A hospitalist boom is a sure thing, say researchers at the University of California, San Francisco.
Hospitalist programs have improved cost efficiency and shortened lengths of stay without adverse effects on quality or patient satisfaction. And they are poised to become the dominant model for hospitals in the United States, concludes the UCSF study, published in the Jan. 23 issue of the Journal of the American Medical Association.
"It is not unanimous that everyone thinks this is the greatest advance in American medicine in the last generation, but it is very unusual to find any parties who don't see the virtues of this model when it is done correctly," says lead author Robert Wachter, M.D.
Since Wachter, associate chairman of the UCSF department of medicine, introduced the term "hospitalist" in 1996, the movement has flourished. The hospitalist workforce is predicted to grow to 19,000 by 2010.
In 15 of 19 hospitalist program studies surveyed, hospitals saw average decreases of 13.4% in costs and 16.6% in lengths of stay. If each of the 5,000 currently practicing hospitalists cared for 600 inpatients annually, they could reduce costs by a total of $2.4 billion--realizing a 10% savings on the average $8,000 inpatient stay--the study says.
Subject to debate is how much, if any, financial support from hospitals is required to maintain a viable hospitalist program.
Wachter says the average hospitalist shortfall is 10% to 50% of professional fee revenues, depending on workload, teaching obligations, payer mix and reimbursement rates.
Winthrop F. Whitcomb, M.D., director of the Mercy Inpatient Medicine Service, says under-reimbursed benefits include hospitalist provision of care for unassigned patients, 24-hour availability to all inpatients, committee leadership and case and utilization management.
Mercy Medical Center, a 180-bed community hospital in Springfield, Mass., owns the group of eight doctors. Physician fee revenues pay about 75% of the program costs, with Mercy paying the remaining 25%.
But not all hospitalist programs require external life support. IPC-The Hospitalist Co. has more than 200 physicians in seven markets. CEO Adam Singer, M.D., insists that 100% of the North Hollywood, Calif.-based company's 45 hospitalist practices are profitable without subsidy. IPC's reported revenue of $40 million in 2001 was up from $25 million in 2000.
"This is a very simple model: You get paid for seeing patients," Singer says.
IPC doctors average $180,000 seeing an annualized 12 patients a day, he says. IPC leverages management by establishing three to four practices, or 18 to 20 hospitalists, in each market. Part-timers, job-sharing and an occasional moonlighter keep hospitals covered without undue call burdens.
Each doctor is mobile, thanks to a handheld computer and proprietary software for billing, coding and general record keeping. And without binding ties to a hospital, IPC physicians answer to themselves and their patients.
But cooperatively improving hospital systems should be what a hospitalist program strives to accomplish, argues Ronald Greeno, M.D., the CMO for Cogent Healthcare. Substantial infrastructure is required to take advantage of opportunities to improve care and efficiency, he says.
Based in Laguna Hills, Calif., Cogent is a hospitalist program management company with more than 300 doctors in eight states. The Cogent model emphasizes disease management and provides care process coordinators. Its system for communicating with primary care physicians doubles as a database for outcomes analysis.
One Cogent client, 492-bed Baptist Hospital in Pensacola, Fla., saves about $1,000 per hospitalist-managed case, with a 50% lower readmission rate for those patients.
"Our charges per case were $10,237 for hospitalists, whereas nonhospitalist patient charges were $13,751," says Craig Miller, M.D., senior vice president of medical affairs at Baptist Healthcare. "Costs per case are $2,559 for Cogent cases and $3,643 for all other doctors."
Cogent reports that revenue grew 50% from June 2001 to December 2001. Contracts are based on a market-sensitive case rate, with 60% paid to the hospitalists. A physician contracting full-time with Cogent can make up to $300,000 a year for "very hard work," including nights, weekends and holidays, Greeno says.