Commonly Asked Questions About Our Hospitalist Services

Q: What is a hospitalist and what will they do?

A: Hospitalists are typically board certified Internal Medicine physicians employed by Apogee Physicians. They are dedicated to the acute care of hospitalized medical patients. They will be available to care for unassigned patients presenting to the Emergency Department who the ED physicians feel may require hospitalization or need an Internal Medicine consult. Additionally they are available to provide inpatient medical consults as requested by sub-specialist and to provide inpatient medical care to the patients of those primary care physicians that choose to enter into a service agreement with the hospitalist practice.

Q: Will the hospitalist program be a mandatory program?

A: No, hospitalist programs that are voluntary tend to be more successful. PCP’s may choose to arrange with the hospitalist group to provide their patients inpatient medical care; or they may choose to continue to provide inpatient medical care to their patients.

Q: Will the hospitalist practice also provide outpatient medical services?

A: No, the hospitalist practice will refer all patients to a PCP for follow-up and ongoing care. The patients will be instructed to see a PCP as soon as possible post discharge.

Q: How will the hospitalist choose a PCP for the unassigned patients?

A: The hospital will be asked to maintain a PCP call schedule. The unassigned patients will be given the name of the on call PCP to follow-up at the time of discharge. Additionally the hospitalist office will notify the on-call PCP of unassigned admissions that will be referred to his office for follow-up care.

Q: How will the PCP be assured that his patients will be returned to him for follow-up care?

A: The Apogee Hospitalists do not maintain an outpatient practice, thereby eliminating “competition” issues among the referring physicians. Additionally, the hospitalist practice will make every effort to identify the patient’s PCP. The hospitalist office will notify the PCP that his patient was admitted to the hospital and additionally he will be notified at the time of discharge from the hospital.

Q: How will giving up the inpatient practice benefit the referring physicians?

A: As referring physicians transfer care of their inpatient services to the hospitalist; they will be freed up to focus their energies on office visits or office procedures. As we know, PCP’s and sub-specialists are caring for a much sicker outpatient population; utilizing hospitalists will allow the referring physicians to devote more time on meeting the increasing needs of this population. Additionally, the referring physicians will be able to see more patients in the office. Some studies document that by eliminating hospital rounds that 4.5 hours/week/MD can be saved. For a primary care physician this is equivalent to approximately 13 extra visits/week and an annual revenue increase of $30,000 per year. Those numbers could be even higher for sub-specialists.

Q: What hours will the hospitalist be available?

A: The hospitalist will have an office located at each facility and will be available 24 hours/day, 7 days/week to provide services.

Q: How will the hospitalist program impact the sub-specialist?

A: The hospitalist will be available to provide Internal Medicine services to the hospitalized patient-allowing sub-specialist to increase productivity in the office. Sub-specialists will be consulted more appropriately to provide the specialty services as needed by the patients. Additionally, sub-specialists and surgeons will be able to consult the hospitalist group to manage medical issues on their primary patients as the need arises.

Q: How will the hospitalist choose a sub-specialist?

A: Hospitalists will make every effort to consult the sub-specialist that the PCP normally uses providing the specialist is on the patient's provider panel. The hospitalist group will elicit the PCP’s referral preferences as the PCP signs service agreements. In the case of the unassigned patient the hospitalist will make every effort to utilize the hospital’s sub-specialty call schedule.

Q: What does the hospital hope to accomplish by providing a hospitalist program?

A: The goals of the hospitalist program are tailored to meet the individual needs of each of the hospitals. Most hospitals overall goal is to continue to focus on decreasing length of stay and costs per case of the inpatient population while maintaining and/or improving the overall quality of care to the patients.

Q: How will the PCP maintain hospital privileges if he transfers his inpatient care to the hospitalist practice?

A: In some cases the Medical staff bylaws will need to be modified to assist the PCPs in maintaining hospital privileges. In some organizations, bylaws address the amount of referrals to the hospital as criteria for maintaining privileges. The hospitalist group will track the numbers of referrals it receives from each of the PCPs.

Q: How will continuity of care be maintained between the inpatient and outpatient setting?

A: Communication is the key to successfully implementing a hospitalist program and maintaining continuity of care. PCP’s will be notified of the patient’s admission to the hospital and pertinent information will be requested from the outpatient medical record. At the time of discharge the PCP will be notified and requested to see the patient in 5-10 days for a follow-up visit. The PCP will be provided pertinent information about the patient’s hospitalization to include the discharge summary, discharge instructions, and discharge medications. In some cases the hospitalist may choose to personally contact the PCP to discuss special issues or concerns.

Q: Can the PCP continue to see his patients that are under the care of the hospitalist?

A: During the patient's stay, the hospitalist is the attending of record, however the referring physicians are welcome to provide courtesy visits to their patients. If they have any specific questions, recommendations or concerns they are welcome to contact the hospitalist and discuss. To eliminate any confusion regarding the patient’s care, the hospitalist will make all final decisions and write the necessary medical orders.

Q: How will the hospitalist charge for services?

A: The hospitalist program will be responsible for all billing and collections of professional fees for the services provided to the patients.

Q: Will the hospitalist provide medical care in the Intensive care units?

A: The hospitalist group will abide by the regulations of the ICU as outlined by the organization. If a hospital does not have closed ICU’s, then the hospitalist group will admit patients to the ICU as appropriate and will consult the appropriate sub-specialty as necessary.

Q: How do hospitalists help to decrease costs and lengths of stay?

A: Because hospitalists are available 24/7 and do not have an outpatient practice they are able to focus their time on the provision of care to the inpatient population and create a sense of urgency throughout the institution. Being readily available allows them to follow-up on tests/procedures, etc in a timely manner and discharge patients, as they are medically ready to be discharged. They are actively involved with case management and begin planning for discharge at the time of admission. Additionally, hospitalists can lead quality improvement teams to focus on the development of care protocols to assist in reducing variations in care.

Q: What is a service agreement?

A: A service agreement is an agreement between the PCP and the hospitalist group. PCP’s who choose to utilize the hospitalist group for inpatient services will be asked to sign a service agreement. This agreement is designed to outline what the PCP can expect from the hospitalist group and what the hospitalist group expects from the PCP.

Q: How do patients feel about hospitalists?

A: Our experience with patient satisfaction surveys has consistently demonstrated that patients are very satisfied with the medical care they receive from Apogee Hospitalist. Our satisfaction scores have consistently been greater than 90% in all of our programs. We have found that both patients and families are pleased when they realize that the physician is available to them to 24/7.