Hospitalists

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      What Hospitalists Need to Know:

      Hospitalists play a relatively new but rapidly growing role in the American healthcare system, and research has shown that Hospitalists reduce the length of hospital stays, reduce treatment costs and generally provide more efficient care for hospitalized patients.

      As a relatively new specialty, many malpractice insurers do not have a separate designation for Hospitalists, and generally group them together with internists, though there is a trend toward a separate classification for Hospitalists. In 2009, The Doctors Company, one of the nation’s large malpractice insurers, began underwriting Hospitalists as a separate group. As in internal medicine, premiums for malpractice insurance in hospital medicine will be toward the lower end of the spectrum. Factors that cause variation among individual physicians’ premiums include geographic location, specific procedures performed, number of hours worked per week, previous claims history and other details of the practice. Most Hospitalists are hospital employees and are covered by insurance purchased by the hospital, but all physicians in the specialty should be aware of the terms and limits of their coverage.

      Because Hospitalists are part of a growing field and in high demand, the specialty is unusually mobile. This mobility creates a higher-than-usual risk of facing a gap in coverage and Hospitalists are often forced to change insurance carriers. Many malpractice insurance policies are written on a claims-made basis. This means that the policy covers only claims satisfying two conditions: The incident must have occurred after the policy’s retroactive date, and the claim must be filed while the policy is active. This means that, when a physician changes insurance carriers, he must purchase “tail coverage” from the previous insurer, so that he or she continues to be covered in case a claim is filed in the future regarding an incident that occurred during the term of the previous policy. Tail coverage can be expensive, and physicians should research the terms of tail coverage before deciding on a policy. Some carriers will offer retroactive coverage, which makes tail coverage from the previous insurer unnecessary.

      Research shows that malpractice claims against Hospitalists are relatively infrequent, though because hospital medicine is a new specialty, it can be difficult to determine exactly how many cases involve Hospitalists. While physicians who practice standard internal medicine are most likely to be sued for failure to diagnose a disease or condition, a suit against a Hospitalist is more likely to be caused by a failure in communication. This is true because Hospitalists do not have the same established relationships with patients as traditional internists. Hospitalists’ primary responsibility is to make sure the patient receives the optimal medical care in a hospital setting, a goal that relies heavily on communication, both with the patient and with other physicians. Good risk management for Hospitalists therefore emphasizes good communication. A good relationship with a patient, in which the patient feels he or she has been listened to and understood, can significantly reduce the likelihood of a lawsuit. Additionally, physicians should follow a set procedure for communicating with colleagues and seeking second opinions; roles and accountabilities should be clearly defined for the entire treatment team.

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      This write-up for Hospitalists was put together by Michael Matray, the Editor of the Medical Liability Monitor

      Resources for Hospitalists

      Evolution of the Hospitalist
      Today’s Hospitalist magazine
      Society of Hospital Medicine
      Effects of Physician Experience on Costs and Outcomes on an Academic General Medicine Service: Results of a Trial of Hospitalists