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More new turf

February 2012

Published in the February 2012 issue of Today’s Hospitalist

Since the birth of hospital medicine, hospitalists have felt constant pressure to expand their roles. In this month’s issue, we look at two new practice areas that hospitalists have moved into, and the challenges that come with that new turf.

Our cover story examines the growth of observation care. While payers see observation care as a way to reduce inpatient costs, it can create huge headaches for hospitalists.

Clinically, patients in observation may take as much time as acute care patients “or more. But when patients are put in observation instead of admitted, their out-of-pocket expenses go up and they may not be covered for follow-up services.

Very often, hospitalists are put in the position of breaking that bad news to patients. It becomes their job, along with delivering a diagnosis, to explain that patients will have to pay twice as much in copays and go without the rehab they might benefit from, all because patients’ insurance won’t cover it. We look at some strategies that hospitals are trying to help observation patients stretch their resources.

Another story looks at hospitalists who have left the hospital altogether and are practicing in settings like LTACs and SNFs. The goal of putting hospitalists outside of the hospital is to help manage patients’ transition from the hospital to home “and cut down on costly readmissions.

The hospitalists we spoke to enjoy their new roles. They see patients over a period of weeks, not days, so they actually get to know patients and their families.

These hospitalists are fast erasing the type of stigma that’s been attached to post-acute care. And “transitionalists” are practicing in a grey zone between outpatient and inpatient settings that’s garnering a lot of new attention.

Hospitalists long ago learned to adapt, and I have no doubt that they’re working out the kinks in both observation and post-acute care. Both areas are too important to American medicine for hospitalists to fail.

edoyleEdward Doyle
Editor & Publisher