More than 15 years ago, the implementation of diagnosis-related groups (DRGs) moved hospital thinking from a la carte charging for each aspirin to managing the use of resources for the entire hospital stay, since their reimbursement was fixed. The DRG payment system as much as anything has encouraged hospitals to develop and support hospital medicine groups. Bundling would extend and expand a DRG-like concept to physicians.
Think of a future where physicians are not reimbursed for an admission work-up, three daily visits, and a discharge summary. Instead, they’d receive a global fee that might include the hospital care, transitions to the outpatient provider, and measurement of performance that might include patient satisfaction and a low readmission rate.
If we look at healthcare from the patient’s viewpoint, this is the kind of service for which they’re crying out. They want to move away from a system that even with the best providers leads to each expert doing his or her individual part well, but with voltage drops and white spaces as the patient moves through an uncoordinated non-system.
Hospitalists are in a unique position to be successful, especially as we look for strategies that align our performance with strong and engaged outpatient physicians and when we fully engage the entire healthcare team.
A Team Sport
Bundling and rewards driven by demonstrable performance create interlinking responsibilities for care among multiple physicians (primary care physicians, emergency physicians, surgeons, subspecialists, and hospitalists), as well as allied health professionals (registered nurses, nurse practitioners, physician assistants, pharmacists, therapists, social workers, and case managers).
While the makeup of the team is important, the environment in which it performs is most crucial for success. A system of healthcare delivery that focuses on and supports best practices and nudges—or forces—providers to make the right choice is of prime importance. In the end, a good system of care and one or two members of the team can save the entire enterprise, leading to the best outcome for the patient.
By the same token, a dysfunctional outlier on the team can sink everyone, including the patient. Think of the “new” healthcare as a crew team that needs a well-made boat (i.e., the system of care), a good coxswain (accountable physician), and a group of rowers, each of whom know and execute their roles. One rower can sink seven Olympians.
We are all in the boat together. We need to be clear where the finish line is and how best to get there. The future is in sight, and we need to continue to shape our role in helping the rest of the team get there. We must do this for ourselves, our profession, and—most of all—our patients today and tomorrow. TH
Dr. Wellikson is CEO of SHM.