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HM10 PREVIEW: The Last Word

From: The Hospitalist, March 2010

by Richard Quinn

When you’re a fixture on the HM speaking circuit, it can be challenging to hold the attention of the crowd year after year—especially when your address is at lunchtime on the final day of SHM’s annual powwow, when a fair number of physicians will be checked out or looking to catch a cab to the airport.

The circumstances rarely faze Robert Wachter, MD, FHM, chief of the hospitalist division, professor, and associate chair of the Department of Medicine at the University of California at San Francisco. In fact, since helping pioneer the use of the term “hospitalist,” Dr. Wachter has become the signature closing presenter at SHM’s annual meetings. Sometimes the talk is a window into patient-safety issues; sometimes it’s an oral white paper on policy issues; and, just once, it was a message in a bottle from the future.

This year, though, Dr. Wachter, former SHM president and author of the blog Wachter’s World (www.wachters world.com), is keeping it local.

“It just strikes me that this year, more than any other in recent memory, what is happening in Washington will have a major impact on what hospitalists do for a living and what hospitalists will do for a living,” he says.

Few would disagree.

“Bob has his fingers on the pulse of how hospital medicine is evolving, where hospital medicine started,” says Amir Jaffer, MD, FHM, chair of the annual meeting committee, associate professor, and division chief of hospital medicine at the University of Miami Miller School of Medicine. “Bob’s really been great in terms of predicting what happens next.”

In light of the fluid realities of healthcare reform, Dr. Wachter’s exact words are likely to change several times before he speaks. Still, his themes have remained relatively constant over the years: He boasts of HM’s growth as a specialty and challenges hospitalists to act as leaders.

“I’ve always seen our field as not just reactive, but at the cutting edge of moving things forward,” he says. “This is an extremely important time because if (hospitalists) can be motivational, they can move the whole system forward.”

Hospitalists and group leaders will have to navigate the intricacies of Washington’s reform package. With that in mind, Dr. Wachter will speak about a number of hot policy topics:

• The future of bundled payments. Hospitalists are wary of how the government will reimburse the industry for delivery of care. Whether a new payment system rewards hospitals directly or physicians continue to bill for their services, HM leaders will need to keep abreast of changes.
• Continued migration toward “accountable-care organizations,” also known as ACOs, where providers partner and share responsibility for both the quality and cost of healthcare for a specific population of beneficiaries.
• Healthcare IT improvements. As the industry continues to embrace electronic health records, and industrywide metrics solidify, hospitalists can take leading roles as quality-improvement (QI) leaders.
• Dr. Watcher says hospitalists should use the changing nature of healthcare reform as an opportunity to take a leading role in the discussion.

“It’s not entirely clear how this will play out, but it is clear some piece of the legislation will push for more efficiency,” he says, “and hospitalists will be a major leader in that area.”

Richard Quinn is a freelance writer based in New Jersey.

PHOTOS MATT FENSTERMACHER