Rice votes to pursue joint venture to create hospitalist program

WILLMAR -- A hospitalist program will be established at Rice Memorial Hospital next year under a proposal approved Wednesday by the hospital's board of directors.

WILLMAR -- A hospitalist program will be established at Rice Memorial Hospital next year under a proposal approved Wednesday by the hospital's board of directors.

The program, a joint venture between the city-owned hospital and Affiliated Community Medical Centers, has been under study for the past year.

Hospitalists -- one of the fastest growing specialties in medicine -- are physicians who specialize in caring for hospitalized pat-ients.

Officials at Rice and Affiliated believe the hospitalist program will help improve care for the sickest of hospital patients and increase efficiency for everything from ordering tests to monitoring how patients are faring. Lorry Massa, CEO of Rice Hospital, called it the wave of the future for regional hospitals like Rice.

"Our expectation is that it will grow," he said. "We can make the system even better."


"Everybody's a winner here," said Dr. Fred Hund, an internal medicine physician at Affiliated who helped develop the proposal.

Hund said the program will help bring a more specialized set of skills to inpatient care at Rice.

"The hospitalist is doing this five days a week instead of once a month," he said. "I think this is going to be an important part of health care in the future. It will take us to the next level as a regional referral center."

A feasibility study, completed earlier this year, concluded a hospitalist program could streamline care and potentially save money. The study by Nelson/Flores Associates also found that the program is financially feasible for both the hospital and the multi-specialty regional clinic.

The next step: Establish a hospital medicine committee, made up of representatives from Rice Hospital and Affiliated, to begin working out the details of a joint venture agreement.

The agreement then will be brought back to the boards of directors of both the hospital and Affiliated for approval.

Dr. Ronald Holmgren, president of Affiliated Community Medical Centers, said it's hoped that the hospitalist program could be in place some time before the end of March.

"I think it is a beginning step," he said in an interview last week. "There'll have to be re-evaluation in six to 12 months of how it's going and whether we want to expand it further. We'll see over a period of time if this model will work."


Officials are looking at an initial two-year agreement that could later be extended to five years as the program develops.

The agreement will include a $96,000 fee that Rice Hospital will pay Affiliated each year to support the program -- and to cover financial losses that Affiliated will incur because reimbursement is lower for hospitalist inpatient care than for office care.

How the program will work: A full-time hospitalist will manage inpatient care during the daytime, Monday through Friday. Evening and after-hours coverage will be handled by Affiliated's internal medicine physicians according to a call schedule.

Holmgren said the hospitalist will be drawn from the staff of Affiliated's internal medicine department and will remain an employee of Affiliated.

It's one of three models studied by Rice and Affiliated. The consultants looked at everything from patient volume to scheduling to overall cost.

Two of the models called for full-time hospitalists seven days a week. Both options were rejected for logistical and financial reasons.

Massa said the third option -- weekday coverage by a hospitalist -- was not Rice Hospital's first choice but appeared to be the most feasible, at least initially.

"We needed to start small," he said.


To start with, the program will concentrate on specific patient populations: those in intensive care, those with complex medical needs, patients from outlying towns whose physician isn't on the Rice Hospital medical staff, and patients who are admitted from the emergency room and don't have their own physician.

Family Practice Medical Center has opted not to formally participate in the venture. For the most part, its physicians will continue to see their own hospitalized patients "just the way we do now," administrator Gary McDowell said in a separate interview.

The clinic's view is that during a hospital stay is when patients "probably need their doctor the most," McDowell said. "It's just the perspective of the way we practice. It just didn't make any sense for us to be involved in the program."

Dr. Mike Morris, president of Family Practice Medical Center, said the family practice clinic may use the hospitalist service from time to time, however.

"We want to be very supportive and I do anticipate we will use it, but more on a consultive basis," he told the hospital board Wednesday night.

Holmgren said the hospitalist program will be "an addition" to the inpatient care that's currently provided by patients' own physicians.

"I think there are advantages to both," he said. "A physician who is trained in critical hospital care will be available throughout the day. There can be more continuity of care during the hospital stay."

Prompt medical evaluation, particularly for patients who are critically ill or whose condition is worsening, will be another benefit, he said.


It's not clear how much money the program might save, or whether the savings will help cover the cost of the program. Hospital officials believe some costs will go down, however, if improved care allows patients to go home sooner and care protocols can be standardized to be more efficient.

Officials also hope Rice can market the hospitalist service to outlying physicians and pick up some patients with complex needs who might otherwise be sent somewhere else.

Massa said the financial projections are deliberately conservative.

"It's been recognized by both parties that this is a work in progress. A lot depends on how quickly the program grows and the mix of patients that are seen," he told the board. "We're going to track it and we'll be able to report back to you."

Other hospitals that have adopted hospitalist programs have seen a twofold return on their investment, Hund said.

"I'm certainly hoping two years from now you all will see the value this has brought to the hospital," he said.

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