This document discusses the hospitalist model and debunks myths about it. It summarizes research showing that hospitalists can reduce length of stay and costs without harming quality of care. While primary care physicians initially had concerns about loss of continuity and poor communication, studies show patient, family, and physician satisfaction are preserved or improved with hospitalists. For hospitals, hospitalists can increase efficiency and market share. The model has grown significantly since being introduced.

1. Debunking the myths about the
hospitalists
Fabiana Rolla Spacassassi, MD
Universidade Federal de São Paulo
Escola Paulista de Medicina
2010

2. Driving Forces of the
Hospitalist Model
• Increased volume of outpatient careIncreased volume of outpatient care
• Decreased frequency and higher acuity ofDecreased frequency and higher acuity of
admissionsadmissions
• Demand for MD availability in both settingsDemand for MD availability in both settings
• Geography & the inefficiency of a commuteGeography & the inefficiency of a commute
• PCP demandPCP demand
• Data & success of programs to dateData & success of programs to date
• Cost pressures in the marketplaceCost pressures in the marketplace
- Length of stay- Length of stay
- Utilization of resources- Utilization of resources
- Patient satisfaction- Patient satisfaction

3. The Hospitalist Movement
• NAIP: fastest growing medical societyNAIP: fastest growing medical society

4. Number of U.S. Physicians in
Various Specialties
0
5000
10000
15000
20000
Hospitalists, 2001
EPS
ID
Geriatrics
Cardiology
ER
Hospitalists, 2005*
*Lurie JD et al. Am J Med, 1999;106:441

5. Potential Disadvantages of
the Hospitalist Model
• Loss of continuity
• Information “voltage drop”
• Potential patient dissatisfaction

6. Initial Concerns & Media’s Myths on
Hospitalists
• There is no movement of anyThere is no movement of any
significance taking place in medicinesignificance taking place in medicine
• They disrupt careThey disrupt care
• They exists only to save moneyThey exists only to save money
• They add cost to the systemThey add cost to the system
• They are managed care Doc’sThey are managed care Doc’s
• Patients don’t like them !Patients don’t like them !

7. The hospitalist moviment-
concerns and myths
• patient
• Primary care physician (PCP)
• Hospital

8. We’re interested in your feelings
about a new model of care...
““...in which a stranger will take...in which a stranger will take
care of your child when he/she iscare of your child when he/she is
in the hospital, really..really...in the hospital, really..really...
sick”sick”
What would You say?

9. We’re interested in your feelings
about a new model of care...
…in which a colleague of your pediatrician, -an
expert in hospital care, who is available to you
throughout the day-- will care for your child
during the hospital stay.
He will keep close contact with him/her and
return your child to his/her care after leaving
the hospital ”
What would You say now?

10. Benefits for Patients
• Taken care by an inpatient specialist
• Immediate availability
• Changes in plan of care throughout the day
• No delays in discharge process
• Less PICU admits
• Improved quality of care
• Reduced LOS

11. The Concerns of the PCP’s
• The door to the hospital will be closedThe door to the hospital will be closed
– They will be forced to use the serviceThey will be forced to use the service
– It happened with the PICU and the NICUIt happened with the PICU and the NICU
• Loss of inpatient skillsLoss of inpatient skills
• Poor communicationsPoor communications
• Patient dissatisfactionPatient dissatisfaction
• Loss of continuityLoss of continuity
(*Notice, money is not on the list)

12. Advantages of
Collaboration for PCP’s
• Increased office availability withoutIncreased office availability without
interruptioninterruption
• See more outpatients in same amount ofSee more outpatients in same amount of
timetime
• No middle of night hospital calls/visitsNo middle of night hospital calls/visits
• Concentrate on outpatient CMEConcentrate on outpatient CME
• Improved quality of lifeImproved quality of life

13. Convincing PCP’s
• Only voluntary system
• Offer what they want
– All patients, ad hoc cases, night time admits, consults,
procedures, weekends..
• Easily accessible- “only one phone call”
• Immediate availability 24/7/365
• Encourage “social” visits
• Same day discharge summary
• Patients feedback

14. Intangible Benefits to Hospital
• Increased censusIncreased census
– PCP’s may send morePCP’s may send more
– Insurance companies may send moreInsurance companies may send more
• Improved quality of careImproved quality of care
• Increased market shareIncreased market share
• Decreased cost of hospitalizationDecreased cost of hospitalization
• Decreased malpractice ?Decreased malpractice ?

15. The Hospitalist Movement 5 Years Later
(JAMA; 2002;287:487-494)
• Reduced hospital costs (13%)
• Reduced LOS (16%)
• Quality measures not harmed
• No mandatory referrals
• Primary Care Physicians
support is critical
• Inpatient satisfaction
preserved
• Communication is the key to
success

16. Few Predictions
• Hospitalists will become the major providers of
hospital care in the U.S.
• Studies will continue to show improved
efficiency, improved quality, and patient and
PCP satisfaction
• Effective systems will overcome the potential
flaw in the model: communication
• The brutal healthcare marketplace will not
tolerate a failure to innovate in the name of
tradition

17. Comparison of hospitalist and pediatric
subspecialist care on selected APR-DRG’: lenght
of stay and hospital charges
Maggioni A, Rolla F. Pediatr res 2004;55(suppl):1790
• APR-DRG severity adjusted retrospectiveAPR-DRG severity adjusted retrospective
observational studyobservational study
• Hospitalist vsHospitalist vs subspecialists in a ward settingsubspecialists in a ward setting
• 20 most common diagnoses20 most common diagnoses
• 10231 patients (3958 hosp x 6273 spec)10231 patients (3958 hosp x 6273 spec)
• LOS 20% shorter for hospitalists (3.8 vs 4.8 d)LOS 20% shorter for hospitalists (3.8 vs 4.8 d)
• hospital costs 31% lower ($10 529 vs $15 380)hospital costs 31% lower ($10 529 vs $15 380)

18. Pediatric Hospitalists: A systematic
review of the literature
(Pediatrics. 2006;117(5):1736-1744)
• 47 publications reviewed,,
• 2020 met criteria for inclusion;;
• 6/7 compared traditional and hospitalist systems of
care demonstrated improvements in costs and/or
length of stay;;
• average decrease in cost was 10%;
• average decrease in length of stay was 10%.;;
• efficiency gains do not generally translate into
revenues for the hospitalist programs themselves;;
• Surveys of families, referring providers, and pediatric
residents demonstrate neutral or improved experiences
in hospitalist systems

19. Charles Darwin
It is not the Strongest, nor theIt is not the Strongest, nor the
Smartest that will survive !Smartest that will survive !
It is the species that canIt is the species that can
best adapt to change.best adapt to change.

20. A, B, C’s for being a successful
pediatric hospitalist
• Always
• Be
• Competente
• Collegial, and
• Communicative
So, You want to be a Hospitalist...
Jack M. Percelay, MD, MPH, FAAP
AAP Section on Hospital Medicine
March 2006