But within the healthcare system, there are concerns. "A highly functioning hospitalist program can help hospitals operating more efficiency," writes Ron Greeno, MD, in Healthcare Financial Management. "Yet despite the potential hospitals have to positively affect hospital operations in the areas of quality, safety and finance, hospitalist programs do not always generate expected returns."
The reason, Greeno writes, is often linked to how a hospital funds such a program, with hospital subsidies linked to hospitalist productivity but not necessarily on their ability to make hospital care more efficient or better, he adds.
Singer appears to embrace some of those concerns as well, and notes that many hospitals have a difficult time establishing a well-balanced partnership with hospitalists, particularly in their failure to align goals and objectives of the hospitalist group with the hospital.
The subsidy program for hospitalists also ironically seems to have a detrimental impact on hospitalists' efforts to have a greater say or become partners in their health care facilities.
"It is unclear if many hospitals are willing to give doctors a stake in performance," he says. "The reason is that today most hospitals that employ or even contract with hospitalists are having to pay a subsidy to begin with. In essence, they are paying for the performance up front in anticipation that a hospitalist program will produce results that are in excess of that subsidy. I see very little upside to these subsidies being offered today."
Singer has been fighting the subsidy arrangements for years. Back in 2003, he told Today's Hospitalist saying he believes that "anything that smacks of financial support and prevents hospitalist programs from flying solo financially is a bad thing."