Safer patients, improved quality of care, innovative uses of resources, increased job satisfaction: Those themes threaded their way through presentation after presentation at “Creating the Hospital of the Future: The Implications for Hospital-Focused Physician Practice,” a one-day meeting of hospitalist leaders and hospital administrators following the annual Health Forum/AHA Leadership Summit on July 21 in San Francisco.
The five-hour presentation to about 80 hospital CEOs, chief financial officers, and chief medical officers focused on the ever-expanding roles of subspecialty hospitalists and how subspecialty hospitalist programs can help administrators solve multiple challenges in an era of healthcare reform.
“When I started in 2007, I could only identify 15 hospitals in the United States with OB hospitalist programs. And now we know of 169, and the nation is adding one or two new programs a month,” says Rob Olson, MD, an OB/GYN hospitalistor “laborist”at PeaceHealth St. Joseph Medical Center in Bellingham, Wash., and editor of ObGynHospitalist.com. “If you think about it, if you can make it safer for women in labor, then duh! Why wouldn’t you want to do that?
“The finances work best at a hospital that delivers more than 2,000 babies a year. But many small hospitals, like those doing 800 or 1,000 deliveries a year, have programs because it makes it safer for women in labor,” he says. “Therefore, even though it might be more expensive at those lower numbers, it’s worth it. It’s the right thing to do.”
The July meeting was the second time SHM gathered stakeholders to discuss the growth of specialty hospitalists; a similar panel of experts convened last November in Las Vegas. Most at the San Francisco meeting recognized the upward trend in such HM-focused subspecialties as neurology, orthopedics, obstetrics, and general surgery, according to John Nelson, MD, MHM, organizer of the focused-practice meetings.
“Most people in healthcare feel like this is going to continue and intensify,” says Dr. Nelson, cofounder and past president of SHM, medical director of the hospitalist practice at Overlake Hospital Medical Center, Bellevue, Wash., and practice-management columnist for The Hospitalist. “There is consensus that each specialty can learn from the other about how they organize their practice and approach their work. There was consensus that we don’t have a lot of research data about what this means for things like cost of care, quality of care, patient experience, physician career longevity. So we need to encourage people to begin to study those things, and what this means for the stakeholders in healthcare.”
Four subspecialty hospitalists—neurohospitalist David Likosky, MD, SFHM, surgicalist John Maa, MD, orthopedic hospitalist Kurt Ehlert, MD, and Dr. Olson, the laborist—took part in a 90-minute panel discussion in which they explained their practice models and fielded questions from the audience.
“My message was that there are a large number of people doing this now—we estimate there are between 600 and 700 neurohospitalists nationally—and that the model holds a lot of promise. There’s not a huge amount of data right now on outcomes and other metrics, but we’re starting to see that data,” said Dr. Likosky, medical director of the Evergreen Neuroscience Institute in Kirkland, Wash., and co-founder of the Neurohospitalist Society (neurohospitalistsociety.org). “The neurohospitalist model is a good solution to many of the problems that hospitals are facing now.”
—Kurt Ehlert, MD, medical director, Orthopedic Hospitalists of New Bern, national director for orthopedic services, Delphi Healthcare Partners, Morrisville, N.C.
Dr. Ehlert, director of orthopaedic services, Orthopeadic Hospitalists of New Bern (N.C.), and national orthopaedic medical director of Delphi of TEAMHealth, says subspecialty HM programs offer hospitals a “great chance of improving quality and patient safety over what they have currently, even if they have their emergency room covered.”
“I think hospitalists who are subspecialists in trauma can provide a bump up in productivity, safety, reliability,” he says. “Results will be better. I think it will be less expensive. [I told them] that there is an option out there that can benefit them in all of the various key ways that groups are looking at right now.”
Dr. Ehlert’s ortho-hospitalist group formed when the 300-bed hospital in New Bern encountered a manpower issue not unfamiliar to hospitals across the country. The bylaws of the medical staff allowed subspecialists to stop taking call when they turned 55, and four of the seven orthopedists aged out.
“Three doctors taking all the call is not really sustainable for them in their private practices,” Dr. Ehlert said. “So they looked at various options, came to us, and we started in December of 2009. It has been very successful, according to the administration. They love us being there. The emergency room is very happy with our responsiveness. I think our results have been very good.”
The new arrangement is a win-win, Dr. Ehlert says. The orthopedists are focused on their elective practices, and “they’re very happy with that. So their life is much better; their elective practice has actually gotten busier because they’re not having to leave space open for all the trauma from the ER. So I think all around it’s been very successful.”
The hospital has added a general surgery hospitalist program, which is doing well, too. “They’re much busier,” he says. “They’re really taking a load off the general surgeons in town.”
Dr. Maa, assistant professor and director of the surgical hospitalist program at University of California San Francisco Medical Center, says growth in his field is fueled by the ever-growing crises in emergency departments.
“Most hospitals critically depend on a general surgical service,” he said. “If you can’t keep a panel of general surgeons to take call, you’re probably going to have to close your emergency room.”
Dr. Maa, who founded UCSF’s surgical hospitalist program in 2005, explained how the terms “surgicalist” and “acute-care surgeon” have come to represent the concept of a dedicated emergency surgeon, whether it be in trauma or in general surgery. “It really does parallel the medical hospitalist model,” he says, adding that his field has had to overcome doubts about scheduling and patient safety.
“The danger in each of these specialty programs is to become too much of the silo mentality, to focus on their own discipline,” he adds. “We need to work across specialties, we need to collaborate, we need to find ways of utilizing the precious existing resources for emergency care, and make certain that the needs of society are met. Society places trust in doctors, hospital leaders, to build a system that will care for them when they need it. It’s our ethical obligation to design the safest, best system, with the resources that we have.”
Jason Carris is editor of The Hospitalist.