Welcome to our seventh annual Top Hospitalists issue! We're excited to showcase the work of the physicians profiled on the following pages, whose efforts in areas like patient safety and satisfaction, quality improvement, high-value care, and medical education are making their mark in facilities across the country. Our call for nominations last spring yielded enthusiastic responses from peers, supervisors, mentors and mentees. ACP Hospitalist's editorial board members then reviewed those nominations and selected the Top Hospitalists. We hope you find the achievements, creativity, and work ethic of these 10 physicians as inspiring as we did, and we look forward to receiving your nominations for next year's honorees.
ACP Hospitalist's Top Hospitalists feature is not part of the ACP National Awards Program.
Quality and safety guru is a champion of high-value care
Hyung (Harry) Cho, MD, ACP Member
Medical School: Temple University School of Medicine, Philadelphia
Residency: Yale-New Haven Hospital, New Haven, Conn.
Title: Director of quality and patient safety, division of hospital medicine, Icahn School of Medicine at Mount Sinai, New York City
When Harry Cho, MD, ACP Member, asks first-year residents what they would order for a patient presenting with shortness of breath, he's used to hearing a textbook recitation of recommended tests. “You've told me what's possible,” he might reply, “now think about what's necessary.”
“They want to be thorough in their workups but I encourage them to think about it a bit more,” said Dr. Cho. “We also discuss what the tests cost and the evidence and value of ordering them, as the patient will be billed when she gets home.”
In less than 3 years as a hospitalist at Mount Sinai, Dr. Cho has earned a reputation as a champion of high-value care, overseeing all quality and safety initiatives within his 40-hospitalist division and chairing the hospital's High Value Care Committee. Over the past year, he's consistently had the lowest length of stay and lowest cost per case index in the division.
“He firmly upholds the tenet of first, do no harm, and strives to minimize both medical and financial harm for patients,” said Joshua Allen-Dicker, MD, MPH, ACP Member, a colleague in the hospital medicine division. “During his rounds, he is a staunch proponent of using evidence-based medicine to guide his testing and treatment.”
Dr. Cho has spearheaded several successful quality improvement projects, including “Lose the Tube,” which resulted in decreasing avoidable catheter-associated urinary tract infections to 0.2 per 1,000 patient catheter days on 5 medical units for 6 months, and a throughput initiative that increased discharges before noon by 49%.
The latter project involved using The Dartmouth Institute's clinical microsystems improvement method. The strategy focuses on making incremental improvements in care based on suggestions from frontline caregivers, including patient care associates, nurses, business associates, and case managers.
“The focus is on communicating very simple goals between the resident and the care team,” said Dr. Cho. “It's a bottom-up approach based on the idea that people are more likely to participate in improvements that come from their own ideas.”
Dr. Cho also developed the Early Discharge Initiation Project to promote discharge for patients who require 1-day admission. Because of regulations in the past, New York City hospitals did not have observation units, and there was often poor communication between physicians who admitted patients on the evening shift and hospitalists who took over the next morning.
“We realized that flagging those patients and communicating to the day team about early discharge would help,” said Dr. Cho. Preliminary results after implementing the new communication system show a 67% rise in the average number of 1-day admissions and a 14% rise in discharge orders by noon.
Increasing value to the hospital and patient is the goal of every project, he said. Care should be patient-centered but also cost-conscious.
“For years people have been thinking that the best care means providing more and more expensive tests,” he said. “But what we're realizing is that that approach isn't necessarily better for the patient and may potentially be worse.”
Recognizing different learning styles makes teaching more effective
Kathleen Finn, MD, FACP
Medical School: Harvard Medical School, Boston
Residency: Brigham and Women's Hospital, Boston
Title: Inpatient clinician educator, associate program director for the residency program, Massachusetts General Hospital; assistant professor of medicine, Harvard Medical School
As a medical student, Kathleen Finn, MD, FACP, remembers leaving many lectures feeling lost and confused. But the problem wasn't so much with the material, she later realized, but the instructor's method of delivering it.
“As a teacher, I came to understand that people learn in different ways,” said Dr. Finn, who teaches students and residents and organizes an annual faculty teaching retreat. “I'm much more of a visual learner so I've tried to vary my teaching, mixing in explanations and visual elements so all different types of learners can follow along.”
The strategy works, judging by the comments of residents who've benefited from her mentorship and teaching.
“Dr. Finn has an incredibly effective way of teaching to different levels—providing the medical students with the appropriate amount of knowledge and then working things through with the interns as they develop into physicians,” said one resident. Another said, “I appreciate that she would bring the whiteboard around to help visual learners. She is compassionate, thoughtful, and a tremendous advocate for residents.”
The response to faculty retreats Dr. Finn has organized for the past 7 years has been equally enthusiastic. She has turned potentially dry topics (teaching the physical exam, giving feedback to residents, for example) into dynamic workshops that keep everyone engaged.
At one retreat entitled, “The Physical Exam: How Best to Teach It?,” Dr. Finn recruited subspecialists to set up stations of volunteer patients with various physical findings, such as 2 distinctive cardiac murmurs for the cardiology station and a palpable thyroid nodule at the endocrine station.
“Dr. Finn's structuring of this single afternoon retreat was masterful,” said Daniel Hunt, MD, FACP, chief of the hospital medicine unit. “It helped reinvigorate interest and confidence among the faculty attendees for teaching the exam to resident and student learners.”
At another workshop, “Praise vs. Criticism: Telling the Inconvenient Truths,” Dr. Finn had residents vote in advance on the usefulness of different physicians' evaluations. Participants were divided into small groups that included a medical student or resident who contributed to the discussion.
“A lot of faculty only work with residents for a couple of weeks so they feel like they can't give feedback,” she said. “At the sessions, they realized what kind of feedback is useful, and that they should feel comfortable giving it.”
Dr. Finn also oversees a peer observation teaching project where faculty physicians observe one another several times a year and offer feedback. Participants have found that the observer gets as much or more out of the experience as the person being observed. “Watching other people causes you to reflect about your own teaching, and we've all started to borrow from each other,” said Dr. Finn. “As we watch each other, we all grow as teachers.”
Creating a culture of quality and safety in the hospital and beyond
Christopher Kim, MD, ACP Member
Medical School: University of Chicago Pritzker School of Medicine
Residency: University of Michigan Health System, internal medicine and pediatrics, Ann Arbor
Title: Clinical associate professor of medicine, University of Michigan; hospitalist, University of Michigan Health System (UMHS)
About 12 years ago, UMHS installed leadership teams comprising medical directors and nurse managers on each of its units. But despite initial enthusiasm, the model never caught on and was eventually dropped. Six years later, Christopher Kim, MD, ACP Member, rolled out the same model with notable success.
The key was putting a support system in place for team leaders, said Dr. Kim. He led the initiative to institute training for physician and nurse leaders, scheduled regular networking forums to exchange ideas, and paved the way for unit-based leaders to understand and adapt health system-wide quality, safety, and patient experience initiatives to be implemented at the local care delivery areas.
“My general approach to helping an organization is collaborative,” said Dr. Kim, who made a point of meeting with each nurse manager and physician leader as the program launched. “I try to understand each individual's perspective and assist them in being the effectors of change.”
A pilot program on 5 general acute medical-surgical care units was so successful in improving quality, safety, and patient experience that it has been expanded to all 25 units in the hospital. Dr. Kim serves as lead physician, reporting directly to the hospital's chief medical and chief nursing officers on this initiative.
Dr. Kim also leads a statewide Transitions of Care Collaborative, modeling his approach on the national BOOST model (Better Outcomes for Older adults Through Safe Transitions). The program, supported by Blue Cross Blue Shield of Michigan, facilitates data-sharing among participating partnerships of hospitals and physician groups throughout the state and assigns mentors to assist with adopting best practices.
“It's been fascinating for me because I'm working with private practitioners, community hospitals, and academic centers,” said Dr. Kim. “I've learned that the basic BOOST model has to be adapted to different environments and the people practicing in those environments.”
In addition to working with faculty and staff, Dr. Kim worked with a colleague to establish a House Officer Quality and Safety Council at the University of Michigan, which has taken on such projects as increasing the number of safety event reports by house officers, reducing hospital-acquired infections, and improving coding and documentation. He also directs the department of internal medicine residency Patient Safety Learning Program, a 2-year longitudinal curriculum that culminates in designing a safety/quality improvement project and presenting the findings at an educational conference.
“At the end of 2 or 3 years, residents come away with a better understanding of quality improvement and our goal is that they continue to apply those concepts in their practice,” said Dr. Kim. “It's been exciting to see them appreciate their role in improving quality and safety in the health system.”
Skilled communicator breaks through silos to improve care
E. Allen Liles Jr., MD
Medical School: University of North Carolina (UNC) School of Medicine
Residency: UNC Hospitals, internal medicine and pediatrics
Title: Section chief of hospital medicine, associate professor of internal medicine and pediatrics, UNC School of Medicine
Soon after becoming head of UNC's hospital medicine program, Allen Liles, MD, perceived an urgent need for a pediatric hospitalist service, but he had trouble convincing colleagues to embrace the project. No one thought it could work, he discovered, because a previous attempt had failed.
“There was a lot of wrangling and many meetings to get it off the ground,” said Dr. Liles. “I had to overcome negative perceptions from faculty and staff to ensure we gained traction and developed enough volume to be successful.”
Breathing new life into the project required someone who was equally at home speaking the languages of finance and medicine. Dr. Liles was perfect for the job, said hospitalist and colleague Richard Hobbs, MD, ACP Member.
“His ability to make the numbers work is why he was able to justify to hospital administration the expansion of our staff to pediatrics,” said Dr. Hobbs. To begin the new program, which is now in its fifth year, Dr. Liles presented convincing financial reasons to justify the hospital's investment in new faculty and a compelling clinical case for a new care delivery model.
“We tend to focus too much on areas of conflict between departments but if we all concentrate on patient safety and efficiency, conflicts will be minimized,” Dr. Liles said. “Making things happen safely and efficiently is good for patients and saves the hospital money.”
The pediatric hospitalist program is just one area where Dr. Liles has set an ambitious goal and marshaled the necessary resources and people to achieve it. Often, those projects call for tearing down silos that have been difficult to breach.
For example, he introduced hospitalist co-management of patients with hip fractures, eliminating confusion about whether the patients should be assigned to medicine or orthopedics after leaving the ED.
“I felt we could take ownership of this area,” said Dr. Liles. “I met with the chair of emergency medicine and orthopedics and developed protocols for hospitalists to be where patients had a home—we took ownership of everything except the orthopedic procedure.”
The initiative was a success, allowing hip fracture patients—who are typically elderly with multiple comorbidities—to move in and out of the hospital more efficiently and eliminating confusion about where they should be sent after admission.
“It's a simple, clear-cut example of how stepping in and taking away a turf battle led to improved care,” said Dr. Liles.
Dr. Liles also led an effort to create individualized care plans (ICP) for high-needs patients who are frequently readmitted. He identified about 55 patients who each had more than 12 combined admissions and ED visits annually and formed a complex care committee made up of hospitalists, care managers, and hospital administrators to address their specific needs and create ICPs. Instead of continuing a pattern of care that was fragmented and frustrating to all, Dr. Liles encouraged a patient-centered approach.
Over the first 8 months, the group created four ICPs and drastically changed those patients' utilization patterns. For example, a patient with sickle cell disease went from visiting the ED twice a month and being admitted at least once a month to a single hospital visit in 5 months and regular visits to UNC's sickle cell outpatient clinic.
“We were able to recognize the difficulties in her life, get substance abuse and mental health help, and coordinate care with the Medicaid system,” he said. “The patient's life improved and there were cost savings on the hospital side, so they are giving us more resources to continue our program.”
“Beyond program leadership, Allen is also consistently the person we turn to for an opinion on diagnosis and management, as well as for career and life mentorship,” said Dr. Hobbs.
This November Dr. Liles is leading his 15th medical mission trip to Guatemala; he has also taken medical service trips to Honduras, Malawi, and the Democratic Republic of the Congo. Residents and faculty from UNC routinely join him.
Clinician applies natural business sense to improving care
Christine Lum Lung, MD
Medical School: University of Colorado Health Sciences Center, Denver
Residency: University of California, San Diego
Title: Medical director, Northern Colorado Hospitalists, Fort Collins, Colo.
Christine Lum Lung, MD, is first and foremost a physician, but she's proven to be equally at home in the business world. Since co-founding an independent hospitalist group in 2004, she has grown it from 3 to 23 physicians and significantly improved quality and efficiency at the 2 hospitals it serves.
“She runs the group with an amazing natural business sense,” said Elizabeth Yoder, MD, ACP Member, Dr. Lum Lung's partner at Northern Colorado Hospitalists. “She consistently performs flawlessly on quality measures, takes exceptional care of her patients, and genuinely cares about perfection in the medical record.”
For the past year, Dr. Lum Lung has participated in a major transition of the medical staff to a service line model at Poudre Valley Hospital in Fort Collins and Medical Center of the Rockies in Loveland—both part of University of Colorado Health's northern division. Under the new structure, multidisciplinary service lines are organized around specialty areas—such as oncology, cardiovascular, or orthopedics—as opposed to the traditional departmental model.
“We wanted to position the medical staff to be more in line with the patient experience, to reflect the way a patient passes through their episodes of care” said Dr. Lum Lung, who chairs the Adult Medicine Inpatient Service Line for the two hospitals. “The service line structure is meant to integrate multidisciplinary teams, including the physicians, nurses, therapists, and others involved in a patient's care. It allows us to look at all of the issues that play into a patient's care simultaneously.”
At the same time, Dr. Lum Lung has initiated quality improvements leading to more efficient workflow and cost savings. For example, she assisted in streamlining the discharge process by adding pharmacy technicians to assist with medication reconciliation at admission, improving the accuracy of medication lists and freeing up physicians and nurses to do other tasks.
“We found that a really good discharge happens first at admission,” she said. “So we added pharmacy admission specialists who meet with patients and families in the emergency department to get medication bottles, call primary care offices, and contact pharmacies to ensure the best admission medication list possible.”
Medication reconciliation at admission turned out to be a “huge piece of getting the discharge right,” she said. After the pilot project produced annualized savings of 3,193 hours and $253,000 based on 5 admissions per day, use of pharmacy technicians became standard for all admissions throughout the hospital system.
Dr. Lum Lung also spearheaded several other quality initiatives that have since gone systemwide, including a venous thromboembolism prophylaxis protocol, a checklist aimed at decreasing unnecessary telemetry, and a dashboard for improving group performance.
She said she is most proud of her group's culture of ownership. All of her colleagues in Northern Colorado Hospitalists participate in process improvement work, serve on committees, and seek out leadership opportunities.
“There is an expectation that we are all here to keep this group performing at an exceptional level. Everyone knows their job goes beyond direct patient care,” she said. “Our physicians don't ask ‘Do I have to do this?’ but ‘What do I get to do?’ I am fortunate to work with such an amazing group of providers.”
Hospitalist involvement also fosters a greater sense of shared purpose among clinicians and administrators, she added.
“It's nice to have administrators and hospitalists in the same room talking about how to approach reaching quality goals,” she said. “Any time we can share struggles and experiences, we are better off.”
System improvements fuel big drop in hospital's mortality rate
Claire de Marcellus Paris, MD
Medical School: St. George's University School of Medicine, True Blue, Granada
Residency: East Tennessee State University, Johnson City, Tenn.
Title: IPC The Hospitalist Company's practice group leader for Mountain States Health Alliance (MSHA), Johnson City, Tenn.
Soon after arriving at Elizabethton, Tenn.-based Sycamore Shoals Hospital in 2010, Claire de Marcellus Paris, MD, was faced with a huge challenge: Figure out why the hospital's mortality rate was above the national average and take steps to lower it. She quickly realized there was no easy fix.
“It turned out many projects [could reduce] our mortality ratio,” said Dr. Paris, who has recently moved from MSHA's 121-bed Sycamore Shoals facility to its flagship 445-bed Johnson City Medical Center. “As we went along, we kept uncovering new possibilities [for improvement].”
Undaunted by the challenge, Dr. Paris launched simultaneous efforts to improve core measures for congestive heart failure; implement new palliative care protocols and documentation; introduce pathways to improve sepsis care; create rapid response teams; and establish a progressive care unit. The results were dramatic: Over 5 years the hospital's observed-to-expected mortality ratio fell from 2.04 to 0.61.
This year, Sycamore Shoals was 1 of 18 hospitals in Premier Inc.'s 350-member QUEST health care improvement collaborative to receive the Award for High-value Healthcare. The facility won for its top performance on measures of cost, evidence-based care, mortality, harm, patient experience, and readmissions.
Dr. Paris' efforts to improve care for congestive heart failure patients also culminated in the hospital's receiving advanced certification in heart failure from The Joint Commission, a significant achievement for a small facility. In addition, she established a chest pain center that is accredited by the Society of Chest Pain Centers.
As part of setting up the chest pain center, Dr. Paris developed a new order set with flow charts that made it easier for clinicians to follow. She also initiated the use of Thrombolysis in Myocardial Infarction (TIMI) scores to risk-stratify patients before admission to the center.
Recently, the center achieved the shortest observation length of stay (0.95 day) and the lowest cost per case ($1,768) among MSHA's 29 hospitals.
“Dr. Paris has dramatically improved hospitalist-directed patient care at Sycamore Shoals Hospital,” said Adam D. Singer, MD, ACP Member, IPC The Hospitalist Company's chief executive. “The chest pain center has met with great success, not only with her hospitalist team but also with the entire medical staff at the hospital, and the community at large.”
Underlying her success is a firm belief in implementing simple, user-friendly processes for clinicians, then monitoring the results, in order to effect change, said Dr. Singer.
“She has introduced new processes and order sets that were subsequently ‘hard-wired’ among staff members, including hospitalists and mid-level providers, to prevent errors,” he said.
For Dr. Paris, satisfaction comes from improving many specific processes that add up to significant improvements for physicians, the hospital, and patients. “I love seeing how a small change in our daily routine can translate into a significant improvement in the data and care delivery down the road,” she said. “I'm always looking for the next way to improve.”
Wearing many hats suits busy hometown hospitalist
Olevia Pitts, MD, ACP Member
Medical School: University of Missouri-Kansas City School of Medicine
Residency: University of Missouri-Kansas City; Consortium for Health Education in Internal Medicine
Title: Regional medical director, Kansas City, Mo., Region, IPC The Hospitalist Company
On a typical workday, Olevia Pitts, MD, ACP Member, might travel to several hospitals in the Kansas City area, stopping at one to round on patients, at another to meet with a chief executive, and still another to interview a staff physician candidate. In the midst of it all, she's fielding calls, dispensing advice, and offering assistance when problems arise.
“My days are crazy, long and structured, yet unstructured enough that I always have some wiggle room to help out where I'm needed,” says Dr. Pitts, who oversees clinical operations at 6 hospitals, 5 post-acute care facilities and 2 long-term acute care facilities. “I wear many different hats, but I love doing all of it.”
Born and raised in the same community where she's practiced since 1989, Dr. Pitts has earned credibility with the many physicians and other colleagues who've worked with her over the years. Those relationships have been instrumental in improving care, such as attracting much-needed subspecialists to Kindred Hospital-Kansas City, a long-term acute care facility where she serves as president of the medical staff.
“Because she is well known in the Kansas City area and respected by the medical community, the subspecialists did not hesitate to provide care in those facilities at her request,” said Adam D. Singer, MD, ACP Member, chief executive of IPC The Hospitalist Company.
Dr. Pitts relates easily to clinicians at all levels, having grown up with a mother and sister who are both nurses.
“When I was in medical school, they told me to think of nurses as my best friends,” she said. “I always treat them with dignity and respect because we're a team—they can't do it without me and I can't do it without them.”
For the past 2 years, the nursing staff at 1 hospital has invited her to instruct graduate nurses on working with hospitalists. In the sessions, she offers strategies for communicating with hospitalists and handling potentially difficult situations, such as the etiquette for calling a physician at 2 a.m.
Dr. Pitts has also developed strategies for other workforce challenges, such as when she initiated a re-entry program for physicians who want to return to inpatient care after being away from it for several years. Under the program, newly hired physicians go through a 3-month training period during which they work with a mentor.
“We found that a lot of physicians have the necessary skills, but they have been out of the hospital for various reasons, such as family responsibilities,” she said. “We help them get the inpatient exposure they need to get hospital credentials.”
With responsibility for facilities in the acute and post-acute care settings, Dr. Pitts understands the needs of both. She said she embraces the interdisciplinary team (IDT) model to ensure a smooth transition for patients moving from one setting to the other.
“The entire IDT—including case management, nursing, wound care, rehab services, pharmacy, and dietary—meet weekly to discuss the entire patient experience from admit to discharge to the appropriate next level of care,” said Dr. Singer. “Dr. Pitts believes this inclusive team approach to care management provides long-term acute patients with the same level of care as they received in acute care.”
Although her day may pull her in many directions, Dr. Pitts says being involved in different areas helps her understand the many factors that go into delivering quality care.
“My goal is to have the opportunity to do the best I can every single day, for the patient, the hospital, and myself,” she said. “If you focus only on one area you lose sight of everything else.”
Championing point-of-care ultrasound as an essential tool
Daniel Schnobrich, MD, ACP Member
Medical School: University of Chicago Pritzker School of Medicine
Residency: Internal medicine and pediatrics, University of Minnesota, Minneapolis
Title: Assistant professor of medicine, University of Minnesota School of Medicine; hospitalist, divisions of general internal medicine and pediatrics, University of Minnesota Medical Center (UMMC)
Daniel Schnobrich, MD, ACP Member, first learned about the use of point-of-care ultrasound (POCUS) at a global health class during residency. Although the focus was on developing countries, he soon realized the technology's potential to transform the way all hospitalists practiced.
“Having this tool to complement our physical exam can totally change our thought process and workflow with patients,” said Dr. Schnobrich. “POCUS is very powerful in addressing so many of the core clinical questions we ask as internists.”
Although POCUS is most often associated with specific procedures, such as paracentesis or thoracentesis, Dr. Schnobrich believes it should become standard equipment at the bedside to complement the physical exam.
Say, for example, a patient is admitted from the clinic for suspected cirrhotic ascites. A hospitalist performs a traditional physical exam and agrees with the suspected diagnosis but an ultrasound probe reveals that the problem is not fluid but gas, thus changing the course of care right at the physician's first exam.
Inspired by the potential of POCUS, Dr. Schnobrich enrolled in hundreds of hours of continuing medical education courses on his own and set up a “POCUS for Hospitalists” training course open to all advanced-practice clinicians at UMMC. He also co-developed an ACP pre-course for a Minnesota Chapter meeting.
“Too many programs simply put the ultrasound in the hands of the providers and turn them loose,” said Bradley J. Benson, MD, FACP, executive director of UMMC's hospital medicine program. “Dan is committed to ongoing demonstration of competence as a core component of privileges.”
The path to privileging is far from smooth, said Dr. Schnobrich. Because there are no national internal medicine guidelines on privileging for use of POCUS, individual hospitals must themselves decide whether physicians are competent, likely by a review of the medical literature and guidelines from other specialties. This makes the process much more arduous and non-uniform and risks hospitals not adopting appropriate policies or any policies at all, he said.
Dr. Schnobrich also developed an introductory course on POCUS for residents and is currently working on expanding it throughout the 3-year program. “We'd like to be able to graduate physicians who could step right in and be ready to use ultrasound as part of their daily practice,” he said.
If that happens, Dr. Schnobrich envisions POCUS becoming as essential to physicians as the stethoscope.
“So many of the tools of our physical exam have been around 100 years,” he said. “It's exciting that we're developing new techniques that might be with us for a long time.”
Helping residents and faculty grow as leaders and teachers
Reham Shaaban, DO
Medical School: Kirksville College of Osteopathic Medicine, Kirksville, Mo.
Residency: Baystate Medical Center, Springfield, Mass.
Title: Associate program director, internal medicine residency; academic hospitalist, Baystate Medical Center, Springfield, Mass.
Senior residents are expected to keep many balls in the air as they transition into more intense leadership and teaching roles. But with little formalized training, many feel underprepared for the challenge, said hospitalist Reham Shaaban, DO.
Identifying a key gap in training, Dr. Shaaban developed a leadership curriculum where senior residents meet in 1-hour weekly sessions to discuss challenges and learn how to become more effective team leaders and teachers. Dr. Shaaban serves as facilitator, giving guidance on topics like creating a safe learning environment, coaching learners, and teaching leadership skills.
“They talk about their fears and learn new skills that they can apply in practice,” she said. “At the next meeting they report back on the results, which has been very empowering.”
The leadership curriculum is now dedicated weekly teaching time that all senior residents participate in during their final year of residency.
Dr. Shaaban also leads a quality improvement track where residents meet monthly to discuss topics and collaborate on quality improvement projects. In 2013-2014, track residents developed a standardized communication model for the patient encounter that has been used in the simulation lab to train residents and hospitalists to improve the patient experience. Another group is working on a protocol to educate clinicians about optimal inpatient diabetes management.
“Each class comes up with its own interests and we go from there,” she said. “They are learning the science of quality improvement and applying it to make real changes in their work environment.”
Building on her success with residents, Dr. Shaaban launched a faculty development training course for staff hospitalists. “We found that faculty with a lot of experience working with residents were much more effective as teachers, so I developed a program where senior educators work with content experts to teach less experienced hospitalists basic teaching skills,” she said.
The enrichment program for junior faculty covers a variety of topics in 8 one-hour workshops, such as learning climate and goal setting, autonomy versus supervision, and self-reflection and mentoring.
“It's helping to build our cohort of teachers and at the same time helping hospitalists get basic teaching experience by rotating onto the teaching service,” she said. She is now working on expanding both leadership programs to other divisions in the hospital. “There is a need to prepare physicians to take on leadership and administrative roles in their careers and not be limited by their training,” she said.
In recognition of her efforts, Dr. Shaaban was named the 2012 Hospitalist of the Year by her peers, and also voted Teacher of the Year in 2013 by residents.
Plight of observation status patients inspires political action
Ann Sheehy, MD
Medical School: Mayo Medical School, Rochester, Minn.
Residency: Johns Hopkins Hospital, Baltimore, MD
Title: Associate professor and director of the division of hospital medicine, University of Wisconsin (UW) School of Medicine and Public Health, Madison, Wis.
Ann Sheehy, MD, remembers clearly the day she decided to become involved in political advocacy. A patient admitted under observation had just been diagnosed with cancer and Dr. Sheehy was charged with delivering even more bad news: Medicare would not cover her transfer to a skilled nursing facility (SNF).
“She had been in the hospital for 3 days and was really struggling,” said Dr. Sheehy, who oversees UW Hospital's 27-physician hospitalist division. “I had to tell her that she was not fully admitted as an inpatient because of her observation status and would not qualify to go to a nursing home.”
Dr. Sheehy went on to lead a study of patients with observation status at UW Hospital that was published in JAMA Internal Medicine in November 2013. She found that 26% of observation stays on the adult general medical service lasted more than 48 hours, and while the overall cost was lower compared with inpatient care, reimbursement was at a much lower rate.
Thus, patients like Dr. Sheehy's were often faced with huge nursing home bills and the realization that, despite spending several nights in the hospital, they were not considered inpatients and did not meet CMS’ 3-day inpatient stay requirement to trigger SNF coverage.
“These patients have paid into the Medicare program their whole lives, but when they need it the most, they aren't eligible for the inpatient coverage they thought they had,” said Dr. Sheehy. “A patient struggling with a medical problem should only be worried about getting better, not getting a bill.”
She has since testified at Congressional committee hearings on the impact of the CMS policy and pushed for change. On behalf of the Society of Hospital Medicine, she spoke in support of a bipartisan bill that would make Medicare patients hospitalized under observation eligible for SNF coverage.
“I'm seeing the impact of the policy on the ground level and can explain things from the clinician's point of view,” she said. “As hospitalists, we have the ability to prompt changes in practice in ways that improve patient care.”
Dr. Sheehy's commitment to improving patient care is evident throughout UW Hospital. For example, she and her colleagues partner with bone marrow transplant, heart failure, solid tumor oncology, palliative care, medical transplant, and advanced pulmonary services to provide hospitalist night coverage. With hospitalists taking over nighttime duty, attending specialists are freed up to round on their patients for extended hours during the day.
Dr. Sheehy also expanded the hospitalist consultative service to postoperative surgical subspecialty patients. That's been very satisfying, she said, because “it allows orthopedic patients to stay on the orthopedic floor, while we come to them to manage any medical problems.”
Dr. Sheehy's strengths as a clinician and researcher have transformed the hospitalist division and earned the admiration of everyone who works with her, according to Douglas B. Coursin, MD, ACP Member, an internist, colleague, and frequent research collaborator. “She is one of the 5 to 10 best internists I have worked with in the past 35 years,” he said.