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Remarks

Blazing Trails

Hospitalists are finding new ways to provide value and quality to the care of hospitalized patients.

By chris nussbaum md

Unique Opportunities The Physician’s Resource Nov/Dec 2007

Hospitalists keep finding new ways to practice medicine that are both productive and valuable, meeting new challenges every day. As the discipline continues to grow and evolve, hospitalists continue to find themselves on the cutting edge of the twenty-first century’s revolution in providing quality care to as many people as possible, discovering new benefits and responding to the demands of the new economy.

In fact, hospital medicine is one of the fastest growing medical specialties in the United States.

Hospitalists have been credited with doing the impossible: lowering cost for hospital administration while still improving quality of care. Hospitalists represent a unique agreement between the practice of medicine and financial reality—an agreement that more and more hospitals are willing and eager to make.

Several medical schools have already added hospitalist tracks to residency training, and in 2006 the Society for Hospital Medicine began publishing the first peer-reviewed journal by and for hospitalists, the Journal for Hospital Medicine. It will not be long before hospitalists are recognized as a separate specialty, along with a separate board certification program.

Discovering new benefits

Residency training in internal medicine for acutely ill hospitalized patients leaves these doctors uniquely suited to practice as hospitalists. So much so that 75 percent of hospitalists come from the ranks of physicians trained in general internal medicine.

One of the primary and most effective uses of hospitalists is to ensure that primary care practitioners are no longer bound to hospital visits, which can make them frayed around the edges. Plus, hospitalists are able to visit their patients more than once a day. As the situation currently stands, effective and palliative hospital visits are nearly impossible for primary care physicians, who may check in only in the case of extreme emergencies.

Freeing PCPs to focus completely on their office practices does three things that are good for medicine in general: 1) It keeps PCPs from having to deal with labyrinthine hospital billing systems that they may not fully understand, 2) it frees them to see patients at their discretion and without external worries, and 3) it allows them to focus on preventative care, establishing a relationship with patients that is not purely based on emergency and acute care.

The hospital tool

Surprisingly, one of the most important ways that hospitalists improve care is for the indigent and elderly. Since there is no money in treating the uninsured, hospitals have found it incredibly difficult to find physicians willing to treat these patients, who may come to the hospital in dire emergencies and need critical care.

Hospitalists provide consistent care to these patients, ensuring that even the poorest and most chronically ill have a safety net. Their jobs are tied to the reputation of the hospital itself, not patients from a private practice. Because hospitalists have no office and work completely out of the hospital, they have a vested interest in making sure that the hospital is operating at peak performance and efficiency.

As a part of the hospital community, hospitalists work to forge relationships between departments. This means attempting to reduce medication errors, distribute drugs efficiently and accurately, and innovate the discharge system to ensure post-acute care that is more than drug information and a leaflet with “dos and don’ts.”

A study by the Mayo Clinic showed that 61 percent of patients co-managed by hospitalists and orthopaedic surgeons were discharged with no complications. Without hospitalists, 51.2 percent had complications when discharged.

Hospitalists are able to use their unique knowledge of the hospital’s capabilities, staff, and problems to treat patients with a maximum of available care. They are patients’ advocates—shepherding them through the hospital with real expertise, alleviating worries and providing a consistent face for the hospital itself.

Improving quality

Because hospitalists can see the way a hospital functions from the top down, they are leaders in developing quality assurance business practices. They ensure that care is standardized, that snags are eliminated, and that procedures reflect the most efficient and intelligent care possible within the system.

As leaders in a hospital setting, hospitalists are able to lead committees and problem-solving efforts to constantly improve a hospital’s quality of care and to eliminate chronic problems that a PCP has no interest in solving. A minor hospital glitch for a primary care physician becomes a constant struggle for a hospitalist, who never leaves the hospital and encounters this problem repeatedly. Therefore, hospitalists work hard to resolve such issues, targeting difficulties and advocating for the necessary changes.

Hospitalist physicians are embedded in the culture of the facilities in which they work, and can navigate with ease the complex environments that can perplex specialists concerned with very specific areas. Hospitalists are specialists in the totality of the hospital world.

Numerous studies have shown that the presence of hospitalists improves quality measures and helps achieve National Quality Forum goals as a value added benefit to their practice. In fact, in some cases, hospitalists have been the only addition to hospitals that has both improved care and lowered costs.

Successful hospitalists bring excellent communication skills and clinical expertise to the halls and bedsides of the hospital, driving improved patient outcomes and enhancing bottom lines. Hospitalists simply make sense for the hospital world, and while future challenges await them, these physicians are poised to meet these challenges with every asset and strength of the hospital system itself behind them. g

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Chris Nussbaum, MD is the CEO and founder of Synergy Medical Group, PA. He established and developed an independent hospitalist group in the Tampa Bay area, growing to the largest admitting group among local hospitals. He can be reached at synergycareteam@yahoo.com.

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