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HM10 PREVIEW: The Last Word


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, 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.

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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.


Time after Time

SHM’s annual meeting has a familiar endnote: Dr. Wachter. Here is a review of his recent presentations:

2009: “Creating ‘Accountability’ in a ‘No Blame’ Culture: The Yin and Yang of the Quality and Safety Revolution.” The talk paired with a keynote address about QI from Joint Commission President Mark Chassin, MD, MPP, MPH.

2008: “Whipsawed: Can Hospitalists Thrive in the Face of Co-Management, Non-Teaching Services, Transparency, P4P, and the Reality of Perpetual Change?” The clunky title alone helped dramatize the point that HM leaders need to stay abreast of a litany of healthcare changes to stay relevant.

2007: “Hospital Medicine 2017: A Note from the Future.” In a fictional letter to SHM leadership, Dr. Wachter used SHM’s 10th annual meeting to whimsically forecast the future of the specialty. Of note was his projection that the industry would swell to 50,000 hospitalists by 2017.

2006: “Consequences (Intended or Otherwise) of the Quality and IT Revolutions.” Progress doesn’t come without complications, and this address focused on the impact that the front wave of quality and technology improvements would have on rank-and-file hospitalists.

2005: “Hospital Medicine 9 Years Later: Still Crazy After All These Years.” An overview of the HM tenet of value improvement and the arguments hospitalist leaders make to maximize their usefulness to the hospitals where they work.

2004: “Internal Bleeding: What We Need to Know and Do to Cure our Epidemic of Medical Mistakes.” A big-picture, case-based discussion on patient safety.

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