Medicolegal Issues

Focused on the Practice


Most HM groups (HMGs) participate in quality initiatives in their hospitals, according to new SHM research. Moreover, 7 out of 10 HMGs participating in QI initiatives are leading those efforts at their hospitals.

The findings are part of SHM’s 2008-2009 Focused Survey, the latest in a series of reports commissioned by the Practice Analysis Committee. The survey and report concentrate on topics of interest from SHM’s comprehensive, biannual survey of its membership.

The survey compiled responses from 145 HMG leaders. In addition to QI initiatives, participants in the survey responded to a variety of questions, including quality-based incentives, hospitalist turnover, and the use of part-time hospitalists.

These surveys answer the kinds of questions that often come up when hospitalists and hospitals begin to evaluate their performance and plan for the future.

—Joe Miller, SHM’s executive advisor to the CEO

“This is certain to be a conversation starter for hospitalists, hospital executives, and others,” says Burke Kealey, MD, FHM, medical director for hospital medicine at St. Paul, Minn.-based HealthPartners and chair of SHM’s Practice Analysis Committee. “The Focused Survey is an opportunity for SHM to answer some of the pressing questions that healthcare executives and providers have about managing a hospitalist practice within the larger context of the hospital.”

Hospital executives and hospitalists use SHM survey findings to better understand what is going on in the specialty, says Joe Miller, SHM’s executive advisor to the CEO. “These surveys answer the kinds of questions that often come up when hospitalists and hospitals begin to evaluate their performance and plan for the future,” Miller says. “We use their questions as source material for this survey, so we can help them answer questions like, ‘How are most hospitalists participating in QI?’ or ‘How are other hospitalists using part-time staff members?’ ”

Practice Management Courses at UCSF Conference

This fall hospitalists and HMG administrators will have new opportunities to make their practices more efficient. SHM will present two practice management courses Sept. 23 before the regional HM conference sponsored by the University of California at San Francisco:

  • “Best Practices in Managing a Hospital Medicine Program” will feature new content for 2009. It is designed for individuals seeking to improve the management and operation of an existing HM program, or to start a new program.
  • “Fundamentals of Inpatient Coding and Documentation: Getting Paid What You Deserve” will aim to enhance a practicing hospitalists’ ability to document and code clinical services.

Both courses were presented at a sold-out HM09 last month in Chicago. Course offerings at regional conferences offer hospitalists who were unable to attend the annual meeting the same opportunity at continuing education, says Joe Miller, SHM’s executive advisor to the CEO. “There’s clearly a demand from hospitalists for the kind of real-world education that the courses on best practices and coding offer,” he says. “We’re glad we can meet that demand.”

For more information, visit the new course micro-site at

Hospitalists Lead the Way

Hospitalists continue to be at the forefront of QI initiatives within their hospitals, according to the latest survey. Almost all respondents (96.5%) reported that their HMG participated in QI programs; the average HMG has six hospitalists playing an active role in QI within the hospital.

The survey also found that 72.1% of respondents involved in QI activity reported that their hospitalists were “responsible for leading project(s)” on QI initiatives.

“The findings about the active role hospitalists play in QI initiatives may surprise even the most staunch advocate of QI within the hospital medicine specialty,” says Leslie Flores, MHA, SHM’s director of the Practice Management Institute and leader of the Focused Survey research. “In essence, it shows that nearly every hospitalist group is active in promoting QI, and that the vast majority of them are taking a leadership position to improve quality. … It is remarkable and extremely exciting that hospitalists are so deeply involved in QI in their organizations.”

The survey identified patient safety, clinical QI, and quality-related IT initiatives as most popular.

Quality Incentive Compensation

In order to track HMG quality incentive compensation, the 2008-2009 Focused Survey asked similar questions about the topic to questions in the 2006-2007 Focused Survey. Quality incentive compensation—paying bonuses or additional payments for meeting QI measures—not only increased markedly in the past two years, but a majority of HMGs also have adopted the practice. The number of HMGs that have quality incentive compensation plans has increased by 39% since 2006, according to the survey.

Nine out of 10 HMGs that receive performance-based compensation reported that the source of the compensation was the hospital or health system. In most cases, the compensation was paid to an individual hospitalist, which represents a shift from 2006, when more groups reported receiving the compensation directly.

The survey also shows that hospitals and HMGs use a number of process measures to evaluate QI incentives, including participation in quality or safety committees, transition of care measures, or core measures for heart failure, pneumonia, and acute myocardial infarction.

New View of Practice Administrators

Another new SHM report reveals that nonphysician administrators (NPAs) are also eager to grow professionally in the HM community. The report, presented at the HM09 Administrators Special Interest Forum, illustrates that many practice administrators—HMG employees responsible for operations and administration—are highly credentialed and actively seeking opportunities for networking and professional development.

Few practice administrators have attended SHM conferences, and many say they are unaware of the resources available to them through SHM.

“Ask most hospitalists, and they’ll tell you that nonphysician administrators are critical to the success and operation of their hospital medicine group,” says Leslie Flores, director of SHM’s Practice Management Institute. “This research indicates that we can do a lot more to promote the existing opportunities for continuing education and collaboration—like the pre-courses and the practice management track at the annual meeting—to help administrators do their job well.”

SHM’s Administrators Task Force commissioned the first-of-its-kind NPA survey. The findings will be used to create new SHM initiatives and materials that promote and define the role of NPAs within the specialty. HM09 included pre-courses on best practices in managing a HM program and inpatient coding and documentation, as well as a variety of breakout sessions on practice management topics.

“Our recent educational sessions and the report represent just a few of the many steps necessary to actively address their needs and improve collaboration between administrators and their physician counterparts,” Flores says.—BS

New Numbers Dispel High Turnover Myth

For years, the conventional wisdom throughout the healthcare community has been that HM suffers from a high turnover rate among its hospitalists. Focused Survey findings suggest otherwise. In fact, turnover rates for hospitalist groups have remained constant since 2005. Nearly a third (31.7%) of HMGs reported no turnover at all within the past 12 months.

“Getting an accurate idea about turnover in hospitalist groups has been an ongoing challenge in our research,” Flores says. “In this year’s Focused Survey, we provided clearer definitions and asked more specific questions to improve our measurement of turnover.”

The added specificity only served to reinforce findings from previous surveys that showed relatively low turnover rates. The most recent research revealed a 12.7% turnover rate, compared with 13% in 2007 and 12% in 2005.

The latest Focused Survey also includes detailed findings on turnover among full-time hospitalists compared with part-time hospitalists.

Part-Time vs. Full-Time

The new data challenge long-held assumptions about the role of part-time hospitalists. The survey queried HMGs about full-time and part-time hospitalist staff, and the proportion of time that each employee covers in the hospital.

Although there isn’t a consensus about what constitutes a full-time hospitalist, it is clear that they cover the vast majority (85%) of HMG staff hours. Part-time hospitalists are responsible for 10% of hospitalist staff hours, and “casual” hospitalists—temporary hospitalists or moonlighters—make up the remaining 5%.

Part-time hospitalists share the same responsibilities as their full-time colleagues, according to the report. More than 70% of HMG leaders said their part-time staff is deployed to cover the same shifts and responsibilities as full-time staff. Many HMGs use part-time staff to cover night and weekend shifts.

Trend Today, Initiative Tomorrow

Taken together, SHM’s bi-annual survey and Focused Survey have begun to reveal some of the most prevalent trends within the specialty, including low turnover and a specialty-wide QI emphasis. However, Flores sees room for additional research in the near future.

“There is a lot more to learn about the nature of hospitalists’ involvement in organizational quality initiatives and what benefits that involvement is delivering to their organizations,” she says. “The survey suggests some areas, particularly in the quality arena, where SHM can develop additional programs and services to support hospitalists and the work they do.”

The 10-page 2008-2009 Focused Survey report is available at TH

Brendon Shank is a freelance writer based in Philadelphia.

Chapter Update

Philadelphia Tri-State Area

The Philadelphia Tri-State Area chapter kicked off its 2009 meeting March 26 with its new “pharma-free” format. The chapter’s decision to forgo an expensive meal and industry-sponsored lecture was the result of an agreement to create more open dialogue among its members.

Chapter co-presidents Jen Myers, assistant professor of clinical medicine and patient safety officer at the Hospital of the University of Pennsylvania, and Erik DeLue, MD, MBA, medical director of the hospitalist program at Virtua Memorial Hospital in Mount Holly, N.J., kicked off the meeting, which focused on recruiting in a competitive market. Despite SHM’s collective recruiting challenges, most medical directors indicated that their groups were fully staffed.

Future meetings will be held at various medical institutions around the greater Philadelphia area. The next is to be held this month at Christiana Medical Center in Wilmington, Del. Future topics will be centered on pragmatic, nonclinical concerns for hospitalists, such as how to best utilize allied health providers.

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