The hospitalist program had immediate measurable impact. Average length of stay dropped by 15%, and Track A and C physicians had similar utilization measures, suggesting that the model of care delivery was the key driver—rather than the amount of time physicians spent in the hospital. Dr. Gibbons was impressed with the hospitalist group’s results, noting that St. Joseph’s average reduced length of stay of 0.7 to one full day was consistent with national benchmarks. Because CPMG sees only Permanente patients, St. Joseph eventually contracted with two other hospitalist groups: the Exempla Faculty Inpatient Team, which covers half of its unassigned patients, and Midtown Inpatient Medicine, private internists who cover the other half of the unassigned patients, co-manage with orthopedic surgeons, and cover for internal medicine groups that no longer make hospital rounds.
CPMG hospitalists also covered Boulder Community Hospital in Denver’s rapidly expanding suburbs until 2005, when CPMG’s contract expired. All six hospitalists moved to nearby Exempla’s new Good Samaritan Hospital, where patient volume grew quickly from 25-30 patients a day to 80; 90% of the patients are Permanente members. Hospitalist staffing jumped to 13 FTEs (19 physicians). “We recruited very aggressively, including lots of locum tenens and moonlighters to cover the booming volume,” explains Brian Thom, MD, assistant regional department chief, Good Samaritan Hospital.
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More Measures
In addition to length of stay, CPMG tracks the percentage of patients discharged in less than 24 hours, readmission rates, and disease-specific mortality by provider. All hospitalists get regular reports of department averages and statistical analyses of individual physicians. “This may be controversial, but we must look at outliers to see if [the problem is] case mix, such as many hospice patients, or something else,” says Dr. Heaton.
Striving for high levels of clinical expertise and consistency is a CPMG hallmark. Working for a medical behemoth in the Denver area, CPMG doctors—whether clinic-based or hospitalists—have a huge opportunity to integrate care and to co-manage many conditions with their colleagues. Hospitalists also staff the ICUs. In 2000, William Kinnard, MD, CPMG’s ICU co-director, commented that the group’s use of data-driven protocols allowed hospitalists to practice effectively in ICUs.
As for patient satisfaction, Dr. Heaton admits to “struggling for good measures,” noting that CPMG tackled it head-on in 1999 when Executive Medical Director Jack Cochran, MD, addressed the level of patient tenacity it took to navigate CPMG. Physician career satisfaction was sinking from long chaotic workdays that left both patients and doctors frustrated. By re-engineering scheduling and visit processes, Dr. Cochran made things run more smoothly. Other initiatives included an eight-hour physician-patient interaction course, video vignettes starring CPMG doctors illustrating communication techniques, and formal physician-to-physician coaching. Dr. Fraser still sends new hires to the course, recognizing that good communication satisfies both patients and physicians.