WASHINGTON The explosive growth of hospitalists has caught the notice of the Medicare Payment Advisory Commission, which advises Congress on cost, quality, and access issues affecting the federal health program.
The number of hospitalists has nearly doubled in the last 5 years and will rise to 24,000 in 2008, according to information presented by MedPAC staff at a recent meeting. Citing figures from the Society for Hospital Medicine, the staff said that 40% of Medicare beneficiaries will receive care from a hospitalist by 2010, which is double the current number.
The MedPAC staff and some of the commissioners expressed concern that the explosion of hospitalist care could increase Medicare's overall spending. According to the staff, hospitalists are usually compensated through a combination of fixed salary and volume-based bonus incentives.
Those volume-based incentives may be driving hospitalists to admit and consult more often, said Zach Gaumer, a MedPAC staff memberand currently, he continued, Medicare's payment system rewards volume, not quality and efficiency.
Hospitalists have shown that they can "create measurable efficiency gains," he said, citing a study that showed that patients treated by hospitalists had a shorter length of stay and lower costs than those who were looked after by a general internist or family physician (N. Engl. J. Med. 2007;357:2589600). There seemed to be no impact, however, on mortality or readmissions, said Mr. Gaumer.
The consistent presence of a hospitalist, however, may improve patient safety and lead to quicker adoption of process-improvement initiatives, he added.
On balance, the collaboration between hospitals and physicians can be a plus for providers and patients, said MedPAC staff member Ann Mutti.
The commission should aim for Medicare incentives that encourage appropriate care and the right mix of care, she said.