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Effect on Physician Productivity and Financial Performance

Joel S. Tieder, MD, MPH; Darren S. Migita, MD; Charles A. Cowan, MD; Sanford M. Melzer, MD, MBA

Arch Pediatr Adolesc Med. 2008;162(1):74-78.

Objective  To describe financial outcomes and physician productivity associated with the inclusion of well-newborn services in a pediatric hospitalist program in a community hospital.

Design  Retrospective review of professional billing records and physician activity logs for newborn and inpatient care, consultations, and procedures.

Setting  Pediatric hospitalist program in a community hospital during a 24-month period from August 1, 2002, through July 31, 2004.

Main Exposures  Newborn care.

Main Outcome Measures  Financial productivity.

Results  Pediatric hospitalists provided daily rounds and on-call services for inpatients and newborns with an average daily census of 3.1 inpatients and 7.9 newborns. Annual work relative value units production was 1508, and gross charges were $162 920 per staffed full-time equivalent. With mean work relative value unit production of 13.8 relative value units per day and average payment rates of $45 per total relative value unit, professional fees from inpatient and newborn care ($873 per day) did not cover salary, benefit, and practice expenses ($1460 per day), necessitating hospital support to cover annual program deficits of $206 744. Without the professional fees derived from newborn care, annual program deficits would have been $345 100, or $95 861 per staffed full-time equivalent.

Conclusions  Community hospital pediatric hospitalist programs with dedicated 24-hour staffing and a low inpatient census can be expected to operate at a substantial financial deficit if hospitalist care is limited to inpatient care and procedures. Financial performance of these programs may be improved by expanding the role of the pediatric hospitalist to include newborn care.

Author Affiliations: Department of Pediatrics, Children's Hospital and Regional Medical Center, University of Washington School of Medicine, Seattle.