Will these big players gobble up independent programs? That depends on how those programs are doing. “I haven’t heard of any programs being replaced if they’re doing all the right things and their costs are in line,” according to Dr. Atchley. “What you’re seeing is national companies either starting programs or salvaging programs that have failed.”
Managing a large number of hospital medicine programs provides these companies with a clearer view of what’s happening in the specialty as it grows and changes. One trend that they’re seeing is a sort of second phase, where hospitals that brought in hospitalists several years ago now seek to improve their programs.
“In the past year, we’ve seen [hospitals express] more need, more interest in a hospital medicine management company coming in and restructuring a struggling program or a failed program,” says Dr. Goldsholl.
EmCare observes the same trend. “Hospitals are a lot savvier than they were five or 10 years ago about the setup of a hospital medicine program,” says Dr. Wagner. “Some [hospital administrators] may be on their second or third program, and they know what they want. They ask about recruitment success, retention rates, your data gathering and reporting tools, and what you do specifically to support your physicians in terms of leadership, quality, and satisfaction.”
These expectations are not simply discussed; they become part of the contractual agreement. “Hospitals also want service deliverables written in the contract,” adds Dr. Wagner, “including physician performance in terms of patient satisfaction, primary care physician satisfaction, JCAHO core measures, and medical staff participation.”
Why Big May Be Better
A large group with an established infrastructure that includes standards for quality checks, patient satisfaction, and so on is appealing to hospitals. “Because of economies of scale, we can offer state-of-the-art technologies, billing and collection, and infrastructure,” says Dr. Singer. “We also have the ability to recruit physicians. Small groups cannot compete with that.”
Another attractive feature is the history that these groups have in a relatively new field. “We have a track record of setting up successful programs,” points out Dr. Reynolds. ”We’ve already learned from our mistakes.”
Working for a national corporation has its benefits, including opportunities for education and advancement and an infrastructure support that can take some of the workload off a hospitalist’s shoulders. Dr. Greeno points out that Cogent handles administrative work for the physicians, freeing up their time for patients.
“One guy said, ‘I like working here because it’s the best opportunity to practice pure medicine,’ ” he says. “Our physicians are not case managers; they’re not schedulers.”
And working as part of a large group provides a built-in network of colleagues. “There’s connectivity for the individual hospitalist, as well as the medical director, to learn from other hospitalists all over the country,” says Dr. Goldsholl.
Dr. Wagner names compliance as one of EmCare’s top benefits. “We code physician notes professionally, and the result is we have greater than 95% compliance with Medicare. That’s something a national company can bring to the table.”
Some say that a large organization may be more attractive to job candidates. “Our size demonstrates stability to candidates,” says Dr. Williams. “Recruiting is a 100%-a-year job, and this helps.”
He points out that a larger program can appeal to the hospitalists within it: “Another advantage to our size is that we can draw from a pool of physicians to help out if necessary.”
Of course, physicians who work for larger companies may enjoy a larger compensation package, which can benefit the entire specialty. “In my experience, when [large companies] have come into my area, their salary structure is higher,” says Dr. Atchley. “The result is that other groups in the region have to change their salaries to be more competitive.”