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.