Practice Management

Equal Time for Hospital Execs

Last month, I wrote a letter to hospital executives, urging them to deliberately invest their own personal time and effort in fostering hospitalist wellbeing. I suggested several actions that leaders can take to enhance hospitalist job satisfaction and reduce the risk of burnout and turnover. Following publication of that post, I heard from several hospital executives and was pleasantly surprised that they all responded positively to my message. Several execs told me that they gained valuable new insights about their hospitalists’ challenges and needs or that they planned to take action on one or more of my suggestions that had never occurred to them before.  Especially useful to them was the idea of a hospitalist “hierarchy of needs,” in which basics such as well-designed work (including adequate staffing), belonging, and esteem must be addressed before expecting hospitalists to undertake “self-actualizing” work, such as engagement in organizational performance improvement initiatives. Their…

Male Versus Female Hospitalists

If you have paid attention to the news, you picked up the study out in JAMA concerning how male versus female physicians deliver inpatient care.  Not just any inpatient docs, though, but hospitalists. The investigators were meticulous in their analysis of over a million Medicare beneficiaries and looked at readmit and mortality rates.  They examined various diagnoses and adjusted for the usual doctor and hospital characteristics. Across the board, males took a drubbing and the NNT for both outcomes of interest hovered around 200 (0.5% absolute difference). Ashish Jha, one of the investigators and a leader in the study of hospital quality and safety (who really needs to speak at an SHM annual, incidentally) goes into more depth over at his blog: (more…)

ER Docs And Out Of Network Billing. Are We In The Same Boat?

This recent article in the NYT and the NEJM study precipitating it widened the (malevolent) coverage of the fees paid by patients and insurance companies to out of network physicians.  If you are not familiar with the issue, doctors working in hospitals--who may not participate in the plans the hospitals accept--separately bill the insurance companies for higher than average charges.  Since there is no upfront negotiated discount, typically found when docs belong to a plan, the insurance company may or may not pay the asking fee.  If they do not, the often sky-high balance becomes the patient's responsibility.  From the patient's point of view, the process makes no sense; if a hospital participates in their plan, so should the docs. Not so.  Hospitals do their thing.  Professional do theirs. The problem of balance billing and out of network providers does not reside in one or two states, and the practice touches…

The Medicaid Overhaul And How Hospitals And Its Providers Could Be Hardest Hit

Given the signs Paul Ryan, Speaker of the House, has flashed during his tenure, expect phase one of the health care financing overhaul to be heavily focused on Medicaid. The incoming administration aligns with this change (#6), as does the president-elect's choice of Tom Price for HHS Secretary.    This turn will have an impact on hospitals and something you should pay attention to.  You will see lots of press over the coming months, and you will hear the term Medicaid block grants.  You should have an opinion, especially if you work in a rural, safety net, urban, or academic medical center.  I would imagine that holds true for many of you. (more…)

An Open Letter to Hospital Executives about Their Hospitalist Programs

Dear Hospital Executive, If you are like many of the hospital leaders with whom I regularly talk, you’re probably concerned that your hospitalist program isn’t delivering the value you need in this metrics-driven and cost-constrained environment. You may see your hospitalists as disengaged free agents who either don’t know, or care too little, about contributing to the success of your organization beyond seeing the patients on their list. They may complain repeatedly about being overworked, underappreciated, or dumped on, and you worry they will leave soon for greener pastures. As a former hospital executive myself, I sympathize. You have a lot of important challenges to manage, and the hospitalists are highly educated, well-paid professionals, for Pete’s sake. Whether your hospitalists are employed by your organization, a local private group, or a management company, you are paying a lot for a vital service that ought to run more or less on…
...23456...10...