Over the years medaptus has worked with a lot of hospital medicine teams, from smaller independent groups to large multi-state corporations. As a result, we have learned a lot about the needs of hospitalist programs. From workflow to charge capture to charge management, handoff, rounding models and scheduling nuances, we’ve seen it all. Our Vice President of Product Management, Dan Nottingham, has worked closely with many of these internal medicine teams over the last few years. He recently offered to share his thoughts on some of the most important things a hospital medicine group can measure for ongoing operational improvement.
Length of Stay (LOS)
No surprise what is number one on the list. Because shorter LOS lowers costs, frees up resources, and reduces the risk of hospital acquired illness (not to mention with concerns about COVID surges, clearing beds is critical for patient flow). While LOS can be impacted by many factors, studies consistently show that continuity of care and lower physician workloads reduce average LOS without increasing re-admissions.
HCAHPS (otherwise known as, patient satisfaction scores)
Not only is patient satisfaction a relevant measure of how individuals feel about the patient care provided to them, it also directly impacts reimbursement from Medicare. Improving continuity of care (both in the short and long term) has been shown to improve patient satisfaction with the quality of their health care. Reducing the number of providers that are assigned to a patient increases his/her confidence as the provider starts to feel like a “PCP in the hospital.”
Discharges Before Noon
This requires close coordination with care team members including nursing, case management, social work, and PT/OT/Speech for establishing safe discharge plans and facilitating discharges in a timely manner. This improves multiple metrics, including LOS and patient flow. Discharging before noon is a reflection of how well a team works together, which can be improved with tools that support communication and coordination.
From a revenue capture standpoint, it is important to know the time between the date of service to charge entry for the provider. For hospitalist teams that service multiple hospitals, paper tickets or disparate systems may be involved and before you know it, a late charge becomes a missing charge and the physician feels this pain in terms of RVUs. Charge lag is a great measure for staying on top of timeliness.
We have found that it is not unusual for a hospitalist to have an unsafe workload while, at the same time, other hospitalists have a light workload. Such workload imbalances impact patient safety as well as physician morale. As a result, hours are spent every morning to determine how to better balance workload and yet imbalances still occur and can lead to or increase peer tension. We have seen that work RVUs can be used to better estimate the daily workload for each physician than simply headcount. This information can help determine correct staffing needs.