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A Bigger Role for Hospitalists

Joe Cantlupe, for HealthLeaders Media, April 15, 2013
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At the same time, hospitalists are filling gaps in specialized care. St. David's Round Rock Medical Center, for instance, employs 11 hospitalists compared to three a few years ago, and it also has specialists, including three surgical specialists for trauma cases and a neurologist.

Hospitals use employed hospitalists, but also contract with local or national physician groups that provide such services. Some have exclusive contracts with individual hospitals and provide full coverage. Occasionally, though, hospitals have had to overcome turf issues among various hospitalist groups. That's why the 1,423-bed Lee Memorial Health System in Fort Myers, Fla., reduced the number of contracted hospitalist groups working for it to improve efficiency and consolidation, says Scott Nygaard, MD, MBA, chief medical officer for physician services at Lee Memorial Health System.

From their perspective, hospitals are seeing more synergistic opportunities, and they have "crossed the divide for better outcomes and quality measures," insists John Donahue, president and CEO of the Brentwood, Tenn.–based Cogent HMG, a hospitalist group. For such companies, "it's a great growth opportunity to be in the market. The pitch to hospitals to hire more hospitalists is: 'If you are underperforming, we can take you to the next level,'" Donahue explains.

E. Allen Joslyn, MD, is hospitalist director of inpatient specialists for Cornerstone Health Care, a multispecialty group practice with more than 300 physicians and midlevel providers in High Point, N.C., and a hospitalist at the 335-bed High Point Regional Hospital. He says when he became a hospitalist seven years ago, he was uncertain about the field's potential. Over time, he has seen the opportunity for improved coordination and quality of care. Now Joslyn says he is riding a wave of "explosive growth of hospitalists, which really has not outpaced the hospital demand.

"Hospitalists are definitely sought, and hospitals are moving toward value-based care, what the C-suite is hungry for," he says.

Success key No. 1: Revamping the program
In 2011, Lee Memorial Health System had many hospitalist groups—at least six—but they were in disarray, often competing against each other and not coordinating care throughout the system, which includes four hospitals. What's more, the patients were unhappy. As a result, the health system changed its contracting procedures, imposed monitoring programs, and contracted with one major hospitalist group instead of different groups, says Nygaard.

"We were traditionally, and maybe excessively, competitive," Nygaard says, referring to the use of multiple hospitalist groups. At first, the hospital decided that having many different hospitalist groups seemed to be the best fit for its different campuses. The hospitalists had overseen at least 50% of the hospital admissions.

Initially, "while there were standards for hospitalist medicine approved by the medical staff, in terms of desired outcomes and communication, in my opinion, none of it was being managed well," Nygaard says. "We had to bring some order to what we were doing."

Not only did the health system internally find problems with coordination and care offered by the hospitalists, but patients responding to surveys showed they were highly dissatisfied, Nygaard says. Indeed, an annual medical survey ranked hospitalists as "very low in performance," he adds.

"We had a lot of patient complaints on a routine basis because of a lack of coordination and lack of understanding what the hospitalists are and how they were supposed to really work effectively. There was no measurable benefit to what they had. And when you look at quality metrics, core measures, and HCAHPS, we were going to lose a lot of money. It wasn't that the hospitalists were solely accountable for that, but they were part of it."

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