Positive clinical and financial outcomes of patient-management accountable metrics contract among hospitalists

Abstract

Background: Studies have shown positive outcomes for patients treated by hospitalists, however, the impact of Patientmanagement Accountable Metrics (PAM) contract among hospitalists on financial and clinical outcomes is unclear. This study intends to determine the impact of PAM contract among hospitalists on these outcomes.
Methods: This retrospective cohort study conducted in a 7-hospital health system in southeast U.S. region included 93,037 adult inpatients treated by 264 hospitalists and discharged in 2018. It measures the impact of PAM contract among hospitalists on total cost, variable cost, contribution margin, length of stay (LOS), 30-day readmission and mortality per inpatient discharge. Univariate and multivariable regression analysis were used for measuring outcomes.
Results: When compared with non- PAM contracted hospitalists, PAM contracted hospitalists were estimated per case to have $437 ([95% CI: $326 to $548]) lower in total cost, $123 ([95% CI: $73 to $173]) lower in variable cost, $361 ([95% CI: $241 to $481]) higher in contribution margin, 0.37 days ([95% CI: 0.33 to 0.42]) shorter in LOS, and lower 30-day readmissions probability with an odds ratio of 0.82, ([95% CI: 0.79 to 0.86]). The impact of PAM contractual status was not significant on mortality rates. Study hospital system projected $17 million annual cost reduction, $14 million contribution margin and 14,000 patient days savings if all hospitalists were PAM contracted.
Conclusions: This study indicates that PAM contract had positive financial and clinical impact among hospitalists. These findings may help hospitals improve clinical outcomes while reducing costs and improve margin.