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Are Regulations Preventing Hospitalists From Reaching Their Full Potential?

How many patients should a hospitalist average on any given day?   What do you think?  The Hospitalist asked that question to hospitalists and  421 of them responded.  They were given responses in quintiles of 10 or fewer,  11-15, 16-20, 21-25, and more than 25 total patient encounters per day.

Go check out their results.  I’m not surprised.  But, as they say,  there is no right answer.  The right number is the number that brings WIN-WIN-WIN-WIN to the patient-doctor-hospital-insurance quadrangle.   WIN-WIN-WIN-WIN is possible.  It just takes a great understanding of removing the barriers to efficiency.  Efficiency and quality of care can move in the same direction.  They don’t have to be opposing forces.  You can be better and faster if given the tools, whether those tools are driven by IT support, systems process changes, communication enhancement, physical and structural hospital layout changes or documentation support tools.  There are many others. These are just a few.  Happy’s daily hospitalist rounds census has grown signifcantly over the years.  I feel it, but I don’t mind it.

We are seeing more patients with more complicated medical issues than ever before.  Does that mean we have to see fewer people to provide the same quality of work.  It does, if we are not in sync with the tools of our working environment.  I am excited about what we can accomplish when all sides are aligned with a common goal.  Often, I say I could see 25-30-35, even 40 patients a day if hospital rounds were structured in ways that aligned with common sense instead of government cents.  We practice medicine based on what is required not what is right.

We trade regulation for efficiency.  When I am forced to document based the assumption I am guilty until proven innocent if my bill does not support the requirements of an archaic and monstrous list of  CPT ® codes, I lose time that could be better spent seeing more patients.  Hopefully, someday, those paying the bills will understand that every regulation comes with economic sacrifice.  There are only 24 hours in a day.  There are unintended consequences and economic sacrifice to every regulatory action that must meet compliance.

What is your daily census?

*This blog post was originally published at The Happy Hospitalist*


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