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 Rick Newell, MD, MPH, FACEP

The Centers for Medicare and Medicaid Services (CMS) currently mandates that one perecent of reimbursement for hospital care be based on measures of value and patient satisfaction. This program is called Value Based Purchasing (VBP). Implementation of VBP started on September 1, 2012 and is the beginning of CMS’ transition from paying for volume to paying for value.  In 2014, VBP will increase the percentage of CMS hospital reimbursement at risk under the VBP program and will include outcome measures.  Now, CMS is planning to extend this program to physicians and physician groups under the new Value Based Payment Modifier (VBM).

Starting on January 1, 2015 VBM will apply to large physician groups (those with more than 100 physicians under the same Tax ID Number) and will transition to all physicians and physician groups by January 1, 2017. Although the reimbursement changes will not occur until 2015, CMS will use 2013 data to calculate the 2015 VBM reimbursements.  In addition, physician groups must select their data reporting methodology in 2013.  So, although the actual change goes into effect two years from now, we need to start preparing now.

Our bi-weekly news updates are designed to keep you up to date with current developments relating to the Acute Care Continuum. Feel free to share your perspective on these stories or link to articles that you have found relevant to today’s healthcare environment.

Today, we are looking at a number of reports examining the problems associated with hospital readmission rates and the connection to the emergency department.

By Patrick Green

In my last post I said that the first R of success in managing the continuum is to “Resolve what you can.” I pointed out that we have tremendous opportunity to be more effective and efficient in managing the Acute Care Continuum, and that it is crucial we do so in this era of shrinking reimbursement and an aging population. If we do not, the organizations we lead are at severe risk.

In this post, we will cover the other two R’s needed to succeed in this regard.

By Kevin Kruse

While acute care hospitals are veterans in the fight to contain costs, healthcare reform is bringing greater focus to other aspects of care including patient satisfaction, provider preventable conditions and readmission rates. One highly effective yet underutilized tool for achieving these goals is employee engagement.

So, what is employee engagement anyway? Let’s start with what it’s not…

By Scott Lopata, MD

So, I’m sitting in a restaurant overlooking our local Arizona ice rink (yes, we do have an active hockey establishment in the desert) and watching my son skating round and round at a school event. As I’m watching him, it occurs to me that the circular nature of the ice rink is a good parallel to the Acute Care Continuum. Lately, I’ve wondered about the growing importance of inpatients understanding their discharge instructions and medication side effects; or how and why we need to be concerned and anticipatory in regards to the prevention of readmissions. 

The concept of the Acute Care Continuum can often be overwhelming. By dictionary definition, a continuum is “a continuous extent, series, or whole.” I read it as patient-centered care at every point in the healthcare process. As an individual healthcare provider, at times I have difficulty imagining how I can singularly make a difference in the entire continuum of care. As an emergency physician who manages just one instance of care, it seems even less likely that I can change a patient’s path – helping him or her avoid the rut in the ice and steering smoothly through the process.