Do hospitalists increase costs?

I wrote a post in my blog addressing this very issue. I titled it Do hospitalists boost costs? - a reality or fiction? This is based on a fresh-from-the-oven article written in Annals of Internal Medicine where it was shown in a large cohort of Medicare patients that care associated with hospitalists yielded a shift in the healthcare expenditure from inpatient to outpatient.

Nobody can deny the impressive statistical methodology behind this article, however, not because I want to be irrationally defensive or be the devil's advocate, I do think there are multiple limitations in the study that should make the general reader cautious and avoid taking precipitous assumptions and conclusions.

It is important to acknowledge the value of this article in the current state of USA economy - a substantial amount (~40%) of the budget goes into insurance (which includes Medicare and Medicaid). Therefore when the authors conclude that Medicare admissions cared by hospitalists may represent and additional 1.1 billions in Medicare costs per year, it is a very serious and frightening statement.

In the search for the perfect model of healthcare, so far it has been assumed that hospitalists decrease costs; but if this is proven otherwise, it may be a hard bite to swallow.

I have several thoughts in my blog post. First of all, the study period is quite far away, and practices have shifted and evolved. In addition, there are more and newer markers of quality of care that are definitely not included in this article. Third, the healthcare system ion USA is living a paradigm shift where the evolution toward a Patient-centered medical home is an ongoing process and where bundled payments may in fact become the standard of cost containment methods and create very different situation than the one which the article concludes.

I think that in the search of transparency and accountability, and search for self-improvement, this article is a breath of fresh air - it should give place to reflection and careful analysis - we can show our value and newer studies may need to be done including newer metrics of quality and patient outcomes. This should not trigger a defensive attitude, but rather an analytical and philosophical one. We can in fact, appreciate it as an opportunity to look into newer ventures for improvement. This is how this movement was created, and this is what drives our movement - the continuous insight to become better and add increased value to healthcare and society.

An increased insight perspective into quality and safety - Musings of a hospitalist

In the current era of Medicine, hospitalists are in the front line of improvement and innovation in quality of patient care and safety. I'm unsure whether this is an unwanted privilege or honor; however, certainly, our job in the extremely complex environment that a Hospital pose, make us witnesses and actors in this fascinating and challenging journey that is the patient safety.

Hospitals by definition are dangerous places. The patients are very sick, the healthcare providers are overworked, the duty hours are demanding, but in addition there are multiple levels at which errors can occur. It is our responsibility to identify those errors and pursue a proactive role in attempting to minimize any preventable error. We need to be humble. Knowledge can easily overpower us. It is impossible to master all knowledge, and in pursuit of the best of patient care, sometimes it is not knowledge, but organization, time to think, good documentation practices, and evidence-based simple practices (such as using checklists, washing hands, etc.) which will allow patient care to be safer.

In this blog post, I discuss on some thoughts that my recent ventures into patient quality and safety have inspired me.

As I concluded in the blog post, "we all need to be on board of the train of safety and quality, as this journey will be the most exciting ever, and as a hospitalist, we are passengers in the First class coach."