Lehigh Valley Hospitalist Services
by Michael J. Pistoria, DO
Michael J. Pistoria, DO
Medical Director, Lehigh Valley Hospitalist Services
Associate Program Director, Internal Medicine Residency
Assistant Professor of Medicine, Penn State College of Medicine
Kevin Flynn, MS, Administrative Director
Lehigh Valley Hospital
Cedar Crest Boulevard and I-78
Allentown, PA 18105
Lehigh Valley Hospital - Cedar Crest
Ardeth Copeland, MD
Shoban Dave, MD
John Davidyock, MD
William Ford, MD
Arvind Gupta, MD (site leader)
Kweku Hayford, MD
Lehigh Valley Hospital - Muhlenberg
Donna Dowlatshahi, Coordinator
Jeff rey Faidley, MD
Melissa Geitz, DO
Wayne Howard, DO (site leader)
Melissa Liu, MD
Dan Mulcahy, DO
Gonzalo Pimentel, MD
Deborah Sterner, Coordinator
All ABIM certified
Lehigh Valley Physician Group and Specialty Physicians of LVHHN, PC
Lehigh Valley Hospital and Health Network (LVHHN) is one of the largest teaching facilities in Pennsylvania. LVHHN consists of three clinical campuses, two of which focus on inpatient care: Lehigh Valley Hospital-Cedar Crest (LVHCC) and Lehigh Valley Hospital-Muhlenberg (LVH-M). The Network has more than 1,100 physicians and is a major clinical campus for Penn State’s College of Medicine. LVH-M opens a new patient care, tower in March 2005 and has approximately 200 inpatient beds on campus. The campus offers cardiac catheterization and open heart surgery capabilities, and its intensive care unit is augmented by a tele-intensivist system. A 24/7 hospitalist program was launched at LVH-M in July 2003 and is presently staffed by six full-time physicians.
The LVH-CC campus is preparing to undergo a major expansion that will bring its total beds to approximately 800 by 2007. This campus is a tertiary care center, featuring medical and surgical intensive care, a Level I trauma unit, a burn center, open heart surgery, perinatal care and renal transplantation services. LVHHN also boasts active teaching programs, with residencies in internal medicine, surgery, OB/GYN, family medicine, and emergency medicine. There are also fellowships in cardiology, pulmonary/critical care, and hematology/oncology. The LVHCC hospitalist program provides 24/7 service staffed by six physicians and was launched in July 2004.
All LVHS physicians are salaried employees. A bonus was paid to the physicians at LVH-M at the end of the first year of services. A bonus structure is being defined for both campuses, focusing on clinical, quality, and service measures. Each hospitalist receives 4 weeks vacation and 5 days of CME. A stipend is also provided for CME. Hospitalists receive malpractice coverage and reimbursement for licensure expenses. Physicians are also entitled to a benefits package that includes disability insurance, a supplemental retirement plan, and a 401(k)/403(b).
Chart abstraction and billing is done by the employer. At the end of each shift, the hospitalist submits a list of the patients seen and/or admitted. Each campus has a program coordinator certified in coding who reviews the charts for documentation and submits for the appropriate level of care. This system has worked well in ensuring proper billing and in allowing prompt feedback to the hospitalists regarding their documentation.
LVH-M: The LVH-M hospitalist program was developed to provide a resource for primary care physicians in the community who wished to focus on outpatient care. Primary care physicians were identified and ranked in terms of their willingness to refer patients to the hospitalist program. Care was taken not to target groups who already had referral patterns to existing LVH-M groups to minimize the adverse impact of the hospitalist program on these groups. Hospitalists then made visits to these offices to explain the hospitalist program and answer questions from the PCPs. The program quickly became successful and now has a well-established referral base.
LVH-CC: The major driver of the hospitalist program at the Cedar Crest campus was assisting with the residency program. The existing faculty group staffed two of the five inpatient teaching services and was becoming increasingly busy as a result of new referrals. The hospitalist program helped decompress some of the volume from the existing faculty services by taking over one of the other inpatient teaching slots and establishing an overflow service. The program also seeks referrals from physicians outside the hospital’s traditional referral radius. The hospitalists have also worked with the medical and surgical subspecialists, developing standards for admission of subspecialty patients to the hospitalist service.
LVH-CC: The LVH-CC hospitalists are intimately involved in the internal medicine residency program. They staff one of five inpatient teaching services during the morning. In the afternoon and overnight hours, the hospitalists cover their own service and the two pre-existing academic inpatient services. The hospitalists round either formally or informally with the residents of these three teams in the afternoon. They also review each new admission between noon and 8 a.m. to the three inpatient teams and provide bedside teaching on these patients.
A second daytime hospitalist also staff s an overflow service to ensure compliance with Residency Review Committee guidelines regarding service and admission caps. If the three teaching services hit their respective caps, any new patients are admitted by the hospitalists to this overflow service. In addition to rounding on the overflow patients, the second hospitalist staff s a consultative medicine service with a PGY-2 or PGY-3 resident.
The hospitalists participate in morning report and the resident lectures. The hospitalists are also involved in faculty development with the academic general internists as well as other residency initiatives.
LVH-M: Hospitalists at the LVH-M campus have no formal involvement in the teaching programs (osteopathic rotating internship and emergency medicine residency) at that campus. They are an available resource for housestaff, however, and have received many positive compliments from the housestaff for their assistance with difficult patients.
LVH-M: The primary rounding hospitalist works Monday through Friday from 7 a.m. to 3 p.m. A second hospitalist works Monday through Friday from 10 a.m. to 7 p.m. and is available on Saturday if the census is high. This hospitalist also works the Sunday night shift beginning at 7 p.m. and ending 7 a.m. Monday. The overnight hospitalist works from 7 p.m. to 7 a.m. Monday through Saturday. There is always a back-up hospitalist available in case of emergency or significant influx of patients that overwhelms the system. The hospitalists work an average of 16 shifts per month.
LVH-CC: There are two hospitalists scheduled during the daytime hours. The hospitalist rounding with the resident team works 7 a.m. to 7 p.m. Monday through Sunday. The overflow/consult hospitalist works 8 a.m. to 8 p.m. Monday through Friday and 7 p.m. to 7 a.m. Saturday and Sunday. The overnight hospitalist works 7 p.m. to 7 a.m. Monday through Friday. The hospitalists work an average of 16 shifts per month.
LVH-M: As the campus continues to grow, the hospitalists aim to become more intricately involved in process improvement and quality-improvement measures. The program is exploring ways of becoming active in the teaching program, either with residents and medical students or with physician assistant students. Additionally, as the Network’s tele-intensivist initiative develops, the hospitalists are working closely with their critical care colleagues to provide top-quality ICU care for patients.
LVH-CC: The LVH-CC hospitalists are becoming increasingly involved in efforts to maximize institutional efficiency and throughput. This program is also seeking to establish itself as a premier research program, in both the educational and clinical realms.
Hospitalists at both campuses are becoming involved in various hospital committees such as Therapeutics and Quality Assurance. Their expertise has also been utilized in various throughput initiatives such as an automated discharge instruction process and electronic signout development.
Given the rapid growth of both programs, staffing needs are expected to increase considerably. One long-term goal is to make it possible for hospitalists to rotate between the two campuses to allow them a variety of experiences. A hospital medicine elective is being developed for PGY-3 residents interested in a career in hospital medicine. There has also been some preliminary discussion of a hospital medicine fellowship that would emphasize teaching, research, and palliative care.
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