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• Filed under: Article, Practice Management, Features

• Keywords: co-management, finances, expansion, billing

New Tools of the Trade

From: The Hospitalist, June 2009

by Richard Quinn

Andrew Fishmann, MD, FCCP, FACP, listened for more than an hour as an award-winning hospitalist talked about strategies to improve communication between physicians and administrators. Brian Bossard, MD, FACP, FHM, gleaned lessons from case studies of how two HM groups (HMGs) navigated the adolescent years. And dozens more hospitalists sat still for the bulk of an hour as they were given a nuts-and-bolts tutorial of HM finances.

Welcome to SHM’s new practice management track, a three-day series of training sessions that debuted at HM09 and focuses on the inner workings of HMGs—from startup to coding and billing to expansion. “There’s always a quality track, there’s always a clinical track, and there’s always a leadership track,” says Kimberly Dickinson, vice president of operations for Cogent Healthcare in Brentwood, Tenn., and an SHM Career Satisfaction Task Force member. “This was trying to bring together some of the nonclinical aspects.”

The experiment drew positive reviews, if rooms crowded with physicians—some lined up along the walls—are any indication. Dr. Fishmann, a Cogent co-founder who is practicing as a hospitalist with California Lung Associates in Los Angeles, says the courses give younger hospitalists different perspectives. “It’s taking doctors a little out of the hospital and putting them in the boardroom,” he says. “You don’t have a choice. … You need to be involved and have more input.”

The practice management courses are structured to give a broad overview of nearly every facet of opening and operating an HMG. One popular course, which ran nearly 15 minutes long because of participant questions, focused on managing HMG growth. Another session spent more than an hour taking physicians through comanagement issues that arise during collaborations with surgeons.

Real-Life Experiences

Most of the courses were led by familiar SHM leaders. But several attendees said they enjoyed sessions that were led by rank-and-file hospitalists and administrators who live the front-line struggles every day.

The “Case Studies in Managing Program Growth” course featured detailed explanations of the growing pains of HM programs in Michigan and Massachusetts. In the former case, Carole Montgomery, MD, talked about how the Michigan Medical PC group she helped start in western Michigan struggled to formalize certain procedures when it signed its first contract with a hospital in 2002. The group doubled its hospitalist roster and instantly went from an informal HM practice in which everyone knew each other and had relatively similar opinions to a business in which it was unclear who would make major decisions.

In response, Dr. Montgomery’s group crafted a mission statement, created a hospitalist executive committee to make routine operational decisions, and changed how it negotiated contracts with hospitals. Soon after, the group fired its first physician. Last year, the group instituted “internal governance guidelines” to make management decisions clearer. Dr. Montgomery says each of the developments taught her that solving major issues takes patience and a willingness to continually adapt. “I thought I was done each time,” she says. “Now I realize it’s an interactive process.”

Dr. Bossard

Results-Oriented

Peter Short, MD, FAAP, CPE, medical director of Northeast Hospital Corp., shared his recent struggles to hire one hospitalist and expand night coverage. Hospitalists in Dr. Short’s service, who practice at Beverly Hospital in Beverly, Mass., resisted the change at first, not wanting to add additional night-shift responsibility. Dr. Short also spoke about financial concerns to the group and the hospital. After explaining the pros and cons of hiring a sixth rounder, the hospitalists embraced the idea. So far, hospital administrators have had zero complaints, as the first three months of data show a reduction in length of stay by 0.3 days and an average cost decrease of roughly $500 per case.

Dr. Short also explained an unexpected byproduct of the hiring: Night work proved so popular that the hospitalists have demanded that they receive a specified number of overnight shifts a year. “They went from not wanting it to fighting for it,” Dr. Short says proudly. “There is no one-size-fits-all for hospital programs.”

Dr. Bossard, who founded Inpatient Physician Associates in Lincoln, Neb., says the types of detail-oriented presentations made by Drs. Montgomery and Short are useful if physicians learn lessons they can take home and adapt to their practice. “If it’s a lot of smoke without an action item or a bullet point we can latch on to,” he says, “it’s not as helpful.”

Richard Quinn is a freelance writer based in New Jersey.