From the Guidelines
Hospitalists can be incentivized through a balanced scorecard of metrics that directly tie to their annual bonus while improving patient outcomes, with a focus on clinical quality measures such as readmission rates, hospital-acquired condition rates, length of stay, and mortality rates, as recommended by recent studies 1. To achieve this, effective metrics should include:
- Clinical quality measures such as readmission rates within 30 days, hospital-acquired condition rates, length of stay compared to expected, and mortality rates
- Operational efficiency metrics that track documentation timeliness, discharge completion before noon, and appropriate utilization of resources like lab tests and imaging
- Patient experience scores from HCAHPS surveys to provide valuable feedback on communication quality and overall satisfaction
- Collaboration metrics to measure interdisciplinary team participation, consultation response times, and transitions of care quality
- Financial metrics that include cost per case and adherence to evidence-based protocols that reduce unnecessary expenses
For implementation, hospitals should establish clear baseline performance data, set achievable but challenging targets (typically 5-10% improvement annually), provide regular performance feedback through dashboards, and ensure metrics are risk-adjusted for patient complexity, as suggested by 1. This comprehensive approach creates alignment between hospitalist compensation and organizational goals while focusing on meaningful improvements in patient care rather than simply increasing patient volume. Additionally, research has shown that incorporating patient-reported outcomes and mortality rates into a composite measure can help ensure that focused methods to avoid readmissions also consider the effect on mortality and patient well-being 1. It is also important to consider the potential implications of alternative iterations of the Hospital Readmissions Reduction Program (HRRP), such as using a single all-cause readmissions and mortality metric, as discussed in 1. By prioritizing these metrics and considering the latest research, hospitalists can be incentivized to improve patient outcomes while achieving their annual bonus.
From the Research
Metrics for Incentivizing Hospitalists
To incentivize hospitalists to achieve their annual bonus and improve patient outcomes, the following metrics can be considered:
- Reduction in hospital-acquired sepsis cases, as identified in the study 2, which found that early recognition of sepsis and timely implementation of care bundles are challenging in older general medical patients
- Improvement in quality of care, as measured by pay-for-performance programs, which have been shown to have a small but positive impact on patient outcomes 3
- Decrease in hospital readmissions, which can be achieved through effective medication reconciliation at discharge, as highlighted in studies 4 and 5
- Enhancement of patient safety, which can be measured by reducing medication discrepancies at hospital discharge, as identified in studies 4 and 5
Patient Outcomes
Patient outcomes can be improved by:
- Implementing evidence-based care bundles for sepsis management, as suggested in the study 2
- Providing education programs for hospitalists on sepsis care standards, as recommended in the study 2
- Improving medication reconciliation processes at discharge, as highlighted in studies 4 and 5
- Encouraging hospitalists to follow best practices for heart failure and sepsis management, as outlined in the study 6
Quality of Care
Quality of care can be measured by:
- Tracking compliance with pay-for-performance programs, as described in the study 3
- Monitoring hospital-acquired condition rates, such as sepsis, as identified in the study 2
- Evaluating patient satisfaction scores, which can be influenced by the quality of care provided by hospitalists
- Assessing the effectiveness of medication reconciliation processes at discharge, as highlighted in studies 4 and 5