The landscape of hospital medicine is evolving throughout the US, and the demands of the practice specialty continue to grow.

“Hospital medicine is going through another phase of adjustment, the pressures are not just theoretical, they are real,” said S. Hasan Naqvi, MD, MBA, professor, chief medical officer-inpatient, and medical director, Clinical & Translational Science Unit at the School of Medicine, University of Missouri-Columbia.

He said issues like length of stay (LOS), margin compression, quality penalties, healthcare-acquired infections, workforce constraints, tele-expansion and AI integration are all converging at once.

“Hospitalists will continue to adapt in this new environment,” stated Naqvi.

LOS Is Not Just a Metric

LOS is not just about money but also about patient access and hospital capacity, he said.

“A hospitalists’ mindset is shifting from ‘medically stable’ to ‘medically optimized’ for transition, and ED [emergency department] boarding, transfer center deferrals, and ICU bottlenecks are everyday realities,” he said.

Naqvi summarized the issues that may affect the workload of hospitalists:

• More disciplined interdisciplinary rounds
• Electronic cues about geometric mean LOS, expected date of discharges, discharge barriers
• Daily discharge goals
• Close working relationships with consultants, therapy, case management, and ancillary services

Financial Pressures Will Demand Clear Value

Healthcare systems are focusing on return on investment.

“Hospital medicine continues to operate in a narrow margin environment. Subsidies are scrutinized,” said Naqvi. “This means hospitalist groups will increasingly be asked to demonstrate value in terms of bed capacity created through LOS reduction, prevention of transfer denials, avoided readmissions, reduced complication rates and documentation accuracy that appropriately reflects severity,” he said.

Broadening the Role as a Hub in Inpatient Healthcare

Hospitalists are highly valued by health systems due to their extensive knowledge of “how to get things done” and because they do not have competing surgical or outpatient responsibilities they devote all of their effort toward ensuring patients receive high-value and efficient care, said Samantha Murray-Bainer, MD, assistant professor and associate chief of clinical affairs, Division of Hospital Medicine, University of Wisconsin School of Medicine and Public Health, in Madison, Wisconsin.

Just as primary care physicians coordinate outpatient consultants, hospitalists centralize inpatient care by acting as a hub linking multidisciplinary teams to decide the best approach for the patient.

“Health systems are increasingly recognizing this skill set and asking hospitalists to take on more types of patients,” she outlined. “Hospitalists now have opportunities to work on inpatient cardiology, bone marrow transplant and cellular therapy, hematology and oncology services, either as the primary provider or in a comanagement model with the consultant.”

Hospitalists are an incredibly rich resource for quality improvement efforts within health systems, both by identifying quality issues and also supplying insight and support of quality improvement projects, noted Murray-Bainer. “They provide vital insight to executive leaders who are working to improve throughput and access to care and should be considered the paramount inpatient representative on hospital wide committees,” she said.

Tele-Hospitalists Will Become More Structured

Tele-hospitalist programs are expanding, and this change can also affect the specialty.

“Although initially deployed for coverage gaps, and cross coverages, telemedicine is now being evaluated for consistency, supervision, and quality parity,” added Naqvi. Tele-hospitalists are not simply a staffing solution; they can become part of the delivery model, he said. “The key question is not whether tele-medicine will grow, but how safely and effectively it is integrated,” he said.

Growth in Informatics Expertise

Another trend that’s being called out is how there will be growth in informatics expertise.

“Hospitalists are getting more involved in hospital operational planning,” said Russell W. Ledford, MD, director of the section of hospital medicine, and an associate professor of clinical medicine at Vanderbilt University Hospital in Nashville, Tennessee. “This has naturally occurred over time but will continue to see rapid growth. Analytics groups within large hospitals are excellent but generally rely on provider/clinician input. This is time intensive.”

“A hospitalist with informatics expertise can significantly cut down on this time-consuming process as they have an inherent understanding of the problems,” he said.

Hospitalists Will Extend Further Into Post-Acute Care

Hospitalists can effectively coordinate both acute and post-acute care for complex patients.

Post-acute bottlenecks are directly contributing to prolonged hospital stays and readmissions.

As a result, many systems are extending hospitalist involvement into inpatient rehabilitation units, skilled nursing facility partnerships, and complex transitions of care and high-risk discharge programs including post discharge clinics, Naqvi said. “Continuity across the care transition is becoming a system priority.”

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