He reviews with patients what’s happened during the previous 24 hours of their hospital stay, including any tests or change in their condition. He helps them make sense of what’s happening with their care. In some cases, he’s an intermediary for his patients, seeking out answers from other medical professionals.
Still, he acknowledges, visiting patients in the hospital makes him and the three other family doctors at his practice “dinosaurs.”
“With (insurance) reimbursements going down ... and our overheads being higher and higher each year, doctors have had to make the decision that it’s more advantageous financially for us to stay at our office than to go to the hospital to take care of patients,” Robbe said.
Increasingly, a group of doctors called “hospitalists” — physicians, usually internists, that specialize in the care of hospitalized patients — are filling the void left by primary-care physicians who no longer do hospital rounds.
Miami Valley Hospital, for example, now employs 32 hospitalists through Premier HealthNet, the region’s largest group of primary care practices. That’s up from two in 2005, said Dr. Gary Collier, MVH’s chief medical officer.
Pediatric Associates of Dayton, a large independent pediatric group with offices in Kettering, Beavercreek and Englewood, ceded hospital rounds to hospitalists at the Children’s Medical Center of Dayton on Jan. 1.
“It’s just better for the kids’ care to have a doctor that’s physically present at the hospital,” said Dr. David Roer of Pediatric Associates. He also noted the time commitments and restraints involved with doing hospital rounds. Relying on hospitalists, he said, allows him to see about 10 percent to 15 percent more patients each day at the office.
“Our primary concern was loss of control” and whether patients would be uncomfortable, Roer said. But he and his fellow pediatricians still talk to patients and hospitalists by phone. “Things have been going well.”
Robbe, who has been practicing medicine since 1989, acknowledges the financial pressure. Given the way insurance reimbursement is structured, he said, only one physician is reimbursed per diagnosis in the hospital. That means Robbe may do paperwork on 15 patients in a morning, for example, but may only receive compensation for the 10 or so on whom he’s following an active medical problem.
“I can see twice that many at the office,” Robbe said.
Still, Robbe and his fellow family doctors see value in hospital rounds.
“That’s a tremendous service to the patient,” he said. And the interaction with specialists and others at the hospital benefits him. “I don’t know if I’d be as complete of a physician if I didn’t go to the hospital.”
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