Dr. Oxenhandler has contemplated pursuing managed care contracts but hesitates because his hospitalist group’s clinical and cost performance is equal to that of the hospitalist group that currently holds such contracts. “Why should they switch to us unless we can outperform the other group?” he muses. “Plus, there would be added cost for us in more paperwork and administration, and we’d have to improve our efficiency to make it worthwhile.”
Per Danielsson, MD, Swedish Medical Center’s Adult Hospitalist Program’s medical director, has hospitalists rotating among the First Hill, Cherry Hill, and Ballard campuses in Seattle, Wash. Demand for hospitalist services at the sites keeps growing, and Dr. Danielsson sees no end in sight. “Today’s hospital stays are getting shorter, and the patients are sicker, and there is increasing pressure for greater efficiency here,” he says.
Overall, clinicians, administrators, and researchers need to zero in on the organizational factors of hospitalist groups—from scheduling to 24/7 coverage, handoffs, and use of in-hospital resources—to improve efficiency. At present, academic hospitalist groups appear to have a slight edge because they’re tied more closely to hospital personnel, technology, and care pathways than private groups that come from outside the hospital. But there isn’t enough data either way to say which group type is the most efficient. TH
Marlene Piturro is a frequent contributor to The Hospitalist.