The highlight of the conference for me was Dr. Kocher’s behind-the-scenes look at what was a very publicly muddy event—the passage of ACA. Coming from a D.C. insider, this under-the-covers peek at the machinations that went into passing the healthcare reform bill was fascinating.
The key message, summarized in this comment referring to the opening plenary about hospitalist compensation and productivity, was that the future is quality and the future is now. In the very near future, we will be measured and paid based on our ability to effect quality outcomes, not patient encounters. The message was simple: It’s about quality, not quantity.
“It costs $7.50 for a healthcare transaction, versus 2 cents for a VISA transaction.”
—Dr. Kocher
A statistic I had not heard before, this quote sums up one of the major problems with American healthcare: waste. The $7.50 transaction he was referring to was the amount of money it takes to file a healthcare claim. We certainly feel it in the challenges of documentation, billing, and denials, but the system feels it in terms of high cost of capturing what in many ways should be as simple as swiping your credit card at Starbucks.
Duty-Hour Restrictions: Harbinger of The Future?
“Don’t begrudge the ACGME—begrudge us.”
—Jeff Wiese, MD, SFHM, SHM past president
In a much-anticipated session on the impact of the new ACGME residency work-hour rules commencing in July—notably limiting intern (16-hour) and resident (28-hour) shift duration—Dr. Wiese aptly pointed out that a lot of the angst toward residency work environment regulation could have been avoided if physician leadership had better reacted to the issues of sleep deprivation and resident fatigue following Libby Zion’s death in 1984. Had we put our energy into improving work conditions rather than debate the impact of sleep deprivation on the outcome in this one case, we might be in a different place today.
I couldn’t help but wonder if the message here could also be applied to society’s push for higher quality, lower cost, and safer care. Either we regulate ourselves or someone else will. In other words, we need to embrace quality and safety, or it will be thrust upon us from external sources in ways we might not like.
A Mariner Calls
“I love you, Papi. Come home and take some baseball cuts.”
—Greyson Glasheen, future Major League Baseball shortstop
I wrote in a column leading up to the annual meeting (see “Annual Meeting Mariner,” April 2011, p. 45) that I was looking forward to the meeting because it was a professional mariner of sorts, a way for me to refresh, reset, and reinvigorate. Indeed, reflecting from the podium, it had been a fantastic meeting that served its purpose well. I had learned a ton, caught up with colleagues I hadn’t seen since the last meeting, saw old medical school friends, and met future old friends. I’d led a committee, given a talk, presented a poster, met up with a mentor, and had a reunion with past attendees of the Academic Hospitalist Academy.
Yet I was ready to get back to normalcy. On the last night of the meeting, I was therefore drawn by a different, more personal mariner—this time, a 14-second voicemail message from a 3-year-old boy waiting impatiently for Dad to come home, to make him his center, to simply play a little tee ball in the backyard. TH
Dr. Glasheen is associate professor of medicine at the University of Colorado at Denver, where he serves as director of the Hospital Medicine Program and the Hospitalist Training Program, and as associate program director of the Internal Medicine Residency Program.