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Filling in the Quality Care Gap

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GEORGETOWN Hospitalists enjoy a unique distinction. They are members of the fastest growing medical specialty ever.

Hospital medicine has been growing hand over fist since Medicare first misaligned hospital and provider incentives with the introduction of DRGs back in the 80s. Payment based on diagnosis shifted the demand for primary care away from rounds and into outpatient care. After DRGs, when patients got really sick, primary care wasn’t around like they used to be, and the coordination of inpatient care suffered under a fragmented system.

Hospital medicine emerged to fill the primary care gap between inpatient and outpatient settings.

Today, hospitals large and small are machines of efficiency when it comes to managing acute care demand. However, the supply of qualified hospitalists to manage those cases is limited, and in this competitive marketplace, recruiting hospitalists is especially difficult for the small or rural community hospital.

Georgetown Community Hospital, managed by LifePoint, is part of the trend of smaller hospitals that contract with hospitalists to perform rounds and manage acute care services. They employ MESA, a Lexington-based emergency and hospital medicine group practice, to staff both departments. There, MESA hospitalist Hunter Housman, MD serves multiple roles within patient care and hospital management.

Hospitalists like Housman are emerging as the new leaders of inpatient care for the way their responsibilities to round on patients integrate with the hospital’s need for standardized quality and patient safety. Their emergence in hospital leadership is reflective of the fact that while inpatient care has become more effective, it has also become more complicated.

“As hospitalists, we make sure that things go smoothly and that patients recover sooner and better. With all of the rules inside the hospital limiting their interactions,” says Housman, “some primary care providers feel like they can’t even go into the hospital.” That’s how he comes to see hospitalists as the stewards of more highly regulated medicine. “We own quality and patient safety. We own accountability.”

Housman serves on multiple quality and safety committees at Georgetown and nearby Bourbon Community Hospital. At Bourbon, he is currently vice chief of staff.

He credits MESA for allowing him to advance his career in his areas of interest. “What drew me to MESA,” he says, “is that as a growing company, I have the chance to develop as a leader and a physician. I see different levels of care and different severities of diagnoses, and I am also involved in the quality and safety processes of the hospital.”

This is a trend nationwide and one that Housman hopes continues. “In the next several years, I would like to integrate more process into what I do. I am interested in finding the processes that hospitalists are developing across the country that improve patient care. I think process, not just that someone is a good doctor, is why things are improving. That’s what I get excited about.”