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SHM Shapes Pay for Performance


Federal officials are increasingly embracing pay for performance (P4P) in an effort to promote high-quality, cost effective care in government health programs. As the Centers for Medicaid and Medicare Services (CMS) and Congress move forward to implement this concept, SHM is working to ensure that the views of hospitalists are represented in this important debate.

More than 100 P4P programs are already up and running in the private sector in an attempt to reward quality healthcare by setting different payment levels for providers based on how well they meet benchmarks of quality and efficiency. CMS is testing the feasibility of applying this concept to the Medicare program through a number of initiatives.

SHM’s Public Policy and Hospital Quality and Patient Safety committees have been involved in evaluating CMS’ Physician Voluntary Reporting Program (PVRP), launched earlier this year and widely believed to be the precursor to an eventual P4P program for physicians’ services. Under this initiative, physicians are encouraged to submit quality data on a “starter set” of 16 evidence-based measures for certain primary care, surgery, nephrology, and emergency medical services. Physicians who participate in the program receive confidential reports on their performance.

Hospital Medicine FAST FACTS click for large version

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SHM has recommended that hospitalists register their intent to report and begin reporting on relevant performance measures to the extent practicable as a way of becoming more familiar with the program. Because these initial 16 measures have only limited relevance to services billed by hospitalists, SHM is engaged in discussions with lawmakers and their staffs, CMS officials, and consensus organizations involved in developing quality measures, to expand the program’s scope.

As part of Advocacy Day on May 3, some 70 SHM members met with legislators and their staffs and conveyed SHM’s support for initiatives like the PVRP that seek to measure resource use and improve quality, to attain better value for the Medicare program. (See coverage in The Hospitalist SHM Meeting Reporter, July 2006, p. 1.) Participants also educated lawmakers on the role of hospitalists in helping their institutions meet quality reporting requirements mandated under the Medicare Modernization Act, which ties annual hospital payment updates to the submission of performance data for 10 quality measures. The participants also expressed SHM’s interest in working with CMS on demonstration projects that assess the contributions of hospital medicine programs to improved patient care and more efficient management of hospital resources.

To further develop its agenda on performance and quality standards in inpatient hospital care, SHM recently established a new Performance and Standards Task Force.

In addition to Congress and CMS, non-governmental groups such as the National Quality Forum (NQF), the American Medical Association Physician Consortium for Performance Improvement (PCPI), and the Ambulatory Care Quality Alliance are actively engaged in providing input to CMS on the PVRP and other P4P-related initiatives. SHM has joined the PCPI, which works with medical specialty organizations to develop physician-level performance measures.

As a new member of the PCPI, SHM submitted feedback during the public comment period on perioperative care measures, the development of which was led by the American College of Surgeons, along with input from other medical specialties. SHM will also participate in two upcoming workgroups—one on emergency medicine, which will focus on treating for MI and pneumonia, and another on geriatrics, which will look at falls, urinary incontinence, and end-of-life care. At least through 2006, the PCPI is focusing on measures that fall under the CMS contract and will be included in the PVRP.

SHM is also a member of the NQF, a nonprofit organization that Congress has charged with endorsing consensus-based national standards for measurement and public reporting of healthcare performance data. NQF is seeking nominations for members of the steering committee and technical advisory panels that will oversee the work on new consensus standards for hospital care. This project, sponsored by the AHRQ, will address issues of patient safety, pediatrics, and inpatient care. SHM will submit nominations during this process and plans to be fully engaged.

To further develop its agenda on performance and quality standards in inpatient hospital care, SHM recently established a new Performance and Standards Task Force. This task force is charged with developing a coordinated approach for SHM to work with external organizations in the performance and standards and quality arena and comprises the chairs of the PPC and HQPS committees and other SHM leaders active in organizations like the JCAHO and the IHI.

P4P is here to stay. SHM is well positioned to influence the development and implementation of inpatient quality measures that may eventually become part of a Medicare P4P program for physician services. TH

Allendorf is senior advisor for Advocacy and Government Affairs at SHM. Epstein is senior advisor for Quality Standards and Compliance at SHM.

SHM Chapter reports


San Diego’s SHM Chapter met on June 14 at Donovan’s Steak and Chop House in La Jolla, Calif. Attendees listened to a report on acute neurologic issues for the hospitalists. David Ko, MD, associate professor at the University of Southern California School of Medicine, Los Angeles, discussed acute stroke, seizure, and status epilepticus.

Join the San Diego Chapter on September 14, 2006, when Alpesh Amin, MD, from the University of California at Irvine will discuss MRSA infections. CME credit will be provided for the September meeting.


SHM’s Philadelphia Chapter met on June 14 at The Capital Grill in Center City, Philadelphia. Gregory Tino, MD, associate professor of medicine, director, Pulmonary Outpatient Practices at the University of Pennsylvania (Philadelphia) Division of Pulmonary, Allergy, and Critical Care gave a presentation: “COPD: Overview of Patient Management.” Twenty-five attendees from nine hospital medicine groups attended.

For more information about the Philadelphia Chapter please contact Jennifer Myers, MD, at


The Rocky Mountain Chapter conducted its June CME program on June 8. The meeting was held at Landry’s at the Downtown Aquarium in Denver. The meeting was attended by 20 hospitalists representing eight hospital medicine groups.

The speakers for the night included Joseph Varon, MD, FACP, FCCP, FCCM, professor, Acute and Continuing Care, The University of Texas Health Sciences Center (San Antonio), who shared his expertise on “Treatment of Hypertensive Emergencies in Surgery, Intracranial Hemorrhage and Stroke” and Jason Haukoos, MD, MS, from the Department of Emergency Medicine, Denver Health Medical Center, who presented “Cardiac Arrest: Beyond ACLS.” Attendees received two category 1 CME credits.


The Chicago Chapter held its quarterly chapter meeting on May 31. The meeting was held at Brazzaz Brazilian restaurant in downtown Chicago. The meeting was attended by 30 hospitalists from the Chicago area.

The SHM Annual Meeting was reviewed in brief, the need for greater local and national participation by members was addressed, and the organizational involvement for furthering DVT prevention was discussed. The keynote speaker was J. Pandolfino, MD, assistant professor, Department of Gastroenterology, Northwestern Memorial Hospital, Chicago. His topic was “NSAIDs in GI Bleeding.” The meeting was concluded with group discussion and networking.

The election process for the next cohort of officers for the Chicago Chapter has been initiated. Voting will occur prior to the next meeting, and officers will be presented. The next Chicago Chapter meeting is planned for August 2006. Location and exact date are to be announced.

To become involved with the Chicago Chapter, please contact Suj Sundararaj, MD, via e-mail at


A group of more than 40 hospitalists representing 27 hospital medicine groups attended the Boston Chapter’s May 30 meeting. Joe Miller, senior vice president of SHM, presented the 2005-2006 results from SHM’s “Bi-Annual Survey on the State of the Hospital Medicine Movement.” The chapter’s next meeting is scheduled for September 2006.


How SHM Manages Your Money

By Steven Poitras

In the past three months you have read articles from my peers, including one by Todd Von Deak concerning the great strides he is making in the membership department by ensuring that we are generating the most benefits for our members; one from Scott Johnson, who is taking us into the future with regard to information services; and from Geri Barnes, our education and quality initiatives director, who is helping drive our organizational mission of promoting excellence in the practice of hospital medicine.

This month I want to tell you about our organization, its structure, and what we are collectively doing to ensure that the dues and grants we receive are put to good use to benefit our members and ensure our place in driving hospital medicine forward.

Studies show that 70% of small businesses and small non-profit organizations survive their first year, 30% survive their second year, and only 20% survive after five years. SHM will celebrate its 10th year in 2007. Congratulations and thank you. It’s you, our members, who have taken us this far. It’s you, our members, who will take us into the next 10, 20, 50 years, and beyond. We are not the same organization we were 10 years ago, and I suspect we will not be the same organization in 10 years that we are today.

Over the years I have worked and consulted in many organizations ranging from small mom-and-pops to large, multinational corporations. More often than not, despite a common desire to succeed, conflict exists within various constituencies (e.g., employees, executive management, board of directors) that leads to differing opinions on the best strategy for the company moving forward. I’m proud to say that this isn’t the case with SHM.

We have formulated a business model that uses tried-and-true corporate tools to ensure our members receive the maximum possible value in areas of the greatest impact. It encompasses both our paid and non-paid staff and volunteers to validate what matters most. Your dollars are put to good use. We concentrate on doing things that can be done and done well. If it’s a great idea but doesn’t get to the heart of what our members need or want, we won’t siphon off money and time. We receive money from our members and grantors with the intent of fulfilling a promise or mission. We try to understand what can be accomplished, and then we apply our resources to those goals, ensuring that a higher percentage of those resources are going to mission critical programs and services.

Both our members and grantors look for a strong return on their investment for the monies they send and set aside for our cause. Performance standards are necessary, not only to ensure high level delivery of services but also to ensure our organization’s fiscal responsibility. We employ a staff with many qualifications and backgrounds and coordinate our efforts further with diverse, educated, and dedicated volunteers who are experts in their areas.

Not only is our staff concerned with producing measurable results attributed to the dollars we receive, but we are also measuring mission success in numeric terms other than profit and loss, most specifically within our education and quality initiatives as well as our membership departments. Together these departments are spearheading metrics initiatives that are, for the most part, completely new to our organization but essential to our growth. We involve our staff at all levels of the organization in the pursuit of obtaining these metrics. We strive to collaboratively fulfill SHM’s objectives, and our adaptability allows us to scan the external environment and respond to the ever-changing needs of our members and grantors. Consistency of these values and the internal systems from our information services department that support problem solving, efficiency, and effectiveness at every level across our organizational boundaries help us obtain fulfilling our mission.

Communication about our direction is provided at every opportunity: staff meetings, board meetings, brown-bag lunches, and one-on-one employee discussions. Teamwork is emphasized as the primary means for accomplishing work. When decisions need to be made, all employees and volunteers are sought for counsel and advice from them, their peers, and others who might have insight about our programs. Armed with knowledge, strategic and tactical objectives that are clearly defined and pursued with greater focus, conviction, and diligence our employees embrace the change that is so evident in our fast moving organization.

Everyone in our organization understands where we are going, how we intend to get there, and how he or she fits into our organization’s strategy. The culture of our organization has shifted, but our focus on the benefits of hospital medicine has remained constant. By utilizing these strategic planning tools and techniques, we are redeveloping and revitalizing our corporate mission statement by understanding our organizations strengths, weaknesses, opportunities, threats, and actual and potential competitive advantages. This allows us to move beyond just mere expectations to actually setting the standard by which everyone will be judged.

Our employees, volunteers, members, and grantors remind us that while the business is managed on a daily basis, during our strategic planning and project implementation we focus our strategy on the vital few rather than the trivial many. This allows us to put our organization on the right track for survival and long-term growth.

As we grow, we will search harder and further for experts to help us fulfill our promise of setting SHM as the standard in hospital medicine. I encourage your feedback. Please reach me at You will find that I am always accessible and open to your thoughts and ideas.

Next month you will hear from Laura Allendorf, senior advisor for advocacy and government affairs.

Poitras is director of Business Operations at SHM.

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