients because of reasons unique to individual circumstances not common to everyone) would be need for low-cost medications due to economic hardship, prioritization of functional improvement versus pain elimination, and tolerance of treatment-related side effects.
It might be fair to say that in its pursuit to create satisfying patient experiences, our healthcare system has focused more on influencing perception and universal patient expectations than it has on addressing unique, personally held patient interests. In the future, we should attend more diligently to individual expectations. By doing so, patients will be better engaged, providers will be better informed, and satisfaction will follow.
Shared Decision-Making
You wouldn’t think of retaining a real estate agent to assist you in purchasing a home without informing that person about your personal needs. In order to satisfy you, the agent must understand what you expect in regard to such issues as price, square footage, yard size, community amenities, school district, proximity to work, etc. Just as your needs in shopping for a home can only be met by considering your personal expectations, your patient’s needs can only be met by understanding their individual healthcare requirements.
Unfortunately, understanding an individual patient’s expectations about their healthcare is more challenging than outlining a list of requirements for their ideal home. Although the reasons for this are multiple (see “Barriers to Understanding Patient Expectations,” left), the solution in large part rests in the application of shared decision-making (SDM).
SDM is defined as a collaborative communication process between provider and patient intended to help the patient decide among multiple acceptable healthcare choices in accordance with their preferences and values. SDM has been demonstrated to positively impact patient satisfaction, as well as care quality, resource utilization, and healthcare costs. A cornerstone feature of SDM is the use of decision aids to assist patients in identifying their personal healthcare expectations while simultaneously educating them about how those expectations apply to care plan options. Decision aids also benefit care providers by creating a standardized framework by which to solicit patients’ input regarding their preferences. When navigated appropriately, SDM balances the clinician’s expertise and knowledge with the patient’s goals and values.
Recent investigations into the application of SDM to HM practice have touted its effectiveness (e.g. when applied to low-risk chest pain evaluations) and questioned the creation of unintended negative consequences (e.g. on hospital resource consumption and affordability).2,3 Despite limited data in the HM setting, several literature reviews examining the effectiveness of SDM across various care sites consistently linked it to greater patient satisfaction.4
It is important to realize that policymakers are lauding the promise of SDM and incorporating its use into rules, regulations, and funding opportunities. For example, the Centers for Medicare & Medicaid Services (CMS) requires SDM to participate in its accountable-care organization (ACO) programs, and several states recently have enacted legislation to promote SDM. Expect thus to experience future pressure to apply SDM in your hospitalist practice. Organizations dedicated to the advancement of SDM include the Society for Participatory Medicine, the Informed Medical Decisions Foundation, the Society for Medical Decision Making, and the Mayo Clinic. More information and resources are available on their websites.
Conclusions
Satisfaction surveys are tools for measuring the quality of patient care experiences. Although satisfaction surveying is an inexact science, and the application of survey results to performance evaluation is challenging, we must remember that the goal is to optimize patient experience. Necessary in the creation of a satisfying patient experience is a robust understanding of patient expectations. SDM is a promising communication strategy that can help both providers and patients better identify the personally held values and goals that determine patient care expectations.
Dr. Frost is president of SHM.
References
- Torcson, P. Patient satisfaction: the hospitalist’s role. The Hospitalist website. Available at: http://www.the-hospitalist.org/details/article/256805/Patient_Satisfaction_the_Hospitalists_Role.html. Accessed Jan. 30, 2013.
- Hess E, et al. The chest pain choice decision aid. A randomized trial. Circ Cardiovasc Qual Outcomes. 2012;5:251-259.
- Tak, HJ, Meltzer, D. Effect of patient preference in medical decision-making on inpatient care [abstract]. J Hosp Med. 2012;7(Suppl 2):91.
- Hostetter, M, Klein S. Helping patients make better treatment choices with decision aids. The Commonwealth Fund website. Available at: http://www.commonwealthfund.org/Newsletters/Quality-Matters/2012/October-November/In-Focus.aspx. Accessed Jan. 30, 2013.
It is difficult to disagree that patients and their families deserve to be satisfied with the care they receive, and furthermore that a satisfying care experience is the foundation upon which the ability to heal is based. Mention the subject of patient satisfaction, however, to care providers, and prepare for many to respond negatively. For most, this frustration likely stems from the challenges associated with satisfaction measurement, and the application of this measurement to provider performance reporting and reimbursement. Perhaps by focusing so intently on quantifying how happy patients are with their care, we have distracted ourselves from the real goal of creating patient experiences that enable optimal healing.
In some respects, healthcare’s preoccupation with satisfaction measurements seems analogous to administering a final examination before teaching the course material. If so, at this juncture, it would be prudent to back up and examine the curriculum required to master the subject matter necessary to perform well on the test. To this end, it is necessary to:
Identify the contributors to a satisfying patient experience, and Focus specifically on understanding patient expectations.
Expectation Examination
An essential reading on the subject of patient experience and satisfaction is a July/August 2005 article in The Hospitalist titled “Patient Satisfaction: the Hospitalist’s Role,” in which Patrick J. Torcson, MD, MMM, FACP, SFHM, introduces “The First Law of Service.”1 According to this law, satisfaction can be mathematically defined as equal to patients’ perceptions of the care they received minus their expectations for that care (satisfaction=perception–expectation). Accordingly, if perception meets or exceeds expectation, an associated degree of satisfaction will be generated.
Both perceptions and expectations can be affected to create satisfaction. Remodeling a hospital lobby is an example of an effort to primarily influence patient perception. When considering efforts to influence patient expectations, it is useful to think of universal versus individual patient requirements, needs, desires, values, and goals. Examples of universal patient expectations (meaning expectations held by all or a majority of patients) would include receiving warm meals at scheduled times, having call lights answered in a timely manner, understanding the side effects of medications, and receiving instructions at the time of discharge. Examples of individual patient expectations (meaning expectations that are personally held by individual patients because of reasons unique to individual circumstances not common to everyone) would be need for low-cost medications due to economic hardship, prioritization of functional improvement versus pain elimination, and tolerance of treatment-related side effects.
It might be fair to say that in its pursuit to create satisfying patient experiences, our healthcare system has focused more on influencing perception and universal patient expectations than it has on addressing unique, personally held patient interests. In the future, we should attend more diligently to individual expectations. By doing so, patients will be better engaged, providers will be better informed, and satisfaction will follow.
Shared Decision-Making
You wouldn’t think of retaining a real estate agent to assist you in purchasing a home without informing that person about your personal needs. In order to satisfy you, the agent must understand what you expect in regard to such issues as price, square footage, yard size, community amenities, school district, proximity to work, etc. Just as your needs in shopping for a home can only be met by considering your personal expectations, your patient’s needs can only be met by understanding their individual healthcare requirements.
Unfortunately, understanding an individual patient’s expectations about their healthcare is more challenging than outlining a list of requirements for their ideal home. Although the reasons for this are multiple (see “Barriers to Understanding Patient Expectations,” left), the solution in large part rests in the application of shared decision-making (SDM).
SDM is defined as a collaborative communication process between provider and patient intended to help the patient decide among multiple acceptable healthcare choices in accordance with their preferences and values. SDM has been demonstrated to positively impact patient satisfaction, as well as care quality, resource utilization, and healthcare costs. A cornerstone feature of SDM is the use of decision aids to assist patients in identifying their personal healthcare expectations while simultaneously educating them about how those expectations apply to care plan options. Decision aids also benefit care providers by creating a standardized framework by which to solicit patients’ input regarding their preferences. When navigated appropriately, SDM balances the clinician’s expertise and knowledge with the patient’s goals and values.
Recent investigations into the application of SDM to HM practice have touted its effectiveness (e.g. when applied to low-risk chest pain evaluations) and questioned the creation of unintended negative consequences (e.g. on hospital resource consumption and affordability).2,3 Despite limited data in the HM setting, several literature reviews examining the effectiveness of SDM across various care sites consistently linked it to greater patient satisfaction.4
It is important to realize that policymakers are lauding the promise of SDM and incorporating its use into rules, regulations, and funding opportunities. For example, the Centers for Medicare & Medicaid Services (CMS) requires SDM to participate in its accountable-care organization (ACO) programs, and several states recently have enacted legislation to promote SDM. Expect thus to experience future pressure to apply SDM in your hospitalist practice. Organizations dedicated to the advancement of SDM include the Society for Participatory Medicine, the Informed Medical Decisions Foundation, the Society for Medical Decision Making, and the Mayo Clinic. More information and resources are available on their websites.
Conclusions
Satisfaction surveys are tools for measuring the quality of patient care experiences. Although satisfaction surveying is an inexact science, and the application of survey results to performance evaluation is challenging, we must remember that the goal is to optimize patient experience. Necessary in the creation of a satisfying patient experience is a robust understanding of patient expectations. SDM is a promising communication strategy that can help both providers and patients better identify the personally held values and goals that determine patient care expectations.
Dr. Frost is president of SHM.
References
- Torcson, P. Patient satisfaction: the hospitalist’s role. The Hospitalist website. Available at: http://www.the-hospitalist.org/details/article/256805/Patient_Satisfaction_the_Hospitalists_Role.html. Accessed Jan. 30, 2013.
- Hess E, et al. The chest pain choice decision aid. A randomized trial. Circ Cardiovasc Qual Outcomes. 2012;5:251-259.
- Tak, HJ, Meltzer, D. Effect of patient preference in medical decision-making on inpatient care [abstract]. J Hosp Med. 2012;7(Suppl 2):91.
- Hostetter, M, Klein S. Helping patients make better treatment choices with decision aids. The Commonwealth Fund website. Available at: http://www.commonwealthfund.org/Newsletters/Quality-Matters/2012/October-November/In-Focus.aspx. Accessed Jan. 30, 2013.
Win Whitcomb: Hospital Value-Based Purchasing Program Adds Measure in Efficiency Domain
HVBP’s First Efficiency Measure
Move over, cost, LOS—make room for ‘Medicare spending per beneficiary’
The unwritten rule in hospitalist circles is that lower cost and length of stay (LOS) mean higher efficiency, with hospitalists (me included) often pointing to one or both of these as a yardstick of performance in the efficiency domain. But if we lower hospital length of stay and costs while shifting costs to post-hospital care, have we solved anything?
This very question was raised by Kuo and Goodwin’s observational study that revealed that decreased hospital costs and LOS were offset by higher utilization and costs after discharge under hospitalist care.1
Efficiency As a Domain of Quality
Using the Institute of Medicine’s (IOM) six domains of quality as a framework (see Table 1, right), the Centers for Medicare & Medicaid Services’ (CMS) Hospital Value-Based Purchasing (HVBP) program seeks to encourage enhanced quality in all of the IOM domains. For HVBP 2015, we see the addition of the first measure in the domain of efficiency.
You may be saying to yourself, “It’s only 2013. Why should I worry about HVBP 2015?” Here’s why: The measurement periods for HVBP 2015 are May to December 2011 (baseline) and May to December 2013 (performance). Hospitals can succeed under HVBP if they demonstrate improvement from baseline or attainment, which indicates maintenance of a high level of performance despite no substantial improvement from baseline. Medicare spending per beneficiary (MSPB) will make up 20% of the 2015 HVBP incentive pool for hospitals.
Medicare Spending Per Beneficiary Instead of Costs or LOS
Why did CMS choose to use MSPB as a measure and not simply hospital costs or length of stay? Measuring efficiency of hospital care has proven to be a sticky wicket. If one simply measures and rewards decreased hospital costs and/or length of stay (which you might legitimately argue is exactly what the current DRG system does by paying a case rate to the hospital), one runs the risk of shifting costs to settings beyond the four walls of the hospital, or even fueling higher rates of hospital readmissions. Also, physician costs and other costs (therapy, home care) are not accounted for; they are accounted for under MSPB (described below). Finally, hospital costs and LOS vary substantially across regions and by severity of illness of the patients being analyzed. This makes it difficult to compare, for example, LOS in California versus Massachusetts.
The MSPB is designed to be a comprehensive and equitable metric:
- It seeks to eliminate cost-shifting among settings by widening the time period from three days prior to 30 days post-inpatient-care episode;
- It looks at the full cost of care by including expenses from both Medicare Part A (hospital) and Part B (doctors, PT, OT, home health, others);
- It incorporates risk adjustment by taking into account differences in patient health status; and
- It seeks to level the playing field by using a price standardization methodology that factors in geographic payment differences in wages, practice costs, and payments for indirect medical education and disproportionate share hospitals (those that treat large numbers of the indigent population).
Driving High Performance in Medicare Spending Per Beneficiary
Hospitalists straddle the Part A and Part B elements of Medicare; they have one foot in the hospital and one foot in the physician practice world. They should be able to improve their hospitals’ performance under the MSPB yardstick. Since the performance measurement period starts in May, now is the time to sharpen your focus on MSPB.
Here are the top priorities for MSPB that I recommend for hospitalists:
Reduction of marginally beneficial resource utilization. This is a process of analyzing resource (e.g. pharmacy, radiology, laboratory, blood products) utilization for the purpose of minimizing costly practices that do not benefit the patient. This is an essential practice of a high-functioning hospitalist program. Through its participation in the Choosing Wisely campaign (see “Stop! Think Twice Before You Order,” p. 46), SHM has helped hospitalists have conversations about these practices with patients.
Hospital throughput. Work on “front end” throughput with the ED by having a process in place to quickly evaluate and facilitate potential admissions. Work with case management to assure timely (and early in the day) discharges.
Safe-discharge processes. We reviewed key elements of a safe discharge last month and provided a link to SHM’s Project BOOST (www.hospitalmedicine.org/boost). From the MSPB perspective: A safe discharge minimizes exorbitant spending after discharge.
Documentation integrity. Because MSPB is risk-adjusted, the more the record reflects patient severity of illness, the better your hospital will perform, all else being equal. Work collaboratively with your documentation integrity professionals!
Much of the success of the HM specialty has been built on the tenet that the hospitalist model delivers efficient inpatient care. In the coming years, the specialty’s contribution will increasingly be gauged by the MSPB measure.
Reference
Dr. Whitcomb is medical director of healthcare quality at Baystate Medical Center in Springfield, Mass. He is a co-founder and past president of SHM. Email him at wfwhit@comcast.net.
HVBP’s First Efficiency Measure
Move over, cost, LOS—make room for ‘Medicare spending per beneficiary’
The unwritten rule in hospitalist circles is that lower cost and length of stay (LOS) mean higher efficiency, with hospitalists (me included) often pointing to one or both of these as a yardstick of performance in the efficiency domain. But if we lower hospital length of stay and costs while shifting costs to post-hospital care, have we solved anything?
This very question was raised by Kuo and Goodwin’s observational study that revealed that decreased hospital costs and LOS were offset by higher utilization and costs after discharge under hospitalist care.1
Efficiency As a Domain of Quality
Using the Institute of Medicine’s (IOM) six domains of quality as a framework (see Table 1, right), the Centers for Medicare & Medicaid Services’ (CMS) Hospital Value-Based Purchasing (HVBP) program seeks to encourage enhanced quality in all of the IOM domains. For HVBP 2015, we see the addition of the first measure in the domain of efficiency.
You may be saying to yourself, “It’s only 2013. Why should I worry about HVBP 2015?” Here’s why: The measurement periods for HVBP 2015 are May to December 2011 (baseline) and May to December 2013 (performance). Hospitals can succeed under HVBP if they demonstrate improvement from baseline or attainment, which indicates maintenance of a high level of performance despite no substantial improvement from baseline. Medicare spending per beneficiary (MSPB) will make up 20% of the 2015 HVBP incentive pool for hospitals.
Medicare Spending Per Beneficiary Instead of Costs or LOS
Why did CMS choose to use MSPB as a measure and not simply hospital costs or length of stay? Measuring efficiency of hospital care has proven to be a sticky wicket. If one simply measures and rewards decreased hospital costs and/or length of stay (which you might legitimately argue is exactly what the current DRG system does by paying a case rate to the hospital), one runs the risk of shifting costs to settings beyond the four walls of the hospital, or even fueling higher rates of hospital readmissions. Also, physician costs and other costs (therapy, home care) are not accounted for; they are accounted for under MSPB (described below). Finally, hospital costs and LOS vary substantially across regions and by severity of illness of the patients being analyzed. This makes it difficult to compare, for example, LOS in California versus Massachusetts.
The MSPB is designed to be a comprehensive and equitable metric:
- It seeks to eliminate cost-shifting among settings by widening the time period from three days prior to 30 days post-inpatient-care episode;
- It looks at the full cost of care by including expenses from both Medicare Part A (hospital) and Part B (doctors, PT, OT, home health, others);
- It incorporates risk adjustment by taking into account differences in patient health status; and
- It seeks to level the playing field by using a price standardization methodology that factors in geographic payment differences in wages, practice costs, and payments for indirect medical education and disproportionate share hospitals (those that treat large numbers of the indigent population).
Driving High Performance in Medicare Spending Per Beneficiary
Hospitalists straddle the Part A and Part B elements of Medicare; they have one foot in the hospital and one foot in the physician practice world. They should be able to improve their hospitals’ performance under the MSPB yardstick. Since the performance measurement period starts in May, now is the time to sharpen your focus on MSPB.
Here are the top priorities for MSPB that I recommend for hospitalists:
Reduction of marginally beneficial resource utilization. This is a process of analyzing resource (e.g. pharmacy, radiology, laboratory, blood products) utilization for the purpose of minimizing costly practices that do not benefit the patient. This is an essential practice of a high-functioning hospitalist program. Through its participation in the Choosing Wisely campaign (see “Stop! Think Twice Before You Order,” p. 46), SHM has helped hospitalists have conversations about these practices with patients.
Hospital throughput. Work on “front end” throughput with the ED by having a process in place to quickly evaluate and facilitate potential admissions. Work with case management to assure timely (and early in the day) discharges.
Safe-discharge processes. We reviewed key elements of a safe discharge last month and provided a link to SHM’s Project BOOST (www.hospitalmedicine.org/boost). From the MSPB perspective: A safe discharge minimizes exorbitant spending after discharge.
Documentation integrity. Because MSPB is risk-adjusted, the more the record reflects patient severity of illness, the better your hospital will perform, all else being equal. Work collaboratively with your documentation integrity professionals!
Much of the success of the HM specialty has been built on the tenet that the hospitalist model delivers efficient inpatient care. In the coming years, the specialty’s contribution will increasingly be gauged by the MSPB measure.
Reference
Dr. Whitcomb is medical director of healthcare quality at Baystate Medical Center in Springfield, Mass. He is a co-founder and past president of SHM. Email him at wfwhit@comcast.net.
HVBP’s First Efficiency Measure
Move over, cost, LOS—make room for ‘Medicare spending per beneficiary’
The unwritten rule in hospitalist circles is that lower cost and length of stay (LOS) mean higher efficiency, with hospitalists (me included) often pointing to one or both of these as a yardstick of performance in the efficiency domain. But if we lower hospital length of stay and costs while shifting costs to post-hospital care, have we solved anything?
This very question was raised by Kuo and Goodwin’s observational study that revealed that decreased hospital costs and LOS were offset by higher utilization and costs after discharge under hospitalist care.1
Efficiency As a Domain of Quality
Using the Institute of Medicine’s (IOM) six domains of quality as a framework (see Table 1, right), the Centers for Medicare & Medicaid Services’ (CMS) Hospital Value-Based Purchasing (HVBP) program seeks to encourage enhanced quality in all of the IOM domains. For HVBP 2015, we see the addition of the first measure in the domain of efficiency.
You may be saying to yourself, “It’s only 2013. Why should I worry about HVBP 2015?” Here’s why: The measurement periods for HVBP 2015 are May to December 2011 (baseline) and May to December 2013 (performance). Hospitals can succeed under HVBP if they demonstrate improvement from baseline or attainment, which indicates maintenance of a high level of performance despite no substantial improvement from baseline. Medicare spending per beneficiary (MSPB) will make up 20% of the 2015 HVBP incentive pool for hospitals.
Medicare Spending Per Beneficiary Instead of Costs or LOS
Why did CMS choose to use MSPB as a measure and not simply hospital costs or length of stay? Measuring efficiency of hospital care has proven to be a sticky wicket. If one simply measures and rewards decreased hospital costs and/or length of stay (which you might legitimately argue is exactly what the current DRG system does by paying a case rate to the hospital), one runs the risk of shifting costs to settings beyond the four walls of the hospital, or even fueling higher rates of hospital readmissions. Also, physician costs and other costs (therapy, home care) are not accounted for; they are accounted for under MSPB (described below). Finally, hospital costs and LOS vary substantially across regions and by severity of illness of the patients being analyzed. This makes it difficult to compare, for example, LOS in California versus Massachusetts.
The MSPB is designed to be a comprehensive and equitable metric:
- It seeks to eliminate cost-shifting among settings by widening the time period from three days prior to 30 days post-inpatient-care episode;
- It looks at the full cost of care by including expenses from both Medicare Part A (hospital) and Part B (doctors, PT, OT, home health, others);
- It incorporates risk adjustment by taking into account differences in patient health status; and
- It seeks to level the playing field by using a price standardization methodology that factors in geographic payment differences in wages, practice costs, and payments for indirect medical education and disproportionate share hospitals (those that treat large numbers of the indigent population).
Driving High Performance in Medicare Spending Per Beneficiary
Hospitalists straddle the Part A and Part B elements of Medicare; they have one foot in the hospital and one foot in the physician practice world. They should be able to improve their hospitals’ performance under the MSPB yardstick. Since the performance measurement period starts in May, now is the time to sharpen your focus on MSPB.
Here are the top priorities for MSPB that I recommend for hospitalists:
Reduction of marginally beneficial resource utilization. This is a process of analyzing resource (e.g. pharmacy, radiology, laboratory, blood products) utilization for the purpose of minimizing costly practices that do not benefit the patient. This is an essential practice of a high-functioning hospitalist program. Through its participation in the Choosing Wisely campaign (see “Stop! Think Twice Before You Order,” p. 46), SHM has helped hospitalists have conversations about these practices with patients.
Hospital throughput. Work on “front end” throughput with the ED by having a process in place to quickly evaluate and facilitate potential admissions. Work with case management to assure timely (and early in the day) discharges.
Safe-discharge processes. We reviewed key elements of a safe discharge last month and provided a link to SHM’s Project BOOST (www.hospitalmedicine.org/boost). From the MSPB perspective: A safe discharge minimizes exorbitant spending after discharge.
Documentation integrity. Because MSPB is risk-adjusted, the more the record reflects patient severity of illness, the better your hospital will perform, all else being equal. Work collaboratively with your documentation integrity professionals!
Much of the success of the HM specialty has been built on the tenet that the hospitalist model delivers efficient inpatient care. In the coming years, the specialty’s contribution will increasingly be gauged by the MSPB measure.
Reference
Dr. Whitcomb is medical director of healthcare quality at Baystate Medical Center in Springfield, Mass. He is a co-founder and past president of SHM. Email him at wfwhit@comcast.net.
Physicians Exercise Their Entrepreneurial Skills, Creativity to Pursue Passions Beyond Clinical Medicine
After years of juggling more than one career, Kulleni Gebreyes, MD, MBA, had a tough decision to make. "I'm a little bit of a glutton for punishment," she admits with a chuckle. While overseeing quality improvement (QI) for a healthcare foundation, she had negotiated to take off every other Friday and work several ED shifts per month on weekends at two local hospitals.
Then, in January 2012, Dr. Gebreyes began a new full-time position as a director at PricewaterhouseCoopers in McLean, Va. It became too time-consuming and exhausting to treat patients and consult in healthcare industries, says the mother of two children, who are 7 and 4.
Dr. Gebreyes is among a growing number of physicians who, after a number of years, opt to give up clinical medicine for nonclinical roles in healthcare or other industries altogether. "You are ready for transition when the new choice excites and energizes you," she explains, "and not necessarily when your first choice disappoints you."
A career shift offers new opportunities for broadening one's horizons while often striking a better work-life balance. Many clinicians make the transition slowly and wisely, and some take an expected financial hit as they carve out an entrepreneurial and creative path.
"Modern medicine is very difficult. You can burn out if you're not careful," says Dan Hale, MD, FAAP, a pediatric hospitalist in the Floating Hospital for Children at Tufts Medical Center in Boston.
Stepping off the merry-go-round can help you regroup. Fortunately, he adds, hospitalists can exercise more flexibility in scheduling than physicians in different specialties. Some hospitalists prefer to work nights and weekends in order to free up weekdays for other activities. Others decrease their clinical shifts and devote more time to teaching, research, or administration.
For those who decide to leave medicine completely, "hospitalists definitely have people skills day to day in their jobs that are applicable in multiple other careers," says Dr. Hale, a Team Hospitalist member. "Becoming a physician requires so much dedication and hard work, so you will succeed in whatever career you choose."
The Society of Physician Entrepreneurs (www.sopenet.org) is expanding by about 150 to 200 new members each month. Founded in 2008 and officially launched in January 2011, the society has more than 4,700 members globally. The interdisciplinary network includes physicians and innovators in other professions—from law to information technology to product development.
Its purpose is to "bring all the stakeholders together in one virtual space to collaborate," says co-founder and president Arlen Meyers, MD, MBA, professor in the departments of otolaryngology, dentistry, and engineering at the University of Colorado Denver, where he directs the graduate program in bio-innovation and entrepreneurship.
"The opportunities for physician entrepreneurs include working with industry, consulting, creating their own company, and much more," Dr. Meyers says. "As domain experts, physicians are in a unique position to add value to the innovation chain.
–Maren Grainger-Monsen, MD, filmmaker-in-residence and director of the bioethics and film program, Stanford Center for Biomedical Ethics, Stanford, Calif.
"However, to leave practice and be successful at something nonclinical requires education, experience, and networks," he says. "Doing what you did successfully in your last career won't be a guarantee of success in your next career, so you have to be willing to pay your dues and accept the risk."
The Writer
Deborah Shlian, MD, MBA, a former family medicine physician and managed-care executive in California, has evolved into a medical management consultant and an author of both fiction and nonfiction titles. Dr. Shlian, who now lives in Boca Raton, Fla., had always wanted to write. Her father, an internist, encouraged the pursuit of medicine, so she followed in his footsteps.
"I wanted to emulate what he did," she says. Over time, she realized that "doctors have a lot of skills that are applicable to other endeavors."
She and her husband, Joel Shlian, MD, MBA, also a former family medicine physician, fully gave up clinical practice about 10 years ago after doing it part time for a decade. The Shlians met as students at the University of Maryland School of Medicine in 1970. Initially, their new business concentrated on physician executive recruitment. As clients requested other services, the Shlians helped identify nonphysician managers as well. Clients included established, as well as start-up health plans, academic institutions, utilization review, and healthcare consulting companies.
Given the accelerated changes in healthcare delivery, earning a graduate education in business is not a quick and easy avenue to another career. "An MBA should never be viewed as the means to 'get out of medical practice,'" Dr. Shlian says in her new book, "Lessons Learned: Stories from Women in Medical Management," released this month by the American College of Physician Executives.
"In fact, I would submit that if you really hate clinical medicine, medical management is not for you," she says. "It can be every bit as demanding and frustrating as clinical practice."
The Entrepreneur
Jeffrey N. Hausfeld, MD, MBA, FACS, completed an MBA program on evenings and weekends. After graduation in 2005, he gave up his 24-year practice of otolaryngology and facial plastic surgery. He continued his education by obtaining a graduate certificate in leadership coaching and organizational development. Then he became involved in the first of several business ventures, capitalizing on his clinical experience.
"Doctors don't have a trusted partner to do their debt collections," says Dr. Hausfeld, co-founder and treasurer of the Society of Physician Entrepreneurs. His own negative experiences with debt-collection agencies contributed to his "understanding the obstacles and objections to create this kind of an entity."
—Kulleni Gebreyes, MD, MBA, director of healthcare consulting, PricewaterhouseCoopers, McLean, Va.
Hence the emergence of FMS Financial Solutions, based in Greenbelt, Md. "This seemed to be a very natural fit for me," says Dr. Hausfeld, who is the managing director. By collecting money owed to physicians, hospitals, and surgical centers, he has increased the revenues of his business fourfold since 2006. The company has 24 full- and part-time workers.
Meanwhile, his son, Joshua, who joined him in the healthcare MBA program at Johns Hopkins University in Baltimore and now works for an investment banking firm that provides real estate loans for senior housing, introduced Dr. Hausfeld to a group of Midwest-based assisted-living-facility developers. Four years ago, they struck a deal to provide private equity funding and create Memory Care Communities of Illinois, with Dr. Hausfeld serving as president. The 24-hour residential facilities are home to patients with Alzheimer's disease and dementia.
To some degree, he misses practicing medicine, but Dr. Hausfeld is enthusiastic about making a difference in even more people's lives than he did as a physician and surgeon.
"I've done 10,000 ear, nose, and throat operations. If I did 1,000 more, how much would I be changing the world?" Dr. Hausfeld says. Ultimately, "you find a way to leave a bigger footprint."
His entrepreneurial spirit has led to other consulting roles. For instance, he is trying to help two startup companies—one in the medical device arena, the other in information technology—grow by leaps and bounds.
The Director
Maren Grainger-Monsen, MD, has made her mark as an award-winning physician filmmaker. She is filmmaker-in-residence and director of the bioethics and film program at the Stanford Center for Biomedical Ethics in Palo Alto, Calif. She studied at the London Film School and received her medical training at the University of Washington in Seattle and Stanford University School of Medicine.
"I have really enjoyed using all of my medical background and knowledge and applying it toward film," Dr. Grainger-Monsen says of her position at Stanford, which she has held since 1998. "It's very grounding. It gives you a purpose."
Her one-hour documentary "Rare," which features a family with a very uncommon genetic disease, aired last August on PBS. Another film, "The Revolutionary Optimists," follows a group of aspiring youngsters in the slums of Calcutta, India, who battle poverty and transform their neighborhoods from the inside out. One-hour and 80-minute versions of the film are slated to air on the PBS series "Independent Lens" as part of the Women and Girls Lead Global partnership.
–Dan Hale, MD, FAAP, a pediatric hospitalist in the Floating Hospital for Children at Tufts Medical Center in Boston
Dr. Grainger-Monsen co-produced and co-directed both films with Nicole Newnham, an independent documentary filmmaker who is in residence at Stanford's bioethics and film program.
As an undergraduate art history major, Dr. Grainger-Monsen became interested in social and ethical issues in medicine. Later, films shown in medical school struck a chord with her. She was amazed at how images could resonate with viewers and trigger animated debate. During the summer between her first and second years of medical school, she was inspired to study film at New York University.
Dr. Grainger-Monsen eventually trained in emergency medicine at Stanford and completed a fellowship in palliative care at Stanford-affiliated Palo Alto Veterans Administration Hospital. For years, she split her career between working in community ER clinics and producing films. Her films are large-scale projects that may take five years or longer to make, and she raises all the funds to bring them to fruition.
"I really do find documentary filmmaking tremendously gratifying," Dr. Grainger-Monsen says of the chance "to talk with all different kinds of people in all different situations and walk in their shoes, with them, for a time. That is what I'm trying to share with the audience."
In creating character-driven documentaries, she aims to spark discussions about important issues in contemporary medicine. "I hope my films can help increase understanding and empathy," she says, "and result in improvements to the delivery of healthcare and reduction of disparities on multiple levels."
Susan Kreimer is a freelance writer in New York.
After years of juggling more than one career, Kulleni Gebreyes, MD, MBA, had a tough decision to make. "I'm a little bit of a glutton for punishment," she admits with a chuckle. While overseeing quality improvement (QI) for a healthcare foundation, she had negotiated to take off every other Friday and work several ED shifts per month on weekends at two local hospitals.
Then, in January 2012, Dr. Gebreyes began a new full-time position as a director at PricewaterhouseCoopers in McLean, Va. It became too time-consuming and exhausting to treat patients and consult in healthcare industries, says the mother of two children, who are 7 and 4.
Dr. Gebreyes is among a growing number of physicians who, after a number of years, opt to give up clinical medicine for nonclinical roles in healthcare or other industries altogether. "You are ready for transition when the new choice excites and energizes you," she explains, "and not necessarily when your first choice disappoints you."
A career shift offers new opportunities for broadening one's horizons while often striking a better work-life balance. Many clinicians make the transition slowly and wisely, and some take an expected financial hit as they carve out an entrepreneurial and creative path.
"Modern medicine is very difficult. You can burn out if you're not careful," says Dan Hale, MD, FAAP, a pediatric hospitalist in the Floating Hospital for Children at Tufts Medical Center in Boston.
Stepping off the merry-go-round can help you regroup. Fortunately, he adds, hospitalists can exercise more flexibility in scheduling than physicians in different specialties. Some hospitalists prefer to work nights and weekends in order to free up weekdays for other activities. Others decrease their clinical shifts and devote more time to teaching, research, or administration.
For those who decide to leave medicine completely, "hospitalists definitely have people skills day to day in their jobs that are applicable in multiple other careers," says Dr. Hale, a Team Hospitalist member. "Becoming a physician requires so much dedication and hard work, so you will succeed in whatever career you choose."
The Society of Physician Entrepreneurs (www.sopenet.org) is expanding by about 150 to 200 new members each month. Founded in 2008 and officially launched in January 2011, the society has more than 4,700 members globally. The interdisciplinary network includes physicians and innovators in other professions—from law to information technology to product development.
Its purpose is to "bring all the stakeholders together in one virtual space to collaborate," says co-founder and president Arlen Meyers, MD, MBA, professor in the departments of otolaryngology, dentistry, and engineering at the University of Colorado Denver, where he directs the graduate program in bio-innovation and entrepreneurship.
"The opportunities for physician entrepreneurs include working with industry, consulting, creating their own company, and much more," Dr. Meyers says. "As domain experts, physicians are in a unique position to add value to the innovation chain.
–Maren Grainger-Monsen, MD, filmmaker-in-residence and director of the bioethics and film program, Stanford Center for Biomedical Ethics, Stanford, Calif.
"However, to leave practice and be successful at something nonclinical requires education, experience, and networks," he says. "Doing what you did successfully in your last career won't be a guarantee of success in your next career, so you have to be willing to pay your dues and accept the risk."
The Writer
Deborah Shlian, MD, MBA, a former family medicine physician and managed-care executive in California, has evolved into a medical management consultant and an author of both fiction and nonfiction titles. Dr. Shlian, who now lives in Boca Raton, Fla., had always wanted to write. Her father, an internist, encouraged the pursuit of medicine, so she followed in his footsteps.
"I wanted to emulate what he did," she says. Over time, she realized that "doctors have a lot of skills that are applicable to other endeavors."
She and her husband, Joel Shlian, MD, MBA, also a former family medicine physician, fully gave up clinical practice about 10 years ago after doing it part time for a decade. The Shlians met as students at the University of Maryland School of Medicine in 1970. Initially, their new business concentrated on physician executive recruitment. As clients requested other services, the Shlians helped identify nonphysician managers as well. Clients included established, as well as start-up health plans, academic institutions, utilization review, and healthcare consulting companies.
Given the accelerated changes in healthcare delivery, earning a graduate education in business is not a quick and easy avenue to another career. "An MBA should never be viewed as the means to 'get out of medical practice,'" Dr. Shlian says in her new book, "Lessons Learned: Stories from Women in Medical Management," released this month by the American College of Physician Executives.
"In fact, I would submit that if you really hate clinical medicine, medical management is not for you," she says. "It can be every bit as demanding and frustrating as clinical practice."
The Entrepreneur
Jeffrey N. Hausfeld, MD, MBA, FACS, completed an MBA program on evenings and weekends. After graduation in 2005, he gave up his 24-year practice of otolaryngology and facial plastic surgery. He continued his education by obtaining a graduate certificate in leadership coaching and organizational development. Then he became involved in the first of several business ventures, capitalizing on his clinical experience.
"Doctors don't have a trusted partner to do their debt collections," says Dr. Hausfeld, co-founder and treasurer of the Society of Physician Entrepreneurs. His own negative experiences with debt-collection agencies contributed to his "understanding the obstacles and objections to create this kind of an entity."
—Kulleni Gebreyes, MD, MBA, director of healthcare consulting, PricewaterhouseCoopers, McLean, Va.
Hence the emergence of FMS Financial Solutions, based in Greenbelt, Md. "This seemed to be a very natural fit for me," says Dr. Hausfeld, who is the managing director. By collecting money owed to physicians, hospitals, and surgical centers, he has increased the revenues of his business fourfold since 2006. The company has 24 full- and part-time workers.
Meanwhile, his son, Joshua, who joined him in the healthcare MBA program at Johns Hopkins University in Baltimore and now works for an investment banking firm that provides real estate loans for senior housing, introduced Dr. Hausfeld to a group of Midwest-based assisted-living-facility developers. Four years ago, they struck a deal to provide private equity funding and create Memory Care Communities of Illinois, with Dr. Hausfeld serving as president. The 24-hour residential facilities are home to patients with Alzheimer's disease and dementia.
To some degree, he misses practicing medicine, but Dr. Hausfeld is enthusiastic about making a difference in even more people's lives than he did as a physician and surgeon.
"I've done 10,000 ear, nose, and throat operations. If I did 1,000 more, how much would I be changing the world?" Dr. Hausfeld says. Ultimately, "you find a way to leave a bigger footprint."
His entrepreneurial spirit has led to other consulting roles. For instance, he is trying to help two startup companies—one in the medical device arena, the other in information technology—grow by leaps and bounds.
The Director
Maren Grainger-Monsen, MD, has made her mark as an award-winning physician filmmaker. She is filmmaker-in-residence and director of the bioethics and film program at the Stanford Center for Biomedical Ethics in Palo Alto, Calif. She studied at the London Film School and received her medical training at the University of Washington in Seattle and Stanford University School of Medicine.
"I have really enjoyed using all of my medical background and knowledge and applying it toward film," Dr. Grainger-Monsen says of her position at Stanford, which she has held since 1998. "It's very grounding. It gives you a purpose."
Her one-hour documentary "Rare," which features a family with a very uncommon genetic disease, aired last August on PBS. Another film, "The Revolutionary Optimists," follows a group of aspiring youngsters in the slums of Calcutta, India, who battle poverty and transform their neighborhoods from the inside out. One-hour and 80-minute versions of the film are slated to air on the PBS series "Independent Lens" as part of the Women and Girls Lead Global partnership.
–Dan Hale, MD, FAAP, a pediatric hospitalist in the Floating Hospital for Children at Tufts Medical Center in Boston
Dr. Grainger-Monsen co-produced and co-directed both films with Nicole Newnham, an independent documentary filmmaker who is in residence at Stanford's bioethics and film program.
As an undergraduate art history major, Dr. Grainger-Monsen became interested in social and ethical issues in medicine. Later, films shown in medical school struck a chord with her. She was amazed at how images could resonate with viewers and trigger animated debate. During the summer between her first and second years of medical school, she was inspired to study film at New York University.
Dr. Grainger-Monsen eventually trained in emergency medicine at Stanford and completed a fellowship in palliative care at Stanford-affiliated Palo Alto Veterans Administration Hospital. For years, she split her career between working in community ER clinics and producing films. Her films are large-scale projects that may take five years or longer to make, and she raises all the funds to bring them to fruition.
"I really do find documentary filmmaking tremendously gratifying," Dr. Grainger-Monsen says of the chance "to talk with all different kinds of people in all different situations and walk in their shoes, with them, for a time. That is what I'm trying to share with the audience."
In creating character-driven documentaries, she aims to spark discussions about important issues in contemporary medicine. "I hope my films can help increase understanding and empathy," she says, "and result in improvements to the delivery of healthcare and reduction of disparities on multiple levels."
Susan Kreimer is a freelance writer in New York.
After years of juggling more than one career, Kulleni Gebreyes, MD, MBA, had a tough decision to make. "I'm a little bit of a glutton for punishment," she admits with a chuckle. While overseeing quality improvement (QI) for a healthcare foundation, she had negotiated to take off every other Friday and work several ED shifts per month on weekends at two local hospitals.
Then, in January 2012, Dr. Gebreyes began a new full-time position as a director at PricewaterhouseCoopers in McLean, Va. It became too time-consuming and exhausting to treat patients and consult in healthcare industries, says the mother of two children, who are 7 and 4.
Dr. Gebreyes is among a growing number of physicians who, after a number of years, opt to give up clinical medicine for nonclinical roles in healthcare or other industries altogether. "You are ready for transition when the new choice excites and energizes you," she explains, "and not necessarily when your first choice disappoints you."
A career shift offers new opportunities for broadening one's horizons while often striking a better work-life balance. Many clinicians make the transition slowly and wisely, and some take an expected financial hit as they carve out an entrepreneurial and creative path.
"Modern medicine is very difficult. You can burn out if you're not careful," says Dan Hale, MD, FAAP, a pediatric hospitalist in the Floating Hospital for Children at Tufts Medical Center in Boston.
Stepping off the merry-go-round can help you regroup. Fortunately, he adds, hospitalists can exercise more flexibility in scheduling than physicians in different specialties. Some hospitalists prefer to work nights and weekends in order to free up weekdays for other activities. Others decrease their clinical shifts and devote more time to teaching, research, or administration.
For those who decide to leave medicine completely, "hospitalists definitely have people skills day to day in their jobs that are applicable in multiple other careers," says Dr. Hale, a Team Hospitalist member. "Becoming a physician requires so much dedication and hard work, so you will succeed in whatever career you choose."
The Society of Physician Entrepreneurs (www.sopenet.org) is expanding by about 150 to 200 new members each month. Founded in 2008 and officially launched in January 2011, the society has more than 4,700 members globally. The interdisciplinary network includes physicians and innovators in other professions—from law to information technology to product development.
Its purpose is to "bring all the stakeholders together in one virtual space to collaborate," says co-founder and president Arlen Meyers, MD, MBA, professor in the departments of otolaryngology, dentistry, and engineering at the University of Colorado Denver, where he directs the graduate program in bio-innovation and entrepreneurship.
"The opportunities for physician entrepreneurs include working with industry, consulting, creating their own company, and much more," Dr. Meyers says. "As domain experts, physicians are in a unique position to add value to the innovation chain.
–Maren Grainger-Monsen, MD, filmmaker-in-residence and director of the bioethics and film program, Stanford Center for Biomedical Ethics, Stanford, Calif.
"However, to leave practice and be successful at something nonclinical requires education, experience, and networks," he says. "Doing what you did successfully in your last career won't be a guarantee of success in your next career, so you have to be willing to pay your dues and accept the risk."
The Writer
Deborah Shlian, MD, MBA, a former family medicine physician and managed-care executive in California, has evolved into a medical management consultant and an author of both fiction and nonfiction titles. Dr. Shlian, who now lives in Boca Raton, Fla., had always wanted to write. Her father, an internist, encouraged the pursuit of medicine, so she followed in his footsteps.
"I wanted to emulate what he did," she says. Over time, she realized that "doctors have a lot of skills that are applicable to other endeavors."
She and her husband, Joel Shlian, MD, MBA, also a former family medicine physician, fully gave up clinical practice about 10 years ago after doing it part time for a decade. The Shlians met as students at the University of Maryland School of Medicine in 1970. Initially, their new business concentrated on physician executive recruitment. As clients requested other services, the Shlians helped identify nonphysician managers as well. Clients included established, as well as start-up health plans, academic institutions, utilization review, and healthcare consulting companies.
Given the accelerated changes in healthcare delivery, earning a graduate education in business is not a quick and easy avenue to another career. "An MBA should never be viewed as the means to 'get out of medical practice,'" Dr. Shlian says in her new book, "Lessons Learned: Stories from Women in Medical Management," released this month by the American College of Physician Executives.
"In fact, I would submit that if you really hate clinical medicine, medical management is not for you," she says. "It can be every bit as demanding and frustrating as clinical practice."
The Entrepreneur
Jeffrey N. Hausfeld, MD, MBA, FACS, completed an MBA program on evenings and weekends. After graduation in 2005, he gave up his 24-year practice of otolaryngology and facial plastic surgery. He continued his education by obtaining a graduate certificate in leadership coaching and organizational development. Then he became involved in the first of several business ventures, capitalizing on his clinical experience.
"Doctors don't have a trusted partner to do their debt collections," says Dr. Hausfeld, co-founder and treasurer of the Society of Physician Entrepreneurs. His own negative experiences with debt-collection agencies contributed to his "understanding the obstacles and objections to create this kind of an entity."
—Kulleni Gebreyes, MD, MBA, director of healthcare consulting, PricewaterhouseCoopers, McLean, Va.
Hence the emergence of FMS Financial Solutions, based in Greenbelt, Md. "This seemed to be a very natural fit for me," says Dr. Hausfeld, who is the managing director. By collecting money owed to physicians, hospitals, and surgical centers, he has increased the revenues of his business fourfold since 2006. The company has 24 full- and part-time workers.
Meanwhile, his son, Joshua, who joined him in the healthcare MBA program at Johns Hopkins University in Baltimore and now works for an investment banking firm that provides real estate loans for senior housing, introduced Dr. Hausfeld to a group of Midwest-based assisted-living-facility developers. Four years ago, they struck a deal to provide private equity funding and create Memory Care Communities of Illinois, with Dr. Hausfeld serving as president. The 24-hour residential facilities are home to patients with Alzheimer's disease and dementia.
To some degree, he misses practicing medicine, but Dr. Hausfeld is enthusiastic about making a difference in even more people's lives than he did as a physician and surgeon.
"I've done 10,000 ear, nose, and throat operations. If I did 1,000 more, how much would I be changing the world?" Dr. Hausfeld says. Ultimately, "you find a way to leave a bigger footprint."
His entrepreneurial spirit has led to other consulting roles. For instance, he is trying to help two startup companies—one in the medical device arena, the other in information technology—grow by leaps and bounds.
The Director
Maren Grainger-Monsen, MD, has made her mark as an award-winning physician filmmaker. She is filmmaker-in-residence and director of the bioethics and film program at the Stanford Center for Biomedical Ethics in Palo Alto, Calif. She studied at the London Film School and received her medical training at the University of Washington in Seattle and Stanford University School of Medicine.
"I have really enjoyed using all of my medical background and knowledge and applying it toward film," Dr. Grainger-Monsen says of her position at Stanford, which she has held since 1998. "It's very grounding. It gives you a purpose."
Her one-hour documentary "Rare," which features a family with a very uncommon genetic disease, aired last August on PBS. Another film, "The Revolutionary Optimists," follows a group of aspiring youngsters in the slums of Calcutta, India, who battle poverty and transform their neighborhoods from the inside out. One-hour and 80-minute versions of the film are slated to air on the PBS series "Independent Lens" as part of the Women and Girls Lead Global partnership.
–Dan Hale, MD, FAAP, a pediatric hospitalist in the Floating Hospital for Children at Tufts Medical Center in Boston
Dr. Grainger-Monsen co-produced and co-directed both films with Nicole Newnham, an independent documentary filmmaker who is in residence at Stanford's bioethics and film program.
As an undergraduate art history major, Dr. Grainger-Monsen became interested in social and ethical issues in medicine. Later, films shown in medical school struck a chord with her. She was amazed at how images could resonate with viewers and trigger animated debate. During the summer between her first and second years of medical school, she was inspired to study film at New York University.
Dr. Grainger-Monsen eventually trained in emergency medicine at Stanford and completed a fellowship in palliative care at Stanford-affiliated Palo Alto Veterans Administration Hospital. For years, she split her career between working in community ER clinics and producing films. Her films are large-scale projects that may take five years or longer to make, and she raises all the funds to bring them to fruition.
"I really do find documentary filmmaking tremendously gratifying," Dr. Grainger-Monsen says of the chance "to talk with all different kinds of people in all different situations and walk in their shoes, with them, for a time. That is what I'm trying to share with the audience."
In creating character-driven documentaries, she aims to spark discussions about important issues in contemporary medicine. "I hope my films can help increase understanding and empathy," she says, "and result in improvements to the delivery of healthcare and reduction of disparities on multiple levels."
Susan Kreimer is a freelance writer in New York.