Patient Care

Quality Control


NATIONAL HARBOR, Md.—As HM10 wound down in this tony Washington, D.C., outpost, a trio of hospitalists from St. Louis smiled widely and brightly as a stranger took their picture in front of the main stage.

Each raved about the quality of the meeting they had just completed, particularly the way it linked HM leaders from across the country to such ubiquitous problems as transitional care and patient falls found in institutions from Seattle to Cincinnati to South Carolina. And with a record 2,500 hospitalists attending SHM’s annual meeting this year, what better time to smile?

Your world suddenly becomes much smaller because you can reach out to people, rather than feel like you’re lost in this massive machine.

—Lois Richard, MD, PhD, FHM, hospitalist, Washington University Physicians, St. Louis

Spectacular views of Washington, D.C.

Spectacular views of Washington, D.C.

Derek Fine, MD, discusses “50 Ways to Kill & 5 or 10 Ways to Save Your Kidneys.

Derek Fine, MD, discusses “50 Ways to Kill & 5 or 10 Ways to Save Your Kidneys.

Former SHM president Pat Cawley, MD, SFHM

Former SHM president Pat Cawley, MD, SFHM

MGMA’s Rose Shattuck, CPC, gives hospitalists a “revenue checkup.”

MGMA’s Rose Shattuck, CPC, gives hospitalists a “revenue checkup.”

Tara Lagu, MD, MPH, (left) explains her RIV poster to Evan Fieldston, MD.

Tara Lagu, MD, MPH, (left) explains her RIV poster to Evan Fieldston, MD.

Greg Fonarow, MD, speaks during the “How to Prevent Heart Failure Re-admissions” session.

Greg Fonarow, MD, speaks during the “How to Prevent Heart Failure Re-admissions” session.

“Your world suddenly becomes much smaller because you can reach out to people, rather than feel like you’re lost in this massive machine,” said Lois Richard, MD, PhD, FHM, a hospitalist with Washington University Physicians at the Washington University School of Medicine in St. Louis.

Dr. Richard’s commentary on belonging to a larger scene is a fitting allegory for the state of HM, as the field has grown beyond its neophyte stage. Now that the field has swelled to an estimated 30,000 nationwide, SHM’s new president said the time has come to move past the adolescent phase. Jeff Wiese, MD, FACP, SFHM, associate professor of medicine at Tulane University Health Sciences Center in New Orleans, wants hospitalists to continue championing quality-improvement (QI) programs and patient-safety efforts.

“We’re at a stage as an organization that we need to continue to do the quality-education efforts, but we need to start rising to that next level, which is the quality execution and solutions,” he said during a keynote address, adding later that “we have great heterogeneity in the society. Some people are quality experts because they received great training from SHM, Intermountain Health, IHI, but then there are many members that are interested and really want to be that quality expert but are to the left on the continuum, still learning how to do it.”

The path to quality development began anew with the four-day meeting April 8-11 at the Gaylord National Resort & Convention Center on the banks of the Potomac River. The largest meeting in SHM history kicked off with its largest menu of pre-course sessions, designed to offer educational credits to CME-hungry physicians. This year’s choices included a pair of new sessions, one geared toward neurology and the other aimed at early-career hospitalists. The increased offerings worked, as SHM officials reported a preliminary pre-course attendance increase of 10% from last year’s meeting.

Another big draw for the meeting was the keynote address from Paul Levy, president and CEO of Beth Israel Deaconess Medical Center in Boston. Levy has quickly built himself a national platform to push for QI in the nation’s hospitals, along with public reporting and transparency. Levy said “we still do too much harm in our hospitals,” but wants to see that improved not because of radical changes in payment streams, but because of physicians who want to do better by their patients.

“Ignore the healthcare reform bill,” he said in his address. “Ignore all the fuss about it. Focus instead on the underlying values that you each have individually, and that you have collectively, as to why you became docs in the first place.”

The theme of quality and the future continued speaker after speaker, session after session. Meeting faculty used their microphones to expound on how the recently passed healthcare legislation does more to expand access to healthcare than change the current rules governing it. Most talked about the potential role hospitalists can play in the fluid landscape bound to develop in the next few years, with SHM CEO Larry Wellikson, MD, SFHM, going as far as to describe the field as “the rocketship moving upward almost to a limitless future.”

Still, the future only comes once the past has been recognized, and this year’s meeting will be remembered for the first three physicians who were honored as Masters in Hospital Medicine: John Nelson, Robert Wachter, and Winthrop Whitcomb. The latter described the ceremony as a moving experience for himself and his family.

“When John and I first started working on this in October 1996, and we had the first substantive conversation, I had a really strong feeling that this was going to be successful,” Dr. Whitcomb said. “I saw the forces gathering to drive this, but I definitely didn’t have any idea it was going to be this thing. I don’t think any of us did. . . . What we did want was to have a community.”

This year’s meeting continued to draw scores of first-timers looking to experience a bit of that community. Meeting attendance has nearly doubled since the 2008 meeting in San Diego, with a significant percentage of attendees falling into the early-career hospitalist category.

That includes physicians like Matthew Mechtenberg, DO, a hospitalist at Parkview Adventist Medical Center in Brunswick, Maine. A two-year hospitalist who formerly worked in private practice, he traveled to the meeting as part of his hospital’s focus on performance measures and QI. He was heartened to learn tricks of the trade—billing for encephalopathy instead of “altered mental status” might capture more costs for some patients—but just as importantly, it was comforting to know many of his institution’s problems are universal.

“Some of the issues I have in my hospital are the same as they have in Beth Israel Deaconess,” Dr. Mechtenberg said. “Issues translate whether you’re in a 50-bed hospital or an 800-bed hospital. That’s reassuring.”

And then there was Bihar Dianati, MD, a hospitalist at Belleville Memorial Hospital in Belleville, Ill., who previously couldn’t attend the annual meeting because he worked a Monday-Friday schedule. With his recent switch to “seven-on, seven-off,” he decided to use his week off for professional development.

Dr. Dianati bounced between sessions, finding some “self-promoting” but others “incredibly helpful.” But any professional meeting is only successful if it draws repeat business. So will Dr. Dianati be back next year for HM11 at the Gaylord Hotel in Grapevine, Texas?

“Oh, definitely,” Dr. Dianati said. “I already took the registration papers for next year.” HM10

Richard Quinn is a freelance writer based in New Jersey.

More from the HM10 Special Report

National Imperative

Hospitalists challenged to keep making healthcare better

ONLINE EXCLUSIVE: Audio interview with SHM President Jeff Wiese

SHM's new president talks about his vision for the next generation of hospitalists

Wachter’s World

HM pioneer says healthcare reform offers HM the chance to define cost savings, QI for future generations

Professional Advice

First-class faculty make HM10 pre-courses highly educational, practical

ONLINE EXCLUSIVE: Audio interview with ABIM Learning Session Director Julius Yang

Dr. Yang discusses the HM10 pre-course that prepares hospitalists for ABIM recertification.

Jam-Packed & Well Worth It

A day in the life of one hospitalist’s annual meeting

ONLINE EXCLUSIVE: Audio interview with Nasim Afsarmanesh

Dr. Afsarmanesh discusses the events of her dawn-to-dusk Day 2 at HM10 in National Harbor, Md.

Core Competencies Lay Pediatric HM Foundation

Framework in place, PHM’s future is in the hands of hospitalists

Special Interests

From IT to education to community issues, hospitalists want to be part of the healthcare solution


Practice Management Session

“The Case for Unit-Based Hospitalists: Benefits and Challenges”

Practice Management Session

“Hospitalist NPPs 301—Advanced Concepts”

Practice Management Session

"The Patient Experience: What Hospitalists Need to Know About Measuring, Reporting, and Benchmarking"

Clinical Session

"Controversies in Anticoagulation and Thrombosis"

Clinical Session

"The New C. Diff"

Quality Session

"The Value Proposition to C-Suites: Aligning Hospital Resources to Support Hospitalist QI"

Quality Session

"Quality Improvement Curriculum: How to Get Started and to Keep Going"

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