Unit 7 Application Assignment # 20 Structure and Funding of Hospitalist Programs- Corey Hodges
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Application Assignment # 20 Structure and Funding of Hospitalist Programs
Corey A. Hodges Department of Business, Park University
HA518: Organization of Healthcare Delivery Systems Dr. Trisha Roth
October 2, 2022
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Structure and Funding of Hospitalist Programs A “hospitalist is a physician whose primary professional focus is the general medical care of hospitalized patients” (Palabindala, V., Salim, S., 2018) “hospitalist is a physician who only practices in an inpatient setting
“and the first hospitalist program was founded in 1994 by Park Nicollet Clinic in Minneapolis St. Paul” (Darr, K., et al., 2017). Over the years countless medical facilities have participated
in such a program including The School of Medicine (SOM) associated with Dogwood Academic Medical Center Hospital (Dogwood). Their hospitalist program is staffed by physicians from the SOM and available to Dogwood. The hospitalist program is expected to continue sustaining a significant annual
deficit, causing SOM to ask Dogwood to continue funding the deficit. Dogwood administration believes that the program may have become too expensive and might need to be substituted for other calculated options or even ending the hospitalist collaboration with SOM entirely. To help with this issue a consultant has been employed to assess and make suggestions that could benefit SOM and Dogwood. Identify key stakeholders and the relationship of Dogwood and the School of Medicine
The key stakeholders of this partnership are the “patients, nonteaching patient care hospitalist, traditional house staff hospitalist, consultation service hospitalist and the medical facilities” (Darr, K., et al., 2017). “Hospitalists provide significant value to their communities and to the patients, physicians, other health professionals, and administrators well beyond direct patient care” (Palabindala, V., Salim, S.,
2018). To help get a better understanding for how the relationship between all the stakeholder flow refer to the figure 1.1 below:
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Figur
e 1.1
Can hospitalist programs be integral part of cost-effective and efficient inpatient care? Under what circumstances
The hospitalist program has several factors that make it an integral part of cost-effective and efficient inpatient care. Hospitalists assist with cost-effectives for hospitals by “reducing lengths of stay for patients and increasing patient throughput and maximizing bed use” (Darr, K., et al., 2017). They also improve resources utilization and minimize additional care costs by reducing unnecessary procedures or redundant laboratory test. One of the most important ways they improve cost effectives is by applying a combination of clinical skills and organizational knowledge with enhanced communication. Hospitalists improve inpatient effectiveness by “monitoring patients closely, reducing clinically unjustified variation in care, using standardized therapies, testing, and by responding quickly to changing clinical needs. They “also handle calls from the transfer center or referral coordinator, and admits patients” (Darr, K., et al., 2017). Also because of the “nature of hospitalists work leads to better discharge
planning” which has a direct impact on hospital readmissions and Medicare reimbursement penalties. Missing or needed information for the consultant’s initial report. The consultants initial report needs to show Dogwoods financial data and the generated based on hospitalist contributions. The report should also provide to show what those figures would be if Dogwood decides to choose another program or organization, providing this evaluation could have an impact on Dogwood options. Another School of Medicine
Dogwood Nonteaching Patient care hospitalist
Consultation service hospitalist
Patients
Traidional house staff hospitalist
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critical piece of information not included was revenue derived from Medicare and Medicaid reimbursements. A piece of information needed is “how the hospital plans to make up the 3.69 million…
because income from patient care does not cover…the cost of hospital subsidizes” (Darr, K., et al., 2017).
Balanced scorecard framework used to quantify impact and performance. The balanced scorecard (BSC) “suggests we examine organizations from four different perspectives…those are from the financial view, customer/stakeholder, internal process, and organizational capacity” (Kaplan, R., Norton, D., 1992). The areas of the BSC that can be applied to the hospitalist program are based on the internal process and financial perspective. In terms of internal processes Dogwood and SOM can view the quality and efficiency of the programs as related to the product be produced by the hospitalist. The other area of used to evaluate and quantify the impact is the customer/stakeholder. The impact on customers in terms of outcomes “includes shorter length of stay with lower total costs…shorter wait times for surgery or consultation and a greater likelihood of receiving guideline-recommended care” (Darr, K., et al., 2017). Advantages and disadvantages of expanding hospital medicine
.
The advantages of expanding hospital medicine program to include procedure services it would provide “improved medical resident education and training, provide faster response times for procedures needed prior to patient discharge, and
increase revenue for the hospitalist program” (Darr, K., et al., 2017). The disadvantage of integrating procedure services “it would require additional full-time equivalent hospitalists” (Darr, K., et al., 2017). With reference to expanding into Neurosurgery services which has a “substantially more complicated patients…and would require additional full time equivalent (FTE) hospitalists” (Darr, K., et al., 2017). The question that needs to be asked is the staffing implications and who is going to be financially responsible for this? Identify strategic recommendations for the hospitalist program and develop recommendations for Dogwood regarding financial development of the program. The strategic recommendations for creating a “formal beside procedure service managed by the hospitalists…which would provide faster
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response times for procedures needed prior to patient discharge, all while providing increase revenue
” (Darr, K., et al., 2017) is a good start. This would allow hospitalists to perform several new procedures per week at current staffing levels. Dogwood should support procedures such as “thoracentesis, paracentesis, and central line placement” which would produce new sources of revenue. The future financial plans should include a “collaboration with Dogwood to share expenditure costs incurred with the needed for more hospitalists salaries” (Darr, K., et al., 2017). They should focus more on reimbursement payment from Medicaid and Medicare as another source of capital. SOM and Dogwood should introduce automated software that would handle billing and coding to guarantee no procedures go undocumented and unbilled.
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References
Darr, K., Farnsworth, T.J., Myrtle, R. (2017, August). Cases in Health Services Management. (6
th
ed.).
Baltimore, MD: Health Professions Press, Inc. Kaplan, R., Norton, D. (1992, February). The Balanced Scorecard Measures that Drive Performance.
Website. Harvard Business Review. The Balanced Scorecard—Measures that Drive Performance (hbr.org)
Palabindala, V., Salim, S. (2018, February). Era of hospitalists. Website. National Library of Medicine.
Era of hospitalists - PMC (nih.gov)
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