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Confidential and Proprietary – UnityPoint HealthConfidential and Proprietary – UnityPoint Health
UPH 3rd Generation Hospitalist Update
UPH Leadership SymposiumApril 28, 2015
Theresa Lewis RN MPA FACHE
Tracy Ekhardt MD
Stephanie Burns MHA
John Nelson MD
Confidential and Proprietary – UnityPoint Health
Agenda
• Emerging Role of Hospitalists in driving acute care performance
• 3rd Generation Hospitalist Program Development
• Nelson Flores Key Findings and Recommendations
• Q/A
2
Hospitalists: Best Outcome for Every Patient Every Time
Confidential and Proprietary – UnityPoint Health
THE EMERGING ROLE OF HOSPITALISTSTRACY EKHARDT MD
Brand Promise:
Best Outcome for Every Patient Every Time
3
Confidential and Proprietary – UnityPoint Health
Emerging Role of Hospitalists• Hospitalists care for an increasing # of inpatients• “Captains” of the inpatient team, leading efforts to
drive performance• Triple Aim reimbursement models require
hospitalist leadership to reduce variation and drive performance
• Variability exists among UPH programs: scope, structure, governance and maturation
• As a result, hospital outcomes vary across UPH
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Hospitalists: Best Outcome for Every Patient Every Time
Confidential and Proprietary – UnityPoint Health
Goals of Hospitalist Program Management
• Top decile performance on Triple Aim– Improved individual quality (outcomes, patient
experience)
– Improved health of the community
– Improved efficiency (cost/case in hospital setting, improved total cost of care per member per month)
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Hospitalists: Best Outcome for Every Patient Every Time
Confidential and Proprietary – UnityPoint Health
System Sustainability: Role of HospitalistsFY15 Sustainability Target: $5.2 million
System Sustainability
Care Support Excellence
Care Delivery Excellence
Keeping Care in the System
Efficiency of Patient Stay
3rd generation Hospitalist
ModelLength of Stay Pharmacy Laboratory Blood
Utilization Cardiology Sepsis Orthopedics
Administrative Excellence
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Hospitalists: Best Outcome for Every Patient Every Time
Program Development
Program Management: Primary Focus for Hospitalists
Program Management: Secondary Role for Hospitalists
7Confidential and Proprietary – UnityPoint Health
System Sustainability: Next Generation Hospitalist Program Performance Management
System Sustainability
Efficiency of Patient Stay
Hospital Case Management
Hospitalist Programs
Hospitalist Program Operational & Performance Management
Hospitalist Program Development
3rd GenerationProgram Development
4th GenerationProgram Development
Hospital Performance
OSC Performance
8Confidential and Proprietary – UnityPoint Health
System Sustainability: Efficiency of Patient Stay Priorities for Hospitalist and Case Management
SustainabilityCare
CoordinationService
OutcomesQuality
Outcomes
Direct Cost per Case
30-day All Cause
Re-admission Rate
RBC Utilization
# Redundant Tests
ALOS
Avoidable Days
7-day PCP Follow-up
% CM assigned to
High Risk Pts
HCAHPS: Post Hosp Care
HCAHPS: Communicatio
n with Physician
Discharge before 11 AM
Hospitalist Survey
DVT Prophylaxis for
all Hosp pts
Initial Abx Selection for
CAP
9Confidential and Proprietary – UnityPoint Health
2015 Goals for CM initiatives that require collaboration/teamwork with Hospitalist
Implement best practices for: 1. Care Coordination (multidisciplinary) Rounds – Manage stay and discharge
planning - LOS
2. Reduction of Avoidable days - Reduces LOS
3. Palliative Care Referrals – Reduce unnecessary/unwanted utilization (Cost/case)
4. High Risk Intervention Order Set (High Risk for Readmission)
5. Medication Management
Implement LOS efficiencies for specific populations: Start with Respiratory/Pulmonary population – Estimated $1.18 million
opportunity for this population alone
Sustainability: Care Delivery Excellence - LOS Efficiencies
Confidential and Proprietary – UnityPoint Health
3RD GENERATION HOSPITALIST PROGRAM MODELSTEPHANIE BURNS MHA
Brand Promise:
Best Outcome for Every Patient Every Time
10
Confidential and Proprietary – UnityPoint Health
Goals of Hospitalist Program Development
1. High Performance– Of Hospital– Of OSC
2. Alignment– Engagement around UPH goals and priorities
3. Value– To marketplace– To stakeholders
4. Sustainability– Return on investments– Reliability– Evolutionary adaptability (to changing healthcare environment)
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Hospitalists: Best Outcome for Every Patient Every Time
Confidential and Proprietary – UnityPoint Health
2015 Hospitalist Program Development
• Establish 3rd generation standard program elements across all regions
• Engage Nelson Flores to review, refine 3rd generation program model and assess current state, recommend strategies to close gaps
• Establish hospitalist program development dyad leadership team within UPC
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Hospitalists: Best Outcome for Every Patient Every Time
Confidential and Proprietary – UnityPoint Health
2015 Hospitalist Program Development
• Develop regional and system level action plans to drive program evolution to 3rd generation standards
• Develop and implement system level solutions to address staffing needs
• Formalize leadership forums for hospitalist leaders to share best practices, identify issues needing common solutions and provide feedback on system level initiatives
13
Hospitalists: Best Outcome for Every Patient Every Time
Confidential and Proprietary – UnityPoint Health
NELSON FLORES KEY FINDINGS AND RECOMMENDATIONSJOHN NELSON MD
Brand Promise:
Best Outcome for Every Patient Every Time
14
Confidential and Proprietary – UnityPoint Health
UPH Hospital Medicine PracticesUPC-Employed or Managed Hospitalist Programs
Non-UPC Hospitalist Programs
3/23/20153rd Generation Hospitalist Model 15
Des Moines Central Iowa
Hospitalists
Penn Avenue
Cedar Rapids Quad Cities Waterloo
Dubuque Fort Dodge Madison Peoria
Methodist
Proctor
Sioux City
Confidential and Proprietary – UnityPoint Health
Program Structure &
Inter-relationship
s
Program Medical Director
Management Support
Relationships and
Communication
Integration with Medical Staff
Hospitalist Group Decision-
Making
Goal Setting
Services
Clinical Scope
Performance Improvement
Qualifications
Staffing Standards
Skill Mix
Performance
Management
Core Competencies
Performance Expectations
Performance Metrics
Dashboards
Accountability Systems
Aligned Compensation
Cost/Revenue Optimization
Program Infrastructu
re
Operating Systems and
Processes
IT and Business Analytics
Communication and Care
Coordination
Talent Manageme
nt
Recruitment and
Onboarding
Temporary Staffing
Resources
Retention Strategies
Professional Development
Promotion and Job Enrichment
Pathways
3rd GenerationHospitalist Program
3/23/20153rd Generation Hospitalist Model 16
Confidential and Proprietary – UnityPoint Health
Recommended System-Level Activities Create a system-level hospital medicine service line
leadership infrastructure
Define and disseminate UPH goals the hospitalist programs are being asked to align with
Maintain and enhance inter-region collaboration of hospitalist program leaders (medical directors and program managers)
Develop a process for requesting local exceptions to 3rd Generation requirements
Establish a basic ongoing leadership development program for hospitalist medical directors and program managers
Make available productivity, compensation and other benchmarking information to guide local decision-making
Make available training in quality/process improvement, Crucial Conversations, language and cultural sensitivity improvement, etc.
Provide centralized resources for periodic pro fee coding audits and ongoing documentation/coding training
Establish system-level performance metrics and dashboard
Develop standardized methodology for reporting hospitalist productivity and program revenues, expenses and financial support amounts
Develop standardized format for annual “State of the Hospitalist Program” reporting
Develop minimum criteria for hospitalist compensation plans, and process for plan approval
Develop criteria for local hospitalist FTE definitions
Develop reporting capabilities to support hospitalist efforts at reducing clinical variation and waste
Turn on Epic IP charge capture across system
Evaluate HIPAA-compliant text messaging and other communication options
Develop dedicated hospitalist recruitment resources at the system level
Develop and administer internal moonlighting job board
Develop and administer an internal “float pool” of hospitalists who can help cover where needed
Negotiate corporate contracts with locums companies
Work with hospital leaders to develop hospitalist job satisfaction survey process
Identify and/or provide resources to assist underperforming hospitalists
3/23/20153rd Generation Hospitalist Model 17
Confidential and Proprietary – UnityPoint Health
UnityPoint HealthOverall Observations and Priorities
Key Observations Top Priorities
There is significant variability among hospitalist programs
Some fairly mature and some struggling
Many programs struggle with hospitalist recruitment and retention
Few programs have robust performance information collection, analysis, or reporting capabilities
Few programs have formal operating systems and processes in place
Case management/care coordination initiatives are crucial to improved hospitalist performance
Stabilize core hospitalist staffing Staffing standards for each program
Ensure adequate staffing coverage
Use of APCs and clinical support staff
Hybrids and locum/PRN providers
Ensure clear relationships and accountability between hospital leaders and hospitalist program leaders
Develop system-level resources and support Performance metrics, performance
reporting, and business analytics
Recruitment and temporary staffing
Professional and leadership development
3/23/20153rd Generation Hospitalist Model 18
Confidential and Proprietary – UnityPoint Health
Program Structure &
Inter-relationship
s
Program Medical Director
Management Support
Relationships and
Communication
Integration with Medical Staff
Hospitalist Group Decision-
Making
Goal Setting
Services
Clinical Scope
Performance Improvement
Qualifications
Staffing Standards
Skill Mix
Performance
Management
Core Competencies
Performance Expectations
Performance Metrics
Dashboards
Accountability Systems
Aligned Compensation
Cost/Revenue Optimization
Program Infrastructu
re
Operating Systems and
Processes
IT and Business Analytics
Communication and Care
Coordination
Talent Manageme
nt
Recruitment and Onboarding
Temporary Staffing
Resources
Retention Strategies
Professional Development
Promotion & Job Enrichment Pathways
UnityPoint Health
3/23/20153rd Generation Hospitalist Model 19
Confidential and Proprietary – UnityPoint Health
20
Hospitalists: Best Outcome for Every Patient Every Time
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