“Hospitalists,” or doctors specializing in hospital medicine, will play a key role at Danville Regional Medical Center as the changing health care landscape requires better quality care at lower costs, hospital leaders say.
At first, hospitalists worked only during the day, but now the program has evolved to where doctors are covering the hospital 24/7, said Dr. Bhushan Pandya, president of the medical staff.
Over the past four years, the program has grown from two hospitalists to 13 full-time doctors, said hospitalists director Dr. Michael Marvinny with Apogee Physicians.
Local hospitalists, who now also receive help from medical residents, see between 75 to 80 percent of admitted patients.
About six primary care doctors and almost every specialist continue to see their patients at the hospital, Pandya said.
For patients, the program allows them to see a doctor faster and have continued access to a doctor in the hospital. Hospitalists are available to review the results of tests or X-rays, meaning faster decision-making, said DRMC Chief Medical Officer Saria Saccocio said.
Another benefit is these doctors are the experts when it comes to hospital medicine and have more experience dealing with heart attacks or other crises, said Dr. Joe Li, president of the Society of Hospital Medicine.
“It’s very patient-centric care,” Li said.
The tradeoff is patients may not see their own doctors, or may see more than one hospitalist during a stay.
But because hospitalists cut back on time staff or patients spend waiting, like waiting for a doctor to sign off on a discharge, patients can also leave the hospital sooner, as appropriate. Compared to a year ago, the average length of stay decreased from about 5 days to 3.68 days now, Marvinny said.
This frees up space for other patients needing those resources, and reduces unnecessary costs.
Additionally, having a core group of hospital doctors enables Danville Regional to focus on initiatives like patient safety with Duke Medicine, where the hospital gets a report card on how the hospitalists are doing, Saccocio said.
“I think with health reform, you have to be more efficient and higher quality and one way to manage that is you have hospitalists,” said Dr. Chal Nunn, Centra senior vice president and chief medical officer.
Centra started employing hospitalists 13 years ago, using a local group, Medical Associates of Central Virginia. At first, local doctors were wary, but now hospitalists are integral to operations and have improved relationships, quality and efficiency.
About 20 hospitalists work at Centra’s two Lynchburg hospitals and manage 50-60 percent of all hospital admissions. The average length of stay in the hospital for Medicare patients is down from more than 5 days to 3.7 days.
While the health system pays for doctors, hospitalists help maximize the efficacy of initiatives or quality programs, as Centra focuses on training 20 doctors instead of 300 community doctors coming to the hospital intermittently.
Communication and collaboration among hospitalists and other doctors is vital to ensuring continuity of care and transition back to the primary care doctor for follow-up. Hospitalists work hand-in-hand with local surgeons, Saccocio said.
“It is seamless communication that is absolutely critical to making this model work from a patient’s perspective,” Li said.
Primary care doctors receive a discharge summary of care and suggested recommendations within 72 hours, Saccocio said.
If a patient doesn’t have a primary care doctor, Danville Regional works to connect patients with one. Hospitalists may also set up patients with home health care or monitoring, Marvinny said.
Communication is a work in progress as the relatively new program matures, Dr. Pandya and Dr. Pradeep Pradhan agreed.
“Is there room for improvement? Yes, there is room for improvement,” said Pradhan of Dominion Primary Care with Centra Medical Group. “As a primary care physician in the community, I would like to know when my patients get admitted.”
Pradhan said he has taken the initiative to call hospitalists and visited his patients many times in the past. Hospitalists have called him, but it’s not consistent.
A hospital community engagement group meets quarterly with Pandya, Saccocio, Deaton and the medical staff to talk about concerns or how the hospital can help physicians.
The hospital also scheduled a meeting on Feb. 8 to hear feedback from primary care doctors and plans to hold such meetings on a regular basis, Saccocio said.
“We want to see what their needs are, what type of support they need,” she said.
Pradhan said the hospitalist program is beneficial to him, as he doesn’t need to leave patients in his office to go to the Emergency Department.
“We have to have the hospitalists, so I think the focus should be to make it better,” Pradhan said.
“As communication and processes improve, everyone sees the benefit of having a hospitalist program,” Pandya said. “It has improved since the start. The program has come a very, very long way.”
Hospitalist a new trend in Danville
While the concept began at least in 1996 when the term “hospitalist” was coined, Danville Regional Medical Center’s current program is just more than four years old.
Before the local program, community doctors would come to the hospital to provide care for their patients. In fact, the first “hospitalists” in Danville were employed by primary care practices in the late 1990s as doctors didn’t want to leave patients in the office to attend to those being hospitalized, according to a 1999 Register & Bee story.
But some doctors began limiting their practices to office visits as demand increased, placing the burden on doctors who continued to go to the hospital, said Dr. Bhushan Pandya, president of the medical staff at DRMC. Eventually, local doctors and medical staff asked for a hospital-based solution.
Danville Regional initiated a hospitalist program in 2004, but it didn’t last, and the hospital was sold to LifePoint Hospitals in 2005. In late 2007, at the request of medical staff, another hospitalist program was born as the concept took off nationally.
Virtually all hospitals with 200 beds or more have hospitalists, and more than 34,000 doctors are working as hospitalists, according to the most recent survey by the American Hospital Association, Li said.
“It’s really a model that has grown very rapidly in the past decade,” Li said.
Danville Regional doesn’t deny physicians who want to see their patients in the hospital, DRMC Saria Saccocio added.
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