St. Vincent growing hospitalist program

St. Vincent Health is further expanding its reach outside Indianapolis by providing hospitalist care to smaller hospitals that find it increasingly hard to attract certain physicians to rural areas.

The local health system began outsourcing hospitalists, or doctors who provide inpatient care, in 2008 to Henry County Hospital in New Castle. Witham Health Services in Lebanon followed in 2009 and, most recently, Logansport Memorial Hospital began its partnership with St. Vincent on Jan. 2 this year.

The term “hospitalist” entered the health care vernacular when a University of California, San Francisco, physician and professor of medicine coined it in a 1996 New England Journal of Medicine article.

Today, it’s one of the fastest-growing areas of medicine. The reasons: increasingly complex health care coupled with a trend toward more medical students choosing specialties over primary care. The result is a growing shortage of primary care physicians, particularly in rural areas and smaller communities.

So the hospitals in Logansport, Lebanon and New Castle have chosen to hand hospitalist care over to St. Vincent, a larger health system that medical students might find more attractive as an employer.

“It’s a very difficult program to run, and for us to have access to the brightest and most brilliant, we had to go with a larger network,” Witham Health CEO Raymond Ingham said.

For St. Vincent, the hospitalist contracts might lead to deeper relationships, said Dr. Craig Wilson, St. Vincent Indianapolis’ executive director for hospitalist services.

“We are entering an age of significantly greater mergers in health care, just because of the reductions in [Medicare] reimbursement and the need for greater efficiency in your supply chain and IT,” he said. “To the degree hospitalist programs can influence that is still questionable. But in terms of relationship-building, hospitalist programs benefit that.”

Perhaps the biggest advantage for St. Vincent is potential for the agreements to lead to patient referrals, said Ed Abel, a hospital accountant at Indianapolis-based Blue & Co.

Patient referrals are heavily regulated by Medicaid and Medicare, yet the practice continues.

“The reality is, if you’re getting your paychecks from St. Vincent, where do you think you’re going to send your referrals?” Abel said. “It would be very unnatural to refer them to St. Francis or IU Health.”

For example, a patient in Logansport with a cardiology problem beyond the scope of its hospital might be referred to The Care Group, which St. Vincent acquired in 2010, he said.

Wilson insisted, though, that hospitalists should help smaller hospitals retain more patients because they provide a higher level of care than a general practitioner might.

A hospitalist’s expertise in several areas of medicine can help provide a safer environment at a time when readmission rates and length-of-stays are closely scrutinized.

About 30,000 hospitalists are practicing in the United States, making it one of the fastest-growing trends in patient care, according to a 2011 survey from the Philadelphia-based Society of Hospital Medicine.

More family doctors are turning their inpatients over to hospitalists because they often simply don’t have the time to provide adequate care. A family physician can see three or four patients at the office in the time it takes to travel to a hospital to visit one inpatient, Wilson said.

“They’re going down that road of wanting to give up that inpatient practice,” said Jeanette Huntoon, chief executive nurse at Logansport Memorial Hospital. “It decreases interruptions.”

St. Vincent has about 45 hospitalists and 15 nurse practitioners spread among the three hospitals in Lebanon, Logansport and New Castle, in addition to its hospital on West 86th Street in Indianapolis.

Ideally, one St. Vincent hospitalist should provide care for no more than 17 patients, Wilson said. Witham has about 40 beds; Logansport Memorial, 83; Henry County Hospital, 100; and St. Vincent in Indianapolis, about 750.

Hospitalists are free to live in the towns where they are assigned to work, Wilson said, but most commute from Indianapolis or the metropolitan area.

As to whether St. Vincent expands its hospitalist program beyond the three hospitals it currently serves, Wilson said, “It’s quite possible.”•