Teaming Up for Better Health

May 1, 2009
Q&A by Shivani Parmar, MPH

MDNG Hospital Medicine, April/May 2009, Volume 3, Issue 2

Relationships are the foundation of any strong hospital medicine program. For 30 years, TeamHealth has been helping to build innovative hospital communities through its clinical outsourcing services and other solutions, all while focusing on a patient-centric, collaborative model of healthcare delivery.

Relationships are the foundation of any strong hospital medicine program. For 30 years, TeamHealth has been helping to build innovative hospital communities through its clinical outsourcing services and other solutions, all while focusing on a patient-centric, collaborative model of healthcare delivery.

Founded in 1979 to provide emergency department (ED) administrative and staffing services, TeamHealth has expanded its services to include military staffing, locum tenens, medical call center support, and much more. Headquartered in Knoxville, TN, TeamHealth is affiliated with more than 6,200 healthcare professionals caring for approximately 9 million patients annually at nearly 550 civilian and military hospitals, clinics, and physician groups. In 2008, TeamHealth provided 78,759 CME credits and enjoyed an average client retention rate of 98%.

TeamHealth has also grown into one of the largest providers of hospitalist services, working with 104 hospital medicine programs across the country. TeamHealth began aiding hospitalist programs in 1993, when one of their ED clients requested that they provide an inpatient component as well. Chris Frost, MD, Vice President of Hospital and Clinical Excellence, discusses some of TeamHealth’s experiences and shares some lessons the company has learned from the process of serving two masters: the hospital that is their client, and the healthcare providers that work within the program.

What services do you offer hospital medicine programs?

We have five main areas of focus, which are clinical education, quality education, coding education, leadership development, and operational resources. To expand on that, for quality education, we focus on core measures and hospital-acquired conditions, which are things that are just not very important to a provider, but to the client hospital as well. In terms of coding education, we’re taught in medical school and residency how to diagnose and how to treat our patients, but frequently we are not taught how to translate the diagnostics and treatment work into the format of the coding world,—the revenue side of the world. We have a national education and medication documentation specialist that helps physicians to understand the importance of translating the clinical work into documented work that pays the bills. For operational resources, we focus on the inner workings of hospital medicine and try to take the theory and translate it into everyday practice, with multidisciplinary rounds being one example. Basically we provide tools and resources to support each of these five areas.

How does TeamHealth work with providers to help them develop leadership skills? How have hospitalists and hospitals responded to this opportunity?

The average age of a hospitalist provider is 37 years and the average age of a hospital medicine leader is 41 years. So it’s a relatively young specialty. Any opportunity to impart leadership skills and education to these providers and their leaders is soaked up quickly. We have a leadership development program, called the LEAD program, that we have been running for about 10 years. All of our facility medical directors proceed through this three-and-a-half-day onsite program that focuses on skills not taught in medical school, such as relationship management, conflict management, negotiation skills, communication skills, and more. We share real experiences from medical directors and demonstrate that there is a real-world application for these “soft skills,” or MBA format skills, that are specific to healthcare and specific to hospital and emergency medicine. When the providers leave the session, they have a skill set or tool box that helps them navigate the relationship management part of their position.

The program has been so well received by both physicians and client hospitals that we’re in the process of creating a “Part 2” for the program, which gets into the more nitty gritty details, such as financial analysis, structuring value-adds for client hospitals, and ED and hospital medicine integration.

Another key to our program is that we have a medical director listserv, which has become a leadership community, and serves as a tremendously robust resource for our facility medical directors. It serves as a conduit, so that if there is something we would like to proactively share with our leadership community we have a portal through which to distribute that information in real time. If you have a best practice or strategy that’s working in a facility on the East Coast, the West Coast affiliates don’t have to wait a long time until the news percolates over there. We can get the information out there in real time by sharing it on our listserv. It also gives the facility medical directors a chance to dialog with one another in reference to questions related to clinical care, quality care, coding, or operational requests. We have found it to be very helpful in fostering a sense of community.

You mentioned multidisciplinary rounds as an example of operational resource support. Can you expand on this?

One of the things we learned while working with a Tennessee hospital is that a hospitalist group is not an island unto itself. To foster and execute the changes our client expects of us, we have to go beyond the touchy-feely teamwork or kumbaya mentality that a lot of people talk about, and truly operationalize the changes. We started having multidisciplinary rounds, meaning that we got together all the appropriate stakeholders relating to length of stay and resource utilization, and put them all into the same room at the same time of the day. This included hospitalists, case managers, social workers, site coordinators, pharmacists, and home healthcare coordinators. Then we developed disposition discussions. We would talk about each of the patients with a brief clinical synopsis of the patient’s stay and then go on to discuss what the plans for disposition were. We took the cliché “Discharge begins on the day of admission” and made it into a reality.

So an example would be “Mrs. Smith came to the hospital with pneumonia. I think she’s probably going to need about two days of hospital stay, but she may need IV antibiotics and she may need home physical therapy.” Then we start to work with the case manager, social worker, and home healthcare coordinator and really make those things a reality early on in the process.

After we implemented this program we saw some real results. We saw a reduction of length of stay by 0.5 days. We saw a 16% reduction in pharmacy costs. We saw a 21% reduction in laboratory utilization costs and a 14% reduction in imaging cost. Doctors absolutely loved it because they used to have a large number of mini-meetings on a daily basis. They had a conversation with the case manager, and then with the social worker, but they were all isolated conversations. This program made it possible to have all of those conversations in one sitting and the hospitalist became more efficient because 5-7 smaller discussions were distilled into one meaningful conversation. The hospital administration loved it because the staff loved it, and also because it demonstrated a real dollar value by moving the needle on resource utilization and length of stay.

We’ve been able to take this practice of multidisciplinary rounds and export it to all of our other practice sites where the hospital administrators had an interest.

How much time to do you spend with the hospital medicine programs that you partner with?

We have long-lasting relationship with our provider partners. The first hospitalist program we started working with was in 1993. Today, we still contract with them and our partnership is still strong. So we’re there for the long-haul commitments. We don’t measure the success of our program in months, but in terms of years.

What impact do you think the current economic pressures will have on hospital medicine programs?

I think hospital medicine will continue to grow. Hospitals are not immune to the economic pressures. As they feel more of those economic pressures, and as more look toward pay for performance and value-based purchasing, you’re going to see more hospitals look for providers that are willing to not just work within their hallways, but partner with the hospitals to ensure a successful relationship. So I think we’re going to see more, not less, hospital medicine over the next 10 years. I also think that as you see more payers, such as the government through CMS, focus on quality, that will be another driver of the growth of hospital medicine, as they will be pushing to accomplish core measures on a truly system level.

There appears to be a lot of emphasis on relationship building in your program.

A lot of hospital medicine, when it comes down to it, is about relationship management. One of the things that make hospitalists unique is that we deal with more stakeholders than the average provider. We’ve come to recognize that there is a great need for physician leadership right now, as opposed to management leadership. One of the things we’ve found that works well is to get our providers involved in the inner workings of a hospital through committee work and special project work. It is really a great way to affect change. This helps make our hospitalist group a real part of the hospital community, rather than just another service that rotates through or another person that just happens to work in the hospital. They really shine as an integrated part of that hospital community.