But even with SHM and many other organizations touching thousands of hospitalists, the HM landscape is varied. Some hospitalist groups are well-formed, well-staffed and supported, and they are delivering on the full promise of HM today. Yet many HM groups are very much a work in progress.
This is not surprising when you realize that the role of hospitalists has been evolving in real time while the hospitals we all work in are changing as well. Throw into the mix the addition of more than 30,000 hospitalists over the last decade with various training, skills, and experience, and it is not unexpected that the results have been a mixed bag.
In the next decade, however, HM groups will need to step up their game to fulfill the promise of HM more broadly in our nation’s hospitals. SHM hopes to provide a guidepost in this process and is considering developing standards for HM groups (HMGs) and possibly creating an aspirational award along the lines of the Baldrige Award. At the beginning, maybe only a few hundred HMGs will qualify for such an award, but the hope is that other HMGs will use this opportunity to obtain the resources and make the improvements to also achieve the highest standard for hospitalists.
A Perfect Partner
At the same time, it is clear that both the government and private insurers are heading toward a new way to pay for healthcare, moving away from the current transactional manner in which the procedure and the visit is the currency, to something where value and performance become crucial.
This is a system in which preventing the DVT is more valued than waiting for the complication and treating it, where doing the first hospitalization right and working with the family and the patient to make the best transition out of the hospital is rewarded more than billing the insurer for the readmission.
The efficient and competent HM group is an ideal partner for the hospital in this future world.
In addition, the hospital community is being reshaped. More and more physicians are gravitating to the hospital as an employee or essential partner. More than 70% of cardiologists are now hospital-employed. Specialty hospitalists, most notably in the fields of OBGYN, neurology, orthopedics, surgery, and psychiatry, are growing.
Accountable-care organizations (ACOs) are being supported by Medicare and should continue to grow as another hospital-physician risk-sharing entity. In many places, hospitalists have been in place for more than 10 years as the original physician partners with their hospitals. It is very likely that hospitalists will be right in the middle of the new medical staff and in driving the expected efficiencies and improvements as the hospital of the future and payment system changes continue to evolve.
In all of this, it is important for HM to continue to be creative and innovative, and not hamstrung by the conventional and the status quo. This calls for more than just fresh ideas and the courage to be bold. It requires new skills and competencies. We must continue to knock down the barriers of autonomy and exchange that for active participation in, and leadership of, the team. We must continue to move away from the mystique of the physician and embrace the need to set a course for change, be willing to be measured and be less than perfect, and seize the opportunity to improve and innovate.
Although the last decade of HM has been no piece of cake, the next 10 years will be even more challenging. The good news is that our skills and competencies can make us a central player, a key partner. But we will need to rise to meet this challenge.