Report Raises Questions On Hospitalists' Costs

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The rising cost of health care is one of the things weighing on government coffers. We're going to look now at how a new kind of doctor factors into that cost. A hospitalist cares for patients who are in a hospital instead of the patient's own personal physician.�

As NPR's Julie Rovner reports, a new study finds that the popularity of hospitalists doesn't necessarily do what many had hoped it would do - save money.

JULIE ROVNER: For a specialty that was basically invented in the 1990s, hospitalists have spread incredibly fast. James Goodwin is a geriatrician at the University of Texas in Galveston.

Dr. JAMES GOODWIN (Geriatrician, University of Texas, Galveston): Probably 30 or 40 percent of patients who go in the hospital are taken care of by physicians who just work full time in the hospital.

ROVNER: The idea is that because hospitalists are around the hospital all the time, and familiar with the way the place works, they'd get patients taken care of better and more efficiently. Goodwin says there's evidence that's been the case.

Dr. GOODWIN: Some of the early studies of hospitalists showed that they got their patients out quicker. And how long you stay in the hospital is the major driver of cost.

ROVNER: But Goodwin and a colleague wanted to know what happened to those patients after they left the hospital. So they looked at the records of Medicare patients. Lots of Medicare patients. And they found something surprising.�

Those who were cared for by hospitalists were more likely to be readmitted within 30 days or to visit the emergency room than those who were cared for in the hospital by their regular doctor.�

Dr. GOODWIN: When you expand it to all hospitalizations nationally that hospitalists are caring for, then Medicare's spending about a billion extra dollars in post-hospital costs.

ROVNER: The main reason is that hospitalists are more likely to discharge patients to a nursing home or rehabilitation facility and less likely to send them straight home.

But Joseph Li, president of the Society of Hospital Medicine, which represents hospitalists, says the problem might be that those patients going straight home aren't getting enough care. And those going to nursing homes or other facilities are getting the right amount.�

Dr. JOSEPH LI (President, Society of Hospital Medicine): These patients are being monitored 24/7 by healthcare providers. Many of these patients being sent back are being appropriately sent back to the hospital for evaluation.

ROVNER: There is one thing that everyone agrees on - hospitalists need to do a better job coordinating with patients' regular doctors. The study appears in the current issue of Annals of Internal Medicine.

Julie Rovner, NPR News.

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