Dr. Clark says that, in terms of pertinent data, the average number of encounters per hour was high on her list. Although that information is not highlighted in the survey’s “Executive Summary,” it is contained in Chapter 8, “Hospitalist Productivity.” Dr. Clark says this issue engenders an ongoing discussion with hospital administration.
“There are only so many patients you can see and provide excellent care, but there is a pull [from the administrative side] that they would like that number to be more,” she explains. “It’s nice to know what the average number of encounters is and what the society considers reasonable. I think it’s one of those things that we’re going to have to emphasize since the trade-off for seeing increased numbers of patients is to sacrifice quality patient care.”
Walter Bohnenblust, MD, is medical director of a hospitalist group at The Reading Hospital and Medical Center in West Reading, Pa. “What I like most about the survey is that productivity is represented not just with total billing, but with encounters and RVUs [relative value units]. We are in a low reimbursement area here, so if the survey included only gross charges and gross collections and not encounters plus RVUs, it would be more difficult in our market to justify to administration how hard we’re working. It’s uncanny how our group fits right in with the median in terms of productivity,” he says. “This gives me a baseline and more leverage with the administration, when they say we should be doing twice as many encounters as I think is reasonable.
“Like it or not, when someone is paying a subsidy for your service, they will try to get more out of you,” continues Dr. Bohnenblust. “It’s their job to try and get more out of the nurses and more out of the doctors. It’s not just us they’re picking on—the ER docs at our hospital have the same pressure. It’s good to have these numbers to go back and say, ‘Look, we are right where we should be [in terms of work productivity]. If you try and work us harder, you may lose some people and also not get out of the program what you wish.’”
Work productivity data provides an additional tool for recruitment, adds Dr. Bohnenblust, although he has not had much problem attracting new staff: “People are smart enough now to not only look at what [the prospective hospitalist group] income is, but how many patients they will have to see and what the work hours are.”
Uses of the Survey
Chapter 3, “The Work of Hospital Medicine Groups,” devotes attention to the types of non-clinical activities in which hospitalists participate. The section, say several sources, can also be a valuable negotiating tool with hospital administrators because it quantifies the amount of time hospitalists spend in such endeavors.
“One of the things that hospitalists add to inpatient care is that they have a greater presence all throughout the day in that facility,” says Timothy Bode, MD, medical director of Hospital Physician Services of Central Alabama. “And they’re a lot more involved with the medical staff, serving on committees, and involved in new processes and changes.
“To be able to see what kind of numbers are represented nationally, with hospitalists’ involvement in non-clinical activities, helps me with the hospitalists in my group,” he continues. “I can use these numbers to say, ‘This is a national trend. We need to be involved and we need to be leaders here as well, because that’s really the core of what we do.’ ”