On behalf of SHM’s Practice Analysis Committee, I’m delighted to announce that the 2018 State of Hospital Medicine Report is now available!
This year’s report may be the most representative yet regarding the current state of hospital medicine. Of the survey’s 569 respondent groups:
- 52% are employed by hospitals or health systems
- 25% are employed by multi-state management companies
- 12% are employed by universities or their affiliates
We had more pediatric hospital medicine groups (HMGs) and more groups that serve both adults and children than in 2016, and almost twice as many academic HMGs participated this year. This gives us great diversity in the respondent pool, and that diversity is reflected in the survey results.
Among the trends we’ve noted is an increase in the proportion of total hospital patients served by hospitalists: up to 75% this year compared to 70% in 2016. I’m guessing this may have to do with hospitalists’ evolving roles in surgical and medical subspecialty co-management. The committee wanted to understand these roles better, and so for the first time, the 2018 survey collected information about whether hospitalists serve as admitting/attending provider or consultant (or some of both) for a variety of specialties.
The specialties for which adult medicine hospitalists most often serve as admitting/attending physician are all medical subspecialties, including:
- GI/liver (78%)
- Palliative care (77%)
- Neurology/stroke (74%)
- Oncology (68%)
Adult medicine hospitalists more often serve in a consultant role with surgical specialties:
- General surgery (38%)
- Cardiovascular surgery (37%)
- Neurosurgery (33%)
- Orthopedics (31%)
Or, they provide a combination of admitting/attending and consultant services for those specialties.
Specialties where hospitalists still report relatively high rates of no co-management activity at all include the care of early term pregnant patients (39%) and cardiovascular surgery (27%).
Another trend is the increasing number of groups performing some work in post-acute settings such as SNFs, LTACs, rehab facilities, and post-discharge clinics, up from 11% in 2016 to 25% this year. This may simply be a function of the increased diversity among the survey respondents, but based on my recent experience working with hospitalist groups around the country, hospitals and health systems seem increasingly interested in having their hospitalists expand their scope into these areas.
There are lots of other new elements in this year’s report, as well. For example, there is information about unfilled positions in HMGs and how they are being covered – including the use of locum tenens providers. We also have information about the prevalence of geographic (unit-based) assignment models and the use of dedicated daytime admitters.
One really valuable adjustment in how the survey data is reported relates to financial support provided to HMGs by hospitals or other sponsors. Because of the increasing presence of NPs, PAs, registered nurses and other clinicians in hospitalist practice, the committee decided this year to report financial support per wRVU, in addition to the traditional metrics of financial support per physician FTE and per total provider FTE. In theory, this places all HMGs on a level playing field and will help hospitals and other sponsors to better understand their investment per unit of work (as opposed to per physician). It will be interesting to see what happens to this new metric over time, but as a starting point this year, the median financial support provided per wRVU for all adult medicine practices was $41.92 (though it varies some by geographic region, employment model, and other group characteristics).
Perhaps the metrics that people are most interested in are the compensation and productivity metrics, which SHM has again licensed from MGMA for inclusion in the SoHM Report. Compensation for internal medicine hospitalists rose to a national median of $289,138 – a 3.8% increase over the 2016 report. Meanwhile, hospitalist productivity has remained generally flat for several years and is reported at a national median 4,147 wRVUs in the new report.
Interestingly, the MGMA median ratio of wRVUs per encounter is down slightly from two years ago, and this finding is supported by a meaningful drop in the proportion of high-level admission and subsequent visit CPT codes submitted by SoHM respondent HMGs.
I hope I’ve whetted your appetite to explore the SoHM Report for yourself. You can find out more about the report, and purchase either the hard copy or online version (or both) at hospitalmedicine.org/sohm. And for you data geeks who would love to be more involved in this sort of thing, I’ll just offer a reminder that SHM is currently accepting applications for the 2019-2020 committee year. Our committee is going to be working with SHM’s IT Department on a significant re-design of the survey platform and the online report for 2020, so it’s going to be a fun and challenging couple of committee years! Apply for an SHM committee here, and I’ll look forward to working with you to make 2020’s SoHM Report even better!