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April 13, 2010

"Saddle up": SHM 2010

After last year's SHM meeting, I wrote a blog entitled "Something is going to happen" to describe the prevailing sentiment about looming health care reform. While that forecast was ultimately correct, I doubt anyone could have predicted just how close it was to being wrong, let alone how absurdly the process would play out. What follows are some random thoughts about this year's conference, which perhaps should more aptly be thematically entitled, "Oh s**t, it happened!"

At this year's conference in Maryland, I found two ribbons waiting for me at registration. The first: "More than 100 years as a member of SHM." Wait, refocus and reach for the bifocals: "More than 10 years." Still shocking.

Second, "Senior Fellow in Hospitalist Medicine." Here is some advice for SHM leadership: Don't remind us that we are getting old. "Master Fellow in Hospitalist Medicine," great name; "Senior" anything, not so much. I would have gone with "Awesome Fellow in Hospitalist Medicine." I need the "cred" with my son.

One of the most interesting parts of the conference was the roundtable discussion on health care reform that included Ron Greeno from Cogent and Leslie Norwalk, a former CMS administrator who's now on the board of Sound Physicians. I believe Dr. Greeno nailed it with his comments about how hospitals and hospitalists will be "colluding" in the future.

I took this to mean that reform may finally financially align physicians—hospitalists, in particular—with hospitals' goal of improving the efficiency and safety of patient care. Dr. Greeno's comments that we need to "saddle up" in this new health care reality were also dead on. Perhaps most entertaining was the Austin Powers "tell" he displayed when criticizing the lack of tort reform and those that would have us believe that defensive medicine adds only $50 billion every 10 years to health care costs.

If you've ever wondered if hospital medicine is a distinct specialty, you can put that question to rest, at least ideologically. When the audience was asked during the roundtable if they supported health care reform, the vast majority of hands went up among the 2,500 hospitalists attending. Same question at a primary care conference? My guess: 50/50 audience mix. Now try a cognitive specialty conference like ID or neurology; no doubt, a chorus of boos. And if you really have guts, try it at a procedural-based specialty conference. The proverbial tomato would likely be the nicest thing sent hurling towards the stage.

Back to Ms. Norwalk. She mentioned, among many good points, that much of reform's success will revolve around the "money." A generalization of course, but I could not agree more, especially given my experience as a health care administrator.

That's why I was surprised when Paul Levy, the Beth Israel Deaconess CEO who gave the opening address immediately after, said he couldn't agree less.

Overall, he gave a great talk, but he may have bent three rules of engagement. The first: Don't challenge someone who's left the stage and can no longer offer a rebuttal. Second, he broke my mother's rule of, "Be Nice" which I found evident in his repeated dismissal of Ms. Norwalk's contention that money drives physician behavior. And finally, don't be wrong. Any CEO who tells you that doctors act solely based on the Hippocratic Oath is either being disingenuous or uninformed. Money doesn't drive all decisions in a vacuum, but you can't possibly believe that physicians are special people who don't worry about their children's tuition payments and the like.

Did I just break my own rule, be nice? Well, to state the obvious, he has a much more important, better written and widely read blog that has helped transform health care transparency. All for the betterment of patient care. However, maybe he should use his blog to further clarify his opposition to Ms. Norwalk's reasoned assumption.

The rest of the conference was fantastic as well. For the most part, the lectures were not only informative but dynamic, which is crucial if I am to create new connections among my aging neurons.

And half the fun of the conference is catching up with so many great colleagues. Too much fun in fact. Let me just say, thank goodness for the E in the CAGE screening test for alcohol abuse. Many late night conversations would have lead to my subsequent failure of said test were it not for the fact that I have avoided reaching for an eye opener the next morning.

Finally, back to Dr. Greeno's comments on tort reform. I had the great misfortune of missing Dr. Wachter's closing talk—which, no doubt, was another masterpiece—for the first time in almost 10 years. Why? I had to catch a flight for a deposition involving a case that's more than five years old. I am no longer named in that suit but I am working gratis to defend my former hospital system. I shouldn't say more, and I won't, but many of my thoughts about litigation are found here.

As a postscript: Thank you to the many people who commented on how much they enjoy my writing (and to those who refrained from saying how much they dislike it). Writing about hospital medicine has been almost as much fun as doing hospital medicine, so I am pleased that some people, on occasion, actually tolerate reading what I write.
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2 Comment(s)

Stefani Daniels wrote:
So much for Levy's 'transparency'--as long as it doesn't involve him.
Clarendon , VT | Sat, May 1 2010 15:50 PM

Erik DeLue wrote:
''Lapses of judgment in a personal relationship'' would disqualify most of us from doing anything other than operating a toll both. I don't believe this rings any hypocrisy alarms, at least from what I know of him from attending two lectures and via his blog. and one has to believe that if it was an egregious act, he would quickly be ousted by the board. If he does resign, Joe Li gets my vote for the first (or one of the first?) hospitalist CEO!
Mt. Holly, NJ | Sat, May 1 2010 15:55 PM


About Erik DeLue, MD
Erik DeLue, MD, examines the challenges of running and reinventing a hospitalist program. He is medical director of the hospitalist program at Virtua Memorial, a hospital in Mt. Holly, N.J.

This is the third community hospital program that Dr. DeLue has worked for in his nine years as a hospitalist. Join in the dialogue on issues that range from compensation and 24/7 scheduling to how to work with competing hospitalist groups.

The opinions expressed by Dr. DeLue are his own and do not necessary reflect the opinions of his employer or Today's Hospitalist.
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