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WestCare adds ‘hospitalists’ to manage in-patient care
By Lynn Hotaling
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Adams
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Crider
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In an effort to better serve both doctors and patients, WestCare Health System has launched a hospitalist program at Harris Regional Hospital.
A “hospitalist” is a physician, nurse-practitioner or physician’s assistant who is trained in hospital medicine, a rapidly growing specialty aimed at managing patient care by reducing stays and lowering medical bills.
At Harris, hospitalist services will be provided by WNC Hospitalist Services, a separate practice within the hospital. That group consists of two physicians, Director Bob Adams and Steve Crider; nurse practitioners Rita Moss and Don Rivenbark; and practice coordinator Dela O’Neal.
According to WestCare CEO Mark Leonard, private physicians in the Sylva area have long had to coordinate the demands of seeing patients at their office while also managing the care of their hospitalized patients.
“Our physicians have done an excellent job both in the office and hospital settings,” Leonard said. “But this has often meant pulling doctors away from their patients in the office to attend to the ones in the hospital.”
The hospitalist specialist evolved as a way to make it easier for all three – the patient in the office, the patient in the hospital and the doctor – Leonard said.
While research has shown that having doctors available at the hospital to oversee a patient’s treatment and care decreases hospital stays and lowers costs, Leonard said the impetus for the local program was doctor recruitment. As WestCare interviewed new family practitioners and internists, officials found that doctors considering relocating to the area didn’t want the strain of providing both types of care.
“They wanted to work in an office or the hospital but not both,” Leonard said. “We started hearing that repeatedly.”
The idea of moving to hospitalists “came in through the back door,” according to Leonard.
“We saw the hospitalist program as a necessity to recruit in order to sustain primary care,” he said.
The choice of whether to turn in-patient care over to a hospitalist rests with each doctor, Leonard said.
“Each physician opts in or opts out,” he said. “Doctors retain full privileges (and treat their own patients in the hospital) or limited privileges and ask the hospitalist to take care of their patients.”
The hospitalist and the primary care doctor discuss the acute problem and exchange information about the patient’s other medical problems, with the doctor’s office typically faxing additional information at the time of admission, Dr. Adams said.
“Primary care doctors have secure access to the hospital computer medical records through the Internet and can look at their patient’s progress through that system,” said Adams. The hospitalist and primary care physician communicate when the patient is discharged and records of the patient’s stay are transmitted to the primary care physician’s office, he said.
Billing for physician care during a hospital stay would come either from the hospitalist group or the primary care physician, Leonard said.
While the hospitalized patient is receiving expert care from a hospitalist, the primary care physician is able to continue seeing his or her regular patients in the office on schedule. A patient who has been waiting to see a primary care physician may get in sooner for an appointment since the doctor is not making rounds in the hospital.
A study published in the Annals of Internal Medicine found that patients are released an average of half a day sooner if their care is managed by a hospitalist.
“A hospitalist is in the hospital all day long and is available to provide care throughout the day. The doctor gets to know the patient’s problems better because he is not rushing through rounds to get to the office. The hospitalist is also available if there is a new problem or emergency. They can spend time coordinating after-hospital care for the patients,” Adams said.
The decision whether to rely on a hospitalist for in-patient care will be the prerogative of the regular doctor, Adams said, when asked whether patients could refuse a hospitalist’s care and ask their regular doctor to continue to care for them.
“That would be up to the primary care provider,” he said. “However, one of the major benefits of the hospitalist program to the patients is having the provider in the office so that they can call in and be seen in a more timely fashion. If the provider makes exceptions and will not be in the office, they will no longer have that benefit.”
According to Adams, it has historically been difficult for physicians to cover both the hospital and the office.
“Because of that, once we make the transition, it is my impression that all of the physicians plan to practice only in the office,” Adams said.
Hospital medicine is the fastest growing specialty in American medicine history, according to the 10-year old Society of Hospital Medicine, the national medical society representing hospitalists. The SHM estimates there are currently 20,000 hospitalists practicing in the United States. The specialty has experienced a 20 percent increase in the last 10 years with approximately 40 percent of U.S. hospitals having hospitalist programs, according to SHM data. The Society of Hospital Medicine includes 300 hospitalist members in North Carolina.
Leonard said he understands that change is always hard and that he wants the community to understand why Harris is making the switch to hospitalists.
“It really is to help us recruit and retain additional primary care physicians,” he said. “All change is difficult, but if it helps us recruit and hold onto additional high quality physicians, then it will be worth it.”
For more information about WNC Hospitalist Services at WestCare Health System call 586-7000 or go to www.westcare.org or www.hospitalmedicine.org.
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