Can your facility succeed with hospitalist program?
Ten critical musts’ your program needs
Maybe you think your hospital, physicians, and patients can benefit from a hospitalist program (see related story, p. 109). Maybe you are right. But before you get started, you need to make sure that the following 10 factors apply. Without them, says Dorothy Merriwether, president of the Houston consulting firm D. Merriwether & Associates, you limit your chance at success:
1. Supportive hospital administration. Merriwether says this means that the administration works collaboratively with medical staff to implement a program that meets community needs.
2. Capability of gathering and sharing data. You have to have the technology, personnel, and willingness to gather data on length of stay, cost per admission, high-cost DRGs, and patient demographics. And, says Merriwether, you have to be willing to share it with the hospitalists so that they and you can assess their performance and look for areas that need further improvement.
3. Mechanisms and personnel to educate physicians and patient population. You need to be able to help educate the physicians on what the system is and isn’t, says Merriwether. For instance, it isn’t a method of dealing with indigent patients. It is a tool for your case management repertoire.
4. Mutual trust across departments and specialties. Everyone has to be able to buy into the program and put the common good above that of his or her own specialty and department, says Merriwether. Turf wars only exacerbate the kind of problems you are trying to cure.
5. Team spirit among physicians providing hospitalist services. The inpatient management group has to be cohesive, Merriwether explains. Group members must share the same values and commitment to make it work. Productivity-based compensation helps this, preventing one member of the team from reaping the rewards of the system while not putting in as much work as the others.
6. Intact and active spiritual support program. Recent studies have shown the link between spirituality and healing. This is something that Merriwether says the hospitalist groups she works with have noted anecdotally for a long time. Many of the patients are seriously ill and need spiritual counseling. Hospital chaplains can also help direct poorer patients to some of the social and community services they may need.
7. Active case management program. This is pretty self-explanatory, says Merriwether. But the point is that hospitalists can’t be the only piece of your case management system. They are merely a part of it.
8. Strong emergency room department with fee-for-service reimbursement. When the ED is based on a fee-for-service system, its physicians are encouraged to turn over the rooms quickly. Merriwether says this helps to align incentives with the hospitalists, who are there to expedite patients through the system. "If ED doctors are on a flat fee, they aren’t [motivated] to turn the rooms over faster."
9. Balanced payer source. Your payer mix will determine if a hospitalist program is viable, says Merriwether. "If you have a lot of indigent care, this probably won’t work. If you have a high percentage of managed care, the physician is paid on a capitated and performance bonus system and there is a per diem system at the hospital, you don’t have aligned incentives. If you have a high Medicare and Medicaid patient population, this is not as profitable to the hospital. You really need to have a balanced payer source."
10. Recognition of hospital need to compensate hospitalists to alleviate financial burden of indigent care. You have to determine if you want hospitalists or an indigent care program, Merriwether says. "You have to proportionally share the burden of indigent care throughout the physician community, or you have to provide compensation for the hospitalists doing this care."
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