When I was a resident, an attending physician in my geriatrics rotation always ended rounds with the question: "What did you put in your toolbox today?"

One of my favorite parts of my job is resident education. For a few months out of the year, I have an internal medicine resident shadow me. This provides me with an opportunity to teach, and perhaps inspire some of them to go into rheumatology, as my mentors in medical school inspired me.

But it is challenging to be responsible for someone’s learning. When I was in medical school I always appreciated the professors whose lectures catered to the levels of our medical knowledge – not talking above or below us. Now that I find myself in a similar position I am quite self-conscious of this. My goal is to teach residents information that will be most helpful for them in their general practice without wasting their time.

Since the bulk of internal medicine residency is focused on inpatient care, and since rheumatology is mostly an outpatient field, there is a fairly large gap between what residents know now and what they will have to know in a few short years. I have a short list of things that I think every internal medicine resident should learn.

– A good clinical eye has to be cultivated. The art of the physical exam is one of the few things that cannot be learned from books. I can think of a few eponymous physical exam findings and maneuvers specific to rheumatology – oh, to make Heberden and Bouchard, Gottron, Yergason, Finklestein, Patrick, and Schober proud – that can help any primary care physician make an accurate diagnosis. The neurological exam is also of some import in our field and so, thanks to Tinel, Phalen, Jendrassik, and Lasegue, I have a few tricks up my sleeve.

– The needle is our friend. Joint aspiration and injection are valuable tools in the primary care physician’s toolbox. A lot of patients present with knee osteoarthritis and it is an easy way to relieve pain, especially when there are comorbidities that preclude the use of NSAIDs. Also useful for when there is a question of septic arthritis on the wards and they can’t wait for the busy rheumatologist to get to the hospital after a long day at clinic, and the orthopedic resident is not cooperating.

– Back pain is ubiquitous. It is, in fact, one of most common reasons for an outpatient sick visit. But there are many different varieties of low back pain, and again, the arts of taking a good history and performing a good physical exam are relevant. I stress to the medical residents that imaging is not always necessary, HLA B27 testing is superfluous, and physical therapy is underutilized but extremely important.

– Know gout well. Much has been made of how poorly gout is managed in the primary care setting (though the numbers do seem to be improving). I still occasionally see patients who stop and start their urate-lowering drugs whenever they are in a flare – precisely not what they should be doing. If there is a relationship between the metabolic syndrome and gout, then shouldn’t primary care providers be just as familiar with the management of gout as they are with the management of hypertension, hyperlipidemia, and diabetes?

– Not all that glitters is gold. One of the more valuable lessons I hope residents leave with after a month with me is that an elevated ESR does not always mean PMR, and an elevated RF does not always mean rheumatoid arthritis. The differentials for these entities are slightly broader and need to be thoroughly investigated. Since primary care providers often order these tests I think they should also be able to interpret it.

Dr. Chan practices rheumatology in Pawtucket, R.I. E-mail her rhnews@elsevier.com.

When I was a resident, an attending physician in my geriatrics rotation always ended rounds with the question: "What did you put in your toolbox today?"

One of my favorite parts of my job is resident education. For a few months out of the year, I have an internal medicine resident shadow me. This provides me with an opportunity to teach, and perhaps inspire some of them to go into rheumatology, as my mentors in medical school inspired me.

But it is challenging to be responsible for someone’s learning. When I was in medical school I always appreciated the professors whose lectures catered to the levels of our medical knowledge – not talking above or below us. Now that I find myself in a similar position I am quite self-conscious of this. My goal is to teach residents information that will be most helpful for them in their general practice without wasting their time.

Since the bulk of internal medicine residency is focused on inpatient care, and since rheumatology is mostly an outpatient field, there is a fairly large gap between what residents know now and what they will have to know in a few short years. I have a short list of things that I think every internal medicine resident should learn.

– A good clinical eye has to be cultivated. The art of the physical exam is one of the few things that cannot be learned from books. I can think of a few eponymous physical exam findings and maneuvers specific to rheumatology – oh, to make Heberden and Bouchard, Gottron, Yergason, Finklestein, Patrick, and Schober proud – that can help any primary care physician make an accurate diagnosis. The neurological exam is also of some import in our field and so, thanks to Tinel, Phalen, Jendrassik, and Lasegue, I have a few tricks up my sleeve.

– The needle is our friend. Joint aspiration and injection are valuable tools in the primary care physician’s toolbox. A lot of patients present with knee osteoarthritis and it is an easy way to relieve pain, especially when there are comorbidities that preclude the use of NSAIDs. Also useful for when there is a question of septic arthritis on the wards and they can’t wait for the busy rheumatologist to get to the hospital after a long day at clinic, and the orthopedic resident is not cooperating.

– Back pain is ubiquitous. It is, in fact, one of most common reasons for an outpatient sick visit. But there are many different varieties of low back pain, and again, the arts of taking a good history and performing a good physical exam are relevant. I stress to the medical residents that imaging is not always necessary, HLA B27 testing is superfluous, and physical therapy is underutilized but extremely important.

– Know gout well. Much has been made of how poorly gout is managed in the primary care setting (though the numbers do seem to be improving). I still occasionally see patients who stop and start their urate-lowering drugs whenever they are in a flare – precisely not what they should be doing. If there is a relationship between the metabolic syndrome and gout, then shouldn’t primary care providers be just as familiar with the management of gout as they are with the management of hypertension, hyperlipidemia, and diabetes?

– Not all that glitters is gold. One of the more valuable lessons I hope residents leave with after a month with me is that an elevated ESR does not always mean PMR, and an elevated RF does not always mean rheumatoid arthritis. The differentials for these entities are slightly broader and need to be thoroughly investigated. Since primary care providers often order these tests I think they should also be able to interpret it.

Dr. Chan practices rheumatology in Pawtucket, R.I. E-mail her rhnews@elsevier.com.

When I was a resident, an attending physician in my geriatrics rotation always ended rounds with the question: "What did you put in your toolbox today?"

One of my favorite parts of my job is resident education. For a few months out of the year, I have an internal medicine resident shadow me. This provides me with an opportunity to teach, and perhaps inspire some of them to go into rheumatology, as my mentors in medical school inspired me.

But it is challenging to be responsible for someone’s learning. When I was in medical school I always appreciated the professors whose lectures catered to the levels of our medical knowledge – not talking above or below us. Now that I find myself in a similar position I am quite self-conscious of this. My goal is to teach residents information that will be most helpful for them in their general practice without wasting their time.

Since the bulk of internal medicine residency is focused on inpatient care, and since rheumatology is mostly an outpatient field, there is a fairly large gap between what residents know now and what they will have to know in a few short years. I have a short list of things that I think every internal medicine resident should learn.

– A good clinical eye has to be cultivated. The art of the physical exam is one of the few things that cannot be learned from books. I can think of a few eponymous physical exam findings and maneuvers specific to rheumatology – oh, to make Heberden and Bouchard, Gottron, Yergason, Finklestein, Patrick, and Schober proud – that can help any primary care physician make an accurate diagnosis. The neurological exam is also of some import in our field and so, thanks to Tinel, Phalen, Jendrassik, and Lasegue, I have a few tricks up my sleeve.

– The needle is our friend. Joint aspiration and injection are valuable tools in the primary care physician’s toolbox. A lot of patients present with knee osteoarthritis and it is an easy way to relieve pain, especially when there are comorbidities that preclude the use of NSAIDs. Also useful for when there is a question of septic arthritis on the wards and they can’t wait for the busy rheumatologist to get to the hospital after a long day at clinic, and the orthopedic resident is not cooperating.

– Back pain is ubiquitous. It is, in fact, one of most common reasons for an outpatient sick visit. But there are many different varieties of low back pain, and again, the arts of taking a good history and performing a good physical exam are relevant. I stress to the medical residents that imaging is not always necessary, HLA B27 testing is superfluous, and physical therapy is underutilized but extremely important.

– Know gout well. Much has been made of how poorly gout is managed in the primary care setting (though the numbers do seem to be improving). I still occasionally see patients who stop and start their urate-lowering drugs whenever they are in a flare – precisely not what they should be doing. If there is a relationship between the metabolic syndrome and gout, then shouldn’t primary care providers be just as familiar with the management of gout as they are with the management of hypertension, hyperlipidemia, and diabetes?

– Not all that glitters is gold. One of the more valuable lessons I hope residents leave with after a month with me is that an elevated ESR does not always mean PMR, and an elevated RF does not always mean rheumatoid arthritis. The differentials for these entities are slightly broader and need to be thoroughly investigated. Since primary care providers often order these tests I think they should also be able to interpret it.

Dr. Chan practices rheumatology in Pawtucket, R.I. E-mail her rhnews@elsevier.com.

Competition is cutthroat in the world of locum tenens physicians. As agencies fight to hire hospitalists and other subspecialists they can assign to positions across the nation, those temporary staffers become a commodity in and of themselves.

Dr. Mohammed is one of those hard assets.

An agency physician placed by Barton Associates in a mid-Atlantic hospital, he did not want to disclose his full name because he is transitioning to full-time locums from his current, full-time position, and he doesn’t want to alienate colleagues by talking publicly of his plans to leave. Barton Associates does not want his name disclosed due to the time, effort, and resources that the firm has invested in him. Barton has been shepherding Dr. Mohammed through the licensing process.

Dr. Mohammed’s reason for transitioning to full-time locum work is simple: flexibility.

“With locums, you have a variety of choices,” he says. “When you’re going into your first permanent job interview, you’re just desperate. You don’t know how the system functions. ... If I would have known about the locum opportunity before I started doing the permanent job, then I would have taken the locums right away.”

Dr. Mohammed, whose ultimate goal is to work for a government facility in South Florida, says he is excited about the opportunities locums work offers. He can move around the country with little difficulty and gain exposure in urban settings, rural hospitals, and everything in between.

And, of course, there is the money. Locum physicians can gross 30% to 40% more per year for the same number of shifts as a typical FTE hospitalist.

“Definitely income─there’s no question,” Dr. Mohammed adds. “When you’re coming out of residency, you don’t have very good income. Some of us that have school debt, family responsibilities—you just want to take care of the financial part.”

Richard Quinn is a freelance writer in New Jersey.

Competition is cutthroat in the world of locum tenens physicians. As agencies fight to hire hospitalists and other subspecialists they can assign to positions across the nation, those temporary staffers become a commodity in and of themselves.

Dr. Mohammed is one of those hard assets.

An agency physician placed by Barton Associates in a mid-Atlantic hospital, he did not want to disclose his full name because he is transitioning to full-time locums from his current, full-time position, and he doesn’t want to alienate colleagues by talking publicly of his plans to leave. Barton Associates does not want his name disclosed due to the time, effort, and resources that the firm has invested in him. Barton has been shepherding Dr. Mohammed through the licensing process.

Dr. Mohammed’s reason for transitioning to full-time locum work is simple: flexibility.

“With locums, you have a variety of choices,” he says. “When you’re going into your first permanent job interview, you’re just desperate. You don’t know how the system functions. ... If I would have known about the locum opportunity before I started doing the permanent job, then I would have taken the locums right away.”

Dr. Mohammed, whose ultimate goal is to work for a government facility in South Florida, says he is excited about the opportunities locums work offers. He can move around the country with little difficulty and gain exposure in urban settings, rural hospitals, and everything in between.

And, of course, there is the money. Locum physicians can gross 30% to 40% more per year for the same number of shifts as a typical FTE hospitalist.

“Definitely income─there’s no question,” Dr. Mohammed adds. “When you’re coming out of residency, you don’t have very good income. Some of us that have school debt, family responsibilities—you just want to take care of the financial part.”

Richard Quinn is a freelance writer in New Jersey.

Competition is cutthroat in the world of locum tenens physicians. As agencies fight to hire hospitalists and other subspecialists they can assign to positions across the nation, those temporary staffers become a commodity in and of themselves.

Dr. Mohammed is one of those hard assets.

An agency physician placed by Barton Associates in a mid-Atlantic hospital, he did not want to disclose his full name because he is transitioning to full-time locums from his current, full-time position, and he doesn’t want to alienate colleagues by talking publicly of his plans to leave. Barton Associates does not want his name disclosed due to the time, effort, and resources that the firm has invested in him. Barton has been shepherding Dr. Mohammed through the licensing process.

Dr. Mohammed’s reason for transitioning to full-time locum work is simple: flexibility.

“With locums, you have a variety of choices,” he says. “When you’re going into your first permanent job interview, you’re just desperate. You don’t know how the system functions. ... If I would have known about the locum opportunity before I started doing the permanent job, then I would have taken the locums right away.”

Dr. Mohammed, whose ultimate goal is to work for a government facility in South Florida, says he is excited about the opportunities locums work offers. He can move around the country with little difficulty and gain exposure in urban settings, rural hospitals, and everything in between.

And, of course, there is the money. Locum physicians can gross 30% to 40% more per year for the same number of shifts as a typical FTE hospitalist.

“Definitely income─there’s no question,” Dr. Mohammed adds. “When you’re coming out of residency, you don’t have very good income. Some of us that have school debt, family responsibilities—you just want to take care of the financial part.”

Richard Quinn is a freelance writer in New Jersey.

Listent to Dr. Shaikewitz talk about hospitalists and patient care.

Listent to Dr. Shaikewitz talk about hospitalists and patient care.

Listent to Dr. Shaikewitz talk about hospitalists and patient care.

Listen to Robert Bessler, CEO of Sound Physicians, discuss the importance of locum agencies.

Listen to Brent Bormaster, of StaffCare, discuss expectations for filling an open hospitalist position and what to look for in a locum agency.

 

Listen to Robert Bessler, CEO of Sound Physicians, discuss the importance of locum agencies.

Listen to Brent Bormaster, of StaffCare, discuss expectations for filling an open hospitalist position and what to look for in a locum agency.

 

Listen to Robert Bessler, CEO of Sound Physicians, discuss the importance of locum agencies.

Listen to Brent Bormaster, of StaffCare, discuss expectations for filling an open hospitalist position and what to look for in a locum agency.

 

There are 10 industry-changing recommendations in the recent Institute of Medicine (IOM) report “Best Care at Lower Cost: The Path to Continuously Learning Health Care in America.” Suggestions include reforming payment, adopting digital infrastructure, and improving the continuity of care. And to Brent James, MD, all of those recommendations are areas in which hospitalists can help lead healthcare from fee-for-service to an organized-care model.

Dr. James, executive director of the Institute for Health Care Delivery Research and chief quality officer at Intermountain Healthcare in Salt Lake City, says hospitalists can be linchpins to that hoped-for sea change because the specialty’s growth the past 15 years shows that physicians taking a collaborative, evidence-based approach to patient care can improve outcomes and lower costs.

“In some sense, the hospitalist movement triggered [the move to organized care],” says Dr. James, one of the IOM report’s authors. “You started to have teams caring for inpatients in a coordinated way. Pieces started to kind of fall into place underneath it. So I regard this as … [hospitalists] coming into their own, their vision of the future starting to really take hold.”

The report estimates the national cost of unnecessary or wasteful healthcare at $750 billion per year. Published in September, the report was crafted by a nationwide committee of healthcare leaders, including hospitalist and medical researcher David Meltzer, MD, PhD, chief of University of Chicago’s Division of Hospital Medicine and director of the Center for Health and Social Sciences in Chicago.

Dr. Meltzer says that for a relatively young specialty, hospitalists have been “remarkably forward-looking.” The specialty, in his view, has embraced teamwork, digital infrastructure, and quality initiatives. As the U.S. healthcare system evolves, he notes, HM leaders need to keep that mentality. Hospitalists are confronted daily with a combination of sicker patients and more treatment options, and making the right decisions is paramount to a “learning healthcare system,” Dr. Meltzer adds.

“As the database of options grows, decision-making becomes more difficult,” he says. “We have an important role to play in how to think about trying to control costs.”

Gary Kaplan, MD, FACP, FACMPE, FACPE, chairman and chief executive officer of Virginia Mason Health System in Seattle, agrees that HM’s priorities dovetail nicely with reform efforts. He hopes the IOM report’s findings will serve as a springboard for hospitalists to further spearhead improvements.

In particular, Dr. Kaplan notes that healthcare delivery organizations should develop, implement, and fine-tune their “systems, engineering tools, and process-improvement methods.” Such changes would help “eliminate inefficiencies, remove unnecessary burdens on clinicians and staff, enhance patient experience, and improve patient health outcomes,” he says.

“The hospitalists and the care teams with which the hospitalist connects are very critical to streamlining operations,” Dr. Kaplan adds.

Dr. James, who has long championed process improvement as the key to improved clinical outcomes, says that extending the hospitalist model throughout healthcare can only have good results. He preaches the implementation of standardized protocols and sees hospitalists as natural torchbearers for the cause.

 

“When you start to focus on process—our old jargon for it was ‘continuum of care’—it forces you to patient-centered care,” he says. “Instead of building your care around the physicians, or around the hospital, or around the technology, you build the care around the patient.”

Dr. James has heard physicians say protocols are too rigid and do not improve patient care. He disagrees—vehemently.

“It’s not just that we allow, or even that we encourage, we demand that you modify [the protocol] for individual patient needs,” he says. “What I have is a standard process of care. That means that you don’t have to bird-dog every little step. I take my most important resource—a trained, expert mind—and focus it on that relatively small set of problems that need to be modified. We’ve found that it massively improves patient outcomes.”

Many of the IOM report’s complaints about unnecessary testing, poor communication, and inefficient care delivery connect with the quality, patient-safety, and practice-management improvements HM groups already push, Dr. Kaplan adds. To advance healthcare delivery’s evolution, hospitalists should view the task of reform as an opportunity, not a challenge.

“There are very powerful opportunities for the hospitalist now to have great impact,” he says. “To not just be the passive participants in a broken and dysfunctional system, but in many ways, [to be] one of the architects of an improved care system going forward.”

Richard Quinn is a freelance writer in New Jersey.

There are 10 industry-changing recommendations in the recent Institute of Medicine (IOM) report “Best Care at Lower Cost: The Path to Continuously Learning Health Care in America.” Suggestions include reforming payment, adopting digital infrastructure, and improving the continuity of care. And to Brent James, MD, all of those recommendations are areas in which hospitalists can help lead healthcare from fee-for-service to an organized-care model.

Dr. James, executive director of the Institute for Health Care Delivery Research and chief quality officer at Intermountain Healthcare in Salt Lake City, says hospitalists can be linchpins to that hoped-for sea change because the specialty’s growth the past 15 years shows that physicians taking a collaborative, evidence-based approach to patient care can improve outcomes and lower costs.

“In some sense, the hospitalist movement triggered [the move to organized care],” says Dr. James, one of the IOM report’s authors. “You started to have teams caring for inpatients in a coordinated way. Pieces started to kind of fall into place underneath it. So I regard this as … [hospitalists] coming into their own, their vision of the future starting to really take hold.”

The report estimates the national cost of unnecessary or wasteful healthcare at $750 billion per year. Published in September, the report was crafted by a nationwide committee of healthcare leaders, including hospitalist and medical researcher David Meltzer, MD, PhD, chief of University of Chicago’s Division of Hospital Medicine and director of the Center for Health and Social Sciences in Chicago.

Dr. Meltzer says that for a relatively young specialty, hospitalists have been “remarkably forward-looking.” The specialty, in his view, has embraced teamwork, digital infrastructure, and quality initiatives. As the U.S. healthcare system evolves, he notes, HM leaders need to keep that mentality. Hospitalists are confronted daily with a combination of sicker patients and more treatment options, and making the right decisions is paramount to a “learning healthcare system,” Dr. Meltzer adds.

“As the database of options grows, decision-making becomes more difficult,” he says. “We have an important role to play in how to think about trying to control costs.”

Gary Kaplan, MD, FACP, FACMPE, FACPE, chairman and chief executive officer of Virginia Mason Health System in Seattle, agrees that HM’s priorities dovetail nicely with reform efforts. He hopes the IOM report’s findings will serve as a springboard for hospitalists to further spearhead improvements.

In particular, Dr. Kaplan notes that healthcare delivery organizations should develop, implement, and fine-tune their “systems, engineering tools, and process-improvement methods.” Such changes would help “eliminate inefficiencies, remove unnecessary burdens on clinicians and staff, enhance patient experience, and improve patient health outcomes,” he says.

“The hospitalists and the care teams with which the hospitalist connects are very critical to streamlining operations,” Dr. Kaplan adds.

Dr. James, who has long championed process improvement as the key to improved clinical outcomes, says that extending the hospitalist model throughout healthcare can only have good results. He preaches the implementation of standardized protocols and sees hospitalists as natural torchbearers for the cause.

 

“When you start to focus on process—our old jargon for it was ‘continuum of care’—it forces you to patient-centered care,” he says. “Instead of building your care around the physicians, or around the hospital, or around the technology, you build the care around the patient.”

Dr. James has heard physicians say protocols are too rigid and do not improve patient care. He disagrees—vehemently.

“It’s not just that we allow, or even that we encourage, we demand that you modify [the protocol] for individual patient needs,” he says. “What I have is a standard process of care. That means that you don’t have to bird-dog every little step. I take my most important resource—a trained, expert mind—and focus it on that relatively small set of problems that need to be modified. We’ve found that it massively improves patient outcomes.”

Many of the IOM report’s complaints about unnecessary testing, poor communication, and inefficient care delivery connect with the quality, patient-safety, and practice-management improvements HM groups already push, Dr. Kaplan adds. To advance healthcare delivery’s evolution, hospitalists should view the task of reform as an opportunity, not a challenge.

“There are very powerful opportunities for the hospitalist now to have great impact,” he says. “To not just be the passive participants in a broken and dysfunctional system, but in many ways, [to be] one of the architects of an improved care system going forward.”

Richard Quinn is a freelance writer in New Jersey.

There are 10 industry-changing recommendations in the recent Institute of Medicine (IOM) report “Best Care at Lower Cost: The Path to Continuously Learning Health Care in America.” Suggestions include reforming payment, adopting digital infrastructure, and improving the continuity of care. And to Brent James, MD, all of those recommendations are areas in which hospitalists can help lead healthcare from fee-for-service to an organized-care model.

Dr. James, executive director of the Institute for Health Care Delivery Research and chief quality officer at Intermountain Healthcare in Salt Lake City, says hospitalists can be linchpins to that hoped-for sea change because the specialty’s growth the past 15 years shows that physicians taking a collaborative, evidence-based approach to patient care can improve outcomes and lower costs.

“In some sense, the hospitalist movement triggered [the move to organized care],” says Dr. James, one of the IOM report’s authors. “You started to have teams caring for inpatients in a coordinated way. Pieces started to kind of fall into place underneath it. So I regard this as … [hospitalists] coming into their own, their vision of the future starting to really take hold.”

The report estimates the national cost of unnecessary or wasteful healthcare at $750 billion per year. Published in September, the report was crafted by a nationwide committee of healthcare leaders, including hospitalist and medical researcher David Meltzer, MD, PhD, chief of University of Chicago’s Division of Hospital Medicine and director of the Center for Health and Social Sciences in Chicago.

Dr. Meltzer says that for a relatively young specialty, hospitalists have been “remarkably forward-looking.” The specialty, in his view, has embraced teamwork, digital infrastructure, and quality initiatives. As the U.S. healthcare system evolves, he notes, HM leaders need to keep that mentality. Hospitalists are confronted daily with a combination of sicker patients and more treatment options, and making the right decisions is paramount to a “learning healthcare system,” Dr. Meltzer adds.

“As the database of options grows, decision-making becomes more difficult,” he says. “We have an important role to play in how to think about trying to control costs.”

Gary Kaplan, MD, FACP, FACMPE, FACPE, chairman and chief executive officer of Virginia Mason Health System in Seattle, agrees that HM’s priorities dovetail nicely with reform efforts. He hopes the IOM report’s findings will serve as a springboard for hospitalists to further spearhead improvements.

In particular, Dr. Kaplan notes that healthcare delivery organizations should develop, implement, and fine-tune their “systems, engineering tools, and process-improvement methods.” Such changes would help “eliminate inefficiencies, remove unnecessary burdens on clinicians and staff, enhance patient experience, and improve patient health outcomes,” he says.

“The hospitalists and the care teams with which the hospitalist connects are very critical to streamlining operations,” Dr. Kaplan adds.

Dr. James, who has long championed process improvement as the key to improved clinical outcomes, says that extending the hospitalist model throughout healthcare can only have good results. He preaches the implementation of standardized protocols and sees hospitalists as natural torchbearers for the cause.

 

“When you start to focus on process—our old jargon for it was ‘continuum of care’—it forces you to patient-centered care,” he says. “Instead of building your care around the physicians, or around the hospital, or around the technology, you build the care around the patient.”

Dr. James has heard physicians say protocols are too rigid and do not improve patient care. He disagrees—vehemently.

“It’s not just that we allow, or even that we encourage, we demand that you modify [the protocol] for individual patient needs,” he says. “What I have is a standard process of care. That means that you don’t have to bird-dog every little step. I take my most important resource—a trained, expert mind—and focus it on that relatively small set of problems that need to be modified. We’ve found that it massively improves patient outcomes.”

Many of the IOM report’s complaints about unnecessary testing, poor communication, and inefficient care delivery connect with the quality, patient-safety, and practice-management improvements HM groups already push, Dr. Kaplan adds. To advance healthcare delivery’s evolution, hospitalists should view the task of reform as an opportunity, not a challenge.

“There are very powerful opportunities for the hospitalist now to have great impact,” he says. “To not just be the passive participants in a broken and dysfunctional system, but in many ways, [to be] one of the architects of an improved care system going forward.”

Richard Quinn is a freelance writer in New Jersey.

Now is the time to make plans to attend Hospital Medicine 2013. With top-notch featured speakers, a full slate of high-demand pre-courses, and even more opportunities to network

and learn, HM13 promises to be SHM’s most popular meeting yet.

More than 3,000 hospitalistsare expected to attend HM13 (www.hospitalmedicine2013.org), May 16-19 at the Gaylord National Resort & Convention Center in National Harbor, Md., just outside of Washington, D.C.

New this year are two sessions in the “potpourri” track and two sessions in the “workshop” track, including how hospitalists can constructively learn from their mistakes and a workshop session titled “Innovative Scheduling and Rounding: How to Improve Continuity, Efficiency and Quality.”

Also new are tracks designed to address some of the most pressing topics facing hospitalists. The “comanagement” track will focus on the relationship between hospitalists and subspecialty consultants in a case-based format. The new “updates” track will feature the latest research and how it applies to clinical work.

In addition to the new elements, hospitalists also can take advantage of annual-meeting favorites, including the Research, Innovation, and Clinical Vignettes (RIV) poster competition. The RIV competition offers hundreds of the very latest ideas and research in hospital medicine.

One of the primary reasons hospitalists come to SHM’s conferences is career-building and networking, and HM13 will have unstructured time for general networking, as well as special-interest forums for 20 different topics, including:

• Evidence-based medicine—a new forum in 2013;
• Women in hospital medicine;
• Early-career hospitalists;
• Quality improvement (QI); and
• Information technology.

View the full program and registration details at www.hospitalmedicine2013.org.

Brendon Shank is SHM’s associate vice president of communications.

Now is the time to make plans to attend Hospital Medicine 2013. With top-notch featured speakers, a full slate of high-demand pre-courses, and even more opportunities to network

and learn, HM13 promises to be SHM’s most popular meeting yet.

More than 3,000 hospitalistsare expected to attend HM13 (www.hospitalmedicine2013.org), May 16-19 at the Gaylord National Resort & Convention Center in National Harbor, Md., just outside of Washington, D.C.

New this year are two sessions in the “potpourri” track and two sessions in the “workshop” track, including how hospitalists can constructively learn from their mistakes and a workshop session titled “Innovative Scheduling and Rounding: How to Improve Continuity, Efficiency and Quality.”

Also new are tracks designed to address some of the most pressing topics facing hospitalists. The “comanagement” track will focus on the relationship between hospitalists and subspecialty consultants in a case-based format. The new “updates” track will feature the latest research and how it applies to clinical work.

In addition to the new elements, hospitalists also can take advantage of annual-meeting favorites, including the Research, Innovation, and Clinical Vignettes (RIV) poster competition. The RIV competition offers hundreds of the very latest ideas and research in hospital medicine.

One of the primary reasons hospitalists come to SHM’s conferences is career-building and networking, and HM13 will have unstructured time for general networking, as well as special-interest forums for 20 different topics, including:

• Evidence-based medicine—a new forum in 2013;
• Women in hospital medicine;
• Early-career hospitalists;
• Quality improvement (QI); and
• Information technology.

View the full program and registration details at www.hospitalmedicine2013.org.

Brendon Shank is SHM’s associate vice president of communications.

Now is the time to make plans to attend Hospital Medicine 2013. With top-notch featured speakers, a full slate of high-demand pre-courses, and even more opportunities to network

and learn, HM13 promises to be SHM’s most popular meeting yet.

More than 3,000 hospitalistsare expected to attend HM13 (www.hospitalmedicine2013.org), May 16-19 at the Gaylord National Resort & Convention Center in National Harbor, Md., just outside of Washington, D.C.

New this year are two sessions in the “potpourri” track and two sessions in the “workshop” track, including how hospitalists can constructively learn from their mistakes and a workshop session titled “Innovative Scheduling and Rounding: How to Improve Continuity, Efficiency and Quality.”

Also new are tracks designed to address some of the most pressing topics facing hospitalists. The “comanagement” track will focus on the relationship between hospitalists and subspecialty consultants in a case-based format. The new “updates” track will feature the latest research and how it applies to clinical work.

In addition to the new elements, hospitalists also can take advantage of annual-meeting favorites, including the Research, Innovation, and Clinical Vignettes (RIV) poster competition. The RIV competition offers hundreds of the very latest ideas and research in hospital medicine.

One of the primary reasons hospitalists come to SHM’s conferences is career-building and networking, and HM13 will have unstructured time for general networking, as well as special-interest forums for 20 different topics, including:

• Evidence-based medicine—a new forum in 2013;
• Women in hospital medicine;
• Early-career hospitalists;
• Quality improvement (QI); and
• Information technology.

View the full program and registration details at www.hospitalmedicine2013.org.

Brendon Shank is SHM’s associate vice president of communications.

Patient-level and institution-level advocacy often come naturally to physicians and health professionals. This level of involvement is integral to providing the best care for patients. Interestingly, a 2006 JAMA study showed that physicians overwhelmingly rated political involvement and collective advocacy as important to their work as healthcare professionals, at 91.6% and 97.0%, respectively. In practice, however, only about a quarter of respondents in the study participated in either type of activity in the past three years.¹

Part of SHM’s advocacy goal is to help hospitalists bridge the divide between their attitudes about political advocacy and their behavior.

Any number of barriers might exist for hospitalists to take action and participate in political action and health policy. Anecdotally, these range from a lack of comfort around the issues to lack of time to the opacity of the process to the unclear impact of individual efforts.

As a medical society, SHM serves a pivotal role in representing the views and perspectives of hospitalists in the health policy arena. Still, these efforts could be greatly intensified with more robust involvement from members. One tactic used by the society is advocacy action alerts that encourage members to engage directly with their elected representatives on policy issues of interest to hospitalists.

For example, a recent alert illustrated the potentially devastating impact of the impending budget sequester. As a budget-deficit and spending reduction mechanism, the budget sequester is poised to institute across-the-board cuts to defense and nondefense spending. For its part, the U.S. Department of Health and Human Services will see an approximate 8.2% cut in its budget, removing critical money from health programs and research funding. These are programs and research efforts in which hospitalists participate.

The action alert culminates with a customizable message that can be easily sent to members of Congress. Quick and easy, the action alert allows SHM members to participate in advocacy efforts with very little time investment. By sending messages to Congress, SHM members are able to share their expertise and perspectives on health policy, as both health professionals and constituents.

The impact of a single message to Congress, of course, is not always clear or easily definable. Advocacy, unfortunately, does not often show immediate results and requires a nuanced, multifaceted, long-term strategy. However, input directly from constituents is consistently rated among the most influential tactics for influencing Congress, and that includes emails, phone calls and in-person visits.²

SHM will continue to ask members to join in its advocacy efforts and, at the next annual meeting, invites all members to partake in in-person visits with their members of Congress during Hospitalists on the Hill. Medicine is as much about the systems as it is the one-on-one interactions; politics is no different. By communicating and meeting with lawmakers one on one, SHM members will continue to have a meaningful impact on the policies that frame the healthcare system. Join us as we continue to grow these efforts.

For more information about Hospitalists on the Hill, visit www.hospitalmedicine2013.org/advocacy.

Joshua Lapps is SHM’s government relations specialist.

References

1. Gruen RL, Campbell EG, Blumenthal D. Public roles of US physicians: community participation, political involvement, and collective advocacy. JAMA. 2006;296(20):2467-2475.
2. The Partnership for A More Perfect Union at the Congressional Management Foundation. Communicating with Congress: Perceptions of Citizen Advocacy on Capitol Hill. Congressional Management Foundation website. Available at: http://www.congressfoundation.org/projects/communicating-with-congress/perceptions-of-citizen-advocacy-on-capitol-hill. Accessed Nov. 1, 2012.

Patient-level and institution-level advocacy often come naturally to physicians and health professionals. This level of involvement is integral to providing the best care for patients. Interestingly, a 2006 JAMA study showed that physicians overwhelmingly rated political involvement and collective advocacy as important to their work as healthcare professionals, at 91.6% and 97.0%, respectively. In practice, however, only about a quarter of respondents in the study participated in either type of activity in the past three years.¹

Part of SHM’s advocacy goal is to help hospitalists bridge the divide between their attitudes about political advocacy and their behavior.

Any number of barriers might exist for hospitalists to take action and participate in political action and health policy. Anecdotally, these range from a lack of comfort around the issues to lack of time to the opacity of the process to the unclear impact of individual efforts.

As a medical society, SHM serves a pivotal role in representing the views and perspectives of hospitalists in the health policy arena. Still, these efforts could be greatly intensified with more robust involvement from members. One tactic used by the society is advocacy action alerts that encourage members to engage directly with their elected representatives on policy issues of interest to hospitalists.

For example, a recent alert illustrated the potentially devastating impact of the impending budget sequester. As a budget-deficit and spending reduction mechanism, the budget sequester is poised to institute across-the-board cuts to defense and nondefense spending. For its part, the U.S. Department of Health and Human Services will see an approximate 8.2% cut in its budget, removing critical money from health programs and research funding. These are programs and research efforts in which hospitalists participate.

The action alert culminates with a customizable message that can be easily sent to members of Congress. Quick and easy, the action alert allows SHM members to participate in advocacy efforts with very little time investment. By sending messages to Congress, SHM members are able to share their expertise and perspectives on health policy, as both health professionals and constituents.

The impact of a single message to Congress, of course, is not always clear or easily definable. Advocacy, unfortunately, does not often show immediate results and requires a nuanced, multifaceted, long-term strategy. However, input directly from constituents is consistently rated among the most influential tactics for influencing Congress, and that includes emails, phone calls and in-person visits.²

SHM will continue to ask members to join in its advocacy efforts and, at the next annual meeting, invites all members to partake in in-person visits with their members of Congress during Hospitalists on the Hill. Medicine is as much about the systems as it is the one-on-one interactions; politics is no different. By communicating and meeting with lawmakers one on one, SHM members will continue to have a meaningful impact on the policies that frame the healthcare system. Join us as we continue to grow these efforts.

For more information about Hospitalists on the Hill, visit www.hospitalmedicine2013.org/advocacy.

Joshua Lapps is SHM’s government relations specialist.

References

1. Gruen RL, Campbell EG, Blumenthal D. Public roles of US physicians: community participation, political involvement, and collective advocacy. JAMA. 2006;296(20):2467-2475.
2. The Partnership for A More Perfect Union at the Congressional Management Foundation. Communicating with Congress: Perceptions of Citizen Advocacy on Capitol Hill. Congressional Management Foundation website. Available at: http://www.congressfoundation.org/projects/communicating-with-congress/perceptions-of-citizen-advocacy-on-capitol-hill. Accessed Nov. 1, 2012.

Patient-level and institution-level advocacy often come naturally to physicians and health professionals. This level of involvement is integral to providing the best care for patients. Interestingly, a 2006 JAMA study showed that physicians overwhelmingly rated political involvement and collective advocacy as important to their work as healthcare professionals, at 91.6% and 97.0%, respectively. In practice, however, only about a quarter of respondents in the study participated in either type of activity in the past three years.¹

Part of SHM’s advocacy goal is to help hospitalists bridge the divide between their attitudes about political advocacy and their behavior.

Any number of barriers might exist for hospitalists to take action and participate in political action and health policy. Anecdotally, these range from a lack of comfort around the issues to lack of time to the opacity of the process to the unclear impact of individual efforts.

As a medical society, SHM serves a pivotal role in representing the views and perspectives of hospitalists in the health policy arena. Still, these efforts could be greatly intensified with more robust involvement from members. One tactic used by the society is advocacy action alerts that encourage members to engage directly with their elected representatives on policy issues of interest to hospitalists.

For example, a recent alert illustrated the potentially devastating impact of the impending budget sequester. As a budget-deficit and spending reduction mechanism, the budget sequester is poised to institute across-the-board cuts to defense and nondefense spending. For its part, the U.S. Department of Health and Human Services will see an approximate 8.2% cut in its budget, removing critical money from health programs and research funding. These are programs and research efforts in which hospitalists participate.

The action alert culminates with a customizable message that can be easily sent to members of Congress. Quick and easy, the action alert allows SHM members to participate in advocacy efforts with very little time investment. By sending messages to Congress, SHM members are able to share their expertise and perspectives on health policy, as both health professionals and constituents.

The impact of a single message to Congress, of course, is not always clear or easily definable. Advocacy, unfortunately, does not often show immediate results and requires a nuanced, multifaceted, long-term strategy. However, input directly from constituents is consistently rated among the most influential tactics for influencing Congress, and that includes emails, phone calls and in-person visits.²

SHM will continue to ask members to join in its advocacy efforts and, at the next annual meeting, invites all members to partake in in-person visits with their members of Congress during Hospitalists on the Hill. Medicine is as much about the systems as it is the one-on-one interactions; politics is no different. By communicating and meeting with lawmakers one on one, SHM members will continue to have a meaningful impact on the policies that frame the healthcare system. Join us as we continue to grow these efforts.

For more information about Hospitalists on the Hill, visit www.hospitalmedicine2013.org/advocacy.

Joshua Lapps is SHM’s government relations specialist.

References

1. Gruen RL, Campbell EG, Blumenthal D. Public roles of US physicians: community participation, political involvement, and collective advocacy. JAMA. 2006;296(20):2467-2475.
2. The Partnership for A More Perfect Union at the Congressional Management Foundation. Communicating with Congress: Perceptions of Citizen Advocacy on Capitol Hill. Congressional Management Foundation website. Available at: http://www.congressfoundation.org/projects/communicating-with-congress/perceptions-of-citizen-advocacy-on-capitol-hill. Accessed Nov. 1, 2012.

Staying up to date on the latest techniques for optimal coding can be daunting, but you don't have to do it alone. SHM's exclusive CODE-H program enables hospitalists (and others in their practice) to learn best practices in coding from national experts in the field. It also allows participants to ask questions of other hospitalists who may be experiencing similar coding challenges.

CODE-H works through SHM's new online collaboration space, HMX (www.hmxchange.org), and provides live webinar sessions with expert faculty, downloadable resources, and a discussion forum for participants to ask questions and provide answers.

Previous CODE-H participants can extend their CODE-H subscriptions. The extension is $300, and free for prior participants who refer an individual or group to CODE-H.

For more information, visit www.hospitalmedicine.org/codeh.

Staying up to date on the latest techniques for optimal coding can be daunting, but you don't have to do it alone. SHM's exclusive CODE-H program enables hospitalists (and others in their practice) to learn best practices in coding from national experts in the field. It also allows participants to ask questions of other hospitalists who may be experiencing similar coding challenges.

CODE-H works through SHM's new online collaboration space, HMX (www.hmxchange.org), and provides live webinar sessions with expert faculty, downloadable resources, and a discussion forum for participants to ask questions and provide answers.

Previous CODE-H participants can extend their CODE-H subscriptions. The extension is $300, and free for prior participants who refer an individual or group to CODE-H.

For more information, visit www.hospitalmedicine.org/codeh.

Staying up to date on the latest techniques for optimal coding can be daunting, but you don't have to do it alone. SHM's exclusive CODE-H program enables hospitalists (and others in their practice) to learn best practices in coding from national experts in the field. It also allows participants to ask questions of other hospitalists who may be experiencing similar coding challenges.

CODE-H works through SHM's new online collaboration space, HMX (www.hmxchange.org), and provides live webinar sessions with expert faculty, downloadable resources, and a discussion forum for participants to ask questions and provide answers.

Previous CODE-H participants can extend their CODE-H subscriptions. The extension is $300, and free for prior participants who refer an individual or group to CODE-H.

For more information, visit www.hospitalmedicine.org/codeh.

Undergraduate education: Cornell University, Ithaca, N.Y.

Medical school: Cornell University Medical College, New York City.

Notable: Dr. Berkery formed and developed the VTE prophylaxis committee at St. Peter’s; because of her efforts, appropriate VTE prophylaxis increased to 95% from 75%, new VTE stewardship rounds were created, and the hospital was able to anticipate new VTE preventive-care regulations and respond to them quickly and effectively. Combining her preventive medicine and IT knowledge, she is a member of the St. Peter’s Hospital CareLink Clinical Leadership Team, where she reviews and designs order sets for forthcoming computerized physician order entry (CPOE) systems.

FYI: In her spare time, Dr. Berkery is a Zumba instructor. She is a diehard New York Yankees fan and loves traveling.

Quotable: “My fellow status in SHM demonstrates my commitment to hospital medicine as a lifelong career, and shows that I am dedicated not just to hospital medicine, but to the hospital system itself.”

Undergraduate education: Cornell University, Ithaca, N.Y.

Medical school: Cornell University Medical College, New York City.

Notable: Dr. Berkery formed and developed the VTE prophylaxis committee at St. Peter’s; because of her efforts, appropriate VTE prophylaxis increased to 95% from 75%, new VTE stewardship rounds were created, and the hospital was able to anticipate new VTE preventive-care regulations and respond to them quickly and effectively. Combining her preventive medicine and IT knowledge, she is a member of the St. Peter’s Hospital CareLink Clinical Leadership Team, where she reviews and designs order sets for forthcoming computerized physician order entry (CPOE) systems.

FYI: In her spare time, Dr. Berkery is a Zumba instructor. She is a diehard New York Yankees fan and loves traveling.

Quotable: “My fellow status in SHM demonstrates my commitment to hospital medicine as a lifelong career, and shows that I am dedicated not just to hospital medicine, but to the hospital system itself.”

Undergraduate education: Cornell University, Ithaca, N.Y.

Medical school: Cornell University Medical College, New York City.

Notable: Dr. Berkery formed and developed the VTE prophylaxis committee at St. Peter’s; because of her efforts, appropriate VTE prophylaxis increased to 95% from 75%, new VTE stewardship rounds were created, and the hospital was able to anticipate new VTE preventive-care regulations and respond to them quickly and effectively. Combining her preventive medicine and IT knowledge, she is a member of the St. Peter’s Hospital CareLink Clinical Leadership Team, where she reviews and designs order sets for forthcoming computerized physician order entry (CPOE) systems.

FYI: In her spare time, Dr. Berkery is a Zumba instructor. She is a diehard New York Yankees fan and loves traveling.

Quotable: “My fellow status in SHM demonstrates my commitment to hospital medicine as a lifelong career, and shows that I am dedicated not just to hospital medicine, but to the hospital system itself.”

There are various things that each of us look for in the 2012 State of Hospital Medicine report (www.hospitalmedicine.org/survey). Many of us look to see what has happened to compensation, while others look at productivity information. There is also, however, a subset of us that focuses on trends in the financial support for hospitalist programs. Certainly those of us who manage HM practices want to justify to our clients that the cost of our services is appropriate. It’s never easy going to administration and asking for more money in these uncertain times.

Those in the business of providing “turnkey” services often have to ask for more financial support during a contract term in order to keep up with physician salary increases. It’s vital that we understand not just the cost and revenue equation, but also how those factors impact the financial support for the program. With looming budget cuts, uncertainty surrounding the impacts of value-based purchasing, readmission penalties, and a stagnant economy, we must continue to ensure that our programs are cost-efficient, all the while maintaining quality patient care.

The 2012 State of Hospital Medicine report shows that the cost of providing hospitalist services is on the rise (see Table 1). The median level of financial support per FTE for nonacademic HM groups serving adults was $140,204. This figure is up 6.6% from the 2011 median of $131,564. There are regional differences in the data, with the median support cost highest in the South at $159,258 per FTE. This might be due to the fact that hospitalist compensation tends to be higher in the South than in other parts of the country, while professional fee reimbursements tend to be lower. Another finding borne out by the data is that very small programs tend to require more financial support per FTE than do larger programs. This makes sense given the ability to spread fixed costs out over the larger model and the increased productivity that comes with the larger model.

Dan Fuller

The 2012 State of Hospital Medicine report also offers a unique opportunity to look at factors that might be contributing to the increase in financial support. Compensation, or labor cost, which constitutes the majority of program costs, rose 6% to $233,855 for adult medicine hospitalists. At the same time, the median number of annual encounters for adult hospitalists declined by 6.4% from the 2011 level, while collections per encounter for adult hospitalists increased 13%. The intersection of all these variables (compensation, encounters, collections, and even size and staffing models) affect the cost of a program and the resulting support required to operate it.

In a time of uncertainty about where healthcare is headed, we need as much information as possible to make informed decisions. It is crucially important that we understand the relationships between physician compensation, the scope of our service, the revenue we generate, and the impact these factors have on cost.

The 2012 State of Hospitalist Medicine report is the best source for all of us to get the information we need to make these informed decisions. I would encourage every HM leader to review and understand the information that is so critical to the success of any hospitalist program.

Dan Fuller is president and founder of IN Compass Health and is a member of SHM’s Practice Analysis Committee.

There are various things that each of us look for in the 2012 State of Hospital Medicine report (www.hospitalmedicine.org/survey). Many of us look to see what has happened to compensation, while others look at productivity information. There is also, however, a subset of us that focuses on trends in the financial support for hospitalist programs. Certainly those of us who manage HM practices want to justify to our clients that the cost of our services is appropriate. It’s never easy going to administration and asking for more money in these uncertain times.

Those in the business of providing “turnkey” services often have to ask for more financial support during a contract term in order to keep up with physician salary increases. It’s vital that we understand not just the cost and revenue equation, but also how those factors impact the financial support for the program. With looming budget cuts, uncertainty surrounding the impacts of value-based purchasing, readmission penalties, and a stagnant economy, we must continue to ensure that our programs are cost-efficient, all the while maintaining quality patient care.

The 2012 State of Hospital Medicine report shows that the cost of providing hospitalist services is on the rise (see Table 1). The median level of financial support per FTE for nonacademic HM groups serving adults was $140,204. This figure is up 6.6% from the 2011 median of $131,564. There are regional differences in the data, with the median support cost highest in the South at $159,258 per FTE. This might be due to the fact that hospitalist compensation tends to be higher in the South than in other parts of the country, while professional fee reimbursements tend to be lower. Another finding borne out by the data is that very small programs tend to require more financial support per FTE than do larger programs. This makes sense given the ability to spread fixed costs out over the larger model and the increased productivity that comes with the larger model.

Dan Fuller

The 2012 State of Hospital Medicine report also offers a unique opportunity to look at factors that might be contributing to the increase in financial support. Compensation, or labor cost, which constitutes the majority of program costs, rose 6% to $233,855 for adult medicine hospitalists. At the same time, the median number of annual encounters for adult hospitalists declined by 6.4% from the 2011 level, while collections per encounter for adult hospitalists increased 13%. The intersection of all these variables (compensation, encounters, collections, and even size and staffing models) affect the cost of a program and the resulting support required to operate it.

In a time of uncertainty about where healthcare is headed, we need as much information as possible to make informed decisions. It is crucially important that we understand the relationships between physician compensation, the scope of our service, the revenue we generate, and the impact these factors have on cost.

The 2012 State of Hospitalist Medicine report is the best source for all of us to get the information we need to make these informed decisions. I would encourage every HM leader to review and understand the information that is so critical to the success of any hospitalist program.

Dan Fuller is president and founder of IN Compass Health and is a member of SHM’s Practice Analysis Committee.

There are various things that each of us look for in the 2012 State of Hospital Medicine report (www.hospitalmedicine.org/survey). Many of us look to see what has happened to compensation, while others look at productivity information. There is also, however, a subset of us that focuses on trends in the financial support for hospitalist programs. Certainly those of us who manage HM practices want to justify to our clients that the cost of our services is appropriate. It’s never easy going to administration and asking for more money in these uncertain times.

Those in the business of providing “turnkey” services often have to ask for more financial support during a contract term in order to keep up with physician salary increases. It’s vital that we understand not just the cost and revenue equation, but also how those factors impact the financial support for the program. With looming budget cuts, uncertainty surrounding the impacts of value-based purchasing, readmission penalties, and a stagnant economy, we must continue to ensure that our programs are cost-efficient, all the while maintaining quality patient care.

The 2012 State of Hospital Medicine report shows that the cost of providing hospitalist services is on the rise (see Table 1). The median level of financial support per FTE for nonacademic HM groups serving adults was $140,204. This figure is up 6.6% from the 2011 median of $131,564. There are regional differences in the data, with the median support cost highest in the South at $159,258 per FTE. This might be due to the fact that hospitalist compensation tends to be higher in the South than in other parts of the country, while professional fee reimbursements tend to be lower. Another finding borne out by the data is that very small programs tend to require more financial support per FTE than do larger programs. This makes sense given the ability to spread fixed costs out over the larger model and the increased productivity that comes with the larger model.

Dan Fuller

The 2012 State of Hospital Medicine report also offers a unique opportunity to look at factors that might be contributing to the increase in financial support. Compensation, or labor cost, which constitutes the majority of program costs, rose 6% to $233,855 for adult medicine hospitalists. At the same time, the median number of annual encounters for adult hospitalists declined by 6.4% from the 2011 level, while collections per encounter for adult hospitalists increased 13%. The intersection of all these variables (compensation, encounters, collections, and even size and staffing models) affect the cost of a program and the resulting support required to operate it.

In a time of uncertainty about where healthcare is headed, we need as much information as possible to make informed decisions. It is crucially important that we understand the relationships between physician compensation, the scope of our service, the revenue we generate, and the impact these factors have on cost.

The 2012 State of Hospitalist Medicine report is the best source for all of us to get the information we need to make these informed decisions. I would encourage every HM leader to review and understand the information that is so critical to the success of any hospitalist program.

Dan Fuller is president and founder of IN Compass Health and is a member of SHM’s Practice Analysis Committee.