Wednesday, November 05, 2008

Is misguided policy driving the success of the hospitalist movement?

The Happy Hospitalist thinks so:

If not for the gross failures of the Medicare National Bank (MNB), hospitalist medicine would fail to exist. We are here ONLY as a financial necessity out of a payment system gone mad. As much as I rile on the MNB, I am forced to admit that my position as a hospitalist would be nonexistent if not for the incompetent clowns making policy decisions based on lobster dinners with lawyer lobbyists.

I’ll go half way on that premise. Maybe I’m na├»ve but it’s hard for me to stomach the thought that I am, first and foremost, part of a business solution. Medicare’s ill conceived and manifestly unfair Prospective Payment System and never events rules do put pressure on hospitals to limit utilization and hospitalists are perceived as a way to do that. And while perception may equal reality for many, the evidence that hospitalist care results in more efficient utilization is not robust.

On the other hand if the Medicare clowns implement the latest idea they’ve been tinkering with, the bundling of doctors’ rounding fees into hospital DRG payments, it will be the final finishing blow for traditional hospital care. The hospitalist model will be secure once and for all. Debates about our value will become moot. The demand for hospitalists will accelerate over the next decade and the future of inflating hospitalist salaries will be secure.

1 comment:

Anonymous said...

As a (now) outpatient only generalist physician, I think you're both right.

I was fairly efficient with my inpatients. While occasionally there'd be a patient who'd wait for me to finish an office appointment before admitting him or her from the ER or discharging them to SNF, that was rare. I brought a lot of detailed knowledge of the patient and family that was often very helpful in reducing unnecessary testing, consults, or length of stay.

But that's all a moot point. The low pay for inpatient work compared to the time it requires to do properly drove us from the hospital. We've kept our credentials current but we're unlikely to ever return to the hospital if the Medicare bundling proposals are enacted. We don't want to get involved in a line of business that give the local hospital such control over our pay. While I understand Medicare's intent, that would be a dangerous business model for independent physician practices.