The Hospitalist

Twenty years after the term was coined, hospitalists are becoming more vital to the hospital environment

Not long ago, it was the duty of the primary care physician to find the time to make rounds of her patients when they were hospitalized. But evolving patient needs, physician responsibilities, and, especially, rising costs of healthcare, have made it more difficult for doctors to do so.

Enter the hospitalist.

An evolving role
Originally termed in 1996 by Robert Wachter, M.D., MHM, the hospitalist is a physician who specializes in delivering care to patients in the hospital. Today, there are an estimated 48,000 hospitalists, according to the Society of Hospital Medicine.

Hospitalists take part in duties ranging from the diagnosis and treatment of illness to the performance of medical procedures, say Tammy Guns, administrator of hospital-based physicians, and Diogo Bauleth, M.D., medical director of hospital medicine, Centura Health – both members of the Society of Hospital Medicine. The hospitalist must coordinate their activities with the hospitalized patient’s primary care physician from admittance to discharge.

By ensuring timely and efficient patient care, say Guns and Bauleth, “hospitalists are very involved with cost saving measures and with reducing the utilization of healthcare resources.”

Because hospitalists are more reliable in treating acutely ill patients in a cost-effective manner, the necessity for them has grown. And because the profession is still relatively young, their role continues to evolve. Hospitalists are one of the few services that are present 24/7 within a hospital environment. Hospital “short-stay” units are usually staffed by a hospitalists’ team. This is because the determinations of whether or not a patient meets inpatient criteria are often decided by hospitalists.

Given the growing need for more coordinated care and population health management, hospitalists play an important role in coordinating care with outpatient providers, and ensuring that patients are taken care of in the correct healthcare setting, say Guns and Bauleth. And by working with purchasing and materials management, they can help standardize equipment and supply use across the hospital or hospital system, thus reducing costs.

Hospital medicine will continue to become a high-demand profession because of the value hospitalists bring to high-quality, cost-efficient inpatient care, they say.

What is a hospitalist?

Hospital medicine is a medical specialty dedicated to the delivery of comprehensive medical care to hospitalized patients. Practitioners of hospital medicine include physicians (“hospitalists”) and non-physician providers who engage in clinical care, teaching, research, or leadership in the field of general hospital medicine. In addition to their core expertise – managing the clinical problems of acutely ill, hospitalized patients – hospital medicine practitioners work to enhance the performance of hospitals and healthcare systems by:

  • Paying prompt and complete attention to all patient care needs including diagnosis, treatment and the performance of medical procedures (within their scope of practice).
  • Employing quality and process improvement techniques.
  • Collaborating with all physicians and healthcare personnel caring for hospitalized patients.
  • Facilitating the safe transition of patient care within the hospital, and from the hospital to the community, which may include oversight of care in post-acute care facilities.
  • Making efficient use of hospital and healthcare resources.

Following medical school, hospitalists typically undergo residency training in general internal medicine, general pediatrics, or family practice, but may also receive training in other medical disciplines. Some hospitalists undergo additional post-residency training specifically focused on hospital medicine, or acquire other indicators of expertise in the field, such as the Society of Hospital Medicine’s Fellowship in Hospital Medicine (FHM) or the American Board of Internal Medicine’s Recognition of Focused Practice (RFP) in Hospital Medicine.

Source: Society of Hospital Medicine




Sidebar head: Hospital medicine has arrived


The recent introduction of a dedicated billing code for hospitalists by the Centers for Medicare & Medicaid Services affirms that hospital medicine is growing in scope and impact, says Laurence Wellikson, M.D., MHM, chief executive officer of the Society of Hospital Medicine.

“The ability for hospital medicine practitioners to differentiate themselves from providers in other specialties will have a huge impact, particularly for upcoming value-based or pay-for-performance programs.”

Until now, hospitalists could only compare their performance to that of practitioners in internal medicine or another related specialty, points out Wellikson. “This new billing code will allow hospitalists to appropriately benchmark and focus improvement efforts with others in the hospital medicine specialty, facilitating more accurate comparisons and fairer assessments of hospitalist performance.”

Says SHM President-Elect Brian Harte, M.D., SFHM, “We have known who we are for years, and the special role that hospitalists play in the well-being of our patients, communities and health systems. The hospitalist provider code will provide Medicare and other players in the healthcare system an important new tool to better understand and acknowledge the critical role we play in the care of hospitalized patients nationwide.”


Source: Society of Hospital Medicine

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