1. The State of Hospital Medicine in 2014 An Overview of SHM’s Newest Survey and Report Leslie Flores, SFHM Partner Nelson Flores Hospital Medicine Consultants leslie.flores@nelsonflores.com 760-771-3323 Tierza Stephan, MD, FACP, SFHM Abbott Northwestern Hospitalists Minneapolis, MN tierza.stephan@allina.com 952-484-6658

2. Survey Background Historical Perspective First Survey – 1997 Published every two years Society of Hospital Medicine (SHM) and Medical Group Management Association (MGMA)

3. What is the State of Hospital Medicine Report? Contains the most up-to-date information on hospitalist subject matter Captures group-level data Intended to educate about operating characteristics of Hospital Medicine Groups Shows trends in Hospital Medicine Used to benchmark

4. How is the Report Generated? SHM Practice Analysis Committee Create and send out survey Publicize and encourage participation Data analysis and processing –Data scrubbing –Confidentiality Combine SHM Survey results with MGMA compensation and productivity data

5. Respondent Demographics Number of Hospital Medicine Groups: 499 Number of physician hospitalist FTE: ~ 6,341 Response rate ? – Approx. 13.9% of Hospital Medicine Groups –Approx. 14.4% of nation’s hospitalists

6. WHAT’S IN THE REPORT?

7. What’s In It? Results of SHM’s 2014 SoHM Survey –HMGs serving adults only (n=422 groups; ~6,100 FTEs) –HMGs serving children only (n=40 groups; 256 FTEs) –HMGs serving both adults and children (n=19 groups; ~ 375 FTEs) Productivity and Compensation Data Licensed from MGMA –All adult hospitalists (IM and FP) (n=3,337) –Family medicine hospitalists (n=351) –Internal medicine hospitalists (n=2,986) –Pediatric hospitalists (n=189) –Med/Peds hospitalists (n=30) –Hospitalist NP/PAs (n=261) –Academic internal medicine hospitalists (n=301) –Academic pediatric hospitalists (n=146)

8. What’s In It? Scope of Clinical Services HMG Staffing HMG Schedules Hospitalist Compensation and Benefits –Group-level information CPT Code Distribution HMG Finances Information About Academic HMGs Innovations Individual-Level Information (licensed from MGMA) –Compensation –Productivity

10. Almost 2/3 of adult HMGs reported having at least one family medicine doc 2/3 of adult HMGs reporting having NP/PAs

11. For adult HMGs with back-up systems in place: –28% provide no additional compensation –59% provide no comp for being on the back-up schedule, but comp if called in

12. 94% of adult HMGs and 87% of pediatric HMGs reported financial shortfalls

13. ACOs 36% of adult HMGs reported one or more of their hospitals was actively involved in or considering an ACO –48% of pediatric HMGs reported the same About half the time, no clear ACO role yet for hospitalists

14. EHR adoption is nearly universal –Hospitalists are often key players

16. Compensation continues to rise...

17. While productivity has leveled off

18. CASE STUDIES

19. Case Studies Create a new hospitalist service –Small hospital –Hospital wants 24/7 coverage –Hospital is concerned about cost State of Hospital Medicine Report gives information about: –No. of small sized HM groups –No. of HM groups providing 24/7 coverage –Schedule models, shift duration, annual no. of shifts –Median compensation data

20. Case studies Implement a nocturnist model State of Hospital Medicine Report gives information about: –No. of HM groups using nocturnists –% of nights covered by nocturnists –Differential between nocturnists and non-nocturnists regarding: no. of shifts, productivity per shift, and compensation

27. vs. SHM median $156,063

28. ISSUES TO CONSIDER

29. Data Limitations Self-reported data –Mostly members of SHM and MGMA –No independent validation –May not be representative Respondent pool varies –Between SHM and MGMA surveys –From year to year –Comparison of results between surveys or years may not be accurate

30. More Considerations Survey data describes what IS, not what SHOULD BE –No aggregate survey data precisely captures the exact circumstances of your practice Data is historical –Not an indication of future trends

31. Interpreting the Data Distribution of data not always a bell-shaped curve –Pay attention to standard deviation Median is usually more useful than mean –Less distorted by extremely high or low values Pay attention to sample size Be sure you understand the survey question Correlation doesn’t mean causation

32. Using the Report Use the Report as only one of many resources for continuous measurement and comparison –Internally over time –Externally to other groups’ experiences How do your group’s characteristics explain variances from the values presented?

33. Questions to Ask Which variables and data cuts are the most meaningful comparators for our group? How much validity in the sample? How does our group differ from survey data? –Do situational factors explain? –Is our performance significantly out of line? Are there things we can change to get in line? How should we measure performance against this variable?

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