Monthly Archives: October 2014

An overview at one year

One year at our newest site in Wilkes-Barre has come and gone and with it, a lot of changes. Starting fresh at a facility that simply hasn’t been progressive in the transition from fee-for-service to pay-for-performance has not been easy. Taking a facility where specialists run the show and transitioning to hospitalists who can manage in a more cost effective and efficient manner was initially met with resistance by many specialists. Perhaps we came on too strong initially, since, after all, this whole hospitalist thing came as a complete culture shock to them. Fortunately, we were able to show an ever increasing split between our data metrics versus the private physician community. That included length of stay, case mix index, and others. Those differences add up to millions of dollars to the hospital when extrapolated over time, and that’s why the administration has been totally supportive of trying to promote the growth of our program.
It isn’t an easy task. What do you say to the worst offenders in the hospital, the ones with the extra-long lengths of stay who waste resources and cost the hospital money? “Well doctor, we want you to give your patients to the hospitalists because we can save money and they do a better job”. Not exactly a way to endear yourself to the medical staff. Economics does speak volumes these days, though, and the hospital does indeed want us to grow because we simply do a better job of inpatient care. By better, they mean more efficient and more cost effective. When we do a better job, people get out of the hospital faster & that saves the hospital lots of money. Larger than that, I think that the higher quality issue is far more important. Hospitalists are supposed to be able to provide care that is better, as in up to date, accurate and effective care. Our group meets every month and has a journal club. We review the latest literature & keep up with the latest standards of care. We work hard to provide the highest quality of care possible and all of our staff are always encouraged to keep up with the latest news in the medical literature. That’s the ‘better’ type of care that I think about. Interesting though, most data suggest that higher quality of care is actually more cost effective as well, so being a top notch doctor usually means being a more cost effective one as well. It has been gratifying that this has been noticed and the administration has given us their full support to continue to expand.
Year two will bring a different set of challenges as we continue to grow. We want to start to put our stamp on the inpatient process and really start to transform things. We have talked about improving patient flow from the ED, geographic rounding, better handoffs, team rounds with nursing, and a host of changes that will result in better communication and better patient care. If we do that, the ‘better’ care becomes more cost-effective care, and the entire hospital benefits in addition to the patients. That’s the brass ring of being a hospitalist. We love the challenge of getting there.