Lets start with that $268 figure. Let us assume that a 300 bed hospital is always full. Let us assume the average hospital stay is 5 days long. How many admissions or diagnosis related groups (DRGs) can a hospital collect in a year? A 300 bed hospital at maximum load will have 109,5000 patient days. If the average length of stay is 5 days, that represents 21,900 hospital admissions or DRGs.
Now imagine if all those 21,900 DRGs, all were taken care of by internists. Then the following year, all of them were taken care of by hospitalists. What is the savings from a well run hospitalist service? That total is $268 * 21,900 or 5,869,000 dollars. Almost six million dollars could be earned by a hospital if all medical admissions once cared for by community internists were instead cared for by a hospitalist service. Obviously in a hospital, not all admissions are handled by internists. Some are surgical, some are observation, some are family practice, so the benefit in direct resource utilization is not quite as high.
Now let us take my hospitalist service for example. Let us use a daily census of 75 as an example. If you plug in this same data, and assume a LOS of 5 days, then our hospitalist service will see on average 5475 DRGs a year. If all were previously admitted by community internists, that $268 just became 1.5 million dollars a year in direct costs savings from resource utilization. So what may seem like chump change, is in fact a huge chunk of change in the tight margins of hospital economics.
Now, this $268, is actually the smallest benefit by far to the hospital. Imagine a full hospital system. If your hospital is at maximum capacity and payment is based on DRG, then the quicker you get them out, the more room you have to admit other patients, such as money making heart bypass and total joint replacement. You have more rent space for profit driven procedural medicine. The reason it pays to get medical patients out as quick as safely possible is because medical admissions generally loose money to a hospital system. So even $268 per DRG is a WIN-WIN.
But let us go back to the length of stay (LOS) benefit of 0.4 days. Let us dissect that number. Imagine again our 300 bed hospital at maximum load. Let us again imagine a LOS of 5 days. That gives 109,500 patient bed days. If the average LOS is 5 days, that gives 21,900 DRG payments. Hospitals are paid on diagnosis related groups (DRGs), so if you are in the hospital for 2 days or 20, they get paid the same (with some minor adjustments). Let us just use a DRG payment of $5000 for simplicity. Revenue for that hospital for the year would be 21,900 * $5000. Or $109,500,000, without the hospitalist service. Now let us imagine if the hospitalist service admitted every single patient to the hospital and was able to shave just 0.4 days off the hospital stay. How many DRGs could a hospital collect in that year?
Well, at a LOS of 4.6 days instead of 5, at a 300 bed hospital, at full capacity, that equates to 23, 804 DRGs, an increase of 1904 DRGs. Let us use that $5,000 average DRG payment (which would actually go up as better paying procedural admissions were made possible with open beds) and you see that a hospital can collect an additional $9,520,000 in DRGs based solely on a decrease length of stay of less than 1/2 day per patient, if a hospitalist service had their mittens on every patient brought into the hospital. This is where the actual direct costs savings come into play. By allowing the hospital to optimize their staffing (the nurse will get paid the same whether there are 21K or 23K DRGs, every additional DRG is pure profit to the hospital. Making beds available for those elective total knees and bypass surgeries increases the average DRG payment, the stuff that drives profit.
$10 million dollars a year. That's how much a hospitalist service could bring to the table. If you imagined a hospitalist group getting 4 million dollars a year in support to see all 300 patients every day in the hospital (at maximum efficiency that would require a group of about 40 docs ), the yearly return on investment of 4 million dollars is 250%, starting at year one. The per doc support would be about $100,000.
Can you think of any other business decision that result in immediate 250% ROI? I can't. That's why hospitalist services and hospitalist salaries are in demand.
This is a simple run down on why a hospitalist service makes sense, and why administrators that get it are willing to support a WIN-WIN solution. And why the hospitalist salary continues to rise.
Nenhum comentário:
Postar um comentário