It’s been another successful year at Advanced Inpatient Medicine in 2017. How do we define success? Making patient care better, faster, safer, & of overall higher quality at the hospitals where we provide hospitalist care. How do we measure that success? It’s all about system & process improvement; finding ways to create changes which result in improved outcomes for patients. We do this while maintaining volume control, work-life balance, and overall satisfaction of our providers. Whether it was moving to a geographic rounding model in Wilkes-Barre, which improves the multidisciplinary approach to care and subsequent improved outcomes, or creating telemetry guidelines to hasten patient flow from the ED in Scranton, our focus on continuous quality improvement remains very successful.
Another measure of success is in recruiting. We have many recruiting interviews scheduled for the month of December as we continue to expand. As more & more traditional outpatient providers transition out of the hospital in 2018, AIM will be poised for growth. When you have a rare group that actually cares about every individual provider and focuses on quality of care and work-life balance, it usually results in our group standing out to recruits. In fact, because of growth projections, AIM plans to add at least 7-8 physicians and 3-4 APCs next year.
Expansion of our Post-Acute division remains a major goal as well. Expanding to other skilled facilities and growing the census in those facilities that AIM already maintains a presence is a virtual certainty for 2018. We have demonstrated through hard data that our involvement in the post-acute market has resulted in improved cost utilization, improved outcomes, shorter lengths of stay, and improved star ratings for those facilities that we serve.
Where do we go from here? Look for a major announcement shortly as AIM positions itself for the long-term future with significant improvement in infrastructure to support growth and the addition of administrative staff to improve efficiency. AIM continues to move forward as the best hospitalist program in the Northeast. For now, that means NE PA. Soon, Northeast US? Big news coming soon…
When AIM was founded over nine years ago, it was created with one purpose. Namely, to provide care of the hospitalized patient that was better, faster, safer, and more cost effective than before. The approach was and still is completely different than the vast majority of hospitalist programs out there that are profit driven. Keeping volumes down to improve quality by allowing staff the time they need to excel is still a novel approach. Taking care of our staff so they have a good work-life balance gives them the energy & motivation to strive for excellence. These concepts are so simple and so successful that you would think they would be widely adopted. Yet, here we are, one of those rare programs that actually cares about every employee and remains solely focused on quality.
A physician that interviewed recently described our approach, along with our excellent benefits package, as maybe ‘too good to be true’. She & her family are lovely people and hopefully will join AIM eventually, but I think it’s sad that this recruit was actually a little unsure because of our approach being so unusual as to make it almost hard to believe. Based on what’s out there, she has every right to be skeptical since 20-25 daily encounters and frequent burnout & staff turnover seems to be the current state of hospitalist affairs, to the point where it’s become accepted as ‘normal’. Are we really so disenfranchised and settled into these ritualized routines of 20+ encounters and punishing shifts daily that AIM keeping it to 15-18 encounters a day seems unbelievable? When the average hospitalist lasts only about four years in a program before moving on as is the case now, hospitalist medicine has a problem.
In the long run, I hope that everyone moves to the quality focused format that AIM has been so successful with. In the meantime, being surrounded by overworked, unappreciated, & burned out hospitalists at so many other programs sure helps with recruiting. Once an interview candidate visits and speaks with members of our team, we usually end up adding a new provider. That’s good for AIM, but not good for hospitalist medicine as a specialty. I think hospitalist medicine has ceded control of its own growth and identity to large hospitalist management groups focused on profits and expansion over quality. That’s going to come back to haunt our profession down the road. Well, AIM will continue to stand alone in our region as a group that understands that patient care is our focus, not dollars. That will never change.
Getting our new site in Wilkes-Barre off the ground has been a rewarding, but intense, experience. Getting a chance to attend the annual Society of Hospitalist Medicine meeting this past week in Las Vegas has been a great way to recharge the batteries after months of hard work. As usual, inspiration was everywhere, with plenty of innovative ideas around and great people to network with. One of the big topics was the recent release of the ‘Key Principles and Characteristics of an Effective Hospitalist Medicine Program’. They were created essentially as an assessment guide for hospitals & a framework for hospitalist groups to look at ways to improve their capabilities and performance. There are ten guiding principles and 47 characteristics listed, which serve as a benchmark to self assess our program to see where we stack up as compared to the gold standard. I am happy to say that AIM stands strong. Our group embodies these standards in almost every aspect. That’s not to say that some of these principles don’t need a little more refinement, but the core structure is there. Our focus on team based care that is patient centered and focused on aligning goals with those of the hospital fits this gold standard well. Working on improving care coordination across care settings by working closely with referring providers is another key principle that AIM has embraced. Playing a leadership role in the hospital in key areas such as patient safety and quality improvement is another core value of our group that is reflected nicely in the publication. In fact, given the similarities of our mission with the new Principles and Characteristics of an Effective Hospitalist Medicine Group, this is yet another testament that AIM remains at the forefront of hospitalist care. These principles and characteristics will no doubt be tweaked over time, but AIM will continue to remain one step ahead of the curve.
As this conference concludes, it’s time to get back to work and apply some fresh ideas to our program to keep AIM a step above the rest. It’s been a great conference for learning new aspects of care, networking for fresh perspectives on ideal hospitalist care, and to verify AIM’s standing as one of the top hospitalists programs in the country. We will be reviewing these principles as a group and looking for ways to raise the bar yet again.
Returning to the annual national Society of Hospitalist Medicine conference always manages to reinvigorate and motivate me to continue to run the best Hospitalist programs in the region. I define best as most efficient, cost effective, and with the highest quality and patient satisfaction. Yesterday, Dr. Patrick Conway spoke about the ideal Hospitalist in 2014 and beyond as part of the opening remarks on day one. We have come a long way since Dr. Robert Wachter’s little group of inpatient physicians. The common theme of the entire meeting was summarized nicely by Dr. Conway: that all hospitalists must buy in to the concept that we need to be the drivers and the leaders in health care reform, that we need to embrace and become the leaders in effective change, and it is up to us at our individual hospitals to show everyone how to be more efficient, cost effective, and maximize the patient experience. Does this sound familiar? You may have just read almost those same words in AIM’s philosophy section on this web site. AIM embraces this challenge of being the best in all these areas.
Speaker number two of the morning was Dr. David Feinberg, CEO of the UCLA health system. Dr. Feinberg’s talk is one that i hope that all hospitalists can view on the SHM web site so we can all be reminded that it all starts with the patient. His title was ‘Healing Humankind One Patient at a Time’, and he spoke of never being satisfied and getting it right ‘all the time’. He mentioned that 85 out of 100 patients at UCLA give the hospital experience the highest rating, which he said made them the ‘cream of the crap’. He wanted to get it right 100% of the time. That’s no easy task, but I echo his statements, especially regarding mentally making every patient a family member and treating them like you would your own. I have used this same analogy when teaching students, and it works well.
There is some validation when I go to meetings like this that AIM remains way ahead of the curve in terms of the excellent care we provide. Our group remains committed to the team approach, a collaboration among the doctors, nurses, social workers, ancillary personnel and anyone else involved in patient care to create a unified system that minimizes risk, improves satisfaction, and controls costs. Now that the batteries have been recharged and I am satisfied that AIM remains among the best hospitalist groups out there, it’s time to leave Washington, DC and get back to work. I can’t wait to apply some things I learned this week to make us even better.