at our institutions, dyad management is common. In general, the physician manages the physician side and the admin the staff side. Tactical and strategic decisions are shared and must be common to the two sides. Incentive pay which is about 30% shares the same outcome goals. This helps keep the two aligned. As has been mentioned, interpersonal chemistry and respect is a must.
Within the hospital, we have worked to increase communication between hospitalists and other providers. This involves collaboration on service agreements. Recently, we have worked on improving progress notes to make hospitalists ability to provide effective patient care easier. Our physicians lounge in the hospital remains a busy place with much interaction between inpatient physicians. Connection to the outpatient world is more difficult and the barriers may be increasing. Not sure this can be impacted.
We experienced a similar trajectory with employee prescriptions. As in your experience, we no longer provide this service. We also started a bedside delivery pharmacy service staffed by techs. We have been able to capture a higher percentage of discharge prescriptions in this way but the profitability of this service remains elusive. Our greatest success was in filling prescriptions from our 340B clinics in the hospital pharmacy. This strategy has been profitable
All complications carry added expense. Wound infections may cause readmission with need for reoperation. At a minimum outpatient antibiotics carry a cost. The same is true for readmission following medical or surgical procedures.
If your quality data shows low readmission, infection, return to the ED, etc, you should be able to make the point that you are saving the healthplan money post discharge even if the initial admission is somewhat more expensive.
Similar to your approach, we pay for call coverage only for physicians required by the trauma system. This list is found in the Washington administrative code book for us. This keeps the decision to pay objective and difficult to criticize as playing favorites. The logic is this is an added responsibility that the physician did not get to vote on. For others, call is part of physician work.
For the covered groups, we use the 50th percentile of MGMA to set the rate. A scoring system that relies on frequency of call, number of hospitals covered, number of admissions when on call, number of surgical cases when on call provides added refinement. This allows us to differentiate work loads among the various specialities.