Medicolegal Issues

SHM Wins $1.4 Million Grant from Hartford


On March 16, the John A. Hartford Foundation awarded SHM a $1.4 million grant to develop interventions to improve care transitions for older adults at the time of hospital discharge.

One of the core values of SHM and hospital medicine is to implement changes that improve the care older Americans receive. With this grant support from The Hartford Foundation, SHM can help define and set standards for best practices in discharge and provide a continuum of training opportunities to support those practices.

As part of this three-year project, SHM will partner with national leaders in care coordination to form a national advisory board, create clinical tools, implement guidelines, and provide technical support and training tools to hospitals across the U.S. The project aims to build capacity in at least 200 hospital sites to improve the discharge process and, ultimately, health outcomes for older adults.

Chapter Report

Los Angeles: The kick-off meeting for the Los Angeles chapter was held at Spago Beverly Hills on April 10. The meeting brought together approximately 25 physicians from eight hospitalist groups throughout Los Angeles County. Larry Wellikson, MD, CEO of SHM, gave a presentation, “The Emergence and Future of Hospital Medicine.” Dr. Wellikson illuminated many important points in his talk and encouraged attendees to become involved in quality improvement at their own hospitals. The meeting was supported by Ortho Biotech.

National Advisory Board AND Project Team

SHM has assembled a national advisory board to inform and guide the project. The board will be chaired by Eric Coleman, MD, MPH, associate professor of medicine within the divisions of healthcare policy and research and geriatric medicine at the University of Colorado Health Sciences Center in Aurora. At press time, members included:

  • Barbara Berkman, DSW, PhD, professor of health and mental health, University School of Social Work, Mount Sinai School of Medicine;
  • Tom Bookwalter, PharmD, clinical pharmacist, American Society of Health-System Pharmacists (ASHP);
  • Alan Korn, MD, chief medical officer and senior vice president for clinical affairs, Blue Cross Blue Shield Association;
  • Chuck Denham, MD, chair, National Quality Forum (NQF);
  • Gavin Hougham, PhD, senior program officer, John A. Hartford Foundation;
  • Seth Landefeld, MD, director, American Geriatrics Society (AGS);
  • Cheri Lattimer, RN, BSN, executive director, Case Management Society of America (CMSA);
  • William Lyons, MD, AGS; Nebraska Medical Center in Omaha;
  • Lorraine Mion, PhD, RN, FAAN, director of nursing services for geriatrics, Metro Health Medical Center in Cleveland, Ohio;
  • Mary Naylor, PhD, RN, FAANS, Marian S. Ware professor in gerontology, University of Pennsylvania;
  • Gail Povar, MD, MPH, chair, George Washington School of Medicine, Cameron Medical Group;
  • Deborah Queenan, national advisory council coordinator, Agency for Healthcare Research and Quality (AHRQ);
  • Pat Rutherford, RN, MS, vice president, Institute for Healthcare Improvement (IHI), Transforming Care at the Bedside (TCAB);
  • Eric Warm, MD, Society General Internal Medicine (SGIM); and
  • Larry Wellikson, MD, CEO of SHM.

Dr. Williams will serve as principal investigator, leading a team of co-investigators including Jeffrey Greenwald, MD, (Boston University co-investigator, AHRQ, Project ReEngineering Discharge); Eric Howell, MD (Johns Hopkins Bayview, SHM/Hartford Safe Steps Demonstration Project); Param Dedhia, MD (Johns Hopkins Bayview, SHM/Hartford Safe STEPS Demonstration Project); Lakshmi Halasyamani, MD (St. Joseph Mercy Hospital); Kathleen Kerr (SHM); and Tina Budnitz, MPH (SHM).

The project team includes investigators from the SHM/Hartford Foundation Safe STEPS project and two AHRQ-funded projects. All three projects aim to pilot test discharge-planning toolkits and interventions and develop implementation strategies for adoption. The current project will leverage the findings of all three projects with the insights of the advisory board to create a transitions bundle to optimize the discharge process. Following development of this bundle, SHM will develop a toolkit for implementation with corresponding training programs, and other technical support.

Hospital Medicine Fast Facts click for large version

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Capacity Building Via Continuum of Training Options

SHM has designed a range of technical support and training options to meet the needs of member institutions aiming to implement and sustain the transitions bundle. Strategies include:

  • A Web-based resource room for care transitions in older adults: The transitions bundle, field guide, and related interventional materials will be freely available in the SHM online resource room.
  • A Quality Pre-Course for QI Teams: The course is scheduled for 2008 and 2009 SHM Annual Meetings.
  • A Transition Planning Mentored Implementation Program (TPMI): This yearlong mentoring program will support sites as they implement and evaluate transitions bundle interventions. The program includes a training conference, monthly teleconferences with expert mentors and peer support mechanisms.
  • A consultation service: This will provide on-site consultation and technical assistance to sites planning, implementing, and evaluating discharge interventions. The service includes site visit, follow-up report of findings, recommendations and resources, and post-visit follow-up to review progress, successes and unforeseen barriers.

These support mechanisms are intended to assist those who lead improvement teams at their institutions. Enrollment will begin in the fall. For more information, contact

A Seat at the Table

SHM active in shaping new performance standards

By Jane Jerrard

Healthcare providers are in the midst of important changes in how they work and how they’re rewarded for that work. Recent initiatives including Medicare’s Physician Quality Reporting Initiative and a Medicare hospital value-based purchasing program mandated by the Deficit Reduction Act spell change for practitioners, including hospitalists.

SHM is working to add a hospitalist voice to discussions and decisions that shape these initiatives. By participating in organizations such as the American Medical Association’s (AMA) Physician consortium for Performance Improvement (PCPI), SHM has a seat at the table where decisions are made.

How Participation Works

The PCPI was convened in 2001 by the AMA, with the mission of physician-led performance improvement. While the primary focus is on improving quality, the Consortium’s performance measures are ultimately those used in CMS and other pay-for-performance (P4P) programs and value-based purchasing initiatives.

SHM didn’t get involved when the PCPI was first formed because the issues weren’t relevant to hospitalists. “SHM was invited to participate at that time, but the focus was really on outpatient care,” says Patrick J. Torcson, MD, MMM, FACP, director of hospital medicine at St. Tammany Parish Hospital in Covington, La. “More recently, when the PCPI began looking at the relation between hospital-level measures and physician-level measures, SHM CEO Larry Wellikson said we need to get involved.”

Dr. Torcson is SHM’s representative on the consortium. “For the last year and a half, I’ve been attending the PCPI meetings to represent SHM and have been involved in various PCPI work groups,” he says. “I had previously served on the SHM HQPS [Healthcare Quality and Patient Safety Task Force] and now serve on the PPC [Public Policy Committee], and I think the SHM leadership thought that combination of interests would be good for a PCPI representative.”

What about the Work Groups?

Work groups within the PCPI are assigned specific areas. These groups are responsible for creating performance measures within an area, which are then reviewed by the entire consortium.

“I participated on a work group to develop performance measures for emergency medicine physicians,” says Dr. Torcson. “This group thought that the current disease-specific measures weren’t relevant for them, and that the current hospital measures were also not relevant. I provided a hospitalist’s perspective on hand-offs and discharge which was really focused on a process of care that begins in the ED [emergency department].”

Each work group has representation from various areas of healthcare. “My work group had about 20 or 25 people, which is probably typical,” says Dr. Torcson. “The AMA provided a methodologist, and there was a CMS representative on the work group.” The work group first met face to face to review relevant evidence-based clinical guidelines and scame up with five to eight measures. These were then reworked through phone calls and e-mails before going before the entire PCPI for approval.

Other SHM representatives participated in relevant PCPI work groups as well. “PPC member Greg Seymann from San Diego participated in a geriatric work group that was convened for the same reason” as the ED group, says Dr. Torcson. “His group looked at creating a number of measures that were relative to both inpatient and outpatient geriatric patients. Some of these measures are now part of the Medicare Physician Quality Reporting Initiative.”

Another SHM member, James C. Pile. MD, FACP, participated in a work group on developing measures for outpatient administration of IV antibiotics. Pile is a staff physician in the Department of General Internal Medicine, Section of Hospital Medicine, at The Cleveland Clinic in Ohio.

In each group, SHM representatives were able to help shape measures that reflect the unique knowledge and perspective of hospital medicine.

“A hospitalist brings the perspective of having seen how these measures are actually incorporated into a practice, how they are actually applied to patient care,” Dr. Torcson points out. “These work groups to develop additional performance measures are ongoing. The PCPI has a rigorous agenda for what they want to accomplish over the next few years.”

SHM to Lead the Way on Care Transitions

The PCPI has asked SHM to be the lead organization for a performance measure development work group on care coordination and care transitions.

“This will be groundbreaking work around this important aspect of care that is very process-focused as opposed to disease-focused,” says Dr. Torcson. “It’s very appropriate that SHM was asked to be the lead group for this. This area of performance improvement is perfect for what hospitalists do.”

The PCPI plans to have care transition performance measures ready for adoption by 2009.

SHM and the Big Three

CMS is also collaborating with the National Quality Forum (NQF) and Ambulatory Quality Alliance (AQA). “The PCPI, AQA, and NQF are the most influential organizations right now for quality and performance measures,” says Dr. Torcson.

The NQF, a unique public and private collaborative, develops consensus standards on different measures submitted to it. “I have had the opportunity to participate on an NQF Steering Committee for performance measure endorsement,” says Dr. Torcson.

The AQA is responsible for standardizing performance measurement and reporting, and developing measures for efficiency to be included in forthcoming Medicare P4P programs. “The AQA is charged with implementing performance measures and bringing them to the marketplace,” explains Dr. Torcson. “SHM is not involved in the AQA process yet.”

Membership in SHM means you are able to access the latest information on issues like CMS reporting initiatives and have representation in the decision-making process.

“I think it’s the responsibility of a professional society to not only be informed on what’s happening on a national level, but to have some influence,” says Dr. Torcson. “And SHM has done a great job in being well-positioned to influence the national agenda on quality and performance improvement.” TH

Jane Jerrard writes frequently for The Hospitalist.

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