Web Extra: Developing Best Practices for Hospitalist Groups
James H. Landman
Early in the program year for HP3: Hospitalist Program Peak Performance—an Illinois PREP initiative program that provides educational resources, motivation, and a process improvement structure for hospitalist programs—participating hospitalist groups complete a self-assessment that measures the group’s performance against best practices for hospitalist groups. Of particular interest to HFMA members are the two following elements of that self-assessment, including the desired attribute and the best practices identified relative to promoting that attribute.
Hospitalist Program Finances
With this element, the objective is to assess the degree to which the hospitalist group understands and is involved in their program’s finance.
Attribute: The hospitalists know how their practice is performing financially and the drivers of financial performance for their organizations.
Two best practices are identified with respect to this attribute:
- The hospitalists regularly see budget variance reports and are engaged in discussions about how to address variances.
- The hospitalists receive information about the total annual financial support and the financial support per FTE being provided to the practice by the hospital.
Participation in Organizational Performance Improvement
Here, the objective is to assess the degree to which hospitals play an active role in fostering improved performance.
Attribute: The hospitalists are actively involved in the design and implementation of organizational performance improvement initiatives.
Four best practices are identified relative to this attribute:
- Many of the hospitalists actively participate in and champion multidisciplinary performance improvement teams and initiatives.
- At least some of the hospitalists have received formal training in process improvement techniques such as Lean, Six Sigma, or similar quality or process improvement programs.
- The hospitalist practice has assumed responsibility as a group for developing at least one performance improvement program or tool (e.g., a standardized order set or care protocol) in the last year.
- At least one hospitalist is an active participant in the team that oversees the electronic health record and/or other clinical IT applications.
A Culture of Ownership for Hospitalist Programs
A chief goal of the HP3 program is to help healthcare organizations foster a strong culture of ownership within their hospitalist programs. To this end, healthcare leaders should consider the following questions focused on evaluating the culture of the hospitalist program:
- When the hospitalists have difficulties with physicians in other specialists, do they gather to figure out how they can address the problem? Or do they say, “I told the chief medical officer about this, and nothing happened”?
- Do the hospitalists know about their performance on value-based purchasing metrics, and are they looking for information on where they need to improve?
- Are the hospitalists aware of the revenue generated both from payers and from hospital financial support? Do they diligently seek both operating efficiencies and revenue cycle enhancement?
James H. Landman, JD, PhD, is director, thought leadership initiatives, HFMA, Westchester, Ill.
For more information, see James Landman's "A Statewide Partnership for Reducing Readmissions", hfm, June 2013