Is the integration of urgent, emergent, inpatient and
care of patients with
acute medical conditions.
By Jim Strafford
If you have practiced healthcare pretty much anywhere in the United States during the last five years, you have probably been involved in at least one Electronic Health Record (EHR) conversion or implementation. In some cases, you may have converted from a user friendly template to a less user friendly EMR. In other cases, your hospital may have converted from one EHR brand to another. Regardless of the specifics of your transition, it is likely that some degree of frustration happened at the point when you adjusted to the first EHR. And it is also likely that after months of frustration you contacted one of those Scribe companies.
EHRs are still in their relative infancy and continuously improving. Penalties for not automating will be implemented in 2015, so they are here to stay. Learning from implementation issues is critical to improving implementation and effective use of EMRs.
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 Lori Winston, MD
According to the Association of American Medical Colleges (AAMC), the United States will face a shortage of 90,000 physicians by 2020 and 130,000 by 2025. And making it more difficult to climb out of this hole, the federal government is reducing Graduate Medical Education (GME) funding, both in the general budget and in sequestration cuts. As a result, the AAMC is pushing for Congress to lift the cap on Medicare-funded residency training programs which was adopted as part of the Balanced Budget Act of 1997. Last month, two bills were introduced to address the shortage. The House’s Training Tomorrow’s Doctors Today Act and the Senate’s Resident Physician Shortage Reduction Act of 2013 would phase in 15,000 residency positions over five years.
Kaweah Delta Medical Center, the hospital where I practice, has invested in starting its own GME department with the addition of residency programs in emergency medicine (EM), family practice, psychiatry, general surgery and transitional year training. This is a win-win on many levels for everyone involved. It will benefit the doctors accepted to the program, the hospital, my physician group, and the entire community.
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 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.
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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 Josh Sheridan, MD, MS
The hospital system I work for has an ED and two Urgent Care Centers (UCCs) in the same city. Between the two UCCs, we serve...
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