2020 State of Hospital Medicine Report

2020 Report based on 2019 Data Society of Hospital Medicine (SHM) Practice Analysis Committee 2019—2021 Committee Members

Andrew White, MD, FACP, SFHM Committee Chair Seattle, WA

Romil Chadha, MD, FACP, MPH, SFHM Lexington, KY

Leslie A. Flores, MHA, SFHM La Quinta, CA

Thomas Frederickson, MD, FACP, SFHM Omaha, NE

Sandra Gage, MD, PhD, FAAP, SFHM Phoenix, AZ

Bryan J. Huang, MD, FHM San Diego, CA

Ajay Kharbanda, MBA, ACMPE, SFHM Dallas, TX

Linda Kurian, MD, FACP, SFHM Garden City, NY

Mihir Patel, MD, FACP 2020 Keller, TX Isha Puri, MD, MPH, FHM Cambridge, MA

Paul Sandroni State of Rochester, NY Carolyn A. Sites, DO, FACP, FHM Portland, OR

Amanda Trask, MBA, MHA, FACHE, SFHM Hospital Englewood, CO

Khuong Vuong, MD, FHM Woodbury, MN Medicine Jerome Siy, MD, MHA, SFHM Board Liaison 2019–2021 St. Paul, MN

SHM Staff and Editors Report Joshua Lapps, MA Director of Policy and Practice Management

2020 Report Based on 2019 Data Luke Heisinger Practice Management Coordinator

Kimberly Schonberger Associate Director of Marketing

Stefania Uragano Senior Graphic Designer Important Notices This Report contains data derived from SHM’s State of Hospital Medicine Survey and MGMA’s Compensation and Production Survey. All Survey results and information obtained from statistical analysis of the results are the proprietary and confidential property of SHM and MGMA, as applicable. Purchasers of this Report are authorized to use the data only for their personal or internal business purposes.

Confidentiality Information provided by State of Hospital Medicine Survey respondents is held strictly confidential and ©2020 Society of Hospital Medicine. is reported only in aggregate form alongside data All rights reserved. submitted by the other respondents. Only SHM staff The Society of Hospital Medicine members see individual survey responses, which are owns all copyrights worldwide used solely to aggregate data and perform statistical in this publication. MGMA owns analyses. Results are published in summary form the copyright for data presented only, and table cells with a low number of responses in Section Six of this publication, were omitted to protect the identity of individual which have been presented survey respondents. with permission. No part of this publication may be reproduced, Intended Use republished, distributed, transmitted, This Report, and the information contained in it, is displayed publicly, modified or intended to educate readers about characteristics stored in any retrieval system, in and trends in the rapidly evolving specialty any form or by any means, graphic, of hospital medicine, including the range of electronic or mechanical, by productivity and compensation reported by Survey photocopying, scanning, recording respondents. These data may not be used for or otherwise, without the prior limiting competition, restraining trade, or reducing written permission of the Society of or stabilizing compensation or benefit levels. Neither Hospital Medicine. SHM nor MGMA render any legal, accounting or Please contact the Society professional advice that might be construed as of Hospital Medicine’s Practice applicable to specific situations. Management Department at [email protected] or Limitations of Survey Data 800-843-3360 for further This Report is based on voluntary survey responses information. provided primarily by members of SHM and MGMA. Requests for permission The data have not been independently validated and should be directed to may not be representative of all hospital medicine [email protected]. practices. Because the respondent pools for the SHM Society of Hospital Medicine State of Hospital Medicine Survey and the MGMA 1500 Spring Garden Street, Suite 501 Compensation and Production Survey are different, Philadelphia, PA 19130 and respondent pools vary from year to year within each survey, comparison of results between the SHM and MGMA surveys or conclusions about longitudinal trends or year-to-year fluctuations may not be accurate. © 2020 Society of Hospital Medicine. All rights reserved. rights All Medicine. Hospital of Society 2020 ©

© 2020 Society of Hospital Medicine. All rights reserved. (Tables 4.14a(Tables Benefits and Compensation Group-Level (Tables 4.8a Scheduling 4.7a —4.7f) (Tables Leadership (Tables4.3 Staffing (Tables 4.1 Services Clinical of Scope Only Patients Pediatric Serving Groups Medicine Hospital 4 SECTION (Tables 3.18a Finances Practice (Tables 3.17a - Groups Medicine Hospital Academic (Table 3.16) Billing CPT 3.14a(Tables —3.15b) Benefits and Compensation Group-Level (Tables 3.8a Scheduling 3.7a —3.7f) (Tables Leadership (Tables3.3 Staffing (Tables 3.1 Services Clinical of Scope Only Patients Adult Serving Groups Medicine Hospital 3 SECTION Profile Group Medicine Hospital 2 SECTION Overview and Summary Executive 1 SECTION A User’s Guide Statistical Interpretation — Report How This Use to Process Survey Introduction Table Contents of — 3.17b) 4.15b)

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vii v v 3.6) 4.6)

— — ii ii 3.13g) 4.13g)

iii iii

—

iv iv 3.18c)

2020 State of Hospital Medicine Report Medicine Hospital of 2020 State

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3.2) 4.2) viii

i i

106 146 127 119 25 95 18 80 90 91 36 89 26 96 49 59 9 4 3 2 1 (Tables 5.14a(Tables —5.15b) Benefits and Compensation Group-Level (Tables 5.8a Scheduling 5.7a —5.7f) (Tables Leadership (Tables 5.3 Staffing (Tables 5.1 Services Clinical of Scope Patients Pediatric and Adult Serving Groups Medicine Hospital 5 SECTION (Tables 4.18a Finances Practice 4.17a(Tables Groups Medicine Hospital Academic (Table 4.16) Billing CPT —6.5k) 6.5a (Tables (Med/Peds) Hospitalists Medicine/Pediatric Internal (Tables 6.4a Hospitalists Pediatric —6.3k) 6.3a (Tables Hospitalists FamilyAdult Medicine —6.2k) 6.2a (Tables Hospitalists Medicine Internal Adult 6.1a(Tables —6.1k) Non-Academic Hospitalists, Adult All and Production Compensation Hospitalist 6 SECTION (Tables 5.18a Finances Practice 5.17a(Tables —5.17d) Groups Medicine Hospital Academic (Table 5.16) Billing CPT (Tables 6.8a Hospitalists Pediatric Academic 6.7a —6.7j) (Tables Hospitalists Medicine Internal Academic Adult —6.6k) 6.6a (Tables Hospitalists (PA) Assistant (NP) Physician and Practitioner Nurse — — 6.8j) 4.17d)

— ix vii vii v 5.6)

vi vi

— ii 5.13g)

iii

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5.18c) 4.18c)

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6.4k)

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5.2) viii viii

Highest-Ranking

Total Compensation about

Information

Compensation (Table Retirement a), Benefits Demographic

Charges (Table c), Total Encounters (Table d), Work RVUs (Table Compensation e), to Total Encounters Ratio (Table f), Compensation to wRVUs Ratio (Table g), Collection to Total Encounters Ratio (Table Collection h), to wRVUs Ratio (Table i), wRVUs to Total Encounters Ratio (Table j) Non-Academic: (Table Collections b), for Professional Charges (Table c), Gross Charges (Table d), Total Encounters (Table Work e), RVUs (Table f), Compensation to Total Encounters Ratio (Table g), Compensation to wRVUs Ratio (Table Professional h), Charges to Total Encounters Ratio (Table i), Collections to wRVU (Table j), wRVUs to Total Encounters (Table k) Academic (Adult IM and Pediatric): (Table Collections a), for Professional Charges (Table Gross b), Finances includes:Practice Amount of Financial Support per FTE Employed Physician, Amount of Financial Support per FTE Provider (All Provider Amount Types), of Financial Support Per wRVU HMGs includes:Academic Amount of Financial Support per FTE for Non-Clinical Workin Academic HMGs, Distribution of Work HMGs, Academic in Requirements AppointmentsAcademic for at Affiliated Institution (Sections 4 and 5 only), Salary Increase Associated with Academic Promotion (Sections 4 and 5 only) includes: TotalLeadership Number of Physician Leaders, Total Dedicated FTE Allocation for All Physician Leaders, Ratio of Leadership FTE to Physician Hospitalists FTE, Highest-Ranking Physician Leader—Percentage of FTE Dedicated to Leadership, Highest-Ranking Physician Leader Percent Compensation Premium, LeaderPhysician Six contains provider-levelSection productivity and compensation data. Each subsection is arranged identically. Tables in each subsection of Section Six include: Pay Differential, Presence of Daytime Admitter Model, Utilization of Unit-Based Assignments includes: StaffingScheduling Back-Up Systems, Compensation for Back-Up Systems, Duration of Daytime Shifts, Duration of Evening/Swing Shifts, Duration of Night Shifts, Annual Number of Shifts or Work Periods for a Full-Time Hospitalist Physician, Number of Clinical Hours Required FTE for a 1.0 (Sections 4 and 5 only), Offering Paid Time Off, Unfilled Hospitalist Positions in Groups, Coverage for Unfilled Positions, Predominant Patterns, Scheduling Model, Coverage Night Predominant Presence of On-Site Night Coverage, Nocturnist Presence and Differentials, Percent Fewer Shifts in Nocturnist Schedule with a Differential, Percent Higher Compensation in Nocturnist with a Billing includes: BillingCPT Distribution of Common Hospital Medicine E&M CPT Code Clusters includes:Presence Staffing of Specialty Trained Physicians, Presence of and Billing for NPs/PAs, Non-Billable NP/PA Services, Percent of Time NP/PA on Non-Billable Services, FTE Staff per Group, Ratio of Support Staff per FTE Physician, Sources of New Physicians, Turnover, Percent of Physicians Who Are Part- Time Status (Sections 4 and 5 only), Percent of Physicians in Group Who Are Board Certified in PHM (Sections 4 and 5 only), Anticipated Change of Budgeted FTE in Next Year CompensationGroup-Level and Benefits includes: Components of Hospitalist Compensation, Use of Differentials for Years of Service, Use of Performance Incentive Measures in Compensation Plan, Value of Annual Employee Benefits, Annual CME Allotment per FTE Hospitalist Scope of Clinical Services Clinical of Scope Services includes: Routinely Provided HMG, Co-Management the Roles by v vi vii viii ix Tables in each subsection each in Tables i ii iii iv 226 225 223

2020 State2020 of Hospital Medicine Report

State of Hospital of Medicine State 2020 Survey Instrument APPENDIX C C APPENDIX APPENDIX B APPENDIX Analysis Methodology and Formulas Glossary APPENDIX A APPENDIX Section 1

Executive Summary and Overview 2020 State of Hospital Medicine Report Demographic Information of SoHM Respondents Data in the 2020 State of Hospital Medicine (SoHM) The growth in FTE physicians and the simultaneous Report reflect a snapshot of hospital medicine from decrease in the number of HMGs participating could 2019. Hospital Medicine Groups (HMGs) reported represent an unintentional oversampling of larger on a continuous 12-month set of data ending either HMGs. However, significant increases in the average on December 31, 2019 or at the end of their fiscal group size across all regions from 2018 suggest that year in 2019. HMGs are consolidating or growing, resulting in data While the number of HMGs responding to the 2020 that reflect this trend (Figure 1.2). The median group th SoHM Survey decreased slightly from 2018 to 2020, size, which indicates the response in the middle (50 the amount of FTE physicians represented has percentile) of respondents, also suggests a growth increased significantly (Figure 1.1). in group sizes, particularly for HMGs serving adults only, which make up the majority of respondents in Figure 1.1 the SoHM Survey (Figure 1.3).

Number of Respondents to SoHM Survey, Figure 1.3 by Year Median HMG Size (FTE Physicians), by Year and Patient Type

Figure 1.2 Average Growth of HMG Size from 2018 to 2020, by Region

+76% +19% East West +47% Midwest

Section One: Executive Summary and Overview 10 © 2020 Society of Hospital Medicine. All rights reserved. Section 1: Section Respondents of Model Ownership/Employment 1.5 Figure medicine. hospital of field the across mix employment current the of representation accurate arelatively is this we believe the in participate to able or inclined less or more may be types 1.5). practice some While (Figure system delivery or integrated system health by ahospital, employed were HMGs respondent of half than more alittle years, previous in As Types Patient Seen of 1.4 Figure 1.4). (Figure respondents of majority the comprise to “Adult as to continue HMG”) (also referred patients adult serving HMGs although HMG”), “Pediatric as to (also referred only patients pediatric serve that 2018 from HMGs of number the increase in threefold anearly showed also participation 2020 Survey Executive Summary and Overview and Summary Executive 2020 State of Hospital Medicine Report Medicine Hospital of 2020 State SoHM

Survey, 1.7 Figure Regional Breakdown Respondents of 1.6 Figure 1.8). (Figure 1.7) (Figure Status Academic Served and Region (Figureincluding 1.6), Hospitals of Number 2018 the to compared stable were Several demographic characteristics other Academic of Respondents Status 1.8 Figure by Respondents Served Hospitals of Number SoHM

respondent pool, respondent 11