Doctor who?

CEDAR RAPIDS - Hospitalized patients are increasingly being seen by someone other than their own doctor, and experts say the trend can benefit patients, physicians and the bottom line.

For example, Internist Associates of Iowa, an affiliate of MercyCare Community Physicians, notified patients at its Cedar Rapids office that, as of Dec. 1, most of its doctors will no longer see patients at St. Luke's Hospital. The doctors will continue to see patients at Mercy Medical Center - the other Cedar Rapids hospital - and patients still can choose which hospital to use.

“The only difference is that if you require hospital care and you choose St. Luke's, the hospitalists will admit you and coordinate care,” the letter said.

Internist Associates is not the first practice to take that step. In fact, most area physicians' offices are referring patients to “hospitalists” - a term coined in 1996 for doctors who devote their time solely to caring for hospitalized patients.

Hospitalists diagnose patients, order medical tests and medication, and communicate with patients' primary care doctors, particularly upon admission and discharge.

“It ends up being a win-win for both patients and doctors,” said Dr. Tracy Reittinger, medical director of St. Luke's adult hospitalist program.

Heather Schrock, 33, of Urbana, said her daughter, Micheala, 6, has become accustomed to seeing the two pediatric hospitalists while at St. Luke's for diabetes complications.

“They're great,” Schrock said. “They spend time; they answer any questions we have. They're very thorough.”

More than 30,000 hospitalists practice in about 3,300 hospitals nationwide, according to the Society of Hospital Medicine.

A study in the Annals of Internal Medicine noted growth has been fueled by an increasing emphasis on efficiency, though concerns remain about continuity of care and miscommunication that can lead to medication errors and future emergency room visits.

Traditionally, primary care doctors would see their hospitalized patients early in the morning before their day starts at the office. By using hospitalists, who are usually employed by the hospital, primary care doctors can devote time to their clinic patients, while hospitalized patients have access to a doctor any time of day or night, Reittinger said.

Dr. Gordon Baustian said hospitalists at Mercy work 12-hour shifts, from 7 a.m. to 7 p.m. or vice-versa, “so there is always somebody here. That's one of the advantages.”

The same is true at all Corridor hospitals.

“It's just the way medicine has evolved,” said Baustian, who joined Mercy's hospitalists three years ago after directing the Cedar Rapids Medical Education residency program. “(Primary care doctors) can't be here all the time like we are. They're so busy in their offices.”

Billing is also streamlined because a separate bill is not needed for primary care doctors' visits, said Dr. Jim Matsuda, medical director for St. Luke's pediatrics hospitalist program.

Mercy does not have a pediatric hospitalist program, so patients of St. Luke's Physicians & Clinics Pediatrics - which is instituting a policy of not seeing patients at Mercy - would be seen by Mercy's neonatologist or a resident with the Cedar Rapids Medical Education Foundation while at Mercy.

Dr. Timothy Quinn, president of MercyCare Community Physicians, noted that the decision by Internists Associates is the same one that nearly all primary care physicians associated with area hospitals have taken.

“Transitioning care of hospitalized patients to hospitalists is a growing trend in our community, as well as across the country,” he said by email. “By increasing the amount of time the physicians spend seeing patients in the clinic, they are able to schedule more one-on-one patient appointments and operate most efficiently.”

Studies have shown that patients seen by hospitalists have shorter hospital stays and better outcomes.

Researchers at the Iowa City Veterans Affairs Medical Center and University of Iowa found patients cared for by hospitalists averaged a one-day shorter length of stay (5.5 vs. 6.5 days) and a 10 percent reduction in hospital costs.

Dr. Scott Wilson, medical director of University of Iowa Hospitals and Clinics' hospitalist program, said the hospital is in a unique situation because only its own medical staff can see patients.

Still, the hospitalist program has jumped from one - when Wilson began in 2000 - to 31. This year alone, 21 hospitalists were added, in response to a new restriction that limits first-year residents to 16 work hours per shift.

Hospitalist programs also have grown since beginning in 2006 at St. Luke's and 2008 at Mercy.

Dr. Martin Izakovic, medical director of Mercy Iowa City's hospitalist program, said 12 doctors have been added since he began as the first hospitalist there in 2006.

“(Medicine) is not the same as it was 20, 30 years ago,” he said, citing increasing specializations in inpatient and outpatient medicine. “I think the hospitalist programs were an unknown entity 15 years ago. Today, it is the fastest-growing subspecialty within internal medicine.”

Hospitalists fit with health care reform's push for higher quality at lower cost, Izakovic said. For example, patients seen by hospitalists at Mercy have lower readmission rates.