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An Update in Hospital Medicine 2006

An Update in Hospital Medicine 2006. Stacy Goldsholl, MD President, TEAMHealth Hospital Medicine. What is Hospital Medicine?. The care and management of the hospitalized patient. Hospital Medicine: The newest subspecialty of Medicine. Workforce of >20,000

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An Update in Hospital Medicine 2006

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  1. An Update in Hospital Medicine 2006 Stacy Goldsholl, MD President, TEAMHealth Hospital Medicine

  2. What is Hospital Medicine?

  3. The care and management of the hospitalized patient.

  4. Hospital Medicine: The newest subspecialty of Medicine • Workforce of >20,000 • Residency training tracks in Hospital Medicine • Fellowships available in Hospital Medicine • Specialty textbook in it’s second edition • Discussions underway for specialty certfication

  5. Hospitalist The Society of Hospital Medicine www.hospitalmedicine.org Hospitalists are physicians whose primary professional focus is the general medical care of hospitalized patients. Their activities include patient care, teaching, research, and leadership related to Hospital Medicine.

  6. Why use a Hospitalist? • Benefits to the Patient • Benefits to the Primary Care Physician • Benefits to the Hospital

  7. Patients Benefit from Hospitalists • Hospital availability • Clinical knowledge and focus • Patient Throughput and Patient Safety

  8. Primary Care Physicians Benefit from Hospitalists • Lifestyle and work life balance • Outpatient availability and productivity • Known entity for inpatient care needs

  9. Hospitals Benefit from Hospitalists • Physician champions for patient safety and quality improvements • Standardization of care • Patient Throughput and Length of Stay management • Decrease ED wait times • Recruitment of Medical Staff • Nursing satisfaction and retention

  10. Hospitalist Program = Hospital Medicine Program

  11. How many Hospitalists Today??

  12. 2010 Work Force Projections AJM 1999: 20,000-30,000 Hospitalists Wachter: (SHM 2005 Annual Meeting) 50,000 Hospitalists (surgical co-management) It’s a buyer’s market for the hospitalist…

  13. 2004 SHM Hospitals 34% Multispecialty 17% Academics 16% Hospitalist only group 20% Multi-state hospitalist only 9% Other ~5% 2002 SHM Hospitals 38% Medical groups 17% Academics 9% Self employed 3% Managed care 9% Hospitalist-only local/Multistate group 16% Hospitalist Employers

  14. Prevalence of Hospital Medicine Programs AHA 2003 Survey Results: • 1451 hospital medicine programs • 29% of all hospitals have a HMP • 55% of hospitals >200 beds • 71% of hospitals >500 beds • 3.93 hospitalists/100 ADC

  15. Support of Hospital Medicine Programs SHM 2001/2 • Mean dollar support: $295,000 SHM 2003/4 • Mean dollar support: $575,000 • $60,000 per FTE • 24/7 Program: $700,000 • $70,000 per FTE

  16. Thoughts on Support, Compensation and LOS Management What is one day LOS savings to professional fee revenue? • 560 cases/yr @ $50/subvisit = $28,000 lost professional fee revenue What is one day LOS savings to the hospital? • 560 days saved @ $500/day savings = $280,000 hospital savings

  17. Relationship between LOS Management and Physician Staffing

  18. Value Added Services • Code Blue Coverage • Rapid Response Teams • Leapfrog intensivist extenders (FCCS)/Integration of Intensivist Programs • 24/7 In-house Availability

  19. Does Real Time Admitting Translate into LOS Savings??

  20. Impact of Real time admitting (24/7) and Second daily visits on LOSCase Study: Covenant HealthCare, Saginaw, MI

  21. Value of One Day Saved 1 Day = $500 savings 1530 days x $500 = $765,000

  22. More Financial AnalysisHard vs Soft Savings

  23. Legislation Past and Present The Physician Availability Act (1999-2001 Indiana) The Hospital Patient Protection Act (2003 S. Carolina) • Both Acts mandate that any hospital greater than 100 beds provide a non-emergency medicine physician in-house 24 hours for emergency consultation • JCAHO considering similar recommendations

  24. Where will the Hospital Medicine Movement go from here?Hospitalists, Intensivists and Emergency Medicine Physicians

  25. The 10 Commandments of Hospital Medicine • Thou shall not confuse a hospitalist with a house officer • Thou shall never underestimate the industry demand for hospitalists • Thou shall never expect a HMP without support • Thou shall never expect a 24/7 HMP without a significant support • Thou shall incent hospitalists for aligned goals (bonus!) • Thou shall never be tempted to start a HMP understaffed • Thou shall honor your PMD’s with protected administrative time and develop their leadership skills • Thou shall not expect to be all things to all hospitals • Thou not covet local infrastructure support (case management, site coordinators, coding/billers) • Thou shall aggressively monitor data to annually demonstrate ROI • Subsidy is an evil word

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