HED:Local study in national journal shows hospitalists reduce patient costs, hospitalization time
By Marty Russell
A new study by North Mississippi Medical Center researchers indicates that patients pay less and have shorter stays when they see a hospitalist, a doctor whose practice is limited to the hospital and not split between hospital and clinic work.
Published in a recent edition of the American Journal of Medicine, the 1997-98 study compared the outcomes and costs of patients seen by hospitalists and patients seen by internists, doctors whose primary practice is in a clinic outside the hospital.
Predictably, patients who saw a hospital-based physician expressed better satisfaction, endured shorter hospital stays and generally paid less for their care. But the researchers who conducted the study said the hospitalists also benefit patients who see physicians in clinics.
“It allows doctors in clinics to stay in clinics,” said principal investigator in the study and NMMC chief medical officer Dr. Ken Davis. “It means you only have to wait 30 minutes in a waiting room instead of four hours because the doctor got called to the hospital.”
What is a hospitalist?
Hospitalists are doctors who limit their practice to the hospital where they are employed. They see patients admitted without a referral from an outside physician or patients whose doctors don’t have hospital privileges.
“It was controversial,” Davis said of the new specialty that caught on with the advent of managed care. “It started in large, urban areas with (health maintenance organizations) doing as much as they can to save costs. We wanted to see, in a rural environment with less managed care, did it work?”
Locally, the program started in October of 1997 with two hospitalists providing daytime and nighttime coverage at NMMC. Since then, a third hospitalist has been added to the staff.
“In the past a primary doctor would cover from home,” Davis said of patients hospitalized overnight. “Now we have a full-time doctor at night who is fresh and making good decisions and that’s been a big plus.”
In the study, Davis and his colleagues pharmacist Karen Koch, nurse Jan Englert, and doctors J. Ken Harvey, Renee Wilson and Patrick D. Gerard looked at the outcomes of patients with 10 common diagnoses and compared time spent in the hospital as well as costs between patients who saw hospitalists and patients who saw internists working primarily outside the hospital.
The research found that patients who saw hospitalists had a shorter hospital stay 4.1 days plus or minus 3.0 days compared to patients of internists who had an average stay of 5.5 days plus or minus 4.9 days.
“It makes a big difference in the more critically ill patients and a large difference in the length of stay,” said Wilson, one of the study’s authors and a NMMC hospitalist.
Wilson attributes the shorter stays under hospitalist care to the doctors being able to concentrate solely on those hospital patients without any clinic duties to distract them.
“I’m here to follow up on tests that day where a doctor in an office might not come back until the next morning,” Wilson said. “Me being on the premises constantly I can address something within an hour instead of five or six hours so you haven’t had time for all hell to break loose.”
Dr. Bill Brohawn, NMMC’s newest hospitalist who left clinic and hospital work in south Florida to come to Tupelo and work solely with hospitalized patients, agrees with Wilson.
“Length of stay is one of the major benefits,” Brohawn said of hospitalist work. “You can start doing things sooner and lose a day or two of a hospital stay.”
Another finding of the study was that patient costs were less with hospitalist care compared to care by internists.
The bills of patients cared for by hospitalists averaged $4,098 plus or minus $2,455 compared to patients of internists whose bills averaged $4,658 plus or minus $4,084.
The researchers again attribute the benefit to length of stay and more timely care.
“It’s been very successful but we didn’t know that going into it,” Davis said of the hospitalist program at NMMC. “All these things have been borne out. In fact, we now have three (hospitalists) and we could have five.”
Hospitalists aren’t meant to replace primary care physicians outside the hospital and, in fact, work closely with clinic physicians to care for their hospitalized patients.
“Our setup works well because we are still affiliated with our base group,” Wilson said of IMA, a local physicians group that refers patients to NMMC.
“Those doctors have to talk,” Davis said of the internists and hospitalists, noting that patient records are computerized at NMMC and available to physicians both in clinic settings and the hospital.
While the recent hospitalist study was intended to gauge the effectiveness of hospitalists in an area with little managed care, the study doesn’t necessarily transfer well to truly rural areas.
“It takes a pretty big hospital to do this,” Davis said. “There has to be enough volume. Anything 200 beds or less is probably not enough volume.”
The hospitalists say the work is rewarding and frees them from the grind of having to work both a clinic and a hospital.
“It’s a little more set hours,” said Brohawn. “And you’re dealing with folks who are definitely sick and definitely need your help.”
As far as missing out on building lasting doctor/patient relationships, Wilson said the rural nature of the region means she sees some patients and their family members more than once.
“Most everyone I see now knows me second or third hand because I’ve seen somebody in their family,” she said.
Davis said the bottom line of the study is that hospitalists provide better care for less cost than doctors who split their time between the clinic and the hospital.
“When you focus on one thing, you do that better,” he said.