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Executive Insight: Hospital-Based Surgery Programs Can Promote Operational, Clinical and Financial Goals

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In a Q&A with Dr. Rohit Uppal, Chief Clinical Officer for TeamHealth Hospitalist Services, we explore the valuable operational, clinical and financial impacts of hospital-based surgery programs.

General and orthopedic surgeons deliver value by providing vital services, improving clinical quality and patient safety and enhancing the overall patient experience. Dr. Uppal explains how hospital-based surgery programs can add value for patients, clinicians and hospitals in today’s challenging operational environment while representing important areas of growth that can help a hospital achieves its most important objectives.

Q: How can a hospital-based surgery program bring financial, clinical and operational value to a Hospital?

RU: Consider that as many as one-third of emergency department visits require surgical or orthopedic evaluation, and hospitals often have to rely on community surgeons to provide necessary “on-call” coverage. Unfortunately, time spent waiting for a physician can sometimes lead to delays in care, longer wait times and higher transfer rates. Surgical conditions are often time-sensitive, as are many of the quality metrics in both general and orthopedic surgery. Thus, a hospital-based surgery program can not only help a hospital ensure that vital patient services are provided, but can enhance clinical quality, patient safety and patient satisfaction goals.

Q: What Are Some of the Benefits of a Hospital-Based Surgery Program?

RU: Hospital-based surgical specialists are clinicians that are dedicated to the acute setting and engaged in process and quality improvement. Having 24/7 in-house coverage by a board- certified surgeon who specializes in the inpatient setting elevates the standard of care for a hospital’s patients. The value equation for a hospital is similar to that often seen in a hospital medicine program. As with hospital medicine, an investment from the hospital is required to support orthopedic and general surgery programs, but the return on that investment is significant and reaches across many areas. The scarcity of available surgeons and orthopedists is especially severe, threatening both the quality of care and the financial success of some hospitals.

Retirement numbers currently outpace new recruits and the majority of new recruits do not wish to accept “on-call” duty. As a result, hospitals are increasingly unable to cover acute care and orthopedic surgical needs.

This lack of coverage for these vital service lines can sacrifice the hospital’s community mission and reputation. In addition, as surgical cases are transferred out to competitor facilities, a great deal of institutional revenue associated with facility fees, physical therapy and imaging are lost. In addition to providing stable, hospital-based coverage that patients expect and deserve, TeamHealth’s surgical specialists are committed to a collaborative relationship with hospital staff, emergency department physicians, hospital medicine specialists, and others to ensure that performance and quality goals are achieved. This important alignment with the mission and goals of the hospital is a key differentiator of our programs.

Q: How Does a Hospital-Based Surgery Program Benefit Community-Based Surgeons and Other Clinicians?

RU: TeamHealth’s hospital-based surgery programs have found broad support from surgeons already on staff at our partner hospitals in a variety of meaningful ways. Perhaps most importantly, a hospital-based surgery program allows community-based specialists to focus on their individual practices and their individual areas of specialty. By eliminating the “on call” issue, community-based surgeons are free to invest their time and energies on those areas that are of meaning and value to them, their partners and their patients.

Other clinicians also derive great benefit from our programs. Emergency department physicians and hospital medicine physicians benefit from the consistent availability of surgical support for referrals and consultations. In that and in other ways, a hospital-based surgery program can be a key driver of recruitment and retention of physicians and advanced practice clinicians in other specialties.

Q: What is the Benefit for Clinicians Who Choose to Work in a Hospital-Based Program?

RU: TeamHealth’s hospital-based surgery programs provide immense benefits to our clinicians. For those surgeons who prefer to focus on inpatient care as opposed to the pressures of staffing, managing and building a community- based practice, our programs are an excellent option. Our staffing models allow our surgeons to achieve better work-life balance through flexible staffing while earning a competitive income. The hospital-based model pairs experienced surgeons with an interest in acute care with hospitals facing rapidly growing deficits in coverage.

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