Hospitalists are here to stay. We are a valuable asset to hospital systems, as witnessed by the rapid expansion of hospitalist salary and hospitalist subsidy/support payments over the last decade. But where is the value? Some folks will argue that hospitalists are not worth hospital support and should be able to stand on their own with medical billing and coding of evaluation and management encounters.
These are the folks who don't understand the 57 million dollar hospitalist advantage. These are the hospital systems destined for failure in a hospital model that can no longer survive without hospitalists.
Length of stay (LOS) is shorter for patients cared for by hospitalists. In a payment model where hospitals get paid by Medicare with diagnosis related groups (DRGs), length of stay means everything to the bottom line. Some detractors argue that hospitalist 30 day discharge Medicare cost utlization is higher for hosptialists than it is for outpatient physicians.
Even if I were to believe an apples to apples comparison was possible, I say so what. Outpatient studies are done as an outpatient because they should be. If that increases total cost, so be it. If Medicare wants them done as an inpatient, they should raise their DRG payments to cover the expense. Hospitalists may simply be exposing the underfunding policies of Medicare when cost shifting outpatient tests into their appropriate outpatient arena.
We practice under the rules we are given. As hosptialists, if we can increase the efficiency of hospital care under a DRG model, we are valuable. If the payment model changes, and hospitalists prove they can continue to provide efficient, high quality care, we will continue to be valuable.
It brings me great pleasure to say that Happy's hospitalist group provides high quality care for our patients. When compared against a severity adjusted national average length of stay, our length of stay is 20% lower than would be expected and we provide this care with over 50% fewer cases of mortality than would be expected based on a nation wide severity of illness adjustment.
And me personally? My length of stay is 30% less than would be expected on a nation wide severity of illness adjustment with an actual mortality rate 60% less than expected. In other words, if you are cared for by any of the doctors in Happy' hospitalist group, you are much more likely to make it home for the holidays. We are able to provide this great care because we have been given an excellent team of professionals to work with. Hands down, from top to bottom, patients WIN.
OK then. I guess that means we can stop trying to be better. I guess it also means I don't need to take my 2011 PQRI (PQRS) windfall to pay $1,700 to re-certify for my internal medicine boards. The data should speak for itself.
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