What hospitalists must know about co-management


With patient co-management arrangements between hospitalists and other surgical and medical subspecialists becoming more common, HM17 attendees won’t want to miss Tuesday afternoon’s session at 3:15–4:20 p.m., “Redefining Co-management in Hospital Medicine.”

“We’ll provide hospitalists effective co-management programs at their respective hospitals,” said copresenter William Atchley Jr., MD, FACP, SFHM, a hospitalist with Sentara Heart Hospital in Norfolk, Va.

Dr. William Atchley Jr.

Dr. William Atchley Jr.

The session will review the history of co-management research and the metrics studied, discuss the practice management benefits of co-management, look at real-world examples, and glimpse into future directions and implications for practice.

More hospital medicine groups are getting involved in co-management, the presenters said. There are two primary models: one in which the hospitalist is the attending of record and the subspecialist is the co-manager and another in which the subspecialist is the attending of record and the hospitalist serves as the co-manager. “Either model can work with the right agreements put in place,” Dr. Atchley said.

Dr. Corey Karlin-Zysman

Dr. Corey Karlin-Zysman

There are several drivers for these agreements, added co-presenter Corey Karlin-Zysman, MD, FHM, FACP, chief of the division of hospital medicine at North Shore University Hospital, Manhasset, N.Y., and Long Island (N.Y.) Jewish Medical Center, which has multiple co-management arrangements in place in areas including orthopedics, urology, otolaryngology, trauma, neurosurgery, cardiology, and psychiatry. “Sometimes surgical co-managers want help and someone to take shared responsibility of the patient so they can focus on their area of expertise. Sometimes the driver is administrative, where someone reviews a subspecialty’s performance or throughput metrics and notes opportunities to work together to reduce hospital length of stay or readmissions.” With the average age of surgical patients rising, surgical subspecialists are becoming more reliant on hospitalists to manage co-morbidities to prevent them from being exacerbated perioperatively.

“We’ll go through some of what we feel are the undiscovered benefits of having a co-management service,” said copresenter Mark Goldin, MD, FACP, a hospitalist at Long Island Jewish Medical Center. “I think a lot of people will be interested to hear that because research on co-management has been mixed, up to this point.” For example, he said, SHM engagement surveys have indicated that hospitalists who do co-management may be at reduced risk of burnout.

Dr. Mark Goldin

Dr. Mark Goldin

For co-management to work well, said Dr. Goldin, “have a very clear, mutually agreed-upon service agreement that details who does what for the patient. That way, you can avoid a lot of the pitfalls of having a mission creep, with hospitalists taking on more and more responsibility.”

Also important is creating a metrics dashboard and monitoring and updating it regularly, Dr. Karlin-Zysman added. “Not only does it keep both sides honest, but it’s how you garner support from the C-suite.”

The Society of Hospital Medicine has resources available to help, Dr. Atchley said. The SHM website includes a white paper on co-management. There also is a listserv called HMS Exchange, in which hospitalists can discuss comanagement topics.

“Co-management is not going away. It’s something that hospitalists are going to be involved with,” Dr. Atchley said. “It’s important to come up with the right agreement and, at the same time, work with everybody in collaboration to improve patient care.”

Redefining Co-management in Hospital Medicine
Tuesday, 3:15–4:20 p.m.

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