Archive for December 2017

Locums vs F/T Hospitalists. Do Temps Stack Up?

Do locums hospitalists outperform…or even make the cut? A new investigation tackles the question, and I will get right to it. In a nutshell, locums docs provided a similar level of care as staff doctors according to a JAMA study published last week. Researchers analyzed 1.8 million Medicare patients hospitalized between 2009 and 2014 who were treated by F/T hospitalists (identified by submitting >90% inpt billing codes) versus locums hospitalists (there is a locums billing code--who knew). The investigators did not find any significant difference in 30-day mortality rates between patients groups. Secondary outcomes included inpatient Medicare Part B (physician) spending, LOS, and 30-day readmits. Here full-time hospitalists differentiated themselves: Differences in patient characteristics, demographics, comorbidities, and reason for admission between locum tenens and non–locum tenens physicians were not clinically relevant. Treatment by locum tenens physicians, compared with treatment by non–locum tenens physicians (n = 44,520 physicians), was not associated with a significant difference in 30-day mortality (8.83%…

Augh! I Just Got Laid Off! What Now?

Wait a minute. Isn’t there an ongoing national shortage of hospitalists? Don’t most hospital medicine groups have trouble recruiting enough providers? You wouldn’t think hospitalists would be at much risk for being laid off. But believe it or not, it does happen. Management companies lose contracts. Hospitals get acquired or lose a big book of business. Some administrator decides NP/PAs are more cost-effective than doctors. And – if our work with hospitalist groups around the country is any indicator – large integrated delivery systems are increasingly expecting top-quartile productivity from their physicians across all specialties, which means more work with fewer resources. I worked with a hospitalist program recently that has laid off several NP/PAs in an effort to improve productivity and financial performance; they haven’t yet laid off any doctors, but it could still happen. While it’s still rare, I expect that hospitalists will become more vulnerable to layoffs…

Do Hospitalists Improve Inpatient Outcomes?

Long continues the debate of what impact hospitalists have on inpatient outcomes. This issue has been playing out in the medical literature for 20 years, since the coining of the term in 1997. In the most recent iteration of the debate, a study was recently published in JAMA Internal Medicine entitled “Comparison of Hospital Resource Use and Outcomes Among Hospitalists, Primary Care Physicians, and Other Generalists”. The study retrospectively evaluated healthcare resources and outcomes from over a half million Medicare beneficiaries hospitalized in 2013 for 20 common DRGs, by type of physician provider (hospitalist, their primary care physician, or other generalist). The study found that non-hospitalists used more consultations and had longer lengths of stays compared to hospitalists. In addition, relative to hospitalists, PCPs were more likely to discharge patients to home, had similar readmission rates, and lower 30-day mortality rates; but generalists were less likely to discharge patients home,…