By Rohit Uppal, MD, MBA, Chief Clinical Officer, Hospitalist Services
I recently participated in a LEAN Flow Improvement course with hospital medicine and emergency medicine clinicians and hospital leaders. LEAN processing focuses on eliminating waste, improving quality and maximizing value. These are familiar concepts to hospitalists because they have been core elements of the hospital medicine movement. Listening to the conversations throughout the course made me reflect on how far hospital medicine has matured in just a few short years, the value that our hospitalists bring to their hospitals and communities and how much more we can do and will be expected to do in the years to come.
Hospital Medicine was born from the need to improve flow and throughput in hospitals. The first major expectations of hospitalists were to reduce length of stay (LOS) and to accept unassigned patients. We were wildly successful at both tasks. A meta-analysis in 2012 showed that, on average, hospitalists reduced LOS by 0.44 days as compared with non-hospitalists. Since the founding of the hospital medicine specialty, hospitalists have gone on to do much more than just admit unassigned patients. The number of hospitalists has exploded from 11,000 in 2003 to more than 60,000 today, and hospitalists now admit more heart failure patients than cardiologists, manage more inpatient diabetic cases than endocrinologists and have virtually replaced neurologists in the management of inpatient stroke patients.
The 1999 Institute of Medicine report “To Err is Human” thrusts patient safety and quality into the spotlight and the hospitalists’ wheelhouse. Over the next several years, core measures, readmission penalties, hospital-acquired condition penalties, Centers for Medicare & Medicaid Services (CMS) hospital compare, value-based purchasing, Joint Commission and Leapfrog group standards and more have made hospitals rely heavily on their hospitalists to preserve their reputations and avoid being penalized for poor performance. The quality and safety movement has made the work of hospitalists immensely more complex, meaningful and valuable.
Hospitals have gone on to face additional pressures, and almost invariably they have placed their trust in hospitalists to provide solutions. With the transition to electronic health records, the growth of community hospital-based graduate medical education programs, the rise of consumerism and the transition to value-based care, hospitals once again are looking to hospitalists to become their partners in championing these changes.
At TeamHealth, our hospitalist services practice area is among the largest and highest performing hospitalist groups in the country. Many of our clinical and operational leaders are well-recognized as leaders in the field. We understand that the skills required of our hospitalist leaders are not part of traditional residency training. Considering that knowledge provides support, education, training, and access to leaders who are true experts in hospital medicine. Hospitalist services have expanded beyond hospital medicine to include obstetrics, general surgery, orthopedic surgery and critical care. We have successfully participated in risk-based programs such as Bundled Payments for Care Initiative (BPCI). Our hospitalist programs furnish hundreds of hospitals with hospitalists who take ownership of the quality, safety, efficiency and work environments within the hospital. Our Hospital Medicine leaders keep the goals, direction and management of our programs closely aligned with the strategic goals of the hospital. We have championed change and created collaborative cultures among the medical and hospital staff.
However, for all we have accomplished, more will be expected of us. Hospitals are facing new and increasing pressures and are determining that without strong hospitalist programs, they simply would not survive. Our hospitals are pushing us to deliver even higher value care at lower cost with greater standardization and waste reduction. Although these pressures cause disruption in the industry, TeamHealth Hospitalist Services continues to thrive under these greater expectations.
We are on a great journey to create even better and safer systems of care and make a significant, positive difference in the way healthcare is delivered in this country. It is an exciting time to be a TeamHealth hospitalist!
To learn how TeamHealth can support your hospital medicine goals, call 800.818.1498 or email us at firstname.lastname@example.org.
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