TMH mulling hospitalist proposal
May 28, 2011
Sukhbir Pannu sat Thursday night before The Memorial Hospital Board and recounted his experiences of raising a family in a rural setting.
In particular, he discussed the quality of medical care in areas off the beaten path.
"The system doesn't think we deserve the same kind of care," he said of small towns. "The best physicians, the best providers are at large hospitals in urban settings."
Pannu is medical director for Rural Physicians Group. On Thursday, he and an associate described the reasons for the health care disparity in rural areas, and how his group could even the playing field.
The solution, he said, are hospitalists.
Hospitalists are medical physicians, or internists, who help alleviate the strains of regular physicians' on-call duties.
Currently, physicians who practice in Craig are responsible for making rounds and being on call at TMH once every five or six days.
While on duty, those physicians could be up all hours of the night and during the day, missing the opportunity to see patients at their own practices.
Hospitalists, on the other hand, live in the hospital — literally. They're available 24 hours a day, seven days a week.
And, they virtually eliminate the need for call.
Once those needs are eliminated, it increases a rural hospital's ability to recruit new doctors.
In other words, if a physician has the choice of joining an urban practice where there are no on-call duties, that doctor is more likely to accept that position versus one that carries a call schedule like the one that currently exists in Craig.
Cindy Johnson, a business development associate for Rural Physicians Group, discussed with the hospital board what her company provides.
"We dedicate three physicians — the same three physicians — to the hospital, with one backup (physician)," Johnson said.
Those physicians, she said, would work in rotation.
For instance, one doctor arrives at TMH and stays within the hospital around the clock for roughly seven days. At the end of the week, that doctor is replaced by a second doctor. And then a third.
At the end of three weeks, the cycle begins again.
"It's not a group of new physicians that are rotating through the hospital," she said. "It's three dedicated physicians that really become part of the community."
Johnson said paitents and their families are afforded total access to hospitalists during their weeklong shifts.
"Our physicians carry a local cell phone," she said. "That local cell phone number is displayed prominently in the patient room. And, upon greeting the patient for the first time … it is explained to them that the phone number is there and available for patients and family members at any time, if there are any questions or concerns."
The system, she said, eliminates the need for family members to coordinate their patient visits with doctors' rounds.
"It doesn't have to be like that anymore," Johnson said. "The physicians are onsite and available."
Hospitalists would remain employees of Rural Physicians Group and be subcontracted by TMH.
George Rohrich, TMH chief executive officer, said the proposal warrants close consideration. He said hospitalists are a good idea for TMH, but the jury is out whether it's economically viable.
"That's the part that we're still analyzing," he said. "Will this program pay for itself through increased business?
"I suspect that, initially, the program will cost more than it generates."
However, Rohrich said hospitalists could lay the groundwork for TMH to expand.
If there are round-the-clock physicians at the hospital, there would be less need to transfer patients to other facilities, thus generating new revenue, gaining market share and earning loyalty.
Dr. Stanley Pense, a general surgeon for TMH, said the idea has merit for both patients and doctors.
"The quality of care would improve because you would have somebody there 24/7," he said. "And, they're available for families to talk to."
Pense said his quality of life would improve, too. It would reduce late-night phone calls he receives from nurses.
"If the patient had a fever and needed Tylenol, instead of waking me up at two in the morning for Tylenol, they could call the hospitalist and the hospitalist could take care of it," he said. "And, in that way, my lifestyle would improve."
Dr. Larry Kipe, who runs a private practice in Craig, said he would be less likely to make use of hospitalists. When his patients are admitted to TMH, Kipe likes to check in on them, he said.
"I'll continue to see my patients, there's just no way around it," he said. "It's one of the things I enjoy doing.
"My in-patient work at the hospital is one of the things that helps to define me personally. I'm not going to be giving that up."
Kipe said he's also concerned about cost.
"The service itself sounds spectacular, I just question whether it's the right thing for the hospital to do," he said. "They're gong to be paying those people quite a lot of money to be doing that, and there's no way the billing that the hospitalists will be doing will in any way come close to paying for this service at all."
Pannu said the Rural Physicians Group helps hospitals increase patient volume. He cited an example of another hospital his group contracted with.
"Their average daily census would run anywhere from two to four," he recalled. "Now, I don't think it's any less than eight or 10.
"This was within eight weeks of having them there."
Pannu said contracts between Rural Physicians Group and TMH would be monthly, and TMH could end the partnership at any time, without cause.
Rohrich said the group's contract flexibility allows for possible experimentation.
"That's what keeps us thinking about it," he said. "There's a safety valve. Otherwise, I think the risk would be too high."
Rohrich also said the flexibility instills faith.
"That demonstrates to me that the company is pretty confident in what they do," he said. "And, it gives us a way to discontinue this if it just doesn't work."
Rohrich said if the hospital were to partner with Rural Physicians Group, TMH would make accommodations for the hospitalists.
"We would make a space for them that would resemble a small hotel room, or a dorm room, if you will," he said. "It hasn't been determined where that might be. We have several of those already for the OB docs and the ER docs who are here for extended periods of time."
Rohrich said he isn't concerned that hospitalists might be overworked during weeklong shifts within the hospital.
"Just like in the emergency room where we do 12- and 24-hour shifts, there are times when everybody is asleep — all the patients are asleep," he said.
In the meantime, Rohrich said there is a lot to like about hospitalists, particularly a higher level of patient care.
"By having a physician there all the time versus coming in and going home, coming in and going home … that availability to patients and patient family would increase satisfaction. We know those things. We would strongly expect those things to increase — quality and satisfaction.
"That's what we're struggling with. Everyone agrees this would be good — good for the hospital, good for the community, good for the physicians.
"But, so much of the things that are good about it are almost impossible to quantify. So, it will be an interesting discussion if it results in a proposal to move forward — how to quantify that."
Rohrich said the matter would be discussed further during the hospital board's June meeting.