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A very productive hospitalist
Brad Flansbaum writes the story of a very productive hospitalist.The physician profiled has 3000 discharges.  Just counting Medicare patients.Most hospitalists I know run a daily census of 8 to 15 patients.  If this fellow is working at a very high level of 25 (and recall, that would imply no commercial or Medicaid patients) with an average length of stay of five days, that would imply 5 discharges per day.At that rate, if you worked 365 days per year, you still would not reach even 2000 discharges.  So the 3000 number doesn't add up.Brad tried his best to get an answer:In preparing the post, I reached ...
Source: Running a hospital - August 25, 2014 Category: Health Managers Source Type: blogs

99225 CPT ® Code Description, Progress Notes, RVU, Distribution.
This 99225 CPT ® lecture reviews the procedure code definition, progress note examples, distribution and RVU values for this new since 2011 subsequent observation care evaluation and management (E/M) code. CPT stands for Current Procedural Terminology. CPT® 99225 is the middle (level 2) subsequent observation care code in this family of codes that also includes CPT® codes99224 and99226.  All three codes are part of the Healthcare Common Procedure Coding System (HCPCS). Observation care is considered outpatient care. A patient is considered outpatient until inpatient admission to a healthcare facility occurs.&n...
Source: The Happy Hospitalist - January 14, 2014 Category: Internal Medicine Authors: The Happy Hospitalist Source Type: blogs

Heart Hospital Scrambles After All Cardiologists Call In Stuck After Snowstorm.
Boston, MA -  Massachusetts Heart Hospital was forced to scramble over the weekend after every single cardiologist called in stuck after a snowstorm dropped over two feet of snow on the city.  House Supervisor Jan Stevenson was notified of the hospital wide physician shortage after nurses started complaining nobody had rounded on any patients for nearly 48 hours, which isn't always unusual."Some nurses became concerned after the first  24 hours, but we decided to hold tight because it was actually nice having none of the doctors around.  After 48 hours, out of physician courtesy, we called every single ...
Source: The Happy Hospitalist - February 6, 2015 Category: Internal Medicine Authors: Tamer Mahrous Source Type: blogs

Drug Therapy Requiring Intensive Monitoring For Toxicity (List) For High Risk Medical Decision Making (MDM) in E/M Explained.
In addition to history and physical, determining the level of medical decision making (MDM) is necessary to define which CPT ® code to correctly submit for payment. The American Medical Association's CPT ® manual is the authoritative reference for all CPT® related questions and should be available for all physicians to quickly reference. Evaluation and management (E/M) rules are complex and are often open to interpretation, including the high risk MDM component of "drug therapy requiring intensive monitoring for toxicity". The same data presented to different coding experts or auditors will invariabl...
Source: The Happy Hospitalist - March 21, 2013 Category: Internal Medicine Authors: The Happy Hospitalist Source Type: blogs

Hospital Quality Measures: Value Based Purchasing 2.0 (The Funny Version).
For years, hospital quality measures have been tracked by private and government insurance programs to try and improve the healthcare services received by their beneficiaries.  The most recent example is the Value-Based Purchasing Program (VBP) initiative by The Centers For Medicare & Medicaid Services (CMS).  How does CMS describe VBP?"Under the Program, CMS will make value-based incentive payments to acute care hospitals, based either on how well the hospitals perform on certain quality measures or how much the hospitals' performance improves on certain quality measures from their performance during a basel...
Source: The Happy Hospitalist - March 14, 2014 Category: Internists and Doctors of Medicine Authors: Tamer Mahrous Source Type: blogs

Hospitalists need to care about costs too
“Dr. Vashist, I’m sorry to bother but you really need to look at this medication being taken by our patient.” My hospital pharmacist gently prodded me as he handed over the patient’s medication list along with cost information and side-effects of the offending medication. The issue with the list was a subcutaneous injectable form of calcitonin, Miacalcin, costing approximately $11,300 per day of treatment. Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.
Source: Kevin, M.D. - Medical Weblog - June 7, 2015 Category: Journals (General) Authors: Tags: Policy Hospital Hospitalist Source Type: blogs

I Joined Twitter to Teach
I joined Twitter to teach. In May 2016, I started tweeting “questions of the day” for my inpatient hospital medicine team at Thomas Jefferson University Hospital from @RJmdphilly. #GreenQOD (“Green” is our teaching service, and “QOD” for question of the day) was born in the days of only 140 characters per tweet (now expanded to 280), which placed a potentially daunting onus on brevity in phrasing—and answering—clinical questions. My inaugural question? “What’s the real story with beta blockers in reactive airway disease? If increase risk is real, how do you balance risk/benefit?” Rules of t...
Source: Academic Medicine Blog - June 30, 2020 Category: Universities & Medical Training Authors: Guest Author Tags: Featured Guest Perspective social media teaching Twitter Source Type: blogs

Failure To Communicate: The Dangers Of Inadequate Hospital Handoffs And What To Do About It
One of my biggest pet peeves is taking over the care of a floor-full of complicated patients without any explanation of their current conditions or plan of care from the physician who most recently treated them. Absent or inadequate verbal and written “handoffs” of patient care are alarmingly common in my experience. I work primarily as a locum tenens physician, traveling across the country to “cover” for my peers on vacation or when hospitals are having a hard time recruiting a full-time MD. This type of work is particularly vulnerable to gaps in continuity of care, and has heightened my awareness ...
Source: Better Health - March 24, 2014 Category: Health Medicine and Bioethics Commentators Authors: Dr. Val Jones Tags: Health Policy Health Tips Opinion Change Of Shift Communication Failure To Communicate hand off History And Physical Exam Hospital Sign-Outs Hospitalists Locum Tenens Medical Errors Nursing Progress Note Sign out Talk Source Type: blogs

Physician Assistant Hires Physician Assistant Assistant to Help Manage Hospital Rounds.
Gainesville, FL -  Two years ago, Physician Assistant Stan Hanover P.A. was so overwhelmed with patients that he hired his own Physician Assistant Assistant (P.A.A.) team to better manage his rising patient load.  Rounding on 30 patients a day and admitting another dozen had become just too much for Stan to handle."I went to my Hospitalist group and said I need more money to hire my own team of Physician Assistant Assistants,"  said Stan.  "At first, they questioned the need for more help, until I told them the Dermatology clinic was hiring for days only, no holidays and no weekends  and they said ...
Source: The Happy Hospitalist - January 31, 2015 Category: Internists and Doctors of Medicine Authors: Tamer Mahrous Source Type: blogs

Start a hospitalist program with these 6 steps
Just to give you my background, I manage a large hospitalist program for a busy downtown community hospital that is part of a large health system consisting of a total of 29 acute care hospitals in the same geographical area. One of the reasons why our team was hired recently to manage this hospitalist program […]Find jobs at  Careers by KevinMD.com.  Search thousands of physician, PA, NP, and CRNA jobs now.  Learn more.
Source: Kevin, M.D. - Medical Weblog - March 8, 2020 Category: General Medicine Authors: < span itemprop="author" > < a href="https://www.kevinmd.com/blog/post-author/rahulkumar-singh" rel="tag" > Rahulkumar Singh, MD < /a > < /span > Tags: Physician Hospital-Based Medicine Hospitalist Source Type: blogs

Thinking on Your Feet Well: Building Adaptive Expertise in Learners Using Simulation
On this episode of the Academic Medicine Podcast, Sam Clarke, MD, MAS, and Jon Ilgen, MD, PhD, join host Toni Gallo to discuss the importance of teaching adaptive expertise to prepare learners for the types of complex cases they will encounter in clinical practice. This conversation also covers what adaptive expertise is, how simulation can be used to foster this skill in learners, and the complementary relationship between performance-oriented cases and adaptive cases in health professions education. This episode is now available through Apple Podcasts, Spotify, and anywhere else podcasts are available. ...
Source: Academic Medicine Blog - July 24, 2023 Category: Universities & Medical Training Authors: amrounds Tags: AM Podcast AM Podcast Transcript Academic Medicine podcast adaptive expertise medical education medical students residents simulation Source Type: blogs

The Perfect Storm: When Parkinson ’s Patients Enter the Hospital
By HOOMAN AZMI MD, FAANS  When a patient enters a hospital either in an elective or more urgent manner, the main focus of the care team is to address the chief complaint. Other diagnoses, while important, may not receive as much attention. While this may not affect patients in most circumstances, it can be very impactful in patients who have Parkinson’s disease (PD). Studies have demonstrated that when patients with Parkinson’s disease enter the hospital, they are more susceptible to developing hospital related complications. Patients with Parkinson’s disease have a higher length of stay (LOS) than those entering th...
Source: The Health Care Blog - January 23, 2019 Category: Consumer Health News Authors: matthew holt Tags: Hospitals Patients Hooman Azmi Hospital-related complications neurology Parkinson's Disease Source Type: blogs