“For groups that have low lengths of stay, it would be important for me to know why,” she says. “Did they have extra supports? Do their [doctors] use Palm Pilots? You don’t always know from looking at the numbers how to apply them, make the connection, and justify the resources you’re trying to achieve,” she says.
No Perfect Measure
The ideal survey for Dr. Dauterive would include specific structured models, providing links between categories so that she could compare characteristics that more closely align with her group’s situation.
“Our program is very mixed, so it would be helpful for me to know how work RVUs were being reported,” she says. Pointing to results showing higher productivity (work RVUs) in practices compensated by 100% incentive (Table 060-A, page 259 of the survey), Dr. Dauterive wonders what factors drive these results. While the 100% incentive might appear to be the most important factor, perhaps these groups also have physician extenders or are located in a geographic location that boosts their productivity.
“I’m in a nonprofit hospital, in a clinical hospitalist service, and I want to be able to approach the administration and say, ‘If you want us to see the most patients, these are the kinds of services that see the most patients,’ ”says Dr. Dauterive. “But, if you are more interested in physician retention and work/life, then these are the characteristics of those successful programs.”
This level of detail can be difficult to interpolate from the survey, agrees Dr. Nelson. Patient acuity, for instance, is not specifically queried in the survey questionnaire. “I agree, in the ideal world, this is all information that you would want to know,” he says. Answers to the following questions could help refine product metrics:
- Does your group have teaching responsibilities for residents?
- Do you take a lot of calls from home, or do you have a separate night shift?
- Do you cover more than one physical hospital on the same day?
- Does your group do more than the typical amount of committee and administrative work?
“All these factors,” notes Dr. Nelson, “would influence productivity. There is no perfect way to know the answer to any of those things.” And, he adds, the survey already comprises 292 pages, including numerous detailed tables of data. To include all pertinent variables would entail a longer questionnaire, which might affect the response rate.
Healthcare Delivery Is Local
In his consultations with hospitalist groups, Dr. Nelson always emphasizes that the survey is “a starting point” and not the goal of what hospitalists should make. He favors adjunctive methods for benchmarking practices: “I think that when you’re benchmarking your practice, it’s as important to gather as much local and regional data as you can—in addition to the SHM survey.” He tries to network with other Seattle hospitalist programs to learn about their patterns of work hours, patient loads, and the like.
Thomas Baudendistel, MD, FACP, associate program director of the Internal Medicine Residency Program at Sutter Health’s California Pacific Medical Center in San Francisco, notes that regional markets differ widely. The healthcare market in the Northern California Bay area is very different from the one in Los Angeles in terms of financial remuneration and incentivization.
“The survey,” he says, “gives a global gestalt of the regional flavor of hospital medicine” and reveals general ballpark medians that can be a good starting point for practice benchmarking. “I think what our administration [at California Pacific Medical Center] wants to see is our data compared to the people across the street and down the road, because that’s a closer comparison in terms of payer mix and insurance reimbursements.”