Bundled fee system can work

A reader responds to our cover story on bundled payments.

I would like to comment on “A Bundle of Joy or Trouble? “ (ACP Hospitalist, December 2009). I believe there will be more bundled money available to the hospitalist as well as to hospitalist groups if they are willing to adapt a new strategy of practice—advancing from low-scale, resident-like history takers to procedural hospitalists.

Their tasks could include echo reading, managing patients on ventilators in intensive care, intubation in emergency settings, etc. I have worked with groups of hospitalists who, when they encounter a new patient, can only pick up the phone and start paging all of the other specialties—infectious disease, hematology, nephrology. I believe you should not call these specialists in any inpatient setting except for very difficult or rare situations. You do not need to call the neurologist or endocrinologist to the hospital unless it is clinically necessary and will change the medical management. If a hospitalist is able to manage meningitis and perform a lumbar puncture, I see no reason to call ID and a neurologist to share a payment with them.

If this policy were adopted, hospitalists would generate a lot of RVUs and financial revenue.

Abdelsalam Mogasbe, MD
Morgan Hill, Calif.