Background: Guiding health care delivery towards patient-centered value can be accelerated by reforming physician reimbursement. Recent legislation including the Medicare Access and CHIP Reauthorization Act (MACRA) and the Affordable Care Act have created frameworks for value-based health care payments. By the end of 2018, the United States Department of Health and Human Services aims to have [...]

Background: In response to skyrocketing healthcare costs, providing high value care is an increasing priority for health care systems. Physicians are responsible for translating high value care (HVC) to the bedside, however there is a paucity of instruments designed to measure observable markers of HVC at the beside. This confounds efforts to develop and measure [...]

Background: Interprofessional teamwork in healthcare organizations is crucial to the delivery of quality patient care. Efforts to improve teamwork on hospital medicine units commonly fail due to clinicians and other care team members (case managers and pharmacists) are responsible for patients scattered across numerous floors and units. UK HealthCare developed and implemented the Interprofessional Teamwork [...]

Background: As part of the ABIM Foundation’s Choosing Wisely campaign the Society of Hospital Medicine recommended providers avoid performing repetitive CBC and chemistry testing in the face of clinical and lab stability. In 2014 as part of an EMR upgrade our institution removed the “daily labs” order. A 1-year post change audit showed no change [...]

Background: Determination of patient stay status, e.g. inpatient vs. observation, is highly important to payers, physicians, and patients alike. Non-Medicare payers perform near concurrent review of admission notes and orders in order to approve the status determination done by the admitting physician. At times, payers will request a change of status. When a status change [...]

Background: Cirrhosis is the permanent fibrosis of the liver and carries a prevalence of 600,000 cases per year. Hospitalizations due to cirrhosis have doubled from 2001 to 2011 with an average hospitalization cost of $15,000. Hospital readmissions for cirrhosis are frequent and have been noted to be up to 3 readmissions per year. Given the [...]

Background: Rising healthcare costs have driven both the government and the private sector to seek cost-saving innovations in health care delivery. The Center for Medicare and Medicaid Innovation (CMMI) is leading this charge from a federal level, with burgeoning efforts coming from universities and private foundations. The Stanford Clinical Excellence Research Center (CERC) was established [...]

Case Presentation: A 24-year-old Hispanic man presented with persistent hyperbilirubinemia for two weeks. Patient was recently diagnosed with acute liver injury secondary to Hepatitis A two months ago when he presented with yellowing skin, fevers, nausea, vomiting, and abdominal pain which had resolved after one week. He had no past medical history and denied alcohol [...]

Case Presentation: A 62 year-old man presented to the emergency room with recurrent, colicky generalized abdominal pain. He had presented with similar abdominal pain in the preceding 6 weeks, requiring two hospital admissions. Admissions were accompanied by asymmetric lower limb swelling and pain on one admission, and swelling of lips on this admission. Six weeks [...]

Case Presentation: Sump syndrome is a rare complication of side-to-side choledochoduodenostomy (CDD). CDD used to be a common surgical procedure done in the era before endoscopic retrograde cholangiopancreatography (ERCP). After side-to-side CDD, the CBD between the anastomosis and the ampulla of Vater becomes a potential sump (a recess or reservoir serving a drain for liquids). [...]