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Q&A: How can we streamline hospitalist-specialist interaction?

Hospitalist Leadership Connection, January 19, 2010

Historically, specialists were integral to actively managing hospitalized patients. However, numerous factors—the advent of hospitalists, changes in the culture of medical residencies, decreasing reimbursement rates, “medico-legal” pressure, and provider burnout—have reshaped their role into that of a consultant or procedurist.

As a result of this transition, hospitalists now manage patients daily who were previously managed by specialists. For both hospitalists and specialists, this arrangement has created opportunities and challenges.

To foster a successful partnership with specialists, a hospitalist practice must first address the following questions:

• When does a specialist refer a patient to the hospitalist service, and how does he or she coordinate the transition?
• What are the standards of care in the community for specialist referral?
• What are the expectations of specialists’ patients?
• What are the hospitalists’ expectations in this arrangement?
• How does a hospitalist practice determine its scope of service?
• What factors are involved in successful delivery of services (e.g., staff numbers, provider skill sets/specialization, practice structure, support services)?
• If a hospitalist practice overextends itself when attempting to care for specialists’ patients, how can it be remedied?

The above excerpt is adapted from Hospitalist Case Studies: Tactics and Strategies for 10 Common Hurdles, published by HCPro, Inc.

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