An increasing number of hospitals are moving to a hospitalist model, oftentimes motivated by a search for increased quality and efficiency in patient care. When utilized properly, hospitalists provide benefits to hospitals including shorter inpatient wait times, personalized family-centered care, and reduced length of stay, cost of hospitalization and readmission rates.
Hospitalists can be defined as physicians whose primary professional focus is the general medical care of hospitalized patients. Their activities include patient care, teaching, research, and leadership related to hospital medicine.
The nation’s hospitals and health systems have welcomed this model of care, yet these efficiencies are often accompanied by a variety of administrative challenges: financial, resourcing, recruitment and coverage. This leads us to the question, how do we provide solutions for these challenges? The answer is telemedicine.
Coupling telemedicine with a hospitalist program could solve staffing, capacity and coverage management challenges.
Growth management
A major challenge for hospital administrators is determining appropriate staffing levels for hospital programs, including hospitalist staffing. Specifically, hospitals are tasked with finding the correct number of physicians needed to meet coverage demand.
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Most hospitalist programs are at an inflection point—when the demand for hospitalist coverage exceeds existing provider availability. The shortage of hospitalists can be attributed to multiple factors. On one hand, physicians are narrowing their focus to specialties they want to concentrate on rather than where they are needed. On the other hand, it is unlikely a hospitalist program can add a part-time or a partial shift to accommodate demand due to limited resources.
Implementing an enterprise-wide telemedicine enables fractionalization of hospitalist capacity across multiple facilities to avoid hiring hospitalists who are underutilized and adding expense to the program – providing only what a hospital needs.
Load balancing
A 2017 survey from the American Medical Association noted that physician burnout is on the rise. Nearly 60 percent of physicians say they feel burned out, specifically in the emergency department (ED), an increase from 50 percent in 2013. Hospitalists are particularly prone to burnout, as they are often at the very front line of patient care in the ED. Hospital administrators are typically familiar with this scenario: when reviewing hospitalist resources, some are very busy, perhaps even worn thin while others may have extra capacity.
Determining the work capacity for a hospitalist — typically the number of hours worked per year — is critical to clearly define aspects that affect work capacity. These include a shift versus call staffing model, scheduling approach, non-patient care responsibilities and staffing philosophy. Benchmark information is extremely helpful in defining these aspects.
Telemedicine allows hospitals to even out the workload virtually, rapidly fixing both coverage shortage and load imbalances. Combining a telemedicine solution with a benchmark reporting tool further enhances its benefits.
Around-the-clock coverage
Night and weekend coverage is an important consideration for hospitalists staffing due to hospitals’ around-the-clock coverage demands. Hospitals with high patient volumes can justify the hiring of full-time nocturnists, who command a higher salary (typically 15 percent higher), for dedicated overnight duty. However, nocturnists often garner lower revenue due to fewer night encounters versus daytime. Hospitals with lower patient volume, particularly in rural areas, do not have the resources to justify the cost to commission full-time nocturnists.
Telemedicine allows for individual hospitalists to be shared across multiple facilities while maximizing their utilization regardless of patient volume.
Staffing a hospitalist is challenging when there is not enough lead time. It also costs twice as much to obtain last-minute coverage. Additionally, what if emergency privileges are required? Such a gap can be critical for a hospitalist program provider and, more troubling, a potential Joint Commission red flag.
Whether for a single shift, weekend, month or longer, telemedicine facilitates the rapid deployment of hospitalists to disparate hospitals and enable doctors to pick up incremental, short-term or flexible hours. This allows more flexibility for hospitalists to choose their ideal hours and the ability for hospitalist programs to fractionalize its staff’s time.
The Association of American Medical Colleges estimates a shortage of 45,000 primary care doctors and 46,000 surgeons and medical specialists by 2020, due in part to increased numbers of older people, who need more care, and the addition of millions of people with health insurance from the Affordable Care Act. With this shortage of clinical staffing for hospitals, mostly around certain specialties where maldistribution of intellectual input exists, there should be no doubt as to the value that hospitalist models provide.
Implementation of a successful hospitalist program will more than pay for itself in improved outcomes. The addition of telehospitalists into that program model serves to ensure programmatic success through growth management, load balancing, around-the-clock care and ad hoc gap coverage.
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