A new report in the Annals of Internal Medicine noting the inpatient and post-discharge statistics of hospital patients seen by hospitalists and those seen by primary-care doctors is old news, according to Dr. Joseph Li, president of the 13,000-member Society of Hospital Medicine.
Hospitalist offers no rebuttal or embrace of readmissions study
Researchers studied records of 58,125 Medicare admissions at 454 hospitals from 2001 to 2006 and found that patients cared for by hospitalists had a shorter average length of stay and their charges were $282 lower. But they also found that Medicare costs for these patients were $332 higher 30 days after discharge. Also, the hospitalist-seen patients were less likely to be discharged to home or to have an appointment with a primary-care physician and more likely to have an emergency-room visit. Readmission rates were higher but not statistically significantly so, according to the report.
Li, the director of the hospital medicine program at 621-bed Beth Israel Deaconess Medical Center in Boston, didn't dispute that and said he "was not trying to bash the study."
"It's incredibly provocative," Li said. "I'm not interested in rebutting the data, and I'm not going to say the study stank and they didn't do a good job. The issue is that it's an observational study and when you look at cost in isolation without quality, it's a hard thing to do. But I'm glad this study was done. It should make us think of quality of care and payment mechanisms that are different than they are today."
Li said there were about 2,000 hospitalists practicing when he started in 1998 and that, during the time of the study, preventing unnecessary or inappropriate rehospitalizations was not the issue it is today, with some 35,000 hospitalists now on the job.
Since 2006, however, the issue has drawn much attention—especially from his organization, which launched Project B.O.O.S.T. (Better Outcomes for Older adults through Safer Transitions) in 2008. Since then, the effort has continued to grow. The program seeks to reduce 30-day readmissions, improve patient satisfaction, improve communication between hospital and outpatient physicians, and ensure that high-risk patients are identified and given specific interventions to lower the risk of readmission.
Li said Project B.O.O.S.T. programs have been implemented in more than 60 hospitals and added that he'd be curious to see a similar study done with more-recent data.
"I'd like to believe it's actually better now—but more work needs to be done," Li said. "The rehospitalization rate will never be zero, but we want to drive the unnecessary-rehospitalization rate to zero."
Follow Andis Robezieks on Twitter: @MHARobeznieks.
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