Are your hospitalists so busy that they’re hurting the bottom line?
It’s been a crazy summer! Our census has nearly doubled over the past six months, but we’ve sustained that growth with no increase in personnel.
I’ve faced days with twenty patients to start the day and much more to do before. But my perspective is decidedly different than it was a mere five years ago. I used to see the high census as a long day ahead, but one that would ultimately benefit the hospital and hospitalist alike. Sure, I was happy to make the extra money!
Things have changed… I’m now convinced that overburdening your hospitalists costs the hospital far more in prestige, reputation, and yes, overall receipts than it brings in. I’m hoping that Program Directors and Financial Officers see the same writing on the wall that I see… We LOSE money when we’re overly busy. Do you understand?
Let’s say, for argument sake, that I bring in $100, on average, for every patient I see. If I see 10 patients per day, I bring in $1000 per day. Meanwhile, I bring in $2000 per day if I see twenty each day. Let say I cost $300,000 per year to have around. So, if I work 200 days per year, then I bring in only $200,000 at 10 patients per day while 20 patients per day makes $400,000. Based on provider receipts, the CFO wants me to be busier so she can make some money off of me. Right!
Wrong! I’m sorry Ma’am, but you’ve got your eye on the wrong number. You should be concerned about what happens to your CMI, LOS, OR cancelations, transfer rate, Meaningful Use, Value Based Purchasing, etc. All of these areas are directly impacted by hospitalist operations at your institution. And they dwarf the productivity gains from provider billing seen in my example above.
How much is a surgery worth to the hospital? Is it $10,000? Is it more? If I can’t get to that case early enough to treat the UTI or reverse the INR, do you lose an OR case for the day? How much of the $10,000 did you lose due to the delay?
What about your Case Mix Index? How much is a 0.01 change in your CMI worth? Is it $100K? Oh that must be a small hospital. How about $1 million or more. Now we’re talking. Is it worth gaining an extra $100,000 in provider billing from me while I cut back on documentation to see all of those cases if it costs you 0.01 of your CMI for the year at $1 million plus?!? Of course not.
I’m willing to work as hard as the next guy or gal. I like taking care of your patients, Madam Hospital CFO. But, please, take a closer look. We’ll all be happier with a balanced approach to patient care where I can see the right number of patients per day, do a great job, and make sure that the quality, satisfaction, and, yes, even the financials all go up together.