As part of the Affordable Care Act, the value-based purchasing program (VBP) is being rolled out this year. Beginning in October, VBP will put hospitals at financial risk for a defined set of clinical and patient satisfaction metrics. Because of the significant impact that this will have on hospitals and HM, SHM had a pre-course focused on this topic at HM12.

Pat Torscon and Joe Miller led the pre-course, which focused on VBP's key components. Through a series of vignettes and studies, the faculty provided nearly 100 attendess a better understanding of the impact.

Key Takeaways

1. VBP is budget neutral. Some Hospitals will receive bonuses, some will not. This will depend on where hospitals fall in the performance score. To receive a bonus, a hospital will have to exceed the 50% threshold. If below, then no opportunity for performance bonus. The model is based on a floor, a threshold (50%), and benchmark, which is presently a bell-shaped curve.

2. The performance score will be 70% clinical process domain and 30% patient experience domain. Hospitalists will have a major role in the perfromance measures around AMI, CHF, pneumonia, SCIP, and patient experience.

3. Hospitalists will need to understand the data and where it comes from. When you combine VBP, Inpatient Quality Reporting, readmissions, hospital-acquired conditions, and meaningful use, the actual amount of payment at risk is 7%. With most hospital profit margins around 1-3% this amount will be significant. Of those hospitals that have been studied, 10% in high performance, and 74% were inconsistent performance across four clinical measures.

4. Concurrent patient management will be important. Hospitalists will become the drivers and champions of this. To move either your HCAHPS score or Press Ganey performance scores will take time. It is important to convey that to the C-suite. An example of the impact of VBP for a 146-bed hospital over five years could be more than $5 million at stake; a 541-bed hospital would be $40 million.

As part of the Affordable Care Act, the value-based purchasing program (VBP) is being rolled out this year. Beginning in October, VBP will put hospitals at financial risk for a defined set of clinical and patient satisfaction metrics. Because of the significant impact that this will have on hospitals and HM, SHM had a pre-course focused on this topic at HM12.

Pat Torscon and Joe Miller led the pre-course, which focused on VBP's key components. Through a series of vignettes and studies, the faculty provided nearly 100 attendess a better understanding of the impact.

Key Takeaways

1. VBP is budget neutral. Some Hospitals will receive bonuses, some will not. This will depend on where hospitals fall in the performance score. To receive a bonus, a hospital will have to exceed the 50% threshold. If below, then no opportunity for performance bonus. The model is based on a floor, a threshold (50%), and benchmark, which is presently a bell-shaped curve.

2. The performance score will be 70% clinical process domain and 30% patient experience domain. Hospitalists will have a major role in the perfromance measures around AMI, CHF, pneumonia, SCIP, and patient experience.

3. Hospitalists will need to understand the data and where it comes from. When you combine VBP, Inpatient Quality Reporting, readmissions, hospital-acquired conditions, and meaningful use, the actual amount of payment at risk is 7%. With most hospital profit margins around 1-3% this amount will be significant. Of those hospitals that have been studied, 10% in high performance, and 74% were inconsistent performance across four clinical measures.

4. Concurrent patient management will be important. Hospitalists will become the drivers and champions of this. To move either your HCAHPS score or Press Ganey performance scores will take time. It is important to convey that to the C-suite. An example of the impact of VBP for a 146-bed hospital over five years could be more than $5 million at stake; a 541-bed hospital would be $40 million.

As part of the Affordable Care Act, the value-based purchasing program (VBP) is being rolled out this year. Beginning in October, VBP will put hospitals at financial risk for a defined set of clinical and patient satisfaction metrics. Because of the significant impact that this will have on hospitals and HM, SHM had a pre-course focused on this topic at HM12.

Pat Torscon and Joe Miller led the pre-course, which focused on VBP's key components. Through a series of vignettes and studies, the faculty provided nearly 100 attendess a better understanding of the impact.

Key Takeaways

1. VBP is budget neutral. Some Hospitals will receive bonuses, some will not. This will depend on where hospitals fall in the performance score. To receive a bonus, a hospital will have to exceed the 50% threshold. If below, then no opportunity for performance bonus. The model is based on a floor, a threshold (50%), and benchmark, which is presently a bell-shaped curve.

2. The performance score will be 70% clinical process domain and 30% patient experience domain. Hospitalists will have a major role in the perfromance measures around AMI, CHF, pneumonia, SCIP, and patient experience.

3. Hospitalists will need to understand the data and where it comes from. When you combine VBP, Inpatient Quality Reporting, readmissions, hospital-acquired conditions, and meaningful use, the actual amount of payment at risk is 7%. With most hospital profit margins around 1-3% this amount will be significant. Of those hospitals that have been studied, 10% in high performance, and 74% were inconsistent performance across four clinical measures.

4. Concurrent patient management will be important. Hospitalists will become the drivers and champions of this. To move either your HCAHPS score or Press Ganey performance scores will take time. It is important to convey that to the C-suite. An example of the impact of VBP for a 146-bed hospital over five years could be more than $5 million at stake; a 541-bed hospital would be $40 million.

HM12 formally kicked off for thousands of hospitalists on Monday morning with two plenary addresses that couldn't have been more different.

First up, Patrick Conway, MD, MSc, FAAP, SFHM, a pediatric hospitalist and chief medical officer of the Centers for Medicare & Medicaid Services (CMS), provided a rapid-fire insight into the breadth of CMS and asked hospitalists to consider the government behemoth as a partner in systems change. Political analyst Norman Ornstein, PhD, MA, then presented a global view of the dysfunction racking the political system (once he finished an opening monologue of political jibes that would have made late-night writers proud).

But while the plenary perspectives differed in theme, they converged on implication: The next few years will be a period of change for healthcare and HM.

"The fact is if we had a political system operating on all cylinders at this point, if we had a law put into place and then assurances that it would continue, and that everybody would be making a good faith effort to make it work, it would still hold years of tumult ahead as we try to figure out how we can change cultures, change behaviors, and still along the way provide quality care at a price that is going to be acceptable enough in the system to make it work,” Ornstein said.

Dr. Conway summed it up this way: “better health, better care, and lower cost.”

Dr. Conway, who maintains a presence in the clinical world by working unpaid weekend shifts at Children's National Medical Center in Washington, D.C., says that while individual hospitalists might feel their contribution is too small to translate to systems change, they are wrong. Change, he says, begins at the local level.

"My challenge to you is: Please don't sit on the sidelines," Dr. Conway said. "Please be actively engaged in your local system in creating this change."

HM12 formally kicked off for thousands of hospitalists on Monday morning with two plenary addresses that couldn't have been more different.

First up, Patrick Conway, MD, MSc, FAAP, SFHM, a pediatric hospitalist and chief medical officer of the Centers for Medicare & Medicaid Services (CMS), provided a rapid-fire insight into the breadth of CMS and asked hospitalists to consider the government behemoth as a partner in systems change. Political analyst Norman Ornstein, PhD, MA, then presented a global view of the dysfunction racking the political system (once he finished an opening monologue of political jibes that would have made late-night writers proud).

But while the plenary perspectives differed in theme, they converged on implication: The next few years will be a period of change for healthcare and HM.

"The fact is if we had a political system operating on all cylinders at this point, if we had a law put into place and then assurances that it would continue, and that everybody would be making a good faith effort to make it work, it would still hold years of tumult ahead as we try to figure out how we can change cultures, change behaviors, and still along the way provide quality care at a price that is going to be acceptable enough in the system to make it work,” Ornstein said.

Dr. Conway summed it up this way: “better health, better care, and lower cost.”

Dr. Conway, who maintains a presence in the clinical world by working unpaid weekend shifts at Children's National Medical Center in Washington, D.C., says that while individual hospitalists might feel their contribution is too small to translate to systems change, they are wrong. Change, he says, begins at the local level.

"My challenge to you is: Please don't sit on the sidelines," Dr. Conway said. "Please be actively engaged in your local system in creating this change."

HM12 formally kicked off for thousands of hospitalists on Monday morning with two plenary addresses that couldn't have been more different.

First up, Patrick Conway, MD, MSc, FAAP, SFHM, a pediatric hospitalist and chief medical officer of the Centers for Medicare & Medicaid Services (CMS), provided a rapid-fire insight into the breadth of CMS and asked hospitalists to consider the government behemoth as a partner in systems change. Political analyst Norman Ornstein, PhD, MA, then presented a global view of the dysfunction racking the political system (once he finished an opening monologue of political jibes that would have made late-night writers proud).

But while the plenary perspectives differed in theme, they converged on implication: The next few years will be a period of change for healthcare and HM.

"The fact is if we had a political system operating on all cylinders at this point, if we had a law put into place and then assurances that it would continue, and that everybody would be making a good faith effort to make it work, it would still hold years of tumult ahead as we try to figure out how we can change cultures, change behaviors, and still along the way provide quality care at a price that is going to be acceptable enough in the system to make it work,” Ornstein said.

Dr. Conway summed it up this way: “better health, better care, and lower cost.”

Dr. Conway, who maintains a presence in the clinical world by working unpaid weekend shifts at Children's National Medical Center in Washington, D.C., says that while individual hospitalists might feel their contribution is too small to translate to systems change, they are wrong. Change, he says, begins at the local level.

"My challenge to you is: Please don't sit on the sidelines," Dr. Conway said. "Please be actively engaged in your local system in creating this change."

Hospitalist scheduling is one of the tools in the toolbox of hospital medicine practices.

“And like any other tool, it can be used for good or ill, depending on the skills of the operator,” said Greg Harlan, MD, MPH, director of medical affairs for IPC The Hospitalist Company, Monday at HM12 in San Diego.

Dr. Harlan encouraged hospitalists to make their schedule a target for systematic process improvement, using quality improvement techniques such as survey/plan/implement/evaluate improvement cycles. Work with various constituencies to clarify their concerns and identify up front the appropriate metrics to track (e.g., length of stay, readmissions, and morning discharges). Dr. Harlan also emphasized the value of hospitalist-led multidisciplinary daily rounding on patients, which can improve communication and efficiency.

There are a variety of scheduling models, including seven days on/seven days off, weekday/weekend, admitters and rounders, zone scheduling, and the CICLE (Creating Incentives and Continuity Leading to Efficiency in Hospital Medicine) model, said co-presenter Shalini Chandra, MD, assistant professor of medicine at Johns Hopkins University. “The key is to find your best fit,” she noted, which may be a hybrid of different approaches that reflects the hospital, the patient population, and the needs of the hospitalist group by considering its members’ stages of life.

Responding to surges in patient census, honoring group members' needs for flexibility in scheduling, may present competing dilemmas for the schedule. An electronic scheduling software could be a helpful adjunct, presenters said.

Wayne DeMott, MD, of Victoria Hospitalist Physicians, Inc., in Victoria, British Columbia, said he came to the session to learn how American hospitalists handle the usual problems of managing schedules.

“I’m pretty convinced that there isn't a Holy Grail of scheduling,” he said, adding that the concerns sound similar on both sides of the border. He also said American hospitals have managed to bring down lengths of hospital stays far beyond their Canadian counterparts.

Hospitalist scheduling is one of the tools in the toolbox of hospital medicine practices.

“And like any other tool, it can be used for good or ill, depending on the skills of the operator,” said Greg Harlan, MD, MPH, director of medical affairs for IPC The Hospitalist Company, Monday at HM12 in San Diego.

Dr. Harlan encouraged hospitalists to make their schedule a target for systematic process improvement, using quality improvement techniques such as survey/plan/implement/evaluate improvement cycles. Work with various constituencies to clarify their concerns and identify up front the appropriate metrics to track (e.g., length of stay, readmissions, and morning discharges). Dr. Harlan also emphasized the value of hospitalist-led multidisciplinary daily rounding on patients, which can improve communication and efficiency.

There are a variety of scheduling models, including seven days on/seven days off, weekday/weekend, admitters and rounders, zone scheduling, and the CICLE (Creating Incentives and Continuity Leading to Efficiency in Hospital Medicine) model, said co-presenter Shalini Chandra, MD, assistant professor of medicine at Johns Hopkins University. “The key is to find your best fit,” she noted, which may be a hybrid of different approaches that reflects the hospital, the patient population, and the needs of the hospitalist group by considering its members’ stages of life.

Responding to surges in patient census, honoring group members' needs for flexibility in scheduling, may present competing dilemmas for the schedule. An electronic scheduling software could be a helpful adjunct, presenters said.

Wayne DeMott, MD, of Victoria Hospitalist Physicians, Inc., in Victoria, British Columbia, said he came to the session to learn how American hospitalists handle the usual problems of managing schedules.

“I’m pretty convinced that there isn't a Holy Grail of scheduling,” he said, adding that the concerns sound similar on both sides of the border. He also said American hospitals have managed to bring down lengths of hospital stays far beyond their Canadian counterparts.

Hospitalist scheduling is one of the tools in the toolbox of hospital medicine practices.

“And like any other tool, it can be used for good or ill, depending on the skills of the operator,” said Greg Harlan, MD, MPH, director of medical affairs for IPC The Hospitalist Company, Monday at HM12 in San Diego.

Dr. Harlan encouraged hospitalists to make their schedule a target for systematic process improvement, using quality improvement techniques such as survey/plan/implement/evaluate improvement cycles. Work with various constituencies to clarify their concerns and identify up front the appropriate metrics to track (e.g., length of stay, readmissions, and morning discharges). Dr. Harlan also emphasized the value of hospitalist-led multidisciplinary daily rounding on patients, which can improve communication and efficiency.

There are a variety of scheduling models, including seven days on/seven days off, weekday/weekend, admitters and rounders, zone scheduling, and the CICLE (Creating Incentives and Continuity Leading to Efficiency in Hospital Medicine) model, said co-presenter Shalini Chandra, MD, assistant professor of medicine at Johns Hopkins University. “The key is to find your best fit,” she noted, which may be a hybrid of different approaches that reflects the hospital, the patient population, and the needs of the hospitalist group by considering its members’ stages of life.

Responding to surges in patient census, honoring group members' needs for flexibility in scheduling, may present competing dilemmas for the schedule. An electronic scheduling software could be a helpful adjunct, presenters said.

Wayne DeMott, MD, of Victoria Hospitalist Physicians, Inc., in Victoria, British Columbia, said he came to the session to learn how American hospitalists handle the usual problems of managing schedules.

“I’m pretty convinced that there isn't a Holy Grail of scheduling,” he said, adding that the concerns sound similar on both sides of the border. He also said American hospitals have managed to bring down lengths of hospital stays far beyond their Canadian counterparts.

"Hopefully there will be a test available to physicians for diagnosing KD in the next 5 years," said Adriana Tremoulet, MD, MAS, who is the Associate Director of the Kawasaki Disease Research Center at Rady Children's Hospital/UC San Diego. Research into biomarkers looks promising and there is even some work underway to develop an app to help with the diagnostic algorithm for atypical cases, shared Dr. Tremoulet.

While many of the ways in which we make the diagnosis of KD have remained the same over the years, with little insight into the etiology, beware of clusters of certain presentations, to include shock, or "Kawashocki" Disease.

Treatment with IVIG remains first-line therapy, but there is a need to do more research into effective treatment for high risk populations—IVIG-resistant children. "The future of this disease is how we will treat all children," Dr. Tremoulet said as she described the research design challenges for children that have already failed therapy. Controlled trials are underway to evaluate new treatments in this population.

Exciting collaborations with climate scientists have produced potential leads into associations with tropospheric wind patterns. "We cannot do this work alone," and physicians on the West Coast are urged to participate in an ongoing collaborative related to this research.

Key Takeaways:

• For unclear reasons, presentations of KD continue to cluster; climate may play a role;
• Use IVIG for children that present with "Kawashocki" Disease;
• Research may soon provide us with diagnostic biomarkers as well as treatments for high-risk children; and
• Contact Olivia Fabri, Research Coordinator, to receive more information related to the West Coast KD Epidemiology Consortium (WIND study).

"Hopefully there will be a test available to physicians for diagnosing KD in the next 5 years," said Adriana Tremoulet, MD, MAS, who is the Associate Director of the Kawasaki Disease Research Center at Rady Children's Hospital/UC San Diego. Research into biomarkers looks promising and there is even some work underway to develop an app to help with the diagnostic algorithm for atypical cases, shared Dr. Tremoulet.

While many of the ways in which we make the diagnosis of KD have remained the same over the years, with little insight into the etiology, beware of clusters of certain presentations, to include shock, or "Kawashocki" Disease.

Treatment with IVIG remains first-line therapy, but there is a need to do more research into effective treatment for high risk populations—IVIG-resistant children. "The future of this disease is how we will treat all children," Dr. Tremoulet said as she described the research design challenges for children that have already failed therapy. Controlled trials are underway to evaluate new treatments in this population.

Exciting collaborations with climate scientists have produced potential leads into associations with tropospheric wind patterns. "We cannot do this work alone," and physicians on the West Coast are urged to participate in an ongoing collaborative related to this research.

Key Takeaways:

• For unclear reasons, presentations of KD continue to cluster; climate may play a role;
• Use IVIG for children that present with "Kawashocki" Disease;
• Research may soon provide us with diagnostic biomarkers as well as treatments for high-risk children; and
• Contact Olivia Fabri, Research Coordinator, to receive more information related to the West Coast KD Epidemiology Consortium (WIND study).

"Hopefully there will be a test available to physicians for diagnosing KD in the next 5 years," said Adriana Tremoulet, MD, MAS, who is the Associate Director of the Kawasaki Disease Research Center at Rady Children's Hospital/UC San Diego. Research into biomarkers looks promising and there is even some work underway to develop an app to help with the diagnostic algorithm for atypical cases, shared Dr. Tremoulet.

While many of the ways in which we make the diagnosis of KD have remained the same over the years, with little insight into the etiology, beware of clusters of certain presentations, to include shock, or "Kawashocki" Disease.

Treatment with IVIG remains first-line therapy, but there is a need to do more research into effective treatment for high risk populations—IVIG-resistant children. "The future of this disease is how we will treat all children," Dr. Tremoulet said as she described the research design challenges for children that have already failed therapy. Controlled trials are underway to evaluate new treatments in this population.

Exciting collaborations with climate scientists have produced potential leads into associations with tropospheric wind patterns. "We cannot do this work alone," and physicians on the West Coast are urged to participate in an ongoing collaborative related to this research.

Key Takeaways:

• For unclear reasons, presentations of KD continue to cluster; climate may play a role;
• Use IVIG for children that present with "Kawashocki" Disease;
• Research may soon provide us with diagnostic biomarkers as well as treatments for high-risk children; and
• Contact Olivia Fabri, Research Coordinator, to receive more information related to the West Coast KD Epidemiology Consortium (WIND study).

Patrick Conway, MD, MSc, chief medical officer of CMS and director of the Office of Clinical Standards and Quality, stated he has taken a position that pays less, has more hours, and tends to upset lots of people. But at the same time, its the most rewarding and most difficult job he has done. And so began an information-filled discussion on CMS policies.

Fortunately, he is one of SHM's own who has the core hospitalist value of quality and patient-centeredness. He also is in a position of power in the government.

An obvious focus of CMS, Dr. Conway explained, is to push the U.S. healthcare system toward a patient-centered outcome measures. Throughout the various projects (value-based purchasing, bundled-payment projects, Save a Million Heart program, readmission reduction) is the goal of improved patient-centered care. In addition the concepts of "better care, better health, and lower costs" represents the cornerstones of this historic time in healthcare.

Key Takeaway: A call to collective action.

What can you do:

1. Partner with your hospital administration and quality improvement teams;
2. Understand your hospitals performance data;
3. Take a physician leadership role; and
4. Create a collaboration with your community partners.

Patrick Conway, MD, MSc, chief medical officer of CMS and director of the Office of Clinical Standards and Quality, stated he has taken a position that pays less, has more hours, and tends to upset lots of people. But at the same time, its the most rewarding and most difficult job he has done. And so began an information-filled discussion on CMS policies.

Fortunately, he is one of SHM's own who has the core hospitalist value of quality and patient-centeredness. He also is in a position of power in the government.

An obvious focus of CMS, Dr. Conway explained, is to push the U.S. healthcare system toward a patient-centered outcome measures. Throughout the various projects (value-based purchasing, bundled-payment projects, Save a Million Heart program, readmission reduction) is the goal of improved patient-centered care. In addition the concepts of "better care, better health, and lower costs" represents the cornerstones of this historic time in healthcare.

Key Takeaway: A call to collective action.

What can you do:

1. Partner with your hospital administration and quality improvement teams;
2. Understand your hospitals performance data;
3. Take a physician leadership role; and
4. Create a collaboration with your community partners.

Patrick Conway, MD, MSc, chief medical officer of CMS and director of the Office of Clinical Standards and Quality, stated he has taken a position that pays less, has more hours, and tends to upset lots of people. But at the same time, its the most rewarding and most difficult job he has done. And so began an information-filled discussion on CMS policies.

Fortunately, he is one of SHM's own who has the core hospitalist value of quality and patient-centeredness. He also is in a position of power in the government.

An obvious focus of CMS, Dr. Conway explained, is to push the U.S. healthcare system toward a patient-centered outcome measures. Throughout the various projects (value-based purchasing, bundled-payment projects, Save a Million Heart program, readmission reduction) is the goal of improved patient-centered care. In addition the concepts of "better care, better health, and lower costs" represents the cornerstones of this historic time in healthcare.

Key Takeaway: A call to collective action.

What can you do:

1. Partner with your hospital administration and quality improvement teams;
2. Understand your hospitals performance data;
3. Take a physician leadership role; and
4. Create a collaboration with your community partners.

Just for level setting, value=quality/cost. Unfortunately, physician payment structure still rewards volume over quality, hence the continued rising cost, and lack of improvement in the value proposition.

Although most physicians believe that the current structure does not adequately financially reward providers for quality, only 1/3 support public reporting.

A pertinent quotation: “If the MDs don’t develop quality measures, the MBAs will.”

The PQRS program is currently elective, with nominal payment incentives, but will become a negative incentive for non-participating providers in 2015. The next step will be the physician feedback program (known as PRUR), which will evolve into the VBP program by physician. Similar to the hospital VBP program, it will be budget neutral, and will be piloted in selected physician groups in 4 states, then rolled out to all physicians in 2017.

Key takeaways for Hospitalists:

• CMMS is moving from public reporting → pay for VALUE performance, for all physicians, through the PQRS → PRUR → VBP programs.
• All physicians need to familiarize themselves with the data and the attribution models.
• All physicians need to gain QI skills to improve their performance metrics.

Just for level setting, value=quality/cost. Unfortunately, physician payment structure still rewards volume over quality, hence the continued rising cost, and lack of improvement in the value proposition.

Although most physicians believe that the current structure does not adequately financially reward providers for quality, only 1/3 support public reporting.

A pertinent quotation: “If the MDs don’t develop quality measures, the MBAs will.”

The PQRS program is currently elective, with nominal payment incentives, but will become a negative incentive for non-participating providers in 2015. The next step will be the physician feedback program (known as PRUR), which will evolve into the VBP program by physician. Similar to the hospital VBP program, it will be budget neutral, and will be piloted in selected physician groups in 4 states, then rolled out to all physicians in 2017.

Key takeaways for Hospitalists:

• CMMS is moving from public reporting → pay for VALUE performance, for all physicians, through the PQRS → PRUR → VBP programs.
• All physicians need to familiarize themselves with the data and the attribution models.
• All physicians need to gain QI skills to improve their performance metrics.

Just for level setting, value=quality/cost. Unfortunately, physician payment structure still rewards volume over quality, hence the continued rising cost, and lack of improvement in the value proposition.

Although most physicians believe that the current structure does not adequately financially reward providers for quality, only 1/3 support public reporting.

A pertinent quotation: “If the MDs don’t develop quality measures, the MBAs will.”

The PQRS program is currently elective, with nominal payment incentives, but will become a negative incentive for non-participating providers in 2015. The next step will be the physician feedback program (known as PRUR), which will evolve into the VBP program by physician. Similar to the hospital VBP program, it will be budget neutral, and will be piloted in selected physician groups in 4 states, then rolled out to all physicians in 2017.

Key takeaways for Hospitalists:

• CMMS is moving from public reporting → pay for VALUE performance, for all physicians, through the PQRS → PRUR → VBP programs.
• All physicians need to familiarize themselves with the data and the attribution models.
• All physicians need to gain QI skills to improve their performance metrics.

Of the hospitalists who responded to SHM's Hospitalist Career Satisfaction Survey, 35% were women (with a mean age of 44) and 50% have been hospitalists for more than seven years. Most respondents worked full time.

Results

• The mean job satisfaction of hospitalists was 3.96 on a 5-point scale.
• Career satisfaction among respondents was a mean of 4.09 on a 5-point scale.
• Pediatric hospitalists are happier than adult hospitalists.
• Things that make hospitalists happy are the quality of the care they provide and the relationships they have with staff, colleagues, patients, and leaders.
• Hospitalists are least satisfied with organizational fairness, personal time, compensation, and autonomy.
• 30% of respondents experienced burnout, and almost half of them say they are likely to leave their jobs in the next two years.

Independent Predictors for Job Satisfaction

• Organizational climate
• Satisfaction with care quality
• Personal time
• Relationship with leader
• Compensation

Overall, U.S. hospitalists report a relatively high degree of job and career satisfaction. But, high burnout levels threaten programs due to job turnover or intent to decrease the amount of clinical work.

The session presenters recommended that we need to address hospitalist burnout and dissatisfaction if we are going to stop the leak out of hospital medicine.

Dr. George is regional medical director/VP of operations, West Cogent Healthcare, South Barrington, Ill.

Of the hospitalists who responded to SHM's Hospitalist Career Satisfaction Survey, 35% were women (with a mean age of 44) and 50% have been hospitalists for more than seven years. Most respondents worked full time.

Results

• The mean job satisfaction of hospitalists was 3.96 on a 5-point scale.
• Career satisfaction among respondents was a mean of 4.09 on a 5-point scale.
• Pediatric hospitalists are happier than adult hospitalists.
• Things that make hospitalists happy are the quality of the care they provide and the relationships they have with staff, colleagues, patients, and leaders.
• Hospitalists are least satisfied with organizational fairness, personal time, compensation, and autonomy.
• 30% of respondents experienced burnout, and almost half of them say they are likely to leave their jobs in the next two years.

Independent Predictors for Job Satisfaction

• Organizational climate
• Satisfaction with care quality
• Personal time
• Relationship with leader
• Compensation

Overall, U.S. hospitalists report a relatively high degree of job and career satisfaction. But, high burnout levels threaten programs due to job turnover or intent to decrease the amount of clinical work.

The session presenters recommended that we need to address hospitalist burnout and dissatisfaction if we are going to stop the leak out of hospital medicine.

Dr. George is regional medical director/VP of operations, West Cogent Healthcare, South Barrington, Ill.

Of the hospitalists who responded to SHM's Hospitalist Career Satisfaction Survey, 35% were women (with a mean age of 44) and 50% have been hospitalists for more than seven years. Most respondents worked full time.

Results

• The mean job satisfaction of hospitalists was 3.96 on a 5-point scale.
• Career satisfaction among respondents was a mean of 4.09 on a 5-point scale.
• Pediatric hospitalists are happier than adult hospitalists.
• Things that make hospitalists happy are the quality of the care they provide and the relationships they have with staff, colleagues, patients, and leaders.
• Hospitalists are least satisfied with organizational fairness, personal time, compensation, and autonomy.
• 30% of respondents experienced burnout, and almost half of them say they are likely to leave their jobs in the next two years.

Independent Predictors for Job Satisfaction

• Organizational climate
• Satisfaction with care quality
• Personal time
• Relationship with leader
• Compensation

Overall, U.S. hospitalists report a relatively high degree of job and career satisfaction. But, high burnout levels threaten programs due to job turnover or intent to decrease the amount of clinical work.

The session presenters recommended that we need to address hospitalist burnout and dissatisfaction if we are going to stop the leak out of hospital medicine.

Dr. George is regional medical director/VP of operations, West Cogent Healthcare, South Barrington, Ill.

Adriana Tremoulet, MD, reviewed the classic presentation as well as the incomplete disease presentation of Kawasaki disease (KD) at a breakout session Monday morning at HM12.

Clinical KD is an immunologic reaction triggered by a presumed infectious agent in a genetically susceptible host. The clinical outcome, including coronary aneurysm, is also likely genetically pre-determined. Early identification is essential for proper treatment to decrease the risk of coronary artery aneurysms. Most KD patients will have some elevation of biomarkers, including CRP, ESR, CSF pleocytosis, GGT, ALT, platelets, and WBC. Anemia may also be present. There are ongoing trials of potential laboratory analysis panels.

IVIG remains standard first line therapy for KD. IVIG-resistant KD is defined as persistent fever 36 hours after initial IVIG treatment. Twenty-two percent of patients with IVIG-resistant KD will develop coronary artery aneurysms, a rate similar to untreated KD. There are multiple treatment options for IVIG-resistant KD including a second dose of IVIG, infliximab, steroids, plasmapheresis, cyclophosphamide, methotrexate, and cyclosporine.

Bottom Line

• Hospitalists should remain vigilant to identify children with acute KD, including atypical or late presentations.
• Treatment options for IVIG-resistant KD patients are available but protocols are still being evaluated for efficacy.
• There is a potential role of biomarkers in diagnosing KD. These include stratification of patients by inflammatory markers in first 10 days of illness that can diagnose incomplete KD in 90% of children.
• Be aware of potential Kawasaki Disease Shock Syndrome, and continue to give IVIG for these patients.

Dr. Hale is a pediatric hospitalist at Floating Hospital for Children, Tufts Medical Center in Boston.

Adriana Tremoulet, MD, reviewed the classic presentation as well as the incomplete disease presentation of Kawasaki disease (KD) at a breakout session Monday morning at HM12.

Clinical KD is an immunologic reaction triggered by a presumed infectious agent in a genetically susceptible host. The clinical outcome, including coronary aneurysm, is also likely genetically pre-determined. Early identification is essential for proper treatment to decrease the risk of coronary artery aneurysms. Most KD patients will have some elevation of biomarkers, including CRP, ESR, CSF pleocytosis, GGT, ALT, platelets, and WBC. Anemia may also be present. There are ongoing trials of potential laboratory analysis panels.

IVIG remains standard first line therapy for KD. IVIG-resistant KD is defined as persistent fever 36 hours after initial IVIG treatment. Twenty-two percent of patients with IVIG-resistant KD will develop coronary artery aneurysms, a rate similar to untreated KD. There are multiple treatment options for IVIG-resistant KD including a second dose of IVIG, infliximab, steroids, plasmapheresis, cyclophosphamide, methotrexate, and cyclosporine.

Bottom Line

• Hospitalists should remain vigilant to identify children with acute KD, including atypical or late presentations.
• Treatment options for IVIG-resistant KD patients are available but protocols are still being evaluated for efficacy.
• There is a potential role of biomarkers in diagnosing KD. These include stratification of patients by inflammatory markers in first 10 days of illness that can diagnose incomplete KD in 90% of children.
• Be aware of potential Kawasaki Disease Shock Syndrome, and continue to give IVIG for these patients.

Dr. Hale is a pediatric hospitalist at Floating Hospital for Children, Tufts Medical Center in Boston.

Adriana Tremoulet, MD, reviewed the classic presentation as well as the incomplete disease presentation of Kawasaki disease (KD) at a breakout session Monday morning at HM12.

Clinical KD is an immunologic reaction triggered by a presumed infectious agent in a genetically susceptible host. The clinical outcome, including coronary aneurysm, is also likely genetically pre-determined. Early identification is essential for proper treatment to decrease the risk of coronary artery aneurysms. Most KD patients will have some elevation of biomarkers, including CRP, ESR, CSF pleocytosis, GGT, ALT, platelets, and WBC. Anemia may also be present. There are ongoing trials of potential laboratory analysis panels.

IVIG remains standard first line therapy for KD. IVIG-resistant KD is defined as persistent fever 36 hours after initial IVIG treatment. Twenty-two percent of patients with IVIG-resistant KD will develop coronary artery aneurysms, a rate similar to untreated KD. There are multiple treatment options for IVIG-resistant KD including a second dose of IVIG, infliximab, steroids, plasmapheresis, cyclophosphamide, methotrexate, and cyclosporine.

Bottom Line

• Hospitalists should remain vigilant to identify children with acute KD, including atypical or late presentations.
• Treatment options for IVIG-resistant KD patients are available but protocols are still being evaluated for efficacy.
• There is a potential role of biomarkers in diagnosing KD. These include stratification of patients by inflammatory markers in first 10 days of illness that can diagnose incomplete KD in 90% of children.
• Be aware of potential Kawasaki Disease Shock Syndrome, and continue to give IVIG for these patients.

Dr. Hale is a pediatric hospitalist at Floating Hospital for Children, Tufts Medical Center in Boston.

The geeks of the Society of Hospital Medicine met to plan out the coming year during the SHM IT Quality Subcommittee Meeting, held Sunday at HM12. Actually, the committee is far from the "The Big Bang Theory" caricature. During the introduction we meet members who snowboard, ski, sail, cycle, play tennis, climb mountains, and even collect German cars. After introductions, the majority of the meeting focused on goals for the year.

The main point of discussion surrounded the concept of Clinical Decision Support (CDS). The committee was very lucky to have Jerry Osheroff, one of the key editors of the new HIMSS publication Improving Outcomes with CDS: An Implementer's Guide. The SHM was a co-sponsor of the publication, and the society's own Kendall Rogers was an editor. Osheroff reviewed the concept of CDS, and included a discussion of the CDS/PI Collaborative, a program he leads. The committee elected to extensively study this approach as a way to bring health IT and quality back together. Brian Donavon best summed up member impressions when he said, "We have lost control of IT."

Bottom Line

• Within a few weeks, the committee will develop goals for the coming year.

• The committee is giving serious consideration to incorporating CDS into the HQPS initiatives, and bringing the concept to the SHM membership at large.

Dr. Holder is medical director of hospitalist services and chief medical information officer, Decatur Memorial Hospital, Decatur, Ill. He is also chairman of the SHM IT Quality Committee.

The geeks of the Society of Hospital Medicine met to plan out the coming year during the SHM IT Quality Subcommittee Meeting, held Sunday at HM12. Actually, the committee is far from the "The Big Bang Theory" caricature. During the introduction we meet members who snowboard, ski, sail, cycle, play tennis, climb mountains, and even collect German cars. After introductions, the majority of the meeting focused on goals for the year.

The main point of discussion surrounded the concept of Clinical Decision Support (CDS). The committee was very lucky to have Jerry Osheroff, one of the key editors of the new HIMSS publication Improving Outcomes with CDS: An Implementer's Guide. The SHM was a co-sponsor of the publication, and the society's own Kendall Rogers was an editor. Osheroff reviewed the concept of CDS, and included a discussion of the CDS/PI Collaborative, a program he leads. The committee elected to extensively study this approach as a way to bring health IT and quality back together. Brian Donavon best summed up member impressions when he said, "We have lost control of IT."

Bottom Line

• Within a few weeks, the committee will develop goals for the coming year.

• The committee is giving serious consideration to incorporating CDS into the HQPS initiatives, and bringing the concept to the SHM membership at large.

Dr. Holder is medical director of hospitalist services and chief medical information officer, Decatur Memorial Hospital, Decatur, Ill. He is also chairman of the SHM IT Quality Committee.

The geeks of the Society of Hospital Medicine met to plan out the coming year during the SHM IT Quality Subcommittee Meeting, held Sunday at HM12. Actually, the committee is far from the "The Big Bang Theory" caricature. During the introduction we meet members who snowboard, ski, sail, cycle, play tennis, climb mountains, and even collect German cars. After introductions, the majority of the meeting focused on goals for the year.

The main point of discussion surrounded the concept of Clinical Decision Support (CDS). The committee was very lucky to have Jerry Osheroff, one of the key editors of the new HIMSS publication Improving Outcomes with CDS: An Implementer's Guide. The SHM was a co-sponsor of the publication, and the society's own Kendall Rogers was an editor. Osheroff reviewed the concept of CDS, and included a discussion of the CDS/PI Collaborative, a program he leads. The committee elected to extensively study this approach as a way to bring health IT and quality back together. Brian Donavon best summed up member impressions when he said, "We have lost control of IT."

Bottom Line

• Within a few weeks, the committee will develop goals for the coming year.

• The committee is giving serious consideration to incorporating CDS into the HQPS initiatives, and bringing the concept to the SHM membership at large.

Dr. Holder is medical director of hospitalist services and chief medical information officer, Decatur Memorial Hospital, Decatur, Ill. He is also chairman of the SHM IT Quality Committee.

Why was President Obama in South Korea visiting the DMZ? Couldn't he get his driver's license here like everyone else? With our current state of politics, sometimes it seems that the only thing to do is laugh. Norm Ornstein, PhD, one of the opening speakers at HM12 on Monday, had the record-number audience laughing at our current challenges during his opening political comical insights.

Ornstein moved quickly into the history of why our current national government is deadlocked. A shift of population and culture has created a two-party system that no longer has the ability to enact laws that are accepted by the general public. The United States has a system of "tribal politics" that impact the freedom of even rational national leaders.

Bottom Line

1. It will be an extremely bumpy ride during this current political period.

2. Political compromise is necessary to further current ideas.

3. Even when the Affordable Care Act decisions are made and the current election cycle is complete, there will be difficult initial planning years for the future of healthcare.

Dr. Hale is a pediatric hospitalist at Floating Hospital for Children at Tufts Medical Center in Boston.

Why was President Obama in South Korea visiting the DMZ? Couldn't he get his driver's license here like everyone else? With our current state of politics, sometimes it seems that the only thing to do is laugh. Norm Ornstein, PhD, one of the opening speakers at HM12 on Monday, had the record-number audience laughing at our current challenges during his opening political comical insights.

Ornstein moved quickly into the history of why our current national government is deadlocked. A shift of population and culture has created a two-party system that no longer has the ability to enact laws that are accepted by the general public. The United States has a system of "tribal politics" that impact the freedom of even rational national leaders.

Bottom Line

1. It will be an extremely bumpy ride during this current political period.

2. Political compromise is necessary to further current ideas.

3. Even when the Affordable Care Act decisions are made and the current election cycle is complete, there will be difficult initial planning years for the future of healthcare.

Dr. Hale is a pediatric hospitalist at Floating Hospital for Children at Tufts Medical Center in Boston.

Why was President Obama in South Korea visiting the DMZ? Couldn't he get his driver's license here like everyone else? With our current state of politics, sometimes it seems that the only thing to do is laugh. Norm Ornstein, PhD, one of the opening speakers at HM12 on Monday, had the record-number audience laughing at our current challenges during his opening political comical insights.

Ornstein moved quickly into the history of why our current national government is deadlocked. A shift of population and culture has created a two-party system that no longer has the ability to enact laws that are accepted by the general public. The United States has a system of "tribal politics" that impact the freedom of even rational national leaders.

Bottom Line

1. It will be an extremely bumpy ride during this current political period.

2. Political compromise is necessary to further current ideas.

3. Even when the Affordable Care Act decisions are made and the current election cycle is complete, there will be difficult initial planning years for the future of healthcare.

Dr. Hale is a pediatric hospitalist at Floating Hospital for Children at Tufts Medical Center in Boston.