Practice Economics

Keys to Successful Hospitalist Co-Management Programs


 

Summary

Co-management is a growing area of pediatric HM involving both surgical and medical subspecialties. According to SHM, co-management is “shared responsibility, authority, and accountability for the care of a hospitalized patient across clinical specialties.”

Motivation for starting a co-management program may come from administrators concerned about quality, safety, or nursing; surgeons or subspecialists driven by time or knowledge constraints; or hospitalists looking to enhance patient safety, clinical skills, and practice development.

Pitfalls for hospitalists include patient “dumping,” care fragmentation, and working outside their scope of practice.

SHM identifies five keys to success for hospitalist co-management programs:

  1. Identify obstacles and challenges, including the program’s stakeholders, goals, risks, and assumptions.
  2. Clarify roles and responsibilities for areas such as admission and discharge, communication, documentation, and delineation of responsibilities. These should be specified in a service agreement.
  3. Identify champions, ideally to include a surgeon or subspecialist, hospitalist, and administrator, as well as input from a family advisory council.
  4. Measure performance in areas such as length of stay, resource utilization, quality, and safety metrics.
  5. Address financial issues. Most programs require some financial support to supplement billing revenue.

Key Takeaway

The AMA ethical guidelines for co-management arrangements state that the highest quality care, not economic considerations, should be the guiding factor. Additionally, one physician should ultimately be responsible for the patient, there can be no kickbacks, and co-management arrangements need to be disclosed to the patient or family.

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