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Beyond Making the Rounds: Hospitalists & Quality of Care under the ACA

By now, everyone knows the Affordable Care Act’s (“ACA”) motto is “increase quality, decrease costs.” As providers transition from the fee for service payment model to new payment systems that are tied to quality, one subset of providers will play a pivotal role in bringing health care into a new era: hospitalists.

Hospitalists (physicians who provide care solely to hospital inpatients) are poised to lead the way in ensuring that patient care is no longer a series of disconnected dots, but rather a continuum of ongoing service. As primary care providers (“PCPs”) and subspecialists increasingly limit time set aside for hospital visits, it is up to hospitalists to improve inpatient efficiency, manage patient expectations and coordinate the overall inpatient experience. The unique nature of hospitalists, still a recently new specialty, makes meeting the lofty expectations of the ACA more attainable.

There are a number of ways that the ACA is emphasizing quality care: (1) integrating care through the creation of more Affordable Care Organizations, Patient Centered Medical Homes and even electronic health records; (2) incentivizing positive patient outcomes, for example the Medicare Advantage program now issues bonus payments to plans with four or five star ratings, and CMS has expanded this to additional plans while also increasing bonuses and also rewarding plans for improvement in their star ratings; and (3) reducing cost through programs such as Medicare’s Hospital Readmissions Reduction Program, which is designed to ensure that hospitals only discharge patients when they are fully prepared and safe for continued care at home or at a lower acuity setting and penalizes hospitals with excessive rates of readmission within 30 days of discharge. Hospitalists are vital to hospitals wanting to ensure they receive the full amount of Medicare payments for several reasons including, but not limited, to those explained below.

Presence

Because hospitalists only work within the walls of a hospital, they have the undeniable appeal of simply being present when needed. In the past, a PCP would be taken away from his practice to make hospital rounds – leaving an inpatient waiting for the physician’s arrival and an outpatient waiting for his return. This practice led to unresponsiveness and unnecessary lulls in care. Now, because a hospitalist is located at the hospital 24/7, inpatients can be seen by a physician repeatedly throughout their stay. Likewise, a PCP is left with more time and energy to dedicate to outpatients, thus raising the quality of care in both settings.

The Home Field Advantage

As a result of this constant presence, hospitalists enjoy a familiarity with the hospital setting that PCPs may not. By knowing how a hospital is run on a day-to-day basis, hospitalists can improve integration and coordination of services provided by di?erent departments while increasing efficiency, establishing protocol, and demanding accountability in the inpatient setting. Because the hospital is “home,” hospitalists are more likely to serve on committees or spearhead projects for the betterment of the hospital.

Accountability

Hospitals generally are limited in the control they can exercise over PCPs. Other than granting or denying hospital facility privileges, a hospital has little authority to manage behavior or measure performance. By employing directly or contracting with hospitalists to provide services, hospitals can ensure their rules and authority are followed. By sharing a unified vision and common principles, specific quality indicators can be more easily met.

On Thursday, I'll discuss the PCP's evolving role for inpatient care, so be sure to check back with us!

This article is intended as a summary of federal and state law and does not constitute legal advice.

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