Saturday, December 22, 2012

What's Old Is New Again; The Plateau Of Hospitalism

Wait long enough, and what's considered old will be new again.

The other day I was talking to a shrewd hospital administrator about the upcoming changes to our health care system.  His eyes shown brightly as he proclaimed that now the name of the game was integration, enhanced communication.  Why, in a matter of months the hospital would connect their EMR to the EMR of a number of skilled nursing facilities.  Not only would that help the hospital qualify for meaningful use, it would usher in an era of higher quality and vertical integration.

Following his arguments, I wondered out loud.  Although talking EMRs are wonderful, something is lost in translation when care is handed from one physician in one institution to a completely different physician in another.  What if the hospitalists rotated through the local nursing homes and continued care in the post hospital setting.  The administrator carried it even further, maybe those same hospitalists could also have a few hours of clinic time each week to follow up with newly discharged patients.  That way, continuity and communication could be maintained through the whole spectrum of care.

He was really excited now, and started to dream about how his institution could rocket past his competitors into a new, efficient, quality driven model with zero voltage drop and minimal hand offs.  The foibles of EMR generated communication gaps would be solved.  Why mess around with making these huge, complex, voluminous systems talk when the real knowledge could remain in one or a small number of physicians heads.  The ultimate accountable care organization.

I couldn't help laugh as I pretended to seriously ponder his suggestion.

You mean...the same doctor would take care of the patient in the hospital, nursing home, and outpatient settings?

He nodded his head vigorously as I continued.

You mean, like the system we had before the invention of hospitalists?

It took only moments to realize that I was teasing him.  But as I walked away, I could see the confused look on his face as he pondered the reality of what I had just convinced him of.

The truth is, few people still believe that hospitalists provide more efficient or cost effective care.  When taken as a whole, the studies suggest that when the costs of hospital and post hospital care are added, it comes out a wash.  So why do we continue with the hospitalists model?  Simple:

1)Hospitalists are great at implementing quality control initiatives and populating the EMR.
2)Hospitalists make eveyone's life easier, and allow primary care physicians an out from the arduous work of inpatient care.
3)Young physicians want to be hospitalists because of work life balance and the ease of having no long term responsibilities to patients.  When your shift is over, your pager gets turned off.

I don't think the hospitalist movement is going anywhere.  For better or worse, it is a model that is here to stay.  But I think it's reached it's plateau.  The new political goal is integrative care over multiple settings.

No one beats the primary care physicians of old at that game.

1 comment:

jimbo26 said...

What goes around comes around .