Use Of Hospitalists Could Lead To More Efficient Care, Cost Reductions

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Hospitalists -- physicianswho provide general care to patients in hospitals in place of traditionalgeneral practitioners and internists -- reduce the average inpatient stay by12% and create modest savings, according to a study published Thursday in the NewEngland Journal of Medicine, the Wall Street Journalreports (Levitz, Wall Street Journal, 12/20). Lead author PeterLindenauer, an associate professor at Massachusetts'Baystate Medical Center, and colleagues examined healthrecords between 2002 and 2005 of about 80,000 patients at 45 unnamed hospitalslocated in the Southeast region of the U.S. The patients were treated forseven common conditions, including pneumonia, chest pain, heart attack andstroke.

Patients treated by hospitalists on average were discharged from hospitalsabout 9.6 hours earlier than those treated by their regular physicians.Hospitalist patients received medical bills of $5,129 -- about 2.4% to 5% lowerthan medical bills totaling $5,254 to $5,397 among patients treated by regulardoctors. The researchers found that hospitalist patients within two weeks ofbeing discharged returned to the hospital or died because of healthcomplications at about the same rate as patients who were being treated byregular physicians (LaMendola, South Florida Sun-Sentinel, 12/20).

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While the study did notassess quality of care, Lindenauer said one of the "disadvantages" ofthe hospitalist model is that it "introduces a handoff betweendoctors," adding, "The primary care doctor is caring for you in youroffice; then they refer you to the hospitalist for hospital care, then at theconclusion, the hospital refers you back to primary care." He added that apotential benefit of being treated by hospitalists is that they are present allday and are able to make medical decisions in "real time" (WallStreet Journal, 12/20).

Groups that oppose the use of hospitalists, including some medical associationsand Families USA, say they replace regularphysicians at an important stage of care and move patients out of the hospitaltoo quickly, the Sun-Sentinel reports (South FloridaSun-Sentinel, 12/20). According to the Journal, experts saythat as the "field grows, there needs to be an emphasis on improvingefficiency, such as better communications between primary-care doctors andhospitalists" (Wall Street Journal, 12/20).

Reprintedwith permission from kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, and sign upfor email delivery at kaisernetwork.org/email . The Kaiser Daily Health PolicyReport is published for kaisernetwork.org, a free service of The Henry J.Kaiser Family Foundation.

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