Vol 26, Issue 6
David Hemsey, MD Division Chief, Hospital Medicine¶
| View from the 9th Floor | 1-3 |
|---|---|
| Announcements | 3 |
| Coding Corner | 4 |
| Nat'l APP Week | 4 |
| DHMParty Photos | 5 |
UNC Division of Hospital Medicine¶
Hospitalist Happenings¶
VIEW FROM THE NINTH FLOOR¶
View from the Ninth Floor¶
September 19, 2025¶
For me, September brings two traditions: the Paperhand Puppet show at the Forest Theater on campus and our incentive calculations. I recommend the show if you haven't seen it it features original music and writing always focused on an environmental theme and quite visually-stunning giant puppets. Having a picnic dinner one weekend evening there has become an annual pilgrimage for our family. These things have some surprising similarities: different every year, quirky, unpredictable and can fuel nightmares on occasions, require me to stretch my mind, and make little sense out of context, but work out well enough in the end most of the time.
The final pool including the mid-year was generous and up 9% from last year's (remember that you have already received some of the clinical pool for FY25!). It remains true that completing the incentive scoring remains one of the more difficult tasks I do. Evaluating individual performance and efforts and turning them into numerical distinctions based on everevolving frameworks from the SOM and DOM compensation plans will always be somewhat subjective despite our efforts to standardize.
Great news: We all shared the at-risk 20% for the DOM Service Differentiation metrics: increasing each of (1) ER discharges, (2) HBR transfers from the Med Center to MDX and (3) ACH admissions by 15% from the first half of FY25 to the second. In fact, we increased the combination by 33% and doubled total diversions from the Med Center from FY24. In the last 6 months, we provided alternative pathways of care for an average of 3 admits/day (up to 20% of our ER traffic) -a huge help to our continued capacity challenges.
Hospitalist Happenings¶
The clinical scoring determined 45% of the pool, about half of which was distributed in March. We scored our metrics based on the entire year's data because the final clinical payout accounted for the previous one -so where you ended up was the most appropriate measure. The metrics were averaged from relative wRVUs, mission critical shifts (evening/weekend/backup), panel size (H/X total encounters and encounters/day), throughput (discharge fraction, MAO recognition), clinical quality (DC summary), clinical contracts and QI contributions.
The final scoring distributed well, as shown. Paul, who does only swing shifts and is remarkably productive and discharges many when doing so, was our outlier this year. Final clinical payout is based on cFTE (with a contribution from non-DHM clinical contracts like last year). The differences in cFTE drive the final number more than the score itself. If you would like more clinical time because of that reality, it is available!
The results from our new DC fraction metric were interesting and it seems to capture individual tendencies, as where people fall has consistency from year-to-year that can be seen in our 3+ years of data. Our H/X rounders discharge from 9-21% of all of their encounters. As discharging our patients safely requires more work and helps throughput, these behaviors are worth rewarding. Our panel size metrics provided additional clinical incentive for those who see more patients than their peers on MDH/X as well as those who only do direct care (by choice or by rule). As these services remain both fundamental to our division and our most challenging, they will also continue. You can see the distribution of these 3 metrics for individuals who round on H/X and reference your own FY25 report card to see where you fall in the group. X axis shows encounters/day, Y axis shows DC fraction and bubble size shows total encounters.
The non-clinical scoring was split this year into citizenship (15%) and academic (20%) and had a higher total value of the pool (35% vs 25%) from last year. This means that nonreporters had a larger penalty for not responding to Carlton's survey on what they are doing outside of clinical work. Citizenship was scored on Local service; National/regional service; and Mentorship, while Academic was Scholarly output; Local education; National/Regional CME; Teaching evaluations; Teaching awards. Those who did best have broad academic portfolios scoring in multiple categories.
I hope you all use the higher paycheck this month for something fun for yourselves -I personally love an excuse to pick up some new guitar gear.
Hospitalist Happenings¶
Speaking of gear, thank you to Beth Ann and Tommy for being super hosts and James and Courtney for the inspiration and decorations at the great fall party last weekend. It was awesome to see so many of our crew dressed for a cruise and with all of their young ones enjoying the bounce slide and goats (and mud). Sometimes I miss those days, as Jess and I find it impossible to drag our teens to these functions.
Finally, I wanted to thank you all for the incredible outpouring of volunteers to help fill the gaps in the upcoming schedule. We had 20 (!!) faculty offer to pick up additional shifts for January to March as well as a number of external moonlighters offer to pre -schedule, for a whole variety of shifts. We feel confident that we will be able to create a schedule that meets our patients' and team's needs. We can't use all of you this quarter but suspect we will have additional need for help April to June, so I hope to be able to call on you again when we start that schedule process.
Announcements¶
Congratulations to Dr. Jennifer McEntee on being elected to the Medical Staff Executive Committee!
Upcoming DHM Faculty Meeting¶
Noon -1:00 | PECR2 & Webex
Sept. 24th: Creating Scientific Posters w/ John Stephens
Chris Williams - Sept. 22nd Lindsey Phillips - Sept. 29th Paul Ossman - Oct. 7th
DHM Operations Weekly Huddle¶
Mondays, 12:30-1:00 | Zoom
Grand Rounds¶
Sept. 25th- Seth Berkowitz, MD -Food is Medicine¶
Hospital Medicine Grand Rounds¶
Oct. 14th¶
Hospitalist Happenings¶
Coding Corner: Key CC/MCCs in Cancer Care and Vizient Impact¶
In oncology hospitalizations, documentation of specific diagnoses that qualify as CCs/MCCs is critical for accurate coding, risk adjustment, and Vizient benchmarking. High-impact diagnoses to include that we often see missed in our cancer patient population include:
- Metastatic disease (document specific sites: bone, brain, liver, etc.)
- Lymph node involvement (at the time of care)
- Pancytopenia due to chemotherapy and/or malignancy
- Malnutrition (severity: mild, mod, severe ASPEN and GLIM both qualify)
- Cancer related fatigue
- Immunosuppression due to chemotherapy, steroids, or other agents (transplant)
- Acute organ dysfunction (renal failure, respiratory failure)
- Electrolyte disorders (e.g., hyponatremia, hypercalcemia of malignancy)
- Hypercoagulable state (due to cancer)
- Cancer status (active vs remission - particularly important in blood cancers coming in for chemo)
- Cerebral Edema from brain mets (aka vasogenic edema)
These conditions influence severity of illness and risk of mortality, driving Vizient metrics such as mortality index, expected length of stay, readmissions, and cost efficiency.
Takeaway: Specific documentation (e.g., pancytopenia secondary to chemotherapy , colon cancer with liver metastases , immunosuppression from steroids ) ensures coding captures the true complexity of care while optimizing institutional performance metrics.
Taylor Herndon, MHA Associate Chief of Administration, Divisions of Hospital Medicine and Geriatrics
Happy National APP Week!¶
'This year's theme, Racing Toward the Future: Celebrating APPs , is all about recognizing the momentum, innovation, and heart you bring to UNC Health every day. Whether you're caring for patients, mentoring learners, or driving change behind the scenes -you're helping shape the future of healthcare.'
Connect & Celebrate: An Evening to Honor APPs
Wednesday, September 24 | 5:30 -7:00 PM | MBRB, Auditorium 2204, 111 Mason Farm Road
Parking information & QR codes will be sent to those who RSVPed
Virtual Option: If you didn't RSVP but would like to join remotely, you can attend via Webex
Thank you to all of our hospitalist APPs for your hard work!¶
Brian Alfano, PA-C¶
Dana Mabry, NP¶
Eric Allman, NP¶
Dana Raines, NP¶
Amy Dacillo-Curso, NP¶
Cherie Ann Somera, NP¶
Vibha Dholakia, NP¶
Keva Southwell, PA-C¶
Kari Hackley, NP¶
Kelly Stepanek, NP¶
Stellamary Inigo, NP¶
Magdalene Tukov-Yual, NP¶
Escher Howard-Williams, MD Associate Medical Director of Clinical Documentation Integrity