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After 24 years in private practice, I have taken a position at North Adams Regional Hospital (NARH) as a hospitalist. As I said good-bye to my patients many of the same questions were asked: What is a hospitalist? How will a hospitalist know me? What about my own doctor, the one who knows me best? What about my specialist physicians? These and other questions have prompted me to attempt to relieve concerns that my patients expressed that are probably shared by many.
What is a hospitalist?
The term hospitalist was coined in 1996 and is applied to a medical practitioner whose primary focus is care of patients in the hospital setting. In most situations, including NARH, hospitalists do not have an office practice. Although there is some variability, most hospitalists are trained in general internal medicine, meaning they are trained to diagnose and treat disease in adults.
Two-thirds of hospitals in Massachusetts have started hospitalist programs or plan to do so. At present, it is estimated that there are about 8,000 hospitalists practicing in the United States. That number is expected to grow to 20,000 by 2010.
The driving force behind the hospitalist movement is the need to reduce health care costs and enhance acute care skills for managing complex patients. In addition, hospitals want to advance quality and safety through physician champions.
Another factor contributing to the growth of hospitalist programs is primary and specialist physicians' desire to implement such programs. In case of emergency, the hospitalist can usually respond immediately, because he or she is in the hospital. Overall, hospital care is usually more efficient. Your recovery is quicker, because the hospitalist can follow up on test results and adjust your treatment throughout the day. The hospitalist’s availability also contributes to improved communication with family members for routine questions, post discharge planning, and during emergencies.
What about my regular doctor?
Most of the medical care you receive is in your primary provider’s office. Because the hospitalist is in the hospital all day, your doctor can spend more time in the office, which often reduces the time you must wait for an appointment. Furthermore, I’m sure that many of you have experienced an interruption or even a cancellation of your scheduled appointment because your doctor was called by the hospital to handle an acute question or medical emergency. The office physician must handle issues coming at him or her from many directions, making it harder to concentrate on you.
The hospitalist is in communication with your regular physician by phone as often as necessary to provide the best care when you are hospitalized. Many office physicians have ready access to the hospital’s computer information about you and use this to stay informed. The hospitalist can be thought of as a consulting specialist in hospital care assisting your primary care provider to better care for you. Critical decisions such as the need for surgery, removing life support machinery and other end of life choices, referral to a rehabilitation or long term care (nursing home) setting are usually made in collaboration with the primary provider, the patient, and the family.
When you leave the hospital, the hospitalist communicates the details of your hospital stay with your primary provider. The hospital provides medical records that address the hospitalization, treatment needs, diet and medication changes, and the need for further testing.
What about my specialists?
When your medical needs call for specialty care, the hospitalist will work closely with your specialist(s). Again, because the hospitalist is at the hospital, the communication with you and your specialist is usually more timely and efficient. The specialist’s recommendations can be carried out with less delay.
Why are hospitals developing hospitalist programs?
Hospitals are in the business of providing the best possible care to the patients they serve. Data from hospitals with existing programs suggest that hospitalists provide better quality of care and patient satisfaction when compared to traditional care by primary physicians in the hospital. Patient safety is also being looked at closely.
The financial impact of hospitalist programs is another important issue for hospitals. Medicare, Medicaid (Mass Health), or medical insurance plans pay for a part of the care of most patients requiring hospitalization. Medicare and Medicaid, as well as some insurance plans, pay the hospital a set amount for a given diagnosis. If your hospital stay is 3 or 7 days, the hospital usually gets paid the same amount, an amount calculated to pay for an “average” stay. With every added day, the cost of care increases, but the reimbursement does not, and the hospital is at risk of losing money. Even though hospitals in Massachusetts are “not-for-profit,” they must still generate enough cash to pay salaries, bills, and to reinvest in equipment and physical plant.
Because hospitalists provide more efficient care, your length of stay in the hospital is often shorter. Even with a shorter stay, and in part because of it, care by hospitalists is often associated with improved patient satisfaction and quality of care. Your care is as good or better, the length of stay is shorter so you get back home quicker, and the hospital does better financially. Everyone wins.