In this study, we focused on the following research questions: 1) Which rural hospitals use hospitalists, and how do they differ from those that do not?; 2) Why are small rural hospitals using hospitalists and how are they being used?; and 3) What impact is hospitalist use having on rural hospital quality of care, finances, and recruitment and retention of primary care physicians?
How can hospitalist programs manage the ongoing shift to value-based care, along with operating costs and the challenges of managing, recruiting and retaining high-quality physicians? Read the report to find out.
Today, there is a strong media coverage on the increasing cost of health care in the United States andin many other countries around the world. This gives rise to a common concern in these countries. So, the question is how best to control the rate of growth in health care expenditures whilst still delivering good healthcare.
Speaker Presentation from U.S. News Healthcare of Tomorrow leadership summit, November 2-4, 2016 in Washington, DC. Find out more about this forum at www.usnewshot.com.
How can hospitalist programs manage the ongoing shift to value-based care, along with operating costs and the challenges of managing, recruiting and retaining high-quality physicians? Read the report to find out.
Today, there is a strong media coverage on the increasing cost of health care in the United States andin many other countries around the world. This gives rise to a common concern in these countries. So, the question is how best to control the rate of growth in health care expenditures whilst still delivering good healthcare.
Speaker Presentation from U.S. News Healthcare of Tomorrow leadership summit, November 2-4, 2016 in Washington, DC. Find out more about this forum at www.usnewshot.com.
Expedited patient-centered outcome measurement development for cancer careCancer Institute NSW
The need for real-time access to outcomes data is well-recognized. However, providers, payers, and patients lack access to timely and relevant outcomes data to support informed decision-making and comparisons across providers and over time. To help address these gaps, MD Anderson initiated a project to develop patient-centered outcome measures and to integrate data collection within the electronic health record (EHR) in 2014.
Palliative Patient Journeys—providing services in a regional and rural settingCancer Institute NSW
Griffith is a multicultural city in south-western NSW, with a population of 16,972, with a greater population living in the surrounding rural and remote areas. Palliative Care & End of Life [EOL] Services, were being provided by a wide range of service providers, in both acute and community sectors. Despite Strategic Planning and Model of Care directives, variation in the integration of services and a lack of resources meant that patients and carers were subject to variations in methods of service delivery.
Ramani Moonesinghe, Associate National Clinical Director for Elective Care at NHS England, discusses the use of data for monitoring care quality at various levels within the system.
Enhancing the patient experience in a new purpose-build MDT meeting room with...Cancer Institute NSW
St Vincent’s Head and Neck Clinic is a well-established, multidisciplinary clinic which has provided a co-ordinated team approach to the head and neck patient’s complex needs for over three decades. With the development of a new, purpose-built cancer facility, a clinical redesign project was undertaken, with the aim to further enhancing the patient experience and improving the quality of care for patients attending the weekly Multidisciplinary Head and Neck Clinic.
Expedited patient-centered outcome measurement development for cancer careCancer Institute NSW
The need for real-time access to outcomes data is well-recognized. However, providers, payers, and patients lack access to timely and relevant outcomes data to support informed decision-making and comparisons across providers and over time. To help address these gaps, MD Anderson initiated a project to develop patient-centered outcome measures and to integrate data collection within the electronic health record (EHR) in 2014.
Palliative Patient Journeys—providing services in a regional and rural settingCancer Institute NSW
Griffith is a multicultural city in south-western NSW, with a population of 16,972, with a greater population living in the surrounding rural and remote areas. Palliative Care & End of Life [EOL] Services, were being provided by a wide range of service providers, in both acute and community sectors. Despite Strategic Planning and Model of Care directives, variation in the integration of services and a lack of resources meant that patients and carers were subject to variations in methods of service delivery.
Ramani Moonesinghe, Associate National Clinical Director for Elective Care at NHS England, discusses the use of data for monitoring care quality at various levels within the system.
Enhancing the patient experience in a new purpose-build MDT meeting room with...Cancer Institute NSW
St Vincent’s Head and Neck Clinic is a well-established, multidisciplinary clinic which has provided a co-ordinated team approach to the head and neck patient’s complex needs for over three decades. With the development of a new, purpose-built cancer facility, a clinical redesign project was undertaken, with the aim to further enhancing the patient experience and improving the quality of care for patients attending the weekly Multidisciplinary Head and Neck Clinic.
Multispecialty Physician Networks: Improved Quality and Accountability - The ...EvidenceNetwork.ca
Multispecialty Physician Networks: Improved Quality and Accountability - The “Health Care Neighbourhood”
by Thérèse A. Stukel, Rick Glazier, Sue Schultz, Jun Guan Institute for Clinical Evaluative Sciences Toronto
Funded by: CIHR Emerging Team Grant in Applied Health Services and Policy Research
Our presentation at AMIA about our regional MRSA collaborative and use of health information technology to share MRSA colonization and infection data electronically.
Patient Satisfaction
Patient Satisfaction Today
• Has become an important buzzword in health
care.
• Patients have access to hospital “report card”
patient satisfaction and quality scores.
– Ex: Hospital Compare
• Hospital placing high priority for patient
satisfaction due to scores being tied to
reimbursement rates.
Patient Satisfaction Today
• Patients are better informed.
• Patients want to understand their medical
care and be a part of the decision-making
process.
• Health care is featured almost daily in the
media, increasing patient expectations of the
care provided.
How is Patient Satisfaction Measured?
• Hospital Consumer Assessment of Healthcare Providers
and Systems (HCAHPS) Survey.
• Standardized survey to gather and compare data across
the nation.
• 27 questions based on:
– Physician/Nurse/Staff Communication
– Hospital Environment
– Pain Management
– Overall rating
– Recommendation of Hospital
• Conducted through mail and/or telephone.
• Conducted after patient discharge.
Sample HCAHPS Questionnaire
• During this hospital stay, how often did nurses treat you with courtesy and
respect?
1. Never 2. Sometimes 3. Usually 4. Always 5. Non Applicable
• During this hospital stay, how often did doctors treat you with courtesy
and respect?
1. Never 2. Sometimes 3. Usually 4. Always 5. Non Applicable
• During this hospital stay, how often was the area around your room quiet at night?
1. Never 2. Sometimes 3. Usually 4. Always 5. Non Applicable
• Would you recommend this hospital to your family and friends?
1. Definitely No 2. Probably No 3. Probably Yes 4. Definitely Yes
• Using any number from 0–10, where 0 is worst hospital possible and 10 is
the best hospital possible, what number would you use to rate this
hospital?
Hospital Compare
Impact of ACA on Patient Satisfaction
• Pay For Performance (P4P).
• DRG payments are adjusted based on
performance on HCAHPS (30%) and clinical
process measures (70%).
• Patient satisfaction makes up 30% of hospital’s
score.
– Recommend Hospital
– Rate Hospital 9–10
Excellent Patient Satisfaction
• Excellent customer satisfaction goes beyond
patient interaction during hospital stay.
• Organizations judged on customer service the
instant contact is made with patient or family
member (phone, face-to-face, email, etc.).
• Higher patient satisfaction with inpatient care
and discharge planning is associated with
lower 30-day readmission rates.
» Source: AM J Managed Care, 2011; 17(1): 41-48
Trickle Down Effect of Excellent Service
• Providing excellent service leads to happy
patients who are less anxious.
• Less anxious patients are more cooperative,
leading to positive results.
Patient Needs
• Customer-friendly environment.
• Compassionate, caring, and individualized
care.
• Respect for privacy.
• Cultural sensitivity.
• Timely and proper explanations about ...
Cheryl Davenport, Director of Health and Care Integration at Leicestershire County Council, talks about how simulation is helping to evaluate how emergency hospital admissions can be reduced.
For the Nuffield Trust Health Policy Summit, Stephen Shortt tells the story of a journey from multiple unconnected practices to accountable community based integrated services at scale.
Hassan Argomandkhah - electronic Transfer of Care to Pharmacy training sessionInnovation Agency
Presentation by Hassan Argomandkhah, Pharmacy LPN Chair (Merseyside), NHS England, at the electronic Transfer of Care to Pharmacy training session on Tuesday 22 January at Formby Hall Golf Resort and Spa
A referral can be defined as a two-way process in which a health worker at a one level of the health system, having insufficient resources (drugs, equipment, skills) to manage a clinical condition, seeks the assistance of a better or differently resourced facility at the same or higher level to assist or manage the client's care and follow-up.
Improving ruli district hospital's patient referral system, final, 4.12.11Wendy_Leonard
Presentation by team of MBA students from Ross School of Business at University of Michigan. Describes recommendations for improving the referral process for rural health centers to the district hospital in rural Rwanda.
Presentation delivered by John Kurvink, VP, Corporate Services, Chief Financial Officer, Georgian Bay General Hospital at the marcus evans National Healthcare CFO Summit Spring 2017 held in Orlando, FL May 15-17.
The Importance of Community Nursing Care.pdfAD Healthcare
NDIS and Community 24/7 Nursing Care is a specific type of support that may be provided under the NDIS for individuals with complex medical needs who require ongoing nursing care in a community setting, such as their home or a supported accommodation facility.
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
Academyhealth 2013 How are Rural Hospitals Using Hospitalists?
1. How are Rural Hospitals
Using Hospitalists?
Michelle Casey, MS
Peiyin Hung, MSPH
Ira Moscovice, PhD
AcademyHealth | June 2013
Supported by the Office of Rural Health Policy,
Health Resources and Services Administration,
PHS Grant No. U1CRH03717
2. Background and Objectives
• Paucity of research with rural context
– Unclear whether prior research findings are
generalizable to smaller rural facilities
– Hospitalists may be part-time with additional
responsibilities
• Study objectives were to examine:
– How hospitalists are being used in rural hospitals
– Which rural hospitals are using hospitalists
3. Trends in Hospitalist Use 2005-2010
8%
11%
14%
16% 18% 21%
26%
32%
41%
44%
56%
61%63%
69%
75%
79% 81%
85%
2005 2006 2007 2008 2009 2010
CAHs All Other Rural Hospitals Urban Hospitals
Data Source: AHA Annual Surveys
4. Data Sources
• Primary data from a national phone survey of
rural hospitals May-August 2011
– Survey sample: Rural hospitals with <100 beds using
hospitalists in AHA annual survey
– Respondents: Hospital CEOs (2/3) and
clinical/administrative staff (1/3)
– Response rate: 86.4% (N=402)
– Statistical analysis of quantitative survey data and
qualitative analysis of open-ended responses
• Secondary data from American Hospital
Association Annual Surveys FY 2010
5. Primary Reasons for Using Hospitalists
Requests from
physicians,
26.6%
Improve care
quality /
continuity,
19.3%
Cover
unassigned
patients, 6.9%
Alleviate physician
shortage, 6.6%
Cover call/reduce
workload for
physicians, 16.4%
Allow physicians
to focus on clinical
practice, 10.3%
Recruit & retain
physicians, 8.6%
7. Additional Care Provided by Hospitalists
Care Settings by Hospitalists Percent of
hospitals
Hospital Outpatient Department 30%
Primary care in clinic or physician office 30%
Emergency Department 17%
8. Perceived Quality Impacts
Positive, 84.4%
Positive &
negative,
9.8% Hospitalists:
• Are available when needed & quick to
respond, spend more time with
patients
• Improve quality, patient safety
measures, communication with nurses,
teamwork
• Possess expertise, ability to handle
more acute patients
• Provide consistent, standardized care;
use evidence-based medicine
No change,
5.8%
9. Perceived Financial Impacts
No change, 5.8%
Positive,
44.6%
Both
positive &
negative,
16.9%
Negative,
32.6%
• Increased admissions
• Improved primary care
physician productivity,
ability to treat higher-
acuity patients
• Reduction in patient
complications, avg.
length of stay, transfers
10. • Costs more than
revenue generated
• Hospital has to
subsidize hospitalist
program
• High costs of
hospitalists’ salaries or
contracts
Perceived Financial Impacts
No change, 5.8%
Positive,
44.6%
Both
positive &
negative,
16.9%
Negative,
32.6%
11. Perceived Recruitment / Retention
Impacts
Easier,
74.4%
No
change,
25.4%
• PCPs don’t want to do
inpatient care or want
flexibility in doing it
• Reduced call, more
work/life balance for PCPs
• New candidates are only
interested in places with
hospitalists
Harder
0.6%
12. Which Facilities Are Using Hospitalists?
• Data
– AHA Annual Survey 2010
– Medicare payment classification data from University of
North Carolina at Chapel Hill
• Sample: Rural hospitals (n=1,462)
• Multivariate logistic regression model calculated
probabilities of hospitalist use given a hospital
characteristic
13. Measures
• Dependent variable
– Binary hospitalist use variable
– 27% of rural hospitals had missing value
• Explanatory variables
– Inpatient days
– Medicare payment classification
– Total primary care physicians with admitting privileges
– System membership
– Ownership
– Census Divisions
14. Probability of Hospitalist Use by Small
Rural Hospitals
Variables Est. Std. Err. P-value
Medicare Payment Classification
[Reference = Rural PPS]
Critical Access Hospital (CAH) -9.2% 3.7% 0.012
Medicare Dependent Hospital (MDH) -8.6% 4.4% 0.054
Sole Community Hospital (SCH) -3.7% 3.8% 0.331
Rural Referral Center (RRC) 5.0% 4.6% 0.271
Total Inpatient Days [Reference = Quartile 1]
Quartile 2 (2,188 – 4,212) 15.6% 3.4% <.001
Quartile 3 (4,213 – 9,259) 24.3% 3.8% <.001
Quartile 4 (>9,259) 37.2% 5.5% <.001
15. Regression Results cont.
Variables Est. Std. Err. P-value
Total Primary Care Physicians 3.8% 1.1% <.001
Total Primary Care Physicians2
-0.1% 0.1% 0.048
System Member 4.6% 2.2% 0.039
Ownership
(Reference = Public/Government)
Private Non-Profit 7.5% 2.5% 0.002
For-Profit 6.8% 4.2% 0.107
16. Conclusions
• Hospitalist use by rural hospitals increased
threefold, 2005-2010
• In rural hospitals, hospitalists:
– Are family physicians and non-physician
providers as well as internists
– Frequently play multiple roles – also providing
outpatient, emergency, and/or primary care
• Hospitalists can help address workforce
shortages in rural areas
17. Conclusions cont.
• Financial impact of hospitalist use is more
complex than costs vs. revenue:
– Enhance recruitment, retention and efficiency of PCPs
– Care for unassigned and uninsured patients
• Likelihood of hospitalist use varies by:
– Type of Medicare reimbursement (prospective
payment vs. cost-based)
– Inpatient volume
19. Medicare Payment
Classification
• Critical Access Hospitals
– 25 or fewer beds
– 101% of reasonable costs for inpatient, outpatient and swing bed
care.
• Sole Community Hospitals
– located either 35 miles from similar hospitals
– receive the higher of the federal PPS rate or an updated hospital-
specific rate based on historical costs.
• Medicare Dependent Hospitals
– fewer than 100 beds and more than 60% of inpatient discharges or
days covered by Medicare
– received the PPS rate plus 75% of the difference between the PPS
rate and an updated rate based on their historical costs.
• Rural Referral Centers
– have a combination of high case mix intensity and specialist supply
– more than 275 beds
– reimbursed using urban PPS rates.
Acknowledge my colleagues who worked on this study, ORHP for funding the study, the Survey Research Center at the University of Minnesota and the 329 rural hospitals that participated in our survey.
Some studies have found reductions in costs & LOS but results inconsistent. Most of them were done in academic or large urban hospitals. Generalizability of these studies to smaller rural facilities unclear.
In rural hospitals, hospitalist may be part-time role with additional responsibilities (e.g., ER coverage) and NP or PA may function in hospitalist role.
Our study focused on smaller rural hospitals Critical Access Hospitals and other rural hospitals with less than 100 beds.
purposes.
Before getting into our survey results, it is important to show the overall trend of hospitalist use by rurality. The use of hospitalists increased across all types of hospitals from 2005 to 2010. But it was relatively in the slow pace in critical access hospitals. Unfortunately, most research on hospitalist program implementation and outcomes has mainly focused on teaching and large urban hospitals.
We surveyed 402 hospitals, including critical access hospitals and other rural hospitals with less or equal to 100 beds using hospitalists in 2008 AHA survey. Of them, 350 hospitals responded but 21 hospitals indicated that they did not use hospitalists at the survey period. The rest of 329 small rural hospitals was analyzed/
Survey topics included:
length of time used and primary reasons for using hospitalists
characteristics of hospitalist practice and hospitalists
perceived impact of hospitalist use on quality of care, hospital finances, recruitment and retention, patient and physician satisfaction
*Critical Access Hospitals, which have 25 or fewer beds, receive 101% of reasonable costs for inpatient, outpatient and swing bed care.
To better understand rural hospitals’ survey responses, especially regarding their reasons for using hospitalists and the financial characteristics of hospitalist use on the hospital, we analyzed the relationship between hospitalist use, inpatient volume, and Medicare payment classifications for all rural hospitals, using secondary data from the FY 2010 AHA Annual Survey.
Open-ended question. Most common reason – 27% of responses - PCPs on medical staff either requested or required that the hospital set up a hospitalist program. One CEO described it as – PCPs said get a hospitalist program or we’re out of here!
2nd reason – 16% cover call, give physicians time off, for work-life balance, and especially on weekends to spend time with family. A number of respondents specifically mentioned need to reduce workload for aging PCPs.
3rd reason - 14% to improve quality of care and continuity of care. "We have a significant ICU but were unable to staff overnight in a manner that was safe and effective. We were going through long overnight stints with no physician on the floor." "We felt it would improve clinical quality of acute inpatient care and enhance primary care by enabling those doctors to focus 100% on ambulatory care."
Other important reasons included allowing physicians to focus on practices, recruitment and retention, coverage of patients who were admitted to the hospital without a physician, having too few medical staff and a desire to increase census, reduce transfers and care for more complex patients.
Literature indicates vast majority of hospitalists in urban settings are internists. We found internists well-represented in rural hospitals, but family physicians are also important.
When we grouped the surveyed hospitals by combinations of specialties used, 42% use both internists and family physicians while 41% use internists and no family physicians, and 15% use family physicians and no internists. These groupings may include PAs, NPs, or other specialties. Very few hospitals have neither IMs or FPs.
Hospitalists in rural hospitals frequently play multiple roles – providing outpatient, emergency, and/or primary care.
We asked survey respondents to indicate whether the use of hospitalists had positive impact, negative impact, both positive and negative or no change in terms of quality and hospital finances.
Assessments of the impact of hospitalist use on quality were very positive with 85% of hospitals reporting positive impacts on quality, 10% both positive and negative impacts, and 6% no change. No respondents reported only negative impacts on quality.
Respondents then asked open-ended question about how the impact had been positive or negative.
The most common positive impacts, in order were:
Hospitalists are available when needed; respond quickly; spend more time with patients
Improved quality and patient safety measures
Hospitalist expertise, ability to handle more acute patients
Provide consistent, standardized care; use evidence-based medicine, protocols
Improved communication with nurses and better teamwork
For the 32 hospitals that described negative as well as positive impacts, more than half described the negative impacts as being that patients want to see own primary care physician. A few also mentioned problems with locums, contract staff
Assessments of the financial impact of hospitalist use were more mixed than impact on quality
45% reporting a positive financial impact
One-third both positive and negative financial impacts
17% a negative financial impact
6% no change in financial status
Assessments of the financial impact of hospitalist use were more mixed than impact on quality
45% reporting a positive financial impact
One-third both positive and negative financial impacts
17% a negative financial impact
6% no change in financial status
Three-quarters of hospitals (74%) reported that the use of hospitalists made it easier for the hospital to recruit and retain primary care physicians and one-quarter indicated that there was no change.
Only 2 hospitals indicated that hospitalists made it harder to recruit and retain.
Critical Access Hospitals, which have 25 or fewer beds, receive 101% of reasonable costs for inpatient, outpatient and swing bed care.
Sole Community Hospitals, which are located either 35 miles from similar hospitals or where closer hospitals are inaccessible, receive the higher of the federal PPS rate or an updated hospital-specific rate based on historical costs.
Until the program recently expired, Medicare Dependent Hospitals with fewer than 100 beds and more than 60% of inpatient discharges or days covered by Medicare received the PPS rate plus 75% of the difference between the PPS rate and an updated rate based on their historical costs.
Rural Referral Centers, which have a combination of high case mix intensity and specialist supply, more than 275 beds, or a high volume of referrals, are reimbursed using urban PPS rates.
Previous research found a significant positive relationship between the number of hospital beds and hospitalist use. Inpatient volume can vary significantly for rural hospitals of similar bed size, so we used inpatient hospital days as a measure of the potential demand for hospitalist services. We were also interested in testing whether rural hospitals’ Medicare payment classification is significantly related to the likelihood of using hospitalists. Our interest was based on suggestions in the literature that prospectively paid hospitals would be more likely to benefit financially from using hospitalists than hospitals paid on a per diem basis (Gregory 2003; Coffman and Rundall 2005), as well as research showing that rural hospital financial performance varies significantly by Medicare payment classification (Holmes et. al. 2010).
Model also controlled for primary care physicians with hospital privileges, system membership, ownership and census division
Hospitalist use appears to offer many potential benefits to rural hospitals, but benefits may need to be balanced against negative financial impacts, especially for hospitals with low inpatient volume