Sept. 10, 2008, WASHINGTON, DC—Studies from the Center for Studying Health System Change (HSC) in the September/October edition of Health Affairs explore the impact of hospitalists on care coordination, the current state of hospital-physician relations and the transition from managed care to consumerism at the community level.
The three Health Affairs articles are based on HSC's sixth round of site visits in 2007 to 12 nationally representative metropolitan communities—Boston; Cleveland; Greenville, S.C.; Indianapolis; Lansing, Mich.; Little Rock, Ark.; Miami; northern New Jersey; Orange County, Calif.; Phoenix; Seattle; and Syracuse, N.Y.
HSC, which has tracked change in these markets since 1996, is a nonpartisan health policy research organization funded in part by the Robert Wood Johnson Foundation, which funded the three studies:
Hospitalists and Care Transitions: The Divorce of Inpatient and Outpatient Care, by Hoangmai H. Pham, Joy M. Grossman, Genna Cohen and Thomas Bodenheimer
This paper examines how the growing use of hospitalists has affected care delivery systems, finding that disrupted relationships between hospitals and community-based physicians have increased the burden of coordination and blur accountability for the quality of post-discharge care. Arrangements where companies and multispecialty medical groups employ hospitalists are more likely than other hospitalist programs to establish routines for ensuring coordinated transitions upon hospital admission and discharge. Policy makers could support the development of guiding principles for care coordination, greater reliance on nonphysicians, and the reintegration of inpatient and outpatient providers.
Hospital-Physician Relations: Two Tracks and the Decline of the Voluntary Medical Staff Model, by Lawrence P. Casalino, Elizabeth A. November, Robert A Berenson and Hoangmai H. Pham
Hospitals are increasingly employing physicians, particularly specialists. Nonemployed physicians are separating from hospitals passively by refusing to serve on medical staff committees or take emergency department call and actively by creating specialized facilities, such as ambulatory surgery centers (ASCs), to compete for hospitals' most profitable services. Employment is more common and physician-owned ASCs are less common in consolidated hospital markets. The interviews also suggest other factors motivating physician employment by, or separation from, hospitals and likely consequences of these trends.
The Transition from Managed Care to Consumerism: A Community-Level Status Report, by Jon B. Christianson, Paul B. Ginsburg and Debra A. Draper
This paper assesses the evolving "facilitated consumerism" model of health care at the community level, finding that in a relatively short time large employers and health plans have made notable progress in putting the building blocks in place to support their vision of consumerism. However, developments in the 12 communities suggest that the consumerism strategy evolving in local markets is more nuanced than implied by some descriptions of health care consumerism. (SOURCE: Center for Studying Health System Change, HSC Alert , http://www.hschange.org/, September 11, 2008)