Last week, I gave my glowing opinion of doing my hospital rounding using my iPhone application. It was quite a hospitalist efficiency booster. I was able to round on 16 people and discharge 13 of them in less than four and a half hours. These patients were all known to me, so I wasn't sure how much time I saved by using my iPhone. Yesterday, I picked up a new service entirely. But I also had my iPad up and running for the first time for my daily rounds. How did I do rounding on a new service of 14 patients I had never met before? I was able to complete my Saturday rounds on 14 patients in four hours and twenty minutes flat and I got out in time to see hang out with grandma!
That's 260 minutes to round on 14 patients. That's an average of 18 minutes and 30 seconds per patient, including all dictations, medication reconciliation on discharge as well as travel and down time between patients. And what did my billing charges consist of for the day? Seven CPT 99238 less than 30 minute discharges, 3 level two hospital follow-ups CPT 99232 and four level three high level hospital follow-ups CPT 99233.
In my state, Medicare pays about $65 for a 99238, $68 for a 99232 and $97 for a 99233. If you add up all my charges, if I had an all Medicare service, I would collect $1,047 for 260 minutes of work, or $241 an hour in revenue.
On an annualized basis, if that was sustainable, that would generate $480,000 in revenue per hospitalist on a 2000 hour per year work year. That's a lot more than the average hourly earnings for primary care. We don't have a doctor shortage in this country. We have a failure of information technology to present valuable patient information to physicians in a manner that blends well with their work flow.
The future of the delivery of medicine lies in technologies that allow the physician to rapidly expand their volume of care while optimizing patient safety. Hospitals that fail to recognize the importance of technologies to standardize many systems process and improve the efficiency in the delivery of care under bundled payment programs are going to suffer greatly when Medicare starts demanding their money back.
These are exciting times and I'm glad I have my first generation iPad to play along. It's only going to get better, faster. Five years ago, none of this would have seemed possible. Five years from now, I'm going to look back and laugh at how we used to do things. That's a good thing if you ask me.
UPDATE: It's January 2013 and I'm currently rounding with an iPhone 5 and a mini iPad. Still loving it!