HM12 Experts Teach Hospitalists to Deal with Practice-Management Issues


Dr. Pistoria

Hospitalists took advantage of more than 90 educational sessions at HM12 in San Diego.

If such a thing exists, hospitalist Dwayne Gard, MD, of Memorial Health in Savannah, Ga., has a good practice management problem: In recent years, his HM group started collaborating with Memorial’s gastrointestinal team to admit their patients. Now, Dr. Gard and his colleagues are in similar discussions with neurosurgery. And ments provide steady revenue for the hospitalist group, too much growth, too fast, can be as dangerous as too little.

“There are a lot of demands, from an administrative standpoint, to cater to the needs of some of the subspecialists at a time where we really need to grow the number of hospitalists within our program before we even consider expanding our services,” says Dr. Gard, whose group has 10 FTE hospitalists and has an average patient census of 90-110 at the 500-bed hospital. “I let our administration know it’s a challenge we’re willing to take on as long as we have the support to get the staff in that we need to safely see those patients.”

Just how to let them know is the art of practice management, a topic that dominates much of SHM’s annual meeting. From a popular, daylong CME pre-course to a dedicated practice-management track, hospitalists looking for real-time advice on the business side of medicine came away from HM12 last month with brown bags full of tips.

“This is a huge pause, a huge opportunity to pause and remind ourselves what’s important,” says Steven Pestka, MD, chief of the hospitalist service at Newton-Wellesley Hospital in Newton, Mass. “And then recognizing that all those other things … need to be kept in context and need to be limited so that the core running of the group can be performed.”

For Dr. Gard, gaining management skills at this year’s annual meeting was a two-step process. First, they sent seven members of their HM groupthree hospitalists, two non-physician providers (NPPs), an administrator, and an office managerto San Diego. The annual-meeting team spread across as many sessions as they could, including pre-courses on value-based purchasing and practice management. Second, and perhaps more important, the team members didn’t decide ahead of time what advice they were going to glean; they came with agendas and schedules of what breakout sessions

they viewed as most valuable while remaining flexible.

“It always seems like while you’re here, you learn something you weren’t expecting,” Dr. Gard adds, “and something that’s actually maybe more pertinent than the reason you maybe thought about coming to the meeting to begin with. You can take that home as well.

“It’s important for our group because a lot of our new hires, the majority of our new hires, are residents within our own training program. Unless we hire hospitalists from outside our own network, it does tend to be the same people in the same system—not thinking outside the box, like we need to do in this day and age.”

Advanced Degrees of Hospital Medicine

Benjamin Frizner, MD, director of the hospitalist program at Saint Agnes Hospital in Baltimore, wonders whether earning an MBA would give him an advantage in “getting into the mind of the CEO and the C-suite.”

“What’s their frame of mind when I go into meetings, so I can talk their language, frame things in a different way?” Dr. Frizner says during a break in a practice-management pre-course. “The topics [at HM12] are focused to a lot of the problems we are facing.”

The issues are specific to individual HM groups. Dr. Frizner also wants to know how to better speak to colleagues and care team members in the hospitals his group services. Madonna Ringswald, DO, medical director of the hospitalist program at Baptist Hospital Northeast in La Grange, Ky., took over management of her group a little more than two years ago and came to San Diego to bounce questions off people who have more experience than she does. Dr. Pestka took home suggestions on how to recognize hospitalist performance in non-compensated ways.

“This is the best meeting I’ve ever been to,” Dr. Ringswald says. “If you can’t find a lecture [that appeals to you], there’s something wrong with you.”

Renewed Focus

Dr. Pistoria

In the annual meeting’s wrap-up address, Michael Pistoria, DO, FACP, SFHM, hospitalist at Lehigh Valley Health Network in Allentown, Pa., described the future of practice management as an amalgam of all the issues HM faces. Improved communication, a renewed focus on costs and high-value care, and continued adoption of best practices found at institutions across the country are all ways to better operate individual practices.

“We move ahead by doing what we do best in hospital medicine,” says Dr. Pistoria, the course director for HM13, which will be May 16-19, 2013, just outside of Washington, D.C. “We get together as teams, we collaborate with each other across our institutions, within our own institution, and professionally. We come up with that one small or big idea that improves care at the level of the patient and at the macro level.”

CMS’ CMO Offers Practice-Management Tips

Dr. Conway

Patrick Conway, MD, MSc, FAAP, SFHM, a pediatric hospitalist and chief medical officer of the Centers for Medicare & Medicaid Services (CMS), has advice for hospitalists looking to better manage their practice:

  • Understand your hospital’s data. What is collected? What is analyzed? Where are the gaps in that research? What does it all mean for you?
  • Take leadership roles. Lead multidisciplinary teams, teach others around you, become known for a focus on evidence-based approaches.
  • Familiarize yourself with resources. CMS, SHM, and myriad other medical organizations and private agencies offer free or low-cost resources. When looking to solve problems, it’s possible someone already has done so.
  • Create collaborative forums. Physicians feel engaged when they believe they can voice opinions in an accepting environment. The reverse is also true.
  • Stay connected to clinical care, even if it’s just occasional shifts to help out.

“My challenge to you is please don’t sit on the sidelines,” Dr. Conway says. “Please be actively engaged in your local system in creating this change. This is not for me or CMS, but stating the obvious: It’s why we went into medicine.”

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