In the past decade, hospitalist subsidies more than doubled and their compensation increased about 40%. Those were just two of the trends shared by Ingenious Med Founder & CMO Steven Liu, MD, SFHM, in our recent webinar, “How Hospitalists and Health Systems Can Work Together to Deliver Greater Value.”
Dr. Liu and presenters Dipali Ruby Sahoo, DO, MBA, FACP, SFHM, Hospital Medicine Performance Director at TeamHealth, and Jason Haley, AVP Revenue Cycle/CBO Operations at LifePoint Health, noted that hospitalist care today has become both ubiquitous and synonymous with high-value care, and that these trends reflect the growing importance of hospitalists in healthcare organizations (HCOs) today. They discussed how today’s hospitalists receive a larger subsidy, deliver far more in value and are critical to efficient operations.
Dr. Liu shared two additional challenges facing HCOs today:
- As hospital margins recover somewhat from the ravages of COVID, health systems are facing historic levels of burnout; 80% of doctors say they face burnout.
- Physicians spend only 27% of their time in actual facetime with patients, due in part to growing administrative burdens.
Excerpts of tips that the presenters shared for enhancing and demonstrating value in the face of today’s enormous challenges follow.
1. Leverage Best Practices and Standardization
Dr. Sahoo described how TeamHealth has gained unique capabilities to manage disasters over a variety of crises, from managing staffing challenges during Hurricane Harvey and the mass shooting in Las Vegas. While these challenges paled in comparison to the long-term challenges of optimizing care and value during COVID, these past experiences have allowed TeamHealth to rise to the challenges COVID has brought on, resulting in overall, long-standing improvement of their organization and greater efficiencies. TeamHealth continues to grow and evolve as a company as a result of the experiences gained during the COVID pandemic.
Even before the pandemic hit, TeamHealth formed an infectious disease task force, consisting of not only pandemic and clinical experts, but also leaders within supply chain and human resources. This team could research and apply best clinical practices across partner facilities, redistribute workforce to address hot spots, and acquire and distribute PPE.
The company invests in performance improvement teams for both emergency medicine and hospital medicine. These teams worked with their practitioners throughout the country to help address throughput and other issues they faced as a result of treating people with COVID. “They even helped to support our physicians on the front lines, doing wellness checks and sometimes accompanying them on multidisciplinary rounds,” said Dr. Sahoo.
Haley noted that LifePoint Health’s revenue cycle department had used Ingenious Med to help them standardize across the system on a number of best practices before COVID hit. He commented, “Increasing our ‘system-ness’ helped us more strategically and consistently look at, track and report on KPIs and be able to observe trends. We were better able to formulate costs and staffing productivity, which are significant indicators. That allowed us to be more prepared for COVID and to ensure we could pay our providers for the services they’ve actually rendered.”
2. Avoid Cutting Too Deeply
When Dr. Liu asked where, in retrospect, the presenters might have made cuts that were too deep, Dr. Sahoo responded by emphasizing that HCOs can’t ignore the added pressures clinicians feel when caring for extremely sick COVID patients. She said, “We must ensure that we don’t add too much to their plates and instead try to streamline their workflow and remove barriers so they can spend more time with patients.”
She added, “Hospitalists impact every department in the hospital but can’t always accomplish goals on their own. For example, we found it important to involve cardiologists and orthopedists in throughput efforts, so they understood our length of stay problem and that early discharges and getting timely test results were a priority. Involving them as part of our team helped us achieve our goals and reduce burnout.”
3. Reduce Burnout with Resources
Haley noted that flexible scheduling was key to preventing burnout among LifePoint Health’s front desk staff, who often were struggling to care for children who were at home all day rather than in school. He said, “For example, we changed working hours from the standard 8 am to 5 pm to a schedule that worked around their needs. And working from home helps our staff save time formerly spent commuting. Since we still achieved our goals, I think these changes will last longer-term.”
“We flew physicians from Florida to New York and vice versa to help meet regional surges in COVID cases.”
Dr. Sahoo cited TeamHealth’s ability to use unconventional staffing approaches as one key to its success during COVID. “We flew physicians from Florida to New York and vice versa to help meet regional surges in COVID cases,” she observed. “That way of staffing is unconventional but necessary given the volume swings we see with COVID.”
TeamHealth also ensured that clinicians had access to and knowledge of a variety of new resources that were available, including leadership guides that gave leaders advice for recognizing and preventing burnout, and supporting clinicians who experienced it. The guides were created in various formats to address the fact that people have different learning styles. The organization also developed webinars, protocols, and algorithms to help leaders assess a clinician’s level of burnout and degree of resiliency.
4. Use Tools That Improve Efficiency
How can hospitalists and HCOs optimize value when the pressure to cut costs while preserving or enhancing quality is intense? One way is to do more with less — using tools and approaches that improve efficiency and productivity.
The presenters underlined the importance of having timely, accurate data and new tools to boost productivity. Haley described how introducing Ingenious Med’s mobile app to new markets and provider simplified charge capture by enabling them to record charges and communicate with colleagues during rounds and out of the hospital. LifePoint’s coders and billers also found that the Ingenious Med app lightened their workloads since the physicians who delivered care are more quickly and accurately capturing charge data.
5. Provide Easy Access to Key Metrics and Benchmarking
Without easy access to good metrics, it’s difficult for hospitalists to demonstrate their value. Dr. Sahoo noted that TeamHealth used Ingenious Med to harness much of the data needed for each facility leader to demonstrate value or know where improvement was needed. “As a practicing physician, I like benchmarking my performance to my peers; it helps us share best practices and standardize on these key metrics,” she said.
Haley commented that an important metric for LifePoint is Collections per Work RVU. “This is a great statistic that reflects the work being done. Accounts receivable days aren’t as relevant during COVID because the patient mix and types of procedures changed so much. We had to tweak where we focused our productivity efforts for the short term.”
Dr. Liu noted that using claims data is optimal. “Physicians can’t argue with claims data because it’s their data. Regularly sharing raw, unblinded data can be very powerful, allowing physicians to self-manage and be partners in practice success. I’ve seen groups have incentives for this at the individual and group level, and it works well.”
According to Dr. Sahoo, COVID has affected nearly every hospitalist metric nationwide. “Where we deliver value is in throughput, patient experience, early discharges, and improved documentation – yet all of these were impacted by COVID. It was difficult to overcome the challenges with restrictive visitation policies, strict protocols that nursing homes had for accepting patients and dramatically increased severity of illness in COVID patients. We found it essential to get input from our frontline hospitalists to make sure we understood these impacts, then support and provide resources for them to improve metrics in a way that works best for patient care during a pandemic.”
Haley found that standardizing LifePoint’s data and reporting helped them increase collections and have better trend and KPI data to drive better decisions.
When a participant asked about the potential value of using KPI report cards to demonstrate value and to incentivize hospitalists, Dr. Sahoo replied, “TeamHealth is a results-oriented and data-driven organization. We educate hospitalists on the importance of KPIs, and we make that data available for our leaders to share at the group and individual level.”
6. Balance Workloads Amid the Need to Enhance Value
Dr. Liu asked the presenters how they balanced hospitalists’ growing roles of co-management and growing their value with keeping their workloads tolerable.
Dr. Sahoo noted, “Our hospitalist leaders and hospital leaders often problem-solved shoulder to shoulder. That partnership and collaboration was essential for our hospitals to respond to pandemic challenges. Our leaders stepped up in new and even non-traditional roles to support our hospitals and communities.
“We took on management of every COVID patient in one hospital in New Jersey, providing care in tent hospitals and covering the ICU where we don’t traditionally do so.”
Haley noted that LifePoint worked more closely and collaboratively with payers during the pandemic. “How we work with them and contact them is changing,” he said. “We’re experiencing similar challenges and we found we needed to be more patient with each other.”