Last week the MediMobile team traveled to the Society of Hospital Medicine (SHM) Annual Meeting in Washington D.C. which was a huge success. While we’ve added no new MediMobile preferences in the last week, there is an update available for iOS MediMobile Charge Capture users.

MediMobile at the Society of Hospital Medicine Annual Meeting

MediMobile attended the Society of Hospital Medicine Annual Meeting in Washington D.C. which took place May 16-19. The conference was a huge success, and both MediMobile Charge Capture and SafeTextMD got a lot of buzz! MediMobile’s green man, a trade show favorite, made an appearance. You can check out some more photos of MediMobile’s booth at the SHM Annual Meeting on our Facebook page. We want to thank the Society of Hospital Medicine for putting on the event.

MediMobile Charge Capture iOS Update

MediMobile today released an update for the iOS version of our Charge Capture app. The Android version will be released later in the week. This update is primarily to help stabilize the platform, and providers should see that the HIPAA compliant secure messaging works even better. If you would like to learn more about our Charge Capture or our secure messaging solution, contact us at support@medimobile.com or (877) 495-2070.

Quote for the Week

“In nothing do men more nearly approach the gods than in giving health to men.”

- Cicero

We are very excited because this week MediMobile will be attending the Society of Hospital Medicine, or SHM, tradeshow in Washington, DC! We have also completed two new integrations with the HealthTexas Provider Network (HTPN) and improved the functionality of SafeTextMD, our secure messaging solution for healthcare professionals.

MediMobile at the SHM Tradeshow

MediMobile will be at the Society of Hospital Medicine Tradeshow taking place on May 16^th -19^th. The tradeshow will take place at the Gaylord National Resort & Convention Center in Washington DC. If you will be attending we would love for you to stop by our booth and say hello! You can learn more about the tradeshow on the SHM website.

SafeTextMD News

Our development team has been working tirelessly to improve the quality of SafeTextMD for our customers. While we’ve made several technical changes, what SafeTextMD users need to know is that they will see improved message readability and a more solid platform overall.

New Charge Capture Integrations

MediMobile has added three new integrations in the past for our Charge Capture solution. Integrations allow MediMobile to pass patient data from a hospital feed directly to a provider’s smartphone or tablet, making charge capture a breeze. MediMobile now has integrations between:

• HTPN and the Irving IPCU
• HTPN and the Plano IPCU

If you would like to learn whether or not MediMobile has an existing integration or to request an integration for your practice or hospital, contact our support team at support@medimobile.com or (877) 495-2070.

New MediMobile Charge Capture Preferences

The only change providers will see this week is that we have updated one of the MediMobile Charge Capture reports. The report we’ve updated this week is the Total Bills by Supervising Physician. It now includes a complete list of both supervising providers and attending providers.

Quote for the Week

“Treat the patient, not the X-ray.”

-  James M. Hunter

Wiese is associate dean for graduate medical education and director of the Internal Medicine Residency Program at the Tulane University School of Medicine, where he is professor and associate chair of medicine in the Section of General Internal Medicine and Geriatrics.

He is Chief of Medicine, Charity and University Hospitals, Medical Center of Louisiana at New Orleans.

Among the many honors Wiese has received for his teaching:

• The Society of Hospital Medicine Excellence in Teaching Award (2005)
• The Accreditation Council for Graduate Medical Education Parker J. Palmer Courage to Teach Award (2006)
• The Association of American Medical Colleges Robert J. Glaser Distinguished Teacher Award (2006)
• The American College of Physicians Walter J. McDonald Award (2007)
• The Arnold Drapkin Memorial Award and the Leonard Tow Humanism in Medicine Award (2008)
• The Society of General Internal Medicine Mid-Career Mentorship Award (2009)

Read about his teaching philosophy

Wiese is a past president of the Society of Hospital Medicine (2010-2011). He has served as board member for the Society of Hospital Medicine, the Association of Program Directors in Internal Medicine and the Association of Subspecialty Professors.

He earned his medical degree at The Johns Hopkins School of Medicine in 1995. He did his internal medicine residency, chief residency and a medical education fellowship at the University of California, San Francisco.

About Medicine Grand Rounds

UCSD’s Medicine Grand Rounds is held weekly on Wednesday mornings, 7:30 – 8:30 a.m., in the Liebow Auditorium, second floor, Biomedical Sciences Building on the UCSD School of Medicine Campus. There is a hiatus in summer.

To see this year’s schedule and find video viewing information, visit the Medicine Grand Rounds page on the Department of Medicine website.

Dr. McIlraith is lead singer for The Remedies. (Courtesy Sam Hayashi/Zuma Light Works)

Dr. Thomas McIlraith knows about that last part. The chairman of the hospital medicine department for Mercy Medical Group, a large hospital medicine and multispecialty medical group in Sacramento, Calif., he’s also the lead singer and songwriter for The Remedies, a regionally popular five-member rock band that includes nephrologist Dr. David Pai playing bass and orthopedic surgeon Dr. Dan Anderson, who is the band’s sound engineer.

“My experience has been that if I don’t have music in my life, the rest of my life doesn’t live up to its potential. It’s kind of a left-brain, right-brain balance. I find that when I fulfill that creative need, I have more energy for other things,” he said. “It feeds back on itself; it pays back in the inspiration and energy you have for patient care.”

He first noticed this in medical school at the University of Wisconsin in 1992, when he ran a 15-person band called The Arrhythmias. Scheduling practices, etc. in the era before e-mail was time-consuming. “I was worried that I’d flunk out, but that’s when I got my best grades,” he said.

Scheduling for The Remedies isn’t simple either, with three physicians on board plus drummer and geologist Greg Marquis, who is gone for long stretches in the field, and guitarist and recycling worker Walt Simmons. As the chairman of his department, Dr. McIlraith’s schedule consists of the leftovers after the other 55 hospitalists have claimed shifts to fill their schedules.

“I work a lot of nights, and then work some days, so it can be a little haphazard. Before our recent show, we went three weeks straight when we couldn’t manage to fit in a practice. Then we had two, and the show went great,” he said.

Dr. McIlraith (left) rocks with Walt Simmons (center) and Dr. David Pai. (Courtesy Sam Hayashi/Zuma Light Works)

Playing in the band is fun, but so is watching co-workers let loose at the shows. It’s a work-hard, play-hard thing. “We work very, very hard on very tough issues, and when we play, it’s nice to see these people cuttin’ loose and dancing. That’s very fulfilling for me,” he said.

The Remedies play mostly covers with some original tunes thrown in, including two that Dr. McIlraith wrote specifically about hospitalist work. “The Long Ride” recalls the early difficult days of establishing hospitalist medicine. McIlraith sings,

Switching back and forth between night and day

Getting’ no respect, never getting’ our way

Stood our ground and demanded a say

That’s why we’re all here today

The lyrics specifically call out the contributions of founding hospitalists Dr. Winthrop F. Whitcomb, Dr. John R. Nelson, and Dr. Laurence D. Wellikson, as well as the Society of Hospital Medicine itself:

Come together, stay strong, and SHM will help carry you on

Gonna do more than just get by

Who would have known it would be such a long ride

“The CPOE Blues” is another original tune that physicians in many specialties might relate to, singing of the “joys” of computerized physician order entry:

Now, there are a few things I’ve come to hate

Like forgetting to click on “initiate”…

Everybody’s looking ’round for clues

On how they’re s’posed to deal with the CPOE blues

Dr. McIlraith’s roles don’t end with hospitalist and rock musician. He’s also a husband and father of two children. How does he juggle all this? Through the magic ingredient that every session on work-life balance emphasizes as a key factor: a supportive spouse.

His wife works at home as an investment manager and she handles much of the home care as well. “She really takes very good care of all of us,” he acknowledged. “I’m extraordinarily blessed in that regard.”

–Sherry Boschert (@sherryboschert on Twitter)

The hottest topic was the persistent pay gap between female and male physicians, as reported in study after study after study and in a recent survey by the society. But before discussion began, the 70 or so hospitalists present (including 3 men) heard a review of the gender-based basics.

Dr. Rachel George (left) and Dr. Patience E. Reich (SHERRY BOSCHERT/IMNG Medical Media)

“There’s an old saying: Before you try to move a fence, find out why it was put there,” said Dr. Patience E. Reich, who chaired the session with Dr. Rachel George.

The studies suggest that at least some of the disparities in pay are due to gender bias, “many times unconscious,” after controlling for the effects of other factors, Dr. Reich said.

She recommends the Web site of the Gender Bias Learning Project of the University of California Hastings College of Law, where visitors can play Gender Bias Bingo and find other tools for understanding gender bias in our society.

The Project identifies four gender bias patterns that many female physicians can appreciate, Dr. Reich said:

 Prove it again! Men are judged by their potential, but women are judged by their accomplishments and have to prove themselves again and again. Women have to work twice as hard to get half as far as men.

The double bind. Men are perceived as assertive, but women who behave the same way are perceived as aggressive. To get ahead, women sometimes have to choose between being respected and not liked, or being liked and not respected.

The maternal wall. Mothers are considered to be uncommitted to work or incompetent. “People don’t bother hiding this one,” Dr. Reich noted. She gave an example of a time when she submitted the name of a female hospitalist for an open leadership position at a hospital where she worked. A committee member dismissed the idea, saying the candidate wouldn’t want the position because “she’s trying to have another baby.” Dr. Reich countered, “Why don’t we just ask her?” When they did, the candidate said she did want the job and applied for it.

Gender wars. Internalized gender bias creates conflict between women. One example: Older female academicians who sacrificed having children in order to have a career and who now resent younger women expecting to have both, and thus refuse to mentor them.

These issues need to be addressed systemically, not just on a case-by-case basis, in order to effect change, Dr. Reich said.

At a Society of Hospital Medicine women’s interest group meeting later the same day, one doctor said Dr. Reich’s and Dr. George’s “women’s issues” session was better than similar ones she had attended at other medical conferences. “It’s important that we talk about gender bias in the open, with women and men present, and not just talk about things like work-life balance, because it’s a systemic theme,” the physician said.

–Sherry Boschert (@sherryboschert on Twitter)

Accepting new leadership positions in hospital quality improvement with UC San Diego and the Society of Hospital Medicine (SHM), Dr. Greg Maynard has stepped down as Hospital Medicine division chief effective July 1.

He will direct the UC San Diego Center for Innovation and Improvement Science (CIIS) and serve as Senior Vice President of the Society of Hospital Medicine’s new Center for Healthcare Improvement and Innovation (CHII).

“I’m excited about the opportunities for collaboration, improvement, and innovation afforded by each of these positions, as well as the potential synergy between them,” said Maynard.

A member of the UC San Diego Department of Medicine faculty since 2003, Maynard was the founding chief of the Division of Hospital Medicine when it was established in 2005.

“As division chief, Greg Maynard has developed one of the most respected and effective hospitalist programs in the country,” said Department of Medicine Interim Chair Wolfgang H. Dillmann, MD.

“I have no doubt that UC San Diego Health System and the Society of Hospital Medicine will make important advances in hospital quality and patient safety through his leadership.”

Longtime UC San Diego hospitalist Gregory B. Seymann, MD, SFHM, Health Sciences Clinical Professor, is the new Hospital Medicine division chief. For the past year, he has served as associate division chief with Dr. Bryan Huang.

“The Division of Hospital Medicine has benefited greatly from Dr. Maynard’s leadership.” Seymann said. “I will work hard during this transition to maintain the excellent patient care, teaching, and systems improvement efforts that our division has championed.”

Health Sciences Assistant Clinical Professor Bryan Huang, MD, will continue in his role as associate division chief.

Maynard will carry out his SHM duties largely from San Diego, with periodic visits to SHM headquarters in Philadelphia.

With a part-time appointment in Hospital Medicine, he will continue to be involved in the division’s clinical, teaching, and quality improvement activities.

He will also continue as chair of the UC San Diego Health System Patient Safety Committee.
Leading The Center in the Society of Hospital Medicine

The Society of Hospital Medicine (SHM) is the primary professional medical society for hospitalists. Its Center for Healthcare Improvement and Innovation, known as The Center, is a new division that gathers all quality improvement initiatives under Maynard’s direction.   |   Read the SHM press release >

Maynard has played influential roles in developing these initiatives. He has served as a leader in SHM collaboratives on venous thromboembolism (VTE) prevention, glycemic control, and transitions of care for older adults in the hospital.

A founder of the SHM’s Mentored Implementation Program, he has guided numerous hospital medicine programs through quality improvement processes that mirror what he and his colleagues have done at UC San Diego.

Now, as Senior Vice President of The Center, Maynard will oversee all QI initiatives and assist the SHM in designing its strategies for supporting and expanding its healthcare quality improvement efforts.

The Center provides a suite of QI tools and resources for hospitalists. Online collaboration programs offer expert guidance in VTE prevention, glycemic control, and transitions of care.

Through The Center, hospitalists can obtain mentored implementation programs, communicate with other QI program directors via a collaborative network, and access an online QI data repository.

The Agency for Healthcare Research and Quality recently recognized The Center as a Patient Safety Organization, which makes it possible for medical centers to submit protected health information to the SHM for analysis of patient safety events without violating HIPAA guidelines.
Leading the UC San Diego Center for Innovation and Improvement Science

The Center for Innovation and Improvement Science is a new entity that conducts quality improvement efforts in collaboration with UC San Diego Health System management, the Performance Improvement and Patient Safety Office, the Clinical and Translational Research Institute, and the Division of Biomedical Informatics.

As director of the CIIS, Maynard is leading UC San Diego’s efforts to address local and regional quality improvement goals:

• Accelerating inpatient quality and safety initiatives and developing tools to assess their progress
• Fostering QI skills in UC San Diego personnel and their collaborators and disseminating their successful QI tools through mentorship, consultation, and publication
• Reviewing new technologies and fostering new research programs

One of the specific goals of the CIIS is to help other local and regional medical centers improve their quality of care, particularly in VTE prevention, glycemic control, anticoagulation management, and transitions of care.

Another goal is to disseminate UC San Diego’s findings and achievements, establishing UC San Diego more firmly as an innovative center and a leader in hospital quality and patient safety.

About Dr. Maynard

Gregory A. Maynard, MD, MSc, SFHM, Health Sciences Clinical Professor, has led the development of patient safety and hospital quality improvement protocols that have gone on to widespread implementation through the Society of Hospital Medicine, the Agency for Healthcare Research and Quality, the Institute for Healthcare Improvement, and the American Society of Health-System Pharmacists.

For their work in venous thromboembolism (VTE) prevention, Maynard and his colleagues received the SHM Team Approaches in Quality Improvement Award in 2008 and the Venous Disease Coalition’s Venous Research Award for Quality Improvement and Implementation of Best Practices in 2009.

Maynard received his MD degree at the University of Illinois and completed his residency and chief residency in Internal Medicine at Good Samaritan Regional Medical Center in Phoenix, Arizona.

Thereafter, he directed the Good Samaritan Hospital Medicine program and served as Senior Associate Director of the Internal Medicine Residency Program.

He earned his MSc in Clinical Research Design and Biostatistics from the University of Michigan in 1993.

Since Maynard came to UC San Diego in 2003, the Hospital Medicine program has expanded from 4 faculty members covering Thornton Hospital to 30 faculty hospitalists covering both Thornton Hospital and the UC San Diego Medical Center in Hillcrest.

Maynard has served as chair of the Inpatient Glycemic Control Committee, the Patient Discharge Process Improvement /Transitions of Care Committee, and the Patient Safety Committee. He has been leader of the VTE Management Task Force and co-leader of the Inpatient Osteoporosis Identification and Management Task Force.

The American College of Physicians named Maynard a Top Hospitalist in the United States in November 2008. This year, he received the UC San Diego School of Medicine’s Leadership and Innovation in Patient-Centered Systems Award.

About Dr. Seymann

Gregory B. Seymann, MD, SFHM, received his MD degree from UCLA in 1994 and completed his residency training in internal medicine at UC San Diego in 1997. Upon his graduation, he joined the UC San Diego Department of Medicine faculty as an assistant professor.

Seymann helped to found the original group of hospitalists at UC San Diego in 1998.

Seymann’s clinical and research interests are in community-acquired and healthcare-associated pneumonia, performance measurement for hospitals and physicians, systems-based quality improvement, and perioperative consult medicine.

In 2008, the San Diego County Medical Society and San Diego Magazine named Seymann to the “San Diego’s Top Doctors” list. In the same year, graduating housestaff honored him with their annual teaching award.

This year, he received the Medicine 401 Excellence in Teaching Award.

In the Society of Hospital Medicine, Seymann chairs the Academic Practice and Promotions Task Force and is a member of the Academic Hospitalist Committee, the Performance and Standards Committee, and the Ethics QI Research Subcommittee.

He is a member of the UC San Diego Patient Safety Committee. In the Department of Medicine, he is a member of the Committee on Advancement and Promotions, the Peer Review Committee, and the Executive Committee. He chairs the Division of Hospital Medicine Peer Review Committee.

Seymann is a member of the UC San Diego ORYX Core Measures Team for Community Acquired Pneumonia. ORYX is an initiative of the Joint Commission for Accreditation of Healthcare Organizations.

About Dr. Huang

Bryan Huang, MD, Health Sciences Assistant Clinical Professor, received his MD degree from UC San Francisco. He has been a member of the Hospital Medicine faculty since his graduation from internal medicine residency training at Stanford University in 2006.

Huang has special interest in the areas of prevention and management of delirium, prevention of falls, transitions of care, VTE prevention, and treatment of pneumonia.

He has completed additional training in quality improvement through the mini-advanced training program offered by Intermountain Healthcare in Salt Lake City, as well as the SHM Leadership Academy.

He served as the Thornton site director for the Core Clerkship in Internal Medicine in the School of Medicine until this June, and will continue to serve on the Medicine 401 course committee.

Huang served on the SHM Early Career Hospitalists committee from 2007 to 2010.

Together with Dr. Greg Seymann, he has served as associate division chief of Hospital Medicine for the past year. His responsibilities have included workflow redesign, scheduling, budgeting, recruitment, and working with the Internal Medicine Residency Program.

By Marian Wang
ProPublica, May 25, 2011, 2:30 p.m.

Brand-name drug manufacturers have long used controversial tactics [1] to keep their generic competitors off the market, but a new report by the Senate Finance Committee sheds light on how one firm leveraged hidden financial ties with reputable medical groups to undermine its generic rivals.

Facing what it called “an imminent threat [2]” to its brand-name blood thinner Lovenox, pharmaceutical company Sanofi-Aventis launched an advocacy campaign to influence the U.S. Food and Drug Administration to delay generic competitors, according to the report. It did so by contacting medical societies and researchers, urging them to write in to the FDA—or in one case, to write an advertorial for the Wall Street Journal—to raise safety concerns about generics.

Podcast

Latest Episode: From paywalls to online-only content, the news industry is evolving at an incredible pace. But where does ProPublica fall into the mix? And what exactly is a ‘story with moral force’? ProPublica General Manager Richard Tofel explains it all in a podcast [link below].

The medical groups—the Society of Hospital Medicine and the North American Thrombrosis Forum—each received more than $2.3 million from Sanofi between 2007 and 2010. A Duke University researcher who wrote the FDA received more than $260,000. None of the letters mentioned financial ties to Sanofi. (The Journal first reported on the two groups’ letters [3] to the FDA last year, sparking the Senate investigation.)

ProPublica has reported on the ways that drug and device makers have sought to influence professional medical societies [4] and health advocacy groups [5] through millions in donations and advertising revenue at conferences. And while we’ve repeatedly raised questions about how the corporate cash influences these groups, there are limits to what reporters can expose about all that happens behind the scenes.

But Senate investigators have subpoena power, and they’ve produced a report drawing on Sanofi documents and emails between the drugmaker and these supposedly independent medical groups. It’s worth reading in full [6]. Here’s some of the email correspondence between Sanofi and the CEO of the Society of Hospital Medicine after the drug company encouraged the group to contact the FDA. From the report [7] (emphasis ours):

SHM has no history of making similar comments to the FDA or any government agency of this kind. While the Ec [Executive Committee] might be supportive they may feel this …

is not something that SHM has the expertise or knowledge to say much about … That being said when something is important to any of our partners (like Sanofi) that we have a long term relationship with we want to give any issue that is important to our partner careful consideration.

Society of Hospital Medicine

The Society of Hospital Medicine did end up sending a letter to the FDA. The group’s CEO sent Sanofi a draft of the letter [8], and he even asked for the name and address [9] of the intended recipient at the FDA.

A senior manager at Sanofi, in an internal email, later listed the letter as a “key accomplishment [10]” for Sanofi’s public relations team.

Emails also show Sanofi representatives worrying about keeping the appearance of these groups’ independence for fear that Sanofi’s involvement—if reported—could tarnish the groups’ credibility.

After the North American Thrombrosis Forum wrote an advertorial for Lovenox that ran in the Journal, a public relations firm hired by Sanofi emailed the piece to some reporters. That set off some alarm bells for one Sanofi spokeswoman, who worried that Sanofi’s involvement might be too obvious [11]: “I’m a little concerned about how this activity by an agency of ours can be perceived by the media, in terms of any s-a [Sanofi-Aventis] involvement in this activity,” she wrote. (A reporter inquiring about the ad asked about [11] the financial ties between Sanofi and the NATF. She was told to ask [12] the NATF.)

The Society of Hospital Medicine told the Journal [13] that the group has new transparency policies, and “if we were writing the FDA now, we would be very clear about our relationship with any partner, including financial support.” The North American Thrombrosis Forum told the Journal that Sanofi’s funding was not intended “to shape public policy.”

Duke University?

As for the Duke University doctor, Dr. Victor Tapson, the Project on Government Oversight posted one of his letters [14] [PDF] to the FDA. Worth noting, as POGO did [15], that it’s on Duke University letterhead. Tapson told the Journal that parts of the Senate report were “very incorrect,” but didn’t explain further. (Read our story [16] on med schools and their policies on doctors receiving payments from pharmaceutical companies. Here’s Duke’s policy [17].)

As for Sanofi, it maintains that the comments from the experts “brought legitimate and important patient [13] safety facts and considerations to the attention of the FDA,” the Journal reported.

The FDA approved the first generic version of Lovenox in July of last year [18].

Keeping generics off the market costs consumers and the government billions in potential savings every year, according to the Federal Trade Commission. The agency has strongly opposed the industry practice known as “pay for delay [19],” whereby drug companies intent on protecting their monopoly on a particular drug pay off generics companies to get them to drop their patent challenges.

Assessment

Drug companies have argued that the practice of reaching these settlements doesn’t prevent competition [1] once the patents expire—something happening for several major brand-name drugs [20] over the next few years. The FTC, however, has said the practice costs consumers and the government more than $3 billion [21] annually.

Link: http://www.propublica.org/blog/item/e-mails-show-drug-company-used-third-party-medical-groups-to-influence-regu

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Sources: Society of Hospital Medicine.  Project BOOST: Improving the Care of Patients as They Transition from Hospital to Home, [2011?].  http://www.hospitalmedicine.org/ResourceRoomRedesign/RR_CareTransitions/PDFs/Project_BOOST_Fact_SheetFinal.pdf ; and, the Boosting Care Transitions website.

Word on Health was therefore somewhat surprised by the results of a new survey just released by the Society of Hospital Medicine (SHM) and the American Society of Health-System Pharmacists (ASHP). According to their research, only 13% of formulary system decisions made by Pharmacy and Therapeutics (P&T) committees in hospitals are influenced by pharmacoeconomic data.

The survey of 319 directors of pharmacy or pharmacy practice managers evaluated the value of effects compared to the cost of pharmaceutical products when making decisions on changes to the formulary system.

In the study, 87% of respondents felt that pharamacoeconomic methods should be used when considering additions or deletions to their hospital formulary. However, when actually making formulary decisions, respondents reported that clinical and therapeutic factors contributed most to these decisions (54%), followed by drug costs (24%), and patient quality of life (9%).

Although, more than nine out of ten survey respondents reported having pharmacoeconomic analysis available during their most recent P&T committee discussion, only a quarter rated the available information as extremely helpful.

“Pharmacoeconomics is all about balancing the costs of medications with the outcomes they provide and this survey pointed out that many P&T Committees underutilize this approach,” said SHM Chief Executive Officer, Laurence Wellikson.

The full report of the SHM-ASHP pharmacoeconomics survey can be found here.

SRxA and its team of specialized Health Outcomes  Advisors can help pharmaceutical companies collect and package pharmacoeconomic data in a meaningful and impactful way. Contact us today for further information.

The Society of Hospital Medicine just wrapped up 3 days of meeting, in which pretty much every SHM officer who got in front of a podium proclaimed that hospitalists are #1 and rising with a bullet.  In case anyone missed the point, Dr. Jeff Wiese, the incoming SHM president, closed out his forward-looking speech by quoting directly from Queen’s nauseatingly triumphant “We Are the Champions.” The crowd was ushered out of the ballroom with the song blaring over the sound system.

Photo courtesy Flickr Creative Commons user Tiago Ribeiro

Do they really have so much to crow about? Well, yes, and no. In case you hadn’t noticed, hospital medicine is one of the, if not the, fastest growing medical specialties.  (For a definition of “hospitalist,” go here.) There are more than 30,000 hospitalists, according to SHM, up from less than 1,000 just 10 years ago. Dr. Scott Flanders, the current SHM president, said that in 2003, only 30% of hospitals had an established hospital medicine program. Now, almost 70% do.

It’s a young, energetic group. From what I could see, there wasn’t a lot of gray hair in the crowd of 2,500 attendees. They are savvy in the ways of politics, business, and social media. They took meetings at the White House and with staff members of key Senate committees during health reform. They aren’t talking about how much less Medicare is paying them or how they didn’t get what they wanted in that law.

Instead, from their perspective, hospitalists see themselves as the keepers of the keys to “bending the cost curve” in health care. They think they can treat people more efficiently and cost effectively in the hospital, and already have protocols in place to reduce readmissions (which Medicare is demanding).

SHM’s own blog coverage of its meeting noted that Dr. Larry Wellikson, the society’s CEO, described the field as “the rocketship moving upward almost to a limitless future.”

But how much of a future is there in treating inpatients if the oft-stated goal of health reform is to keep people out of the hospital? If Americans continue their slothful ways, it’s entirely possible hospitalists will have a wealth of ongoing business, at least for the current crop of physicians.

Where do you think hospital medicine is headed?

— Alicia Ault (on Twitter @aliciaault)

The relationship of physicians and executives represent two legs of the famous “three legged-stool,” a metaphor that has been a long-standing staple in graduate school education.  The relationship between physicians and administration has intensified.  Some physicians are now “owned” by hospitals.  Independent physician practices look at hospital-owned practices as hospitals competing for their business, and inevitably favoring them.  Hospitals see independent physicians forming freestanding facilities as competing for bread and butter hospital business.  New competition is arising such as from retail-based health clinics, that are adding services like wart removal.  These clinics have the further potential to disrupt referrals.

On Friday, July 25, 2009, I’m going to be participating in an exclusive panel discussion at the AHA Health Forum Leadership Summit in San Francisco.  Sponsored by ARAMARK Healthcare and led by Patrick Cawley, MD, MBA, chief medical officer of Medical University of South Carolina (MUSC) Medical Center in Charleston, South Carolina and President, Society of Hospital Medicine, the session will explore some of the ways in which successful hospitals are working with physicians in a collaborative role in the operations of a hospital.

Health reform needs to come from us in the industry.  What are the approaches we need to make to provide for better health outcomes?  How can we improve the processes of care?  How can the legs of the stool – board, physicians, and administration become sturdier and improve the care that society depends on us to provide?

Look for comments from the meeting later on this blog.

The outside world sees physicians as “circling the wagons” and “not willing to ask the hard questions and take the hard action,” he said. “I think they’re actually completely right.”

The no-blame culture arose from a seminal paper, “The Wrong Patient,” reported in 2002 that examined a patient who was mistaken taken for another patient’s invasive cardiac procedure. A root cause analysis identified 17 distinct errors, no single one of which could have caused the adverse event by itself. The interpretation of this and other cases like it was that the system was at fault and that blame is inappropriate and distracting.

But much has transpired since 2002.

“What’s changed is the recognition that our system produces low quality, unsafe, unreliable care, partly because there’s been no incentive to do any thing other than professionalism, which we’ve come to recognize is too weak an incentive to get systems to completely transform the way they do their work…,” Dr. Wachter said.

Individual physicians have been somewhat insulated from the pressures of accountability because hospitals – by their very size and capacity for data handling – are more likely to end up in the cross hairs of governing agencies, media and patients. Consider the popularity of Web sites like Hospital Compares  and Dr. Wachter’s favorite.

Hospitalists however, may find themselves the target of hospital accountability, he suggests, because they draw most of their dollars from hospitals and have positioned themselves as the quality and safety leaders. “Who are hospitals going to pressure? Neurosurgeons” who bring in thousands of dollars?, he asked.

Still, Dr. Wachter sees this as an opportunity for hospitalists to ultimately change the nature of the way care is delivered in hospitals through leadership and the creation of new quality and safety systems that reduce errors and improve quality. No less than 400 papers detailing such efforts were submitted to SHM 2009 alone.

While there remains a place for withholding blame, the new thinking is that there should be a clear demarcation of blameworthy acts, he said.

“There are firing offenses in every safe industry,” he said. “They mostly are no blame; they want to encourage people to speak up, but they have certain lines that are quite clear that require real action. We have not done that and I think we have to change that.”

-By Patrice Wendling

The honor was announced in November. It recognizes Dr. Maynard’s outstanding contributions in improving the quality of hospital care and mentoring hospitalists in the U.S. and abroad.

Dr. Maynard has led the UCSD hospitalist team in developing nationally-recognized patient safety and quality improvement programs.

These efforts have advanced two crucial aspects of patient safety in the hospital: venous thromboembolism prevention and glycemic control.

Dr. Maynard is also an active mentor in the developing field of hospital medicine.

He’s advising a number of institutions as they develop hospital medicine programs. Among these is the Pontificia Catholic University of Chile in Santiago, where Dr. Maynard helped conduct the first-ever Chilean hospitalist meeting last November.

Dr. Maynard and the other “Top Hospitalist” honorees are profiled in the November 2008 issue of ACP Hospitalist.  |  Read the article

UCSD’s advances in patient care quality improvement

Gregory A. Maynard, M.D., M.Sc., joined the UCSD faculty in 2003 as head of the new Hospital Medicine division.

Since then, the division has expanded to 23 faculty members and has won national awards for its achievements in hospital care quality improvement.

In 2008, the Society of Hospital Medicine honored Dr. Maynard and the UCSD hospitalists with the Team Improvement Award for their venous thromboembolism prevention program.

The program was developed with funding from the Agency for Healthcare Research and Quality.

Dr. Maynard and his colleagues developed a risk assessment tool that allows healthcare professionals to identify quickly and accurately the most appropriate venous thromboembolism prevention measures for each hospitalized patient.

As a result, the UCSD Medical Center is among the leaders in the U.S. in preventing venous thromboembolism in its inpatients.

At the UCSD Medical Center in Hillcrest alone, the program prevents approximately 50 cases of venous thromboembolism each year.

The tool, now part of the Venous Thromboembolism Resource Room on the Society of Hospital Medicine website, is now in use at medical centers around the nation.

UCSD’s hospitalists also play a major part in the Society of Hospital Medicine’s Inpatient Glycemic Control Task Force, which is headed by Dr. Maynard.

The work of the task force was presented recently in a special supplement issue of the Journal of Hospital Medicine (JHM).

“Most of the work on the SHM website, this supplement, and the SHM QI pre-courses features contributions and lessons learned from the hospitalists at UCSD,” Dr. Maynard said.

The term “hospitalist” was first used in 1996 in a New England Journal of Medicine article that highlighted the importance of inpatient-focused care in healthcare today.  |  Read the article

The role of the hospitalist

In creating the “Top Hospitalists” list, the American College of Physicians is recognizing the increasing importance of the new specialty of hospital medicine.

Hospitalists dedicate themselves to improving the quality of care for hospitalized patients. Their efforts range from creating new disease management protocols to revamping hospital information systems.

According to the Society of Hospital Medicine, there are an estimated 20,000 hospitalists in practice today.

As experienced attending physicians who are continuously available on the wards, hospitalists also play a central role in training students, residents, and fellows.

More Information

• About Dr. Maynard and the UCSD hospitalists
  • “2008 Top Hospitalists” story from the American College of Physicians journal ACP Online
  • UCSD Division of Hospital Medicine
  • UC San Diego VTE Prevention Team Wins National Award – Department of Medicine news story
• UCSD hospitalists’ quality improvement efforts
  • Current quality improvement projects
  • Quality improvement news from UCSD’s hospitalists
  • Recent publications in quality improvement from Hospital Medicine at UCSD
  • Glycemic Control Task Force, Society of Hospital Medicine
  • Special supplement issue of the Journal of Hospital Medicine (JHM) on glycemic control
  • Venous thromboembolism prevention program
  • Venous thromboembolism risk assessment tool
• About hospitalists
  • ACP Hospitalist online journal
  • Term coined in 1996 New England Journal of Medicine article
• Other links
  • Agency for Healthcare Research and Quality
  • American College of Physicians
  • Society of Hospital Medicine

The national award recognizes the team for its exemplary efforts in preventing VTE in hospitalized patients at UC San Diego Medical Center.

The program has significantly lowered the incidence of VTE in inpatients and has become a model for VTE prevention efforts nationwide.

For the program’s success, team leader Dr. Gregory Maynard credits the efforts of the multidisciplinary team and the support of the UC San Diego Medical Center and the Department of Medicine.

Dr. Maynard is Clinical Professor of Medicine and Chief of the Division of Hospital Medicine. The VTE Prevention Team includes UC San Diego hospitalists, other physician specialists, pharmacists, and nurses.

The Team Approaches in Quality Improvement Award was presented in a ceremony on April 5 at the Hospital Medicine 2008 meeting here in San Diego.

More Information

• News Stories
  • Read our news story about the VTE Prevention Project
  • Read the Society of Hospital Medicine’s press release about this honor for the UC San Diego VTE Prevention Program team
  • Read the official press release from UC San Diego Health Sciences Communications
• Links
  • Society of Hospital Medicine
  • UC San Diego Division of Hospital Medicine
• Podcast
  • Dr. Maynard talks about the VTE Prevention Program Project at the Hospital Medicine 2008 meeting (mp3)

During any hospital stay, a patient has a significant risk of developing a blood clot in a limb (deep vein thrombosis, or DVT) that may travel to the lung (pulmonary embolism). Pulmonary embolism is considered the leading cause of preventable death in hospitalized patients.

The overall term for this phenomenon is hospital-acquired venous thromboembolism (VTE).

Careful measures can reduce the risk of hospital-acquired VTE substantially. These include activity, support hose, sequential compression devices, and blood-thinning medications such as heparin.

On average, hospitals across the nation are offering adequate blood clot prevention measures to about half of the patients who stay in the hospital.

That was UCSD’s level of performance before the Division of Hospital Medicine started a “Partners in Patient Safety” project funded by the Agency for Healthcare Research and Quality (AHRQ) of the US Department of Health and Human Services.

Now, just two years later, over 95% of UCSD inpatients are receiving adequate clot prevention regimens, setting a new national benchmark. The number of UCSD patients who develop hospital-acquired clots has dropped by about 35%.

Heading the UCSD blood clot prevention project is Dr. Greg Maynard, Chief of the Division of Hospital Medicine and a national leader in the field of patient safety.

The two-year study is titled “Optimal Prevention of Hospital Acquired Venous Thromboembolism” under AHRQ grant 1U18HS015826-01. Its purpose is to find the best ways to prevent hospital-acquired blood clots, and build tool kits that enable others to do the same.

Other major contributors include Dr. Tim Morris, Associate Professor of Clinical Medicine and Director of Pulmonary Clinical Programs at the UCSD Medical Center – Hillcrest) and pharmacists Robert Schoenhaus, Pharm.D., and Douglas Humber, Pharm.D.

Dr. Maynard and his coworkers have developed a VTE prevention protocol, tested it, found it highly successful, and published it for other centers to use.

Under the new protocol, every new or transferred patient is quickly evaluated for his or her risk of developing a blood clot, and the appropriate measures are ordered. Nurses act as another line of defense, and can help identify patients who might otherwise have slipped between the cracks as their bleeding risk or clot risk changed.

Whether the risk is low, average, or high depends on a patient’s age, medical condition, reason for hospitalization, and other factors.

The task called for Dr. Maynard and his colleagues to develop a quick, accurate, reliable way for nurses or other medical staff to screen each patient for blood clot risk. He said existing methods were discarded because they failed to be useful in actual practice.

“We needed a reliable tool that we could apply to any patient of any description in 10 seconds or less,” he said.

The tool kit is now housed at the Society of Hospital Medicine (SHM) website, where it is the centerpiece of a SHM VTE Prevention Collaborative involving 30 medical centers from all over the country.

About the VTE Prevention Collaborative, Dr. Maynard says, “We’re using tools, largely developed here, to help guide other medical centers through the process. We’re mentoring other hospitalists to be leaders in hospital improvement in general, not only as pertains to VTE.”

As part of the Collaborative, Dr. Maynard is one of two mentors who work with hospitalists around the country. By telephone and email, he advises hospitalists at about a dozen centers who download and use the patient care protocols he has helped to develop.

He sees this as part of the mission of hospital medicine. “We identify the best practices and try to build them into a protocol on the front line of use so that every patient is exposed to that treatment practice,” he says. “And we enable others beyond our local environment to do the same thing.”

Dr. Maynard has been a major figure in national efforts to improve the quality of inpatient care for many years. He is a leading member of the Society of Hospital Medicine, and has also worked nationally on inpatient management of diabetes and other common inpatient problems.

At UCSD, where he has headed the Division of Hospital Medicine since 2003, Dr. Maynard is Chairman of the Patient Safety Committee.

The UCSD Division of Hospital Medicine focuses on the special issues that affect the health and care of patients who are hospitalized at UCSD. Its mission is to improve the quality and safety of inpatient care.