Building a Hospice and Palliative Medicine (HPM) Medical Staff

A former colleague with many years of hospital executive experience recently accepted a position as the chief executive of a mid-sized, not-for-profit hospice (115 ADC). Upon review of employee staffing, she noticed that the hospice had half-dozen "arrangements" with physicians (with varying commitments but all under 15 hours per week) to provide largely unspecified clinical and administrative services. She asked if medical staff planning customary in hospitals had applicability and relevance for hospices. Of course, I replied, the "planning process" has great relevance, although there are several differences in scope and scale.

To prepare a Hospice Medical Staff Development Plan, we follow a systematic five-step process:
Step1 – analyze HPM professional fee billings and Activity/Effort reports and job descriptions for physician roles,
Step2 – conduct interviews with key stakeholders (including all physicians practicing HPM in any capacity and commitment),
Step3- compile Hospital and Community Palliative Performance Profiles using Dartmouth Medical Atlas,
Step4 – review Hospice strategic plan and contracts/agreements between the Hospice and physicians,
Step5 – using Responsibility Charting process, define professional expectations, metrics, and accountability.

Through this five-step process, we gain insights that address the most common questions posed by hospice executives (administrators and physicians) about medical staff development: To what extent may nonphysician providers be used to meet additional clinical demands?When will additional physician staff be needed, and what are the anticipated time requirements to recruit these individuals?When should recruitment occur given practice ramp-up time and total recruitment budgets?Are there sufficient resources and the political will to build a hospice-sponsored HPM physician group?In what communities and health provider sites do we place physicians to meet our organization’s strategic objectives?

Are there other questions regarding building of a medical staff on your minds? I invite your comments on what challenges each of you face in building a hospice medical staff?