Armed with the power of their patient referrals, office-based physicians will be able to demand that hospitals show proof of performance—thus becoming their patients’ ombudsmen. “I’m your shopper for the best healthcare, so the hospital has to step up to the plate and make sure it gets the business,” Dr. Wellikson explains. “They want standards because their patients need the best treatment, and they will have a choice of which hospital to put their patients into. If I now have a choice of three hospitals, I am looking to see that you are the Lexus of healthcare for my patients.”
Looking out for their patients’ interests is not the only way office-based physicians will continue to affect hospitals. As in-patient revenue declines, hospitals must look to the outpatient side to make up the difference. “The hospital is lucky if they break even on the inpatient side; they get the vast majority of money on the outpatient side: testing and procedures that private attendings are sending to the hospital,” Dr. Yu says.
He cautions against alienating those private practitioners by forcing change that is not mutually beneficial. “If you alienate them, you might lose money because they can send their patients to a different institution,” he warns. “These are the same doctors that never admit patients but do order the outpatient ultrasounds, blood tests, and therapies that are all money makers for the hospital. Why would you want to alienate these physicians?”
Dr. Patrick agrees: office-based physicians and hospitalists need each other. “I have to work with the primaries,” he says. “They are my source of referrals.”
There is another group that hospitals must learn to court, according to Dr. Axon: its own hospitalists. “I think you will see more innovative solutions to problems of recruiting hospital-based physicians to perform these functions,” he says. “For that to happen, the doctors will need to get more out of it. Many hospitalist groups are in a quandary; they are expected to do all these extra things, but pay is closely liked to clinical production and the number of patients they see. Those incentives will have to be aligned.”
All of which increases the reliance on—and importance of—those physicians who do work in the hospital—the home team. As Dr. Yu puts it: “I think the hospitalist model, whether you like or hate it, is the wave of the future.” TH
Carol Berczuk is a journalist based in New York.