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8/8/2019 Wksp 107 Hos Pita List Medicine_Ceriani

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30TH ANNUAL AIM EDUCATION

HOSPITAL MEDICINEGROWTH, RETENTION AND TRANSITION TO AN

ACADEMIC PROGRAM

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AAIM MeetingsOctober 21 25, 2009Philadelphia, PA

Version 3 9/28/09

Presenters:Peter J. CerianiBeth Gentilesco, MDSajeev Handa, MD, FHMTammy L. Lederer

AGENDA

1. Welcome Who We Are

Who Are You

2. Challenge # 1- Rapid Growth atRIH

Hospitalist Compensation Incentives Crisis Staff ing - Moonlighting Basic Contracting (MD and Hospital)

3. RIH History of HospitalistProgram Activities Recruitment Orientation

4. Challenge # 2 - AcademicModel Transition Definit ion of Academic Core Issues:

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Becoming Significant Contributors Creating a Rewarding Position Nurturing Growth

5. Questions


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Who We AreLifespan Includes 4 Hospitals

o e s an osp ta

The Miriam Hospital (247)

Newport Hospi tal (129)

Bradley Hospital (60)

Statistics (2008) Employees

Licensed Beds

RIH 6,863

719

TMH 2,475

247

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Discharges

ED Visits

Outpatient Visits Research Revenue

Net Patient Revenue

Charity Care (costs)

,

34,102

144,343

199,023 $49.3M

$840 M

$25.8M

15,661

50,199

47,312 $22.7M

$313M

$6.7M

The Rhode Island Hospital

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The Miriam Hospital

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Challenge # 1 Rapid Growth at RIH(July 2008 June 2009)

Cap on Resident Training Admissions Allowed Group of 75 Community-based MDs No Longer Providing Own Hospitalists Marketplace Shifts

Active Recruitment Through Word of Mouth Ads (NEJM, Local Papers, Website) Recruitment Firm

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Provider Supply Could Not Keep Up With Increased Patient Census Developed Numerous Moonlighting Models

Residents Fellows Contracted Outside UMF Faculty


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Hospitalist Compensation & Incentives - MD 12 Hour Shifts - 15 Shifts / Month - Alternate Nights - 157 Shifts/Year

For a Census of 105 126 7 MDs Days (15 18 Patients/MD is Safety Margin)

2 MDs Evenings

3 MDs Nigh ts

Base Compensation = 80% of Total Market Driven Compensation 10% Volume WRVUs Capped at a $15,000 -$25,000 Range Pool

10% Quality Chose Press Ganey Patient Satisfaction (In Year 1)

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Resources: MGMA and Local Market for Total Compensation

Actual Median Achieved by Last Years Cohort of MDs For WRVUs

Press Ganey Reports of 6 Months Prior at 95% Confidence Interval

All financial dollars are for illustration purposes only

Bonus Benefit # Shifts # Shifts Extra # Required On call

FY 2010Hospitalist Employment Model Flexible Scheduling

ategory g e g e per ont per ear s ts/st pen on a / r st pen

1 Full time Model - Flex 1.0 Yes Yes 15 158 $1,000 none -

2 Part time Model - Flex 0.5 Yes Yes 8 84 $1,000 20 $150

3 Hybrid Model - Flex 0.4 No No 6 63 $1,100 16 $175

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1. Base Salary at $ 145,000 - $185,000 Range

2. FT = 10.5 months of service (4 weeks vacation, 2 weeks holiday/CME) = 158 (12 hour) shift/year.3. Ranges of flex time per model: 1 full time - 15, range 13 - 17 shifts/month

2 part time - 8, range 6 - 10 shifts/month3 hybrid 6, range, 4 - 8 shifts/month



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Crisis Staffing / Moonlighting Options - 1

-

Offer Resident Moonlighting $700 + $50/Admission Week Night $800 + $50 / Admission Weekend, Holiday

Offer Fellow Moonlighting

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Offer Faculty Moonlighting

Existing Core of 120 Multi-specialists


Crisis Staffing / Moonlighting Options - 2

Faculty Models for Daily Overflow (Beyond Safety Census) $250/Case (for Morning Calls Often 8:00 am) $15,000 + 10% Pension / Year for 1 Shift/Month (and Sign Annual Contract

Amendment) $8,000/Week (3 Admissions/Day, 21 Cases/Week, Primary Care)

Weekdays (Nights ) $1,500/ Shift + 10% Pension if 2 MDs on $1,750/ Shift + 10% Pension if Solo

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$1,750 + 10% Pension (Days) $2,000 + 10% Pension (Nights)

Sign up for 1,2,3 Shifts/Month



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UMF Hires MDs and Subcontracts their Services to the Hospitals

Basic Hospitalist Contracting

Hospitals Cover Net MD and NP Support, Relocation and Legal Expensesand Recruitment Firm Costs

Contract Revenue has Multiple Components: UMF Bills FFS revenues UMF Receives Deficit Funding From Hospitals

Annual Reconciliation Goal:

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evenues All Approved Expenses (UMF)= Net $0

MDs and NPs Treated Identical in the Contract Methodology

How to Calculate Split Revenues - 1

Cost of Employment of MDs, NPs

a ary

Bonus or Evening Stipends

Fringe Benefits / Pension (28%)

Malpractice Insurance Premiums

Cell phone, CME, Licenses

UMF General Administration Overhead

Academic Enrichment Fund Contribution (AEF)

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Revenues from Fee-for-Service Expected

Less Billing Service fee 8%

Hospital provides Space, Equipment, Office supplies


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How to Calculate Split Revenues - 2A. Revenues: Fee-for-Service Collections of Professional Charges

Billing Services Fee (8%)

= Net Patient Revenues

B. Expenses: Employment Related and Agreed Upon with Hospital(Includes MDs, NPs, Support Staff)

C. Net Subsidy from Hospital

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Calculate Net Subsidy for MD $ ___________

NP $ ____________

Related to FFS Ability of Each Type of Provider

Allocates Administrative Support Staff to MDs and NPs

RIH History

First Inpatient Program In Rhode Island

Service Begins August 7, 1996 with 3.0 FTE MDs

Known as the Internal Medicine Inpatient Service (IMIS)

Under the Division of General Internal Medicine

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Service Non-Teaching

Role: Cultivate Relationships with Community Physicians and Provide24/7 Coverage


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RIH History - 2

Demand for Group Steadily Increases

Outpatient Practitioners Realized that Hospital Practice Becoming aMore Complex Endeavor

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Graduate Medical Educations Residency Review Committee

RIH History - 3

u y v s on o osp ta e c ne sta s e -DHM)

Two Services:

The Internal Medicine Inpatient Service (IMIS) Hospitalist Program The Community Physician Alliance Service (CPAS) Primarily

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Both services non-teaching

2003 Designated Hospital Medicine Units Established


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Activities - 1

Medical Student Teaching

Elective Rotation for PGY II & III

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IT CPOE

Division Morbidity & Mortality Review

Activities - 2

Medical Reconciliation

Heart Failure

Vaccination Improvement

Patient Flow

Clinical Documentation Integrity

Patient Satisfaction

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Physician Communication

Universal Protocol


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Activities - 3

UMF Board of Directors

Human Resources Committee

Compliance Oversight Committee

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Investment Committee

Recruitment - 1

Sources of New Hospitalists Residency or Fellowship: 50%

Another Hospitalist Group: 28%

Different Field of Medicine: 19%

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Other: 1%; Unknown 1%SHM Biannual Survey 2007-2008


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Recruitment - 2

Residency or Fellowship: 86%

Another Hospitalist Group: 14% (RIH- DHM n=14)

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Recruitment - 3

Another Hospitalist Program: 33%

Fellowship/Other Training Program: 26%

Different Field Of Medicine: 22%

Family/Personal Reasons: 9%

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e ca m n strat on onsu t ng: Retirement: 1%

Other Choice: 2%

Unknown Choice: 2% SHM Biannual Survey 2007-2008


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Recruitment - 4

Staffing changes (DHM) 2007-2008 10 MDs 1 Termination- Fellowship

2008-2009 15 MDs 4 Terminations- 3 Fellowship;1 Relocation - Hospitalist

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Recruitment - 5

.

Five Months?

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Recruitment - 6

New Strategies Head Hunter

LORs then Invitation to Visit

Coordinate Visit and Interview Schedule

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The Red Carpet Treatment

Recruitment - 7

Sellin our Communities and Life St les

Housing and Community Tours

Supporting Applicant with New Hire Process

Important Relations

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Candidates Head Hunter Relocation Specialist Immigration Lawyer RI DOH


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Recruitment - 8

- 1.0 Medical Director

23.25 Clinical FTEs

4.0 FTE Nurse Practitioners

Shift Based Model 8a 8p

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2p 11p

8p 8a

11p 8a

9a 5p

Orientation - 1

- Welcome Address Chair/CMO

Introduction Review of Service Guidelines

Compliance Billing

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-

Physician Order Management Training

Overview Nursing Clinical Managers (DHM Floors)


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Orientation - 2

Opportunity to Ask Questions

Provide Support (Seasoned/Senior MD)

Ramp Up Case-load Gradually

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Address Problems Early

Provide Detailed Written Guidelines

On the Path to an Academic Model

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Challenge #2 Academic Model Transition

o s an ca em c A Community Hospitalist Takes Care of Patients

An Academic Hospitalist Takes Care of Patients and DoesSomething Else Too

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Putting the Academic in

Hospitalist Program?

In-patient Care Predominates

Teaching

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Research


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Core Issues for the MDs

Community

Creating a Rewarding Job

Nurturin the Other Half

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Committees

Become Part of the Fabric

Co-management

Procedures

Quality

Education

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IT Research

Safety


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Creating a Rewarding JobPreventing Burnout

Teaching vs. Non-teaching Time

Average Daily Patient Census (safety)

Other Services (Procedures, Nights)

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Clinical vs. Non-clinical Time

Scheduling/ Vacation/ Planning Ahead

Nurturing the Growth

r entat on

Mentorship

Faculty Development (Research, Teaching)

Morale Building

Meetin s

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Opportunities


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Questions

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Peter Ceriani, MBA

Contact Information

Sajeev Handa, MD, FHM

University Medicine Foundation, Inc.Rhode Island Hospital593 Eddy StreetProvidence, RI 02903401-444-5135401-444-5492 (fax)[email protected]

Beth Gentilesco MD Tamm L Lederer

,University Medicine Foundation, Inc.Rhode Island Hospital593 Eddy StreetProvidence, RI 02903401-444-3985401-444-3986(fax)[email protected]

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,

Assistant Professor of MedicineUniversity Medicine Foundation, Inc.The Miriam Hospital164 Summit AvenueProvidence, RI 02906401-793-2104401-793-4047 (fax)[email protected]

.

Chief, Human Resources OfficerUniversity Medicine Foundation, Inc.Rhode Island Hospital593 Eddy StreetProvidence, RI 02903401-444-7815401-444-5492 (fax)[email protected]

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