The growth of the hospitalist specialty is undeniable and while there are financial incentives for primary care physicians to work with a hospitalist, the biggest concern is trust.
The growth of the hospitalist specialty is undeniable. The Association of American Medical Colleges reports that “surveys from both the Society of Hospital Medicine and the American Hospital Association estimated that there were approximately 30,000 hospitalists in the United States in 2010.” Some estimates put the number at greater than 40,000.
But more important than the shear number is the benefit provided by hospitalists to physicians.
“If you’re seeing three or four patients in two facilities you have to carve out a good two hours of travel time and patient visit time on that same period of time where you could probably see an additional six to eight patients in a facility,” says Felix Aguirre, MD, vice president of medical affairs for IPC The Hospitalist Company. “And with the shortage out there in the primary care facilities that would enhance the ability for the primary care doctor to see more patients.”
Management and health care consultant Abhay Padgaonkar, president of Innovative Solutions Consulting, says there are many ways hospitalists add value to private practices. For example, hospitalists allow primary care physicians to focus on their outpatient practices Monday through Friday by relieving them of their 24/7 responsibilities at multiple venues. They also inform primary care physicians every time one of their patients is admitted and manage the transition of care in real time.
Aguirre agrees, and points out that hospitalists provide primary care physicians with non-medical benefits as well, such as an improved quality of life.
“The way the regulations read right now, if the emergency room needs a doctor right on the spot, usually the hospitalists are right there in the hospital, so they can go visit that patient,” Aguirre explains. “If the primary care physician is in the office and it’s 10 in the morning, he has to wrap things up very quickly to go see that patient in the ER for an emergency consultation if requested, and that kind of tears right in the middle of the work day.”
Furthermore, physician’s evenings will be freed up. They won’t have to take calls of sick patients admitted to the hospital at night since the hospitalist is there and can take care of the patient.
Padgaonkar says that working with hospitalists provides patient benefits as well. He explains that with an expected influx of millions of patients into the health care system, combined with an even greater emphasis on reducing readmissions and population health management, the link between private practices and hospitalists will be extremely important.
Aguirre echoes those thoughts, pointing out that a primary care doctor may see a complicated case of pneumonia once or twice a year, but a hospitalist might see it 40 or 50 cases.
“The hospitalist can definitely streamline the process and of course the treatment regimen to get those patients moving faster and healthier faster,” Aguirre says. “That would definitely benefit the patient, as well as the satisfaction with the primary care doctor getting that patient to that specialist.”
The benefits are business related, too.
“When you’re in a private practice, [working with a hospitalist] gives you more time to practice in the office setting, and having more efficient care rather than having to travel back and forth to different facilities,” Aguirre explains. “Not only do you lose out on the patient care in the clinic, you also lose out on that reimbursement as well.”
In addition, if physicians see fewer patients in the hospital, their medical or liability risk decreases as well.
Making it work
Aguirre believes that communication is the only adjustment needed to a medical practice workflow when working with a hospitalist. He says that communication has a tendency to drop off when practices begin using hospitalists, so it’s important to keep that in mind.
Most important, says Aguirre, is the level of trust that exists between the primary care physician and the hospitalist.
“You must understand that the first thing on the mind of the primary care physician is the quality of care,” he explains. “‘Am I going to trust this hospitalist to take care of my patient?’”
Financial incentives are secondary to concern over whether the hospitalist can adequately care for a patient. According to Aguirre, that concern was the biggest barrier at the onset of the hospitalist movement.
“When I started back in 1995 there were fewer than 300 hospitalists in the country,” he says. “Today there are more than 40,000. The hospitalist movement is depleting some of the primary care physician pool, so we’re part of the solution, but also part of the problem.”