Letter from the Editor

This month's issue features a look at small hospitals and readmission measures, as well as ways to prevent acute kidney injury and to predict sepsis.

Everyone has questions about the future of health care financing, but those who work at small hospitals have particular reason to wonder. This month's cover story describes how a number of factors, from the need for new technology to changes in Medicare reimbursement, are creating challenges for small, independent hospitals. But it also shows how some facilities are finding solutions to these problems so they can continue providing care to their patients, many of whom live a significant distance from any other hospital.

I traveled a distance to bring you conference coverage of the University of California San Francisco's Management of the Hospitalized Patient meeting. In its 19th year, it's one of the oldest things in hospitalist practice, but conference speakers focused on the newest evidence. Look for tips on what not to do in palliative care and advice on diagnosing and treating inpatients with influenza.

While you're treating patients' flu, be sure not to give them acute kidney injury. Our story gathers evidence and expert perspectives on how to possibly prevent this common complication of illness and treatment. (Also, check out the related Test Yourself starting.) Complications can mean readmissions, and everyone knows how Medicare feels about those. But are the readmission penalties actually succeeding at improving hospital care? This question is debated. Whether or not you believe the penalties work perfectly, you'll want to avoid them, and the story also offers some suggestions on how to do that, especially for physicians at safety net hospitals.

Reducing readmissions is also the focus of this month's Success Story, which reports on a hospitalist postdischarge clinic. Learn about apps for inpatients in the Q&A and amyloidosis in the Expert Analysis. Do you have a success we should cover, or a topic you'd like an expert to analyze? E-mail us.

Stacey Butterfield
Editor-in-Chief, ACP Hospitalist