Having managed the patient throughout his hospital stay, the hospitalist — again working together with a multidisciplinary team —can facilitate arrangements to send the patient home or to a rehabilitation or skilled nursing facility or alternative housing situation upon discharge, as well as coordinating post-discharge care, whether it be arranging for a visiting nursing or social services or communicating with the primary care physician regarding follow-up appointments. If additional outpatient care is prescribed, the hospitalist will work with the discharge planning staff to contact various community agencies to arrange services best suited to the patient’s needs. Efficient discharge makes possible the admission of other, more critically ill patients, potentially enhancing the hospital’s revenue stream.
Five specific stakeholders need to be examined to document the value-added by hospitalists. Anecdotal evidence, as well as documented studies, has demonstrated numerous returns—physical, social, psychological and financial—to stakeholders involved in the hospital process. With regard to throughput, the hospitalist provides benefits to each of the stakeholders listed in Table 1.
A dozen studies have been conducted that document the impact of hospital medicine programs on cost and clinical outcomes. Of these trials, nine found a significant decrease in the average length of stay (15%) as well as reductions in cost (9). Two other studies, one from an academic medical center and the other from a community teaching hospital, demonstrate similar reductions during a 2-year follow-up period. At the Western Penn Hospital, a 54% reduction in readmissions was reported with a 12% decrease in hospital costs, while the average LOS was 17% shorter. Additionally, an unpublished study from the University of California, San Francisco Medical Center revealed a consistent 10-15% decline in cost and length of stay between hospitalists and non-hospitalist teaching faculty. More important, those differences remained stable through 6 years of follow-up. In general, hospitals with hospitalist programs realized a 5-39% decrease in costs and a shortened average LOS of 7-25% (6).
According to Robert M. Wachter, author of the 2002 study, “If the average U.S. hospitalist cares for 600 inpatients each year and generates a 10% savings over the average medical inpatient cost of $8,000, the nation’s 4500 hospitalists save approximately $2.2 billion per year while potentially improving quality” (6).
In a study conducted by Douglas Gregory, Walter Baigelman, and Ira B. Wilson, hospitalists at Tufts-New England Medical Center in Boston, MA were found to substantially improve throughput with high baseline occupancy levels. Compared with a control group, the hospitalist group reduced LOS from 3.45 days to 2.19 days (p<.001). Additionally, the total cost of hospital admission decreased from $2,332 to $1,775 (p<.001) when hospitalists were involved. According to the study authors, improved throughput generated an incremental 266 patients per year with a related incremental hospital profitability of $1.3 million with the use of hospitalists (7).
As hospital administrators attempt to address the issue of expeditiously admitting, treating and discharging patients in these days of restricted budgets and increased demand, hospitalist programs are poised as an invaluable factor in the throughput process.
Dr. Cawley can be contacted at [email protected].
- Hospital Statistics: the comprehensive reference source for analysis and comparison of hospital trends. Published annually by Health Forum, an affiliate of the American Hospital Association.
- National and local impact of long-term demographic change on inpatient acute care. 2001. Solucient, LLC.
- Zibulewsky J. The Emergency Medical Treatment and Active Labor Act (EMTALA): what it is and what it means for physicians. Baylor University Medical Center (BUMC) Proceedings. 2001;14:339-46.
- Wachter RM, Goldman L. The emerging role of “hospitalists” in the American health care system. N Eng J Med. 1996;335:514-7.
- Heffner JE. Executive medical director, Medical University of South Carolina (MUSC). Personal interview. June 24, 2004.
- Whitcomb WF. Director, Mercy Inpatient Medicine Service, Mercy Medical Center, Springfield, MA.
- Gregory D, Baigelman W, Wilson IB. Hospital economics of the hospitalist. Health Serv Res. 2003;38:905-18.
- Huddleston JM, Long KH, Naessens JM, et al. Medical and surgical co-management after elective hip and knee arthroplasty: a randomized, controlled trial. Ann Intern Med. 2004;141:28-38.
- Wachter RM. The evolution of the hospitalist model in the United States. Med Clin North Am. 2002;86:687-706.