Hospitalists More Likely to Bill at Highest Level of Severity

The growing number of hospitalists that are billing Medicare for higher-severity encounters may be an important driver of rising hospital costs.

Hospitalists are more likely to bill at the highest level of clinical severity possible for their medical encounters for hospitalized Medicare patients compared with non-hospitalist who see similarly complex patients, according to a study published by the Journal of the American Medical Association. 

In addition, this gap has been growing over time from the study's earliest samples from 2009 to the latest in 2018, the study said.

The study looked at more than four million Medicare fee-for-service Part A and Part B medical claims between the years of 2009 and 2018 and compared the high-severity billing between hospitalists versus non-hospitalists across initial, subsequent, and discharge encounters.

Hospitalists were found to have more of these medical encounters in the hospital, reaching roughly 775 of all encounters by 2018. According to the study, "high-severity billing increased over time for hospital encounters at higher rates for hospitalists than non-hospitalists," noting the differences "do not appear to be explained by patient complexity."

Additionally, "the increase in the number of hospitalists over time may be contributing to rising national costs related to hospital care," the study said.