An Analysis of Hospitalist Programs in Critical Access Hospitals

Abstract

Hospitalists are physicians specially trained in the care of hospitalized patients. In critical access hospitals (CAHs), the annual cost of a physician-based hospitalist program is approximately $1M. The high cost of hospitalist programs must be offset by the hospitalists’ ability to reduce the cost of inpatient care and/or by their ability to generate additional inpatient volume and revenue. Two well-established metrics are used to measure hospitalist performance: the average inpatient length of stay (ALOS) and the average daily census (ADC). Well-performing hospitalist programs are expected to reduce ALOS and increase ADC. The most pressing question for CAH administrators is whether sufficient cost saving and revenue enhancement opportunities exist at CAHs to offset the high cost of the programs.

Little is known regarding hospitalist performance at CAHs specifically. This study was designed to address that gap in the literature.

This study posited that due to very low inpatient census levels, relatively low inpatient acuity, and small rural populations, hospitalists at CAH’s do not have a statistically significant impact on either ALOS or ADC when compared to non-hospitalist models of inpatient care. The study used a five-year, multivariable, longitudinal, random-effects panel data analysis to reach its conclusions. The analysis first studied variances in two groups of hospitals: those that exclusively used hospitalists over the five-year study period and those that did not use hospitalists at all during the same period. To provide additional analytic sensitivity, the study sample was then expanded to include hospitals that started the five-year period not using hospitalists but converted to a hospitalist model during the study period. The analysis was then repeated, and the results were compared.

Both analyses confirmed that despite low inpatient census levels, low patient acuity, and low rural population levels, hospitalists in CAHs reduce the ALOS by approximately one full day per patient and increase the ADC by approximately three patients per day when compared to hospitals that used alternative models of inpatient care.