Abstract
Evidence is lacking on the consequences of high rates of inpatient consultation. To examine outcomes and resource use of patients cared for by hospitalists who use more inpatient consultation than their colleagues. A retrospective cohort study of medical admissions to hospitalists among fee-for-service Medicare beneficiaries was conducted. Hospitalist consultation tendency was identified from January 1, 2013, to December 31, 2014; admissions were calculated in 2013; and outcomes were measured in 2014. Data were analyzed from January 31, 2017, to May 9, 2019. A total of 711 654 admissions with patients receiving care from 14 584 hospitalists at 737 hospitals were included. Admission to high-consulting hospitalists, considered to be those who were in the top 25% of the distribution of consulting frequency at their own hospital (adjusted for patient case mix). Outcomes included length of stay, Medicare Part B inpatient charges, discharge destination, all-cause 7- and 30-day readmissions, 90-day outpatient specialist visits, and 30-day mortality. The 711 654 hospital admissions included 408 489 women (57.4%); mean (SD) age of the population was 80 (8.5) years. Length of stay of patients cared for by high-consulting hospitalists was longer compared with other hospitalists (adjusted incidence rate ratio, 1.04; 95% CI, 1.03-1.05). The admissions resulted in a mean of $137.91 (95% CI, $118.89-$156.93) more in Medicare Part B charges and were less likely to end with the patient going home (adjusted odds ratio [aOR], 0.96; 95% CI, 0.94-0.98) compared with patients cared for by other hospitalists in the cohort. Patients cared for by high-consulting hospitalists also were 7% more likely than patients cared for by other hospitalists to see an outpatient specialist at 90 days (aOR 1.07; 95% CI, 1.05-1.09), with no significant differences in 30-day mortality (aOR 1.01, 95% CI, 0.98-1.03) or readmissions (7-day readmissions: aOR 1.01; 95% CI, 0.98-1.03; 30-day readmissions: aOR, 1.01; 95% CI, 0.99-1.03). Hospitalists who obtain consultations more than their colleagues at the same institution were associated with greater use of health care resources without apparent mortality benefit. Further investigation should identify whether reducing high rates of consultation can reduce resource use without harming patients.
Highlights
As US health care spending continues to increase more quickly than inflation, attention has focused on reducing delivery of health care services that do not benefit patients.[1,2,3,4] because most hospitals in the United States are paid via a fixed diagnosis-adjusted reimbursement per admission, little research has assessed low-value care during hospitalizations
Hospitalists who obtain consultations more than their colleagues at the same institution were associated with greater use of health care resources without apparent mortality benefit
Further investigation should identify whether reducing high rates of consultation can reduce resource use without harming patients
Summary
As US health care spending continues to increase more quickly than inflation, attention has focused on reducing delivery of health care services that do not benefit patients.[1,2,3,4] because most hospitals in the United States are paid via a fixed diagnosis-adjusted reimbursement per admission, little research has assessed low-value care during hospitalizations. Curtailing use of such services may yield only incremental savings.[13]
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