Background: Co-management across service lines has become increasingly common in hospital medicine. SHM’s Co-Management Task Force has outlined several components of a successful co-management program. Recent studies have shown that cross-disciplinary service arrangements, which are more collaborative, enhance provider satisfaction and may improve patient care. These benefits have encouraged institutions to roll out multiple co-management services. Yet, there exists little guidance on leading a hospitalist group through the development of parallel co-management services. Key challenges include resource allocation/scheduling, partitioning clinical time between co-management and general medical services, cultivating niches of expertise, and establishing expected documentation, metrics, and revenues for different subsets of hospitalists.
Purpose:
To describe a strategy for implementing multiple parallel co-management services via a 36 FTE academic hospitalist group at a tertiary care center.
Description:
We created co-management services with Neurology, Orthopedics and an on-campus inpatient psychiatric facility. Common partner service line expectations were availability, accessibility, close work with a limited number of physicians, and improved performance, quality and patient experience metrics.
A hospitalist was designated lead physician for each service line, which had the added benefit of creating leadership roles for group members. The lead assisted in creating a core group, met regularly with the service line, arranged in-services and assisted with metric analysis. Each hospitalist participated in their designated co-management service ¼ of the year, allowing other clinical opportunities and minimizing burnout.
Each service highlights hospitalist attributes such as 24/7 availability, ability to meet regularly on-site, investment in hospital metrics and enhanced communication. We insisted on attending-to-attending communication to build rapport and to avoid the negativity sometimes associated with intermediaries. Service lines were provided a dedicated line of communication and scheduled email digests.
This program has achieved a 50% reduction in readmissions from our partner psychiatric facility compared to 2014. Orthopedics co-management hospitalists have generated a 40% increase in wRVU compared to average general medicine hospitalists over the last 4 months; as well, HCAHPS percentile rankings for similar hospitals for pain management and likelihood to recommend hospital have improved from 97 to 99 and 88 to 92, respectively, compared to 5 months pre-rollout.
Conclusions:
By building parallel co-management services, we were able to expand our footprint and simultaneously develop clinical niches within our group, standardizing care for several patient cohorts. Feedback suggests enhanced communication has been a key driver of our success. This is a viable model for a large hospitalist group to increase productivity and specialization without sacrificing job satisfaction or clinical scope.