As the practice of hospital medicine continues to grow as a specialty, hospitalist physicians will likely need to sharpen their practice management skills.
Unfortunately, much traditional practice management education is irrelevant to them, says Leslie Flores, senior advisor for practice management at the Philadelphia-based Society of Hospital Medicine.
Flores says hospitalists are unique from other physicians in that they are not office-based, but practice solely in an inpatient setting, and thus have distinctive practice management requirements.
“Hospitalists don’t need to worry about appointment systems, or whether their office staff is productive,” Flores said. “In many cases, hospitalist practices don’t even have a practice infrastructure, including a practice manager or support staff. It’s often left to a physician leader to manage the practice.”
The SHM is the largest U. S. professional society for hospitalists, and recently held its annual conference in Washington, D.C. Flores and a hospitalist task force developed a practice management track at the event to help encourage best practices in practice administration.
Approximately half of U.S. hospitalist practices are administered by a non-physician manager or coordinator, Flores said. However, the financial and administrative demands of running a hospitalist practice often require a different focus.
“Almost all of these practices require some sort of financial subsidy in order to break even,” Flores said. “How do you negotiate that subsidy from your hospital partner? And for the hospitalist, virtually every patient is a brand-new patient. How do you distribute the workload among your hospitalists and how do you schedule to maximize physician-patient continuity?”
Just as at office-based practices, accurate reimbursement is critical to hospitalist groups, said Rose Shattuck, a consultant with Rose Shattuck & Associates in Raleigh, N.C.
Shattuck told practice administrators at the SHM annual conference that they must keep close tabs on their billing companies and work with their physicians to improve their charge capture accuracy.
“Hospitalists are losing thirty to fifty thousand dollars annually due to incorrect coding,” Shattuck said. “Much of this is due to inadequate documentation. Many hospitalists are downcoding themselves, and if you don’t perform random audits, you won’t catch it.”
A majority of hospitalists do not work in independent practices, however. Flores said almost 40 percent are employed by hospitals or health systems and 24 percent are based in academic practices – a clear example of hospital-physician integration that is the goal of much healthcare reform.
Robert Wachter, MD, chief of the Division of Hospital Medicine at the University of California, San Francisco, and past president of the SHM, believes that hospitalist practices have a lot to teach other providers in the wake of the “unfinished” reform process.
“The (reform) bill does little to tackle the fundamental problems of the payment and delivery systems – problems that have resulted in major quality gaps, large numbers of medical errors, fragmented care, and backbreaking costs,” said Wachter. “It may be that hospitals and doctors need not look to Rochester, Minnesota or Danville, Pennsylvania for positive examples of physician-hospital collaboration in the name of improvement, but simply to their own local hospitalist groups.”