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Overview

Hospitalists are themselves a subset of [hospital-based physicians] possessing unique challenges and characteristics. The term is used to describe physicians who devote most of their time to the care of hospitalized patients of other physicians and act as the patient’s primary doctor while the patient is hospitalized. See MedicineNet.com; Merriam-Webster.com.

As of 2011, an estimated 30,000 hospitalists are practicing in the United States. Lisa Sprague, The Hospitalist: Better Value in Inpatient Care?, George Washington University National Health Policy Issue Brief No. 842 (2011). This number has been growing exponentially since 1996, when the term "hospitalist" was first coined. Luci Leykum, Eric Mortensen, Exploring the Potential Causes of the Emergence of Hospitalists: Chicken vs. Egg, 25 J. of Gen. Internal Med. (No. 5), 378, 379 (2010). As a matter of patient care, the use of hospitalists is generally considered successful at reducing length-of-stay and overall costs, but death and readmission rates are similar to those of general internists. Peter Lindenaur, et al., Outcomes of Care by Hospitalists, General Internists, and Family Physicians, 357 N. Engl. J. Med. 2589, 2592 (2007). In part, because of this link between hospitalists and reduced patient costs, it has been suggested that current health care reform efforts can be supported by increased use of hospitalists. Molly Gamble, Hospitalists and ACOs: The Perfect Fit?, Becker’s Hospital Review (March 21, 2011), available at http://www.beckershospitalreview.com/hospital-physician-relationships/hospitalists-and-acos-the-perfect-fit.html.

Policy

Accountable Care Organizations (ACOs), which "consist of providers who are jointly held accountable for achieving measured quality improvements and reductions in the rate of spending growth" (Mark McClellan et al., "A national strategy to put accountable care into practice," 29 Health Affairs 982-990 (2010)), seem to be well suited for hospitalists, who tend to be aligned with a hospital’s mission, vision, and values, because of their employment by or contract with the hospital. Molly Gamble, Hospitalists and ACOs: The Perfect Fit?, Becker’s Hospital Review (March 21, 2011), available at http://www.beckershospitalreview.com/hospital-physician-relationships/hospitalists-and-acos-the-perfect-fit.html.

However, there may be a deficit in communication and information transfer between hospitalists and primary care physicians at the time of patient discharge. Sunil Kripalani, Deficits in Communication and Information Transfer Between Hospital-Based and Primary Care Physicians: Implications for Patient Safety and Continuity of Care, 297 J. Amer. Med. Ass’n 831 (2007). Such deficits include delayed or inaccurate communication between the hospitalist and the primary care physician, who the patient will follow up with as an outpatient. Id. These deficits may negatively affect patient care. Id.

Future Direction

Additionally, the use of hospitalists may not be warmly received by the medical staff. In years past, one of the primary ways that a physician could grow his practice was by fulfilling his Emergency Department on-call obligations. A new patient admitted to the hospital through the Emergency Department would be assigned to the service of the on-call physician. Once discharged, the patient typically would visit that physician in his office for a follow-up, possibly resulting in an ongoing relationship between the physician and the patient. However, because hospitalists are often responsible for all or a large part of Emergency Department on-call coverage, other physicians are not included on the call schedule and have lost this avenue by which to build their practice. Not only do they not have the initial patient encounter in the hospital, they also may not receive the referral from the hospitalist for the patient follow-up.

Leonard Henzke, Call of the Riled Addressing the Financial Impact of ED Call Coverage, 61 Healthcare Financial Management 78, 82 (Jan. 2007). Also, Emergency Department on-call obligations often come with compensation. Steven Nahm, Are There Alternatives to ED On-Call Pay?, Health Leaders News (Apr. 19, 2007) available at http://www.thecamdengroup.com/pdfs/Nahm_Are%20There%20Alternatives%20to%20Ed%20On-Call%20Pay.pdf.

Conclusion

When hospitalists are employed or contracted to fulfill these obligations, other members of the medical staff may raise anti-competitive concerns because they have had revenue streams cut off that were previously available to them.

Excerpt from Karen S. Rieger, Eric S. Fisher, Stephanie A. Russo, The Fundamentals of Medical Staff Issues: Minimizing Risks and Maximizing Collaboration, Fundamentals of Health Law (American Health Lawyers Association Nov. 2011).