A Bigger Role for Hospitalists
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At the outset, the hospital took steps to revamp its relationship with hospitalists. "We developed a mutually agreed-upon scorecard to measure quality enhancement and put measurable targets in there," Nygaard recalls. A joint operating committee was appointed for each campus, which included administrative leadership and a hospital medical group executive committee, to examine the hospitalist structure. "The board and the medical executive committee of the hospital approved a resolution to allow Lee Memorial Health System to contract with hospitalist groups directly," Nygaard adds. "We put some expectations in the service agreement that allow us to manage the hospitalists' program better."
Next, Lee Memorial Health System formed a relationship with a new physician group—Inpatient Specialists of Southwest Florida—to manage and provide hospitalist services across the four-hospital health system. This Fort Myers, Fla.–based group of 35 hospitalists oversees hospitalist care at each of the hospitals. ISSF was formed through a partnership of hospitalist affiliates of Cogent and Hospitalist Group of Southwest Florida.
As for patient satisfaction, Nygaard says, Lee Memorial Health System is working toward improvements. In Hospital Compare data, when asked if doctors were "always" ready to help out, Lee Memorial Health System scored 73%; lower than Florida, 77%, and the rest of the nation, 81%. However, when rated for always excellent care, Lee Memorial Health System received 20%; higher than Florida, 17%, and the rest of the nation, 15%.
"We're not there yet but, our figures are showing that patients are becoming satisfied," Nygaard says. The latest internal patient satisfaction poll shows patient satisfaction with hospitalists at 100%, he adds.
In Mesa, Ariz., the 342-bed Banner Baywood Medical Center also reduced the number of hospitalist groups working for the hospital, says Larry Spratling, MD, chief medical officer. There was much infighting, competition, and ultimately uncertainty in delivery of care, he adds.
"Several years ago, there was basically a chaotic situation: entrepreneuring physicians and competing hospitalist groups working for their market share," he says. "The competition was pretty intense, and we weren't getting the service in terms of hospital needs."
In addition, the hospitalists at Banner Baywood "were trying to increase the patient volume by claiming a larger share of patients admitted without a previously established attending physician," Spratling recalls. "We chose, for unassigned patient care, to contract with the best performing group. The other groups, without a contract, experienced a decline in patient volume and were noncompetitive," he says.
Success key No. 2: Transition to acute care
To improve care coordination and reduce readmissions, particularly among patients discharged to skilled nursing or rehab centers, hospitals are tasking hospitalists with coordinating care, especially for patients without primary care physicians. "We are increasingly seeing patients who don't have primary care physicians, who don't have insurance, who have low health literacy," says Vaidyan of St. Mary's. The hospital implemented Project BOOST (Better Outcomes for Older adults through Safe Transitions), a program to help prevent discharge medication errors and reduce readmissions. Project BOOST is sponsored by the Society of Hospital Medicine and aimed at improving transitions of care.
Because of concerns about readmissions, healthcare facilities are also contracting with hospitalist companies, such as IPC and Cogent, both of which provide hospitalist services to dozens of hospitals. For the most part, hospitals are working to incorporate hospitalists into postacute care to reduce the "revolving door" of readmissions, says Jerome Wilborn, MD, FCCP, a national medical director of postacute care for IPC.
Donahue, the Cogent CEO, says the discharge strategy for patients is becoming increasingly important to prevent readmissions. "We put a discharge plan in place and coordinate with primary care, home health agencies, visiting nurses, and family members."
Hospitalist groups are tapping into electronic health records to enable smooth transition of care and to ensure that laboratory results are finalized following a patient discharge, Donahue and Wilborn say. In addition, once patients are discharged, follow-up information is sent to primary care physicians. If a patient doesn't have a PCP, hospitalists work as the primary care physician to oversee follow-up care, or connect with other physicians if the patient needs additional observation or care in a nursing home. Vaidyan says St. Mary's has worked closely with community programs and nursing homes to improve handoff of patients following hospital discharge.
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