Organizing a hospitalist program: an overview of fundamental concepts

The organization of hospitalist programs varies significantly, partly because of the structure of different health care settings. As hospitalist programs mature, however, many principles emerge as valuable components of effective practices. Developing a new hospitalist practice requires addressing the following fundamental issues: 1. Determining the need and potential benefits 2. Gaining buy-in from key stakeholders 3. Anticipating practice volume, revenue, and staffing needs 4. Developing an acceptable schedule for hospitalist staffing 5. Communication with referring physicians and fellow hospitalists 6. Hospitalist compensation 7. Role of the hospitalist medical director. This article emphasizes communication and scheduling issues for hospitalists because they are fundamental to success. It also provides the outline of a business plan projecting revenue based on identified sources of referrals. In addition, this article provides an overview of hospitalist compensation based on several surveys, followed by a discussion of principles underlying a case-rate incentive plan. The stimuli for the creation of hospitalist practices, and their structure, vary widely. The hospitalist practice model is still young and evolving. Accordingly, there are no clear standards outlining how best to organize this practice. The medical society for hospitalists, the National Association of Inpatient Physicians (NAIP), and organizations such as the Medical Group Management Association are collecting data about the operational details of hospitalist practices nationwide. It is hoped that this information will illuminate optimal methods for operating a hospitalist program, but it may simply describe what is most common, not necessarily what is ideal. In 2001, the NAIP developed a task force to collect more detailed information about benchmarks related to hospitalist workloads, compensation, and other variables. Information from that research is available through NAIP and will be updated every 1-2 years. This research should be the most reliable information describing hospitalist practices across the United States. This article highlights several important topics in organizing a hospitalist practice to guide those starting a new practice or improve an existing one. It focuses primarily on the administrative aspects of practice operation and not patient care per se. None of the recommendations offered here should be regarded as conclusive evidence that this is the way a practice should operate. Nor can this article be an entirely comprehensive guide to operating a hospitalist program. Instead, it attempts to synthesize available information, some published research, and the authors' own experience to assist anyone attempting to organize a hospitalist practice.