title: Community pediatric hospitalists providing care in the emergency department: an analysis of physician productivity and financial performance.
abstract: OBJECTIVE
  Community hospital pediatric inpatient programs are being threatened by current financial and demographic trends. We describe a model of care and report on the financial implications associated with combining emergency department (ED) and inpatient care of pediatric patients. We determine whether this type of model could generate sufficient revenue to support physician salaries for continuous in-house coverage in community hospitals.
  
  
  METHODS
  Financial productivity and selected performance indicators were obtained from a retrospective review of registration and billing records. Data were obtained from 2 community-based pediatric hospitalist programs, which are part of a single health system and included care delivered in the ED and inpatient settings during a 1-year period from July 1, 2008, to July 1, 2009.
  
  
  RESULTS
  Together, the combined programs were able to generate 6079 total relative value units and collections of $244,828 annually per full-time equivalent (FTE). Salary, benefits, and practice expenses totaled $235,674 per FTE. Thus, combined daily revenues exceeded expenses and provided 104% of physician salary, benefits, and practice expenses. However, 1 program generated a net profit of $329,715 ($40,706 per FTE), whereas the other recorded a loss of $207,969 ($39,994 per FTE). Emergency department throughput times and left-without-being-seen rates at both programs were comparable to national benchmarks.
  
  
  CONCLUSIONS
  Incorporating ED care into a pediatric hospitalist program can be an effective strategy to maintain the financial viability of pediatric services at community hospitals with low inpatient volumes that seek to provide 24-hour pediatric staffing.
authors: Department of Pediatrics, Johns Hopkins Bayview Medical Center, Baltimore, MD 21224, USA. rdudas@jhmi.edu
authors: Robert A
authors: RA
authors: Dudas
authors: David
authors: D
authors: Monroe
authors: Melissa
authors: M
authors: McColligan Borger
mesh_terms: D002648:Child; D059019:Clinical Coding; D003953:Diagnosis-Related Groups; D004526:Efficiency; D004636:Emergency Service, Hospital / Q000191:economics / Q000458:organization & administration* / Q000706:statistics & numerical data; D005249:Fees and Charges; D020445:Hospitalists / Q000191:economics / Q000706:statistics & numerical data; D006764:Hospitals, Community / Q000191:economics / Q000458:organization & administration*; D006785:Hospitals, University / Q000191:economics / Q000458:organization & administration; D006786:Hospitals, Urban / Q000191:economics / Q000458:organization & administration; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D007349:Insurance, Health, Reimbursement; D008396:Maryland; D008962:Models, Theoretical; D010343:Patient Admission / Q000191:economics / Q000706:statistics & numerical data; D010372:Pediatrics / Q000191:economics / Q000706:statistics & numerical data; D015397:Program Evaluation; D012051:Reimbursement Mechanisms; D012189:Retrospective Studies; D012456:Salaries and Fringe Benefits; D016526:Workload / Q000191:economics / Q000706:statistics & numerical data