Letter from the Editor

With health care reform in the news, bundled payments have been getting a lot of attention. Under this plan, payers would pay a lump sum per hospital admission that hospitals and physicians would share, in contrast to the current system based on separate billing for relative value units. Bundled payments offer possible advantages, but there are possible pitfalls, too.


With health care reform in the news, one topic in particular has been getting a lot of attention from hospitalists: bundled payments. Under this plan, payers would pay a lump sum per hospital admission that hospitals and physicians would share, in contrast to the current system based on separate billing for relative value units. Bundled payments offer possible advantages, such as greater incentives to coordinate care, which could make hospitalists even more valuable to their institutions. But some hospitalists express concern about having their income entirely controlled by hospitals, which could happen if hospitals are made responsible for distributing bundled payments. And although experts agree that the effect of such payments will vary depending on where hospitalists work, no one is quite sure how. In our cover story, Stacey Butterfield talks to leaders in the field about what a bundled payment system might look like and what it could mean for hospital medicine.

Hospitalists are always working to improve handoffs to primary care physicians, and recent research suggests that pending test results at discharge are a particularly vulnerable area. A study in the Journal of General Internal Medicine found that of 696 patients released from two academic medical centers with pending test results, only 25% of their discharge summaries mentioned the tests and only 13% listed all pending results. But not all pending test results are equally important, and hospitalists don't always know which clinic or clinician should receive them. Our story offers some ways to solve this particular handoff problem.

Hospitalists who work at academic medical centers can face specific and not insignificant hurdles to promotion, as well as a nebulous position in the academic hierarchy. Lack of mentors can be a problem, as can lack of time to participate in research projects. But some changes are on the horizon, thanks to recent efforts to more clearly define the role of academic hospitalists and design a career path for those interested in combining teaching and research with patient care. Learn more about developments in this area.

Do you have an opinion on bundled payments, or a tip on managing pending test results? What's it like to be an academic hospitalist at your institution? Let us know.

Sincerely,
Jennifer Kearney-Strouse
Executive Editor, ACP Hospitalist