Society of Hospital Medicine (SHM): Hospital-Focused Practice Meeting

LAS VEGAS – Traditional internal medicine, family medicine, and pediatric hospitalists have joined hospitalists from obstetrics, neurology, orthopedics, surgery, and even dermatology to learn about each other and where the new specialty fields may be headed in the future.

About 65 people, mostly physicians, gathered in a nondescript meeting room in a Las Vegas hotel in November to explore the lessons learned from the first 15 years of hospital medicine and to hear how specialists are adapting the hospitalist model to their own fields.

Although there is a common focus on quality and safety across all the groups, there are also plenty of differences in the models, too, said Dr. John Nelson, a cofounder and past president of the Society of Hospital Medicine (SHM) and one of the organizers of the meeting.

For example, while traditional medicine hospitalists tend to have a high volume of cases, some of the other specialties see a smaller number of patients. And while medicine hospitalists do little to no outpatient work, that’s different in surgery where hospitalists must conduct outpatient follow-up for all of their cases to avoid complications.

There are also differences in income. Traditional medicine hospitalists can generally earn more as hospitalists than similarly trained colleagues working in the outpatient setting. But the opposite is generally true for other specialties like neurology, orthopedics, and surgery. In specialty areas, hospitalists tend to earn less than their outpatient counterparts. In part that’s a trade-off for better hours, Dr. Nelson said.

One of the reasons that the Society of Hospital Medicine decided to convene the meeting was to find out more about the similarities and differences between specialty hospitalists and traditional hospitalists and to see where there are areas for collaboration, said Dr. Larry Wellikson, CEO of the SHM.

Dr. Wellikson said that the SHM is sensitive to concerns that specialty hospitalists don’t fit the traditional hospitalist model and that’s why the society is taking its time and feeling out the relationship it will have with these new hospitalists. "We’re right in the exploratory phase," he said. "We’re sort of dating."

There’s clearly the potential for the new specialty hospitalists to become allies for traditional medicine hospitalists in dealing with systems problems in the hospital, Dr. Wellikson said. For example, orthopedic hospitalists might help traditional hospitalists work with the emergency department to move patients out of the ED.

While many of the specialty hospitalist models are only a few years old, they are already being embraced at Hoag, a regional not-for-profit health care system in Orange County, Calif. Dr. Richard Afable, Hoag’s president and CEO, said his health system has six hospitalist programs in place and is considering adding more. "From my view, it’s a standard of care," Dr. Afable said.

At Hoag, millions of dollars have been invested in hospitalist programs, but Dr. Afable said it’s been well worth it. In the traditional medicine hospitalist program, the return on investment is about seven to one, with most of the value coming from reduced length of stay. But even without the return on investment, Dr. Afable said they’d still have hospitalists.

"It’s a necessary expense to run a great hospital," he said.

Dr. Jack S. Weiss, the regional chief medical officer–West for United Healthcare, said the move to specialization in hospital medicine is a "natural evolution on several counts." But he said he also has some concerns about the movement, and he’s not convinced that specialization alone will be a "game changer" in terms of achieving improved care while lowering overall costs. One worry, Dr. Weiss said, is that specialization in hospital medicine will have the same results as specialization in the outpatient world. Specifically, the concern is that generalists would get lower reimbursement and that the hospital would lose the generalist perspective, he said.

LAS VEGAS – Traditional internal medicine, family medicine, and pediatric hospitalists have joined hospitalists from obstetrics, neurology, orthopedics, surgery, and even dermatology to learn about each other and where the new specialty fields may be headed in the future.

About 65 people, mostly physicians, gathered in a nondescript meeting room in a Las Vegas hotel in November to explore the lessons learned from the first 15 years of hospital medicine and to hear how specialists are adapting the hospitalist model to their own fields.

Although there is a common focus on quality and safety across all the groups, there are also plenty of differences in the models, too, said Dr. John Nelson, a cofounder and past president of the Society of Hospital Medicine (SHM) and one of the organizers of the meeting.

For example, while traditional medicine hospitalists tend to have a high volume of cases, some of the other specialties see a smaller number of patients. And while medicine hospitalists do little to no outpatient work, that’s different in surgery where hospitalists must conduct outpatient follow-up for all of their cases to avoid complications.

There are also differences in income. Traditional medicine hospitalists can generally earn more as hospitalists than similarly trained colleagues working in the outpatient setting. But the opposite is generally true for other specialties like neurology, orthopedics, and surgery. In specialty areas, hospitalists tend to earn less than their outpatient counterparts. In part that’s a trade-off for better hours, Dr. Nelson said.

One of the reasons that the Society of Hospital Medicine decided to convene the meeting was to find out more about the similarities and differences between specialty hospitalists and traditional hospitalists and to see where there are areas for collaboration, said Dr. Larry Wellikson, CEO of the SHM.

Dr. Wellikson said that the SHM is sensitive to concerns that specialty hospitalists don’t fit the traditional hospitalist model and that’s why the society is taking its time and feeling out the relationship it will have with these new hospitalists. "We’re right in the exploratory phase," he said. "We’re sort of dating."

There’s clearly the potential for the new specialty hospitalists to become allies for traditional medicine hospitalists in dealing with systems problems in the hospital, Dr. Wellikson said. For example, orthopedic hospitalists might help traditional hospitalists work with the emergency department to move patients out of the ED.

While many of the specialty hospitalist models are only a few years old, they are already being embraced at Hoag, a regional not-for-profit health care system in Orange County, Calif. Dr. Richard Afable, Hoag’s president and CEO, said his health system has six hospitalist programs in place and is considering adding more. "From my view, it’s a standard of care," Dr. Afable said.

At Hoag, millions of dollars have been invested in hospitalist programs, but Dr. Afable said it’s been well worth it. In the traditional medicine hospitalist program, the return on investment is about seven to one, with most of the value coming from reduced length of stay. But even without the return on investment, Dr. Afable said they’d still have hospitalists.

"It’s a necessary expense to run a great hospital," he said.

Dr. Jack S. Weiss, the regional chief medical officer–West for United Healthcare, said the move to specialization in hospital medicine is a "natural evolution on several counts." But he said he also has some concerns about the movement, and he’s not convinced that specialization alone will be a "game changer" in terms of achieving improved care while lowering overall costs. One worry, Dr. Weiss said, is that specialization in hospital medicine will have the same results as specialization in the outpatient world. Specifically, the concern is that generalists would get lower reimbursement and that the hospital would lose the generalist perspective, he said.

LAS VEGAS – Traditional internal medicine, family medicine, and pediatric hospitalists have joined hospitalists from obstetrics, neurology, orthopedics, surgery, and even dermatology to learn about each other and where the new specialty fields may be headed in the future.

About 65 people, mostly physicians, gathered in a nondescript meeting room in a Las Vegas hotel in November to explore the lessons learned from the first 15 years of hospital medicine and to hear how specialists are adapting the hospitalist model to their own fields.

Although there is a common focus on quality and safety across all the groups, there are also plenty of differences in the models, too, said Dr. John Nelson, a cofounder and past president of the Society of Hospital Medicine (SHM) and one of the organizers of the meeting.

For example, while traditional medicine hospitalists tend to have a high volume of cases, some of the other specialties see a smaller number of patients. And while medicine hospitalists do little to no outpatient work, that’s different in surgery where hospitalists must conduct outpatient follow-up for all of their cases to avoid complications.

There are also differences in income. Traditional medicine hospitalists can generally earn more as hospitalists than similarly trained colleagues working in the outpatient setting. But the opposite is generally true for other specialties like neurology, orthopedics, and surgery. In specialty areas, hospitalists tend to earn less than their outpatient counterparts. In part that’s a trade-off for better hours, Dr. Nelson said.

One of the reasons that the Society of Hospital Medicine decided to convene the meeting was to find out more about the similarities and differences between specialty hospitalists and traditional hospitalists and to see where there are areas for collaboration, said Dr. Larry Wellikson, CEO of the SHM.

Dr. Wellikson said that the SHM is sensitive to concerns that specialty hospitalists don’t fit the traditional hospitalist model and that’s why the society is taking its time and feeling out the relationship it will have with these new hospitalists. "We’re right in the exploratory phase," he said. "We’re sort of dating."

There’s clearly the potential for the new specialty hospitalists to become allies for traditional medicine hospitalists in dealing with systems problems in the hospital, Dr. Wellikson said. For example, orthopedic hospitalists might help traditional hospitalists work with the emergency department to move patients out of the ED.

While many of the specialty hospitalist models are only a few years old, they are already being embraced at Hoag, a regional not-for-profit health care system in Orange County, Calif. Dr. Richard Afable, Hoag’s president and CEO, said his health system has six hospitalist programs in place and is considering adding more. "From my view, it’s a standard of care," Dr. Afable said.

At Hoag, millions of dollars have been invested in hospitalist programs, but Dr. Afable said it’s been well worth it. In the traditional medicine hospitalist program, the return on investment is about seven to one, with most of the value coming from reduced length of stay. But even without the return on investment, Dr. Afable said they’d still have hospitalists.

"It’s a necessary expense to run a great hospital," he said.

Dr. Jack S. Weiss, the regional chief medical officer–West for United Healthcare, said the move to specialization in hospital medicine is a "natural evolution on several counts." But he said he also has some concerns about the movement, and he’s not convinced that specialization alone will be a "game changer" in terms of achieving improved care while lowering overall costs. One worry, Dr. Weiss said, is that specialization in hospital medicine will have the same results as specialization in the outpatient world. Specifically, the concern is that generalists would get lower reimbursement and that the hospital would lose the generalist perspective, he said.