Control healthcare costs with effective use of hospitalists

November 1, 2007

An effective use of hospitalists is to have them available to free up general practitioners from hospital rounds. Appropriate use of hospitalists can also enable physicians to visit patients more than once a day in the hospital setting.

An effective use of hospitalists is to have them available to free up general practitioners from hospital rounds. Appropriate use of hospitalists can also enable physicians to visit patients more than once a day in the hospital setting.

According to the Society for Hospital Medicine, beginning in the mid-1970s, general practitioners started to become hospital satellites, with an average of 10 patients in the hospital at any given time, each one admitted for 8 to 10 days. This meant that doctors started to spend 30% to 40% of each day visiting hospital patients in addition to their administrative demands.

Currently, effective palliative hospital visits are nearly impossible for GPs, who may check in only in extreme emergencies. Such fractured care has given hospitals a bad reputation, leading to little-or-no preventive or outpatient care, as GPs have been forced to work round-the-clock only to provide the bare minimum.

Freeing GPs to focus completely on their office practice offers the following benefits: it frees up GPs from having to deal with hospital billing systems, it frees them to see patients at their discretion, and it allows them to focus on preventive care, establishing a relationship with patients that is not purely based on emergency and acute care.

Hospitalists were first adopted as an emergency measure – hospital internists who could make the hospital administration happy while still trying to provide the best possible care to patients. However, while there were only 1,000 hospitalists in the mid-1990s, by 2004 the number swelled to 13,000, with more than 63% of hospitals with more than 200 beds retaining hospitalists, and 59% of teaching hospitals using the discipline.

Hospitalists consistently have been cost-effective. Hospitalists have no office and work completely out of the hospital. Hospitalists also have a vested interest in making sure that a hospital is operating at peak performance and efficiency.

Statistics

According to a study by the Mayo Clinic, 61% of patients co-managed by hospitalists and orthopedic surgeons were discharged with no complications. Without hospitalists, 51.2% had complications when discharged. Hospitalists are able to use their knowledge of the hospital's capabilities, staff, and problems to treat patients with maximum available care. They are patient's advocates – shepherding them through the hospital with real expertise, alleviating worries and providing a consistent face for the hospital.

Hospitalists can be especially effective in improving care for the indigent and elderly. Since there is no money in treating the uninsured, hospitals have found it difficult to find physicians willing to treat these patients who come to the hospital in dire emergencies and need critical care as a life-or-death proposition.

According to the Congressional Budget Office, Medicare spent approximately $22.6 billion on patients treated by hospitalists, which represents approximately 20% of all Medicare discharges. The Society for Hospital Medicine projects that the number will increase to 43% by 2010.

Hospitalists reduce re-admission rates of Medicare patients, and may reduce Medicare costs in the long run by ensuring hospitals take full advantage of their facilities. Hospitalists provide consistent care to these patients, ensuring that even the poorest and most chronically ill have a safety net.

Humanizing medicine

Hospitalists become leaders in a hospital setting, leading committees and problem-solving efforts to constantly improve a hospital's quality of care and eliminate chronic problems for the GP. Hospitalist physicians are able to embed in the culture of the facilities they work in, and to navigate with ease the complex environments that can perplex specialists.

In numerous studies, they have proven to be an optimum way to improve quality measures, to implement National Quality Forum goals as a value added benefit to their practice, and as a team player for the hospitals in which they work.

Successful hospitalists bring excellent communication skills and clinical expertise to the halls and bedsides of the hospital, driving improved patient outcomes, and enhancing bottom lines.

Dr. Chris Nussbaum, CEO and founder of Synergy Medical Group, P.A., established and developed an independent hospitalist group in the Tampa Bay area.