The cost and quality of hospitalists.

Abstract

The Hospitalist concept is becoming the standard of practice as managed care penetration grows. It is increasingly difficult to do a good job in the outpatient arena and this makes the old "double threat" model in which the physician speeds through inpatient rounds in the morning before clinic, during lunch, and again at night after his office closes, obsolete. There is simply too much at stake in the inpatient arena to have large periods of time in which physician coverage is minimal. Controversy exists as to whether or not the services should be "outsourced" to a Hospitalist management company or developed internally, using physicians who historically have had a significant presence in the hospital. If the services are outsourced, then it is essential that they be built around a strong local physician leader who remains active in patient care. The French author, Anais Nin wrote: "There are very few human beings who receive the truth, complete and staggering, by instant illumination. Most of them acquire it fragment by fragment, on a small scale, by successive developments, cellularly, like a laborious mosaic." Inpatient care in the United States is adequately described as a laborious mosaic in which providers of many different services surround patients with many different problems. Hospitalist programs can help to bring order to the mosaic by consistently combining the correct physician talent with the system's sickest and most expensive patients in order to achieve the best possible outcomes.