4 Fallouts of an Ill-Conceived Hospitalist Program

As physician practices are rapidly being devoured by larger entities including HMOs and hospital-owned networks, hospitalist programs have seen a swift rise in popularity. This relatively new concept can be beneficial when it comes to improving the efficiency of a large healthcare facility, therefore, making it possible to serve a large patient base. However, if not implemented correctly, such a program can fall flat on its face, causing many issues that affect patient satisfaction and ultimately the reputation of the organization.

The care delivery model has undergone a fundamental change over the past two decades. In the past, local community physicians cared for their patients throughout the care continuum which included periods of hospitalization too. A revamped care structure introduces the idea of hospitalists who take over patient care from the PCP as soon as admission occurs. Hospitalists are physicians who focus on inpatient care and are predominantly internal medicine specialists. Their primary responsibilities are coordinating patient care in cases where multiple specialists are involved, monitoring care, and communicating with patients and their families. While all of this sounds great on paper, the efficacy of such a program is heavily dependent on the way it is rolled out. An ill-planned hospitalist program has many limitations, some of which can be:

  1. Increased Complexity – A hospitalist program adds a layer of transition in a patient’s care lifecycle, leading to a higher chance of miscommunication. Patients tend to continue consulting their PCPs, unofficially, as they are usually not comfortable dealing with a new physician in the form of the hospitalist assigned to them. This three-way communication is a direct fallout of the increased complexity introduced by a hospitalist program.

  2. Reduced Quality Standards – The quality of care delivered to patients suffers a painful blow when a hospitalist program is implemented haphazardly. Lapses in care coordination could lead to numerous fatal errors like mismatched prescriptions ordered by different specialists, insufficient follow-up post discharge, and an inability to see the larger picture due to a lack of understanding of the patients’ prior histories before the commencement of the hospital stay.

  3. Adverse Fiscal Impact – An outcome of improper care resulting from the communication chasms, quality issues, and mismanaged care transitions mentioned in the points above is an increase in healthcare costs. Unjustifiable utilization is also a result of a poor hospitalist program. All of these after-effects tie into higher claims denials, penalties, and malpractice risks.

  4. Sliding Customer Satisfaction – When patients are unable to decipher how the care transition works and get the impression of being deserted in an unfamiliar setup, it is easy for them to lose faith in the establishment. Such an eventuality is possible in a care setup where the hospitalists are not in sync with their patients, and there are communication gaps.

The amalgamation of medical practices is unavoidable. The best way forward is to accept hospitalist and intensivist programs and build robust processes around them to prevent overutilization, wastage and a break in the physician-patient connect.

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