Five Areas of Focus

To achieve maximum success, AIM regularly examines five main areas targeted for ongoing continuous quality improvement:

Medical Care       Patient Satisfaction       QI and Patient Safety       Economics       The Future

1. MEDICAL CARE

AIM physicians are expected to perform at the highest standards of care. Each provider will be invested in Continuous Medical Education to maintain the highest proficiency at the bedside. The group will meet monthly, and part of that meeting includes journal club, which will update the entire group on the latest news in care of the hospitalized patient. Group teaching is strongly encouraged. AIM expects to provide the best care without exception.

Communication with the referring providers is absolutely vital to making a hospitalist program work efficiently. AIM providers are trained to personally phone referring providers when a patient has a major change in condition or management plan. Discharge summaries are to be done on a stat line at the time of discharge, and systems are in place to assure those summaries are on the referring provider’s desk within 48 hours of discharge.

Creation of a multi-disciplinary team morning report starts each day. This team will consist of members of utilization review, nursing, social services, physical therapy, nutrition, home health, etc. Every patient’s case will be briefly reviewed so that all team members are aware of the current plan of care. While serving multiple functions, this is particularly effective in discharge planning and reducing readmissions.

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2. PATIENT SATISFACTION

AIM believes that it’s often “the little things” which optimizes patient satisfaction. All of our hospitalists are expected to provide a photo business card at the time of the initial patient encounter. Sitting at the bedside, holding a patient’s hand, making contact with families daily, and performing re-rounds later in the day are mandatory expectations of AIM hospitalists, with proven results. AIM continually reviews AIDET (Acknowledge, Introduce, Duration, Explanation and Thank You) techniques at every monthly meeting, and prides itself on having excellent patient satisfaction scores. Patient satisfaction scores are tied to hospitalist performance bonuses.

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3. QI & PATIENT SAFETY

Each AIM hospitalist must see their role as more than simply providing patient care. They must also work to improve the performance of the hospital in all related areas. AIM hospitalists, for example, are expected to treat the patient with pneumonia to the best of their abilities and skills, but also to ask how they can better care for the additional four hundred pneumonia patients they admit over a year. Systems improvement is a part of their job description, and each hospitalist must be engaged in this process. AIM providers will work on protocols, standing order sets, and other QI projects on an ongoing basis. AIM providers will fully integrate with the hospital at the committee level, leading efforts to effect change which will improve patient care and control costs. These committees include P&T, Utilization Review, Medical Care, QI Committees, Patient Safety and others as appropriate.

AIM recognizes that national data shows 10% of patients will suffer a serious, preventable adverse event during their hospital stay. AIM wants to change this, and this is one of our most important goals. A close relationship with the IS Department in EMR design and implementation, along with use of order sets mandated to capture all core measure and quality data will be a large part of our QI approach. As Value Based Purchasing begins to take a larger role, it would be wise for any hospital system to invest in a strong quality infrastructure. AIM would like to be at the core of that infrastructure.

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4. ECONOMICS

AIM recognizes the enormous fiscal pressures all hospitals must endure. Providing cost effectiveness as a group through controlling direct and indirect costs and maximizing revenues is a must. All hospitalist programs are subsidized to some extent. The median subsidy for an East region hospitalist per 2014 MGMA survey data was >$143,000 per FTE hospitalist, a significant outlay. AIM uses a variety of approaches to minimize this subsidy and provide a positive return on investment.

First, AIM hospitalists are trained to become expert coders. They receive specific coding and billing instruction with regular chart review and feedback. No money is left on the table. This serves not only to lower subsidy payments as much as possible, but also to raise the case-mix index, resulting in increased payments directly to the hospital.

Maintaining proper staffing is also critical. This will require a thorough analysis of the current staffing, average census, length of stay and other factors. The addition of Advanced Practice Clinician (APC) providers including PA-Cs and CRNPs serves to improve efficiency without adding a full FTE physician.

Interventions to decrease utilization such as pharmacy, lab, radiology and supply costs will also serve as a means of cost containment. In fact, an article by Stephen Rauh in the New England Journal of Medicine provided evidence that clinical quality improvement has not provided a significant cost savings to hospitals because of the number of fixed costs. Working to reduce pharmacy and other supply costs appears to have some of the largest impact on cost containment. Having regular meetings with administration regarding ongoing return on investment and assuring there is complete alignment of goals will be routine so that AIM will bring as much value to your facility as possible.

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5. THE FUTURE

This is a very interesting time in healthcare, as the industry slowly tries to change from a traditional fee-for-service model to value-based models and other integrated healthcare delivery systems. AIM will remain at the forefront of understanding those models of healthcare delivery and work closely with administration to ensure a successful transition as these changes are realized. Changes in transition of care measures, Value-Based Purchasing, readmission penalties, and many other challenges to reimbursement with be discussed with administration on an ongoing basis. AIM will continually integrate its business plan with your facility’s administration to reflect these changes in order to provide a maximum return on investment. AIM is now integrating its care model throughout the patient care continuum, including nursing homes, long-term acute care (LTAC) facilities and palliative care/hospice. The natural extension of a hospitalist program in a quality and value-based model is to create equally effective programs of high quality and cost-effectiveness in non-hospital arenas of care.

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