Comments on: Most hospitalists are good, but some, like these ones, aren’t http://www.kevinmd.com/blog/2009/04/most-hospitalists-are-good-but-some.html Tue, 14 Feb 2012 22:28:00 +0000 hourly 1 By: Anonymoushttp://www.kevinmd.com/blog/2009/04/most-hospitalists-are-good-but-some.html#comment-90681 Anonymous Fri, 03 Apr 2009 14:03:00 +0000 http://clients.emmense.com/kevinmd/2009/04/most-hospitalists-are-good-but-some-like-these-ones-arent.html#comment-90681 The point is that this "hospitalists are good" mentality is mostly anecdotal. And, as a family practitioner who still takes care of his patients when hospitalized, I get a little offended when I constantly read how good hospitalists are. There is a hospitalist group in my hospital and they pretty much stink.<br/><br/>Let's make a deal: stop trying to convince me how good you are and I'll stop feeling threatened that you think you are better than me.<br/><br/>A family practitioner The point is that this “hospitalists are good” mentality is mostly anecdotal. And, as a family practitioner who still takes care of his patients when hospitalized, I get a little offended when I constantly read how good hospitalists are. There is a hospitalist group in my hospital and they pretty much stink.

Let’s make a deal: stop trying to convince me how good you are and I’ll stop feeling threatened that you think you are better than me.

A family practitioner

]]> By: Chuck Brookshttp://www.kevinmd.com/blog/2009/04/most-hospitalists-are-good-but-some.html#comment-90675 Chuck Brooks Thu, 02 Apr 2009 23:33:00 +0000 http://clients.emmense.com/kevinmd/2009/04/most-hospitalists-are-good-but-some-like-these-ones-arent.html#comment-90675 Interesting how the payment incentives are aligned, and what little influence, if any, that customers/patients have. Hard to see how any reform can address this, as the same thinking is driving all other economic aspects of health care. Beyond that, the ethical and moral issues in these actions bode ill for the future.<br/>Chuck Brooks<br/>FutureWare SCG Interesting how the payment incentives are aligned, and what little influence, if any, that customers/patients have. Hard to see how any reform can address this, as the same thinking is driving all other economic aspects of health care. Beyond that, the ethical and moral issues in these actions bode ill for the future.
Chuck Brooks
FutureWare SCG

]]> By: Reality Roundshttp://www.kevinmd.com/blog/2009/04/most-hospitalists-are-good-but-some.html#comment-90674 Reality Rounds Thu, 02 Apr 2009 23:27:00 +0000 http://clients.emmense.com/kevinmd/2009/04/most-hospitalists-are-good-but-some-like-these-ones-arent.html#comment-90674 I work in a small community hospital in a big city. Our hospital used to contract with a university hospital's neonatologists to attend our high risk deliveries and manage our sick babies. They had a total of 30 minutes to arrive at a delivery. Since babies don't wait, they often missed the delivery and we managed the best we could. A few years back we contracted pediatric hospitalists. We looooooooooove them.<br/>They actually have time to spend with the patients, are up to date on the latest standard, and mostly have good skills. For community hospitals with limited resources, I think they are great. I work in a small community hospital in a big city. Our hospital used to contract with a university hospital’s neonatologists to attend our high risk deliveries and manage our sick babies. They had a total of 30 minutes to arrive at a delivery. Since babies don’t wait, they often missed the delivery and we managed the best we could. A few years back we contracted pediatric hospitalists. We looooooooooove them.
They actually have time to spend with the patients, are up to date on the latest standard, and mostly have good skills. For community hospitals with limited resources, I think they are great.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2009/04/most-hospitalists-are-good-but-some.html#comment-90672 Anonymous Thu, 02 Apr 2009 22:33:00 +0000 http://clients.emmense.com/kevinmd/2009/04/most-hospitalists-are-good-but-some-like-these-ones-arent.html#comment-90672 As a hospitalist, I was asked by an RT to try to get an ABG on an unconscious heroin addict (not my patient) who was a tough stick. While I was in there getting it a nephrologist walked in looked at the guy and walked out. He then documented a comprehensive physical exam in the chart.<br/><br/>It cuts across specialties. As a hospitalist, I was asked by an RT to try to get an ABG on an unconscious heroin addict (not my patient) who was a tough stick. While I was in there getting it a nephrologist walked in looked at the guy and walked out. He then documented a comprehensive physical exam in the chart.

It cuts across specialties.

]]> By: i~RNhttp://www.kevinmd.com/blog/2009/04/most-hospitalists-are-good-but-some.html#comment-90670 i~RN Thu, 02 Apr 2009 21:01:00 +0000 http://clients.emmense.com/kevinmd/2009/04/most-hospitalists-are-good-but-some-like-these-ones-arent.html#comment-90670 It's all true! We have hospitalists where I work (I'm a nurse) who go in, chat for a minute and leave. They won't do any further unless the patient has a complaint, or if the labs are showing something very awry.<br/>Mucho diagnostice testing of the elderly who have mucho comorbities. No wonder healthcare costs are humongous. It’s all true! We have hospitalists where I work (I’m a nurse) who go in, chat for a minute and leave. They won’t do any further unless the patient has a complaint, or if the labs are showing something very awry.
Mucho diagnostice testing of the elderly who have mucho comorbities. No wonder healthcare costs are humongous.

]]> By: stargirl65http://www.kevinmd.com/blog/2009/04/most-hospitalists-are-good-but-some.html#comment-90666 stargirl65 Thu, 02 Apr 2009 16:24:00 +0000 http://clients.emmense.com/kevinmd/2009/04/most-hospitalists-are-good-but-some-like-these-ones-arent.html#comment-90666 Happy Hospitalist:<br/>Thank you for correcting me.<br/><br/> It always seems like the hospitalists are ordering a lot of extra tests including ECHOs or MRIs on patients that just had these tests. I realize there are times where things can change quickly, but I do not see that they really expected to gain more info. It was just easier to order the test than review the patient's chart/history? Part of this may be the push to get them in and out very fast. Order every test on day one, instead of stepwise, because you only get 48 hours for that DRG. Now of course they are talking about the doctor and the hospital splitting the money for the DRG. And also not paying if they are readmitted in under 30 days. CRAZY!!!<br/><br/>I agree many doctors order a multitude of tests whether they are needed or not. But who wants to miss something and get sued? It is a system wide problem. Happy Hospitalist:
Thank you for correcting me.

It always seems like the hospitalists are ordering a lot of extra tests including ECHOs or MRIs on patients that just had these tests. I realize there are times where things can change quickly, but I do not see that they really expected to gain more info. It was just easier to order the test than review the patient’s chart/history? Part of this may be the push to get them in and out very fast. Order every test on day one, instead of stepwise, because you only get 48 hours for that DRG. Now of course they are talking about the doctor and the hospital splitting the money for the DRG. And also not paying if they are readmitted in under 30 days. CRAZY!!!

I agree many doctors order a multitude of tests whether they are needed or not. But who wants to miss something and get sued? It is a system wide problem.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2009/04/most-hospitalists-are-good-but-some.html#comment-90662 Anonymous Thu, 02 Apr 2009 12:37:00 +0000 http://clients.emmense.com/kevinmd/2009/04/most-hospitalists-are-good-but-some-like-these-ones-arent.html#comment-90662 Irresponsible. Agree with comments above. Why single out hospitalists--you can substitute just about any discipline and write the same piece? This is a group or hospital specific phenomena. <br/><br/>I have watched the same behavior with medical and surgical subspecialties, and yes, primary care docs.<br/><br/>I would also add, goes beyond payment--cultural and professionalism issues here as well. Irresponsible. Agree with comments above. Why single out hospitalists–you can substitute just about any discipline and write the same piece? This is a group or hospital specific phenomena.

I have watched the same behavior with medical and surgical subspecialties, and yes, primary care docs.

I would also add, goes beyond payment–cultural and professionalism issues here as well.

]]> By: The Happy Hospitalisthttp://www.kevinmd.com/blog/2009/04/most-hospitalists-are-good-but-some.html#comment-90661 The Happy Hospitalist Thu, 02 Apr 2009 12:30:00 +0000 http://clients.emmense.com/kevinmd/2009/04/most-hospitalists-are-good-but-some-like-these-ones-arent.html#comment-90661 star girl. You have it mixed up. Unless you are a critical care access hospital, you get paid by DRG. That means you get X dollars for X diagnosis, with modifiers for complicating and major complicating conditions.<br/><br/>Hospitals do not get extra money for when hospitalists order extra test. In fact, the more xrays and labs and other ancillary studies you order the less money a hospital makes because they are using up time and resources for those studies.<br/><br/>Hospitalists who order lots of tests add less value, not more to a hospitals bottom line. star girl. You have it mixed up. Unless you are a critical care access hospital, you get paid by DRG. That means you get X dollars for X diagnosis, with modifiers for complicating and major complicating conditions.

Hospitals do not get extra money for when hospitalists order extra test. In fact, the more xrays and labs and other ancillary studies you order the less money a hospital makes because they are using up time and resources for those studies.

Hospitalists who order lots of tests add less value, not more to a hospitals bottom line.

]]> By: stargirl65http://www.kevinmd.com/blog/2009/04/most-hospitalists-are-good-but-some.html#comment-90660 stargirl65 Thu, 02 Apr 2009 12:20:00 +0000 http://clients.emmense.com/kevinmd/2009/04/most-hospitalists-are-good-but-some-like-these-ones-arent.html#comment-90660 Hospitalists at some institutions are employed by the hospital. They may get a bonus for increased testing ordered, but not so much more time with the patient. The hospital makes money on the tests. It is very hard to make money just by examining and talking to patients. Medicare and insurance companies do NOT value good old fashion doctoring. They only value high priced procedures and testing. This is partly why primary care is failing. Hospitalists at some institutions are employed by the hospital. They may get a bonus for increased testing ordered, but not so much more time with the patient. The hospital makes money on the tests. It is very hard to make money just by examining and talking to patients. Medicare and insurance companies do NOT value good old fashion doctoring. They only value high priced procedures and testing. This is partly why primary care is failing.

]]> By: The Happy Hospitalisthttp://www.kevinmd.com/blog/2009/04/most-hospitalists-are-good-but-some.html#comment-90658 The Happy Hospitalist Thu, 02 Apr 2009 08:14:00 +0000 http://clients.emmense.com/kevinmd/2009/04/most-hospitalists-are-good-but-some-like-these-ones-arent.html#comment-90658 This scenario sounds like a what I see every day with some subspecialist rounding. Door way rounds. I can assure you this is doctor specific and not indicative of any specialty per say.<br/><br/>I gotta say though, if a hospitalist program is nothing more than a glorified triage service, their value to a hospital, economically will be nil. Subsidizing doctors to go free nilly with consultations so they can see 50 patients a day at 5 minutes a pop adds nothing of value and will be quickly exposed for what it is. <br/><br/>Worthless. This scenario sounds like a what I see every day with some subspecialist rounding. Door way rounds. I can assure you this is doctor specific and not indicative of any specialty per say.

I gotta say though, if a hospitalist program is nothing more than a glorified triage service, their value to a hospital, economically will be nil. Subsidizing doctors to go free nilly with consultations so they can see 50 patients a day at 5 minutes a pop adds nothing of value and will be quickly exposed for what it is.

Worthless.

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