John Nelson writes . . .

Recently one of our blog readers wrote in with the following question for our blogging team:

Our small general IM group (3) is interested in starting a hospitalist group for our small community hospital (50bed) because neither our group or our family practice groups can recruit without one. There are no hospitals our size that have hospitalists. Where do we start?

My blogging colleagues may have additional thoughts on this subject, but I’ll get the ball rolling with the following (more…)

Mike Radzienda writes…

Over the past ten years, hospitals have been bombarded with external regulatory mandates aimed at improving quality of care.  Amidst these challenges, payer mixes have dwindled and operating margins have narrowed.  This has left hospitals few resources for implementing thoughtful and robust quality improvement infrastructures.  As a result, hospital COOs struggle to develop meaningful partnerships with physicians who can effectively advance the local QI agenda.

Due to a dearth of availability and leadership in the traditional physician staff model, hospital administrators have taken on this QI agenda. This tactic has failed (more…)

Troy Ahlstrom writes…

The SHM Productivity Survey Closes in a Mere Month.

The MGMA-SHM Hospitalist Productivity and Compensation Survey is ongoing NOW, and data submission closes March 12th.  As you know, SHM has provided the most comprehensive data set and incisive analysis regarding Hospitalist practice for 10 years now.  We are not the only source of such information, but we have provided the most detailed, comprehensive analysis of Hospitalist practice in the past.

This year, in 2010, with all of the tumult and unrest over budgets, the economy, and healthcare reform, we will all need (more…)

Mike Radzienda writes…

Hospitalists’ certitude number one-hundred-one: “It is never a good thing to be speaking with the chairman of Emergency Medicine at 1:00 AM on a Monday.”

And there I was trying to explain why the admitting medical officer hadn’t returned a page to the emergency department (ED) for thirty minutes; and why, when he did, he seemed “so overwhelmed.”

This was not flu pandemic season; it was just one of those busy “full moon” nights. Our hospitalists (more…)

Rob Bessler writes…

Currently consult codes go away. This will lead to hospitalists having to use the admission codes selectively combined with using more follow up codes for times when they assume care of patients.

Admission codes rvu’s and hence payment are less than the high level consult codes which mean less revenue. Some practices use the prolonged service codes to obtain additional revenue for services performed. Some payers pay for this and most don’t. Currently there is a 21% cut that goes into effect January one. All experts seem to think a patch will get passed to prevent this. Some say (more…)

John Nelson writes…

As I’ve written before (here and here), nearly every specialty in medicine is continuing to turn to the hospitalist model.  I’m aware of community, and in many cases academic, hospitalist practices in nearly every specialty in medicine including surgical (general surgery) hospitalists, orthopedic hospitalist, and more.  The list includes psychiatry, obstetrics, gastroenterology, infectious disease, and on and on.  Someone once told me he knew of a dermatology hospitalist somewhere. (I’d love to talk to this doctor, but never got any details and wonder if this was a myth or a very loose interpretation of what makes one a hospitalist.)

How can we document this growth?
(more…)

John Nelson writes…

Compensation and production surveys generally set the standard on physician compensation and production.  The longer I spend looking at survey methodologies and results, the more I’m convinced that there are a lot of devils in the details that may misled many people who rely on these surveys.  As an example, I’ve adapted below something originally written by, Leslie Flores, who is the director of SHM’s Practice Management Institute and my consulting colleague.  What follows was written in response to a question about the differences in the SHM and MGMA surveys of hospitalist productivity and compensation, especially related to their results in the South.  It serves an example of the complexity of interpreting the surveys. (more…)

John Nelson writes…

In my work with practices around the country, I’m struck by the wide variation in how each practice defines what constitutes full-time work.  This is a pretty big deal for reasons that are obvious and not so obvious.

Say you’re in a practice that defines full-time as 181 shifts annually.  The practice across town provides higher compensation and also requires 181 shifts annually.  The other practice gets a better deal, right?  (more…)

Rob Bessler writes…

As we enter 2009, and in follow up to my theme on housekeeping related to 360 degree feedback, I thought I would share another key area that every practice would benefit from: Have a plan.

It doesn’t need to be complicated, but it starts with defining some local goals for your practice and team. Are everyone’s heads down and just seeing patients, or is their discussion at the site level as to how you want your practice to be shaped in 2009? Does your team just care for patients, sit on or lead committees and react to the prevailing winds of the hospital, or do you and your team talk about what we want in 2009? I encourage you to set aside time with your team on these areas. (more…)

Robert Chang, MD writes -

One of my long-term goals for our hospitalist group would be the establishment of multiple relationships with academic centers overseas, in particular in the sub-Saharan subcontinent, Africa or China.  The benefits would be enormous for us as well as our partners would include professional satisfaction, exposure to other educational systems, and a highly mutual exchange of information and clinical experience. (more…)