Practice Management

Risks and Rewards of Hospitalist Participation in New CMS Bundle Model

by Win Whitcomb, MD, MHM
By: Win Whitcomb, MD, MHM Hospitalist groups have been among the highest volume participants in Medicare’s Bundled Payments for Care Improvement (BPCI) demonstration project, initiating almost 200,000 episodes representing over $4.7B in spending since the model began1. On January 9, the Centers for Medicare and Medicaid Services (CMS) announced BPCI’s follow-on model, ‘BPCI Advanced’,2 which starts in October of this year and is slated to finish at year-end 2023. CMS intends for the program to qualify as an Advanced Alternative Payment Model (APM). As BPCI Advanced focuses on 29 common medical and surgical episodes involving an inpatient stay (it also includes three outpatient episodes) and the subsequent 90 day recovery period, it represents the first large scale opportunity for hospitalists to meet criteria for Advanced APM participation. Qualifying for the Advanced APM track of the Quality Payment Program – which involves meeting patient volume or payment thresholds3 - comes with a…
Author Win Whitcomb, MD, MHM is Chief Medical Officer of Remedy Partners. He is co-founder and past president of SHM. Email him at [email protected]

Survey Says…

It’s that time of (every other) year! Once again, your hospital medicine group (HMG) has a unique opportunity to contribute to our collective understanding of the current state of hospital medicine in the United States. SHM’s State of Hospital Medicine Survey kicked off this week and will be open until February 16th. I strongly urge you to take the time to participate. I have been integrally involved in SHM’s survey processes since 2006 and am deeply committed to this important work that SHM does on behalf of its members and the entire specialty of hospital medicine. Here are several reasons why it’s more important than ever that your group participate this year. The information contained in the State of Hospital Medicine Report is used by HMGs – and by hospital and physician enterprise leaders – to justify proposals and make operational decisions. The field of hospital medicine is evolving rapidly…

Augh! I Just Got Laid Off! What Now?

Wait a minute. Isn’t there an ongoing national shortage of hospitalists? Don’t most hospital medicine groups have trouble recruiting enough providers? You wouldn’t think hospitalists would be at much risk for being laid off. But believe it or not, it does happen. Management companies lose contracts. Hospitals get acquired or lose a big book of business. Some administrator decides NP/PAs are more cost-effective than doctors. And – if our work with hospitalist groups around the country is any indicator – large integrated delivery systems are increasingly expecting top-quartile productivity from their physicians across all specialties, which means more work with fewer resources. I worked with a hospitalist program recently that has laid off several NP/PAs in an effort to improve productivity and financial performance; they haven’t yet laid off any doctors, but it could still happen. While it’s still rare, I expect that hospitalists will become more vulnerable to layoffs…

Up Your Game in APP Integration

I receive lots of calls and emails from HM group leaders, APP leads and others looking to up their game in APP integration. The calls fall into certain domains, and I thought it might be a good time to address some of these concerns. Training/Onboarding: This is the number one domain I get questions about. And it is important. Poor onboarding and lack of standardized training for APPs is a major barrier to success in HM practices looking to maximize their APP providers. Didactic that is congruent with SHM’s Core Competencies in Hospital Medicine is a good place to start. But before you embark on this fabulous onboarding program that is the envy of all who survey, realize that another key to success is appropriate expectations.The best onboarding or training program cannot “season” an APP the way time does. New grads can easily take nine months to a year to…

Making the Implicit Explicit

Last month, I wrote about some interesting workplace trends, in particular about how the implied compact between U.S. workers and their employers is evolving rapidly. Few of us in the workforce today can conceive of an employment relationship in which we are guaranteed lifelong employment and a generous benefits package including full healthcare and retirement in exchange for hard work and loyalty to a single employer. Since then, I’ve had several conversations about the term “compact” as I used it in that post. At its most fundamental, a compact is an agreement between two or more parties. In my recent post, I used the term to refer to the generally accepted but rarely articulated set of expectations that workers and their employers have of each other. There is an implied compact between physicians and the hospitals where they practice as well. Historically that compact assumed that doctors would refer lots…
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