Tier 1

Foundational

Does your Hospital Medicine program…

  • Staff providers to match program volume/acuity?
  • Provide documentation that accurately reflects the patient’s illness and documents everything being done for the patient in order to maximize physician reimbursement and case mix index?
  • Excel at patient handoffs between departments/specialties?
  • Act as a “quarterback” to manage patient care throughout stay?
  • See patients multiple times a day as appropriate?
  • Discharge patients whenever they are ready, with a focus on patients that are ready to go earlier in the day?
  • Coordinate with the Emergency Department to ensure smooth transition of patients from the emergency room to the hospital and to support ED throughput metrics?
Tier 2

Intermediate

Does your Hospital Medicine program…

  • Participate in multidisciplinary rounds?
  • Utilize geographic rounding?
  • Center decisions around patient/family experience and remain available for patients and families throughout the day?
  • Demonstrate leadership in hospital-wide improvement initiatives?
  • Manage patient stays so patients are discharged within expected length of stays?
Tier 3

Advanced

Does your Hospital Medicine program…

  • Empower NPs/PAs to practice at top-of-license?
  • Utilize telemedicine capabilities?
  • Execute post-discharge care coordination services?
  • Ensure patients are discharged to appropriate next site of care?
  • Coordinate with the Emergency Department to reduce/eliminate inappropriate readmissions?

Scoring Instructions

  1. Enter in the total number of white boxes checked for each of the three tiers and complete the simple equation below to generate your program development score.
  2. Find out where your score lands, then keeping scrolling down the page for actions you can take to get started on the competency boxes you didn’t check.

Scoring Equation

#Foundational (X1)
+ #Intermediate (X2)
+ #Advance Boxes (X3) = _____


Where do you land?

0-11: Just Getting Started
12-23: Well on Your Way
24-32: Outstanding

Recommended Actions & Approaches

Tier 1: Foundational

Staff providers to program volume/acuity
Examine case mix index, geographic footprint of your hospital, and volume trends to determine the best patient-provider target ratio for your organization.

Focus on documentation improvement
Very small changes go a long way here. Focus on documentation education, reinforcement, and auditing to avoid/catch small errors in verbiage or missed steps that could save considerable dollars.

Excel at patient handoffs between departments/ specialties
Deploy joint operations committees, communication tools, and team building exercises to unite various types of providers and ensure safe patient transitions.

Designate a “quarterback” to manage patient care throughout stay
Establish a point provider to guide each patient’s journey—including managing case consultants, advocating for patient interests, and streamlining communication.

Tier 2: Intermediate

Utilize geographic rounding to support participation in multidisciplinary rounds

  • Group each hospitalist’s patients in the same area to increase amount of time the care team can spend with each patient and improve other efficiencies.
  • Once patients are organized more effectively, bring relevant disciplines together to review care plans, get patient updates, and decide next steps; create checklists and other resources to help these disciplines communicate in a consistent, systematic way; and be clear with the patient about who the care team leader is.

Center decisions around patient/family experience
Train providers to communicate more effectively, round at a reasonable time for both patients and family members, and prioritize patient convenience as much as possible.

Optimize length of stay
Round in timely fashion, and eliminate unnecessary care variation and testing.

Demonstrate leadership in hospital initiatives
Champion and drive positive change in patient experience, innovation, quality and safety, and more.

Tier 3: Advanced

Operate proactively rather than reactively
Be data-oriented and driven, encourage and solicit innovative ideas from staff.

Empower NPs/PAs to practice at top-of-license
Ensure bylaws are updated appropriately to allow full NP/PA contribution; train physicians on best practices for working with NPs/PAs.

Utilize technology to expand care team
Be open to innovation, give regular trainings on best practices for technology use, embrace telemedicine providers as a resource to cover scheduling gaps and overnight shifts and provide virtual visits for minor acute patients.

Execute post-discharge care coordination services
Set up clinical and nonclinical support systems to assist patients with follow-up care plans, referral coordination, Transitional Care Management, and more.