There are 10 industry-changing recommendations in the recent Institute of Medicine (IOM) report “Best Care at Lower Cost: The Path to Continuously Learning Health Care in America.” Suggestions include reforming payment, adopting digital infrastructure, and improving the continuity of care. And to Brent James, MD, all of those recommendations are areas in which hospitalists can help lead healthcare from fee-for-service to an organized-care model.
Dr. James, executive director of the Institute for Health Care Delivery Research and chief quality officer at Intermountain Healthcare in Salt Lake City, says hospitalists can be linchpins to that hoped-for sea change because the specialty’s growth the past 15 years shows that physicians taking a collaborative, evidence-based approach to patient care can improve outcomes and lower costs.
“In some sense, the hospitalist movement triggered [the move to organized care],” says Dr. James, one of the IOM report’s authors. “You started to have teams caring for inpatients in a coordinated way. Pieces started to kind of fall into place underneath it. So I regard this as … [hospitalists] coming into their own, their vision of the future starting to really take hold.”
The report estimates the national cost of unnecessary or wasteful healthcare at $750 billion per year. Published in September, the report was crafted by a nationwide committee of healthcare leaders, including hospitalist and medical researcher David Meltzer, MD, PhD, chief of University of Chicago’s Division of Hospital Medicine and director of the Center for Health and Social Sciences in Chicago.
Dr. Meltzer says that for a relatively young specialty, hospitalists have been “remarkably forward-looking.” The specialty, in his view, has embraced teamwork, digital infrastructure, and quality initiatives. As the U.S. healthcare system evolves, he notes, HM leaders need to keep that mentality. Hospitalists are confronted daily with a combination of sicker patients and more treatment options, and making the right decisions is paramount to a “learning healthcare system,” Dr. Meltzer adds.
“As the database of options grows, decision-making becomes more difficult,” he says. “We have an important role to play in how to think about trying to control costs.”
Gary Kaplan, MD, FACP, FACMPE, FACPE, chairman and chief executive officer of Virginia Mason Health System in Seattle, agrees that HM’s priorities dovetail nicely with reform efforts. He hopes the IOM report’s findings will serve as a springboard for hospitalists to further spearhead improvements.
In particular, Dr. Kaplan notes that healthcare delivery organizations should develop, implement, and fine-tune their “systems, engineering tools, and process-improvement methods.” Such changes would help “eliminate inefficiencies, remove unnecessary burdens on clinicians and staff, enhance patient experience, and improve patient health outcomes,” he says.
“The hospitalists and the care teams with which the hospitalist connects are very critical to streamlining operations,” Dr. Kaplan adds.
Dr. James, who has long championed process improvement as the key to improved clinical outcomes, says that extending the hospitalist model throughout healthcare can only have good results. He preaches the implementation of standardized protocols and sees hospitalists as natural torchbearers for the cause.
“When you start to focus on process—our old jargon for it was ‘continuum of care’—it forces you to patient-centered care,” he says. “Instead of building your care around the physicians, or around the hospital, or around the technology, you build the care around the patient.”
Dr. James has heard physicians say protocols are too rigid and do not improve patient care. He disagrees—vehemently.
—Brent James, MD, executive director of the Institute for Health Care Delivery Research and chief quality officer, Intermountain Healthcare, Salt Lake City
“It’s not just that we allow, or even that we encourage, we demand that you modify [the protocol] for individual patient needs,” he says. “What I have is a standard process of care. That means that you don’t have to bird-dog every little step. I take my most important resource—a trained, expert mind—and focus it on that relatively small set of problems that need to be modified. We’ve found that it massively improves patient outcomes.”
Many of the IOM report’s complaints about unnecessary testing, poor communication, and inefficient care delivery connect with the quality, patient-safety, and practice-management improvements HM groups already push, Dr. Kaplan adds. To advance healthcare delivery’s evolution, hospitalists should view the task of reform as an opportunity, not a challenge.
“There are very powerful opportunities for the hospitalist now to have great impact,” he says. “To not just be the passive participants in a broken and dysfunctional system, but in many ways, [to be] one of the architects of an improved care system going forward.”
Richard Quinn is a freelance writer in New Jersey.