Question: We work with a large orthopedic group. We would like to propose a more formal structure to this. We are interested in building business and partnerships. Do you know of any articles or references to support hospitalists doing this, or any sources to show the orthopedic group we can and would improve outcomes and their work life and workload?
Julie Lepzinski, director,
hospitalist medicine group,
Dr. Hospitalist responds: I commend you and your hospitalist group for taking the initiative to develop a relationship with your orthopedics colleagues. Many hospitalist groups are exploring such relationships with not only orthopedists but also with other surgical and medical subspecialists.
As you mentioned, the opportunity exists to improve your group’s income and improve orthopedist work life. More importantly, there is a real opportunity to improve the medical care of patients admitted to the hospital primarily with orthopedic problems.
There are published data from an academic medical center on a hospitalist-orthopedics co-management model. Huddleston, et al., studied the effect of such a co-management model on the care of patients after elective hip and knee arthroplasty at the Mayo Clinic.1 They found that “the co-management medical hospitalist-orthopedic team model reduced minor postoperative complication rates with no statistically significant difference in length of stay or cost. The nurses and surgeons strongly preferred the co-management hospitalist model.”
This study would seem to support your notion that orthopedists may prefer the involvement of hospitalists in the care of their patients. Hospitalist involvement reduced minor complications (urinary tract infections, fever, electrolyte abnormalities). However, investigators did not find that hospitalist co-management reduced major postoperative complications (death, myocardial infarction, renal failure requiring hemodialysis) or intermediate ones (heart failure, pulmonary embolus, ileus, pneumonia).
Mayo Clinic hospitalists also studied the impact of a hospitalist-orthopedist co-management model of the care on elderly patients admitted to their hospital with hip fracture.2 Phy, et al., found that, “In elderly patients with hip fracture, a hospitalist model decreased time to surgery, time from surgery to dismissal and length of stay without adversely affecting inpatient deaths or 30-day readmission rates.” This study demonstrated that hospitalist co-management can decrease hospital length of stay in this population of patients.
We should recognize the obvious limitations of these studies. They were done at a single large academic institution with a largely Caucasian population at the turn of the century (2000-2001), early in the hospitalist movement. The hospitalist movement has matured, with approximately 20,000 hospitalists in the country. I hope we will soon see more robust data coming from multicenter trials that include a more diverse population of patients as well as a mix of community and academic institutions.
Start an HMG?
Question: We own a medical clinic in Arizona and are thinking of starting a hospitalist group as a separate business entity. Are you aware of any recommended reading or articles on how to start one, if it’s profitable, and in what shape or form? And most important–regarding the current trends and projections–I wonder if the need has changed, as most hospitals reduce their number of vendors.
Shawn Toloui, president and owner,
1st Care Medical Clinic,
Dr. Hospitalist responds: These are the kind of questions people have been asking since the term “hospitalist” was coined in 1996. Over the past decade, we have seen an explosion in the number of hospitalists in the country. Few folks in the 1990s thought there would be 20,000 hospitalists today.