1. John Doe MD Director of Hospitalist Program 5.20.2010 John Doe MD Director of Hospitalist Program 5.20.2010 Hospitalists at Your Health System

2. …and now we want to help YHS grow. YHS Hospitalist Service has grown since 1998… Coming together is a beginning; keeping together is progress; working together is success. Henry Ford

3. History of Hospitalists Year# Hospitalists# Hospitals ‘96-20001000 → 2000 200723,00053% 200928,00083% (>320 beds) YearTotal Hospitalist Encounters/yr Hospitalist Encounters/Day ‘05-’06255815-18 ’07-’08244714-16 Society of Hospital Medicine Annual Report-2010 American Hospital Association Report-2012

4. Evidence Based Hospitalists’ Success  LOS- site specific  ED Efficiency-John Hopkins/ Baltimore  Reduce Re-admissions-6.4% (Cogent Medicare Model)  ↓ Re-admits/Complications: Co-Managed Ortho Pts  Numerous Quality/ Performance Improvement Initiatives

5. Your Health System-Hospitalists  1996 YHS site A: Medical group team started-3 docs  1997 YHS site A: Private group team started- 4 docs  1997 YHS site B: Site B hospitalist team started- 6 docs  2004 YHS Hospitalist Groups Merge-2 hospitals, 25 docs  2012: YHS Hospitalist Group-42 docs –7 teams at site A, 5 teams at site B –SNF team at Happy Home SNF –Peri-op clinic directors –15 encounter/doc/day –76,650 encounters/year

6. Your Health System: Hospitalists-Performance Improvement Projects  Emergency Dept: –24/7 coverage AND Flexed Coverage –Throughput –Admit self pay and unassigned  EHR Adoption-Champions, Super Users  DVT Prevention  Med Reconciliation  Transfers out of ICU and IMCU  Documentation  Pre-Op clinic (Were they involved, asked or told?)

7. Hospitalists Value- Total Revenue This is data from Midas and Star Inpatients only Consults and Observation Patients NOT included in these numbers 2009 Patient Volume Total Discharges Percent cared by Hospitalist Number cared by Hospitalist YHS-site A1321056%7398 YHS-site B905454%4889 2009 Total Revenue by Hospitalist Revenue per Patient Total Revenue for Hospitalist Patients YHS-site A$16,735$123.8M YHS-site B$15,245$74.5M

8. Hospitalists Value- Medicare Savings 2009 Medicare Medicare patients (%) Hospitalist Medicare patients (total #) Hospitalist LOS Non- Hospitalist LOS YHS-site A62%4587 4.24.7 YHS-site B68%3325 4.34.9 Medicare Revenue Saved Bed Days SavedRevenue Saved YHS-site A 2,294$5.05M YHS-site B 1,995$4.39M This is data from Midas and Star $2,200 cost per Medicare Bed Day

9. Hospitalists Value- Potential in the Future  ACO Model –Coordinate Care –ED management of potential admits  Observation Unit  Post Acute Care Clinic  Discharge Improvement to Reduce Readmissions  Continue to Optimize –LOS –Patient Satisfaction –Status Designation

10. Hospitalist Rapid Cycle Improvement Project Hospitalist Steering Committee  Identify and implement Health System-Hospitalist Improvement Projects  Committee members: –Hospitalist Leaders –CNOs –Director of Care Management –Hospital Administrators-Executive Sponsors (COO and/or CEO) Questions, Discussion….