Hospitalist Futures: Turning Turbulence into Favorable Change

Dr. Sahoo

As hospitalists, we’ve perfected our routine, from pre-rounding methods to our friendly introduction to our patients and their families. We have our favorite silly stories or relatable examples we review with our patients to teach them about their illnesses or communicate a solid discharge plan. After making so many necessary revisions and perfecting our routines, our practice continues to evolve as the world of medicine continues to change around us. 

It has been our ability to manage and lead change that has made us so valuable as a specialty. As change agents, we lead efforts to improve quality and patient safety, reduce barriers to patient throughput, and enhance communication among the entire health care team. During the COVID-19 pandemic, our knowledge and skill in leading change have been incredibly valuable to health care systems’ abilities to respond rapidly to changing conditions.

These days, we hear about the length of stay reduction, early discharges, and patient experience almost daily. All these phrases were almost unheard of 10 years ago. So, what’s changed? For one thing, regulations from the Centers for Medicare and Medicaid Services (CMS), hospitals’ biggest payer, now require us to pay attention to patient experience and prevent health care-associated conditions and adverse events, or else we risk financial penalties. In addition, consumerism has become a part of health care with patients playing a more active role in their care. We’re continually revising our practice routines to provide higher quality care at lower costs to patients and health care payers. 

The specialty of hospital medicine is dependent for the service we provide on revenue, which is actively changing. Despite so much advocacy work done by SHM and other organizations to prevent cuts to our pay, recent changes from CMS are predicted to lead to a reduction in reimbursement for our services. Commercial insurance companies are making even larger cuts to our reimbursement rates. While we continue to provide significant value to hospitals and communities in our care, our compensation has the potential to change adversely, if it hasn’t already, due to these cuts.

In addition to direct blows to reimbursement for services, hospitals are operating in far more difficult financial environments than before as they deal with supply-chain delays, labor shortages, and throughput delays, all resulting in higher costs. In the setting of higher costs with lower reimbursements, the whole system is strained.

In my role at TeamHealth, I am regularly having conversations with hospitalists practicing in various parts of the country who are understandably concerned over the uncertain financial and operational future of hospital medicine. With increasing financial burdens on health care systems, further changes in our lives and practice patterns are inevitable in the months and years ahead. While we can expect more changes in the future, I encourage you to channel your angst, frustration, and/or anger over these changes. We cannot allow these changes to occur without our hospitalist voices being factored into the change. We must use our voices and unique talents to drive positive change.

Wondering how you can help change this for the better? Get involved in your local SHM chapter to find other individuals with similar struggles, develop solutions, and acquire strength in numbers as you charge through the change. Participate in Special Interest Groups, which are online forums within SHM where you can discuss how best to keep up with the changes. Get to know your local U.S. representative and let them know the value of a hospitalist to the hospitals and communities for which we provide care. Cutting reimbursement further to physicians and hospitals is not going to bode well for us or our patients, and the time to change that is now. Find out what the hospital, health system, or management group you are affiliated with or are employed by is doing to advocate for hospitalists. Do they have lobbyists on the Hill fighting reimbursement cuts? Are they working with SHM to advocate in our favor? Are they taking on health insurance companies that have engaged in unethical business practices and (thus far) gotten away with it? See if there is an opportunity to get involved.

Last but certainly not least, educate yourself on what governmental policy changes are being proposed, what that means to you, your patients, and your profession, and join your voice with others to make your support and opinion powerful. You may feel like you don’t have time for advocacy or getting involved in matters outside your immediate practice, but I assure you this will have a significant impact on you and your practice and will be worth your time. 

Keep in mind the words of the 2014 Nobel Peace Prize laureate, Malala Yousafzai: “When the world is silent, even one voice becomes powerful.” The world of health care is rapidly changing around us. It’s up to each one of us to make our voices heard so that the changes work for us as well as our patients.

Dr. Sahoo is a hospitalist in the St. David’s Health System of HCA in Austin, Texas,  a National Hospital Medicine Performance Director with TeamHealth, a faculty member at Texas A&M School of Medicine, and an SHM Board Member.