“Something ignited the fire within me to be a hospitalist,” she says. “I knew I could reduce bed days and increase patient satisfaction because I wouldn’t be in a rush when I saw patients.”
She sent resumes to hospital administrators, colleagues, and her mentor, who introduced Dr. Borik to North Hollywood, Calif.-based IPC-The Hospitalist Company. Dr. Borik and two other physicians launched IPC-Phoenix at Phoenix Arizona Heart Hospital, generating initial referrals by knocking on primary care physicians’ doors, offering to cover night call and vacations. They agreed to take all unassigned patients at the hospital. “We did things that didn’t threaten other doctors. Only what would make their lives easier,” she adds.
Much has changed since the program’s launch. All IPC physicians now use PDAs with proprietary software, leading to 100% compliance with billing, and discharge reports sent directly to primary care physicians. Call centers contact every patient within 48 hours of discharge to follow-up on recommendations. Recognizing that becoming a hospitalist is a difficult transition for any physician, IPC has a six-month orientation period, especially vital for doctors just out of residency.
“We helped kick off this medical specialty,” says Dr. Borik. “What a great feeling that is.”
—Michael Pistoria, DO
Second Time’s a Charm
Sometimes all the planning for a hospitalist program doesn’t produce expected results, and the launch has to be rethought. Mark Krivopal, MD, director of the Hospitalist Program at Beth Israel Deaconess (BID), Needham (Mass.) faced that challenge. Although BID’s main hospital (an academic medical center) had a thriving hospitalist program, the first attempt three years ago to start one at BID-Needham, a 45-bed community hospital, went awry.
“The community physicians didn’t want to cover night call so they hired third-year residents and moonlighters to do so,” says Dr. Krivopal. “There were problems: no 24/7 coverage, the residents capped the number of admissions and called the medical staff to come in beyond that number, the billing system was sub par, and the community doctors felt they were overcharged.”
The program foundered and BID went back to the drawing board with an internal request for proposals to hospital medicine groups. Dr. Krivopal’s group, Affiliated Physicians Group Hospitalists, proposed a program starting with three hospitalists taking referrals from seven of Needham’s medical groups already familiar with them. They eliminated caps on admissions, implemented 24/7 coverage, fixed the billing system, started covering the seven-bed ICU, and decreased moonlighters’ hours.
Twenty medical groups now use Affiliated Physicians Group Hospitalists. As for relationships among the hospitalists, Dr. Krivopal aims for democratic decision-making held over quarterly dinners, frequent e-mails to share information and derail hidden agendas, and financial incentives that reward a steady increase in ADC. He has integrated hospitalists into BID-Needham’s committees, including the executive committee, P&T, medical review, and patient safety. “It’s not billable hours, but committee work gives us knowledge of what goes on in the hospital, from A to Z,” he concludes.
The hospitalists at Dallas’ Presbyterian Hospital also did better the second time around. In 1992 local physicians grew tired of night admissions; they paid two residents to cover for them and then billed payers. Several years later the referring physicians became unhappy with these arrangements and approached the hospital to start a hospitalist service. In 1997 Scott Fitzgerald, MD, who was then chief resident, contemplated the debt and hassles of opening an office, saw a good fit for Dallas Presbyterian’s need for a hospitalist service and his professional goals. He founded MD on Call, a private hospital medicine group, which still serves Dallas Presbyterian and now employs 16 hospitalists. Having experimented with staffing for a 180 patient load, each physician has an ADC of 12-13. “We keep it lower than most groups’ 16-20 patients,” says Dr. Fitzgerald. “Because I scrutinize quarterly data I know that above 16 our costs and LOS creep up.”