Mixing It Up: Operational Impact of Hospitalist Caseload and Case-mix

Management Science

63 Pages Posted: 13 Oct 2019 Last revised: 7 Jan 2022

See all articles by Masoud Kamalahmadi

Masoud Kamalahmadi

Miami Herbert Business School, University of Miami; Miami Herbert Business School, University of Miami

Kurt Bretthauer

Indiana University - Kelley School of Business - Department of Operation & Decision Technologies

Jonathan Helm

Indiana University - Kelley School of Business - Department of Operation & Decision Technologies

Alex Mills

Baruch College Zicklin School of Business

Edwin Coe

affiliation not provided to SSRN

Alisa Judy-Malcolm

affiliation not provided to SSRN

Areeba Kara

affiliation not provided to SSRN

Julian Pan

Lean Care Solutions Corporation Pte. Ltd

Date Written: January 4, 2021

Abstract

Hospitalists are medical doctors that specialize in the care of hospitalized patients, a role that until recently belonged to primary care physicians. We develop an operational model of hospitalist-patient interactions with rounding and responding service modes, optimizing hospitalist caseload and case-mix to achieve the maximal reduction in patient length of stay (LOS). We show that hospitalists are effective at reducing LOS for patients with complex conditions, corroborating intuitive reasoning. However, the optimal hospitalist case-mix also includes "simple" patients with few interventions and short LOS, as they can effectively reduce discharge delays. This actionable insight is particularly salient for small community hospitals with simple, short-stay patients, where hospitalists may be undervalued due to the prevailing belief that they are primarily effective for complex patients. We conduct a comparative case study of a small community hospital and a large academic hospital, drawing a stark contrast between the two in terms of ideal caseload and patient coverage. Despite the fact that the academic hospital treats higher complexity patients, hospitalists at the community hospital should actually have a lower caseload than hospitalists at the academic hospital due to shorter stays in the community hospital. We find that both hospitals are understaffed but for different reasons: the academic hospital needs to staff more hospitalists to reduce the current caseload of its hospitalists, whereas the community hospital needs to staff more hospitalists to expand its hospitalist coverage to more patients. We estimate that these hospitals can save on average $1.5 million annually by implementing the optimal staffing policies.

Keywords: healthcare operations management; hospitalist workload; case-mix; length of stay

Suggested Citation

Kamalahmadi, Masoud and Bretthauer, Kurt and Helm, Jonathan and Mills, Alex and Coe, Edwin and Judy-Malcolm, Alisa and Kara, Areeba and Pan, Julian, Mixing It Up: Operational Impact of Hospitalist Caseload and Case-mix (January 4, 2021). Management Science, Available at SSRN: https://ssrn.com/abstract=3456882 or http://dx.doi.org/10.2139/ssrn.3456882

Masoud Kamalahmadi (Contact Author)

Miami Herbert Business School, University of Miami ( email )

5250 University Dr
KE 308
Coral Gables, FL 33146
United States

HOME PAGE: http://www.masoudkamalahmadi.com

Miami Herbert Business School, University of Miami ( email )

5250 University Dr
KE 308
Coral Gables, FL 33146
United States

HOME PAGE: http://www.masoudkamalahmadi.com

Kurt Bretthauer

Indiana University - Kelley School of Business - Department of Operation & Decision Technologies ( email )

Business 670
1309 E. Tenth Street
Bloomington, IN 47401
United States

Jonathan Helm

Indiana University - Kelley School of Business - Department of Operation & Decision Technologies ( email )

Business 670
1309 E. Tenth Street
Bloomington, IN 47401
United States

Alex Mills

Baruch College Zicklin School of Business ( email )

55 Lexington Ave
New York, NY 10010
United States

Edwin Coe

affiliation not provided to SSRN

Alisa Judy-Malcolm

affiliation not provided to SSRN

Areeba Kara

affiliation not provided to SSRN

Julian Pan

Lean Care Solutions Corporation Pte. Ltd ( email )

Singapore

Do you have negative results from your research you’d like to share?

Paper statistics

Downloads
381
Abstract Views
1,832
Rank
143,746
PlumX Metrics