Collaboration, Not Calculation: A Qualitative Study of How Hospital Executives Value Hospital Medicine Groups

Abstract

receive financial support from hospitals. Determining a fair amount of financial support requires negotiation between HMG and hospital leaders. As the hospital medicine care model evolves, hospital leaders may regularly challenge HMGs to demonstrate the financial value of activities that do not directly generate revenue. OBJECTIVE: To describe current attitudes and beliefs of hospital executives regarding the value of contributions made by HMGs. DESIGN: Thematic content analysis of key informant interviews. PARTICIPANTS: Twenty-four healthcare institutional leaders, including hospital presidents, chief medical officers, chief executive officers, and chief financial officers. Participants comprised a diverse sample from all regions in the United States, including rural, suburban, and urban locations, and academic and nonacademic institutions. RESULTS: Executives highly valued hospitalist groups that demonstrate alignment with hospital priorities, and often used this concept to summarize the HMG’s success across several value domains. Most executives evaluated only a few key HMG metrics, but almost no executives reported calculating the HMG return on investment by summing pertinent quantitative contributions. Respondents described an evolving concept of hospitalist value and believed that HMGs generate substantial value that is difficult to measure financially. CONCLUSIONS: Hospital executives appear to make financial support decisions based on a small number of basic financial or care quality metrics combined with a subjective assessment of the HMG’s broader alignment with hospital priorities. HMG leaders should focus on building relationships that facilitate dialog about alignment with hospital needs.

Characteristics of the ideal hospitalist inpatient care program: perceptions of Canadian health system leaders

“…As a result, some healthcare administrators perceive their hospitalist programs as a financial loss and this perspective can impact the way they perceive their hospitalist program’s value proposition [ 24 ]. Despite this, in the US there is a general agreement that “hospitalists are here to stay” [ 17 , 18 ] and healthcare leaders need to focus instead on maximizing their partnership with hospitalist physicians in order to enhance care efficiency and quality.…”

“…A number of systematic reviews have suggested that hospitalist care is associated with reductions in length of stay (LOS) and cost of hospitalization along with improvements in patient satisfaction [ 15 , 16 ]. Similarly, studies in the United States (US) have shown widespread acceptance of the hospitalist model among hospital administrators [ 17 , 18 ].…”

“…In many institutions, these hospital medicine programs quickly expanded to care for the bulk of general medicine hospitalized patients [ 22 , 23 ]. In little over two decades, organizations that were accustomed to seeing their patients cared for by a range of physicians (such as community family physicians, internists and other specialists) at no direct cost, found themselves in a position where they increasingly needed to reallocate funds form their “global budgets” to compensate physicians for delivering inpatient care [ 10 , 17 ].…”

“…Anecdotal evidence suggests that some leaders may not appreciate the value that hospitalists can bring to their institutions [ 24 ]. This may be partly due to a strong belief in the merits of traditional models for inpatient physician coverage (such as full service family medicine [ 25 ]), or the financial burden of subsidizing hospitalist physician compensation and program administrative costs [ 17 ].…”

Defining a New Normal While Awaiting the Pandemic’s Next Wave

“…Third, highlight hospitalists' nonfiscal contributions, especially in terms of crisis leadership, to continue engagement with executive leaders. 5 This may include a dialogue about the disproportionate influence of work relative value unit production on salary and about how to create compensation systems that can also recognize crisis readiness as an important feature of sustainability and quality care. The next pandemic surge may be weeks or months away, and hospitalists will again need to be leaders in the response.…”