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Building, Growing and Managing a Hospitalist Practice

INTRODUCTION

According to the Society of Hospital Medicine, the number of hospitalists has increased from approximately 5,000 hospitalists in 2005 to more than 44,000 hospitalists in 2015. Despite this explosive growth and the fact that the majority of hospitals now have hospitalist programs, not all of them have been successful in establishing a thriving organization that becomes part of the fabric of the hospital. The supply-demand imbalance for hospitalists continues. The etiology for the imbalance is multifactorial. Contributing factors include the small number of medical school graduates pursing hospital medicine continues to be below the market needs and the relative ease of moving from one hospitalist team to another. Couple these factors with the increased level of physician stress secondary to understaffed programs and a continued push on scope of practice with physicians who are younger than those in other specialties and these factors together perpetuate the supply-demand imbalance in the market today. The issues experienced by hospitalists are not unique; other specialties including emergency medicine and critical care have similar challenges with turnover, recruiting physicians and temporary workers.

More emphasis is now placed on the patient experience of care with the introduction of value-based purchasing. There has been a focus on educating patients about the role of hospitalists yet many patients and their families continue to express confusion about the role. It is still common for patients to misconstrue the term “hospitalists” for “hospice.” Too often, hospitalists assume patients understand their presence at the bedside. More effort in explaining the role of the hospitalist as the internal medicine physician or family medicine physician who is responsible for patient care while the patient is in the hospital is essential. Once patients understand that the hospitalist is the physician assuming responsibility for everything from admission to discharge, including making patient rounds and ordering all needed tests and procedures it helps them understand why the hospitalist is caring for them. An important component of the dialog is that the patient understands that their primary care provider (PCP) is informed of their progress and resumes care for the patient postdischarge.

With the Centers for Medicare and Medicaid Services moving from a fee-for-service to a fee-for-value payor, the hospitalist takes on an important role in coordination of care with a focus on population health. Today there is a deeper understanding of the importance of managing population health to drive the health of the community that a health system serves. Central to this movement is the need for robust measurement systems that enable us to concentrate on the outcomes of a population instead of individual silos within the delivery system. Hospitalists are in unique position to deliver on the Institute of Medicine’s “Triple Aim,” targeting better health for the population, better quality and patient experience of care while lowering the cost of care. With more than 50% of all health care ...

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