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Whither the Hospitalists?
By Dr. David Edward Marcinko; MBA, CMP™
[Publisher-in-Chief]
New Role also includes Hospital Based Medical Groups
The usual role of inpatient care in this country, for many decades, saw hospitalized patients cared for by their primary care doctor or admitting physician.
Although this model had the advantage of continuity, and perhaps personalization, it often suffered because of the limited knowledge base of the physician, as well as familiarity with the available internal and external resources of the hospital. Furthermore, the limited time spent with each individual patient prevented the physician from becoming the quality leader in this setting.
These shortcomings have led hundreds of hospitals around the country to turn to the hospitalists as dedicated inpatient specialists. The National Association of Inpatient Physicians (NAIP) estimates the model could result in up to 50,000 hospitalists by the Year 2008. The term hospitalist was coined by Dr. Robert M. Wachter of the University of California at San Francisco. It denotes a specialist in inpatient medicine (personal communication).
At its center is the concept of low cost and comprehensive broad based care in the hospital, hospice or even extended care setting. If, well designed, hospitalist programs can offer benefits beyond the often cited inpatient efficiencies they bring.
For example, the average length of stay for patients on the medical service of UCSF’s Moffitt-Long Hospital initially fell by 15%, compared to historical controls adjusted for case mix. There was no reported decrease in patient satisfaction or clinical outcomes.
Similarly, another integration model is “on-site” employee affiliations that represent an adjustment of the hospitalist concept. This redeployment of existing MDs into the workplace (factory, police station, office building) or retail setting (Walmart, Intel Corp, Microsoft, IBM etc) is another exciting challenge in heath care today.
The keys to success are thoughtful implementation and a commitment to measure the results of change and use the data to produce further innovations.
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Conclusion
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Filed under: Career Development | Tagged: Career Development |
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http://www.springerpub.com/prod.aspx?prod_id=23759
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Hospital Medicine
Our Publisher Dr. David E. Marcinko, and his book “Financial Planning for Physicians and Advisors“, was mentioned by Jane Jarrard as a “Resource for the Future” in Hospital Medicine [Constructive Criticism – Part II].
Click to access THMarch2007Article361.pdf
Read the link and enjoy.
Hope Hetico; RN, MHA
[Editor-in-Chief]
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Dr. Marcinko
Nice reporting. But, are patient relationships lost, or diminished, with hospitalists?
I too think they are; and with all due respect to Bob Wachter; MD.
http://www.kevinmd.com/blog/2009/08/relationships-lost-medicine-hospitalists-partly-responsible.html
If so, isn’t this the exact opposite of a Health 2.0 collaborative care philosophy?
Fraternally
Dr. Howard Fineman
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Enter the “Extensivists”
A Medicare Advantage Plan [MAP] just expanded the role of its employed physician hospitalists, using them to care for frail elderly members at high risk of hospital admission or readmission in the skilled nursing facility and the outpatient setting both before and after a hospital stay.
Known as “extensivists” and supported by sophisticated information technology systems, these physicians generally split their time between the hospital where they round on a small group of members each day, and an outpatient clinic, where they see recently discharged and other members at high risk of admission.
For example, once or twice a week, these physicians also see members in skilled nursing facilities. The program reduced readmission rates and has led to lower length of stay and below-average inpatient utilization in a high-acuity population.
http://www.innovations.ahrq.gov/content.aspx?id=2903
So, move over hospitalists. Is there a new sheriff in town?
Your thoughts are appreciated.
Ann Miller RN MHA
[Executive-Director]
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Resurrecting the House Call
It has been about 50 years since physicians made house calls on a regular basis.
http://www.physiciansmoneydigest.com/blogs/financial-health-check-up/10-2010/Resurrecting-the-House-Call
In fact, a physician house call was virtually unheard of just a short time ago. Times change however, or as Norman Vinn, DO, MBA, founder and chief medical officer of Housecall Doctors Medical Group Inc., likes to say, “Something very old is becoming something very new.”
http://housecalldoctorsmedicalgroup.com/
“Residentialists” are resurrecting the house call. I kid you not!
Maxwell
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Do Overworked Hospitalists Harm Patient Care?
Nearly forty percent of hospital-based general practitioners who are responsible for overseeing patients’ care say they juggle unsafe patient workloads at least once a week, according to a study just published in JAMA Internal Medicine.
http://archinte.jamanetwork.com/article.aspx?articleid=1566604#qundefined
In the study, researchers at Johns Hopkins University invited nearly 900 attending hospitalists, to complete an online survey that measured various characteristics, including the number of patients they thought they could manage safely during a typical shift.
Ann Miller RN MHA
http://www.BusinessofMedicalPractice.com
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Improving Access to Integrated Palliative Care
Palliative care is one of the fastest growing areas in health care, with three times as many hospitals providing palliative services today as did just 15 years ago.
Offering personalized, coordinated treatment to address the pain, symptoms and stress associated with serious illness, palliative care has been shown to reduce emergency department use and hospital re-admissions while improving quality of life and extending survival times.
However, access to these services continues to be limited by low levels of physician referrals, workforce shortages and reimbursement challenges.
Fraternally
Dr. Howard Fineman
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