Other payment changes, including bundling of both the facility fee (Medicare Part A) and the professional fee (Medicare Part B), further plants the hospitalist group firmly in the middle of hospital funding and allocation of manpower. Bundled payments would not necessarily flow to the hospital to distribute to the physicians, but more likely would be managed by a joint physician-hospital partnership. The entire enterprise (doctors and the hospital) would be rewarded for efficient and effective care (i.e., using the appropriate resources to generate the best outcomes.) Decisions would need to be made and negotiated to allocate funds to the hospital and to each physician who participated in the patient’s care, based on time, skill, and performance. With hospitalists taking an important role in most inpatient care, one can see how central they will be in this new system of payment.
But it would be naïve to think that today all hospitalists are ready to step up to the new challenges brought on by payment reform and the increasing demand for documented performance improvement and patient safety. That is where SHM and some of the partnerships we are entertaining come in.
SHM has seen hospitalists coming out of their residency training or from a previous practice mode entering hospital medicine as a career with enthusiasm and drive, but needing key new skills if they are to step up to and into new roles as change leaders at their hospitals. With this in mind, SHM has created our Practice Management Institute with training in starting, managing, growing, and improving a hospital medicine group, including front-end skills in billing and collecting, as well as dashboards for data collection and analysis, and taking the hospitalist enterprise to the next level.
Knowing that helping create the next generation of hospital medicine leaders and hospital leaders is a key competency for hospital medicine, SHM’s successful Leadership Academy already has started nearly 1,000 hospital medicine leaders in the right direction in the last four years. Understanding the growing need for trained leaders in quality improvement and patient safety, SHM has been providing courses for quality improvement leaders, as well as practical implementation tools and strategies in quality improvement and patient safety in Web based resource rooms, as well as mentored implementation strategies and expert training that gets results on a local level on the fronts lines where care is delivered and results matter.
Several things are clear right now.
- Hospital CEOs, the rest of the C-suite, medical staffs, and allied health recognize that hospitalists are not only part of their medical landscape, but a potential partner in many of the acute care changes coming to their hospitals.
- We are moving to a time where there is more action than talk about changing the way hospitals and their doctors are paid and what level of performance is expected, to a time where CMS and the Blues are making incremental changes that will reshape the way hospitals function.
- While the first steps may be CMS not paying for “never events” or CEO compensation being tied to patient satisfaction, more likely sooner than later we will see coverage for the 47 million uninsured, a revamping of primary care, a shift to value based purchasing, and with a bundling of payment for inpatient care.
- Some who are near the end of their professional careers may have the luxury of playing out the string and waiting out any changes. For hospitalists who are by and large at the beginning of their careers, and by the very virtue of their practice styles right smack in the middle of the hospital, literally and figuratively, this is not a choice but a destiny. We need to embrace change, prepare for our role, and create a future that works for our patients, our health communities, and ourselves.