If I understand you correctly, you are concerned that because many hospitals are reducing their numbers of vendors, this may have an adverse effect on the need for hospitalists. Hospitals will engage in business relationships with hospitalists as long as the hospitalists can bring solutions to problems and fulfill needs. To understand this better, let’s examine the reasons the numbers of hospitalists have grown over the past decade.
Costs: When Medicare started paying hospitals based on diagnosis-related groups (DRGs) in the early ’80s, this forced hospitals to “manage” patients’ length of stay. The DRG system pays a fixed fee regardless of the length of stay but allows for an adjusted higher payment based on a hospital’s case mix index (a measure of how “sick” patients are in a given hospital).
This reimbursement system encourages hospitals to take care of ill patients but also to “manage” their length of stay. It is difficult for doctors to manage any hospitalized patients from outpatient offices, let alone sick patients. Hospitals and payers found that hospitalists are able to manage sick patients and reduce costs, mostly by being available to admit, manage, and discharge patients in a timely manner. This increased throughput of patients also allows hospitals to put another patient in a bed sooner, bringing additional revenue.
Quality: By serendipity, the hospitalist movement coincided with the quality movement. Hospitalists have helped reduce variations in care by working locally to develop and implement clinical-care pathways. Hospitalists have also served as partners for hospitals to achieve compliance with payer quality mandates.
For example, in 2003, Medicare began requiring hospitals to report a handful of diagnosis-based quality measures it called the Core Measures. The number of measures continues to grow. In 2007, Medicare tied hospital reimbursement to performance on the Core Measures. I hear from hospital administrators that they find it easier to educate and work with a small group of hospitalists, rather than a large medical staff, to achieve optimal results on these measures.
Satisfaction: The exodus of primary care physicians (PCPs) from the hospital has fueled much of the growth in hospital medicine. PCPs have found it increasingly difficult to care for hospitalized patients while juggling the demands of a busy outpatient practice. In hospitalists, nurses have found a physician partner who is available physically to work with them in the care of acutely ill patients.
PCPs and nurses have been very satisfied with the hospitalist model of care. Although provider satisfaction is important, satisfaction in healthcare begins and ends with patients. Despite the discontinuity of care of meeting a new provider during hospitalization, patients have been satisfied with hospitalist care. Patients view hospitalists as providers available to provide for their acute needs while also communicating with the patients’ outpatient providers to understand their long-term needs.
I expect the number of hospitalists to grow over the next decade, albeit at a slower pace as most programs begin to fill their available positions. SHM believes the numbers of hospitalists will grow to 40,000.
There are a number of resources that can help you understand how to develop, manage, and grow a hospitalist program. I suggest you visit the “Practice Resources” section of the SHM Web site at www.hospitalmedicine.org. In particular, I recommend the “Best Practices in Managing a Hospital Medicine Program,” held twice a year. The spring program is held in conjunction with the SHM Annual Meeting in San Diego, April 3-5. The fall program is held in conjunction with the University of California, San Francisco’s “Management of the Hospitalized Patient” course in San Francisco. Also, the book Hospitalists: A Guide to Building and Sustaining a Successful Program by SHM Senior Vice President Joe Miller and SHM cofounders John Nelson, MD, and Winthrop F. Whitcomb, MD, is a must read for anybody looking to build a hospitalist program. TH