Hospitalists are looking to SHM to provide comanagement guidelines—a basic “rules of engagement”—that could be used to help shape discussion with the specialists and hospital administrators who are central to the process and payment issues surrounding patient care.
Yet many hospitalists are uncomfortable with comanagement, even as the idea continues to gain acceptance nationwide. Those were the takeaways from the Comanagement/Consultative Hospital Medicine Forum at HM09 in Chicago, one of nearly 20 forums that afforded hospitalists more interactive settings to address HM issues.
SHM board member Sylvia McKean, MD, FHM, outlined steps HM programs need to consider before they create a comanagement service:
- Identify the need for the service;
- Develop ground rules; and
- Establish measures.
“It’s tough to make a one-size-fits-all,” Dr. McKean, assistant professor of medicine at Brigham and Women’s Hospital in Boston, told one hospitalist who called for SHM to develop a practice model. She did, however, explain that the society has formed a task force to address issues including screening tools, protocols, and reimbursement for services.
Sean Fennessey, MD, of Swedish Medical Center in Seattle, expressed concerns about training, billing, and liability. A new comanagement agreement with the neurosurgery department at Swedish is helping to fund an expansion at his HM group.
“My group is using the phrase ‘physician manager,’ ” Dr. Fennessey said. “We think we would likely be involved in these cases at some point. Maybe we should be involved early on and find the medical issues.”
Two dozen hospitalists with a knack for software and a desire to start using it more want SHM to be a leading voice for information technology (IT) in healthcare.
“We’re on board with the idea of IT. … It’s impossible for us to get to high-reliability systems without the IT tools,” said Kendall Rogers, MD, assistant professor at the University of New Mexico School of Medicine and chair of SHM’s IT task force. But “Where is hospitalists’ place at the table?” he asked.
Dr. Rogers and other task force members hope to answer that question in the coming months as they introduce online resources that point HM groups to proven IT systems and Web-based forums to keep the conversation current. The task force hopes to reach out to organizations that are focused on patient safety and QI.
IT Forum participants agreed SHM can educate non-IT-savvy physicians, letting them know the technology is there to help and that new systems rarely come off the shelf without a glitch. Training and software improvements will help alleviate those pressures, Dr. Rogers says. Interactive discussion networks should stimulate evaluation of systems used in HM, allowing peer groups to help each other discover the right fit for their groups.
Value and Competition
“Subsidy” as a dirty word and increased competition from specialists were just a couple of the weighty topics discussed at the Community-Based Hospitalist Forum at HM09 in Chicago.
John Nelson, MD, FHM, FACP, a principal in national hospitalist practice management consulting firm Nelson/Flores Associates and a columnist for The Hospitalist, and Winthrop F. Whitcomb, MD, FHM, a hospitalist at Mercy Medical Center in Springfield, Mass., led a group discussion about issues affecting their groups. Dr. Nelson asked hospitalists if they were dealing with competition from specialists. “Years ago, it was just us,” he said. “No one ever presented the case that their specialty deserved or required special support from the hospital. Now, essentially they all do.”
Jesse Wagner, MD, FHM, a hospitalist at Middlesex Hospital, a 275-bed facility in Middletown, Conn., said hospital administrators need to understand the value of the subsidies they provide HM groups. “I hate the term ‘subsidy.’ It’s not a subsidy because of the value,” Dr. Wagner said. “When I present my administrators with our budget every year, part of the value I present is they don’t have to pay for call for medicine at all because we’re there, we’ll do it. … The hospital’s bottom line is clearly better for having a hospitalist program.” TH