Hospitalists play a significant role in efforts to improve both the quality and cost-effectiveness of patient care in acute care settings.

 

Hospitalists are at the center of efforts within the acute care setting to foster a team-based, coordinated approach to patient care, and they help to ensure a smooth transition of patients to post-acute care facilities or to post-acute care delivered by the patient’s primary physician. 

The work of the more than 40,000 hospitalists across the country addresses concerns at the top of most hospitals’ priority lists, including the reduction of hospital-acquired conditions and avoidable readmissions. Given the growing numbers within the hospital medicine specialty and the significance of the hospitalist’s role, hospital executives should understand the key principles and characteristics of an effective hospital medicine group. Building such an understanding can better position hospital executives to enhance the value of hospitalists’ contributions—and develop and support the capabilities needed for their organizations to thrive in a more value-based payment and care delivery environment.

The Society for Hospital Medicine (SHM) recently released an assessment guide for hospitals and hospitalists to gauge and improve the effectiveness of their hospital medicine groups. Recognizing that hospitals are directly involved with most hospital medicine groups as either employers or contractors, executive leaders for hospitals are one of two primary audiences for the assessment guide (the second is hospitalists themselves). Although the chief medical officer will be the primary executive involved with the hospital medicine group, the assessment guide’s attention to such areas as contributions to hospital efficiency, compliance with documentation and coding guidelines, and optimization of clinical resource utilization and cost per stay makes the guide of considerable interest to CFOs as well.

Assessing the Effectiveness of Hospital Medicine Groups

The assessment guide is the product of two years of work, involving the input and feedback of more than 200 reviewers. SHM’s board of directors authorized the work in recognition of the variability in capabilities and performance of hospital medicine groups today. The resulting guide offers a framework for assessment of hospital medicine groups, outlines a pathway for improvement, and better defines the hospitalist’s central role in coordinating team-based, patient-centered care in the acute care setting.

The assessment guide is designed to be aspirational, helping to raise the bar for the specialty of hospital medicine. It identifies 47 key characteristics of an effective hospital medicine group organized under 10 principles. CFOs will be interested in five of these principles, in particular.

Principle 3: The hospital medicine group has adequate resources. This principle addresses the resource needs of hospital medicine groups, helping to ensure that all team members within the group have meaningful roles and that the group has followed an objective approach in determining its resource needs.

Principle 4: The hospital medicine group has an effective planning and management infrastructure. This principle includes characteristics focused on strategic and business planning, budget preparation, performance benchmarking and reporting, and documentation and coding compliance plans.

Principle 5: The hospital medicine group is aligned with the hospital and/or health system. Characteristics gathered under this principle include development of annual goals that align with the goals of the hospital or health system served, compensation models that align hospitalist incentives with hospital or system goals, and collaboration with patient relations and risk-management staff to reduce errors and improve patient perception of the hospital. 

Principle 6: The hospital medicine group supports care coordination across settings. This principle includes characteristics that define the hospitalists’ role in establishing effective and reliable communications with the patient’s primary care physician or other providers in the non-acute care setting and contributing to hospital efforts to improve care transitions.

Principle 7: The hospital medicine group plays a leadership role in addressing key clinical issues in the hospital and/or health system: teaching, quality, safety, efficiency, and the patient/family experience. Characteristics defining the hospital medicine group’s effectiveness under this principle include meaningful contributions to improving hospital efficiency and optimizing clinical resource utilization, supporting continous quality improvement, and enhancing the patient and family experience.

A full listing of the principles and characteristics is available.

Collaborative Partners to Improve Value

Since its inception, HFMA’s Value Project has emphasized the need for close collaboration between finance professionals and clinicians. Hospitalists are natural partners in this collaborative effort. I was able to witness hospitalists’ interest in collaborating with finance first hand at last year’s SHM annual conference, where I moderated a well-attended and enthusiastically received session on “The Value of Hospitalist Programs,” which featured examples of finance and hospitalist collaboration from Miami-based Baptist Health South Florida and from OSF HealthCare, based in Peoria, Ill. That interest is continued in the program for this year’s SHM annual conference, which will be held at the end of this month in Las Vegas. A new conference track dedicated to “Bending the Cost Curve” has been added, featuring such sessions as “What Keeps Your CFO Awake at Night: What Hospital Finances (Should) Mean for You.”

SHM’s new assessment guide provides a tool for identifying where some of the most fruitful collaborations with hospitalists might lie within your organization. It also describes how the hospital’s and hospital medicine group’s shared goals of high-quality, cost-effective care might best be attained. If you have not yet begun to work with your organization’s hospital medicine group to achieve these goals, now is a good time to start. 


James H. Landman, JD, PhD, is director, healthcare finance policy, perspectives and analysis, HFMA.

Publication Date: Monday, March 03, 2014

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