Dr. Likosky and fellow neurohospitalists Dr. Josephson and W. David Freeman, MD, assistant professor in the department of neurology and critical care at the Mayo Clinic College of Medicine in Jacksonville, Fla., offered the first neurology precourse in April at HM10 in Washington, D.C., and more and more hospitalist meetings are including neurohospitalist courses on their schedules.
Increased education also is a benefit of Mount Sinai’s adaptation of the MACE concept, Dr. Farber says. Because the hospitalist-run MACE patients are located throughout the hospital, the team conducts nursing grand rounds to educate other hospital staff about geriatrics-centered HM principles.
This represents a transformation of the way an academic medical center is structured. We’ve traditionally prioritized research ahead of patient care, but this model is inverting that. It is patient-centered, making them the priority.
—John Maa, MD, FACS, assistant professor, Department of Surgery; assistant chair, Surgery Quality Improvement Program; director, Surgical Hospitalist Program, University of California at San Francisco
Economies of Scale
Dr. Fox, the dermatology hospitalist, is the first to admit that UCSF’s practice model probably works best in a large, tertiary-care, academic medical center. However, the potential exists for extension into rural settings with telemedicine models and trained physician assistants or nurse practitioners, she notes.
Dr. Farber agrees the HM model is adaptable to a variety of medical specialties; he foresees geriatric hospitalists working in community settings. “Even in smaller hospitals with fewer discharges, there will be a sizable subset of admissions of patients at risk for high utilization of resources,” he says. “Many of Medicare’s hospital-acquired conditions are geriatrics-related, such as catheter-associated urinary tract infections, central-line infections, and falls. The investment [in geriatrician-hospitalist teams] could be justified if you track the outcomes of these high-risk patients over time and see whether you’re reducing length of stay, direct costs, and readmissions.”
Dr. Likosky says the benefits of the neurohospitalist model closely mirror those of the HM model, and although volumes are lower, the benefits “remain significant even in relatively small hospitals.” His American Academy of Neurology (AAN) survey backs up this observation: Neurohospitalists were about evenly split between academic and private settings (49% and 51%, respectively). “Unlike dermatology, neurologic diagnoses are very common as either a primary or secondary reason for admission to the hospital,” Dr. Likosky says.
In the community setting, surgical hospitalist programs provide a new answer for ED call coverage, Dr. Maa says. Surgical practices often approach the medical center leadership to negotiate a stipend, then contribute salary support so that a new surgeon can be recruited to join the practice. This physician—usually a younger surgeon—then is hired in the role of a surgicalist so that timely patient care and surgeon availability can be ensured.
In rural settings, however, even this model might not be feasible, Dr. Maa says, because surgical practices could be comprised of only one or two surgeons. “We will have to think differently about telemedicine, telesurgery, and having ERs equipped with video monitors so that the ED physician can examine the patient while a surgeon, at a remote centralized area, can provide input,” he says.
Adoption of the hospitalist model by other specialties shows no sign of slowing down. That’s good news for HM and patient care, Dr. Maa says.
“This represents a transformation of the way an academic medical center is structured,” he adds. “We’ve traditionally prioritized research ahead of patient care, but this model is inverting that. It is patient-centered, making them the priority, and answers the question, ‘How can we reconfigure what we have to take better care of patients?’ And that’s why I think we’ll succeed.” TH