The growth of hospital medicine since its inception 20 years ago has been nothing less than phenomenal. The specialty has ballooned from just a few hundred physicians to become one of the largest in the country.
According to a recent NEJM study, more than 50,000 hospitalists currently practice in the U.S., making it the third largest specialty behind general internal medicine and family medicine. Over 75 percent of hospitals now number hospitalists among their ranks -- and demand continues to grow.
The reasons for such rapid growth are well known to any hospital executive: The presence of hospitalists leads to improved quality, patient safety, and efficiency of care. But the question is, are you finding that to be true with your facility’s hospital medicine program?
Hospitalist Revenue Gap Widening
Due to the popularity and rapid growth of this field, hospitalist salaries have risen substantially. From 2010 to 2016, earnings grew by more than 30 percent (including 10 percent growth just since 2014).
At the same time, hospitalist revenue has remained relatively flat, meaning there is a widening gap between what hospitalists bring in as clinical income versus what they get paid.
Many hospitals have been willing to support this growing specialty financially, primarily through stipends furnished by the hospitals or health systems in which they practice. But as budgets tighten and margins decrease, it’s more important than ever that hospitalists demonstrate their value and show a return on the hospital's investment, both financially and qualitatively.
4 Ways Hospitalists Can Show Value
There are many ways hospitalist programs can prove their value relative to ROI and quality care. Here, we share four key ways your hospital medicine team should be benefitting your hospital:
Achieving Metrics and Goals
Medicare payment to hospitals -- aka value-based purchasing -- is increasingly dependent on the performance of facilities concerning specific quality metrics. Examples include process measures (core measures), experience measures (patient satisfaction), outcomes (such as mortality), and cost of care.
By partnering with the hospital to achieve these metrics goals, your hospitalists should impact the amount of Medicare revenue that your facility receives. In most cases, this increased revenue can far surpass the stipend required to support the hospitalist program, providing a clear return on investment.
Reducing Readmission Rates
Readmission rates and hospital-acquired complications such as catheter-associated UTIs and decubitus ulcers impact a hospital's reimbursement. By gaining proficiency at improving the continuum of care, hospitalists can help alleviate the problems that lead to readmissions. Has your hospital seen a downward trend in readmissions since launching its hospitalist program? Or, is it achieving a reasonably low rate the hospitalist team is helping to maintain?
A truly impactful way hospitalists can produce value is to become experts and champions of your hospital’s electronic health records (EHRs).
No doubt your hospital staff works hard to motivate all physicians to use computerized physician order entry (CPOE) to meet meaningful use standards, which also impact the hospital’s bottom line.
But since hospitalists usually manage many more patients than other specialists, consider looking to your hospitalist group to be leaders of EHR use and CPOE.
Focusing on Documentation
Hospitalists can further provide value by focusing on appropriate documentation of the patient’s diagnosis and severity of illness, to capture all the comorbidities and complications.
This practice will help the hospital bill for the appropriate DRG and improve its case mix index (CMI). It can also significantly impact revenue and show a very clear ROI for the hospitalist program.
Hospitalists can be valuable assets to any hospital, both from ROI and quality patient care standpoints. To accomplish these goals, they will need to achieve Medicare value-based payment metrics, reduce admission rates by providing an optimized continuum of care, champion EHRs, and focus on proper documentation.
In doing so, the administration will have little doubt that the hospital could perform nearly as well or run just as efficiently without the presence of a hospitalist program and the value it supplies.