Association of hospitalist care with medical utilization after discharge: evidence of cost shift from a cohort study

Abstract

Background: Hospitalist care has grown rapidly, in part because it is associated with decreased length of stay and hospital costs. No national studies examining the effect of hospitalist care on hospital costs or on medical utilization and costs after discharge have been done.

Objective: To assess the relationship of hospitalist care with hospital length of stay, hospital charges, and medical utilization and Medicare costs after discharge.

Design: Population-based national cohort study.

Setting: Hospital care of Medicare patients.

Patients: A 5% national sample of enrollees in Medicare parts A and B with a primary care physician who were cared for by their primary care physician or a hospitalist during medical hospitalizations from 2001 to 2006.

Measurements: Length of stay, hospital charges, discharge location and physician visits, emergency department visits, rehospitalization, and Medicare spending within 30 days after discharge.

Results: In propensity score analysis, hospital length of stay was 0.64 day less among patients receiving hospitalist care. Hospital charges were $282 lower, whereas Medicare costs in the 30 days after discharge were $332 higher (P < 0.001 for both). Patients cared for by hospitalists were less likely to be discharged to home (odds ratio, 0.82 [95% CI, 0.78 to 0.86]) and were more likely to have emergency department visits (odds ratio, 1.18 [CI, 1.12 to 1.24]) and readmissions (odds ratio, 1.08 [CI, 1.02 to 1.14]) after discharge. They also had fewer visits with their primary care physician and more nursing facility visits after discharge.

Limitation: Observational studies are subject to selection bias.

Conclusion: Decreased length of stay and hospital costs associated with hospitalist care are offset by higher medical utilization and costs after discharge.

Primary funding source: National Institute on Aging and National Cancer Institute.

Appendix Figure

Distribution of propensity scores for admissions cared for by hospitalists and primary care physicians.