Is the integration of urgent, emergent, inpatient and
care of patients with
acute medical conditions.
By Imamu Tomlinson, MD, MBA
In an era of healthcare when there is a call for emergency physicians and hospitalists to increase collaboration, and many working hard to facilitate this, I have seen this pairing blend together effectively just by putting together highly motivated and empowered physicians.
In 1996, my physician group signed an emergency department (ED) contract in Selma, CA. Since that time, we have been invited to staff three EDs, three inpatient departments, an urgent care center (UCC) and a skilled nursing facility (SNF)—all within the forty mile area that includes Selma. How did this come about?
By Dan Culhane, MD, FACEP
The cost of losing someone from your company is quite significant. The actual financial loss, including factors such as lost productivity and costs of integrating employee new person into your organization, can be greater than their salary. For someone as highly specialized as a physician, according to industry experts this can add up to more than twice their salary.
Cejka Search and AMGA recently published their 2012 Physician Retention Survey, which studies data and trends in physician retention. Their report on the current physician turnover rate makes it obvious that reducing this number would create huge operational and financial benefits to healthcare companies.
By Gary Li, MD, FACEP
In most of the prior blogs you have heard a lot about the inexorable forces of change in our healthcare system which are leading to consolidation of health care entities, integration of service lines, accountable care organizations, and so on. Fundamentally, these forces are the oft-state three mandates of improving quality, improving access, and decreasing costs. Keith Bontrager of mountain bike building fame used to say “strong, light, cheap—pick two out of three.” Well, perhaps carbon fiber has changed that paradigm for bikes. Going forward, in medicine, we are also expected to go three for three. Here I would like get into the weeds a bit and ponder resource utilization in clinical practice and the relationship with the Acute Care Continuum.
Analogous to fast food “supersize” meals, more medical care does not always mean better care. Gradually, many healthcare providers and members of the public are beginning to understand this. The “Choosing Wisely” initiative of the American Board of Internal Medicine Foundation is indicative of this recognition and concern. In this program, each medical specialty identifies five diagnostic or therapeutic interventions that may be of questionable value. Programs like this are encouraging medical providers to let go of tests and procedures that are not helpful, may be harmful, and are expensive.
By Amina Martel, MD
The term “hospitalist” was first mentioned in 1996 in an article in the New England Journal of Medicine. Although the field has come far since then, there are still no residencies offered for hospital medicine. Without a formal residency to train hospitalist candidates, administrators must decide whether to recruit recent graduates or experienced hospitalists to fill their needs for this rapidly growing specialty.
Since there are no hospitalist residencies, most of our candidates apply to us after doing a traditional Internal Medicine (IM) residency. We are fortunate to have a plethora of qualified physicians applying for our positions and the majority of them tend to be recent graduates. Being in the San Francisco South Bay region helps us draw candidates, as does our affiliation with a major teaching center. In addition, having our own IM residency gives us a pool of applicants who are already familiar with our hospital. We tend to get more CVs than we have capacity for, which, as physician recruiting expert Barbara Katz points out, is not the norm right now across the country.
By Ted Kloth, MD, FACEP
The time is coming when consolidation and transparency will reign supreme, and the effects are already being felt throughout the healthcare arena.
Looking at the healthcare landscape and how the major players are reacting to the effects of reform, it is obvious to me that the need to consolidate is becoming a reality for many physician groups and service providers. Health systems are merging with larger health systems and clinical outsourcing groups are entering into joint ventures with their long-time clients to provide care at a lower cost. The rationale behind this shift is the belief that integrated systems reduce costs and increase profits for all parties involved. And with fewer reimbursement dollars at play, it seems most are looking for ways to increase profit margins by doing more for less.
By Theo Koury, MD, FACEP
Hospitals across the country are starting to feel the effects of healthcare reform. Beginning in fiscal year 2013 (September 1, 2012), part of hospital reimbursement has been based on a value-based purchasing (VBP) plan that has been created by the Centers for Medicare and Medicaid Services (CMS). This is the first step in a process that will transform the current fee-for-service system into to a fee-for-performance system. This transformation will be taking place gradually, so those who prepare now will improve their strategic position for the future.
CMS established VBP with two goals in mind: to decrease healthcare costs and to improve outcomes for healthcare services. In order to create incentives for hospitals to achieve these goals, they have developed quality criteria which include both clinical process measures and patient experience measures. To start off, CMS will withhold one percent of all hospital payments, and will remit that one percent to hospitals only if they meet the new criteria. The amount withheld will increase annually, finally reaching two percent in 2017.
By Phil Piccinini, MD
As health reform moves forward, we will need to work with fewer resources and find innovative ways to streamline care. One such solution is what my group calls “Team Care”—medical personnel working together to optimize efficiency. As ED visits go up and the patient traffic increases without any increase in structural capacity, Team Care adds functional capacity by reducing overall time in the department.
For example, Team Care is cutting the throughput times for patients in our EDs. Recent studies have shown that crowded EDs are more than just a financial drain and risk management concern for hospital; they are actually bad for patients’ health. Waiting in an ED is like a layover in an airport. Nobody likes sitting around in airports waiting for departures that never seem to happen. In an ED, it’s even worse: the people who have to wait are anxious and in pain. For some patients, waiting for care can be life threatening. But even for patients who are not critically ill, long lines in the ED can lead to dissatisfaction. ED patients need to get checked in quickly, and then be either admitted to the hospital or released to go home as soon as possible. And Team Care helps this happen.
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By Kevin Kruse
While acute care hospitals are veterans in the fight to contain costs, healthcare reform is bringing greater focus to other aspects...
By Bruce Friedberg, MD
The northern San Diego region is growing rapidly, and last year, Palomar Health unveiled a state-of-the-art hospital to meet...
By Mike Harrington
About thirty years ago, I was an accountant for Arthur Young. One of my auditing clients was a young emergency...
By Ted Kloth, MD, FACEP
The time is coming when consolidation and transparency will reign supreme, and the effects are already being felt throughout...
By Theo Koury, MD, FACEP
Hospitals across the country are starting to feel the effects of healthcare reform. Beginning in fiscal year 2013 (September...
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