On-line Resource Center | Society of Hospital Medicine Practice Management

Hospitalist Co-Management with Surgeons and Specialists

The co-management of patients with surgeons and specialists has become a mainstay of the specialty of hospital medicine. Consider the following published data:

  • The 2005-2006 SHM survey indicated that 85% of hospital medicine groups did co-management
  • A recent article in the New England Journal (Kuo, et.al., 360:1102-12) indicated that the number of patients with Orthopedic DRGs seen by hospitalists alone increased by 47% between 2001-06

In basic terms, co-management can be defined as the "shared responsibility, authority and accountability for the care of a hospitalized patient." In the case of co-managed surgical patients, the patient's surgeon manages the surgery related treatments and a hospitalist manages the patient's medical conditions.

The definition of co-management varies from program to program and continues to evolve. While there are opportunities for hospitalists to add real value as co-managers of the surgical patient (e.g. in preventing DVT and pulmonary emboli or reducing post operative infections and other post-surgical complications), the implementation of co-management varies markedly from one hospital to another.

An article in the Journal of Hospital Medicine (Siegal) describes the pros and cons of implementing co-management programs and raises important questions for hospitalist leaders to consider.

In light of this evolving role for hospitalists, SHM chartered a Task Force to provide guidance and develop resources on co-management for the specialty. This web area is the product of contributions from members of the Task Force.

A Guide to Building a Co-Management Program: This document outlines five keys to a successful co-management program, including the need to identify obstacles and challenges and the need to clarify roles and responsibilities.

Co-Management Program Profiles: The members of the Task Force completed profiles describing their co-management programs.

Co-Management Service Agreements: SHM has assembled several documents prepared by hospital medicine groups defining the respective roles of the hospitalist and the surgeon/specialist in their co-management program. (NOTE: These documents represent samples and are not intended to be SHM recommendations or best practices.)

Co-Management Documentation, Coding, and Billing: SHM has asked a faculty member of its documentation/coding course to prepare guidelines on issues relevant to billing for co-management, specifically requirements for the Inpatient Consultation and the Global Surgical Fee.

NOTE: SHM has webinar on "Hot Topics in Evaluation and Management Coding for Hospitalists".