From the Society

The state of hospital medicine in 2018


 

“Recently there’s been an increased focus on paying hospitalists to focus on quality rather than just productivity. Some of our clients are willing to pay for that, and we are trying to assign value to this non-billable time or adjust our productivity standards appropriately. I think hospitals definitely understand the value of non-billable services from hospitalists, but still will push us on the productivity targets,” Ms. Himebaugh said.

Roberta Himebaugh, senior vice president of acute care services for the national hospitalist management company TeamHealth

Roberta Himebaugh

“I don’t believe hospital medicine can be sustainable long term on flat productivity or flat RVUs,” she added. “Yet the costs of burnout associated with pushing higher productivity are not sustainable, either.” So what are the answers? She said many inefficiencies are involved in responding to inquiries on the floor that could have been addressed another way, or waiting for the turnaround of diagnostic tests.

“Maybe we don’t need physicians to be in the hospital 24/7 if we have access to telehealth, or a partnership with the emergency department, or greater use of advanced care practice providers,” Ms. Himebaugh said. “Our hospitals are examining those options, and we have to look at how we can become more efficient and less costly. At TeamHealth, we are trying to staff for value – looking at patient flow patterns and adjusting our schedules accordingly. Is there a bolus of admissions tied to emergency department shift changes, or to certain days of the week? How can we move from the 12-hour shift that begins at 7 a.m. and ends at 7 p.m., and instead provide coverage for when the patients are there?”

Mark Williams, MD, MHM, chief of the division of hospital medicine at the University of Kentucky, Lexington, said he appreciates the volume of data in the report but wishes for even more survey participants, which could make the breakouts for subgroups such as academic hospitalists more robust. Other current sources of hospitalist salary data include the Association of American Medical Colleges (AAMC), which produces compensation reports to help medical schools and teaching hospitals with benchmarking, and the Faculty Practice Solution Center developed jointly by AAMC and Vizient to provide faculty practice plans with analytic tools. The Medical Group Management Association (MGMA) is another valuable source of information, some of which was licensed for inclusion in the SoHM report.

Dr. Mark Williams, chief of the division of hospital medicine at the University of Kentucky

Dr. Mark Williams

“There is no source of absolute truth that hospitalists can point to,” Dr. Williams said. “I will present my data and my administrators will reply: ‘We have our own data.’ Our institution has consistently ranked first or second nationwide for the sickest patients. We take more Medicaid and dually eligible patients, who have a lot of social issues. They take a lot of time to manage medically and the RVUs don’t reflect that. And yet I’m still judged by my RVUs generated per hospitalist. Hospital administrators understandably want to get the most productivity, and they are looking for their own data for average productivity numbers.”

Ryan Brown, MD, specialty medical director for hospital medicine with Atrium Health in Charlotte, N.C., said that hospital medicine’s flat productivity trends would be difficult to sustain in the business world. But there aren’t easy or obvious ways to increase hospitalists’ productivity. The SoHM report also shows that as productivity increases, total compensation increases but at a lower rate, resulting in a gradual decrease in compensation per RVU.

Pressures to increase productivity can be a double-edged sword, Dr. Williams added. Demanding that doctors make more billable visits faster to generate more RVUs can be a recipe for burnout and turnover, with huge costs associated with recruiting replacements.

“If there was recent turnover of hospitalists at the hospital, with the need to find replacements, there may be institutional memory about that,” he said. “But where are hospitals spending their money? Bottom line, we still need to learn to cut our costs.”

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