Hospitalist model work in progress

Healthcare executives are counting on the hospitalist model for efficiencies and quality outcomes, based on hospitalists' experience with acute care medicine and familiarity with the hospital setting. However, the model is still a work in progress, and some programs still lack the level of communication patients and PCPs expect.

Hospitalists are to inpatient care what PCPs are to office-based care. In essence, they focus on a patient's primary health issue during a hospital stay but do not supplant any specialists who deliver care to the patient. They eliminate the need for a traditional "on call" physician and often work in the more critical units.

Emergency rooms, critical care and hospitalists evolved because of the pressing need to do a better job of caring for the sickest patients, according to Ron Greeno, MD, chief medical officer and co-founder of Cogent Healthcare in Brentwood, Tenn.

Donald Liss, MD, regional medical director at Aetna, agrees.

However, the most obvious Achilles' heel is the potential for discontinuity of care, which can only be overcome by hard-wired communication between the hospitalist team and the primary care physician. That communication should occur, at a minimum, at admission and discharge, Dr. Greeno says.

Authors of the editorial, "The Growth of Hospitalists and the Changing Face of Primary Care," published in the March 12, 2009, issue of NEJM, acknowledge the benefits of hospitalists. However, they say, "their involvement disrupts the continuity of care provided by the patients' primary care physicians, resulting in potential adverse effects . . . Proactive strategies to enhance communication between hospitalists and primary care physicians and to efficiently transmit discharge summaries and updated medication lists can promote better care."

Physicians and hospitals regularly ask incoming hospitalist groups how they will maintain communication and continuity during a patient's stay, says Martin Buser, founding partner of Hospitalist Management Resources (HMR) LLC, a national hospitalist consulting firm in San Diego.

"About 40% of our consults are with programs that are in trouble," he says.