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Hospitalists are part of changing health-care picture

March 26, 2006|By TAMELA BAKER

HAGERSTOWN

It's been a year since Washington County Hospital inaugurated a program that puts doctors specializing in hospital care on staff at all hours.

The "hospitalist" program had two approaches, hospital officials said. One was to provide consistent care for people who did not have a primary care physician.

The other was to give primary care physicians a break - between the time they spent seeing patients in their own offices and making rounds at the hospital, "it wasn't uncommon for them to have to spend 18-hour days," said Kelsey M. Wilkes, director of integrated patient support services.

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In the past year, the program "has surpassed our expectations," said Deborah Addo Samuels, vice president for patient care services at the hospital, though she said there have been some growing pains.

"It really is a program in transition," Samuels said.

The use of hospitalists is a fairly young practice, they said, employed nationally for about 10 years.

Medical care in general is in transition in Maryland, according to physicians seeking legislative reforms. Development of Washington County's hospitalist program coincided with a statewide push for action on medical malpractice laws, with scores of specialists restricting their practices or, in some cases, abandoning them altogether as the cost of malpractice insurance premiums increased.

As those practices were diminishing, the use of hospitalists at Washington County Hospital expanded. Response to the hospitalist program prompted the hospital to add another doctor in September. But just how much impact the malpractice issue might have on the hospitalist program - and vice versa - is vague. When the hospitalist program started, Samuels said, "it really was not tied at all to medical malpractice."

But she and Wilkes said that before the hospitalist program, the hospital had an "elaborate" call system, bringing in doctors to care for patients who had no regular doctor. Taking those calls cut into the time the doctors could spend seeing patients in their own offices.

That, combined with the upward spiral of malpractice insurance costs, made fewer doctors willing to "take call," said Karl Riggle, chief of surgery at the hospital.

By implementing the hospitalist program, he said, the hospital had stepped forward to fill the need.

Converging forces

Riggle, a leader in the fight for malpractice law reform in Maryland, has contended from the start that the state's malpractice climate affects health care in a number of ways.

Earlier this month, he outlined some of the effects in Western Maryland for the House Judiciary Committee, telling legislators that more than 80 percent of Washington County's primary care physicians no longer see patients in the hospital, and that hospitalists are caring even for patients who have regular doctors.

Riggle said Friday that hospital officials "have done everything they can to try to preserve access" to health care despite inaction on the malpractice issue.

"Unfortunately, they can only do so much," he said.

And while hospitalists can step in for a family practitioner, "specialists don't have hospitalists," he said.

Specialists in many cases have taken the hardest hit in the malpractice insurance debate - the higher the risk in the practice, the higher the cost of the insurance premium.

"If there are physicians statewide who are not gonna practice" certain procedures, Wilkes said, "it reduces the pool of availability" for hospitals.

"For hospitalists, the challenge is how to get medical care for you in the hospital - what will hospitalists do that specialists would have done," she said.

And it is true that fewer doctors take call since the hospitalist program began.

"We had close to 12 physicians who would still take call" after the program started, Samuels said. "That lasted for about a month." A few physicians still do, but Samuels and Wilkes said that doctors who partner with the hospitalist program found they could expand their office hours, getting their patients in and out faster because they aren't being called to the hospital.

More patients are being managed as outpatients as a result, they said, and only have to be admitted to the hospital for treatment that can't be given at the doctor's office. At that point, hospitalists take over their in-hospital care.

Continued care

Still, the bulk of the hospitalists' work is with patients unattached to primary physicians. From July through February, Wilkes said, 55 percent of the patients in the hospitalists' care did not have regular doctors.

Samuels said the hospital tries to link those patients with primary physicians for follow-up care after they're discharged, and has established relationships with several practices to take those patients.

"It's very hands-on," Wilkes added, with the hospital helping those patients make appointments.

"That has provided more continuity than in the past," Samuels said.

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