Managed Healthcare Executive - April 2009 - (Page 28) { HOSPITALS AND PROVIDERS } tems for communication and feedback; daily administrative rounds; software systems to track patients and monitor performance; and post-discharge phone calls to assure follow-up care. The emphasis on communication Admissions, follow-ups, discharges: 73.6% makes a big di erence in addressing disConsultations: 8.2% continuity of care, believes Burke KeObservation days: 8.0% aley, MD, associate medical director at HealthPartners Medical Group. As part Critical care: 4.0% of a large medical group, HealthPartners Procedures: 2.0% has built a hospitalist program with an emphasis on communication. Of ce encounters/consultations: 1.1% The program makes use of electronic Skilled nursing facility/Rest home visits: 1.0% medical records, electronic noti cations, ED encounters: 0.9% voice messaging and personal contact. “Through care coordination, we have Other encounters: 1.1% a multi-disciplinary team, comprised of Source: Society of Hospital Medicine’s 2007-2008 Bi-Annual Survey on the State of the Hospital Medicine Movement whoever is needed for that particular patient: pharmacist, nurse manager, nurse, social worker, chaplain, etc.,” Dr. Kealey are within a team. “At the present time, the crisis in priadds. “We coach our hospitalists to be “The number of hand-o s that are mary care is threatening that obligation leaders. They are like the quarterback involved in any given admission may be and the sudden rise of the hospitalist sysof the team, ultimately responsible for many more than would be the case in tems may be inadvertently contributing the entire progression of care.” past traditional models,” Dr. Neubauer to that,” he says. “The patient-centered says. “It is well established that the more medical home concept, which is currently NOT SHIFT WORKERS hand-o s that are taking place, the more being discussed and piloted, needs to rise Richard Neubauer, MD, a member of room for error there is. In addition, there to the top of our national discussion of the American College of Physicians’ are risks of discontinuity between the redesigning the medical delivery system. Board of Regents, notes there are real inpatient and outpatient setting.” Unless we do that, patients coming out of risks of communication breakdown Stakeholders also have the responsibility the hospital may not always have access to when hospitalists see themselves as of ensuring that there is a robust, appropri- the care they need.” “shift workers,” who can simply hand ate system of outpatient primary care for all The hospitalist model does build in a o patients instead of clinicians who patients, according to Dr. Neubauer. “purposeful discontinuity” between inpatient and outpatient care, says Dr. Wachter, who many consider to be the academic leader of the hospitalist movement. Types of patients seen: Adults only: 86%; Pediatrics only: 10%; Both adults “Call PCPs at admission, at discharge and children: 4% and when there are huge decisions such as how to approach end-of-life care,” Dr. Median hours de ning a full-time hospitalist*: 2,080 Wachter says. “Build electronic links beMean percent hospitalist time for non-clinical activities: 8.6% tween the hospital and the o ce so the PCP can get the key data. All of these Median percent leader time administrative activities: 20% things are being done, but it is a work in Compensation Model: Salary: 25.3%; Production: 6.1%; Mix Salary and progress.” MHE Mean percent of hospitalist encounters by category Characteristics of the work of hospitalists Bonus: 68.5% * 30% of responding groups did not answer this question, many of which may not de ne a full-time hospitalist in terms of hours Source: Society of Hospital Medicine’s 2007-2008 Bi-Annual Survey on the State of the Hospital Medicine Movement FOR MORE INSIGHT See more Hospitals and Providers managedhealthcareexecutive.com 28 APRIL 2009 http://www.managedhealthcareexecutive.com
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