Dr. Li does not believe these funding questions will affect the bottom line for his hospitalist group because their compensation is based on productivity, as measured by relative value units (RVUs).
The next 10 months or so leading up to the July 1, 2007, deadline for purchase of individual health insurance policies will be revealing for consumers and physicians alike. Although the devil will be in the details, Dr. Lee notes, “The big picture is not uncertain. We know there is going to be more transparency, more data, on quality and efficiency.”
That means that hospitals’ delivery of care will endure more scrutiny, and that pay for performance will become commonplace.
The influx of patients into the healthcare system, which legislators hope will be a consequence of greater access to care, will necessitate some consciousness-raising for hospitalists, Dr. Allison maintains. While hospitalists already work closely with other providers on the multidisciplinary team (social workers, case managers, and primary care physicians), they will have to strengthen those collaborations to ensure that patients don’t fall through the cracks. Community outreach may become part of the hospitalists’ job description.
For example, he explains, many preventive or follow-up services that are now being performed in the hospital because patients have no primary care physicians can now be referred to outpatient sites. “Now that these people will have doctors and will be tied into the healthcare system, these services can be performed in the right setting, instead of using more expensive inpatient resources,” he says.
Steering patients to community-based preventive services, such as early cardiac and cancer screenings, will fall to hospitalists, who will be “on the frontlines seeing these patients and referring them appropriately as they leave the hospital,” says Dr. Allison. Hospitalists and all providers will also be evaluated by how well they deliver culturally competent care—another mandate of the statute. To steer through these changes, hospitalists must become much more conscious, he says, of costs, communications, referrals, and resources. “That, as far as I can see, has not been a major emphasis of hospitalist literature or debate.”
A Role to Play
Dr. McKean and others contend that by virtue of their skill set and core mission, hospitalists will have much to contribute toward moderating the costs of healthcare. “The good news for hospitalists,” says Turnbull, “is that if we’re successful in providing health coverage to many people who are now uninsured and if that coverage is adequate there should be more people receiving primary and preventive care and services. This should prevent them from needing to go to the hospital in the first place. We should also be able to create more rational systems of care for people, so that when patients are in the hospital, they need to be there, and they can take full advantage of the talents and contributions that hospitalists make.”
Dr. Kingsdale agrees with the assessment that hospitalists will have a potentially significant role to play in improving the delivery, efficiency, and quality of care, as well as reducing medical errors. He hopes the new insurance products generated by companies will include financial incentives for hospitals and other providers who will be doing “the difficult work of changing their systems of care.”
“The healthcare system really has to improve,” asserts Dr. Lee. “In our organization, we say that we need both an industrial revolution and a cultural revolution, where we develop and use systems that reduce errors. There are electronic records and other industrial systems, and then there are human-ware systems, like hospitalists and disease management programs.”