Forum News & Updates

In this issue:

AHA report examines value of CME

A new report from the AHA’s Physician Leadership Forum recommends ways to improve the value of continuing medical education to hospitals. Hospitals provided 35 percent of the accredited CME in 2013, investing close to $1 billion. “CME allows physicians to reach their full potential both as caregivers and leaders of the health care field,” said AHA Senior Vice President John Combes, M.D. “We have an opportunity to use CME strategically to achieve the goals not only of individual physicians but the entire delivery system to meet the needs of the patients and communities we serve.” To improve the use of CME as a strategic resource for hospitals, the report recommends greater use of performance-based CME; more streamlined accreditation standards; broader sharing of best practices; increased communication between CME departments and senior leadership; and greater involvement of physician leaders as CME champions. The report “Continuing Medical Education as a Strategic Resource,” is available at

AHA submits comments on proposed physician fee schedule rule for CY 2015

The American Hospital Association (AHA) recently submitted comments to the Centers for Medicare & Medicaid Services (CMS) on its proposed rule for the calendar year 2015 physician fee schedule. In the letter, AHA expresses its support for CMS’s proposal to add seven new codes to its list of approved Medicare telehealth services and encourages the agency to consider adding other services in future rulemaking. AHA also commends CMS for recognizing the need to pay for services related to chronic care management, but suggests the agency re- examine whether the rate of $41.92 adequately reimburses providers for the full scope of services. In addition, AHA urges the agency to carefully reconsider its proposed methodology of creating a Healthcare Common Procedure Coding System modifier to track services furnished in off-campus, provider-based hospital outpatient departments. AHA also suggests several changes to CMS’s physician quality measurement proposals. The letter also provides comment on CMS’s proposals related to: clinical lab local coverage determination policies; proposed changes to the clinical lab fee schedule; and the electronic health record incentive program.

Study finds potential for hospitals to reduce redundant antimicrobial therapies

Some hospital clinicians may be using redundant intravenous antimicrobial therapies, which could represent a potential opportunity to improve antimicrobial stewardship, according to a study of 500 hospitals published in the October issue of Infection Control and Hospital Epidemiology. At 78 percent of the hospitals, the study of inpatient pharmacy data between 2008 and 2011 found evidence of potentially unnecessary combinations of antibiotics being administered for two or more days. In addition to reducing costs, eliminating unnecessarily duplicative antibiotic therapy could reduce the risk of adverse drug events and antimicrobial resistance, the study by Premier Inc. and the Centers for Disease Control and Prevention suggests. In July, the American Hospital Association (AHA) and six national partners released a toolkit to help hospitals and health systems enhance their antimicrobial stewardship programs. A new infographic on the ABCs of antibiotics was recently added to the toolkit. Developed by the Association for Professionals in Infection Control and Epidemiology, the infographic helps patients and families better understand their role in preventing infections and includes a list of questions to ask their health care provider about antibiotics. According to a 2013 AHA Physician Leadership Forum white paper, appropriate use of antibiotics is one of five areas where hospitals, in partnership with their clinical staff and patients, should look to reduce non-beneficial care through appropriate use of medical resources.

Half of all primary care, internal med positions went unfilled in 2013 survey finds

A new article from HealthLeaders Media details a recent Association of Staff Physician Recruiters (ASPR) survey that found in 2013 half of all primary care and internal medicine positions went unfilled. Overall, 38 percent of positions went unfilled, compared to 33 percent the prior year. The survey looked at more than 5,000 physician and advanced practice nurse searches by 145 health care organizations across the country in 2012-2013. Other findings from the survey include:
  • Nearly 70 percent of organizations searched for a family medicine physician
  • More than 19 percent of all searches were for advanced practice providers
  • Median number of provider searches conducted per organization increased from 20 to 26
  • Annual recruitment budgets for these organizations rose more than $75,000 from 2012 to 2013

In the article for HealthLeaders Media, Jennifer Metivier, ASPR Executive Director says, “I don’t think there are any surprises with primary care continuing to be the top searches for both physicians and advanced practice providers. The percentage of positions that go unfilled every year continues to be a problem.”

Teaching good bedside manner

A recent article from H&HN Daily discusses bedside manner and whether compassion can be taught to physicians. The article notes how 30 percent of a hospital’s reimbursement for in-patient services to Medicare patients will be based on patient satisfaction scores. In the article, Michael Kahn, MD, a psychiatrist at Boston’s Beth Israel Deaconess Medical Center and an assistant professor at Harvard Medical School, says there have been numerous attempts to teach compassion and empathy to physicians, but no systematic way to do so. To that end he developed a checklist physicians can use when meeting a hospitalized patient. This checklist was first published in the New England Journal of Medicine in 2008.
  1. Ask permission to enter the room; wait for an answer.
  2. Introduce yourself, showing ID badge.
  3. Shake hands (wear glove if needed).
  4. Sit down. Smile if appropriate.
  5. Briefly explain your role on the team.
  6. Ask the patient how he or she is feeling about being in the hospital. [Emphasis added.]

Although asking a patient how they feel about being in the hospital is a simple thing to do, Dr. Kahn says the answer is often very helpful and allows the patient to vent a little.

Study looks at the price paid for futile care

Futile care can crowd out those patients who might actually benefit from treatment, according to a recent study (abstract only) from the journal Critical Care Medicine. In an interview for WBUR, Dr. Neil Wenger, senior author on the paper and a UCLA professor of primary care medicine and head of the university’s ethics center, discusses the study’s implications. For three months, Dr. Wenger and his colleagues surveyed physicians in five ICUs to identify patients that clinicians identified as receiving futile treatment. Overall, they found a total of 11 percent of patients were receiving futile care, with another 9 percent of patients identified as “probably getting” futile care. They also found ICUs were more likely to have patients receiving futile care when they were less full compared to when they were full. Dr. Wenger attributes this to doctors having harder conversations and working harder to reduce the amount of inappropriate treatment when there’s a crunch on resources. Dr. Wenger says he hopes the study will spark an open debate on the appropriate use of health care resources.

Lack of physicians practicing in rural areas remains a problem

A recent article from The Atlantic asks why there are so few physicians practicing in rural America. The article notes a fifth of Americans live in rural areas yet only a tenth of physicians practice there. The article says there are a number of reasons for this discrepancy, such as the lack of medical school applicants from rural areas. Of those students that do come from the countryside, half decide not to return there after they graduate. Also, residents tend to practice where they train and most of the prestigious medical schools are located in big cities. The article cites a recent poll from Sermo, a social network for doctors, which found a lack of cultural opportunities topped the list of reasons it was hard to recruit rural physicians. Some stopgap measures have been enacted to temporarily fix the problem, the article notes. For example, the Affordable Care Act has created grants for programs that train doctors who will work in rural areas. Also, scholarships from the National Health Service Corp are available to students who train as primary care physicians as long as the agree to serve for a year in a designated shortage area.

Next PLF webinar to discuss physician-nurse dyads

On Wednesday, November 12 beginning at 2 p.m. ET, the PLF will host an hour-long webinar titled, “Creating Exceptional Physician-Nurse Dyads: Using Collaborative Partnerships to Raise the Standard of Care and Improve the Overall Patient Experience.” Presenters Alan J. Conrad, MD, a practicing primary care physician and medical director at Palomar Health in San Diego County, and Tracy Duberman, PhD, CEO and founder, The Leadership Development Group, Inc., will share the story of one health system’s journey to creating collaborative partnerships through a dyad activation process that raised the standard of care and improved the overall patient experience.

The session will offer a case study focusing on Palomar Health’s journey through an applied physician leadership academy that included physicians, nurse leaders, and administrators to drive alignment and facilitate a team-based care approach.

To register for this complimentary webinar, click here.