Tuesday, April 20, 2010

Thoughts and impressions after returning home from Hospital Medicine 2010

HM 2010 was a wonderful experience. I'll be spending the next few weeks reviewing course materials, thinking about how to incorporate changes into my practice, and reflecting on what the experience meant to me. I've done this throughout my career. In recent years blogging about meetings has added a new dimension. I tried to blog HM 2010 in real time. That lasted one day. The delivery of content was too fast for me to do it justice. Ideas and research findings in medicine are seldom “breaking news” and I prefer to offer discussion and links to background sources rather than a series of sound bites. I'll be doing that (if no one else is interested, just for my own reference) with some of the remaining course content in the near future.

On the final day of sessions we were treated to a talk by Bob Wachter. Though he and I are polar opposites on the political spectrum I find his talks insightful and entertaining. He discussed how health care reform---both the law itself and the conversation surrounding it---might affect hospitalists. If you're a follower of his blog you can imagine some of the things he had to say. As he has said there, there will be a major new emphasis on shared accountability and integration---attributes that separate the Mayos from the McAllens of the world. (Look for ACO to be the new HMO). He suggested, as he has said before in his blog, that hospitalist groups might have a role in promoting such integration in their local communities. Up to now, unfortunately, the growth of hospital medicine seems to have had the opposite effect. Will that change under new incentives? It's anybody's guess.

An important piece of integration lies in improving transitions between hospital and clinic. The transitions problem is exacerbated by the shortage of primary care physicians. One idea that's gaining traction was mentioned several times at HM 2010: hospitalists running post-discharge clinics. I have commented before that I oppose that idea. Follow up care of high acuity post-discharge patients is important but it is the role of the primary care physician. Hospitalists who staff such clinics are reverting to the role of the traditional internist. They are no longer hospitalists. The hospitalist model of care built a disconnect between hospital medicine and clinic medicine, and that disconnect is a quality and safety problem. The logical extension of the post-discharge clinic would be to address that safety problem by dismantling the hospitalist movement altogether.

I came away from HM 2010 a little less cynical about the Society of Hospital Medicine. I truly believe they approach quality and safety for hospitalized patients with a level of sincerity and vigor unmatched by any other professional organization. That said, I'm still troubled by their uncritical acceptance of faulty ideas about such things as performance measures, never events and hospitalists as utility players.

Finally, a few words about the exhibit hall. The high level of industry support was readily apparent. The SHM annual meeting would not be of the quality it is without such support. I am more convinced than ever that the “firewalls” were adequate to address any conflicts of interest. Public access to the digital archives of the meeting presentations will be available in about a month. I challenge anyone to cite bias or other degradation of content related to industry support. But what was most impressive about the exhibit hall was the number of recruiting displays by health care systems and staffing companies. There are still plenty of hospitalist jobs out there!

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