Use of hospitalists growing in LV

Michelle Swafford

Monday, Feb. 28, 2005 | 10:49 a.m.

Physicians who specialize in treating hospital patients are increasing in number in the Las Vegas Valley but remain less common than in other metropolitan areas.

Called hospitalists, these physicians are generally internal medicine specialists who spend the majority of their time caring for patients from hospital admission to discharge even if they have their own primary care doctors.

There are several reasons why hospitalists are gaining popularity including financial and time savings and improved patient safety. Hospitalists typically work for private companies and are contracted by hospitals, insurers and other doctors.

A recent study by the Center for Studying Health System Change reported that the number of hospitalists has increased from a few hundred in the mid-1990s to more than 8,000 in 2003.

The center is a nonprofit, nonpartisan organization funded primarily by the Robert Wood Johnson Foundation. The study focused on hospitalists in 12 cities including Phoenix, Boston, Cleveland, Indianapolis, Seattle and Little Rock, Ark.

The frequency of hospitalists in the hospitals that were studied varied from 5 percent at a Miami hospital to 100 percent of nonintensive care unit patients at a Phoenix hospital.

In the Las Vegas Valley -- which was not part of the study -- insurers such as Sierra Health Services Inc., Aetna Inc., NevadaCare Inc. and PacifiCare Health Systems Inc. use hospitalists. University Medical Center also uses hospitalists in its emergency room.

There are several local companies providing the physicians, including IPC -- The Hospitalist Company, which is based in North Hollywood, Calif., and opened a Las Vegas office in September with six hospitalists.

Steve Peterson, executive director for IPC Las Vegas, said local hospitals are more inclined to contract for specialists such as anesthesiologists and radiologists than hospitalists, but that is likely to change in the coming years.

One of the reasons hospitals have not looked to hospitalists is because many doctors want to be on-call in emergency rooms because they are trying to build their practices in the Las Vegas Valley, he said.

"In other communities like Phoenix, doctors don't want to take call," Peterson said. "They find it more efficient to work in their offices and have a hospitalist take call."

It is estimated that between 25 to 30 percent of admitted patients in medical-surgical beds are cared for by a hospitalist and that share will likely more than double in five years to improve cost and quality, Peterson said.

Other hospitalists providers include: local large medical groups with their own hospitalists network and Inpatient Physicians Network, a subsidiary of Pinnacle Health System LLC in Las Vegas. It was established in 1999 and has more than 30 hospitalists who work on behalf of Sierra Health, PacifiCare, Aetna and a few employers and unions.

Hospitalists provide cost savings to health plans, time savings to primary care doctors and both types of savings to patients.

Clark County-owned University Medical Center contracts hospitalists for emergency room patients who do not have a primary care doctor and says the specialized doctors have been an asset to the hospital and patients in the last 1 1/2 years.

"If a physician is right here on a regular basis, he or she understands how to most efficiently access care within that system,"said Kathy Silver, associate administrator of managed care and business development for UMC.

With hospitalists, the patients' length of stay is shorter and fewer services and tests are repeated, all of which saves money, Silver said.

"Medicare pays a flat fee for a particular diagnosis and there's an expected length of stay with that diagnosis," Silver said. "If you're able to achieve efficiency and that patient goes home early, then that's a better financial outcome for the hospital."

For doctors, "it's an expensive proposition to go to two-to-three hospitals for rounds in a day," she said. "That's two or three hours he can't be in the office. I think the physicians would like to be able to do that, but economically it doesn't make any sense."

Dr. Christine Peterson, vice president and chief medical officer of Sierra Health Services Inc., said her company started using hospitalists about six years ago and has 21 that are employed as part of the company's medical group, Southwest Medical Associates.

"Medicine is complex enough now that we're needing to separate the inpatient care and the outpatient care," she said. "They're (hospitalists) there all day and see more cases of heart attacks, of clots in lungs. When you do things repetitively you become more efficient, quicker and more proficient. Your results are better."

Sierra also appreciates patients' shorter lengths of stay, Peterson said.

"Patients like that. Health plans like that, Medicare likes that. It's safer for the patient as well as less expensive," she said, adding that shorter hospital stays mean fewer chances of a medical error or hospital infection.

The Culinary Union Local 226 and MGM Mirage contracted with IPN and Freemont Medical Centers for hospitalists in November to improve communication and efficiency, said Dr. Jerry Reeves, president of Las Vegas benefits operations for the Culinary Health Fund.

"In the surveys that are done of patients that have been recently hospitalized, the number one problem identified by the end patients was that they did not receive timely or adequate answers to their questions about their condition; about what's happening next," Reeves said. "The patients and family were confused about who's in charge and who can answer my questions."

Some cite communication with primary doctors as a drawback to hospitalists, but hospitalist companies say they addressed that by giving informational pamphlets to patients and sending regular patient updates to primary doctors.

"They've gone out of their way to overcome that lack of continuity and it really has worked well based on the systems they have in place," said Dr. Richard Jones, Aetna medical director for Arizona and Nevada. "We entered into an agreement with IPN in 2001 and since then we have noticed that the hospitalists are, in general, more efficient than the general physician population because they are a subspecialty of hospital care."

Having a different doctor for inpatient and outpatient care sometimes confuses patients, hospital officials say.

Tim Hington, CEO and managing director of Summerlin Hospital, said the name hospitalists sometimes misleads patients into thinking hospitals employ them.

"The No. 1 question we get from people is why can't my doctor take care of me on the inpatient side," he said. "It's just a different model of care. They're getting very good care."

Universal Health Services Inc.-owned Summerlin Hospital uses hospitalists in cases where insurers provide them and that is not likely to change, Hington said.