Letter from the Editor

This month's issue includes an in-depth look at CMS##rsquo; new observation status regulations, as well as stories on bariatric surgery complications and how to talk to patients about POLSTs.

If you're having trouble getting a handle on CMS’ new rules for inpatient and observation care, you're not alone. While the updated rules, which took effect Oct. 1, likely were meant to clarify a confusing issue, many experts express doubt that this goal was attained. Instead, they foresee that a new set of problems may arise with the so-called “2-midnight rule,” which states that physicians need to predict whether a patient will stay overnight in the hospital for 2 midnights and thus qualify as an inpatient (and not an observation patient). This determination can have a very real effect on how much patients end up paying for their care and whether or not they will qualify for Medicare coverage of a nursing home stay. In our cover story, Stacey Butterfield translates the nuances of the new rule into plain language and describes how it will affect hospitalists and their patients. Meanwhile, ACP Hospitalist editorial advisor James S. Newman, MD, FACP, who handles utilization review at Mayo Clinic, weighs in on the new rules.

Our clinical feature this month covers postoperative care after bariatric surgery. Experts offer advice on how to recognize red flags for emergent and serious complications, such as a gastric leak at the surgical site, as well as signs of longer-term digestion and nutrition problems. In conference coverage, our report from the Diagnostic Error in Medicine 6th International Symposium discusses actions hospitalists can take right now to reduce diagnostic errors in their individual practice, on their service, and in their hospital.

A second feature delves into how to begin and continue difficult conversations with patients about Physician Orders for Life-Sustaining Treatment (POLST). End-of-life care is the focus of our MKSAP test questions, as well. Speaking of difficult conversations, our Q&A explores ways to talk with patients about sexual activity as a component of health. Studies show patients want to have these conversations but are reluctant to bring up the topic of sex.

Are there any topics you'd like to discuss? Don't be shy; please write to us anytime.

Jessica Berthold
Editor, ACP Hospitalist