But has anyone spoken to the hospitalists? Has anyone asked us about the benefits of our profession? Many of the hospitalists I meet mention “reduction of length of stay” as a main reason to have hospitalists. I think that response was appropriate more often than not over the past 15 years.
But today, ask any hospital administrator that same question, and what do you expect the answer to be? It should not be surprising to hospitalists that most hospitals expect much more from their hospitalist programs than “just reducing the length of stay.” These are the same hospitals that often support—to the tune of more than $100,000 per hospitalist full-time equivalent—your HM program. If your hospitalist program is anything like mine at Beth Israel Deaconess Medical Center in Boston, this represents millions of dollars to the hospitalist program budget.
Increased Pressures
The fact that hospitals’ expectations of hospitalists have changed should not come as a surprise. Americans’ expectations of hospitals have changed markedly over the past 15 years. In the 1990s, when hospital medicine was “born,” there was little mention of quality and patient satisfaction when it came to healthcare. Who would argue that improving quality and patient satisfaction is a bad thing?
Over the past decade, we’ve seen the development of Medicare core measures and the link between patient outcomes and Medicare reimbursement. Hospitals could not have achieved many of their performance improvements without their partnerships with hospitalists.
Hospitals are under increasing pressure to not only decrease costs, but also improve quality. It is understandable that they turn to the “inpatient specialists”—the hospitalists—to help them meet societal expectations. But as hospitalists, this puts pressure on us to continually improve our game—or face the consequences. A pin factory in Scotland can only survive if it produces higher-quality pins at a lower cost than its competitor.
Hospitals and our American healthcare system expect much more today from hospitalists, and they should; patients’ lives are at stake. It should not be a surprise that hospitalist programs that struggle are those that fail to meet expectations. Successful hospitalist programs, the ones that are able to demonstrate their “value,” do so well beyond knowing their patient’s average length of stay.
I am interested in learning about your efforts to demonstrate the “value” of your hospitalist group. Feel free to email me at [email protected].
Dr. Li is president of SHM.