THE HOSPITAL LEADER

Only seven days left to submit the survey by March 11^th.

Finally, we come to the Hospital Medicine Questionnaire.  I’ll assume you completed the Management Matrix in a fashion similar to the Productivity Matrix. We should now be on page 9 of the survey.  Here’s the trick for the last few pages…  STAY ALERT and think about the questions.  In my review of the survey data from last year, it seems that respondents might be getting tired at the end, especially on the last two questions.  But this is where the hospitalist specific data comes together.  SHM and MGMA are the only ones collecting this kind of information, and we need to make sure it’s the best quality we can provide.  Let’s press on!

Question 2 – This question has important implications for the end of the questionnaire.  If you answer “No”, you’re more likely to have in-kind or other support located in different parts of the global budget.  See Questions 25 and 26 for details.

Question 4 – The questions in this section refer to the MAIN hospital being reported.  But, you may have included provider productivity from other sites linked to the main hospital site.  Here, one reports the number of sites having their productivity reported on the finished productivity matrix.

Question 5 – Remember, report the characteristics of the MAIN HOSPITAL ONLY.

Question 6 – Answer each one independently, yes or no.

Question 7 – If your practice utilized NP/PAs, answer yes.  If you didn’t have to officially pay for them, yet you still used them, answer yes.  See questions 25 and 26 as well.

For the following tabular data, some of the table formatting in my browser window was off such that the columns didn’t line up in columns as intended in some sections.  There should be two columns for numbers 8-12 and three columns for numbers 14-16.

Questions 8-12 – If you reported data for only one site, then you can likely just pull the FTE numbers off the productivity matrix for the Actual FTE numbers here… Remember that no provider can be more than a 1.0 FTE according to MGMA.  Even if they work like two normal people, they’re still only 1 FTE.  However, a part-time provider filling a three quarter time slot is a 0.75 FTE.  In summary, less than 1 FTE workers (fractional FTEs) are OK, 1 FTE workers are OK, but greater than 1 FTE workers are still only 1 FTE.  For sites that budget by the FTE, Approved FTEs may equal Actual FTEs if you’re fully staffed.  If you’re not fully staffed, then Actual FTEs will be less than Approved FTEs.  If you think you have more than the Approved FTEs, think again.  (Your site probably doesn’t run its budget based on the physical FTEs.  It might run on encounters, wRVUs, some other measure, or a fixed budget.)

Questions 14-16 – Only people who left a practice entirely would be reported in the third column.  People who decreased their work schedules are not losses.  Providers who moonlight as hospitalists or only help out for short time periods as a supplement to their regular job are not reported in any of the sections here.  (We often have about 1 FTE of workload made up of 10 or 12 such providers, but none are ours officially.  They’re not reported here.)

Question 21 – Some practices have a mix of compensation models.  If that is the case in your practice, try averaging the models together to get the base vs. other percentages.

Questions 22-24 – You should be able to pull this data from your databases utilized to complete the Productivity Matrix.

Questions 25 and 26 – Last questions.  BIG QUESTIONS.  Let’s make sure we get the correct information.

Before going any further, consider data from an older SHM State of Hospital Medicine report.  Based on 2007 data, SHM previously reported that hospitalist management companies received an average of $157,000 in hospital support per hospitalist FTE while all other hospitalists, such as those owned locally by hospitals or physicians, received just under $100,000 in support per FTE.  Why is that?  Is it just unfair?  Nope, I don’t think so.  It’s an apples and oranges comparison because the hospitalist management companies reported their entire deficit (Question #25) and support stipend (Question #26) to the last penny while the others had portions of their budget taken care of by the hospital in other ways or, gasp, just didn’t bother to calculate the total deficit or support level.

Is this inaccurate reporting still occurring?  Well, while we no longer report stipend per FTE broken out by management structure, I still believe the most recent data belies questionable reporting on Question #25 last year.  The median deficit was reported as a cool $1,000,000 and the 75%tile deficit was an even-steven $2,000,000.  C’mon now… you don’t expect me to believe the numbers are actually that clean and round, do you?

Organizations that run their entire operation in house, like management companies, can total all those hard to see costs like scheduling, practice administration, recruiting, benefits, payroll taxes, and everything else because they do it all themselves.  Our challenge is to report our true operating deficits and support levels as accurately as groups that pay for everything themselves.

-          If you have space in the hospital dedicated to your use, but pay nothing for it, that’s “in-kind” support.  Multiply the square footage by the cots per square for medical office space at your institution and add it in.

-          If you have PA/NPs working on your service with the hospital footing the bill outside of your official budget bucket, it’s still producitivity paid for by the hospital.  Add the entire annual cost of employment, including benefits and taxes, for those PA/NPs to the total.

-          If you have residents doing work on the service for which you’d have to hire other hospitalists if the residents weren’t present, then take the workload done by residents and convert it into hospitalist equivalents for your program.  (Maybe that work would take 2.5 hospitalists.  Take the total cost of the average hospitalist in you program, multiply by 2.5, and add it to the bottom line.)

-          If the hospital employs recruiters, scheduler or other administrative personnel for your program, add in their costs to the bottom line too.

-          Don’t forget the taxes… FICA, Medicare, Medicaid, State.  Each person costs more than their salary, benefits, and retirement.  If you can’t calculate them, a good rule of thumb is to take the compensation and add another 30-40% to it to estimate all of those costs on top of compensation.  (For example, If a hospitalist makes $215,000, use $215,000 X 1.35 to estimate $290,250 as the all inclusive cost for each hospitalist with benefits, taxes, retirement, etc.)

So, in the interest of providing a realistic picture of what our operating costs truly are, don’t wimp out on the last questions.  We can do better… And we really need to do better given that our C-suite partners are facing 30% cuts in their CMS payments over the next ten years.  If we can’t document the real costs and benefits of a functional hospitalist program, we can’t expect to build realistic budgets.

Finally, CONGRATULATIONS! We’re done.  Thanks for participating.  On behalf of the Practice Analysis Committee, I wish you conscientious calculating and smooth surveying.