How Hospital Medicine Has Transformed as a Medical Program

For community private practice clinicians, the benefits still reflect what we saw in the origin story: efficiency for their practice time and more attentive hospital care for their patients.

For dedicated HM providers, there is protected time off (work-life balance) and patient volumes are driven by the hospital. Additionally, they don’t need to build their own private practice and can specialize in inpatient internal medicine. The experience of caring for a high-acuity patient over a short period of time and being able to safely send them home is deeply gratifying.

For systems and facilities, the benefits of a well-run HM program span three categories: growth and reputation, quality and clinical outcomes, and financial performance.

Growth and Reputation

One of the most important priorities to anyone who works in healthcare, anyone who has ever needed care, and anyone who has walked through medical scenarios with loved ones (so, nearly all of us) is patient experience. For hospitals, having a dedicated inpatient provider team is the key to many patient experience initiatives. It allows for continuity of care through a centralized and limited number of people—which creates stability and clarity for both the patients and their families. With this continuity comes improved operational throughput, rigorous patient safety, and timely discharges to the next appropriate site of care (ideally, home)—again enhancing the patient’s experience by providing the best care in the most efficient manner. Better patient flow throughout the hospital allows quick turnover to beds and growth in inpatient capacity. Ultimately, this positions the hospital to be the preferred facility in its community and to gain a larger share of patients.

Quality and Clinical Outcomes

Along with improved patient experience, optimized length of stay and improved throughput are beneficial for the hospital’s clinical and quality performance. The longer patients stay in the hospital, the higher their complication rates. A dedicated HM team has a solid grip on the right length and rigor of care that each type of patient needs and can develop best practices for healing their communities. In fact, research shows that higher numbers of hospitalists are associated with lower hospital readmission rates.

This team can also collaborate closely with other clinicians. HM providers can work with other departments to drive quality and safety initiatives (sepsis protocols, for example). They can build solid relationships and rhythms with the nurses on their floors. As a result, workflows become smoother, process compliance is enhanced, and resources are utilized more wisely.

Financial Performance

In financial terms, reduced length of stay as a result of dedicated HM programs emerges as an important factor again. Keeping patients for only the appropriate amount of days translates to fewer unnecessary costs on the hospital. And, as mentioned earlier, readmission rates have also declined with the growth of hospitalists— improving hospital ratings and reimbursement. Having a consistent team of hospitalists also enables hospitals to invest wisely in clinical documentation improvement programs. Return on that investment is realized when more accurate coding and billing improves case mix index—again driving higher hospital ratings and reimbursement.

The expected benefits of a dedicated HM program to the patient were explored within the provider and hospital sections, but to summarize:

• Regular and consistent visits from providers (rather than waiting on a community provider or on-call specialists to find available rounding time)
• Efficient movement through the admission, care, and discharge processes, enabling them to get home (or to the next site of care) at the right time
• Proven, best-practice treatments from providers who specialize in the care they need
• Lighter financial burden due to less unnecessary testing, fewer medications, and only staying the right number of days in the hospital

Now that we’ve illuminated the beneficial role HM plays in healthcare, let’s take a look at the other side of the coin. There are still some important financial implications to be aware of when looking at HM programs.

Evolve the focus from episodic patient satisfaction scores to longitudinal patient loyalty. This involves thinking about all the bumps and barriers that patients encounter when interacting with the hospital—before, during, and after admission.

Consider the following:

• how patients are interacting with hospital services and representatives in the community
• where they are located and how they transport themselves
• what they know about how to navigate the revenue cycle process
• how they access their health information
• what their jobs demand physically and emotionally (or how they cope if they lack jobs)
• who comprises (or is missing from) their support systems
• what they might be struggling with that could affect their health journey

All of these questions (and more) are important to answer because they have a distinct impact on patient outcomes, population health, and the success of hospital initiatives. Prioritizing patients to this extent can require a widespread culture change, new or revised positions within the hospital, and working with external partners to help structure and deploy these efforts.

The HM model has evolved to primarily use 12-hour shifts with seven days on and seven days off for providers. While this model has it benefits, it also has some unfavorable side effects—and may need to be revised.

From a capacity perspective, the traditional scheduling model is too static. It is not responsive to unexpected daily or monthly changes and cannot flex to fit typical hospital volume patterns. With margins as tight as they are, hospitals cannot afford to bring on extra providers who may only be needed for the relatively brief increments where it is too busy for the normally scheduled providers to safely manage. On the flip side, hospitals cannot afford to find themselves regularly understaffed, as this builds up inefficiencies that result in patients leaving without treatment, transferring out, or staying too many days.

Changes to this model could happen in a number of ways, but two technology-enabled examples are:

• using supplemental telemedicine coverage to augment onsite HM providers during surge periods
• allowing hospitalists to re-deploy excess time during slow periods by taking virtual visits Be innovative here and think outside the box.

For example, consider offering virtual sports physicals at schools during the day—this creates ease for the patient and family, while also using your providers’ time wisely.

HM teams must be focused on how to get patients on the best track for successful recovery. Set your organization up to be successful over the course of 90-day bundles, or other value-based care arrangements as they continue to grow in our market. These programs are—and will increasingly become—critical to helping sustainably fund a dedicated HM program

In order to be an innovative organization, be willing to think differently. This does not mean thoughtlessly investing in any new gadget or trick that emerges in the market. It does mean evaluating the hospital’s goals, soliciting input from various employees within the organization, and looking at the greater community’s needs when evaluating and choosing what technology to implement.

Consumers of all ages adjusted to and became comfortable with a virtual life as a result of the COVID-19 pandemic. Though virtual health was already on the rise, it is now an imperative for hospitals and health systems as they adjust to their patients’ new priorities. Offering accessible, affordable, and socially-distanced care options will significantly help hospitals rebuild consumers’ trust and loyalty, provide care when and where patients need it, and promote improved health throughout their communities.

While we believe that telemedicine capabilities are essential, hospitals should also consider the possible benefits of artificial intelligence, big data, natural language processing, blockchain, and more

As the specialty of HM continues to mature, there must be a discussion about how the increasing responsibilities of the department changes the role of the physician as well.

Given the existing role of quarterback, hospitalists have a good view into the processes of and interactions between other specialties within the hospital. As more care starts to take place outside the hospital, the provider has to be able to flex those QB muscles with external contacts. The hospitalist is critical to forming positive and sustainable partnerships with other members of the medical staff, primary care physicians in the community, local post-acute care providers, and community organizations; creating loyalty among the patient population; and bolstering the reputation of the hospital with patients and other providers along the care continuum.

While we’ve discussed the importance of hospitalists leading the charge on quality, safety, and experience initiatives, they should also be on the front lines of technological advancement in decision-making and implementation. To again quote the Society of Hospital Medicine, “they need to continue to master technology, clinical care, and the evergrowing importance of where those two intersect.” This includes being proactive in pursuing the training and developing the skills needed to understand the industry’s innovation landscape and provide care in new, technology-enabled ways.

Finally, hospitalists must be active participants in the industry-wide drive to reduce and avoid provider burnout. This means personally adopting self-care and stress-relieving habits, mentoring the next generation of hospitalists in healthy practices, and being leaders in the organization to call out and change any patterns or pressures that place unnecessary burden on the care team.