“Since the hospitalist team’s job is to cover the hospital 24/7, they don’t always connect the dots of what’s happening throughout the system,” says Ford. That’s why top managers must focus on the future. “If management has the right road map and vision for the future, a lot of good things happen for hospitalists: Patients get better care, which leads to better outcomes, [and] we lower costs and pass the savings along to payers. That, in turn, drives higher market share and increases the hospital’s value proposition.”
Hospital medicine groups rather than individual physicians may be best suited to track the hospital’s business drivers, and align incentives accordingly. Davin Juckett, CPA, MBA, of the Charlotte, N.C., Piedmont Healthcare Management Group, a physician-owned consultancy to more than 100 hospitalists in the southeast, advises hospitalists to use their billing and encounter data to improve their decision-making.
“Hospitalists tend to be very focused on their LOS and quality indicators but there’s a lot more out there,” says Juckett. “Business drivers such as consumer-directed care and P4P [pay for performance] make quantifiable data extremely important. Some MCOs have started star ratings of hospitalist and ER groups, and some doctors are up in arms because they feel it’s subjective. But that’s the future.”
Juckett sees another key business driver for 2006 and 2007: an increasingly competitive business environment for hospitalists. “Hospital medicine groups will have to defend their contracts,” he says. “True, the newness of the specialty makes recruitment an issue, but supply will eventually catch up with demand, and P4P will happen.”
Hospitalists might examine how another major business driver—aggressive competition for payer dollars—can put them at odds with office-based colleagues. By competing with hospitals for lucrative procedures in orthopedics, gynecology, cardiology, and other specialties, community physicians can lure market share away. Hospitalists are well positioned to mediate the conflict, although a report by VHA of Irving, Texas, says hospitalists often don’t keep community doctors informed of issues facing their hospitals. That report adds that hospitalists do a poor job of bringing hospital administrators and physicians together to forge common solutions.
Bricks and Mortar
Balancing soaring construction costs with the need to give picky consumers and physicians the latest technology in gleaming new buildings is another trend. Big-ticket items keep Joann Marqusee, MPP, senior vice-president of operations and facilities at Boston-based Beth Israel Deaconess Medical Center occupied. Her job—prioritizing capital projects, keeping facilities up to date, and tailoring spending to reduce future maintenance needs—got even more challenging with Hurricane Katrina. “Things are always difficult, but now the price of oil and steel are rising,” says Marqusee. “And we can’t find dehumidifiers to help with our little floods; they’re all in New Orleans.”
She has capital-spending decisions down to a disciplined process: Match projects with the strategic plan (e.g., neurosurgery ahead of ob/gyn), assess impact on patient volume and return on investment, and improve patient safety and quality. Explaining those decisions to physicians who get feisty when a favored project is delayed or cancelled is the tough part.
To gain doctors’ support for management’s spending priorities, Marqusee has a PowerPoint presentation for them: “Space: The Final Frontier.” She raves about hospitalists’ response: ”The hospitalists’ input has been fantastic because of their analytic training. For example, they understand ED throughput, and we use their expertise to improve design. And when we tell them that the new ICU can’t open as soon as they’d like because it’s being built above the bone marrow transplant center, and we need a new HVAC system installed first, they get it. They care about patients and when we introduce bottom line issues as well, we strengthen our working relationship.”