Bryan Weiss, MBA, FHM, managing director of the consulting services practice at Irving, Texas-based MedSynergies, agrees that hospitalists and PCPs are connected. He believes the higher compensation figures are a sign of how young HM is as a specialty. He fears compensation “is probably growing too fast.”
“This takes me back to the 1990s, with the private [physician practice management]-type model, where it just grew so fast that the bottom fell out,” says Weiss, a member of Team Hospitalist. “Not that I think the bottom is going to fall out of hospital medicine, but a lot of this is reminiscent of that, and I think there’s going to be a ceiling, or at least a slowing down.”
We’re not talking about disenfranchising healthcare or providers. We’re talking about more reasonable growth and about, more than anything, paying for the right things.
—Stuart Guterman, vice president, Medicare and cost control, The Commonwealth Fund
In contrast, one good sign for the specialty’s compensation and financial support is that “hospitals are still the hub of the healthcare system and need to be an important part of healthcare reform,” says Stuart Guterman, vice president for Medicare and cost control at The Commonwealth Fund, a New York foundation focused on improving healthcare delivery. Guterman says that while President Obama and congressional leaders are looking to cut the rate of growth in healthcare spending, the figure is already so high that there should still be plenty of resources in the system.
“If you took today’s spending and you increased it at the [GDP] growth rate for 10 years, I think we’re talking about something over $30 trillion over 10 years,” Guterman says. “And remember that we’re starting at a point that’s over 50% higher than any other country in the world. So, we’re talking about plenty of resources still in this healthcare system.”
With accountable care organizations, the specter of bundled payments, and penalties for readmitted patients, Guterman says that the pending issue for the specialty isn’t whether hospitalists—or other hospital-based practitioners—are going to get paid more or less, but rather what their compensation will be based on.
“Things like better coordination of care, sending the patients to the right place, having the patients in the right place, having them in the hospital if they need to be, or keeping them out of the hospital if they don’t need to be in the hospital,” he explains. “But the hospital is certainly a big part of that health system.”
In fact, physicians who play to the strengths of the new healthcare metrics—quality, value, lower-cost care—can probably earn as much compensation as, if not more than, they could in the traditional fee-for-service model hospitalists, Guterman says.
“The big point is to remind people that when we’re talking about controlling health spending growth, we’re still talking about a growing industry,” he notes. “We’re not talking about disenfranchising healthcare or providers. We’re talking about more reasonable growth and about, more than anything, paying for the right things. Folks ought to be able to do quite well if they do the right things.”
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Table 4. Scheduling Model
SOURCE: State of Hospital Medicine report, 2014
Multiple Uses
The SOHM report can be used as a measuring stick to compare against national and regional competitors and to provide data points for discussions with hospital administrators, says Team Hospitalist’s Weiss.
“This is vital in terms of recruiting physicians,” he says, “as well as negotiating with the hospital, as far as what the average investment is.”
Dr. Landis of SHM’s Practice Analysis Committee believes that having data points to make “resourcing decisions” with is particularly helpful, both in hiring and scheduling and in “right-sizing” hospital support for groups that are not self-sufficient.