Hospital medicine has arrived at just the right moment for a healthcare delivery system in need of change. Medical errors and cost escalation continue to dominate the headlines. With regard to quality the National Quality Foundation is attempting to define standards and health plans are creating incentives through Pay for Performance programs. With regard to costs, there are expectations that they will rise even higher as the baby boomer population ages.
Providing high-quality, cost-effective care to acutely ill patients in the hospital is becoming more complex. It requires physicians who can focus on inpatient care, allowing primary care physicians, surgeons, and subspecialists to concentrate on what they do best. Providing the best care available to the hospitalized patients can no longer be done by one health professional acting alone, no matter how wise and well meaning. Hospitalists have dedicated their professional careers to providing team-based, patient-centered care that achieves cost-effective, quality outcomes.
As the specialty society for hospital medicine, SHM provides a vehicle to define this new specialty. We are doing this with our surveys of hospitalist productivity and compensation, by articles that appear in the medical and lay press, and by the Core Curriculum for Hospital Medicine that will be published in the coming months.
Hospitalists provide significant value to their healthcare communities and to patients, physicians, other health professionals, and administrators well beyond the benefits of direct patient care. This supplement to The Hospitalist, the official publication of SHM, is a compendium of papers designed to further define the full range of benefits provided by the specialty of hospital medicine.
Physician Methods of Payment Outdated
As the American healthcare system is reshaped, we must recognize that part of the problem is the outdated way in which we pay for medical services. Physicians are rewarded as piece workers by the unit of the visit or the procedure. This has led to a culture of doing more things for one individual patient rather than attempting to make the hospital work better for all patients. In addition, this unit-based payment does not reward efficiency or effectiveness.
Hospitalists are, in many ways, change agents in the inpatient environment. Hospitalists can spend as much as 50% of their professional time improving the entire enterprise by taking on the responsibilities of other physicians, developing plans to improve quality educating hospital staff or medical trainees, addressing efficiencies through earlier discharge or improved throughput in the ED or ICU, creating teams of health professionals, or being available around the clock.
The diverse work that hospitalizes perform is very important and time consuming. However, the traditional payment scheme for physicians does not provide a direct way to compensate the hospitalist for this skill and expertise.
Hospitals have realized that these hospitalist skills bring real value to their health communities. And hospitals have been willing to invest their own funds to grow and support their hospital medicine groups to the tune of $75,000 or more per hospitalist per year. This is not a hand-out or a subsidy. This is true commerce. Hospitals continue to get significant benefits from their hospitalists.
In fact, when confronted with the choice of whether to ask the hospitalists to ''just see patients'' to generate more direct patient fees or to continue to improve the effectiveness and efficiency of their health communities, enlightened hospital executives vote with their money and ask the hospitalists to improve quality, build teams, reduce LOS, improve throughput, educate their staff, and generally build the hospital of the future.
With regard to paying physicians, SHM believes that the Pay for Performance movement is an important step in the right direction. Hospitalists welcome a reimbursement scheme that rewards institutions that follow best practices and achieve superior outcomes.
Audiences for this Supplement
This supplement, How Hospitalists Add Value, has two major audiences. First, hospitalists need to categorize what they can and will do for their hospitals and healthcare communities. They need to understand that this is not voluntary work to be done in their spare time. The provision of these services provides strategic and market benefits to their hospital.
Second, there are hospital administrators and leaders at 1,500 hospitals who have been crucial to growing hospital medicine to more than 12,000 hospitalists. They recognize that hospitalists are core to their future. This supplement will further confirm and document the ways in which hospitalists can help their organizations. The facts put forth in these papers can create a rationale for continued support with dollars and manpower, not as a subsidy but as an intelligent investment for the hospital.
Hospitalists Add Value
- Hospitalists can provide measurable quality improvement through setting standards and compliance.
- Hospitalists can save money and resources by reducing LOS and achieving better utilization.
- Hospitalists can improve the efficiency of the hospital by early discharge, better throughput in the ED, and the opening up of ICU beds.
- Hospitalists can create a seamless continuity from inpatient to outpatient care, from the ED to the floor, and from the ICU to the floor.
- Hospitalists can make other physicians' lives better and help hospitals to recruit and retain PCPs, surgeons, and specialists.
- Hospitalists can do things other physicians have given up by admitting patients without health insurance or by serving on hospital committees.
- Hospitalists can be instrumental in creating teams of healthcare professionals that make better use of the talent at the hospital and create a better working environment for nurses and others.
- Hospitalists can have a leading role in educating nurses, other hospital staff, and physicals in training.
- And hospitalizes can take care of the acutely ill complex hospitalized patients.
Add it all up and it is clear that hospitalists are a resource to hospitals in meeting the complex challenges of their healthcare communities. Hopefully, this set of important papers will define these issues more clearly and assist hospitalists and their hospital leaders in creating a stable and supportive environment for collaboration that can lead to better healthcare for our patients.