The use of hospitalists at hospitals throughout the United States has become increasingly popular. Hospitalist programs can improve patient outcomes and reduce the need for admitting physicians to round on patients, both of which are attractive to hospitals looking to satisfy both patients and physicians.
Stephen Houff, MD, president and CEO of Hospitalists Management Group, discusses current trends in hospitalist programs.
Q: Within programs, what trends are you seeing regarding expectations for hospitalists?
Dr. Houff: Many hospitals are seeking high-service programs, and by that I specifically mean hospitalists that are procedurally competent and capable. They are looking for hospitalists that are willing to handle inpatient emergencies and are comfortable initiating ICU care. More and more, hospitalists need to be trained and certified in hospital-based procedures, such as placing lines and managing airways, and need to be willing to respond to rapid response calls in the hospital.
It is also becoming more common that hospitalists serve as the primary admitters of patients previously admitted by specialty physicians. Hospitalists have always managed ER unassigned inpatients and primary care referrals, but increasingly specialists such as orthopedic surgeons, neurologists, nephrologists and interventional cardiologists, are seeking hospitalists to be the primary admitter or a very active co-manager of hospital inpatients.
Q: Why are specialists now seeking hospitalists to serve as co-managers of patients?
SH: Because the design of their practice is such their incomes are driven primarily by the procedures they perform, the burden of the being primary call and manager of hospital inpatients competes with their livelihood. Also, many subspecialty groups are thinly covered on weekends and holidays, so the use of hospitalists is becoming increasingly attractive to specialists.
Strong hospitalist programs can give facilities a market share advantage. Specialists who seek strong hospitalist services will need to utilize institutions with these programs. They may preferentially refer to an institution with a strong hospitalist program as a result.
Q: What should hospitals that wish to use their hospitalist programs to attract referring physicians do to strengthen their hospitalist services?
SH: Hospitals should determine the service plan and scope of the hospitalist program, as well as its desired outcomes, before the program services patients. Regardless of whether the program is outsourced or in-house, it must have clearly defined expectations and plans to ensure that the program has the resources to meet those expectations.
Q: What is the biggest challenge to hospitalist programs?
SH: I think that many hospitals with in-house solutions find that the programs require more management resources and expertise than they thought. Although hospitals with in-house hospitalist programs may have successful employment relationships with primary care or specialty physicians, recruiting and maintaining [a hospitalist program] is a very different animal. Several years ago, hospitalists underwent a tremendous amount of wage inflation driven by a desire to bring in hospitalists and set up programs. Many hospitals rushed into the space without really considering what they wanted out of a program. If you don't set up a program with the right alignment and focus on productivity, it's very difficult to change the culture of the program.
Hospitalist programs face a high level of turnover and productivity challenges. Hiring young physicians and providing them with only a small amount of onboarding isn't enough to build a successful program that meets the outcomes expectations of the hospital. Strong physician leadership is required to lead and train the young physicians that are brought on to be hospitalists, and programs need to be able to benchmark and analyze outcomes data. Given that most in-house hospitalists are salaried, it is difficult for the health system to provide incentives to drive productivity and desired outcomes. Programs that provide incentives for performance and create leadership opportunities will attract motivated and talented physicians that will help the organization to achieve its goals.
Learn more about Hospitalists Management Group.
Stephen Houff, MD, president and CEO of Hospitalists Management Group, discusses current trends in hospitalist programs.
Q: Within programs, what trends are you seeing regarding expectations for hospitalists?
Dr. Houff: Many hospitals are seeking high-service programs, and by that I specifically mean hospitalists that are procedurally competent and capable. They are looking for hospitalists that are willing to handle inpatient emergencies and are comfortable initiating ICU care. More and more, hospitalists need to be trained and certified in hospital-based procedures, such as placing lines and managing airways, and need to be willing to respond to rapid response calls in the hospital.
It is also becoming more common that hospitalists serve as the primary admitters of patients previously admitted by specialty physicians. Hospitalists have always managed ER unassigned inpatients and primary care referrals, but increasingly specialists such as orthopedic surgeons, neurologists, nephrologists and interventional cardiologists, are seeking hospitalists to be the primary admitter or a very active co-manager of hospital inpatients.
Q: Why are specialists now seeking hospitalists to serve as co-managers of patients?
SH: Because the design of their practice is such their incomes are driven primarily by the procedures they perform, the burden of the being primary call and manager of hospital inpatients competes with their livelihood. Also, many subspecialty groups are thinly covered on weekends and holidays, so the use of hospitalists is becoming increasingly attractive to specialists.
Strong hospitalist programs can give facilities a market share advantage. Specialists who seek strong hospitalist services will need to utilize institutions with these programs. They may preferentially refer to an institution with a strong hospitalist program as a result.
Q: What should hospitals that wish to use their hospitalist programs to attract referring physicians do to strengthen their hospitalist services?
SH: Hospitals should determine the service plan and scope of the hospitalist program, as well as its desired outcomes, before the program services patients. Regardless of whether the program is outsourced or in-house, it must have clearly defined expectations and plans to ensure that the program has the resources to meet those expectations.
Q: What is the biggest challenge to hospitalist programs?
SH: I think that many hospitals with in-house solutions find that the programs require more management resources and expertise than they thought. Although hospitals with in-house hospitalist programs may have successful employment relationships with primary care or specialty physicians, recruiting and maintaining [a hospitalist program] is a very different animal. Several years ago, hospitalists underwent a tremendous amount of wage inflation driven by a desire to bring in hospitalists and set up programs. Many hospitals rushed into the space without really considering what they wanted out of a program. If you don't set up a program with the right alignment and focus on productivity, it's very difficult to change the culture of the program.
Hospitalist programs face a high level of turnover and productivity challenges. Hiring young physicians and providing them with only a small amount of onboarding isn't enough to build a successful program that meets the outcomes expectations of the hospital. Strong physician leadership is required to lead and train the young physicians that are brought on to be hospitalists, and programs need to be able to benchmark and analyze outcomes data. Given that most in-house hospitalists are salaried, it is difficult for the health system to provide incentives to drive productivity and desired outcomes. Programs that provide incentives for performance and create leadership opportunities will attract motivated and talented physicians that will help the organization to achieve its goals.
Learn more about Hospitalists Management Group.