Part of the York Hospital mindset is that the demand for inpatient services would keep climbing as the community continued to attract newcomers. An unanticipated consequence of having a hospital medicine program was that outpatient practices quickly grew by 20% because they had offloaded their hospital work, in turn generating more hospital admissions. Brockie and York leaders, recognizing the possibility of stress and burnout on hospitalists as their volume of work grew, took steps to avert problems. “We’re in a sustained growth mode and we need the hospitalists to be satisfied with their compensation and schedules to be able to recruit new physicians,” says Dr. McConville. “Hospital administration underwrites the hospitalist program’s shortfall so that we can pay [the hospitalists] a salary commensurate with MGMA [Medical Group Management Association] guidelines plus productivity. It’s a substantial amount annually and well worth it,” he adds.
Unlike many hospitalist programs, York Hospital’s did not arise because physicians wanted to avoid driving to the hospital to make rounds. “Some groups are five minutes away and they gave us their inpatient work, while a group that’s 45 minutes away still does hospital rounds. What drives physicians here is their view of continuity of care,” says Dr. McConville.
Brockie is York’s only hospitalist group, although three other medical groups have hired two doctors to handle their inpatient work. “It’s not a problem for us. We don’t have a sense of competition,” says Dr. Whitney.
The Nuts and Bolts
Perhaps it’s Brockie’s long tenure as a medical group, its acquisition by WellSpan and the performance expectations that such an acquisition denotes, the thoroughness of its hospitalist leaders, or some combination of the above, but the hospitalists have their schedules and compensation calculations down pat.
Dr. Lamanteer spends much time and thought on the hospitalists’ compensation package. He studies national salary data and factors them into a sophisticated system of relative value units (RVUs) and case-based data to maintain a “competitive compensation package that provides incentives for both our physicians and the hospital to balance productivity with keeping length of stay in check,” he says. That’s not as easy as he makes it sound, because bumping up RVUs and volume has to be balanced with a length of stay that is both efficient and safe for patients.
Compensation begins with base salary—either Level I for 132 hours or Level II for 147 hours over three weeks. Productivity bonuses start with one point awarded for each admission, discharge, consult, and ED evaluation. Point values are then adjusted for average professional revenue generated per patient. The threshold for bonus pay is 806 points. Additionally, three clinical performance criteria, chosen annually, impact the bonus. For example, recent targets include ordering a tentative discharge time one or more days in advance (>65%), abiding by the “do not use” abbreviation list created by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) (>90%), and complying with diagnostic coding rules (>75% accuracy).