Although the use of hospitalists is associated with a shorter length of stay and lower hospital costs, these savings are offset by more emergency department visits and readmissions, according to an Annals of Internal Medicine report by researchers from the Sealy Center on Aging at the University of Texas Medical Branch, Galveston.
Study weighs hospitalist savings, post-discharge costs
The researchers studied records of 58,125 Medicare admissions at 454 hospitals from 2001 to 2006, with 36,871 patients seen in the hospital by their primary-care physician and 21,254 seen by a hospitalist. They found that patients cared for by hospitalists had 0.64 of a day shorter average length of stay (5.17 days compared to 5.82) and their charges were $282 lower ($15,019 vs. $15,301). But the researchers said Medicare costs for these patients were $332 higher 30 days after discharge ($3,279 vs. $2,947).
Also, the hospitalist-seen patients were less likely to be discharged to home or have an appointment with a primary-care physician and more likely to have an emergency department visit. Readmission rates were also higher, but not statistically significant, according to the report.
“The cost shift might be considered modest,” the researchers wrote. “However, if applied to the approximate 25% of Medicare admissions cared for by hospitalists, this represents more than $1.1 billion in additional Medicare costs annually.”
They also noted how, as more hospitalists are being used in institutions across the country, “the outcomes may also have changed,” and that the results for patients with an established primary-care physician may not apply to patients without an identified primary-care doctor.
In an accompanying editorial, physicians with the Ann Arbor (Mich.) Veterans Affairs Medical Center's Hospital Outcomes Program of Excellence noted similar caveats about the report, but said the study still raises the question: “Are hospitalists discharging their patients more quickly but less appropriately, such that some of their patients bounce back?”
They note that shorter lengths of stay, in general, are associated with higher rates of readmission, but said the study raises important questions.
“One might wonder why hospitalist care would be associated with greater use of post-discharge services,” the physicians wrote. “Under pressure to shorten length of stay, hospitalists may be willing to discharge sicker patients, leading to increased readmissions.”
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