SHM Converge Scientific Abstract ePoster Gallery-Improving Financial Sustainability of a Hospitalist-Run Medicine Procedure Service

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This document describes efforts to improve the financial sustainability of a hospitalist-run Medical Procedure Service (MPS) at a tertiary academic medical center. Hospitalist procedure services can shorten time to procedure, reduce length of stay, and decrease reliance on subspecialty consults, but they still face financial challenges.<br /><br />The project used a retrospective analysis of deidentified procedure volumes and billed charges from July 2019 to April 2022. The service implemented an iterative set of interventions focused on three main areas: increasing appropriate use and documentation of point-of-care ultrasound (POCUS) for procedure guidance, billing diagnostic POCUS exams when procedures were not indicated (“no fluid exams”), and adding new procedures such as tPA/Dornase administration for pleural drains.<br /><br />Key implementation strategies included improving access to ultrasound devices, strengthening POCUS training for both trainees and experienced clinicians, and making electronic medical record documentation and image upload more efficient.<br /><br />Results showed improved documentation of ultrasound guidance: 45% for paracentesis, 41% for thoracentesis, and 18% for pleural drain insertion. Financially, these changes led to more than a two-fold increase in annual charges for paracentesis and thoracentesis. Additional revenue was generated from diagnostic chest and abdominal POCUS exams, as well as tPA/Dornase administration.<br /><br />The authors conclude that simple, practical interventions targeting POCUS utilization, documentation, and expanded procedure offerings can significantly improve the profitability and sustainability of a hospitalist-run procedure service while also supporting patient care.

Asset Subtitle

Stephen A. Ferraro

Meta Tag

Author List Carolina Ortiz Lopez, Henry R. Kramer, Michelle Fleshner, Stephen A. Ferraro

Category Innovations

Concept Hospitalist-Run Procedure Service

Concept Medical Procedure

Concept Health System Sustainability

Concept Point-of-Care Ultrasound

Concept Efficiency

Distinguished Non-Finalist

Presenter Organization University of Colorado SOM

Presenting Author Stephen A. Ferraro

Track Quality Improvement

Keywords

hospitalist-run procedure service

financial sustainability

point-of-care ultrasound

POCUS documentation

procedure billing

paracentesis

thoracentesis

pleural drain

tPA/Dornase administration

academic medical center

Hospitalist-Run Procedure Service

Medical Procedure

Health System Sustainability

Point-of-Care Ultrasound

Efficiency