Three years into their growth spurt, hospitalists appear to have a rosy future. But it's still a matter of debate how prevalent hospitalist programs will become.
There's plenty of anecdotal evidence that hospitalists reduce costs without hurting quality or patient satisfaction. Yet brewing discord over the method of implementation-voluntary or mandatory-could be a key factor in their acceptance among physicians and the public.
While fewer than 10% of the nation's hospitals use specialists who manage inpatient care, many more are expected to adopt hospitalist programs.
The National Association of Inpatient Physicians, a year-old professional organization for hospitalists, estimates that there are 2,500 to 3,000 specialists managing the care of hospitalized patients, up from 500 three years ago.
Further driving growth are a handful of new companies that manage hospitalists, enabling hospitals to outsource hospitalist programs as they do with emergency room doctors (See chart).
Gwynedd, Pa.-based Sherlock Co. estimates 34,244 hospitalists are needed for complete market penetration.
At most hospitals, the use of hospitalists is voluntary. However, some managed-care companies have mandated their use. Humana, for example, has expanded the use of hospitalists to at least 12 markets after observing that their use in Florida coincided with a 17% drop in inpatient days. The company plans to add another market by Aug. 1. Humana says hospitalists can focus more attention on hospitalized patients than primary-care physicians do.
But a new report by the American Medical Association's Council on Medical Service opposes the mandatory approach, calling voluntary participation perhaps "the most critical factor" in hospitalist programs.
The report, which will be considered at the AMA House of Delegates annual meeting this week, recommends that hospitalist programs be voluntary for primary-care physicians and patients.
John Nelson, M.D., NAIP co-president, says mandating the use of hospitalists could generate a backlash.
"As the public becomes more aware of this trend (toward mandating), I predict some HMO will advertise the exact opposite and say, `With us, you get to see your own doctor,' " he says. "I think most hospitalists believe that it actually works better when it's optional for everybody."
Increasingly, primary-care physicians are requesting hospitalist programs so they can devote 100% of their time to growing outpatient work, says Nelson, who helps hospitals establish hospitalist programs.
At HealthSystem Minnesota in Minneapolis, which implemented a hospitalist program in 1994, 89% of physicians at its Park Nicollet Clinic reported that the hospitalist system was "better or much better" than the former system, according to the AMA report.
Two-thirds of the clinic's family physicians and one-third of its internists chose to stop seeing hospitalized patients, devoting all their time to office visits. Perhaps most telling, clinic patients reported significant improvements that coincided with the hospitalist program: easier access to appointments, decreased waiting times and better preventive advice.