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Emergency Medicine and Hospitalist Services: To Outsource or Bring In House?

Matt Davis | Guest Blog Post Series, Healthcare Administrators, Healthcare Information, Physician Recruiting, Physicians

Guest Blog Post Series #6

With the physician shortage, hospitals across the country are developing strategies to help overcome their staffing shortages. 

One specific area where this shortage can be felt on a day to day basis is with Emergency Medicine and Hospitalist services lines. 

Organizations have found it necessary to supplement staffing and coverage shortages with expensive locum or contract providers.  In more rural locations Emergency Medicine and Hospitalist services have largely been covered by third-party contract services. 

Fully integrating emergency medicine and hospitalist services by employing instead of contracting these physicians on a full-time basis is one strategy some facilities have implemented, but far more are still debating. 

There are many factors hospitals must weigh when making these decisions. 

For today’s Guest Blog we’ve asked Brenda Palmore, Vice President of Practice Management & Business Development for VCU Health Community Memorial Hospital in South Hill, VA to weigh in on this topic.

Our Conversation with Brenda

AMP:  Brenda, over the last few years, VCU – CMH made the decision to transition their hospitalist program from a third party contracted service to fully integrated hospital employees. 

What was the motivation behind VCU-CMH making this decision?

Brenda:  In 2010 things changed drastically and quickly in terms of inpatient care.  We had a group of different private practices in our community that cared for and rounded on the inpatients. 

Within a 90-day window, one practice closed, one solo provider passed away, and a group with six providers gave notice that they no longer wished to care for inpatients. 

Within 90 days the hospital was forced to start a hospitalist program. 

We contracted with Eagle Physicians and began the journey.  Eagle managed the program and provided physicians to cover.  After two years with Eagle, we transitioned to Sound Physicians with the goal of having an onsite medical director presence.

After two years with Sound, we made the decision to bring the program in-house for several reasons. 

  1. Expense
  2. Need for a constant team of providers providing continuity of care
  3. Having control of our program and the quality of care we wanted

Lastly, consistent onsite leadership was needed daily. 

AMP:  What were the questions that needed answering before deciding to move forward?

Brenda:  Obviously cost of the program, coverage, leadership, patient satisfaction, and continuity of care were all concerns.  Recruitment and the ability to fill the open positions was a concern.  However, within the first six months, we successfully filled 50% of the positions.

AMP:  What were some of the challenges you faced during the transition?

Brenda:  A constant flow of locums and constantly credentialing someone that may only work for one week or two and never return.  Getting the locums to provide patient satisfaction and work as a team was a challenge.   Not having a medical director present on site to handle day to day issues were frustrating for everyone.

AMP:  Did integrating those services benefit VCU-CMH and produce the outcomes your organization expected?

Brenda:  Yes – within 1 year a perm team was recruited however it took 4 years to secure a perm medical director.  Several providers attempted in an interim role; however, due to the demands, they quickly stepped down.

AMP:  Once the process was complete were there any surprise benefits you were not anticipating?  

Brenda:  Providers seemed less stress and burned out because they were no longer trying to juggle hospital and office work.  Patients caught on to the concept rather quickly which was shocking in a small rural area. 

AMP:  As you look back at the process, what did you learn and what advice would you share with another facility considering a similar transition?

Brenda:  The leader is the most critical position; however, it was our last position to fill.  The volume required adjustments to the program in year two to include two physicians and one APP (Advanced Practice Providers).  Today we have two teams on day shift with a physician and APP on each team, and we have one physician that handles are admissions and ED calls.  We started with shifts being 7 to 7 but changed to 6 to 6 because all hospital departments seemed to be changing at 7 (Lab, ED, Nursing, etc.).  We still struggle with discharge orders being entered by 10 AM.  Our goal is 50%, however, we are around 24%.  We still struggle with HCAPS scores in reference to physician communication with the patient and family.

AMP: Thank you, Brenda,for sharing this journey with us and what you and your team learned from this experience.

Brenda T. Palmore, DHA, FACMPE, FASPR – Bio

Brenda Palmore was born at Community Memorial Hospital and raised in the area. She has been employed with CMH since 1999. Dr. Palmore has a Bachelor of Science in Business Admin with a concentration in Management from Longwood and a Master of Business Admin from Averett University. She received her Doctorate of Health Care Administration and Leadership from the Medical University of South Carolina.

Dr. Palmore is a Fellow of the American College of Medical Practice Executives and a Fellow of the Association of Staff Physician Recruiters (FASPR).  Additionally, she earned Lean Six Sigma Certification, Yellow Belt.