Despite operating mostly in community hospitals, Dr. Goldsholl has fielded more queries from academic medical centers (AMCs) in the past several years.
“We’re definitely getting more interest from AMCs,” Dr. Goldsholl notes. “The work-hours restriction on residents—faculty who are uninterested in being hospitalists—whatever is driving their interest, they’re looking for solutions for handling their unassigned patients and beyond. To outsource to a private hospitalist company, an academic medical center would have to be in some pain, but interest is definitely picking up.”
Cogent Healthcare’s June 2006 contract with Temple University Hospital (TUH), Philadelphia, to provide a 24/7 hospitalist program of teaching and non-teaching services is another example of hospitals striving for efficiency. To better reach its clinical, economic, and regulatory goals, TUH switched from its own academic hospitalist group to partner with Cogent to manage its adult medical/surgical population. It’s too soon to gauge the results.
Despite stakeholders’ need to know more about which hospitalist group structure is most efficient, there’s little published data on AMC versus private group efficiency. One important study, published in the American Journal of Medicine (AJM) in May 2005, compared an academic hospitalist group with a private hospitalist group and community internists on several efficiency measures. The academic hospitalists’ patients had a 13% shorter LOS than those patients cared for by other groups and academic hospitalists had lowered costs by $173 per case, versus $109 for the private hospitalist group. The academic hospitalists also had a 20% relative risk reduction for severity of illness over the community physicians.
Lakshmi Halasyamani, MD, the AJM study’s lead author and chair of the Hospital Quality and Patient Safety Committee for SHM, speculated that the academic hospitalist groups’ efficiency resulted from fewer handoffs and that academic hospitalists’ relationships with their hospitals were more aligned than those of outsiders, both from financial and quality perspectives. Additionally, the academic hospitalist group used the hospital’s computerized physician order entry system and followed its protocols for clinical pathways and core measures. Scheduling also made a difference. The academic group worked in half-month blocks for an average of 14 weeks, while the private hospitalists worked from 8 a.m. to 6 p.m. on weekdays and some nights and weekends, leaving moonlighters to cover 75% of nights, weekends, and holidays and providing for rockier handoffs.
Another study comparing a traditional pediatric faculty group with two private hospitalist groups at St. Joseph’s Hospital and Medical Center of Phoenix showed that the faculty group outperformed the private hospitalists on all measures.
The authors concluded that faculty models can be as efficient as or more efficient than private groups in terms of direct costs and LOS.
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Fine Tuning
Although academic hospitalist groups have been thought of as less efficient than private hospitalist groups because the former tend to use salaried employees while the latter tend to compensate employees based more on performance, the data cited above indicate academic hospitalist groups may have a competitive edge with regard to efficiency. What may account for the difference is that academic hospitalists are familiar with and often products of their hospital’s culture and mores. Unlike physicians working for private hospitalist groups with their own structure and culture, academic hospitalists are of a piece with their hospital. It’s common to find academic hospitalists who return to their medical school alma mater after a stint in an office-based practice. Some never left, joining the academic hospitalist group directly from residency.
For the chief of a hospitalist program, being so attuned to the hospital’s rhythms can be a mixed blessing.