There are many reasons that your Internists are not coming to the hospital anymore. They have equally trained Hospitalists available to see their patients. Patients are sicker in the outpatient setting as lengths of stay have dropped and making it even harder to see their full slate of patients. Increasing costs associated with reduction in revenue from managed care have required them to see more outpatients. In increasingly complicated and regulated healthcare environment has made the time per patient to go up. The revenue for caring for inpatients is less than the opportunity cost. They are needed in the outpatient setting. As I assume you are a specialist, I am sure that you are asked to see patients that you have never seen before and professionally manage their acute issues. The same is true for a well trained Hospitalist. We are specialists and not the proverbial fleas you refer to. We expertly manage the delivery system. It seems to me that you long for the old days. Where your buddies hung out together in the doctors dining room. Those days are gone not because of Hospitalists but for the increased demand for performance in controlling costs and improving the quality of care. I can assure you that a qualified Hospitalist should have no issues with expert management of the like you lament. Managing hypertension or diabetes does not take a long term outpatient relationship to achieve quality. I would also remind yo that in the best of worlds including the ancient times you pine for, more than 25% of the patients had no PCP on arrival throught the ER. It sounds to me that your issues are much more related to the individuals providing your Hospitalist care versus the system in general. I feel that pain. there are many a Hospital that we serve where I would prefer a surgeon from somewhere else.
Adam Singer MD
CEO IPC The Hospitalist Company
PS Check out my blog and www.hospitalistblog.com
I agree with pretty much all of what you are saying, and thanks for the thoughtful comment. I can only add that this is a system in evolution, and works better in some hospitals than in others; unfortunately, in mine, it resembles an old VW more than a shiny new Mercedes.
At my hospital--or my soon to be former hospital--the hospitalists spent so much time taking care of Ortho patients that I'm not sure they had time to do anything else. But that was for the best I suppose--I mean the ortho floor was occasionally referred to as the "Death Star" prior to internist intervention.
But my experience with a pure hospitalist service is limited b/c I'm in a university setting.
But there's certainly a role for the hospitalist. There's just not enough time in the day for many PCPs to see all their outpatients--and then take care of a few inpatients--many of which are much sicker than any inpatient of 25 years ago.
Amen to that, brother! I was consulted stat to see a patient with a fungating breast mass, but her blood pressure was 210/95 and no medications were ever ordered in the chart. Worse yet, our hospital is talking about hiring a surgilist (just because the hosital administration is trying to tweak our 5 surgeon group).
Hey brother, care to join me for a blood meal after work?
best,
Flea
Here is where the lovely -24 modifier comes in quite handy. Document your managment of the co-morbidities and submit the claim (daily visit charge) with the appropriate diagnosis.
Our Medicare carrier has steadfastly refused to pay for anything submitted with the -24 modifier (and frequently -22, and -57, etc.)
I'm just a regular person. Patient, mother of patient, wife of patient and daughter of patient.
If I'm not watching out for myself and my loved ones it is way too easy to get screwed. Even when we mere mortals are doing our best to keep 5 different specialists informed since they can't communicate efficiently themselves things go sour all too often.
Gone are the days when your family doctor was your pointman, organized your care...it's up to the layperson now. I and my family are lucky, we're well educated, speak English and medical-ese fairly well and have insurance. If you are missing any of these criteria?? Oh well. You just have to hope someone has your back.
Apart from my regular check ups and tests which thank God have deemed me the picture of health I avoid doctors altogether. They scare me. What seems to scare me, and please excuse the broad sweeping generalization, is how little they put together. Sometimes I feel they are really paid by the pharmaceutical companies. They are in a rush to write a prescription and rush me out the door.
I've had nothing but great dealings with my hospitalists. Although I feel a little guilty abdicating some of the comprehensive skills I learned during residency, it has made my life signifigantly more managable when I have to deal with very morbid patients
An amazing thing happened to a friend of mine last week. She got a call from her mom that her dad was having trouble breathing and could she meet them at the hospital? Mom also called Dad's PCP, who practices in a super-small town in southwest VA. By the time the ambulance got Dad to the hospital in bigger small town in northeast TN, the staff was lined up to do labs, EKG, x-rays etc. that PCP had called in orders for and he came in 30 minutes behind the ambulance after seeing the two patients who were currently in exam rooms at his office.
Friend and Mom were floored, but that's what family doctors do in SW VA and the hospitalists are doing what PCP says for Dad.
DocSurg, my own readers know that I'm not at all fond of the hospitalist movement. This last year, I even lost my nephrologist ... he left his longstanding, successful practice to become a hospitalist.
As someone with a chronic illness, the apparent trend toward impersonal, production line, medicine is frightening.
I see the hospitalist movement as one response to healthcare's downhill spiral ... due to too many outside influences: government interference, insurance companies with their restrictions and demands, litigation happy lawyers looking for their next meal (or boat), and the general trend toward economizing everything which can be ... and some things which should never be.
As I watch generalists close shop, one after the other, I can't help but recall what a friend told me last year, as he left his practice to go into hospitalist medicine: within the decade, our family practices would be staffed solely by medical support staff.
Our MDs and DOs were unable to keep up with all of it ... how will we fare with NPs and PAs trying to pick up the slack?
I think your hands will be even fuller in the future ...
{{{ comfort }}}
I agree with your post, doc; again, as an anesthesiologist, I see lots of patients who are victims of inadequate primary care. My town, Las Vegas, has a real shortage of PCP's, and most of the best are trying their hadns at the concierge thing. Can't say that I blame them, either, although as a Liberal sort of guy (sorry), I lament it. Anyway, I have the same expereience with hospitalists as you articulate; it's not that they are not competent. It's just that they are not available really pre-op, and most of what they can do, I can do sitting at the head of an OR table for a couple of hours with a phone, and if needs be, an echo. FOr anesthesia, practicing medicine is fun, anyway; after all, what else are we going to do during an anesthetic; read the WSJ?
Cheers!
Mitch
oh yes; one other thing; besides PCP reimbursement, there is no injustice quite like the injustice of general and cardiac surgical fees; you guys are getting hosed relative to the amount of work you do and the overhead structure; since general surgeons are by and large boy scouts by nature,(at least relative to other surgeons) you all tolerate the abuse...
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I liked all of your comments about Hospitalists.Time for a 7 on 7 off schedule with no overhead,and time to PAD the progress notes for cash. No need to really do anything,Just ask IPC.(Increased Physician Charges). Too bad all of their doctors are so "Rookie" that they aren't smart enough to see how IPC is taking them for a ride. Not long before the system turns back to real doctors.
I am not sure what you mean, I thought IPC was the leading Hospitalist company in the Country?
Please say NO to the Corporate Practice of Medicine. Here's how it works,little Kamry.(1) Bill for your services,but never tell you how much they really collect (2) Charge all the expenses to you and keep the rest for a managemnet FEE ..(You should know that the avearage overhead cost of a Hospitalist Program is under 15%). They are the LEADER all right. Biggest CON Job since the "STING".
I was looking at a Hospitalist Job at a large National Company. Some of their workers seemed a little upset with their compensation plan. Any advice on what is reasonable? How do some of the companies offer 14 days a month work rotations at 15 patients a day for a basepay of 170K and others say that is not possible?
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