Welcome to our ninth annual Top Hospitalists issue! The physicians profiled on the following pages were nominated by their colleagues and chosen by ACP Hospitalist's editorial board for their accomplishments in areas of hospitalist practice such as patient care, quality improvement, and medical education. Read on to learn about their achievements and innovations, and make a note to nominate any top docs you know next summer. Note: ACP Hospitalist's Top Hospitalists feature is not part of the ACP National Awards Program.
Targeting transitions for the toughest patients
Gabrielle Berger, MD, ACP Member
Medical school: Emory University School of Medicine, Atlanta
Residency: University of California, San Francisco
Title: Associate medical director for inpatient capacity and hospitalist at the University of Washington (UW) Medical Center and clinical assistant professor at the UW School of Medicine, Seattle
As associate medical director for inpatient capacity, Gabrielle Berger, MD, ACP Member, focuses on improving care transitions for particularly challenging patients.
She meets weekly with the directors of social work and care coordination at her facility, a quaternary care referral center, to review all the patients who have been in the hospital for 12 days or longer. “We discuss all our patients with long lengths of stay, which ranges from 40 patients in a good week to 65 in a bad week,” said Dr. Berger.
After conducting these reviews, she reaches out to physicians and service chiefs, working to understand the patients' medical conditions, barriers to discharge, and what must be done to help them succeed as they transition to postacute care. “Facilitating safe, efficient transitions of care for our vulnerable patients is extremely gratifying work,” Dr. Berger said. Over her past 2 years operating this initiative, the number of total hospital days for patients with a length of stay (LOS) between 15 and 30 days has decreased by 20%, she reported.
In addition, observed-to-expected LOS on the medicine services over the past 4 years has dropped by 10% despite a dramatic rise in the case-mix index, Dr. Berger said. “Our patients have become increasingly complex, yet we've managed to continue reducing our LOS,” she said.
Her efforts often focus on very specific patient populations, for example, those with ventricular assist devices who are unable to manage them independently. In order to improve their postacute care options, Dr. Berger and the care coordination department connected a community skilled nursing facility with the hospital's cardiology department, which trained the nurses in managing the 24-hour care of patients with such devices.
The hospital's 5-state referral base includes patients from Wyoming, Alaska, Montana, and Idaho. “Last year, we experienced an unprecedented demand for our services, as we have grown our cardiology and transplant services. Our capacity on our medical-surgery units was routinely hovering around 95%, a level at which we experience decreased clinical efficiency,” Dr. Berger said.
So over the past year, with the aim of creating more efficient transitions without increasing boarding times, she spearheaded development of the “transfer MD” program. As part of the program, a designated hospitalist works across service lines to expedite transfers for the most critically ill patients. “The transfer MD serves as a physician partner for the patient flow supervisor and is alerted to all incoming transfers to our hospital, including for the cardiology, transplant, and surgical services,” Dr. Berger said. “And if there's any concern about capacity, we work to identify the priority patients and triage accordingly to ensure that the sickest and most acute patients are transferred in a safe and efficient manner.”
Dr. Berger also serves as assistant program director for intern education and enjoys teaching about transitions of care, interprofessional education, and clinical reasoning. “It's been hugely rewarding for me to get to work so closely with our interns and with our program leadership,” she said.
Shaping tomorrow's hospitalists
Amar R. Chadaga, MD, FACP
Medical school: Southern Illinois University School of Medicine, Springfield, Ill.
Residency: McGaw Medical Center of Northwestern University, Evanston, Ill.
Title: Associate program director of the internal medicine residency at Advocate Christ Medical Center, Oak Lawn, Ill.
Growing up in the small town of Carterville in southern Illinois, Amar R. Chadaga, MD, FACP, said some of his greatest mentors were his coaches and teachers. “That really had a lasting impact on me: that you can have an exponential, positive effect on people's lives on a micro level,” he said.
Now a mentor in his own right, Dr. Chadaga tries to teach the process of doctoring rather than sheer memorization. As associate program director for nearly 5 years, he gives 40 to 50 annual lectures to rotating medical students and works directly with the interns at intern report. “One of my sayings that they laugh at is ‘Your history is your scalpel,’” said Dr. Chadaga. “We're not surgeons; we're internal medicine doctors, so taking a great history leads to a great differential diagnosis, leads to great focus on the physical exam, and leads to high-value, cost-conscious care.”
He also meets with 5 to 10 medical students and residents each week to review curricula vitae, critique personal statements, and conduct mock interviews. “For the longest time as a young physician, you feel like you're still trying to become the attending you always wanted to be. And in the recent years, I feel like I've arrived,” Dr. Chadaga said. “I'm in a position where I can hopefully impact people's lives and, if I teach them well enough in a way that they can remember, then they can pass that on.”
As recruitment director for the residency program, he reviews nearly 4,000 applications each year. In 2015, he redesigned the system for interviewing residency candidates. Prior to the change, program staff conducted an interview day that lasted 8 hours for 3 months out of the year. “It was not only impacting our residents, but our education system, as well, because we would have to change around conferences; it was really taking attendings away from teaching,” Dr. Chadaga said.
To find out what changes to make, he asked the applicants themselves what they preferred, which turned out to be a shorter day of interviews conducted only in the months of November and December. “So that's what we changed....And we found unanimously that the applicants really liked the efficiency and education, and a byproduct of that was being able to not impact our own residents too much on their education,” he said.
Dr. Chadaga is now working on the issue of bullying in residency. He's currently assessing surveys from residents at 3 of the hospital's programs to obtain a baseline before attempting interventions and gauging progress. (His prior survey on the national prevalence of bullying in graduate medical education, published in March by PLOS ONE, was featured in the June issue of ACP Hospitalist.) “We find that people who are bullied more leave the field earlier, so I want to try to nip this, if I can, and just make people, especially my residents, aware that this is not OK and to please let us know,” Dr. Chadaga said.
He noted that 3 threads tie his work together: community, integrity, and loyalty. Among his other initiatives, he and a current chief resident created his hospital's first internal medicine residency volunteer committee, which partners with the Greater Chicago Food Depository to volunteer physicians' time, collect food for donation, and sponsor a family at Christmastime.
Improvement with multidisciplinary input
John Gelzhiser, MD
Medical school: Drexel University College of Medicine, Philadelphia
Residency: Brown University program at Rhode Island Hospital, Providence, R.I.
Title: Director of inpatient medicine at Care New England Health System, Rhode Island
After meeting his wife in medical school and following her to residency, John Gelzhiser, MD, joined her in 2007 at Kent Hospital in Warwick, R.I. As a freshly minted hospitalist, he wanted to train new doctors. But aside from working with some physician assistants, there weren't many teaching opportunities.
This all changed when his wife helped create the facility's first internal medicine residency program about 6 years ago, and Dr. Gelzhiser became a faculty attending. “People were actually pretty excited to have residents around and do some teaching,” he said. “It's refreshing to be challenged a little bit and have somebody to work with.”
This year, the residents unanimously awarded Dr. Gelzhiser the Faculty of the Year Award. “We've done a lot to be able to bring in new medical students and residents and turn them into doctors,” he said, noting that 3 residents joined the group as hospitalists after graduation. “So that's rewarding to see them grow up and actually become really good doctors that we want to hire, and I think it says a lot about our group's culture.”
Before becoming the health system's director of inpatient medicine in January, Dr. Gelzhiser was associate director of the hospitalist program at Kent Hospital for about 5 years. “My clinical shifts decreased a couple months ago down to 4, so I'm more administrative than clinical right now,” he said.
As an administrator, Dr. Gelzhiser has overseen many changes at the hospital over the past year, including instituting multidisciplinary rounds on all floors. These morning rounds include the hospitalist, nurse manager, nurse, pharmacist, case manager, and sometimes a social worker. “That involved a lot of changes,” Dr. Gelzhiser said. “It involved a lot of predicting what the consequences of each team was going be and how we could use that as an opportunity to improve something else.”
Administrators worked hard to limit transfers to facilitate multidisciplinary rounds. For example, converting a cardiac telemetry unit to a medical-surgical unit, training nurses in cardiac care, and ensuring that all units of the hospital have some telemetry capabilities helped to limit patient transfers for cardiac issues, he said. “We didn't want patients transferring for these types of issues,” Dr. Gelzhiser said. “We wanted to keep them on the same unit so the hospitalists, nurse, and nurse manager would be familiar with them.”
He noted some anecdotal benefits of multidisciplinary rounds. “It does seem that patients are getting discharged earlier, and the hospitalist, nurse, [and] nurse manager satisfaction is a little bit better because they feel like they know what's going on a little bit better, nurses particularly,” he said. “Multidisciplinary rounds are the most effective way for them to figure out what's happening on the floor.”
Translating research into safer prescribing practices
Shoshana Herzig, MD, MPH, ACP Member
Medical school: New York Medical College, Valhalla, N.Y.
Residency: Beth Israel Deaconess Medical Center, Boston
Title: Director of hospital medicine research and hospitalist at Beth Israel Deaconess Medical Center and assistant professor at Harvard Medical School, Boston
As a resident, Shoshana Herzig, MD, MPH, ACP Member, observed that inpatient clinicians indiscriminately ordered certain medications, such as proton-pump inhibitors. “I noticed that a lot of patients were getting started on those medications and wasn't really clear on why,” she said. “When I looked at the evidence, the evidence wasn't really there, and I thought that we could potentially be causing harm.”
Dr. Herzig examined the downstream risks of acid-suppressive medications, publishing in 2009 in JAMA her finding that their use was associated with 30% increased odds of hospital-acquired pneumonia. “That was one of the defining moments in my career: when I realized I can really have an impact on patients beyond the patients that I care for as a clinician in the hospital,” she said.
In response to the findings, Dr. Herzig's hospital created a computer decision prompt that required input of an indication. If clinicians prescribed an acid-suppressive medication only for stress-ulcer prophylaxis, the most common inappropriate indication, a screen came up clarifying the specific patient populations that should receive it. “We don't believe in having hard stops on medication ordering, so they could proceed, go back and revise their indication, or cancel their order,” Dr. Herzig said, adding that the prompt reduced rates of unnecessary prophylaxis.
Most recently, she assessed local and national inpatient utilization of opioids to better understand how often physicians are prescribing these drugs and why. More than half of nonsurgical hospitalized patients are exposed to opioids during their stay, according to her study published in 2014 by the Journal of Hospital Medicine.
“I think the inpatient setting has been somewhat of a black box related to opioid prescribing,” said Dr. Herzig. “If you look at the CDC recommendations that have come out and a lot of the regulations that are going into effect, they all pretty much exclusively focus on the outpatient setting.”
Dr. Herzig has also studied inpatient antipsychotic prescribing, finding that between 6% and 9% of hospitalized patients receive antipsychotics for nonpsychiatric, off-label indications, according to a study published in August by the Journal of Hospital Medicine.
Her hospital's next step is to implement a series of prompts that encourage safe opioid prescribing. “If those are successful and lead to a reduction in nosocomial complications related to opioid use, then those prompts would certainly be something that could potentially be adopted nationally,” she said.
The end goal is for her research to provide a better understanding of the risks and benefits of medications that are commonly used in the hospital setting, as well as help develop approaches to modify that risk and encourage safe use. “As a hospitalist, you have a bird's eye view of all that,” she said. “You're basically seeing where the errors happen and what decisions you're being forced to make without an adequate evidence base or knowledge base behind them. I want to make those decisions easier and safer.”
Hospital medicine on a huge scale
Dan Huynh, MD, FACP
Medical school: University of California, Irvine, College of Medicine
Residency: University of California, Irvine, UCI Medical Center
Title: Regional hospitalist chief and regional assistant medical director of hospital quality at Southern California Permanente Medical Group
Overseeing all Kaiser Permanente hospitalists across Southern California means that Dan Huynh, MD, FACP, manages roughly 500 hospitalists taking care of more than 4 million members. In this role, he works to encourage effective collaboration between those many physicians. “What I try to emphasize is how we can best work interdependently to provide the highest quality of care for our members,” Dr. Huynh said.
Hospitalists and emergency medicine physicians are the 2 largest physician groups that impact hospital care and patient volume, yet they're often not aligned, he said. “We're joined by the hips, but in many settings, we still practice in silos,” Dr. Huynh said.
To improve this situation, he partnered with the regional emergency medicine chief to start the Kaiser Permanente Southern California Regional Emergency and Hospital Medicine Summit, first held in 2014 and again in May 2016. At each summit, nearly 300 hospitalists and emergency medicine physicians from the system's hospitals discussed how to best collaborate on delivering care for specific diagnoses that present to the ED, such as brain hemorrhage, chest pain, sepsis, and pneumonia.
“It's really trying to get the groups together, firm up the service agreements, and improve the communication and camaraderie between these 2 groups,” he said. This collaboration led to improvements in patient care in the ED. “While the full impact of these improvements has not been quantified, our ability to make progress toward the triple aim has been greatly enhanced by the new partnership between emergency medicine physicians and hospitalists,” Dr. Huynh said.
Another big focus over the past 4 years has been readmissions. Kaiser's electronic health record automatically calculates a LACE readmission risk score for all patients who are discharged, and now, as part of a transitions bundle he implemented, any patients who score an 11 or higher receive medication reconciliation, access to a transition hotline with the ability to contact an on-call hospitalist if necessary, a postdischarge phone call within 72 hours, and a follow-up visit with a primary care physician within 5 days, he said. With the spread of the transition hotline, Dr. Huynh showed his region can avoid 60% of unnecessary ED visits.
“Focusing on optimal transitions in care has not always been a priority for hospitalists...Our change of mindset with this bundle is connecting patients to all the resources and support they may need before they get discharged,” said Dr. Huynh. By aligning the goals of nurses, case managers, staff, and physicians, his region's hospitals have reduced their readmission rate by more than 20%, with a current overall readmission rate of 12%.
Treating all patients equally
Ramon E.A. Jacobs-Shaw, MD, FACP
Medical school: University of North Carolina School of Medicine, Chapel Hill, N.C.
Residency: Harvard University combined medicine-pediatrics at Massachusetts General Hospital and Boston Children's Hospital, Boston
Title: Associate professor of medicine at New York University School of Medicine and medical unit director and ward attending at Tisch Hospital/NYU Langone Medical Center, New York City
The lesbian, gay, bisexual, transgender, and queer (LGBTQ) patient population has endured many years of bias and discrimination, which have led to health disparities. In these challenges, however, Ramon E.A. Jacobs-Shaw, MD, FACP, sees an opportunity to educate.
Serving on the NYU Langone Medical Center LGBTQ Advisory Council since its start in 2011, he helped create an online learning module to introduce staff members to important facts about LGBTQ care, such as unequal rates of certain cancers. To date, more than 2,000 people have taken the module, “which is a tremendous amount of people, especially since it's not a mandatory part of the training here,” said Dr. Jacobs-Shaw. “Since then, people are definitely more aware of the care of LGBTQ patients in particular.”
Dr. Jacobs-Shaw, who identifies as a gay man, said he has experienced discrimination and bullying firsthand, and hearing patients' stories also fuels his passion to advocate for the LGBTQ community. “Whether it's my transgender patient who has suffered discrimination and inadequate care or a married lesbian couple who, prior to marriage equality, were not recognized in the state where they were living, I've seen a variety of different experiences from my patients—things that in this day and age should not be anything that any person should be facing,” he said.
Prior to 2012, NYU Langone had never applied to be selected as a leading hospital in LGBTQ care through the Human Rights Campaign's Healthcare Equality Index. “We knew we were doing all the right things and delivering excellent care to this particular patient population, but we never applied....Now is our fourth year in a row where we've been designated as that,” said Dr. Jacobs-Shaw.
Through the LGBTQ council, he also advocated for the electronic health record to include sexual orientation and gender identity as mandatory questions in the admission process. “It allows us to better care for our LGBTQ patients by knowing what their preferences are right from the beginning,” Dr. Jacobs-Shaw said, adding that this patient population is vastly underrepresented in medical research. “This will allow us to create a critical database that will lead to research studies that hopefully will positively impact the quality of care we deliver to LGBTQ patients and their caregivers.”
With recent advances in marriage equality, employment rights, and access to health insurance, progress is underway for this patient population, he said. “I feel that the future is brighter, and how far we've come in the past 10 years has been leaps and bounds over anything prior to that,” Dr. Jacobs-Shaw said. “But it really takes a lot of work and effort on every individual's part. That's why I'm a big believer in cultural competency and people taking the time and making the effort to understand the patients they're taking care of.”
Moving forward, Dr. Jacobs-Shaw is interested in leading nonprofit organizations focused on improving the health care of all patient populations. He's now working on a master's degree in public administration at the NYU Robert F. Wagner School of Public Service. “I felt like I could do much more to help diverse populations,” he said. “I feel like I'm doing it here at this institution, but I feel like I could have an even broader impact. In my mind, we will not be able to achieve health care equity and health equality fully until we really have social equity...and we're able to treat everybody equally.”
Providing high-quality medicine to the military
Chin Hee Kim, MD
Medical school: Penn State University College of Medicine, Hershey, Pa.
Residency: George Washington University, Washington, D.C.
Title: Assistant chief of the general internal medicine service at Walter Reed National Military Medical Center, Bethesda, Md.
As the assistant program director for quality and patient safety for Walter Reed's internal medicine residency program, Chin Hee Kim, MD, changed the culture of patient safety to be more transparent and proactive in making improvements.
In 2012, she helped a group of residents formalize morbidity and mortality conferences that required learners to perform root-cause analysis for not just cognitive errors, but also system errors. One conference reviewed a particular sentinel event where a root-cause analysis suggested that changes needed to be made in overnight supervision and staffing. “We also learned that we did not define when a learner recognized that they hit their limitation and when they needed to ask for help,” she said.
With these findings in hand, the service in July bumped up its nighttime staffing from just 2 interns and 1 senior resident to 3 interns and 2 senior residents. “I think the interns appreciate the fact that there is increased oversight, especially as they're starting off their careers,” said Dr. Kim. Residents now also have a standard set of criteria where they must call supervising physicians regarding changes in clinical status of patients that require a consultation, for example. “Providing specific ‘must-call’ guidance removes barriers and allows for improved communication among all members of a medical team to optimize patient safety,” she said.
Since the changes were implemented, Dr. Kim has witnessed more overnight documentation and workup. “The interns are consistently speaking with someone more senior than they are, even for something as simple as a fever or someone with new abdominal pain,” she said. “It's made it so that when you come in the morning, there's less in terms of surprises that happen at night, and for whatever issues, the workup is already initiated and not deferred to the primary team.”
Dr. Kim said she is most proud of leading efforts to formalize the quality improvement (QI) curriculum for the internal medicine residency after the Army and Navy programs combined in 2011. “When they combined, each program had its own QI requirements, but there were no formalized didactics or a specific end product that residents were required to submit,” she said. “I saw that as an opportunity and, starting in 2012, formalized a yearlong QI curriculum for our residents.” Since then, residents have completed about 44 QI projects, including one that made simple changes in the standard admission order set to reduce unnecessary lab testing by about 15% and saved about $100,000 over the year, Dr. Kim said.
It was not easy to change the culture of patient safety among residents. “When the QI curriculum was first launched, the requirement was considered an additional burden by our residents,” she said. “Now, residents are volunteering to be part of hospital committees and take on working groups to optimize discharge planning, for example, to change how we provide patient care.”
Dr. Kim worked at a civilian hospital prior to joining Walter Reed in 2009 and noted that major advantages of working at a military medical center include facilitated coordination between inpatient and outpatient clinicians and more transparency with test results. “I've never had a physician who works here ever tell me ‘no’ when I pick up the phone and ask them for a special request to fit a patient in for a follow-up within a week of discharge,” she said.
Clinicians are also unified by their respect for their patients, who include active-duty military, military retirees and their spouses, and veterans, she said. “We know that they sacrifice a lot currently and in the past, and we feel that much more of an obligation to go above and beyond,” Dr. Kim said. “All doctors do, but I think there's that special attention that we give to our patients that they deserve because of what they have done for our country.”
Bringing PCP experience to long-term acute care
Joseph D. Landers, MD, FACP
Medical school: Louisiana State University School of Medicine, New Orleans
Residency: Ochsner Medical Center, New Orleans
Title: Hospitalist at St. Tammany Parish Hospital, Covington, La.
After several medical staff leadership roles, Joseph D. Landers, MD, FACP, recently went back to his clinical roots. In addition to his 7-on/7-off schedule at the hospital, he wanted to do some extra work during his time off. “So I thought, ‘When patients go to these long-term acute care facilities, why not keep them with a doctor who already knows them from the hospital and knows their care already?’” Dr. Landers said. “I thought it made natural sense to follow these patients where they go.”
In this postacute role, he sees his patients or his partner's patients after they transfer to a longer-term inpatient care facility for further medical treatment, such as receiving antibiotics or wound care. “So it's kind of like an extension of a hospitalist,” Dr. Landers said. “In a way, it's gratifying to see patients through the whole course of their hospitalization.”
He spent 7 years practicing primary care prior to working exclusively in an inpatient setting. “So when I switched to being a hospitalist, which I've always enjoyed doing, seeing those patients who need further inpatient medical care when they leave the hospital almost gives me that primary care doctor mentality,” Dr. Landers said.
During his 10 years as a hospitalist at St. Tammany, he has worked with a multidisciplinary task force to decrease 30-day readmission rates for patients with pneumonia and is currently working to improve the hospital's sepsis protocol. “We target patients that have sepsis based on guidelines that come from CMS,” Dr. Landers said. “We've been trying to follow those guidelines and make an impact on mortality with septic patients, which we've actually started to show this past year.”
Although clinical duties are his main focus now, he's enjoyed several administrative roles because of their potential to effect change throughout the hospital. “I think patient safety and improving quality of care are probably the biggest motivators for me,” he said. “Because there's so much variance that can occur, you try to standardize processes throughout the hospital to reduce variations, and hopefully with that plan, you're reducing errors.”
As chair of the hospital's formulary committee, Dr. Landers refined and standardized the formulary, helping the hospital pharmacy save hundreds of thousands of dollars in costs. He was then elected to the medical executive committee, serving as treasurer, vice chief of staff, and chief of the medical staff during his 4-year tenure. As chief of staff in 2014, Dr. Landers oversaw credentialing, patient care, and other inner workings of the hospital. “I had the honor of being the first hospitalist to do that in our hospital,” he said.
Not academic, but always teaching
Karlyn Paglia, MD, ACP Member
Medical school: Jefferson Medical College, Philadelphia
Residency: Medical Center of Delaware, Newark
Title: Director of hospital medicine and associate chief medical officer at Geisinger Wyoming Valley Medical Center, Wilkes-Barre, Pa.
Although Geisinger Health System recently acquired the Commonwealth Medical School in Scranton, Pa., it was not previously an academic system. But that didn't stop Karlyn Paglia, MD, ACP Member, from leading her hospital's efforts to develop and implement 2 nonaccredited fellowships in clinical hospital medicine and hospital medicine leadership. “We decided, ‘Who better to teach than the people that are on the ground, the hospitalists that have been practicing inpatient medicine for years?’” she said.
Now in its second year, the clinical fellowship recruits primarily family medicine residency graduates who want to practice inpatient medicine but may not have had enough exposure during residency, Dr. Paglia said. Fellows in the leadership program, which is recruiting for the third year, divide their time between clinical practice and administrative duties, focusing on areas such as quality improvement and performance measures, she said.
In addition, she helped establish a medicine teaching service that is currently training 2 medical students and 3 residents per block. The medical students come from 2 schools that have clinical campus arrangements with the medical center, and the residents come from an affiliated program. “We get to see them when they're young and fresh and interested in just about everything, and we help mold them and figure out what it is they're looking for,” said Dr. Paglia.
When she took on an increasingly administrative role, she made sure to leave time in her schedule to see patients and mentor trainees. “For me, the best part of the day is being able to spend some time not only practicing the clinical aspect, but trying to get to know the individuals a little bit, help them with career management, and guide them on the right path,” Dr. Paglia said, noting that the new Geisinger Commonwealth College of Medicine will provide even more opportunities to reach trainees.
Otherwise, she devotes much of her time to improving efficiency and the patient experience at a hospital that is constantly above 95% capacity. “Probably one of the bigger challenges I've had is trying to squeeze 200 people into a hospital with fewer beds than that,” said Dr. Paglia, who has been with Geisinger for 6 years.
A hospitalist since she graduated from residency, she's seen the specialty grow up around her. “I feel like we've come a long way, but there's still a lot to do in hospital medicine, and that's what I like to impart on young people,” Dr. Paglia said. With 4 children and a husband who is also a Geisinger physician, multi-tasking is another specialty altogether. “When the kids were young, there were plenty of days that I would be coming off duty, my husband would be going on duty, and we would pull up in front of the hospital, switch cars, and drive the kids away,” Dr. Paglia said.
Growing up in the nearby Pocono Mountains with a nurse for a mom and a passion for healing, she always knew she wanted to come back after training and serve her community. “I joke that when I don't know what else to do administratively, when things seem overwhelming, I just go see a patient because it all comes down to that moment in time when you make a difference,” said Dr. Paglia. “Then, all the other stuff, the capacity management, the quality issues, they just don't seem so overwhelming.”
Bringing a business approach to medicine
Venkataraman Palabindala, MD, FACP
Medical school: Kamineni Institute of Medical Sciences, Telangana, India
Residency: Greater Baltimore Medical Center
Title: Lead hospitalist at the University of Mississippi Medical Center, Jackson
Not many doctors have a passion for documentation, but Venkataraman Palabindala, MD, FACP, prides himself on his business acumen. Before joining his current hospital this year, he served as clerkship director for Southeast Alabama Medical Center in Dothan, Ala., teaching trainees the ABCDE approach: academics, business, coding, documentation, and evaluation.
“Most of the rotations that medical students and residents do are basically focused on just the educational part. But once they're outside our walls, they cannot avoid the fact that they have to properly document for recording. That's the money, right?” he said.
So in addition to medicine, Dr. Palabindala's teaching focuses on appropriate documentation, coding, billing, and why it all matters. “Especially related to ICD-10, you have to be very specific, and when we teach, we try to be as detailed as possible. As hospitalists, I think we've kind of mastered it because it's just part of our workflow every day,” he said.
As lead hospitalist, Dr. Palabindala is responsible for the daily clinical routine of the hospitalist service, overseeing patient flow, mortality reviews, and quality metrics in addition to appropriate documentation. “Hospital medicine is about saving money, choosing wisely, making things better with the minimal resources possible, avoiding the waste, and decreasing harm,” he said. “Those are the things that make me feel good about hospital medicine every day.”
Dr. Palabindala is now working to establish a telemedicine consultation program between his hospital and Global Hospitals, a 150-bed facility in Hyderabad, India. The directors of this hospital are old friends of his from medical school. So far, there have been a couple of Skype consults from hospital medicine, nephrology, and endocrinology specialists, he said.
“People love it. Getting a consultation from a U.S. doctor makes them feel good, and they like that they're getting opinions from all over the world....But I want to actually make that a formal process where there's a billing and payment opportunity for the physicians who are going to give the services,” Dr. Palabindala said.
Another priority for him is getting hospitalists to openly communicate with patients about the tests they're ordering so that patients know what to expect from their health insurance systems, he said. “People have this taboo that we shouldn't be talking about money when we're taking care of the patient, but unfortunately, you cannot avoid that,” Dr. Palabindala said. “If you're not thinking about whether the insurance will cover this or not, patients will suffer.”
He said he's proud to be a hospitalist and cannot imagine himself doing anything else. “You're there all the time. You take the time to bond with the patients, and you establish that bond so quick when they're sick and vulnerable. And when you heal them and they are ready to go home, it gives me immense satisfaction. I don't think I'll get that satisfaction in any other field,” said Dr. Palabindala.