HOSPITALIST PROGRAMS: START SMALL & BE CREATIVE
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- Sharlene Goodwin
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1 HOSPITALIST PROGRAMS: START SMALL & BE CREATIVE
2 HOSPITALIST PROGRAMS: START SMALL & BE CREATIVE 1. GROWTH OF HOSPITALIST MEDICINE 2. BIG PICTURE HOSPITAL IMPACT/BENEFIT 3. KEY QUESTIONS 4. STAFFING MODELS 5. MANAGING THE MODEL 6. GENERAL OBSERVATIONS
3 SALIENT DISCLOSURE RHPI PROJECTS: 12 HOSPITALIST LOCUMS PLACEMENT: 4 YEARS HOSPITALIST MANAGEMENT: TRINITY MEDICAL CENTER, BIRMINGHAM AL ADC 75 UAB MEDICAL WEST, BESSEMER AL ADC 45 SALIENT HOSPITALIST MEDICAL DIRECTOR M. D. A. Robert Sheppard DCH REGIONAL MEDICAL CENTER HOSPITALIST FELLOWSHIP PROGRAM
4 HOSPITALIST PROGRAMS: START SMALL & BE CREATIVE 1. GROWTH OF HOSPITALIST MEDICINE 1996 article in New England Journal of Medicine written by Drs. Robert Wachter and Lee Goldman a new breed of physicians who will be responsible for managing the care of hospitalized patients in the same way that primary care physicians are managing the care of outpatients..as hospital stays become shorter and inpatient care becomes more intensive, a greater premium will be placed on the skill, experience, and availability of physicians caring for inpatients.
5 HOSPITALIST PROGRAMS: START SMALL & BE CREATIVE Percent of Hospitals Reporting that Hospitalists Provide Care in their Hospital, % 55.0% 57.8% 59.8% 39.9% 44.4% 29.6% 33.8%
6 2. BIG PICTURE HOSPITAL IMPACT/BENEFIT HOSPITAL EFFICIENCY PATIENT/MD SATISFACTION QUALITY OUTCOMES
7 HOSPITAL EFFICIENCY CONTINUITY OF CARE LENGTH OF STAY STANDARDIZATION OF PROCESS/PRACTICE MD TIME MANAGEMENT PATIENT/FAMILY FOCUS
8 PATIENT/MD SATISFACTION TRANSITION OF CARE ED ADMISSIONS DIRECT ADMISSIONS PATIENT CO-MANAGMENT NURSE COMMUNICATION ANCILARY SERVICES COMMUNICATION CASE MANAGEMENT DISCHARGE PLANNING HOME HEALTH NURSING HOME TRANSITION HOSPICE CARE FAMILY CONFERENCE
9 QUALITY OUTCOMES IMPROVEMENT OF CARE (PROCESS) SPECIFIC CORE MEASURE FOCUS REDUCE INPATIENT COSTS REDUCE READMISSION RATES DISCHARGE FOLLOW UP APPOINTMENTS MADE AND KEPT TECHNOLOGY IMPLEMENTATIONS OVERALL HOSPITAL PROCESS IMPROVEMENT INTEREST
10 3. KEY QUESTIONS: A. PCP BASE B. ED/INPATIENT VOLUME
11 3. KEY QUESTIONS: A. PCP BASE CAPACITY MD PUSH BACK COMMUNITY PUSHBACK
12 3. KEY QUESTIONS: B. ED/INPATIENT VOLUME ADMISSIONS THAT SHOULD STAY AT HOME ADMISSIONS THAT SHOULD DISCHARGE TIMELY ADMISSIONS RESULTING IN POSITIVE FEEDBACK
13 4. STAFFING MODELS A. FULL TIME HOSPITALIST COVERAGE B. TRANSITION OF EXISTING MD(s) C. ROTATION BETWEEN CLINIC AND HOSPITAL D. WEEKENDS ONLY E. OTHER CREATIVE OPTIONS
14 6. GENERAL OBSERVATIONS Consistent MD coverage is ESSENTIAL! MD S clinically competent AND willing MD balance between Cowboy and Outlaw Patient care/outcomes Hospital process/culture ED Pharmacy/ancillary departments Nursing Medical Staff Case Management
15 6. GENERAL OBSERVATIONS Billing codes: Initial encounters (admits/consults) Subsequent encounters (rounding) Discharge encounters Critical care and/or procedures Rule of Thumb: $60 collection/encounter 1 FT Hospitalist MD = $230K (inclusive of benefits) (+/-) $230K = 3833 encounters 3833 / 26 weeks of coverage = 21 encounters/day
16 A. FULL TIME HOSPITALIST COVERAGE 1. Patient volume = 15 encounter/day 2. 2 MD s each working 7ON/7OFF (1 MD/week) 3. Not working ED Hospitalist coverage ONLY 4. Not necessary to create independent legal entity for MD s functioning in role as Hospitalist
17 E. OTHER CREATIVE OPTIONS 1. What is the composition of your medical staff? 2. Where are your inpatient volume spikes? 3. Potential: Holidays Weekends Vacations Test, Experiment, Out of the Box
18 5. MANAGING THE MODEL A. DOCUMENTATION Dictate Critical Care encounters Format/template for Progress Notes B. CODING 2 patient encounters in same 24-hr day Observation vs. Inpatient admission (RAC RED FLAG) Cross Coverage/House Coverage C. BILLING/COLLECTIONS 4%-5.5% Self-pay strategy and communication D. MEETINGS AND COMMUNICATION Meetings: Rare but scheduled Quarterly Communication: Phones not beepers E. RECRUITING Residency programs IM/Sub-specialty Fellows Large Hospitalist programs with young MD s looking for extra shifts or coverage opportunities
19 CONTACT INFORMATION: STEVE NYQUIST
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