Hospitalist In-patient Management

Hospitalists have made great contributions to in-patient management. What is not mentioned as one of their achievements is improving relations with hospital administration. This love-hate relationship is often based on need and necessity rather than purpose or aligned goals. At least economically speaking, the hospital and physician interests run in opposing directions. For example, for diagnosis related grouping based reimbursement, hospitals want to discharge patients home as soon as possible. Physicians, on the other hand, are paid on a fee for service model with obvious financial loss with early discharge. Added to this, are the competing interests of providing services in the hospital versus in an office. I vividly remember the heated department of medicine meeting I chaired years ago, when the hospital first started giving Pneumonia vaccines to the in-patients.

There is also difference of opinion about physician behavior, rounding time, representations on board and medical executive committees, payment for emergency room unassigned call, payment for serving on committees, and various other administrative responsibilities. Control over hospital bylaws, governance, and financial transparency are usually the cause of these conflicts. With this background information, it is easy to understand the mistrust and suspicion inherent in this relationship. It is in fact surprising that physicians and hospitals are able to work together while maintaining a façade of civility. In one recent article, this relationship was compared to that of the Cobra and the Mongoose, leaving the identities of who is who undeclared.

What hospitalists bring to table is alignment of interests. With physician income often liberated off the length of stay, hospital and physician interests are aligned in the same direction. Being in the hospital all the time, physicians are able to find time to participate and lead committees, spearhead quality initiatives, participate in governance, and help hospitals with emergency room boarding, patient satisfaction, and hospital bylaws. There is definitely a new chapter in the relationship. Since the goals and interests are aligned, they often work together as business partners rather than competing groups forced to work together on a project. While this honeymoon lasts, both parties need to cement this relationship and establish a platform from where this can only get better. The underlying reasons of this improved relationship could be setting goals and targets together (physician buy in), frequent face to face meetings, involvement in hospital processes, and transparency of numbers. Perhaps the same good will and courtesy could be extended to the rest of the medical staff as well. The hospitalists otherwise run the danger of being seen as the arm of hospital administration, rather than as part of the physician faculty.