Building a Partnership with your Hospitalist
It is no secret that physicians drive upwards of 80% of clinical costs and are directly and indirectly responsible for clinical and financial outcomes of care delivered. Even though, the payer determines whether treatment, care or service will be reimbursed under terms of the contract. It is the provider, who determines the type and extent of treatment care and services. Dr. Atul Gawande once said, “The most expensive piece of medical equipment is a doctor’s pen.”
Hospitalists' primary focus is the clinical care of hospitalized patients, however their role as a team member to ensure safe and effective care goes far beyond that explanation. The Society of Hospital Medicine was established in 1997 to promote exceptional care for hospitalized patients (www.hospitalmedicine.org). The objective of each hospitalist is to provide high quality care for the patient and to advance state of the art care through innovation and collaboration with the patient at the center.
With this knowledge, it is clear that teamwork between the hospitalist and the multidisciplinary team is vital to the success of the hospital system. However, how can executive sponsors import this value into the physicians daily workflow when hospitalist’s are overwhelmed and may not see the connection between the team and their patient care? They will tell you that they are too busy to attend the meetings. They are too busy to attend daily rounds. It interrupts their time to see patients and they do not see the point. What they are really saying is, What is in it for me (WIIFM)? Why should I attend? How is it worth my time to meet you, be at that meeting, or come to the leadership meetings to discuss metrics?
The average hospitalist has the potential to get around 4 calls per day per patient on their census. So for an average daily census of 18 patients, that hospitalist can expect up to a combination of about 72 calls, queries, and texts per day from the care team which includes care management, nursing, therapies, pharmacy, specialist, CDI, coding, utilization review, insurance, physician advisor, etc.
It is no secret that physicians drive upwards of 80% of clinical costs and are directly and indirectly responsible for clinical and financial outcomes of care delivered. Even though, the payer determines whether treatment, care or service will be reimbursed under terms of the contract. It is the provider, who determines the type and extent of treatment care and services. Dr. Atul Gawande once said, “The most expensive piece of medical equipment is a doctor’s pen.”
To achieve excellence in patient outcomes and satisfaction, it is imperative that dialogue takes place that discusses how a successful relationship can be accomplished. Moving towards hospital and patient outcome goals should be the partnership to deliver great care. Hospitalist and administrative alignment must start at the c-suite and ensure common goals and expectations to ensure they are steering the ship in the same direction.
Case management can be explained as the hub of the wheel that connects all disciplines to the patient with its primary spoke being the physician. The case management team, including the utilization review specialist can inform and educate the hospitalist on access, progress of care and transition opportunities that optimize resource utilization. Several avenues can assist in educating the hospitalist and elevating the care of the patient which will in return improve patient care metrics and outcomes which reflect positively on the hospital and the hospitalist’s performance. Case management must position themselves as the key partner to the hospitalist if they want to prove their value to the organization and positively influence patient outcomes.
Some key ways to ensure partnership include;
Case management must utilize their expertise to leverage and influence a consistent WIIFM “What’s in it for me” strategy, through proactive communication and data.
If case management understands that physicians are their number one ally to the success of the patient, then case management assignments should be paired with the hospitalist over the nursing units.
Daily multidisciplinary rounds should be optimal to ensure physicians attend, which means that only key players participate, members such as case management, UR, nursing, pharmacy, physician therapy, PAs, and hospitalists all know their role and accountability of next steps when rounds are over. Members are prepared before they attend and understand what needs to occur when rounds are over and who is going to communicate next steps to the patient. Case management must do their part by coming prepared to discuss any potential barriers and possible solutions for the progression and transition of patient care through the system.
Case management leadership should have regular touch points with the hospitalist director to ensure both teams are collaborative and supportive of one another. The hospitalist medical director needs to trust that the CM leadership team will follow up on issues presented to the department and vice versa.
Although case management's primary role is to advocate for the patient, they must ensure they are not directing the care of the patient. This will turn off the hospitalist team pretty quickly. They must understand their scope and role in the relationship. The case manager will be most successful if they can problem solve from the physicians’ perspective, provide proactive solutions, serve as a consistent resource, and eliminate hassles. Remember, the case manager is expected to be skilled in critical thinking with typically a nursing or social work background. At that education level, they should not be utilized for setting discharge logistic task mastery.
In Phoenix Medical Management's many travels across health systems, we find that hospitalists consistently look for proactive support from case management. They don’t want to place an order for home health and then wait for the case manager to respond and then start working on it. They want the case manager to already know the patient could benefit from home health and come prepared with information and the necessary forms for the hospitalist to complete if supportive of the plan. As influencers to length of stay and cost per case, case management should not be the reason for the progression of care delay or avoidable delay. For case management to succeed they must positively position themselves with the hospitalist and physician teams under a WIIFM strategy.