On one hand, payors have determined (appropriately so) that they want quality over quantity, and those who can provide superior outcomes will be better reimbursed. With thinning margins, hospitals will look for effector arms to engage the type of process improvement necessary to improve outcomes and, subsequently, revenue. We should not cower from this challenge, rather, embrace it; this is our chance to shine. Hospitalists are better positioned, better than any other medical group, to re-engineer the processes of care required to improve the quality of hospital care.
At the same time, our customers—the patients—likely will be footing more of the bill. As such, this new breed of healthcare consumer will expect a higher level of service than previously delivered. Again, hospitals that can provide five-star service will be better positioned to capture this coveted but ever-shrinking cohort of paying patients. This again positions hospitalists well. In my hospital, our group cares for just over 25% of all hospitalized patients, about 5,500 admissions per year.
Many hospitalist groups have a reach well beyond that, perhaps approaching 75%. Consider the type of bargaining power a hospitalist group could have by systematically showing that your work improves patient satisfaction, retention, and referral.
Measurement Is Crucial
Which brings me to my final point: As the economy tightens further, we will feel a heretofore-unrealized pressure to document our benefit. If we cannot document the fact our work improves processes, reduces length of stay, enhances the quality of patient care, and increases patient satisfaction, then we run the risk of being a glaringly large, negative budgetary line item waiting to be slashed.
With resolutions in the air, I resolve to work closely with my group and our hospital to document our value, prove our worth, do it better. Indubitably, this will meet with resistance, as some will advocate turning a blind eye, afraid of the challenges we might encounter. I, however, am going to choose to embrace these opportunities by fearing the known, rather than the unknown.
I have no doubt an honest assessment of the work we do and the value we provide might be anxiety provoking. It will force us to evaluate our care in ways we fear, measure our outcomes in ways we fear, push ourselves to improve in ways we fear.
In a word, change. TH
Dr. Glasheen is associate professor of medicine at the University of Colorado Denver, where he serves as director of the Hospital Medicine Program and the Hospitalist Training Program, and as associate program director of the Internal Medicine Residency Program.