All Entries in the "Collaboration" Category
Plan for interdisciplinary morning rounds
During a patient's hospitalization, it's imperative that the hospitalist remain in continuous contact with the treatment team through interdisciplinary morning rounds. That involves appropriate nursing staff, social services, discharge planners, physical/speech/occupation therapists, and pharmacy staff, among others.
You can use the following best practices when establishing interdisciplinary morning rounds:
Contest entry: Promote hospitalist-case manager partnership
Stefani Daniels, managing partner at the PHOENIX: The Hospital Case Mgmt Co., submitted her entry for The Greeley Medical Staff Institute Symposium contest. At every client hospital that Phoenix works with is a plan for dedicated case managers to be assigned to hospitalist teams, in what Stefani calls a “win-win relationship.”
“For the hospitalist, it means that he or she has someone who will help manage the ‘business’ of managing care—someone who will deal with the insurers if necessary, the utilization review nurses, the documentation improvement specialists, and others who want a piece of the hospitalist’s time to ensure compliance with the rapidly escalating regulatory requirements.”
R-E-S-P-E-C-T : This is What it Means to Me
Most hospitalists were not yet born when Aretha Franklin recorded the lyric, “R-E-S-P-E-C-T – Find out what it means to me.” Still, the song remains popular and captures quite well the drive for legitimacy in hospital medicine. Many hospitalists do not feel respected, not by specialists who want to dump patient care responsibilities on them, not by hospital administrators who deny them fair compensation and appropriate staffing, and not by patients wanting to know why their doctor is not seeing them. The secret of gaining respect is to show respect to others.
Many older physicians resent the changes that have occurred in medical practice and regard hospitalists as part of the problem, not as part of the solution. The key to getting along with these doctors is to show that you value the things that they consider important, most particularly the physician-patient relationship. Start by sitting down with them in the cafeteria and the doctors’ lounge. Listen carefully to what they say, and you will learn a lot about the history and traditions of the hospital. Some things may be outdated, but you will discover that most of the rules and procedures of the medical staff were developed for very good reasons that remain valid today.
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Accountable Care Organizations and hospitalists
A recent article in the American Medical News Web site discusses Accountable Care Organizations (ACOs) as a potential element in healthcare reform.
Don’t feel bad if you have not heard of this delivery model. It is not yet in practice in any significant way. However, look for several demonstration projects to start during the next year or two.
Basically, ACOs are an integrated delivery system (including hospitals, primary care physicians, specialists, and probably some other providers as well) which will coordinate care across the organization in a manner designed to improve quality and decrease costs. Medicare reimbursement would most likely remain fee-for-service. However, reimbursement would probably have a “withhold” that could be returned in the form of a bonus (resulting from meeting quality benchmarks and cost savings). It will be up to an administrator to distribute the savings bonus amongst the various provider elements of the ACO.
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9/11: A remembrance
By Richard Rohr, MD, MMM, FACP, FHM
I had not planned to write about this, but seeing the 9/11 memorials this morning brought back some memories.
At 8 a.m. on September 11, 2001 we convened a meeting of the Department of Medicine at Milford Hospital in Milford, CT. The major topic of discussion was whether or not hospitalists should have full membership and privileges in the department. I had been hired several years earlier as a “daytime house physician” (Bob Wachter had not yet told us what a hospitalist was), and we had recently recruited full-time physicians to replace moonlighting cardiology fellows from Yale who had provided night coverage for many years. We were ready to launch a full-service hospitalist program, but there were still many members of the private medical staff who saw this as a way for the hospital to diminish the physicians’ control. It was a more contentious meeting than usual, and I recall that the privileges were approved by a single vote.
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Contest entry: Hospitalist and ED communication
Keep those contest entries coming, and you could win the free registration to The Greeley Medical Staff Institute Symposium (Nov. 8-9, Naples, Fl)!
Here is one helpful tip from David L. Hoff, CEO of Wayne Memorial Hospital in Honesdale, PA about using electronic communication between hospitalists and the emergency department:
“Our hospital has begun to role out CPOE. The best place to start is with the ER doctors since they interface with the hospitalists very frequently on admission decisions. We have found having CPOE in the ER has resulted in much better communication between the ER doctors and the hospitalists on patient management decisions and has reduced the time for admissions orders.”
We’ll share the entries on the blog and select the best one at the end of the month.
To enter the drawing, submit your best practice, tool, or tip to us. Find more details here!
What should the goals of hospitalist palliative care team be?
While I was doing some research for an upcoming article on palliative hospitalists, I looked back at some of the literature on these specialty hospitalists.
As the population ages, the burden on hospitalists to provide effective care to patients with chronic illness increases. The U.S. Census Bureau estimates that the population of adults 65+ will grow by approximately 50% by the year 2020.
Q&A: Do specialty hospitalists have a future in practice or will the trend fade out?
A new book just arrived on my desk, Emergency Department On-Call Strategies: Solutions for Physician-Hospital Alignment, Second Edition, and I'm pleased to share a bit from the book about specialty hospitalists.
A lot of people wonder about the 'ist movement and whether it has staying power.
Q: Do specialty hosptialists have a future in practice or will the trend fade out?
A: Yes, as emergency department (ED) call panel stipends reach high enough levels, hospitals are taking a page from internal medicine hospitalist programs and applying it to other specialties on call. Stipend payments are escalating beyond belief, and it is common to find hospitals paying $8 million to $10 million per year for ED call coverage stipends. Now, a new breed of specialist is in the ranks of internal medicine:
Are concierge hospitalists coming?
I recently had the opportunity to have lunch with a member of the board of directors of a company called MDVIP and was fascinated by their business model. MDVIP helps primary care physicians transition from a traditional practice model to a concierge practice. This company was featured in a recent article on CNNmoney.com.
Here are some of the basics of MDVIP as I understand them:
- The patient pays an annual retainer of approx. $1,500 or $125 per month
- The practice limits the number of patients to between 300—600
- The physician is accessible to any patient around the clock by cell phone and will even meet the patient in the emergency room when an emergency arises
- The patient keeps his or her health insurance in place
- The patient must take an annual “Mayo Clinic” level physical, and the practice focuses on wellness and prevention
Blogging: It’s a two-way street
By Richard Rohr, MD, MMM, FACP, FHM
Writing a blog can be an exercise in self-indulgence. Any notion that comes to mind can seem like the wisdom of the ages when set into type on a Web page. What keeps the blogger grounded in reality is the response from the readers.
My intention of my last posting, “A Contrarian view of hospital medicine,” was to bring out a point of view not often discussed in public forums but to represent some of the lingering doubts about the legitimacy of hospital medicine. I express my appreciation to the individuals who have posted their reactions to my piece. I especially appreciate the contribution of Jon Lovins for stating what is positive and progressive about hospital medicine. I happen to know Jon from my days in Conn.; he and his sister Rachel are both progressive forces in hospital medicine.
Physicians ready to retire? Flexible work options could be the fix
Despite findings from government think-tanks that that our nation appears to be emerging from economic woes, the fact remains that there are a great many physicians today who wanted to retire this year but didn’t because of economic and financial pressures.
According to a recently released 2008 Physician Retention Survey by Cejka Search and the AMGA, nearly two-thirds (62%) of survey respondents believe that physicians are delaying retirement due to the economy. How did organizations respond to the threat of their physicians’ retirement? Almost half (49%) of respondents said they find that part-time options are enabling physicians to delay retirement.
Medical groups are also generally willing to modify work schedules of pre-retirement physicians to encourage them to stay longer:
- 73% of respondents offer their pre-retirement physicians reduced hours
- 56% allow for no-call responsibility
- 20% allow for specialization with certain patient groups
“Physicians can’t retire now,” said Kathy Murray, senior director of recruitment partnerships of the physician search division of Cejka Search. Murray further explained that “increasing numbers of physicians who have retired are looking to get back into the workforce or to supplement their retirement income.”
How has your facility dealt with retiring physicians this year? What have you done for retention? Please share your tips below in the Comments section.
