An efficient hospitalist program can have significant positive impacts throughout the hospital. While these programs have historically been costly to operate, organizations can employ several strategies to help offset these costs by increasing inpatient capacity, which will drive additional revenue while also improving quality.
Reducing Length of Stay
Length of stay remains top of mind for healthcare executives today—and for good reason. Not only does reducing LOS have patient satisfaction and financial implications, but it is also an access issue, according to Rachel Thompson, MD, CMO, Core Clinical Partners.
“If we want to improve access to care in our communities, we have to have beds, and if we have inefficiencies in our systems that result in long length of stay, we don’t have that access,” says Thompson, who is also an ACHE Member and immediate past president of the Society of Hospital Medicine. “Hospitalists can help improve care and increase efficiency.”
One way an efficient hospitalist program can help address LOS is focusing on interdisciplinary team care models. According to Thompson, that involves identifying the key players on the team—clinicians, including the hospitalist who is the primary clinician in charge of a patient’s care; nurses; therapists; social workers; utilization management staff; patients; and families—and making sure everyone’s goals are aligned.
“No one role on the team is responsible for an increased length of stay,” she says. “We need to have a team care model where everybody is owning the plan of care together.”
Two other strategies Thompson deems critical to reducing LOS are enhanced communication and improved team geography. “Scripted” opportunities for communication, such as multidisciplinary rounds, help care team members better understand a patient’s care plan and any challenges, including discharge barriers. Being what Thompson calls more “geographic”—ensuring the care team is working as closely together as possible, even in a shared office––can also help enhance teamwork and communication. A well-run hospitalist program can also help bridge the gap between acute care and post-acute care services. Hospitalists are already leading patients’ care, so they’re well-positioned to manage them to the next step of the continuum of care, including coordinating with post-acute facilities to ensure smooth handoffs.
“The hospitalist team can be the leaders who are saying, ‘We need to prioritize talking with post-acute earlier in the morning, making sure that our rounds are done earlier, and connecting with all the other services and everything that needs to be done to discharge,’” says Jessica Long, COO, Core Clinical Partners, and an ACHE Member.
Increasing Capacity
Increasing capacity, improving access and freeing up beds for patient transfers are direct byproducts of improving LOS. The additional transfers into a hospital that come from just a small decrease in LOS can more than offset the cost of the hospitalist program.
“Making turnover more efficient is key and one part of the puzzle,” Thompson says. “The other part is having the right patient in the right place at the right time, and that includes focusing on opportunities to treat patients in ways we didn’t know we could even five years ago, such as through telehealth.”
Since the COVID-19 pandemic accelerated adoption of telehealth capabilities, provider organizations now have more opportunities to use these technologies to see more patients and improve overall patient flow.
“In some settings, we’ve actually reduced the need for transfers when we deploy technology or simply improve communication among different care sites,” Thompson says. For example, a patient who was going to be transferred might be a good candidate for a telehealth visit, which could eliminate the need for a transfer and improve patient care continuity and, often, patient satisfaction.
Effective hospitalist programs across the country have also had success rethinking observation units as another way to improve patient turnover and increase bed capacity. When lower acuity patients are grouped together in a high-functioning observation unit, care can be better coordinated and more protocol driven, which can increase efficiency and reduce LOS, according to Thompson.
“If this is done effectively with the hospitalist team, then you can be much more efficient and continue to get your length of stay down by having this particular patient population more effectively cared for,” Long says.
Adds Thompson, “a well-run observation unit should have lengths of stay that are 15 to 18 hours. This is in contrast to the 36 to 48 hours that observation status patients often stay in hospitals.”
Improving Patient Satisfaction
Several studies have shown that effective hospitalist care can also contribute to increased patient satisfaction. In one study, which appeared April 12, 2019, in the Journal of Community Hospital Internal Medicine Perspectives, patients scored hospitalists particularly high on their concern for patients’ worries and their responsiveness to patients’ questions. As the primary contact for their inpatient care, hospitalists have the unique position to improve communication and foster patient trust.
“The hospitalist has the opportunity to be a constant for our patients,” Long says. “To know that this is the person who is quarterbacking their care and understanding everything that is going on is a tremendous satisfier.”
Partnering for Success
With the right partner, implementing these and other strategies aimed to elevate an organization’s hospitalist program can be even more successful. A strategic partner should be able to think holistically about hospital medicine and be nimble enough to understand what Long describes as the “ripple effects” of every decision made in a hospital.
“In hospital medicine, you can be efficient with your rounding and discharging and the coordination of all the different individuals who are caring for a patient, and then that creates capacity to see other patients faster, which enables you to generate revenue,” she says. “In addition, if the hospitalists are driving increased patient satisfaction, this can drive other people to want to come to your hospital.”
In the fast-paced, day-to-day business of healthcare, it’s also important for healthcare leaders to take a moment to recognize the immeasurable value all front-line clinicians, including hospitalists, bring. “Elevate your hospital medicine teams and celebrate the work that they’re doing,” Thompson says. “This is a group of clinicians who can—and will—drive the change that you need.”
For more information, please contact Joyce Kennedy, senior vice president of Strategy, Core Clinical Partners, at jkennedy@coreclinicalpartners.com.