Analyze This

The Hospitalist. 2010 September;2010(09):

September 1, 2010 | The Hospitalist

One thing the new metrics have in common is that they show hospitalists across the nation are becoming more efficient. “The numbers essentially reaffirm the overall trends for hospital medicine, in that the productivity continues to increase and the compensation paid to a provider continues to increase,” says Troy Ahlstrom, MD, FHM, CFO of Traverse City-based Hospitalists of Northern Michigan, which has nearly 50 hospitalists supporting three hospitals. “When you dig into the numbers, hospitalists are producing more work and more RVUs per encounter than they had been in the past.”

Financial support per hospitalist FTE, another key practice-management metric, parallels the compensation growth. Practices receive a median of $98,253 of support per hospitalist FTE, according to 2010 data. The 2008 report did not provide a median figure for support; instead, it published a mean figure of $97,375 of support per FTE. The 2010 mean (average) is $111,486.

Pediatric HM also shows signs of growth; median compensation is $160,038 in the new report. The 2008 report had pediatric hospitalist median compensation at $144,600.

The new data show a spike in HM groups providing “on site” care of patients 24 hours a day, seven days a week. More than 68% have on-site care with a physician, nurse practitioner, or physician assistant. Only 53% of groups had 24/7 coverage in the 2008 report; 51% had round-the-clock coverage in the 2006 report.

Dr. Ahlstrom, a veteran member of SHM’s Practice Analysis Committee, says he expects that trend to continue, especially with the large numbers of young hospitalists in the field interested in set schedules and work-life balance. “That’s the trend,” he says. “Younger physicians are more interested in seeing that split, where the days and nights are clearly set off. Older physicians are more than happy to have a nocturnist around, just as long as it’s not going to cost them a lot of money or productivity.”

A Word of Caution, and Unintended Benefits

Survey Stipulation: Only Fools Rush In

The following are excerpts from Dr. Nelson’s “caveats and caution” in “Interpreting and Using the Survey Data,” which precedes the actual data contained in the State of Hospital Medicine: 2010 Report Based on 2009 Data:

Remember that these data do not reflect the position of SHM or MGMA regarding the right, optimal, or appropriate standards for hospitalist practice. In most cases, these numbers should not be regarded as the right targets for any particular practice, but rather as a frame of reference.
Like all national surveys of hospitalist data, the responses are not audited or verified independently. Survey staff contacted respondents who reported any data element that was outside of predetermined thresholds to ensure that the respondent understood the questions and responded accurately.
Ensure that you evaluate data points from multiple categories, and do not make decisions based solely on numbers such as means and medians for all hospitalists.
Review the original questions asked in the survey. To make sense of the survey responses, you will need to clearly understand the questions used to collect the data.
Use caution when trending data from previous surveys. This is especially important for this survey because it is the first time SHM and MGMA have collaborated on a joint survey. Many of the questions asked this year are worded differently than they were in previous SHM surveys.

The new report is based on a supplemental set of questions specifically directed at hospitalist practices in MGMA’s annual Physician Compensation and Productivity Survey. The survey is voluntary and is not audited, but it is the “best data” available for hospitalists, according to practice-management experts.

“So many people assume this data is what you should do,” says John Nelson, MD, MHM, co-founder and past president of SHM and a principal in hospitalist-consulting firm Nelson Flores Hospital Medicine Consultants. “It’s not. It is a survey of what’s happening. It’s a starting point, a frame of reference. It is the best data there is, no doubt. But you should not build your practice by trying to match the medians. You might have local data that deviates. You might be starting a program or be in a competitive situation.”