Home From The Editor Hospital medicine’s bad press

Hospital medicine’s bad press

September 2011

Published in the September 2011 issue of Today’s Hospitalist

This year’s batch of studies has brought some harsh news for hospitalists. After years in which hospital medicine has chalked up fairly glowing evidence, recent research is either giving hospital medicine some low marks or sending hospitalists back to the drawing board to rethink key elements of their job.

This month’s cover story, for instance, looks at a study that concluded that hospitalist care costs more than that provided by primary care physicians who follow patients into the hospital. (The hospitalists saved inpatient dollars, but their patients had higher post-discharge costs.) Because saving money has always been one of hospital medicine’s strongest suits, being pointed to as the financially profligate inpatient model comes as a shock.

Many of the sources we spoke to for our story don’t reach the conclusion that hospitalists are the higher-priced alternative. Instead, sources say, higher post-discharge costs have more to do with the realities of post-acute care than the hospitalist model.

But they admit that the study is a wake-up call that everyone ” hospitalists, hospital and the post-acute community “needs to do a better job post-discharge. That won’t be news to hospitalists, who have for years been trying to reduce readmissions and bolster post-discharge care.

And one of this month’s Analysis articles looks at another study that ostensibly delivered bad news. In that study, many discharge elements that hospitalists pay close attention to “like medication reconciliation “turned out to not affect readmission rates.

The study’s lead author concludes that hospitalists need better metrics to gauge whether patients comprehend the discharge instructions they receive.

The “bad news” delivered in that study “just like in the Annals article ” will no doubt spur more innovations and better quality care. In a specialty that’s proved to be so agile, challenging evidence will only help drive new adaptations.

edoyleEdward Doyle
Editor & Publisher
edoyle@todayshospitalist.com