Blog Posts


Featured Clinician: Brian Haas, MD

Posted on Wed, Jul 06, 2016
Featured Clinician: Brian Haas, MD

The heart and soul of our practice are our clinicians. Meet Brian Haas, MD, hospitalist at Centerpoint Hospital in Independence, Mo.

Years with EmCare: 3.5 years

Years practicing medicine: 8.5 (including Residency)

Why did you decide to become a doctor? Why did you choose your specialty? I decided to become a doctor after I was told that I had a heart condition during my senior year sports physical in high school. I was initially told I was not allowed to do anything strenuous, until more testing had been done. I remember being terrified and wishing that I understood more of what was going on. At that point I decided that I needed to become a doctor so that I could understand myself as well as to help others to be less afraid than I had been.

What career did you want to pursue when you were younger? As a child I thought that I was going to be a teacher. Between college and medical school I was a long-term English substitute teacher.

Describe one of your greatest professional accomplishments. I won a national medicine/pediatric poster presentation and was given a certificate at the national AAP convention in San Francisco in October 2010.

What is in the pockets of your lab coat? Some of our new Bio Cards; they help the patients understand who is taking care of them. It has my picture on it.

What would be your ideal category on “Jeopardy”? Famous Swimmers in History

How do you stay organized at work? By taking each task as it comes and finishing it once I start, and not putting it off.

What are your tips for “leaving work at work” and not getting burned out professionally? I make sure that before I leave that all of the work is done. I don’t want to have a chart hanging over my head while I am off.

How are you “making healthcare work better”? I continue to try to get to know our emergency medicine colleagues better. I want to make sure that the patients who are admitted are well taken care of and that the transition is as smooth as possible. I feel that through personal relationship building of the providers we will be better suited to take care of patients.

What’s the best advice you’ve received about work or life? Enjoy your work. You spend more than 50% of your life there you better enjoy it.

What do you enjoy outside of work? I love spending time with my family, running, biking and swimming when there is time.

What’s your favorite inspirational quote? “There is no substitution for hard work.” –Thomas Edison

What qualities make a successful doctor? Interpersonal skills. I enjoy spending time at the bedside. I don’t have a problem holding someone’s hand when I have to give them bad news, or to give them a high five when there is good news.

How would your co-workers describe you? My colleagues would describe me as boisterous, energetic and always wearing a ridiculously large smile.

Tell us something that most people at work don't know about you. I taught myself to juggle in hopes of entertaining my daughter when she was six months old ... she wasn’t impressed.

If you could have dinner with anyone, living or historical, who would you choose and why? I would need a dinner party with Will Ferrell, Paul Rudd and Chris Farley, and of course my wife. I can’t imagine a more entertaining evening with four of the most hilarious people in the world.

What’s the most interesting place that you’ve been? Green Sand Beach on the island of Hawaii.  The sand really is green!

What are you currently reading? "Leading Change," by John P. Kotter. It was a recommended read at the Pillars conference.

What’s your favorite TV show? Game of Thrones - Are there other TV shows?

What personal accomplishment are you most proud of? My family, because they make life worth living. They inspire me to greatness.  I always want to set the example for my daughter, that she can do anything and she can do it with a smile on her face.


Featured Clinician: Kathryn Cullen, DO

Posted on Wed, Mar 09, 2016
Featured Clinician: Kathryn Cullen, DO

EmCare is in San Diego this week exhibiting at Hospital Medicine 2016. In honor of the annual conference, we're spotlighting Kathryn Cullen, DO, medical director of the hospitalist program at Columbia Memorial Hospital in Hudson, N.Y.

Years with EmCare: 8 years

Years practicing medicine: 8 years

Why did you decide to become a doctor? I always wanted to help people and my mother was a nurse, so she sparked my interest in medicine as a way to do it.

Why did you choose hospital medicine? I have always felt more comfortable in a hospital than the outpatient setting. I enjoy the variety of issues and acuity levels of patients in the hospital. One always has to be prepared for anything!

What career did you want to pursue when you were younger? I've wanted to be a doctor for as long as I can remember. At first I wanted to be an OB/Gyn, but as I went through my training, my interests turned to adult medicine, then specifically inpatient medicine.

Describe one of your greatest professional accomplishments. When I arrived at Columbia Memorial Hospital, the group was very discouraged and frustrated with their work environment. I'm very proud that with Dr. Alex Strachan and Dr. Gina Puglisi, we've been able to significantly improve their work environment. The providers look forward to coming to work now. They are providing top-notch patient care, and they have grown closer as a team. 

What is in the pockets of your lab coat? When I wear a lab coat, I have my phone, stethoscope, pens and business cards.

What would be your ideal category on “Jeopardy”? I’m a little ashamed to admit it, but if I saw the final Jeopardy category was “Useless Pop Culture Facts,” I would know I was taking home the win.

How do you stay organized at work? In addition to having the best site administrator, I make "To Do" lists everyday, then prioritize. I file things right away; I don't leave them on my desk as clutter causes me stress. 

What are your tips for “leaving work at work” and not getting burned out professionally? Due to my position as medical director, I can’t “leave work at work,” but I can bring only the “essentials” home. Just as I use the drive to work to prepare myself for the day, I use the drive home to let go of the day. I put on some of my favorite music and focus only on the music and road, and when I get home, the work day is no longer in my mind. I believe that it’s important to take time for you, so I ensure that days off and vacations are protected for my providers, as well as myself. You need those days to “turn off” your mind and enjoy the important things in life: family and friends.

How are you “making healthcare work better”? Since arriving at Columbia Memorial Hospital, we have made great strides in improving not only the work environment for the providers but the care that is delivered. By increasing the number of providers on each day, we have decreased the patient load for each provider. This allows them to spend time with their patients and provide the proper care. We have also instituted multidisciplinary rounds to help improve the flow of patient and post-discharge care.  Just these few changes have starting to improve the quality of care delivered to this small community.
What’s the best advice you’ve received about work or life? The first is that ICU nurses can be your best friends or your worst enemies. Treat them with the respect that they deserve, and it will come back to you many times over. And No. 2 is at those times when you feel overwhelmed, frustrated or unsure of yourself, sit down, take 10 deep breaths and take things on one at a time.

What do you enjoy outside of work? I enjoy spending time with family and friends.

What’s your favorite inspirational quote? It may not necessarily be inspirational but it helps me not forget about the big picture: “If you hold on tight to what you think is your thing, you may find you’re missing all the rest.”-Dave Matthews

What qualities make a successful doctor? A successful doctor of course needs to be knowledgeable and proficient. However, some of the more important qualities for success are empathy, patience and kindness. Patients have to feel that their doctor is listening, understands their situation and wants to help fix it. Without that, the patient cannot trust their doctor, which is essential to a successful doctor-patient relationship.

How would your co-workers describe you? I think they would use words like hard working and compassionate.

Tell us something that most people at work don't know about you. It’s kind of silly, but most people I work with don’t know or don’t believe I was a cheerleader in high school. I guess I don’t “look like a cheerleader,” but it was a big part of my life in high school.

If you could have dinner with anyone, living or historical, who would you choose and why? I would want to have dinner with Jesus. Besides hearing the story of his life from his perspective, I would want to know his feelings on religion today and how it's manipulated by some for their benefit.

What’s the most interesting place that you’ve been? I took my parents to Ireland for their 40th wedding anniversary. It was amazing. We are 100 percent Irish descent on both sides of my family, so seeing the areas where my ancestors lived was life changing. In addition to that, it has some of the most beautiful scenery I've ever seen in my life and the nicest people you'll ever meet.

What are you currently reading? I don’t have much of a chance to read, so when I do, I’m reading the latest JAMA or Journal of Hospital Medicine

What’s your favorite TV show? Maybe I should have gone into psychiatry because my favorite TV show is "Criminal Minds."

What personal accomplishment are you most proud of? I have struggled with health and weight issues my entire life and have had many failed attempts at weight loss in the past. I made the decision in 2013 to finally improve my health before I developed diabetes, hypertension, arthritis, etc. In October 2013, I underwent surgery, and to date I have lost 90 pounds and I’m off all medications. It’s not the weight loss that I’m most proud of; it’s having the courage to take a drastic step in hopes to be able to start living my life. It was the best thing I ever could have done for myself and is my proudest moment yet.


Featured Recruiter: Victoria Wrede

Posted on Mon, Mar 07, 2016
Featured Recruiter: Victoria Wrede

Looking to make a career change? Meet recruiter Victoria Wrede!

Name: Victoria Wrede
Position: Recruiter – Hospitalist & Anesthesia
Division: South
Location: St. Petersburg, Fla.

Education: Associate Degree, Certified Hospitality Supervisor

Years with EmCare: 6 years

Years in the recruiting field? 4 years

Why did you decide to become a recruiter? Before changing career paths into healthcare, I spent more than 20 years working in the hospitality industry. Healthcare and hospitality are similar, since they both function 24 hours a day and require a high level of customer service. I started with EmCare in 2010 in the scheduling department and transferred into recruiting after almost two years. The intent was to learn more about the hiring process and to see if I could help make a difference with staffing.

How does your experience enable you to connect candidates with the right positions? As a result of years in customer service, I'm able to connect with candidates and identify the best demographic area and program structure to fit their lifestyle or goals.

Describe one of your greatest professional accomplishments. My first year recruiting with EmCare I had a Chief Resident who only wanted to work at one specific location in a highly desired demographic area. She was initially declined for unsubstantiated reasons. I was an advocate for her and was able to get her the job. To this day she is still at the same facility and has been an asset not only to that program but has worked at other facilities when we were short staffed.

What makes EmCare attractive to candidates? EmCare has been focusing on growth in other service lines, including Hospital Medicine, Anesthesia, Radiology, and beyond. The longevity and reputation of the company attracts well-qualified providers.

Describe your ideal candidate. A candidate who knows what demographic area and program structure they are focused on is ideal. “Job clickers” or indecisive candidates who don’t know where they want to go can be frustrating and time consuming.

How important is the “relationship” between recruiter and candidate? The recruiter builds trust with the candidate and that is the foundation for a solid relationship.

What do you like most about working at EmCare? The best part about working at EmCare is the staff. I have met some very dynamic people who have influenced me tremendously both personally and professionally.

What do you enjoy outside of work? I enjoy spontaneous trips to major sporting events and theme parks with my family. I recently went to the Orange Bowl in Miami and then to Phoenix for the Fiesta Bowl in one weekend excursion.

What’s your favorite inspirational quote? “Real integrity is doing the right thing, knowing that nobody’s going to know whether you did it or not” Oprah Winfrey

What qualities make a successful recruiter? A successful recruiter follows through and has the best interest of the candidate and practice in mind.

Why should physicians and advanced practice providers join EmCare? EmCare is a physician-led company, which means our decision makers have paid their clinical dues and manage from experience.

What should residents do now to prepare themselves for future hiring opportunities? Identify your short-term and long-term goals post residency. Stability and a clean record will help candidates get their ideal positions.

What “insider tips” do you have for anyone applying to EmCare? Turn your paperwork in a timely manner. Communicate with your recruiter regarding your intentions. The ideal position might not be available today but the more we know, the sooner we can contact you when the opportunity arises.

How should a candidate follow up after an interview with you? Within a few days of the interview it's essential that you provide feedback on the experience so we can relay the information to administration and our leaders. This will allow us to advocate for you if it's a position you are interested in.

Where do you look for candidates, both in-person and online? Do you use social media? Yes social media is a great tool. I make a lot of connections at conferences, job fairs and residency dinners.

Tell me about your ideal candidate. What kind of clinical and educational experience is in demand now? The Hospitalist field is growing rapidly and certain skill sets are in high demand, such as the ability to perform procedures, run codes and exhibit leadership. An ideal candidate will tell me about their strengths so I can help market them to leadership. Flexibility and willingness to be a team player is also an asset.

Why should a provider want to work for EmCare? What’s different or unique about the culture, the opportunities, or the work itself? Our company is always looking ahead to next big healthcare trend which will provide optimal patient care. We offer many opportunities to help achieve your personal and professional goals.

How would your co-workers describe you? Hard working, diligent and non-conventional.

Tell us something that most people at work don't know about you. I am very sarcastic but that is an inherited trait.

What was the last book you read? I only read newspapers and magazines, short and to the point.

What personal accomplishment are you most proud of? My greatest accomplishment by far has been raising my two children: Austen, 17, and Alexis, 16, and by giving them the stability, opportunities and experiences I wasn’t afforded as a child. The cycle can be broken.


The Future of Hospital Medicine: The Tools and Integrations Shaping the Specialty

Posted on Tue, Dec 22, 2015
The Future of Hospital Medicine: The Tools and Integrations Shaping the Specialty

By Francisco Loya, MD
The technologies we are using to improve the delivery of care in hospital medicine are showing great promise – if not outright success. EmCare’s Hospital Medicine team is deploying innovations that improve operational efficiency, enhance quality of care, ease staffing challenges and upgrade billing and coding practices. As these tech tools become more prevalent, I would argue that the future of hospital medicine has arrived, and with it the promise of better care and lower costs.
Operational Efficiency in a VBP World

The value-based purchasing environment has increased pressure on hospital medicine teams. The onus is largely on us to try to prevent readmissions while still being expedient with inpatient care and discharge to help increase patient satisfaction. Through automation, we have been able to reduce wait times for patients, streamline the admissions process and improve rounding and charge capture.
Through technology, we have created a platform for emergency physicians and hospitalists to meet and confer virtually so that the hospitalist may admit patients without having to visit the emergency department. This platform has allowed for a decrease in boarding times by 2.5 hours, an 8 percent reduction in “left without treatment” rates and overall improvement (to nearly 100 percent) in CMS core measure compliance. A by-product of the reduced wait times for patients is an increase in E.D. volume of nearly 27 percent. This has meant more volume for the hospital without any additional strain on resources.
Another technology we use coordinates admissions between hospitals and primary care physicians. This direct admit system is enacted with a click of a button by the primary care physician, who can then complete an online form to admit the patient to the hospital. The platform also generates a “boarding pass” for the patient to bypass the E.D. and go straight to the inpatient floor. Not only does this technology improve cohesion between hospitals and primary care physicians, it also improves patient satisfaction since wait times are reduced. That, in turn, leads to a decrease in E.D. crowding and an increase to the hospital’s referral base.
These tools certainly don’t substitute for human interaction and can’t guarantee improved quality of care, but they do allow for greater control and management over various administrative protocols. The results from these tools have been positive – both for hospitals and patients. Doctors are able to increase their focus on patient care, and most hospital medicine support staff and caregivers say their jobs are easier and more efficient.
Telemedicine Can Ease Staffing Woes

Telemedicine is another futuristic technology that’s growing in use and importance. Hospitalists are benefitting from virtual care and robotic caregivers who can help hospitals meet staffing and practice challenges.
“Five years ago, the technology wasn’t there,” said Angel Iscovich, M.D., a divisional CEO of staffing and innovation for EmCare. “The safeguards for patient privacy to protect encounters conducted over video just weren’t ready.”
Now we have cybersecurity that allows doctors to engage with patients via a video screen and webcam. The practice is easing staffing shortages for hospitals and putting patients at ease since they’re able to meet with highly qualified specialists no matter where those physicians are.
And, patients are responding positively to robot doctors. Robots are slowly taking over rounding duties in some hospitals, acting as nocturnists that provide after-hours care. Companies that provide "robodocs," such as InTouch Health, report that its robots can monitor heart sounds and connect to EMRs to improve care and efficiency. The robots are controlled with a tablet, so a caregiver can operate the robots onsite, or doctors can control the robots remotely for virtual visits. The robots can easily round on the intensive care unit, interface with the equipment and provide more expedient and effective rounding than some of their human counterparts.
Cameras for the “robodocs” provide enough mobility and resolution to offer high-quality care. One doctor, through the use of video screens and robots, can cover multiple facilities while staying in one place. Hospitals can reduce costs by “sharing” the off-site physicians. And patient satisfaction scores have, so far, not suffered because of the technological intermediaries. If anything, early studies show that patients believe the robodocs and tele-visits provide access to quality providers that otherwise would be unattainable.
Bundled Payment Initiative Requires Integration

The Bundled Payments for Care Improvement (BCPI) initiative is a federal government program designed to help manage costs for Medicare patients. BCPI allows disparate organizations to combine services and arrange for payment models that include financial and performance accountability for episodes of care. The program includes four broadly defined models of care to include various combinations of pre-acute care, acute care and post-acute care.
With this recent inducement for organizations to work together, clinical integration is more important than ever. Companies will need to attain certain levels of synergy outside of their own organizations. There are, however, some companies that are diversified enough to maximize the potential benefits of BCPI for themselves, their clients and patients. This type of self-integration tends to be more reliable because they have more control over more pieces of the BCPI integration – they are better able to manage quality of care across the care continuum. Through integrated services – for example, a post-acute care company working with hospitalists – costs are reduced, which increases patient satisfaction, since that patient is less likely to need readmitting and can receive care at home (where the patient generally prefers to be). With the cost offset, reimbursement from CMS can be more meaningful for the hospital as well.
Medical Command Center Provides Remote Care Coordination

Technology is allowing post-acute care companies greater control over the care offered in a patient’s home as webcams and video screens put caregivers face-to-face with patients. Our parent company, Envision Healthcare, has pioneered the Medical Command Center, a new concept that allows healthcare providers to check in with patients to regulate prescriptions, check vitals and confirm operation of in-home medical devices. Medical Command Center staff use their high-tech control rooms to manage care for patients in a number of states and can quickly dispatch a caregiver, such as a mobile integrated paramedic or physician assistant, to a patient’s home when necessary.
These software advancements, tech tools and integrated services are becoming more pervasive as technology advances and providers find new ways to effectively integrate their services. By focusing on operational protocols like admissions, rounding and discharge, along with streamlined billing practices and more seamless care, patients reap the benefits of high-quality personal care provided by caregivers while waiting less, paying less and visiting hospitals and doctors’ offices less.
By embracing the technologies that are available now and those on the horizon, hospitalists create more efficient practices for themselves and their patients, and are better able to focus on patient care, as opposed to the administrative processes that often keep us from the bedside - where many physicians prefer to be.

Francisco Loya
Francisco Loya, MD, MS, is chief executive officer of EmCare Hospital Medicine. In addition to his EmCare duties, Dr. Loya serves on several committees for the Society of Hospital Medicine, including the Practice Administrators Committee, the Hospital Quality and Patient Safety Committee and the Information Technology Committee. As a physician, Dr. Loya specializes in internal medicine. He earned his undergraduate degree at Rice University, earning a B.S. in Biochemistry and Molecular Biology. His M.D. came from the University of Texas Southwestern Medical School in Dallas and his internal medicine residency was completed at Brigham and Women’s Hospital in Boston – an affiliate of Harvard Medical School. Dr. Loya has also earned his Master of Science degree in Healthcare Management from the Harvard School of Public Health. After earning his master’s degree, Dr. Loya created the technology he named CMORx, which is now offered exclusively by EmCare.

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