Surrounded by the bucolic grounds of the Disney Yacht and Beach Club Resort in Lake Buena Vista, Fla., more than 800 pediatric hospitalists gathered in July for Pediatric Hospital Medicine 2014 (PHM14). Preceded by the Society for Pediatric Sedation’s pre-course, PHM14 began in earnest with a warm welcome from Doug Carlson, MD, FAAP, chief of pediatric hospital medicine programs at St. Louis (Mo.) Children’s Hospital and chair of the PHM14 organizing committee.
The first day of the conference started with Patrick Conway, MD, MSc, FAAP, MHM, chief medical officer for the Centers for Medicare and Medicaid Services (CMS), who gave an update of ongoing reforms in the U.S. health delivery system, with a focus on pediatrics. With three years of experience as CMS’ top doc, Dr. Conway related the difficulties of going from an unsustainable fee-for-service system to a people-centered, outcomes-driven system.
“Pediatrics,” Dr. Conway said, “is a leader in patient and family engagement and population health.” This practice, he added, means that the six goals of the CMS Quality Strategy align well with ongoing efforts in PHM.
Despite the difficulties of instituting change in a system that handles $3 billion daily, Dr. Conway, formerly a pediatric hospitalist at Cincinnati Children’s Hospital, said he’s witnessed many signs of improvement in the CMS landscape. Preliminary data from 2012-2014, he said, have shown a 9% reduction in hospital-acquired conditions across all measures, and overall hospital utilization is “dropping like a rock.”
While “having a foot in the boat and a foot on the dock” has been difficult, the transition, through its alphabet soup of innovation programs, is now beginning to pay off. Giving providers a pathway through the changing landscape of risk, Dr. Conway said, is an ongoing priority.
Wrapping up the first day, three healthcare system CEOs took the stage to answer questions from the audience, with Mark Shen, MD, SFHM, president of Dell Children’s Medical Center of Central Texas in Austin, Texas, posing questions like a seasoned talk show host. Panel members included David J. Bailey, MD, MBA, president and CEO of the Nemours Foundation; Steve Narang, MD, MHCM, FAAP, CEO of Banner Good Samaritan Medical Center in Phoenix, Ariz.; and Jeff Sperring, MD, FAAP, president and CEO of Riley Hospital for Children at Indiana University Health in Indianapolis.
Questions were wide-ranging.
Q: How did you become a CEO?
“All I had to do was keep on saying ‘yes,’” Dr. Bailey said.
Q: What are you doing as a CEO to move from a fee-for-service system to a population-based system?
“We are still living in two different worlds. …It depends on ACO penetration, whether quality or volume will be the driver over the next three to five years,” Dr. Narang said.
Q: If PHM fellowship becomes a requirement, will your hospital fund them?
“It’s hard to define what we do, but we know there are core competencies. I don’t think we’re going to be at a point where certification will limit being a hospitalist anytime soon,” Dr. Shen said.
Q: What are the three most important things, from a CEO perspective, that a hospitalist should know?
“Know where your organization wants to go,” Dr. Sperring said.
The next day kicked off with an inspiring call to action by Steve Meuthing, MD, vice president for safety at Cincinnati Children’s Hospital Medical Center. He called on pediatric hospitalists to eliminate all serious harm from children’s hospitals in the U.S. As a part of the Children’s Hospitals’ Solutions for Patient Safety (SPS) network, an organization accounting for 25% of all children hospitalized in the U.S., Dr. Meuthing related the need to employ high reliability theory, along with operational and cultural changes, to improve reliability in patient safety.
“If you don’t standardize, the rest is just chaos,” he said. “We have to make it easy to do these things.”
Dr. Meuthing said improving process reliability is key to reducing adverse outcomes, and high reliability organizations have utilized this approach to reduce serious harm events across the 81 SPS hospitals. While prevention of patient harm is the goal, an additional benefit is cost savings. He estimated $27 million of cost savings was realized within SPS network hospitals in 2012-2013.
Oral abstract and conundrum presentations, concurrent with 23 sessions across nine tracks, kept attendees busy. Topics ranged from a PHM circumcision service to decreasing overuse of continuous pulse oximetry. The day’s talks wrapped up with the respective presidents of the meeting’s co-sponsors—the American Academy of Pediatrics, the American Pediatrics Association, and SHM—sharing their organizations’ visions of PHM’s future in a town hall format.
The second full day began with an update of the Joint Council of Pediatric Hospital Medicine’s efforts to further advance PHM as a field. The process of submitting a petition to the American Board of Pediatrics was reviewed, as were the current status and time course of the move toward Accreditation Council for Graduate Medical Education certification.
After lunch, the highly anticipated “Top Articles” session was presented by Robert Dudas, MD, medical director of the pediatric hospitalist program at Johns Hopkins Bayview Medical Center in Baltimore, and Karen Wilson, MD, MPH, section head for pediatric hospital medicine at Children’s Hospital Colorado in Aurora. The presenters reviewed literature from the past year on topics ranging from nebulized hypertonic saline for bronchiolitis to antibiotic prophylaxis in vesicoureteral reflux.
The final day commenced with a talk by Alberto Puig, MD, PhD, FACP, associate director of undergraduate education at Massachusetts General Hospital in Boston, whose experiences as an internist provided insight regarding the history of the physical examination, from the aphorisms of Hippocrates to the family-centered bedside rounding of today.
Dr. Chang is associate clinical professor of medicine and pediatrics at the University of California at San Diego School of Medicine and a hospitalist at both UCSD Medical Center and Rady Children’s Hospital. He is pediatric editor of The Hospitalist.
Dr. O’Callaghan is a clinical assistant professor of pediatrics at the University of Washington and a member of Team Hospitalist.
Dr. Hale is a past member of Team Hospitalist and a pediatric hospitalist at the Floating Hospital for Children at Tufts Medical Center in Boston.
Dr. Pressel is a pediatric hospitalist and inpatient medical director at Nemours/Alfred I. duPont Hospital for Children in Wilmington, Del., and a member of Team Hospitalist.