Medicolegal Issues

SHM Surveys Revisited


The Benchmarks Committee has had a busy 2006 so far. Many thanks to the 400-plus hospital medicine groups that completed the 2005-06 SHM survey, “The Authoritative Source on the State of Hospital Medicine,” as well as those of you who participated in the follow-up survey to clarify questions around additional revenue or supplements to program income.

We had some behind-the-scenes work on the survey. After the first pass of data analysis, it became clear that there was something amiss with the responses pertaining to the supplemental income questions. Only 47% of programs reported that they received additional income from hospitals or other sources. This seemed incompatible with what we know about current payment rates for fee-for-service work. A quick discussion took place among the committee and we decided to resurvey the group with more precise questions on exactly how finances flow into a program. As you have seen, the additional results bore out our suspicions. With the revised survey tool, 97% of the programs (when re-queried) reported receiving income above and beyond fees from direct patient care.

A recommendation came out of our meeting to change from large-scale, all-encompassing, biannual surveys to smaller annual surveys.

It was a Herculean task of digesting and formatting the data into usable form. SHM Senior Vice President Joe Miller deserves many thanks for poring through the data and creating something that all of you can use to better your programs.

Now, a few words about the recent annual meeting in Washington, DC: The work of the Benchmarks Committee was highlighted by SHM CEO Larry Wellikson, MD, in a plenary session on the first day of the meeting. An insightful panel discussion followed in which panel members Bob Wachter, MD (representing academic hospital medicine), Mary Jo Gorman, MD (corporate hospital medicine), and John Nelson, MD (community hospital medicine) gave some insightful commentary on the results of the survey and then fielded questions from the audience.

In between sessions at the conference, the committee held its annual face-to-face meeting and discussed plans for the year.

Under the guidance and editorial excellence of committee member Leslie Flores, the Benchmarks Committee continues to make strong progress with the dashboard project. As you may recall, this project will document and describe 10 commonly used dashboard metrics, including sample reports. There are plans for this material to be published as a supplement to The Hospitalist later this year.

The committee discussed the type of surveys conducted by SHM. A recommendation came out of our meeting to change from large-scale, all-encompassing, biannual surveys to smaller annual surveys. The annual survey would alternate its focus every other year between evaluating individuals’ productivity and compensation, and the characteristics of hospital medicine groups. Each survey would also have the flexibility to address specific timely questions that might focus on a specific research or hot topic of the day. The goal is to get our first trial survey out by the end of 2006, which would focus on group characteristics.

Lastly, a big thank you to our outgoing chairperson, Teresa Jones. Her hard work and organizational skills are going to be a tough act to follow.

Dr. Kealey is chair of SHM’s Benchmarks Committee

The more SHM members interact with members of Congress and their staff, the louder our voices and the more effective our messages.

Advocacy Day Educates Lawmakers about Hospital Medicine

By Eric Siegal, MD

As reported in the SHM Meeting Reporter (see July The Hospitalist, supplement 1), SHM’s first Legislative Advocacy Day was an overwhelming success. More than 70 members from 29 states visited Capitol Hill on May 3 to educate lawmakers and their staffs about hospital medicine and SHM’s proposals to improve the quality of care in our nation’s hospitals.

Advocacy Day participants attended a morning briefing that covered procedural tips on how to have a successful meeting and the health issues currently before Congress—and SHM’s positions—before leaving for previously scheduled appointments on Capitol Hill.

Once there, hospitalists took time to educate legislators and their staff members about the fastest growing medical specialty in the United States, and then turned to SHM’s recommendations for improving the quality, safety, and cost-effectiveness of inpatient medical care.

Among the issues discussed with lawmakers: the need for more funding for the Agency for Healthcare Research and Quality (AHRQ); SHM support for federal initiatives to measure resource use and improve quality, including a CMS demonstration project to assess the contributions of hospital medicine programs to improve patient care and more efficient management of hospital resources; and the importance of gainsharing demonstration projects that focus on inpatient medical services such as those provided by hospital medicine programs.

More than 130 appointments were scheduled with House and Senate offices, many with members of Congress who sit on the key health committees with jurisdiction over Medicare as well as on committees responsible for determining funding levels for the National Institutes of Health, the CDC, and the Agency for Healthcare Research and Quality.

SHM encourages those of you who participated in Advocacy Day to thank the lawmakers and staff with whom you visited (view the sample thank-you letter and instructions online at under “Advocacy & Policy”).

Advocacy Day opened doors to congressional offices; follow-up from SHM members will keep hospital medicine’s issues before lawmakers as they vote on legislation of importance to our specialty. The more SHM members interact with members of Congress and their staff, the louder our voices and the more effective our messages. Advocacy Day is just the beginning of regular contact by hospitalists with their elected representatives in Washington.

Chapter Updates ONLINE

For additional information on SHM chapters visit and click on “Chapters.”

A New Way to Get Everything SHM

SHM has launched the SHM Store, a new Internet-based marketplace that will redefine the way SHM educational products and apparel are distributed. The online store will be a convenient option for hectic lifestyles because it will be open 24 hours a day and can be accessed from anywhere there is an Internet connection.

The SHM Store is user-friendly and allows you to easily and quickly purchase the quality products and apparel that you have come to expect from SHM. Apparel and accessories include men’s and women’s wind jackets, golf shirts, scrub tops, baseball caps, and lapel pins—all with the SHM logo.

You’ll also find the most up-to-date educational materials from SHM. The 2005-2006 results of the SHM survey, “The Authoritative Source on the State of Hospital Medicine,” can be ordered in CD and print format. The Practice Management Course CD with binder is also available. This combination package includes all of the materials distributed at an onsite presentation of the course. And, last but not least, get your very own copy or additional copies of The Core Competencies in Hospital Medicine: A Framework For Curriculum Development.

The ordering process is simple. Access the SHM Store at or navigate from and click on SHM Store. The store allows you to browse available products and descriptions. When you see something you want, select the quantity you’d like to purchase and add the items to your shopping cart. Once you have completed your shopping trip, click “Check Out.” A confirmation of your transaction will be sent to your e-mail inbox and your products will be shipped to your attention.

It’s that easy. Make sure you go online to browse the new SHM Store. If you have any questions or would like to learn more about the SHM Store, contact SHM at CustomerServic[email protected] org.

SHM, Health Groups Urge House to Boost Discretionary Funding

SHM joined more than 800 health, education, and labor organizations in writing a May 8 letter to the House leadership. Organized by the Coalition for Health Funding and the Committee on Education Funding, the letter calls on Congress to add $7 billion to the budget in discretionary funding for health, education, and labor programs. It asks lawmakers to ensure that the final allocation for the House and Senate Labor, Health and Human Services, Education Appropriations Subcommittees reflects a $7 billion increase above the President’s request for these critically important programs in FY 2007.

“While our organizations represent a wide array of domestic priorities,” the letter states, “we are united in our effort to advance the bipartisan goal of adding $7 billion in discretionary funding for health, education, labor enforcement, job training, and social services programs as the budget process moves forward. On behalf of our millions of constituents, we strongly urge you to provide at least $7 billion in additional federal support to restore funding levels to FY 2005. This is essential to sustain the well-being and prosperity of our nation.”

Agencies whose funding could be boosted by the additional spending called for in the coalition letter include the Agency for Healthcare Research and Quality, the National Institutes of Health, and the Centers for Disease Control and Prevention.

For full coverage of May 2006 advocacy and policy news, visit TH

Dr. Siegal is chair of SHM’s Public Policy Committee.


Education and Quality Initiatives: SHM’s Heart and Soul

By Geri Barnes

This month’s SHM staff article highlights the department responsible for SHM’s education and quality initiatives. While my fellow senior managers may disagree, I believe that we are the heart and soul of SHM in meeting members’ needs. So important is this organizational focus that the Education Committee, chaired by Preetha Basaviah, MD, has its own mission, which parallels and provides detail to the organizational mission of promoting excellence in the practice of hospital medicine. And the Hospital Quality and Patient Safety Committee, chaired by Mahalakshmi Halasyamani, MD, is one of the most dynamic and prolific of SHM’s committees.

We know that members join SHM for the opportunity to effect change and network with colleagues. Equally strong is the quest for educational resources that will facilitate their efforts in improving quality inpatient care. SHM’s education plan focuses and organizes our energy on developing those resources.

SHM’s resources come in many forms. The most visible is our annual meeting. By all accounts, the 2006 annual meeting was extremely successful. It was our largest meeting to date, with almost 1,200 attendees, 99% of whom were members. That number represents more than 21% of our total membership. I wonder how many other organizations can boast of such a high percentage of member attendance at their annual meeting. The attendees actively participated in the educational sessions and the Research, Innovations, and Clinical Vignettes poster session, visited the exhibits, and networked during breaks and social events. To enhance the educational experience, we created a password-protected Web site where registrants could access the handouts for sessions they planned to attend. Because of the value of these materials, we are currently determining ways to utilize the handouts to expand our educational resources.

For several years, SHM has presented the Leadership Academy and “Best Practices in Managing a Hospital Medicine Program” course. These courses are so popular that they have become a mainstay of SHM educational programs and are offered on an annual basis. In September we will present the first Level II Leadership Academy designed to build upon and expand Leadership Academy I. Additionally, “Fundamentals in Billing and Coding” a pre-course to the University of California San Francisco “Management of the Hospitalized Patient” course will be offered in October for the first time. This outgrowth of the Best Practices course was identified as a need by attendees and other members. We anticipate that we will continue to offer these important programs for many years to come.

While we reach a significant number of hospitalists and other healthcare providers through our annual meeting and other face-to-face meetings, we reach many more through other educational and quality improvement efforts. Hospitalists, in their unique role as providers responsible for the general medical care of hospitalized patients, find themselves filling roles as key players and drivers of institutional quality improvement. To aid them in this effort, we’ve developed Web-based resource rooms designed to facilitate the implementation of a quality improvement program for specific disease state/clinical condition, including antimicrobial resistance, stroke, venous thromboembolism, and heart failure. Resource rooms on glycemic control and discharge planning are currently under development.

For most resource rooms, the key is the QI Workbook, a resource built on proven principles of quality improvement, personal experiences, and evidence-based medicine. Resources in addition to the workbook include slide sets that can be used in training sessions, “Teaching Pearls,” patient education resources, and clinical tools in the form of algorithms, order sets, and discharge planning sheets. Most of the resource rooms have online CME programs and each room has a well-developed bibliography.

What will likely prove to be SHM’s most far-reaching resource is The Core Competencies in Hospital Medicine: A Framework For Curriculum Development. Published earlier this year as a supplement to the Journal of Hospital Medicine, the Core Competencies provides a structure for professional and curricular development based on a shared understanding of the essential knowledge, skills, and attitudes expected of physicians working as hospitalists. While the target audience is the directors of hospitalist programs and fellowships and residency programs (and medical school internal medicine clerkships), imagine the number of people reached when the Core Competencies touch hospitalist students across the board. Additionally, the Core Competencies are the focal point for every educational and quality improvement initiative that we undertake. This document will continue to drive the content of each annual meeting, provide direction for the organization, and help us prioritize the development of resources rooms and other educational and quality improvement resources.

SHM is lucky to have partners who understand the importance of hospitalists as key members of the multidisciplinary team and the army that will lead the charge in implementing protocols to improve patient care. From foundations and sister associations, to government and industry, we partner with organizations that appreciate the role that hospitalists play in improving the healthcare system. The partnerships have led to the development of toolkits, resource rooms, CME modules, and other important resources. New initiatives soon to be launched are mentored implementation programs and demonstration projects that will provide us with increased knowledge of how our resources are used and identify areas in which they can be improved.

What is required on a staff level to make this happen? A commitment to do whatever it takes to get the job done. Six of us are equally dedicated to leading, managing, and supporting these efforts. In addition to me, staff members Tina Budnitz, Erica Pearson, Joy Wittnebert, Lillian Higgins, and Theresa Jones chart new ground and are actively engaged in a dynamic learning process on a daily basis. But it is our members and experts that drive this process, and we are grateful for their patience and guidance.

The Education and Quality Initiatives staff members do not work in a vacuum in the national office. We have the support and brainpower of the rest of the staff, with whom we collaborate daily. Membership and marketing, information technology, and business operations staff all play a role in our success.

What makes the national office run as a well-oiled machine? Next month you’ll hear from Steve Poitras, director, Business Operations, who is instrumental in making that happen.

Barnes is director, Education & Quality Initiatives, for SHM.

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