Practice Economics

Multi-Site Hospitalist Leaders: HM15 Session Summary


Session: Multi-site Hospitalist Leaders: Unique Challenges/What You Should Know

HM15 Presenter/Moderator: Scott Rissmiller, MD

Summation: This standing-room-only session was the result of a popular HMX e-community, which has become an active discussion board. As hospitals and health systems continue to consolidate across the country, there has been a rapid growth of multi-hospital systems. The role of the “Chief Hospitalist,” whose job is to lead multiple hospitalist groups within these systems, is evolving. These “Chief Hospitalists” are growing in number and they, as well as their followers, face unique challenges.

These points regarding organization structure were discussed, and as you look at your own organizational structure, these questions deserve your attention:

  1. Purpose of your structure?
  2. Is your structure centralized or decentralized?
  3. How does your organizational structure support decision-making?
  4. How does the structure ensure proper communication?
  5. How are resources shared across geography?
  6. What is your administrative support structure?
  7. How is administrative time allocated for physician leaders?
  8. How do you ensure engagement from all providers?
  9. How does your organization structure create alignment with the healthcare system?

The following compensation issues were discussed, and can be used as a discussion outline for most groups:

  1. How does your compensation (comp) plan align with the goals and values of the system?
  2. How does your comp plan account for regional variances?
  3. How does the comp plan encourage teamwork and sharing of resources?
  4. How does comp plan account for differences in acuity, hospital size, night frequency, etc.?
  5. Are goals and incentives group based, site based, or individual based?
  6. How does the comp plan fairly reward “non-RVU” work? (teaching, committee service, etc.)
  7. Should all site leaders receive the same comp regardless of group size?
  8. Does the comp plan incorporate “minimum work standards”/social compact?

Key Points/HM Takeaways:

  • Panel discussion was valuable and reassured attendees that there are multiple ways to make groups successful. One common variable of successful groups is open lines of communication at all levels.
  • Physician on-boarding is critical and should be utilized to set clear expectations.
  • HM Goals/expectations must be aligned with those of the hospital and health system.
  • When multiple hospitals are part of a larger system, it is desirable for goals to be aligned across the health system.
  • Two-way open communication is necessary for success.
  • Try to take a walk in your colleague’s/stakeholder’s shoes:
    • How does my hospital administrative partner see this issue?
    • How does my regional director/system lead see this issue?
    • How does my bedside hospitalist physician/provider see this issue?
    • How would my patients view this issue?
  • Issues facing different types of groups, academic vs. community and for profit vs. not for profit, are somewhat variable.
  • The leadership Dyad consisting of a physician and practice management professional in partnership is an effective and well-proven management model.

Many thanks to Drs. T.J. Richardson and Dan Duzan for their input and assistance with this session summary. Dr. Richardson is a Regional Medical Director and Dr. Duzan is a Facility Medical Director, both work for TeamHealth.

Julianna Lindsey is a hospitalist and physician leader based in the Dallas-Fort Worth Metroplex. Her focus is patient safety/quality and physician leadership. She is a member of TeamHospitalist.

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