enter the neurohospitalists the solution to a problem n.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Enter the Neurohospitalists The solution to a problem PowerPoint Presentation
Download Presentation
Enter the Neurohospitalists The solution to a problem

Loading in 2 Seconds...

play fullscreen
1 / 46

Enter the Neurohospitalists The solution to a problem - PowerPoint PPT Presentation


  • 76 Views
  • Uploaded on

Enter the Neurohospitalists The solution to a problem. David Likosky MD SFHM Hospitalist Neurology/Internal Medicine Vascular Neurology Evergreen Hospital . A brief Hospitalist Hx Definition What problem are we trying to solve? Who are these people?

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Enter the Neurohospitalists The solution to a problem' - gomer


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
enter the neurohospitalists the solution to a problem
Enter the NeurohospitalistsThe solution to a problem

David Likosky MD SFHM

Hospitalist Neurology/Internal Medicine

Vascular Neurology

Evergreen Hospital

slide2
A brief Hospitalist Hx
  • Definition
  • What problem are we trying to solve?
  • Who are these people?
  • What are the advantages and disadvantages?
hospitalists
Hospitalists

Response to failings of inpatient general medical care

hospitalists1
Hospitalists

80% of hospitals >200 beds

3,300 hospitals nationally

30,000 hospitalists total

SHM 2011

the evolution of the model
The evolution of the model

Filling the call schedule

Not losing too much money

Looking at outcomes

Documenting value

neurohospitalists
Neurohospitalists

A physician whose primary professional focus is the neurological care of hospitalized patients.

adapted from Nelson J, SHM

why neurohospitalists
Why Neurohospitalists?
  • Two places
  • Hospital Practice
  • SHM survey
  • Workforce issues
slide10

Examples

  • The busy office, a tPApt arrives
  • Covering two hospitals on call
  • Trade overhead/paying patient for liability/no pay
multitasking
Multitasking
  • Hospitalists - 3.4 times/hour
  • ER docs
    • q5 minutes
    • 2/3 did not return to prior task

O’Leary, KJ, et al, J Hosp Med, 2006, Chisolmet. al. AcadEmerg Med. 2000

how has the hospital changed
How has the hospital changed?

Wachter, NEJM 2004, Freeman Neurol. 2008, Josephson Annal Neurol. 2008

how has the hospital changed1
How has the hospital changed?

Wachter, NEJM 2004, Freeman Neurol. 2008, Josephson Annal Neurol. 2008

how has the hospital changed2
How has the hospital changed?

Wachter, NEJM 2004, Freeman Neurol. 2008, Josephson Annal Neurol. 2008

how has the hospital changed3
How has the hospital changed?

Wachter, NEJM 2004, Freeman Neurol. 2008, Josephson Annal Neurol. 2008

how has the hospital changed4
How has the hospital changed?

Wachter, NEJM 2004, Freeman Neurol. 2008, Josephson Annal Neurol. 2008

how has the hospital changed5
How has the hospital changed?

Wachter, NEJM 2004, Freeman Neurol. 2008, Josephson Annal Neurol. 2008

how has the hospital changed6
How has the hospital changed?

Wachter, NEJM 2004, Freeman Neurol. 2008, Josephson Annal Neurol. 2008

who did the stroke care nationally
Who did the stroke care nationally?

Neurologist

Other

Smith et al, Cerebrovasc Dis 2006

all that aside
All that aside...

Are there enough Neurologists to see all the patients?

aan us membership
AAN US Membership

25,000

20,000

15,000

10,000

5000

1950 1960 1970 1980 1990 2000 2004 2008

196 PGY-1 & 385 PGY-2 Neurology Positions in 2009

NRMP 2009, AAN census 2009

hospitalists2
Hospitalists

15,000

projected

4,922 PGY-1 categorical Internal Medicine Positions in 2009

SHM website, 2009; NRMP 2009

slide32

Advantages of Neurohospitalistsfor other Neurologists

  • Less (or no) inpatient call
  • Uninterrupted clinic
  • Increased income?
  • Less stress
slide33

Advantages of Neurohospitalistsfor Patients

  • Timely care
  • Better outcomes - if internal medicine data holds
  • Decreased length of stay?
  • Increased physician availability
  • Alignment of interests
slide34

Advantages of Neurohospitalistsfor Hospitals

  • Medical staff satisfaction
  • Hospitalist qol
  • Call coverage
  • Stroke center certification?
  • Alignment of interests
  • ? Decreased liability
new hospitalist programs
New hospitalist programs
  • Thank you for answering my call
advantages of neurohospitalists for neurohospitalists
Advantages of Neurohospitalistsfor Neurohospitalists
  • Qol - possibly
  • Less risk?
  • More defined hours/responsibilities
neurohospitalist disadvantages
Neurohospitalist Disadvantages
  • Discontinuity of care
  • Costs of a neurohospitalist
  • Changes in skillset over time?
  • Privileging/credentialing changes?
  • Competition with outpatient practices?
who are the neurohospitalists
Who are the neurohospitalists?
  • Average age 42
  • 82% male
  • Split between academic and private
  • 73% primarily inpatient focused

(US neurologist 53, hospitalist 40)

(US neurologist 76%, hospitalist 62%)

AAN survey 2009

SHM survey 2007-8

Likosky et al, 2009

clinical work what do neurohospitalists see
Clinical work - what do neurohospitalists see?
  • Stroke
  • Encephalopathy
  • Seizure
  • Neuromuscular
  • CNS infection
non clinical work
Non-clinical work
  • 18% of time
  • 42% receive additional compensation

Likosky et al, 2009

how are im hospitalists paid
How are IM Hospitalists paid?

“Call” isn’t

Society of Hospital Medicine, 2010

neurohospitalist salaries
Neurohospitalist Salaries

Pay for call?

Likosky et al, 2008

pay for non clinical work
Pay for non-clinical work

Likosky et al, 2008

what beyond direct patient care
What beyond direct patient care?
  • Pathways
  • CPOE
  • Education
  • Telemedicine
  • Delirium prevention
  • Hospital administration
  • Outcomes driven care
  • Role in ACO’s
  • Joint Commission mandates/stroke centers
conclusion
Conclusion
  • Site specific specialists now in many fields
  • Well positioned for changes in healthcare
  • Strong alternative to traditional practice
  • Likely to continue growing rapidly

likosky@gmail.com