EVALUATE HOSPITALIST MODEL

Identifying Project and Provider Information: Category 2: Redesign to Improve
Patient Experience; Project Option 2.4.3: 094109802.2.3; Increased patient
satisfaction; HCA Las Palmas Del Sol (094109802).

Project Description: Under this project, HCA Las Palmas Del Sol will research,
design, and implement (if found to be effective) a hospitalist model to increase
productivity and access to care for patients, involving both physicians and mid-level
providers. Under the current care model at our hospital, patient care is managed by
individual primary care physicians who work in tandem with the hospital staff for their
specific patients. Currently, there is a shortage of primary care physicians in El Paso
and statewide that is causing lack of access to care. This lack of access is causing
increased length of stay and decreased patient satisfaction. We would like to
evaluate the possibility of implementing a hospitalist model, under which the hospital
would have a staff of physicians and mid-level providers to treat hospital patients, in
lieu of having primary care physicians make calls and visits on a fractured basis. Our
research will determine if an all-physician hospitalist model would be appropriate or
some type of mixed-model with mid-level providers is more effective. We expect to
determine if and how much a hospitalist model will improve the patient experience
by creating a more stable continuity of care during a hospital stay and providing
easier access to doctors and nurses. Assuming the program is feasible and
desirable, we expect that the move to a hospitalist model will improve patient
satisfaction by reducing the wait time for treatment decisions, and will improve the
documentation of patients’ diagnoses, treatment, and outcomes. The model should
also improve the quality of life for physicians as they would no longer have to be on
call or round in the middle of the night. Challenges include: high cost of providing the
nurses and physicians; determining whether the hospitalist model will make a
positive impact for patients; convincing primary care physicians that this model is
better for their patients; accurately measuring the change in patient satisfaction.

Starting Point/Baseline: Currently, patients are admitted to their primary care
physician or the primary care physician on-call for the emergency department. Due
to the shortage of primary care physicians, our physicians are over-burdened with
their practice and often do not see patients in a timely manner. This causes delays in
treatments which can lead to poor outcomes and increased lengths of stay. Roughly
one-third of the El Paso population is under-insured or uninsured and does not have
a primary care physician.

Rationale: Implemented hospitalist projects have the potential to yield
improvements in the level of care integration and coordination for patients and
ultimately lead to better health and better patient experience of care. Currently, there
is a shortage of primary care physicians in El Paso and statewide that is causing
lack of access to care. This lack of access is causing increased lengths of stay and
decreased patient satisfaction. We expect that the move to a hospitalist model will
improve patient satisfaction by reducing the wait time for treatment decisions, and
will improve the documentation of patients’ diagnoses, treatment, and outcomes.
Hospitalists will manage the acute care of patients and expedite the care of patients
within the hospital setting. Hospitalists will ensure patients’ needs are met within a
timely manner. Because hospitalists are on duty 24 hours a day, they are fully
available to patients from admission to discharge. This reduces complications,
lengths of stay, and the costs of providing care. This model will relieve some primary
care physicians from rounding in the hospital, thus enabling greater patient access
to care as physicians will be able to spend more time in their practice.

Related Category 3 Outcome Measure(s): OD-6: Patient Satisfaction; IT-6.1:
Percent improvement over baseline of patient satisfaction scores; 094109802.3.8.

Relationship to Other Projects: This project is part of LPDS’s larger plans to
expand and develop primary care and specialty care services, while improving
access to care and containing the costs of care. Together with LPDS’s Physician
Training and Quality project (094109802.1.5) and Electronic Medical Records project
(094109802.2.1), this project will greatly improve the quality and efficiency of the
inpatient experience at LPDS.

Relationship to Other Performing Providers’ Projects in the RHP: TBD

Plan for Learning Collaborative: TBD

Project Valuation: $4,257,644. The valuation of each LPDS project takes into
account the transformational impact of the project, the population served by the
project (both number of people and complexity of patient needs), the alignment of
the project with community needs, and the magnitude of costs avoided or reduced
by the project. In particular, this project has been valued based on the logistical work
required to change patterns of care in the inpatient setting, as well as the potential
for quality improvement and patient experience improvement resulting from a
successfully implemented hospitalist program.
094109802.2.3
2.4.3.X
HCA Las Palmas Del Sol
094109802.3.8
IT-6.1
Related Category 3
Outcome Measure(s):
Year 2
(10/1/2012 – 9/30/2013)
Milestone 1: Establish baseline for
metrics P-11.1, I-16.1, and I-16.2.
Metric 1: Establish baseline for future
years.
Milestone 1 Estimated Incentive
Payment: $1,041,269
2.4.3
Year 3
(10/1/2013 – 9/30/2014)
Milestone 2 [P-11]: Orchestrate
improvement work on identified
experience targets. Workgroups
should be formed under the steering
committee to work on experience
targets. Detailed implementation
plans should be created for each
workgroup.
Metric 1 [P-11.1]: Submission of
implementation plan.
Baseline/Goal: n/a
Data Source: Implementation
plans.
Milestone 2 Estimated Incentive
Payment: $1,135,968
EVALUATE HOSPITALIST MODEL
094109802
Percent improvement over baseline of patient satisfaction scores
Year 4
(10/1/2014 – 9/30/2015)
Year 5
(10/1/2015 – 9/30/2016)
Milestone 3 [I-16]: Improve patient
satisfaction/experience scores.
Milestone 4 [I-16]: Improve patient
satisfaction/experience scores.
Metric 1 [I-16.1]: Percent
improvement of patient satisfaction
scores for a specific tool over baseline.
Baseline/Goal: 5% increase over DY
2 baseline.
Data Source: Patient
satisfaction/experience surveys
such as Clinician and Group
Consumer Assessment of Health
Care Providers and Systems (CGCAHPS) and/or Hospital Quality
Initiative Hospital Consumer
Assessment of Healthcare Providers
and Systems (HCAHPS) scores.
Metric 1 [I-16.1]: Percent improvement of
patient satisfaction scores for a specific tool
over baseline.
Baseline/Goal: 5% increase over DY 4.
Data Source: Patient
satisfaction/experience surveys such as
Clinician and Group Consumer Assessment
of Health Care Providers and Systems (CGCAHPS) and/or Hospital Quality Initiative
Hospital Consumer Assessment of
Healthcare Providers and Systems
(HCAHPS) scores.
Metric 2 [I-16.2]: Percent
improvement of patient satisfaction
scores for a subset of measures that
the provider targets for improvement
in a specific tool.
Baseline/Goal: 5% increase over DY
2 baseline.
Data Source: Patient
satisfaction/experience survey
and/or HCAHPS or CG-CAHPS
scores.
Milestone 3 Estimated Incentive
Payment: $1,139,270
Metric 2 [I-16.2]: Percent improvement of
patient satisfaction scores for a subset of
measures that the provider targets for
improvement in a specific tool.
Baseline/Goal: 5% increase over DY 4.
Data Source: Patient
satisfaction/experience survey and/or
HCAHPS or CG-CAHPS scores.
Milestone 4 Estimated Incentive Payment:
$941,136
094109802.2.3
2.4.3.X
HCA Las Palmas Del Sol
094109802.3.8
IT-6.1
Related Category 3
Outcome Measure(s):
Year 2
(10/1/2012 – 9/30/2013)
Year 2 Estimated Milestone Bundle
Amount: $1,041,269
2.4.3
EVALUATE HOSPITALIST MODEL
094109802
Percent improvement over baseline of patient satisfaction scores
Year 3
(10/1/2013 – 9/30/2014)
Year 3 Estimated Milestone Bundle
Amount: $1,135,968
Year 4
(10/1/2014 – 9/30/2015)
Year 4 Estimated Milestone Bundle
Amount: $1,139,270
TOTAL ESTIMATED INCENTIVE PAYMENTS FOR 4-YEAR PERIOD: $4,257,644
91328
Year 5
(10/1/2015 – 9/30/2016)
Year 5 Estimated Milestone Bundle Amount:
$941,136