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Want to know the number one factor determining hospital inpatient care cost? Hint: It's not the color of hospital staff's scrubs

By Dr. Rupesh Nigam

At Kelsey-Seybold, there's a key person who manages a patient's transition from the primary care physician, through hospital care, discharge, and back to the primary care or outpatient specialist and home care – the hospitalist.

Hospitalist role in a patient's hospital stay
For those unfamiliar with the term, a hospitalist is a physician who specializes in providing and managing the care of hospitalized patients. You could compare the hospitalist to a symphony conductor, or to a football team quarterback. A provider group hospitalist is in a unique position to manage the most effective care handoffs for hospitalized patients right from the start – which can be the most critical time of the patient's stay.

When patients arrive at the hospital, they may not be able to breathe, may be in pain, or may have neurological issues. It is the hospitalist's job to discern the most likely cause of that ailment and then consult a specialist, if needed, to contribute to the patient's care.

Assembling the hospital team
In this way, the hospitalist leads the hospital medical team in coordinating all the patient's care – including imaging, diagnostics, and lab work. He/she can order treatments, consult with specialists, and prescribe medication. Hospitalists working in a health care system like Kelsey-Seybold can also assess whether patients arriving in the emergency room truly need hospital level care. This determination can pre-empt a lot of unnecessary low-benefit, high-cost treatment and procedures.

Coordination and communication tools
A symphony conductor uses a baton and eye contact to coordinate musicians' actions, while a quarterback uses verbal signals to direct players. To enable immediate care coordination, Kelsey-Seybold hospitalists use Patient Ping, a digital application that alerts physician group hospitalists in real time when a Kelsey-Seybold patient arrives at the hospital emergency room. With this tool, patients are more likely to get continuous, coordinated care throughout their inpatient stay.

Hospitalists aren't created equal
Kelsey-Seybold hospitalists are part of an accountable care organization (ACO), using a coordinated care approach that gives the hospitalist direct access to the patient's primary care physician. He/she can access and forward the patient's entire electronic medical record, which helps to ensure timely, cost-effective treatment.

In contrast, a hospitalist from a hospital system may not have access to a patient's medical history. Without knowing about a patient's previously diagnosed conditions and tests, a hospitalist from a hospital system may order unnecessary or duplicate tests. This can produce longer inpatient stays, poorer outcomes, and significantly higher costs.

As the patient nears discharge, Kelsey-Seybold hospitalists provide counseling to the patient, family members, and caregivers to help provide an effective transition into the home or post-acute environment. They organize follow-up care, seamlessly handing off the patient to the primary care physician or outpatient specialist.

Hospitalists play a pivotal part in an accountable care organization like Kelsey-Seybold. They're uniquely positioned to provide integrated and coordinated patient care when they need it most, while helping to mitigate avoidable costs.

Dr. Rupesh Nigam

About the Author

Rupesh Nigam, M.D., F.A.C.P., is Kelsey-Seybold Clinic’s medical director of population health and associate medical director of hospital services. He graduated India’s University of Pune Armed Forces Medical College. He also studied at Baylor College of Medicine and The University of Texas MD Anderson Cancer Center and UT Health Science Center at Houston. Learn more about Dr. Nigam here.

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