尽管成本上升，心脏病专家短缺, cardiovascular (CV) programs remain among the top revenue-producing services in US acute care hospitals. And while there is a noticeable trend of migrating elective CV procedures to the outpatient (OP) setting, 急诊科(ED)仍然是一个 主接入点 医院偶遇.
与 more than 85% of the US population having access to a local or regional emergency STEMI system of care, an annual estimated 500,000 ED visits are dispositioned directly to a cardiac cath lab. 因此, addressing the challenge of sustaining cardiology call coverage remains a top priority for CV service line leaders across the country.
电话覆盖的发展趋势
General and interventional cardiologists often have 24/7 on-call coverage requirements, 以及一些高度专业化的项目, demand for call coverage is expanding to include electrophysiology (EP) and heart failure cardiologists. At the same time, workforce constraints are making it difficult to sustain adequate coverage:
- 目前，超过60%的在职心脏病专家年龄超过55岁, 而且，许多年长的心脏病专家不愿承担必要的电话费用.
- The US is not graduating enough net-new cardiologists to fill the gap for any level of access, 更不用说电话覆盖了.
- A growing number of cardiologists are pursuing subspecialty fellowships and entering practice with an expectation of providing very limited call, 给将军施加越来越大的压力, 非介入性心脏病专家提供足够的覆盖面.
在心脏病学领域，为随叫随到的云顶集团付费并不是一个新概念, 历史上，它仅限于介入心脏病专家. 然而, 因为普通心脏病专家的数量减少了, many organizations are extending compensation to these providers to incentivize them to cover call. 面对当前的财政压力, 云顶集团部门的领导必须寻找创造性的解决方案来维持呼叫覆盖率.
Below are three foundational strategies CV program leaders can use to better manage cardiology call coverage over the longer term.
策略一:积极进行劳动力计划
心脏病云顶集团40011官网的短缺预计将在未来五年内持续, 至关重要的是，提供商组织应保持全面的, 多学科, 三到五年的劳动力计划. Executive leadership should collaborate with physician leaders to plan for service line succession, 在现有项目中预计的数量增长, 以及未来的项目发展.
专门针对心脏病学, 我们预计将继续向专业化方向发展, meaning it will be important to develop guiding principles and objective criteria for how call will be managed for both general and subspecialty services. 例如, 在什么情况下有必要为调用实现专用EP, 一般的呼叫需要如何回复?
策略二:设计当代薪酬模式
因为总是会有心脏病学的需求, 大多数云顶集团40011官网选择为这一覆盖支付费用, 即使历史上没有.
适用于私人和雇佣团体, there is often a standard expectation of call coverage built into cardiologists’ base compensation, 额外支付超出保险范围的费用. 除了满足法规和法律要求, a contemporary compensation model should be designed as follows to effectively manage CV service line call coverage expectations:
- Acknowledges call burden and sets clear expectations for responsibility and citizenship in covering call
- Clearly articulates the value of the total compensation package, inclusive of call coverage
- Embeds call requirements for every subspecialty in the overall compensation plan and establishes formal criteria to consider excess or specialty call coverage not already defined
- Includes thresholds, guidelines, and processes to manage growth (or contraction) in call needs
- Outlines procedural requirements and financial consequences for reducing call or leaving the call service altogether
CV领导者希望最大限度地利用现有的云顶集团40011官网资源, 要么通过合同规定，要么通过医务人员章程规定, 在产生额外随叫随到云顶集团的费用之前.
战略三:探索创新运营模式
To help mitigate the burden of general cardiology call, we will need new ideas and strategies. 下面是几个可能提供解决方案的操作模型. They can be tailored and/or mixed and matched to account for specific market characteristics and workforce supply issues.
呼叫、咨询和轮询小组
组织可以实现共享护理模型, 由普通心脏病专家组成的轮转医疗团队, CV subspecialists with heavy call demand (traditionally interventional cardiologists), 和应用程序分担呼叫负担. 当小组每周轮换时，可以实现最佳的护理连续性, 这个模型支持效率, 改进的通信, 对于心脏病学团队和转诊云顶集团40011官网来说，这是一个高水平的可预测性. The number of physicians and APPs should be based on the average daily demand for inpatient consults and follow-up visits. 在放电, 病人回到他们原来的心脏科云顶集团40011官网或, 如果他们没有的话, 成为住院心脏病专家小组的一员.
“第一响应者”覆盖范围
Call responsibilities are assigned to a hospitalist or APP whose primary job is to cover call. 急救人员对病人进行评估, 执行历史记录和物理检查, and order initial diagnostics with the goal of ensuring the patient is seen promptly to avoid care delays and then assigned to the most appropriate cardiology subspecialty service.
心脏病住院医师或夜行医师计划
This is a dedicated team of providers acting as full-time hospitalists and/or nocturnists for cardiology services. 团队成员可能包括心脏病专家, 内科云顶集团40011官网, or PCPs with both interest and skill in the management of hospitalized cardiology patients and observation patients with suspected cardiac issues, 以及应用程序. 支持协作, 沟通, 护理协调, 这些团队是心脏病学小组的理想成员.
APP首次呼叫夜间覆盖
APPs may be assigned to handle the first call after hours for issues that can be managed by phone via established care pathways. 如果有必要的话，这个小组会有心脏病专家的支持, this option offers a safe and effective way to minimize the impact of after-hours calls on cardiologists.
Telecardiology
Managing call remotely may be possible via telehealth technology that allows providers to examine the patient and access diagnostic tests and imaging.
修改工作
尽管近年来不太常见, some organizations offer modified post-调用时间表 to mitigate the physical demand of high-volume call. 就像任何日程调整一样, 需要仔细规划，以确保诊所访问不中断或减少.
兼职族
兼职族 are often fellows who are completing their fellowship training nearby and provide part-time support, 比如晚上和周末的报道, 以帮助减少对心脏病专家的电话需求.
慢下来的高级介入心脏病专家
These cardiologists may be willing to accept a set schedule of general cardiology call to limit the overall burden for their colleagues.
当小心至关重要时，安全呼叫也同样重要
随着美国心血管疾病的发病率持续上升, CV云顶集团仍将是医院和云顶集团40011官网的基础项目, 使这些组织确保可持续发展至关重要, 有效的电话覆盖安排. 通过使用这里概述的一些策略, 你可以确保你的病人继续得到他们需要的重症监护.
云顶集团的团队
If you need assistance in your program or you would simply like more information about call coverage arrangements, 调用时间表, 通话覆盖补偿, 或公平市场价值云顶集团, we have a team of dedicated professionals who focus on cardiology and call coverage arrangements who can help. 进一步了解我们的 简历云顶集团团队.
编辑: 艾米丽约翰逊
2023年9月1日出版
