But as a group, “it’s understood that we may not break even or generate positive cash flow,” he says. “Like most hospitalist groups, we have to be subsidized as far as the upfront cash flow, but there are benefits on the back end as far as reduced lengths of stay and better documentation.”
Dr. Bossard cautions against letting support staff take over certain duties. The group has avoided letting anyone but physicians take calls from referring primary care physicians, or make calls to primary care physicians at the time of discharge.
“We want to market ourselves as service oriented and felt that placing an intermediary in the communications process isn’t a good thing to do,” he says. “We don’t think it’s good to have secretaries triage calls from physicians. It takes a lot of the physicians’ time, but that’s time well spent.”
Dr. Wright says efficiency and cost containment can improve according to how well the hospitalist group works with the hospital infrastructure and how invested hospitalists and support staff feel in the success of their program. “If they know they’re valued and they feel like they have a say in the work they do, they’ll be more invested in the work they do,” she says. “That usually leads to more efficiency, in my experience.”
Though it’s important for hospitalist groups to work closely with hospitals, Dr. Nelson warns hospitalists not to copy the administrative structures and systems they see in hospitals. “It’s too easy for practices to make mistakes based on what is going on in hospitals,” he says. “They need to critically think about what’s needed in their practice.” TH
Lisa Phillips is a medical writer based in New York.