Hospitalist programs in the age of healthcare reform.

a s hospital leaders position for healthcare reform, they are bombarded with seminars, e-mails, and articles about how to prepare for the coming onslaught of changes. Those who have prepared their organizations for the changes will survive the deep cuts in reimbursement that include payment shifts from volume to value, growing interest in bundled payment, and an increasing focus on accountable care. Hospitals’ primary problem will shift from the many uninsured patients to the lack of beds and too few physicians. Pressure to produce low-cost, high-quality care will increase. Under the new legislation, hospitals will be penalized for readmissions, medical errors, hospital-acquired infections, and inefficient operating systems. The leaders who thrive will be those with capacity for integrating with physicians, skills in costing and pricing new bundles of services, propensity toward value, ability to manage risk, and willingness to reengineer the clinical process. To cope with the changes that come with reform, common strategies that have worked in the past will resurface, including expense containment, staffing productivity, effective management of service lines, redesign of the care process, closer alignment of physician practices, and, as I will focus on for the remainder of this column, enhancement of the hospitalist program.