SHM Annual Meeting 2008SHM Annual Meeting 2008

Value of a Hospitalist Program

Michael Wagner, MD FACPChief General Medicine, Tufts-NEMC

Steve Houff, MDCEO, Hospitalist Management Group

Robert Bessler, MDCEO and President, Sound Inpatient Physicians

Outline of DiscussionOutline of DiscussionOutline of DiscussionOutline of Discussion

Drivers of hospitalist medicineDrivers of hospitalist medicine

CustomersCustomers

AssumptionsAssumptions

Value propositionValue proposition

Quality and costQuality and cost

Benefits of a hospitalist programBenefits of a hospitalist program

2

Hospital driversHospital drivers1.1. Utilization ManagementUtilization Management

• LOS, cost per case, denialsLOS, cost per case, denials2.2. Quality ManagementQuality Management

• Core measuresCore measures3.3. Customer serviceCustomer service

• Patient satisfactionPatient satisfaction• PCP satisfactionPCP satisfaction• Specialist satisfactionSpecialist satisfaction• Nursing satisfactionNursing satisfaction

Medical staff driversMedical staff drivers1.1. Uncovered unassigned callUncovered unassigned call2.2. House dutiesHouse duties3.3. PCP recruitmentPCP recruitment4.4. Specialist re-focusing on specialty care Specialist re-focusing on specialty care

WorkforceWorkforce1.1. Ready made training programs Ready made training programs 2.2. Recent graduates lifestyle orientedRecent graduates lifestyle oriented

Drivers for Hospitalist MedicineDrivers for Hospitalist MedicineDrivers for Hospitalist MedicineDrivers for Hospitalist Medicine

HospitalistHospitalist

Program CoordinatorProgram CoordinatorProgram CoordinatorProgram Coordinator

Patient and FamilyPatient and FamilyPatient and FamilyPatient and Family

Nursing and CMNursing and CMNursing and CMNursing and CM

Hospital adminHospital adminHospital adminHospital admin

Ancillary servicesAncillary servicesAncillary servicesAncillary services

Primary Care PhysicianPrimary Care PhysicianPrimary Care PhysicianPrimary Care Physician

Specialist PhysicianSpecialist PhysicianSpecialist PhysicianSpecialist Physician

Third Party PayersThird Party PayersThird Party PayersThird Party Payers

Rehab/LT care facilityRehab/LT care facilityRehab/LT care facilityRehab/LT care facility

Emergency MedicineEmergency MedicineEmergency MedicineEmergency Medicine

Hospitalist CustomersHospitalist CustomersHospitalist CustomersHospitalist Customers

4

Physician core competence Physician core competence – Hospitalist have basic knowledge and skill to care for Hospitalist have basic knowledge and skill to care for

hospitalized patientshospitalized patients

Physicians are team playersPhysicians are team players– Work as team (sign in/out)Work as team (sign in/out)– Complete medical records and hospital related paperworkComplete medical records and hospital related paperwork

Practice management infrastructure Practice management infrastructure – DocumentationDocumentation– Coding, billing, complianceCoding, billing, compliance– MalpracticeMalpractice– Recruitment, scheduling, payrollRecruitment, scheduling, payroll– Enrollment and credentialingEnrollment and credentialing

Assumptions Assumptions (what the world expects)(what the world expects)Assumptions Assumptions (what the world expects)(what the world expects)

The Value PropositionThe Value PropositionThe Value PropositionThe Value Proposition

Value = Quality / CostValue = Quality / Cost

6

Clinical outcomesClinical outcomes– MortalityMortality– ReadmissionReadmission– Absence of bad outcomesAbsence of bad outcomes

Quality managementQuality management– JCAHO core measuresJCAHO core measures– Pathway adherencePathway adherence– Peer reviewPeer review

Customer service (satisfaction)Customer service (satisfaction)– Press-Ganey, Gallup, etc.Press-Ganey, Gallup, etc.– Site specific surveysSite specific surveys– ReputationReputation

Domains of QualityDomains of QualityDomains of QualityDomains of Quality

Cost of direct patient careCost of direct patient care– LOSLOS– Cost per caseCost per case– UtilizationUtilization

Cost of supportCost of support– SubsidySubsidy– Indirect costsIndirect costs

ReputationReputation– Negative reputationNegative reputation

Domains of CostDomains of CostDomains of CostDomains of Cost

Benefits of a Hospitalist ProgramBenefits of a Hospitalist ProgramBenefits of a Hospitalist ProgramBenefits of a Hospitalist Program

Medical leadership Medical leadership

Improve medical record documentationImprove medical record documentation Compliment orphaned servicesCompliment orphaned services Nursing support and educationNursing support and education Halo effect to other medical staffHalo effect to other medical staff Support the emergency departmentSupport the emergency department Increase referrals from non-aligned or Increase referrals from non-aligned or

distant physiciansdistant physicians