Learning From Hospitalists
Long term care providers that are hiring staff physicians can learn much from the hospitalist model. “In my experience, I found that hospitalists were trained, had a specific niche, and seemed to be very efficient,” says Matthew Wayne, MD, medical director at several Cleveland-area nursing facilities.
However, Karyn Leible, MD, chief clinical officer for Pinon Management, notes that “the hospitalist model generally lacks the continuity of care that is so important in long term care. One person cares for the patient for a week, someone else the next week. It’s not as patient-centered.”
In looking at the hospitalist model, says hospitalist Ethan Cumbler, MD, it is important to recognize the difference between a hospitalist and an inpatient rounder. Cumbler, who is associate professor of medicine in the Hospital Section, University of Colorado, says the hospitalist is invested in caring for the patient in front of them but also in the system of care at the facility itself.
“As providers, they aren’t simply caring for the patients in the institution but improving quality of care for the entire institution,” he says. Key to a successful model with physician employees is one that recognizes that “the best way to get the inpatient team up and running is not to exclude outpatient providers but to partner with them.”
Checking The Benefits
Cumbler notes that there are several advantages to having physicians as employees. “One is alignment of incentives.” They take ownership of the patient’s experience as a team and break away from the siloed approach to treating the patient’s illnesses and problems. Having staff physicians also aligns priorities and creates some leverage, says Cumbler. “If they are incentivized by the institution to attend to quality goals, this creates some semblance of value-based purchasing.”
Some hospitalist groups already have a presence in long term care. “They offer an opportunity to create some synergy of coordination with their hospitalist brethren within the hospital setting,”
Cumbler says. However, not every hospitalist group is likely to have the training and experience to manage the long term care patient population. As Cumbler notes, “The average internal or family medicine resident doesn’t have the skill set to function as a long term care physician. It requires some on-the-job training.”
While specialization such as the hospitalists have established can be good, Wayne suggests, it presents a challenge.
“By creating a physician who specializes in a single environment, you are fragmenting care. Fragmentation isn’t necessarily evil, but it does require better systems of communication.”