Faculty Bibliography

BACKGROUND:Accurately identifying the number of practicing hospitalists across the United States continues to be a challenge. Characterizing the workforce is important in the context of healthcare reforms and public reporting. OBJECTIVE:We sought to estimate the number of adult hospitalists practicing in the United States over an 8-year period, to examine patterns in growth, and begin to explore billing patterns. DESIGN, SETTINGS, AND PARTICIPANTS/METHODS:Retrospective study using national Medicare Part B claims datasets. We applied a commonly used 90% threshold of billing hospital visit-associated Healthcare Common Procedure Coding System codes to identify adult hospitalists in publicly available Medicare Provider Utilization and Payment data for 2012-2019. We then analyzed billing patterns for those identified hospitalists. MAIN OUTCOMES AND MEASURES/METHODS:Identify trends in the number of identified adult hospitalists, including those self-identified. Compare hospitalists' billing to that of non-hospitalist Internal Medicine and Familiy Medicine physicians. RESULTS:We saw more than a 50% growth rate of practicing adult hospitalists between 2012 and 2019. In 2019, we identified 44,037 adult hospitalists. CONCLUSIONS:The number of adult hospitalists continued to grow at a consistent rate, such that hospitalists are in the top five largest physician specialties in the United States. In the absence of more formal identification and consistent use by hospitalists, a threshold continues to be a meaningful tool to characterize the workforce.

In the absence of a unique identifier, it is difficult to assess the number of practicing hospitalists. We use a variety of thresholds of billing activity to identify hospitalists in a dataset of publicly released 2012 Medicare physician pay data. Our study updates previous estimates of the number of hospitalists practicing nationwide in 2012 and suggests the field continues to grow. This research also highlights a need for a more precise system of identifying hospitalists. Journal of Hospital Medicine 2016;11:45-47. (c) 2015 Society of Hospital Medicine.

Outpatient versus inpatient status determinations for hospitalized patients impact how hospitals bill Medicare for hospital services. Medicare policies related to status determinations and the Recovery Audit Contractor (RAC) program charged with postpayment review of such determinations are of increasing concern to hospitals and physicians. We present an overview and discussion of these policies, including the recent 2-midnight rule, the effect on status determinations by the RAC program, and other recent and pertinent legislative and regulatory activity. Finally, we discuss the future direction of Medicare status determination policies and the RAC program, so that physicians and other healthcare providers caring for hospitalized Medicare beneficiaries may better understand these important and dynamic topics. Journal of Hospital Medicine 2014. (c) 2014 Society of Hospital Medicine.