Is the integration of urgent, emergent, inpatient and
care of patients with
acute medical conditions.
Which Hospital-Based Physician Specialty Will Wield The Mightiest Pen In The Future?
In my last two blogs I examined how the dynamic behind bundled payments will create a vacuum to be filled by those with the most leverage. The leverage wielded by any physician specialty group will be determined not only by its ability to generate the most revenue and to save the most money, but also by the size of its integrated group. And as CMS puts greater emphasis on hospital-acquired infections and readmission rates, I believe we will see the hospitalist emerge as the hospital-based physician specialty that holds the most leverage within the hospital in the new healthcare environment.
In the past, hospitalists have been on the lower end of average compensation for all hospital-based physicians, but that can be expected to change significantly in the future. Although they are a relatively new specialty compared to their colleagues, the growing leverage of the hospital medicine physician within the hospital may soon overshadow that of the other, more-established hospital-based physicians. Their importance to the financial performance of the hospital continues to become more apparent with new compensation methods being promoted by both commercial and public payers.
The saying, “No margin, no mission,” neatly summarizes this point. It will be the physicians who save or generate money who will have the clout within the hospital environment in the future.
The hospitalist’s ability to do both will become more apparent as fee for service policies are abandoned in favor of fee for value. Currently, hospitalists often cannot generate sufficient revenue by billing through the current fee for service methodology because they frequently serve uninsured or underinsured patients where collections are insufficient. For this reason, they have been perceived to require financial subsidies, and hospitals have historically shifted revenue from other hospital revenue/departments to supplement their compensation at market rates due to insufficient collections. But when all fees are pooled and apportioned according to services provided, hospitalists, like other hospital-based specialists, will be paid according to the work they do. Their inability to collect directly from insurance companies on a fee for service basis will be almost irrelevant.
Therefore we should expect that the hospitalists, now seen as requiring a subsidy, may likely become the hospital-based physician specialist with the best value proposition and mightiest pen in the future. When bundled payments are widely implemented, today’s shortfall of up to $130,000 will be no longer treated on the books as a subsidy by the risk-bearing entity. Hospitalists will and rightfully so be compensated based on the value they provide across the Acute Care Continuum, and the last recognized hospital based physician specialty will be first in terms of leverage in the hospital within the new paradigm of healthcare.
Thanks for this article Dr. Curry. I am seeing hospitalists in several regions bringing great value to the hospitals they serve, already. It's exciting to see. Something I have noticed: Even at sites where hospitalists are very active (in several regions) I still notice that there are a fair amount of transfers to neighboring facilities because of a lack of "back up consultants". Apart from the categories of "trauma" and "STEMI/STROKE" transfers which are expected, another large category of transfer is for patients with GI bleeding. Despite the presence of hospitalists, there is sometimes a reluctance to admit GI bleed patients without the assurance of GI backup (which I find understandable). This is not a criticism of our hospitalist groups. On the contrary, so many of our small to medium sized sites do not have this paid on-call resource which can create an impediment. I have seen this as a frustration for both ER providers as well as our hospitalist cohorts, alike. An idea has been bouncing around in my head: As we look at specialties and subspecialties with whom to align, and as fee for service gives way to bundled payments, I wonder if we might be well served by identifying GI specialists (who are most often internists) with whom to align and add to our hospitalist ranks. I realize financials would be at the heart of any such discussion as well as work environment/schedule. But it seems that a GI specialist might be willing to align with a group like CEP America to "hedge his/her bets" against the future (if for no other reason) while perhaps retaining the ability to perform routine GI procedures if such a model fit. 1. Hospitalist groups with a GI specialist would have increased admitting confidence (or at least "backup" assurance). 2. Our customer hospital would be happy to keep its community of patients admitted to its own facility - (a financial advantage, also) 3. Less hassle for ER physicians arranging transfers to neighboring hospitals and more time focusing on incoming patients. 4. Receiving hospitals would have fewer battles with their own on-call GI specialists receiving these patients. 5. Patients would likely be happier not to be transferred many miles away from home in some cases and their families similarly happy. 6. It would add perceived and actual increased value for a hospital (and our group) within a community. I work at both a hospital that is a sender and a hospital that is a receiver of GI bleed patients. It has been interesting to understand both perspectives. My first blog...I appreciate the opportunity to "wax philosophical". Sorry for the length (I think blogs are supposed to be shorter). Would love to hear what others think (pro or con). Thanks, David "The Graying"
Click here to cancel reply.
Email (*) will only be visible to blog administrators
Remember my details
Notify me of followup comments via e-mail
Enter your email address:
By Kevin Kruse
While acute care hospitals are veterans in the fight to contain costs, healthcare reform is bringing greater focus to other aspects...
By Bruce Friedberg, MD
The northern San Diego region is growing rapidly, and last year, Palomar Health unveiled a state-of-the-art hospital to meet...
By Mike Harrington
About thirty years ago, I was an accountant for Arthur Young. One of my auditing clients was a young emergency...
By Ted Kloth, MD, FACEP
The time is coming when consolidation and transparency will reign supreme, and the effects are already being felt throughout...
By Theo Koury, MD, FACEP
Hospitals across the country are starting to feel the effects of healthcare reform. Beginning in fiscal year 2013 (September...
Re: Employee Engagement: A Critical Tool in the Age of Healthcare Reform
Être un sujet de fait inéluctable, la quantité de questions d'une dame porte couplé avec elle, va sur...
Re: Who Will Rescue Healthcare and Solve The EMR Debacle? We Need Another Steve Jobs
isaba.com I recently came across your blog and have been reading along. I thought I would leave my first...
Re: All the World’s A Stage for this (Pay for) Performance
Acute care settings include but are not limited to: emergency department, intensive care, coronary care...
Re: Triage Out
The financial benefits to both the individual and the medical center from a triage out system are obvious...
Re: Changing Physician Behavior – When ‘Incentives’ Go Wrong
Every physician should go for better incentives; not only physicians every employee used to work to get...