Every medical center desires for its objectives, incentives, and interests to be closely aligned with those of its hospitalists. While effective alignment is highly desired, our experience reveals that achieving such state of alignment is a rare phenomenon. The daily demands on hospitalist services and individual hospitalists certainly come into play, but a more likely culprit may simply be the disparate financial systems hospitals and physicians operate within.
The fact that hospitals and physicians operate under disparate financial systems and incentives is well established. Consider the following as it relates to hospitals and hospitalists:
In a hospital inpatient setting, a significant responsibility of the typical Case Manager is to help manage the inpatient episode of care, identify likely post-acute patient needs, facilitate the discharge process, and coordinate the transition from the acute care to the post-acute care setting.
Currently, hospitalists admit the majority of patients in the typical hospital. Hospitalists are rapidly trending towards being the admitting/attending physician of record for every patient admitted to a
hospital, with specialists consulted as needed.
Thus, hospital case managers now rely primarily on hospitalists, and will in due time rely exclusively on hospitalists (as it relates to the “physician-dependent” element of their responsibilities).
Yet our experiences have yielded the following observation: hospitalists and hospital case managers typically do not work in an integrated fashion. This observation is evidenced by the following:
We believe the day has arrived when the Case Management function and the Hospitalist Service should be formally integrated.
So the (1) disparate financial incentives in play for hospitals and hospitalists, coupled with the (2) lack of coordination and integration between case managers and hospitalists; served as motivation to develop a model which dramatically re-aligns interests of hospitals and hospitalists. This quest resulted in an exciting new Model we affectionately call the Hospitalist Alignment Model, and which is illustrated below:
Furthermore, adoption of the Hospitalist Alignment Model has the innate ability to produce a tangible Return on Investment (ROI) to hospitals and health systems on their hospitalist programs. The innovative comp plan, re-aligned team, and new team focus have the capability to substantially reduce, the expense of most hospitalist programs: