Hospitals’ use of hospitalists: Implications for financial performance

Epané, Josué Patien; Weech‐Maldonado, Robert; Hearld, Larry; Menachemi, Nir; Sen, Bisakha; OʼConnor, Stephen J; Ramamonjiarivelo, Zo

doi:10.1097/hmr.0000000000000170

Cited by 17 publications

(19 citation statements)

References 22 publications

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“…MA contracting may not be a sufficient incentive for hospitals to adopt hospitalists because of the upfront costs associated with adopting hospitalists and the increased costs at the organizational level associated with the adoption of hospitalists as shown in previous studies. 6…”

Section: Discussion and Policy Implicationsmentioning

confidence: 99%

“…[11][12][13] Market characteristics including, urban location, 11,13 and Medicare Advantage (MA) penetration 13 were significantly associated with innovation adoption in healthcare while market competition [11][12][13] and per capita income 11,12 were not. Financial performance (return on assets, operating margin, operating revenues and expenses, total margin) was found to be significantly associated with innovation adoption in some cases in healthcare, 3,6,12,14 but not in others. 11,12,14 However, to date, there is a dearth of research documenting predictors of hospitals' adoption of hospitalists.…”

Section: Introductionmentioning

confidence: 94%

“…19 Therefore, survival and ability to maintain a competitive advantage will depend on how well they are able to meet the needs of their constituencies (both internal and external). Hospitals located in more competitive markets will be more likely to adopt the use of hospitalists as a strategy to achieve competitive advantage to help them meet the needs of their constituencies as the use of hospitalists have been associated with quality of care, 5,9,22 greater efficiency, 3,22 enhanced financial performance, 6 and increased satisfaction 23 We therefore hypothesize that: H 1 : Hospitals in markets with higher competition are more likely to use hospitalists.…”

Section: Conceptual Frameworkmentioning

confidence: 99%

“…2 Benefits associated with the use of hospitalists include reduction of length of stay (LOS) and costs, 3–5 as such, hospitals may admit more patients and increase throughput, potentially increasing revenues and profitability. 6 Additional benefits for using hospitalists include increased patient, family, and provider satisfaction. 7–9 While there is evidence of benefits associated with hospitals’ use of hospitalists, little is known about characteristics of facilities that use hospitalists and the markets in which they operate.…”

Section: Introductionmentioning

confidence: 99%

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Hospitalists, two decades later: Which US hospitals utilize them?

Epané

Weech‐Maldonado

Hearld

et al. 2020

Health Serv Manage Res

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Hospitalists, or specialists of hospital medicine, have long been practicing in Canada and Europe. However, it was not until the mid-1990s, when hospitals in the U.S. started widespread adoption of hospitalists. Since then, the number of hospitalists has grown exponentially in the U.S. from a few hundred to over 50,000 in 2016. Prior studies on hospitalists have well documented benefits hospitals gain from adopting this innovative staffing strategy. However, there is a dearth of research documenting predictors of hospitals’ adoption of hospitalists. To fill this gap, this longitudinal study (2003–2015) purposes to determine organizational and market characteristics of U.S. hospitals that utilize hospitalists. Our findings indicate that private not-for-profit, system affiliated, teaching, and urban hospitals, and those located in higher per capita income markets have a higher probability of utilizing hospitalists. Additionally, large or medium, profitable hospitals, and those that treat sicker patients have a higher probability of adoption. Finally, hospitals with a high proportion of Medicaid patients have a lower probability of utilizing hospitalists. Our results suggest that hospitals with greater slack resources and those located in munificent counties are more likely to use hospitalists, while their under-resourced counterparts may experience more barriers in adopting this innovative staffing strategy.

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Section: Discussion and Policy Implicationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 94%

Section: Conceptual Frameworkmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Hospitalists, two decades later: Which US hospitals utilize them?

Epané

Weech‐Maldonado

Hearld

et al. 2020

Health Serv Manage Res

Self Cite

View full text Add to dashboard Cite

show abstract

“…[1][2][3][4] Numerous studies have compared care delivery in hospitals between hospitalists and non-hospitalists and showcased the advantages hospitalists have in acute inpatient care. [5][6][7][8][9] Ultimately, they have yielded to the success of the hospital medicine movement. [10][11][12] However, what separates high and low performing hospitalists has yet to be dissected.…”

Section: Introductionmentioning

confidence: 99%

Positive clinical and financial outcomes of patient-management accountable metrics contract among hospitalists

Yi¹,

Davidyock²,

Haywood

2019

JHA

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Background: Studies have shown positive outcomes for patients treated by hospitalists, however, the impact of Patientmanagement Accountable Metrics (PAM) contract among hospitalists on financial and clinical outcomes is unclear. This study intends to determine the impact of PAM contract among hospitalists on these outcomes.Methods: This retrospective cohort study conducted in a 7-hospital health system in southeast U.S. region included 93,037 adult inpatients treated by 264 hospitalists and discharged in 2018. It measures the impact of PAM contract among hospitalists on total cost, variable cost, contribution margin, length of stay (LOS), 30-day readmission and mortality per inpatient discharge. Univariate and multivariable regression analysis were used for measuring outcomes.Results: When compared with non- PAM contracted hospitalists, PAM contracted hospitalists were estimated per case to have $437 ([95% CI: $326 to $548]) lower in total cost, $123 ([95% CI: $73 to $173]) lower in variable cost, $361 ([95% CI: $241 to $481]) higher in contribution margin, 0.37 days ([95% CI: 0.33 to 0.42]) shorter in LOS, and lower 30-day readmissions probability with an odds ratio of 0.82, ([95% CI: 0.79 to 0.86]). The impact of PAM contractual status was not significant on mortality rates. Study hospital system projected $17 million annual cost reduction, $14 million contribution margin and 14,000 patient days savings if all hospitalists were PAM contracted.Conclusions: This study indicates that PAM contract had positive financial and clinical impact among hospitalists. These findings may help hospitals improve clinical outcomes while reducing costs and improve margin.

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The Hospital Value‐Based Purchasing Program: Do hospitalists improve health care value

Spaulding

Tafili

Dunn

et al. 2022

Journal of Hospital Medicine

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Introduction As healthcare organizations examine the associated benefits of employing a larger hospitalist workforce, there is a need to better understand the association with patients' quality, experience, and efficiency. However, there is a lack of information regarding how hospital use of hospitalists over time influences hospital scoring on quality programs, such as the Center for Medicare and Medicaid Services (CMS) Hospital Inpatient Value‐Based Purchasing (HVBP) Program. This study examines the association between hospitalist staffing between 2014 and 2019 and HVBP scores. Methods We used a cross‐sectional panel study design. Total Performance Score (TPS) and its domains were obtained from CMS from 2014 to 2019 and merged with the American Hospital Association Annual Survey Database. We utilized random‐effects multivariable panel regression models and zero‐inflated negative binomial regression to examine the association between the hospitalist‐staffing ratio and the HVBP Program. All models were adjusted for hospital characteristics. Results A total of 2126 hospitals were included in the study. The average ratio of hospitalists per staffed bed was 0.06, with a standard deviation of 0.15. This study suggests that hospitals that employ a higher percentage of hospitalists see improvement in their overall TPS (β = 5.40; p < .001), Patient Experience (β = 2.49; p <.05), and Efficiency (incidence‐rate ratio= 1.41; p < .001) domain. However, the Clinical Care domain was no different in organizations employing more hospitalists. Conclusion There are benefits associated with TPS, Patient Experience, and Efficiency from employing hospitalists. Managers should seek opportunities to leverage hospitalists' expertise in providing care, particularly in improving care processes.

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Hospitals’ use of hospitalists: Implications for financial performance

Abstract: These findings suggest that the rise in the use of hospitalists may be fueled by financial incentives such as increased revenues and profitability in addition to other drivers of adoption.

Cited by 17 publications

References 22 publications

Hospitalists, two decades later: Which US hospitals utilize them?

Hospitalists, two decades later: Which US hospitals utilize them?

Positive clinical and financial outcomes of patient-management accountable metrics contract among hospitalists

The Hospital Value‐Based Purchasing Program: Do hospitalists improve health care value

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