Comparison of Hospital Costs and Length of Stay for Community Internists, Hospitalists, and Academicians

Abstract

BACKGROUND:The model of inpatient medical management has evolved toward Hospitalists because of greater cost efficiency compared to traditional practice. The optimal model of inpatient care is not known. OBJECTIVE:To compare three models of inpatient Internal Medicine (traditional private practice Internists, private Hospitalist Internists, and Academic Internists with resident teams) for cost efficiency and quality at a community teaching hospital. DESIGN:Single-institution retrospective cohort study. MEASUREMENTS AND MAIN RESULTS:Measurements were hospital cost, length of stay (LOS), mortality, and 30-day readmission rate adjusted for severity, demographics, and case mix. Academic Internist teams had 30% lower cost and 40% lower LOS compared to traditional private Internists and 24% lower cost and 30% lower LOS compared to private Hospitalists. Hospital mortality was equivalent for all groups. Academic teams had 2.3-2.6% more 30-day readmissions than the other groups.CONCLUSIONS: Academic teams compare favorably to private Hospitalists and traditional Internists for hospital cost efficiency and quality.

Comparing Patient Outcomes of Academician-Preceptors, Hospitalist-Preceptors, and Hospitalists on Internal Medicine Services in an Academic Medical Center

“…[1][2][3][4][5][6][7] Among these models, practice specialization in inpatient medicine has gained broad acceptance in medicine and pediatrics, [8][9][10] yet the impact of "hospitalist" physicians on quality of care remains unclear. A recent meta-analysis 11 reported a small but statistically significant reduction in length of stay (LOS) compared to non-hospitalists, but no cost reduction.…”

“…3,19,20 . Thus, it is Electronic supplementary material The online version of this article (doi:10.1007/s11606-014-2982-y) contains supplementary material, which is available to authorized users.…”

Non–housestaff medicine services in academic centers: Models and challenges

“…Their involvement in patient care may produce reductions in length of stay, greater efficiency in discharge planning, and significant cost savings. [35][36][37] Hospitalists may also improve throughput in emergency departments and decrease wait times, leading to more efficient bed utilization. 38 This leads to a potential for greater hospital revenue by increasing both the number of admissions, particularly surgical cases, and staffed inpatient beds, the latter a premium, as AMCs continue to expand their bed capacity almost annually.…”

“…Table 2 provides no data on the quality or efficiency of housestaff versus non-housestaff services, though this type of investigation is underway and will be critical in future planning. [39][40] Table 2 does illustrate several important considerations in structuring non-housestaff services. For example, if a non-housestaff service operates at a different physical location, careful triage of patients is necessary.…”

Inpatient Care Is an Important Part of Family Medicine

“…Furthermore, evidence suggests that while hospitalists may provide modest cost efficiency, they do not improve on the quality of care provided by community physicians. 2 It may well be time to examine how inpatient care is taught. Work hour rules, short stays, high patient volumes, and documentation requirements are certainly affecting how much medicine is being learned by inpatient residents.…”