Hospitalists may soon find themselves at the center of health care reform.
The Obama administration is likely to zero in on hospital care when taking the first steps toward health care reform, said Dr. Ron Angus, a Dallas-based hospitalist and a member of the public policy committee of the Society of Hospital Medicine. The federal government can examine data on care in the hospital more easily than it can review outpatient data, making inpatient care a more likely target for initial policy changes, he noted.
He predicted that Congress will mandate more “flavors of pay for performance.” For example, one much-discussed proposal is for the federal government to stop paying hospitals for care delivered to patients when they are readmitted to the hospital with the same condition as their original admission. Medicare and several private insurers have already started down this path by refusing to pay for costs associated with certain preventable complications in the hospital.
If Medicare and other payers restrict payment for readmissions, hospitals are likely to lean heavily on hospitalists to help improve the discharge process. As part of the effort to avoid readmissions, the hospitalist would become the point person making contact with patients after hospital discharge to ensure that they follow their treatment plans, said Dr. Angus, a past president of the Society of Hospital Medicine and founder of MD On Call, one of the first hospitalist groups in Dallas.
An emphasis on pay for performance in health care reform legislation is also likely to mean that hospitalists will take on a larger role in ensuring that their hospitals have health information technology systems in place. Such systems can analyze data about care provided and submit it to government pay-for-performance programs.
Many eyes will be on hospitalists if such reforms are implemented, Dr. Angus said. “We all need to take a deep breath over the next 3 months,” he said. The initial challenge will be to pay close attention to Congress this summer as legislators begin marking up the first pieces of health care reform legislation. It's essential to be involved when the bills are being drafted, rather than waiting until they become law.
Hospitalists are uniquely positioned to carry out quality improvement changes in the hospital, and if all goes well, physicians from many other specialties and in other settings of care will be looking toward hospitalists as leaders, he said.
The next challenge will be to manage the workflow so that hospitalists don't become overwhelmed, Dr. Angus said. Many hospitalists are feeling squeezed already as their role in the hospital evolves and expands.
When Dr. Angus started in hospital medicine in 1992, before the term hospitalist was in use, he envisioned his job as being a primary care physician who worked only in the hospital. Today, his role has grown to include new areas, including comanagement of complex patients and involvement in systems changes. He offered a word of warning to new hospitalists, who can find themselves taking on unforeseen tasks: “Be careful with what you say yes to, because those yeses will pile up quickly as the facilities you work at realize how valuable you are.”
To avoid burnout, it's critical to avoid taking on more than you can manage, Dr. Angus advised. Don't expand your services until you have the staff to handle it. And develop a plan for your growth that covers more than the next 6 months, including the potential for new health policy mandates.
Physicians from many other specialties and in other settings will be looking toward hospitalists as leaders. DR. ANGUS