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Lapps J, Flansbaum B, Leykum LK, Bischoff H, Howell E. Growth trends of the adult hospitalist workforce between 2012 and 2019. J Hosp Med 2022; 17:888-892. [PMID: 36039963 DOI: 10.1002/jhm.12954] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 08/05/2022] [Accepted: 08/15/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Accurately identifying the number of practicing hospitalists across the United States continues to be a challenge. Characterizing the workforce is important in the context of healthcare reforms and public reporting. OBJECTIVE We sought to estimate the number of adult hospitalists practicing in the United States over an 8-year period, to examine patterns in growth, and begin to explore billing patterns. DESIGN, SETTINGS, AND PARTICIPANTS Retrospective study using national Medicare Part B claims datasets. We applied a commonly used 90% threshold of billing hospital visit-associated Healthcare Common Procedure Coding System codes to identify adult hospitalists in publicly available Medicare Provider Utilization and Payment data for 2012-2019. We then analyzed billing patterns for those identified hospitalists. MAIN OUTCOMES AND MEASURES Identify trends in the number of identified adult hospitalists, including those self-identified. Compare hospitalists' billing to that of non-hospitalist Internal Medicine and Family Medicine physicians. RESULTS We saw more than a 50% growth rate of practicing adult hospitalists between 2012 and 2019. In 2019, we identified 44,037 adult hospitalists. CONCLUSIONS The number of adult hospitalists continued to grow at a consistent rate, such that hospitalists are in the top five largest physician specialties in the United States. In the absence of more formal identification and consistent use by hospitalists, a threshold continues to be a meaningful tool to characterize the workforce.
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Affiliation(s)
- Joshua Lapps
- Society of Hospital Medicine, Philadelphia, Pennsylvania, USA
| | - Bradley Flansbaum
- Department of Medicine, NYU Langone Medical Center, New York, New York, USA
| | - Luci K Leykum
- Department of Internal Medicine, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
- Medicine Service, South Texas Veterans Health Care System, San Antonio, Texas, USA
| | - Heidi Bischoff
- Society of Hospital Medicine, Philadelphia, Pennsylvania, USA
| | - Eric Howell
- Society of Hospital Medicine, Philadelphia, Pennsylvania, USA
- Division of Hospital Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA
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Abstract
The Centers for Medicare and Medicaid Services awarded Hospital Medicine a Medicare specialty code, "C6", in 2016. We examined the early uptake of C6 code using the 2017 Medicare Part B utilization data. We also compared the actual C6 specialty code usage against estimated rates of overall hospitalist billing using threshold-based hospitalist rates of Evaluation and Management codes to assess the integration of the newly introduced code. Billing activity associated with the C6 code was approximately one-tenth of expected rates.
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Affiliation(s)
| | - Luci Leykum
- University of Texas Heatlh Science Center at San Antonio, San Antonio, Texas
- South Texas Veterans Health Care System, San Antonio, Texas
| | - Joshua Lapps
- Society of Hospital Medicine, Philadelphia, Pennsylvania
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White AA, McIlraith T, Chivu AM, Cyrus R, Cockerham C, Vora H, Vulgamore P. Collaboration, Not Calculation: A Qualitative Study of How Hospital Executives Value Hospital Medicine Groups. J Hosp Med 2019; 14:662-667. [PMID: 31339842 DOI: 10.12788/jhm.3249] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Hospital medicine groups (HMGs) typically receive financial support from hospitals. Determining a fair amount of financial support requires negotiation between HMG and hospital leaders. As the hospital medicine care model evolves, hospital leaders may regularly challenge HMGs to demonstrate the financial value of activities that do not directly generate revenue. OBJECTIVE To describe current attitudes and beliefs of hospital executives regarding the value of contributions made by HMGs. DESIGN Thematic content analysis of key informant interviews. PARTICIPANTS Twenty-four healthcare institutional leaders, including hospital presidents, chief medical officers, chief executive officers, and chief financial officers. Participants comprised a diverse sample from all regions in the United States, including rural, suburban, and urban locations, and academic and nonacademic institutions. RESULTS Executives highly valued hospitalist groups that demonstrate alignment with hospital priorities, and often used this concept to summarize the HMG's success across several value domains. Most executives evaluated only a few key HMG metrics, but almost no executives reported calculating the HMG return on investment by summing pertinent quantitative contributions. Respondents described an evolving concept of hospitalist value and believed that HMGs generate substantial value that is difficult to measure financially. CONCLUSIONS Hospital executives appear to make financial support decisions based on a small number of basic financial or care quality metrics combined with a subjective assessment of the HMG's broader alignment with hospital priorities. HMG leaders should focus on building relationships that facilitate dialog about alignment with hospital needs.
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Affiliation(s)
- Andrew A White
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | | | - Anton M Chivu
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Rachel Cyrus
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Hardik Vora
- Hospital Medicine Division, Riverside Regional Medical Center, Newport News, Virginia
| | - Patrick Vulgamore
- Temple Center for Population Health, Temple University Health System, Philadelphia, Pennsylvania
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Miller CS, Fogerty RL, Gann J, Bruti CP, Klein R. The Growth of Hospitalists and the Future of the Society of General Internal Medicine: Results from the 2014 Membership Survey. J Gen Intern Med 2017; 32:1179-1185. [PMID: 28744705 PMCID: PMC5653553 DOI: 10.1007/s11606-017-4126-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 06/12/2017] [Accepted: 06/22/2017] [Indexed: 11/30/2022]
Abstract
According to the most recent annual membership surveys, hospitalists are a rapidly growing component of the Society of General Internal Medicine (SGIM). Should this trend continue, hospitalists could increase from 22% of SGIM membership in 2014 to nearly 33% by 2020. Only 34% of hospitalists who responded to the survey, however, consider SGIM their academic home, compared to 54% of non-hospitalist respondents. Based on these survey findings, it is clear that the landscape of general internal medicine is changing with the growth of hospitalists, and SGIM will need to strategize to keep these hospitalist members actively engaged in the organization.
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Affiliation(s)
- Chad S Miller
- Department of Internal Medicine, Saint Louis University, St. Louis, MO, USA.
| | - Robert L Fogerty
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Jillian Gann
- Society of General Internal Medicine, Alexandria, VA, USA
| | - Christopher P Bruti
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Robin Klein
- Department of Medicine, Emory University, Atlanta, GA, USA
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Fang H, Gong Q. Detecting Potential Overbilling in Medicare Reimbursement via Hours Worked. THE AMERICAN ECONOMIC REVIEW 2017; 107:562-591. [PMID: 29553228 DOI: 10.1257/aer.20160349] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
We propose a novel and easy-to-implement approach to detect potential overbilling based on the hours worked implied by the service codes which physicians submit to Medicare. Using the Medicare Part B Fee- for-Service (FFS) Physician Utilization and Payment Data in 2012 and 2013 released by the Centers for Medicare and Medicaid Services, we construct estimates for physicians' hours spent on Medicare beneficiaries. We find that about 2,300 physicians, representing about 3 percent of those with 20 or more hours of Medicare Part B FFS services, have billed Medicare over 100 hours per week. We consider these implausibly long hours.
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Affiliation(s)
- Hanming Fang
- Department of Economics and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
| | - Qing Gong
- Department of Economics and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
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Seymann GB, Southern W, Burger A, Brotman DJ, Chakraborti C, Harrison R, Parekh V, Sharpe BA, Pile J, Hunt D, Leykum LK. Features of successful academic hospitalist programs: Insights from the SCHOLAR (SuCcessful HOspitaLists in academics and research) project. J Hosp Med 2016; 11:708-713. [PMID: 27189874 DOI: 10.1002/jhm.2603] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 04/06/2016] [Accepted: 04/18/2016] [Indexed: 11/08/2022]
Abstract
BACKGROUND As clinical demands increase, understanding the features that allow academic hospital medicine programs (AHPs) to thrive has become increasingly important. OBJECTIVE To develop and validate a quantifiable definition of academic success for AHPs. METHODS A working group of academic hospitalists was formed. The group identified grant funding, academic promotion, and scholarship as key domains reflective of success, and specific metrics and approaches to assess these domains were developed. Self-reported data on funding and promotion were available from a preexisting survey of AHP leaders, including total funding/group, funding/full-time equivalent (FTE), and number of faculty at each academic rank. Scholarship was defined in terms of research abstracts presented over a 2-year period. Lists of top performers in each of the 3 domains were constructed. Programs appearing on at least 1 list (the SCHOLAR cohort [SuCcessful HOspitaLists in Academics and Research]) were examined. We compared grant funding and proportion of promoted faculty within the SCHOLAR cohort to a sample of other AHPs identified in the preexisting survey. RESULTS Seventeen SCHOLAR programs were identified, with a mean age of 13.2 years (range, 6-18 years) and mean size of 36 faculty (range, 18-95). The mean total grant funding/program was $4 million (range, $0-$15 million), with mean funding/FTE of $364,000 (range, $0-$1.4 million); both were significantly higher than the comparison sample. The majority of SCHOLAR faculty (82%) were junior, a lower percentage than the comparison sample. The mean number of research abstracts presented over 2 years was 10.8 (range, 9-23). DISCUSSION Our approach effectively identified a subset of successful AHPs. Despite the relative maturity and large size of the programs in the SCHOLAR cohort, they were comprised of relatively few senior faculty members and varied widely in the quantity of funded research and scholarship. Journal of Hospital Medicine 2016;11:708-713. © 2016 Society of Hospital Medicine.
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Affiliation(s)
- Gregory B Seymann
- Department of Medicine, Division of Hospital Medicine, University of California, San Diego, San Diego, California.
| | - William Southern
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Alfred Burger
- Department of Medicine, Division of Hospital Medicine, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Daniel J Brotman
- Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland
| | | | - Rebecca Harrison
- Department of Hospital Medicine, Oregon Health & Science University, Portland, Oregon
| | - Vikas Parekh
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Bradley A Sharpe
- Department of Medicine, University of California, San Francisco, San Francisco, California
| | - James Pile
- Department of Hospital Medicine, Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Daniel Hunt
- Department of Medicine, Emory University, Atlanta, Georgia
| | - Luci K Leykum
- Department of Medicine, UT Health Science Center at San Antonio/South Texas Veterans Health Care System, San Antonio, Texas
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