Here I want to list some of the bonus metrics that hospitalist programs use across the country to incentivize the hospitalists to perform better and reach the goals of the hospital medicine program.
There vary widely across different hospitals. These depend on location and stage of evoluation of the program.
The same hospitalist programs may also change them with time depending on the results they want to see in the next few months.
It becomes easy to achieve certain goals by giving incentive and usually the programs decide how much weight each metric is given. Not all carry same weightage. There are not national standards dictating how much or what metrics can be used.
The Medical Director usually decides what metrics among these to use in their program.
Most important bonus metrics used in hospital medicine programs for hospitalists are: They are not listed in any order.
Usage of the certain order sets: Stroke/TIA, CHF, COPD and sepsis for example.
Use of specific Discharge instructions for CHF and COPD: recommending follow up appointments in 3 to 5 days to prevent readmission.
Participation in ‘Quality Improvement‘ processes
Discharge by certain time of the day: This time varies by the program. It could be before 10am or before noon. Usually they look for the discharged bed to be ready for the next patient.
Decreasing the use of high-risk medications: Its mostly for some medications which could have significant side effects in elderly e.g. Ambien, Flexeril, Narcotics etc.
Length of Stay [LOS]: This is self explanatory. Decreasing LOS saves money for the hospitalists by several mechanisms.
Readmission rate: Since hospitals are penalized for readmissions in 1 month, some hospitals may look at the readmission rates as a bonus metric.
Mortality: Some systems may use this but it depends on the location of the hospital and the demographics in that area. To standardize this metric, Observed to Expected Mortality ratio can be used.
Productivity: Hospitals always look at the money you make for them.
Attending meetings: It can be either monthly hospitalist meetings or various committee meetings.
HCAHPS scores: This is one important metric for bonuses in most programs.
Good citizenship: This may include several things. It can be helping with covering gaps in schedule, supporting a PA or an NP, or teaching students.
Answering queries on time: Queries are very important part of the overall financial health of an institution. Answering them promptly helps in getting timely reimbursement.
Billing timely and correctly: This is not an issue in most programs where the billing is in the EMR itself. But, for those programs using software like IMbills or any separate billing software, this encourages hospitalists to bill on time and accurately.
Does your Hospital Medicine program use any other metrics. I am sure it does. Comment below.
