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How Hospitalists Can Put SHM's State of Hospital Medicine Survey to Work
The 2014 State of Hospital Medicine survey is under way.
Participate now at www.hospitalmedicine.org/survey.
Each year, we look forward to receiving the Society of Hospital Medicine’s State of Hospital Medicine survey results. Over the years we have refined the way we use the information for our practices, which include HM services at the five hospitals of WellStar Health System in Northwest Atlanta. Historically, the report had been used merely to look at the industry trends, and, at times, to cover the scope of service, compensation, and other data points. The information was not widely shared with either the hospitalist team or health system administration.
Our approach to the survey changed when we set our sights on becoming a destination of choice for hospitalists in the Southeast Region. This stated goal made it clear we needed to take a more active approach to benchmarking ourselves against our peers in the field. The State of Hospital Medicine report, with its abundance of data, was the perfect tool. We set up an annual review of our HM practices (54 physicians and 21 advanced practice professionals spread among five hospitals) that enumerated individual provider performance in key measures: total compensation, total wRVUs, compensation per wRVU, and professional collections per wRVU. We then benchmarked the data against the survey data, highlighting the percentile achievement in each category. This allowed us to identify pockets of opportunities and make adjustments to compensation model and productivity targets, thus positioning ourselves competitively in the local and regional market.
Not only did this process aid in demonstrating our performance as compared to industry peers, but it also highlighted the differences in practice patterns within our health system. In turn, we reduced variation and promoted best practices among the five WellStar hospitals—standard workflow, scope of services, transfer policies, and collaboration with advanced practice professionals, to name a few.
In addition, transparent discussion of external and internal benchmarking findings dramatically improved provider engagement; individuals were eager to learn how other practices were able to achieve success. As a result, the clinical footprint of HM services expanded tremendously, ultimately benefiting patients, referring and consulting physicians, and hospitals.
The report also helped us to reiterate the value of WellStar Hospital Medicine to our administrative partners. Complementary to our balanced scorecard, which tracks quality, efficiency, and patient satisfaction measures, the external benchmarking validated a very strong return on the investment that WellStar Health System is making in its hospitalist programs.
The State of Hospital Medicine survey can be a tremendous resource to your practice, as it has been to ours. We recommend setting a mission and vision statement for your practice and then formulating a plan around the best way to share and utilize the data from the report to pursue your mission. As we experienced, a meaningful review, along with follow through on identified opportunities, can be positively transformative.
Dr. Akopov is vice president and chief of hospital medicine operations at WellStar Health System in Atlanta, Ga. Ms. Papetti is assistant vice president of WellStar Medical Group in Atlanta, and a member of SHM’s Practice Analysis Committee.
The 2014 State of Hospital Medicine survey is under way.
Participate now at www.hospitalmedicine.org/survey.
Each year, we look forward to receiving the Society of Hospital Medicine’s State of Hospital Medicine survey results. Over the years we have refined the way we use the information for our practices, which include HM services at the five hospitals of WellStar Health System in Northwest Atlanta. Historically, the report had been used merely to look at the industry trends, and, at times, to cover the scope of service, compensation, and other data points. The information was not widely shared with either the hospitalist team or health system administration.
Our approach to the survey changed when we set our sights on becoming a destination of choice for hospitalists in the Southeast Region. This stated goal made it clear we needed to take a more active approach to benchmarking ourselves against our peers in the field. The State of Hospital Medicine report, with its abundance of data, was the perfect tool. We set up an annual review of our HM practices (54 physicians and 21 advanced practice professionals spread among five hospitals) that enumerated individual provider performance in key measures: total compensation, total wRVUs, compensation per wRVU, and professional collections per wRVU. We then benchmarked the data against the survey data, highlighting the percentile achievement in each category. This allowed us to identify pockets of opportunities and make adjustments to compensation model and productivity targets, thus positioning ourselves competitively in the local and regional market.
Not only did this process aid in demonstrating our performance as compared to industry peers, but it also highlighted the differences in practice patterns within our health system. In turn, we reduced variation and promoted best practices among the five WellStar hospitals—standard workflow, scope of services, transfer policies, and collaboration with advanced practice professionals, to name a few.
In addition, transparent discussion of external and internal benchmarking findings dramatically improved provider engagement; individuals were eager to learn how other practices were able to achieve success. As a result, the clinical footprint of HM services expanded tremendously, ultimately benefiting patients, referring and consulting physicians, and hospitals.
The report also helped us to reiterate the value of WellStar Hospital Medicine to our administrative partners. Complementary to our balanced scorecard, which tracks quality, efficiency, and patient satisfaction measures, the external benchmarking validated a very strong return on the investment that WellStar Health System is making in its hospitalist programs.
The State of Hospital Medicine survey can be a tremendous resource to your practice, as it has been to ours. We recommend setting a mission and vision statement for your practice and then formulating a plan around the best way to share and utilize the data from the report to pursue your mission. As we experienced, a meaningful review, along with follow through on identified opportunities, can be positively transformative.
Dr. Akopov is vice president and chief of hospital medicine operations at WellStar Health System in Atlanta, Ga. Ms. Papetti is assistant vice president of WellStar Medical Group in Atlanta, and a member of SHM’s Practice Analysis Committee.
The 2014 State of Hospital Medicine survey is under way.
Participate now at www.hospitalmedicine.org/survey.
Each year, we look forward to receiving the Society of Hospital Medicine’s State of Hospital Medicine survey results. Over the years we have refined the way we use the information for our practices, which include HM services at the five hospitals of WellStar Health System in Northwest Atlanta. Historically, the report had been used merely to look at the industry trends, and, at times, to cover the scope of service, compensation, and other data points. The information was not widely shared with either the hospitalist team or health system administration.
Our approach to the survey changed when we set our sights on becoming a destination of choice for hospitalists in the Southeast Region. This stated goal made it clear we needed to take a more active approach to benchmarking ourselves against our peers in the field. The State of Hospital Medicine report, with its abundance of data, was the perfect tool. We set up an annual review of our HM practices (54 physicians and 21 advanced practice professionals spread among five hospitals) that enumerated individual provider performance in key measures: total compensation, total wRVUs, compensation per wRVU, and professional collections per wRVU. We then benchmarked the data against the survey data, highlighting the percentile achievement in each category. This allowed us to identify pockets of opportunities and make adjustments to compensation model and productivity targets, thus positioning ourselves competitively in the local and regional market.
Not only did this process aid in demonstrating our performance as compared to industry peers, but it also highlighted the differences in practice patterns within our health system. In turn, we reduced variation and promoted best practices among the five WellStar hospitals—standard workflow, scope of services, transfer policies, and collaboration with advanced practice professionals, to name a few.
In addition, transparent discussion of external and internal benchmarking findings dramatically improved provider engagement; individuals were eager to learn how other practices were able to achieve success. As a result, the clinical footprint of HM services expanded tremendously, ultimately benefiting patients, referring and consulting physicians, and hospitals.
The report also helped us to reiterate the value of WellStar Hospital Medicine to our administrative partners. Complementary to our balanced scorecard, which tracks quality, efficiency, and patient satisfaction measures, the external benchmarking validated a very strong return on the investment that WellStar Health System is making in its hospitalist programs.
The State of Hospital Medicine survey can be a tremendous resource to your practice, as it has been to ours. We recommend setting a mission and vision statement for your practice and then formulating a plan around the best way to share and utilize the data from the report to pursue your mission. As we experienced, a meaningful review, along with follow through on identified opportunities, can be positively transformative.
Dr. Akopov is vice president and chief of hospital medicine operations at WellStar Health System in Atlanta, Ga. Ms. Papetti is assistant vice president of WellStar Medical Group in Atlanta, and a member of SHM’s Practice Analysis Committee.
Nocturnists Vital For Hospitalist Group Continuity, Physician Retention
Having nocturnist coverage in your practice is a coveted position to be in for many hospital medicine providers. Rick Washington, MD, medical director for WellStar Kennestone Hospital in Marietta, Ga., says that “not only does it make it easier to recruit and retain daytime physicians when you have nocturnists as a part of your program, but they also serve a very valuable role in the continuity of the program throughout the nighttime hours, providing a stable admitting presence in the emergency department at all times.”
According to the 2012 State of Hospital Medicine Report, nearly half of all hospital medicine groups (HMGs) serving adults only incorporate nocturnists into their programs. Nocturnists are most common in HMGs employed by universities or medical schools (67%) and hospitals/integrated delivery systems (50%). The prevalence among management company-employed groups is much lower (25%), and no data was available for multispecialty groups or private hospitalist-only groups (see Figure 1).
As could be expected, the prevalence of nocturnists increases dramatically as the number of total FTEs of the practice increases. As the number of patients on a service, and thus the number of FTEs, grows, so does the expectation to provide on-site night coverage.
The percentage of compensation paid as base salary also has an impact; in general, the higher the percentage of compensation in base salary, the more likely that practice is to have nocturnists. Typically, night shifts tend to be less productive from a billable encounter perspective, so having a base rate of pay tends to be an essential factor in successfully maintaining nocturnists.
However, surprisingly, in the 63% of groups that reported paying a nocturnist differential, the clinicians earned only a median of 15% more in total compensation than their non-nocturnist counterparts. Perhaps this has to do with other factors that programs are utilizing in order to entice and retain nocturnists, which includes the possibility of doing fewer shifts or shorter shifts than their colleagues. In fact, 49% of respondent groups reported implementing a nocturnist schedule differential, most commonly in the range of one to 20% fewer shifts than non-nocturnist hospitalists in the same practice.
Other practices implement a schedule differential by shortening the length of nocturnist shifts, instead of reducing the number of shifts worked.
“For me, the key to doing this long term has been the ability to have an eight-hour shift rather than 12 hours,” says Dr. Nancy Maignan, who soon will celebrate five years as a nocturnist at WellStar Kennestone Hospital. “Another factor is flexibility with our schedule. We do not work 7-on/7-off. My schedule is dependent on my family’s schedule…this allows me to attend field trips and be off for most of their [her kids] school break.”
Although she points out that a supportive family is crucial, a supportive HMG is key. I would encourage groups thinking of implementing a nocturnist role to think carefully about how to make the job one that hospitalists can successfully do for a long time, rather than just trying to attract people to the role by making it financially lucrative.
Beth Papetti is assistant vice president of WellStar Medical Group in Marrietta, Ga. She is a member of SHM’s Practice Analysis Committee.
Having nocturnist coverage in your practice is a coveted position to be in for many hospital medicine providers. Rick Washington, MD, medical director for WellStar Kennestone Hospital in Marietta, Ga., says that “not only does it make it easier to recruit and retain daytime physicians when you have nocturnists as a part of your program, but they also serve a very valuable role in the continuity of the program throughout the nighttime hours, providing a stable admitting presence in the emergency department at all times.”
According to the 2012 State of Hospital Medicine Report, nearly half of all hospital medicine groups (HMGs) serving adults only incorporate nocturnists into their programs. Nocturnists are most common in HMGs employed by universities or medical schools (67%) and hospitals/integrated delivery systems (50%). The prevalence among management company-employed groups is much lower (25%), and no data was available for multispecialty groups or private hospitalist-only groups (see Figure 1).
As could be expected, the prevalence of nocturnists increases dramatically as the number of total FTEs of the practice increases. As the number of patients on a service, and thus the number of FTEs, grows, so does the expectation to provide on-site night coverage.
The percentage of compensation paid as base salary also has an impact; in general, the higher the percentage of compensation in base salary, the more likely that practice is to have nocturnists. Typically, night shifts tend to be less productive from a billable encounter perspective, so having a base rate of pay tends to be an essential factor in successfully maintaining nocturnists.
However, surprisingly, in the 63% of groups that reported paying a nocturnist differential, the clinicians earned only a median of 15% more in total compensation than their non-nocturnist counterparts. Perhaps this has to do with other factors that programs are utilizing in order to entice and retain nocturnists, which includes the possibility of doing fewer shifts or shorter shifts than their colleagues. In fact, 49% of respondent groups reported implementing a nocturnist schedule differential, most commonly in the range of one to 20% fewer shifts than non-nocturnist hospitalists in the same practice.
Other practices implement a schedule differential by shortening the length of nocturnist shifts, instead of reducing the number of shifts worked.
“For me, the key to doing this long term has been the ability to have an eight-hour shift rather than 12 hours,” says Dr. Nancy Maignan, who soon will celebrate five years as a nocturnist at WellStar Kennestone Hospital. “Another factor is flexibility with our schedule. We do not work 7-on/7-off. My schedule is dependent on my family’s schedule…this allows me to attend field trips and be off for most of their [her kids] school break.”
Although she points out that a supportive family is crucial, a supportive HMG is key. I would encourage groups thinking of implementing a nocturnist role to think carefully about how to make the job one that hospitalists can successfully do for a long time, rather than just trying to attract people to the role by making it financially lucrative.
Beth Papetti is assistant vice president of WellStar Medical Group in Marrietta, Ga. She is a member of SHM’s Practice Analysis Committee.
Having nocturnist coverage in your practice is a coveted position to be in for many hospital medicine providers. Rick Washington, MD, medical director for WellStar Kennestone Hospital in Marietta, Ga., says that “not only does it make it easier to recruit and retain daytime physicians when you have nocturnists as a part of your program, but they also serve a very valuable role in the continuity of the program throughout the nighttime hours, providing a stable admitting presence in the emergency department at all times.”
According to the 2012 State of Hospital Medicine Report, nearly half of all hospital medicine groups (HMGs) serving adults only incorporate nocturnists into their programs. Nocturnists are most common in HMGs employed by universities or medical schools (67%) and hospitals/integrated delivery systems (50%). The prevalence among management company-employed groups is much lower (25%), and no data was available for multispecialty groups or private hospitalist-only groups (see Figure 1).
As could be expected, the prevalence of nocturnists increases dramatically as the number of total FTEs of the practice increases. As the number of patients on a service, and thus the number of FTEs, grows, so does the expectation to provide on-site night coverage.
The percentage of compensation paid as base salary also has an impact; in general, the higher the percentage of compensation in base salary, the more likely that practice is to have nocturnists. Typically, night shifts tend to be less productive from a billable encounter perspective, so having a base rate of pay tends to be an essential factor in successfully maintaining nocturnists.
However, surprisingly, in the 63% of groups that reported paying a nocturnist differential, the clinicians earned only a median of 15% more in total compensation than their non-nocturnist counterparts. Perhaps this has to do with other factors that programs are utilizing in order to entice and retain nocturnists, which includes the possibility of doing fewer shifts or shorter shifts than their colleagues. In fact, 49% of respondent groups reported implementing a nocturnist schedule differential, most commonly in the range of one to 20% fewer shifts than non-nocturnist hospitalists in the same practice.
Other practices implement a schedule differential by shortening the length of nocturnist shifts, instead of reducing the number of shifts worked.
“For me, the key to doing this long term has been the ability to have an eight-hour shift rather than 12 hours,” says Dr. Nancy Maignan, who soon will celebrate five years as a nocturnist at WellStar Kennestone Hospital. “Another factor is flexibility with our schedule. We do not work 7-on/7-off. My schedule is dependent on my family’s schedule…this allows me to attend field trips and be off for most of their [her kids] school break.”
Although she points out that a supportive family is crucial, a supportive HMG is key. I would encourage groups thinking of implementing a nocturnist role to think carefully about how to make the job one that hospitalists can successfully do for a long time, rather than just trying to attract people to the role by making it financially lucrative.
Beth Papetti is assistant vice president of WellStar Medical Group in Marrietta, Ga. She is a member of SHM’s Practice Analysis Committee.