Hospitalists Rise, Medicare Falls

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By  |  July 28, 2015 | 

Sorta.

A new study out today in JAMA you will want to know about: How has Medicare done on the inpatient side from 1999-2013?

Medicare all-cause mortality?  DOWN

medicare mortality

 

Medicare hospitals deaths and utilization? DOWN

mcare hospital rates

 

Trends in Hospitalizations and Expenditures in the Last Months of Life? DOWN

Yeah, yeah, the investigators attribute the declines to CMS policy, healthy behaviors, technological advances, and a bunch of other junk.

Do you want to know the real reason?

hm graph

 

Holy cow.  That’s hospitalist growth, my friends.  Correlation, causation, ecologic fallacy–forget it. Take a victory lap.

And after you have your protein shake, talk to your CFO about your hospital’s reduced hospital occupancy rates, falling payer reimbursement…and gulp, future hiring prospects.  To the victor go the spoils.

More here.

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7 Comments

  1. Leslie Flores July 28, 2015 at 5:53 pm - Reply

    Cool post, Brad.

    SHM estimates the number of hospitalists in 2015 is closing in on 48,000 or so. Based on the distribution of responses to the MGMA survey, perhaps 6% of those are pediatricians or med/peds, and another 9% are family medicine. That means around 41,000 internal medicine hospitalists in the country.

    AHRQ estimates the total number of practicing GIM docs to be 71,487. Assuming these numbers are even close, that means something like 57% of all GIM doctors in the country are practicing as hospitalists – a job that didn’t even really exist 25 years ago. Remarkable.

  2. John Bulger July 29, 2015 at 10:43 am - Reply

    Nice said (and correlated)!

  3. Raman Palabindala July 29, 2015 at 12:17 pm - Reply

    Does this mean demand for hospitalist will decrease or increase?

    Do you think traditional internal medicine practice failed to do this?

    Did we reach a plateau? Given the fact that so many smaller hospitals shutting down – how is it going to affect the future of hospital medicine? – what is our role to provide acute care to medically under served population

    • Brad Flansbaum July 29, 2015 at 1:36 pm - Reply

      Your second and third questions wider in scope within context of post and best left for another day.

      As for number one, with empty beds and community care on the rise (“hospital at home”), we will need fewer hospitalists (thanks to our great job). Conversely, the surge of recent younger and healthier beneficiaries into the program (65-70 yo vs. 70-80) will cause a temporary dip in demand. Those benes will age however and in a decade a so, we might see a spike. It’s a guessing game, and all depends on how our system evolves.

  4. Leslie Flores July 29, 2015 at 3:01 pm - Reply

    How hospitalist scope of practice evolves will also play into future demand. As hospital medicine continues to move toward “universal admitter” status I think the demand for hospitalists is likely to continue to grow for a while, despite fewer hospital beds and a (temporarily) younger Medicare population.

  5. Rupesh Prasad July 29, 2015 at 5:22 pm - Reply

    Thank you for an interesting post Brad. I think that the demand for Hospitalists will continue to increase though not at the current levels (? Meteoric so far).

    With regards to the post by Leslie considering that SHM membership currently stands at around 15,000 (please correct me if I am wrong), it appears that we have a ways to go to try capture this untapped group of providers and involve them in SHM activities.
    Thanks.
    Rupesh Prasad.

  6. Donald Milligan August 2, 2015 at 8:46 pm - Reply

    The primary reason for growth of hospitalists is the desire of hospital system CEOs to control(and absorb) that revenue stream. Hospitalists do useful work, but similtanaeity does not imply causation. Overall mortality dropped, not just that managed by hospitalists.

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About the Author: Bradley Flansbaum

Bradley Flansbaum, DO, MPH, MHM works for Geisinger Health System in Danville, PA in both the divisions of hospital medicine and population health. He began working as a hospitalist in 1996, at the inception of the hospital medicine movement. He is a founding member of the Society of Hospital Medicine and served as a board member and officer. He speaks nationally in promoting hospital medicine and has presented at many statewide meetings and conferences. He is also actively involved in house staff education. Currently, he serves on the SHM Public Policy Committee and has an interest in payment policy, healthcare market competition, health disparities, cost-effectiveness analysis, and pain and palliative care. He is SHM’s delegate for the AMA House of Delegates. Dr. Flansbaum received his undergraduate degree from Union College in Schenectady, NY and attended medical school at the New York College of Osteopathic Medicine. He completed his residency and chief residency in Internal Medicine at Long Island Jewish Medical Center in New York. He received his M.P.H. in Health Policy and Management at Columbia University. He is a political junky, and loves to cook, stay fit, read non-fiction, listen to many genres of music, and is a resident of Danville, PA.

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