Primary care group tied to Angola hospital’s growth

By Aimee Ambrose | Posted: Thursday, November 19, 2015 10:00 pm

A team of hospitalists gets credit for helping Cameron Memorial Community Hospital increase service numbers.

The Angola-based hospital had a surge in patient totals and medical procedures over the past few years since the introduction of the hospitalist team and construction of a new facility.

An increase in business at the hospital wasn’t too surprising to spokeswoman Laura Lutterbeck. The astounding element was the size of the growth.

“Overall, anecdotally, we knew numbers were up,” Lutterbeck said. “When you see them graphically, it makes a bigger impression.”

Cameron admitted nearly 1,300 patients by the end of September, the final day of its 2015 fiscal year, a nearly 50-percent jump from 2012 when the hospital had 875 patients, data from Cameron shows.

The number of patients admitted for critical care vaulted by 200 percent in that time, a surprise for hospital staff. Those patients also stayed at the hospital longer. Emergency room patient admissions increased by 97 percent, medical/surgical patient admissions rose by about 43 percent, observation visits grew by 133 percent and inpatient lab procedures jumped 86 percent from 2012 to 2015.

Lutterbeck attributed the majority of the growth to health care services provided by physicians from Hospitalist Care Group, a Fort Wayne-based organization that specializes in primary care in hospital settings.

“A lot of the admit patterns that start increasing in 2012 begin with the engagement with the hospitalist group,” she said.

The group effect

Cameron began contracting with the group in 2012, a few months after the group incorporated.

With an expertise in general medicine, the organization provides 24/7, year-round inpatient care through two full-time physicians who rotate shifts there weekly. A physician’s assistant provides care in the evenings, and mid-level staffers operate on an on-call basis during the overnight hours, said Mark Drapala, the group’s CEO.

“The continuity of care is the big thing,” Drapala said.

Patients generally can count on having the same doctor treat them through each phase of care at the hospital, which is huge in terms of improving quality of care, he noted.

The team is averaging about 14 patients a week at Cameron, more than doubling its volume in the past few years.

As the hospitalists boost Cameron’s ability to treat patients for medical issues in Angola, the hospital also doesn’t have to transport patients to larger hospitals as frequently for services now, which helps account for the higher numbers in advanced care admissions and hospital stays.

“With the hospitalists, we saw an opportunity to help more sick people,” Lutterbeck said. “It just opens up those opportunities and allows us to provide broader care locally.”

Cameron also saw a 75-percent increase in inpatient surgical procedures, a 26-percent growth in outpatient procedures and a 20-percent rise in occupational therapy procedures. Those numbers likely stem from other specialists who provide services at the hospital, Drapala said.

Hospitalists’ role

The group helps fill a need for primary care in Steuben County as the area and other predominately rural areas are considered medically underserved by the federal government.

Hospitalists focus on the care of hospitalized patients, including those who seek such care without already having a family or primary care physician. Their focus eases workloads for family physicians, many of whom are overworked and burnt out, according to medical studies. In rural areas, primary care doctors tend to divide their time treating patients in offices and at hospitals, which has been a big turn-off for medical residents entering the field, said Drapala.

The hospitalist model gives physicians opportunities to choose whether to focus on outpatient practices or to concentrate predominately on hospital care. Both routes provide doctors more time to work with their patients.

“When you’re in traditional practice, you’re pretty much tied to your practice 24/7,” he said. “Hospitalists can devote more time to patient care in the hospital.”

Growing trend

About 48,000 hospitalists now work nationwide, up 55 percent from 31,000 in 2011, and more than double the fewer than 20,000 who were in service in 2005, data from the Society of Hospital Medicine shows. About 700 hospitalists work in a 100-mile radius around Fort Wayne.

Hospitalist Care Group’s business took off after joining Cameron three years ago. The organization grew from a staff of about four providers to 30 and now serves 10 hospitals – four in northeast Indiana, including Dupont Hospital in Fort Wayne, and six in northwest Ohio.

“We’re doing phenomenally,” Drapala said. “We’ve really focused on recruiting high-quality local people who want to stay and work in the area.”

Patients have given positive responses to the group at Cameron, Lutterbeck said.

In addition to the hospitalists, she attributes the statistical increases to the opening of the larger new $42-million hospital last December and the new amenities it provides.

Among them is a cafe at the entrance, which seems to be the reason why Cameron also served about 22,000 more meals this year than last year. Customers apparently visit the hospital just to eat and hang out, Lutterbeck said.

Published: October 27, 2013 

A hospitalist in house

Startup provides doctors who specialize in hospital care

Sherry Slater | The Journal Gazette

 A local startup is providing small hospitals affordable access to doctors who specialize in treating hospital patients.

The service addresses a growing demand, the entrepreneurs say, because more medical school graduates who go into family medicine are choosing to treat patients during office hours only.

That creates a need for doctors who spend all day at hospitals, caring for patients suffering from congestive heart failure, pneumonia and other serious illnesses.

“We have the expertise to take care of these kinds of patients,” said Dr. Khurrum Shaikh, a hospitalist.

Shaikh and Mark Drapala founded the Hospital Care Group in October 2012. Since then, they’ve signed on five clients in northeast Indiana and northwest Ohio.

They hire physicians, who are assigned to work in client hospitals in much the same way an accountant or other professional might work as a contractor assigned to an office. Hospitalists coordinate care and services for patients admitted to a hospital.

Shaikh (pronounced “shake”) first teamed with Drapala in 2007, when they worked for Parkview Health.

Similar programs cost hundreds of thousands of dollars to implement, a cost many smaller hospitals can’t afford, Drapala said. The Hospital Care Group’s fees are based on a hospital’s patient volume and can be anywhere from 30 percent to 50 percent of the cost of a full program, he said.

National median salaries for hospitalists are higher than those for primary care doctors, according to sources. The Society of Hospital Medicine, a professional group for hospitalists, said a 2012 report showed median compensation of $233,855 for internal medicine hospitalists. That same year, the Bureau of Labor Statistics reported general internists received $191,520 in mean wages. Neither organization reported numbers for both physician specialties.

The Hospital Care Group, which employs four doctors and two nurse practitioners, specializes in working with hospitals with fewer than 200 beds.

Connie McCahill, Cameron Memorial Community Hospital’s chief operating officer, said the Angola hospital has contracted with Hospital Care Group for one year.

She’s never received a complaint that a patient preferred his primary care doctor to the hospitalist.

“The physicians maintain a high level of communication,” McCahill said, adding that many primary care doctors visit patients at the hospital. “From the patients’ perspective, it’s a team effort.”

Many patients who come into the emergency room don’t have primary care doctors, she said. Having a hospitalist allows them to receive high-quality care regardless.

Dr. Shaikh, one of two hospitalists assigned to Cameron, said patients’ families appreciate not having to travel to visit hospitalized loved ones. Smaller hospitals often transfer seriously patients ill to larger, regional hospitals, he said.

A trained hospitalist allows smaller hospitals to provide necessary care, which increases hospital revenue, he said.

Cameron has transferred fewer patients since hiring the hospitalist service, McCahill said. But she doesn’t have exact numbers. Overall, the hospital has also seen an increase in the number of patients and how sick patients are.

Providing high-quality care to all patients is the driving force behind the contract, McCahill said. She was unwilling to estimate how much the nonprofit hospital is paying Hospital Care Group versus how much additional revenue it takes in because patients stay longer.

“There are so many soft costs and soft benefits that you can’t quantify in a dollar amount,” she said.

But, McCahill added, Cameron wouldn’t have the program if officials didn’t believe it offers value to patients and the community.

Mercy Western Region in Defiance, Ohio, has contracted with Hospital Care Group for a little more than a year to cover evenings and weekends when the one full-time hospitalist is off duty. That doctor works weekdays from 7 a.m. to 7 p.m.

The hospital still transfers patients to larger, regional hospitals at the same rate as before. But it’s now easier for local doctors because they can limit their practices to office hours, said Chad Peter, president and CEO. Mercy Western Region includes a hospital and a clinic.

More and more doctors in the Defiance area prefer to see patients exclusively in their offices, he said.

Peter believes patients benefit from hospitalist care because the program ensures a doctor is either in the building or on call at all times. The result is a faster response when nurses have questions or concerns, he said.

The approach has proved beneficial at larger hospitals, local officials said.

Lutheran Health Network started using hospitalists in September 2006 at Dupont Hospital. Since then, the program has grown to include about 25 hospitalists working at five Lutheran-run hospitals, officials said.

“The main objective is to help the hospital deliver care as efficiently and effectively as possible regardless of the hour,” Brian Bauer, Lutheran Health Network’s interim CEO, said in a statement. “We’ve found the growth of our hospitalist programs to enhance the continuum of care and patient experience.”

Parkview Health employs 28 hospitalists, who work at Parkview Regional Medical Center and Parkview Hospital on Randallia.

Hospitalists don’t cover Parkview’s community hospitals in Huntington, LaGrange, Noble and Whitley counties. Primary care doctors continue caring for their patients in those hospitals, spokesman Eric Clabaugh said.

Spencer Grover, vice president of the Indiana Hospital Association, said hospitals of various sizes have increasingly embraced the contractor model as a way to stock their staffs with specialists.

Grover, based in Indianapolis, previously worked for a company that managed hospitals by contracting out CEOs.

This allowed health care executives greater upward mobility, making it easier to transfer from a smaller to larger hospital, he said.

Smaller hospitals are able to hire experienced professionals who might not otherwise be willing to risk coming to a smaller, rural market. Also, it relieves them of the hassle of the interview process, Grover said.

But the trend doesn’t end at CEOs or hospitalists. Some hospitals contract with companies to provide emergency, radiology or neurology care.

“There’s plenty of contracting going around,” Grover said.

Many recent medical school graduates believe they can be just as productive and efficient while restricting their practices to office hours, when they treat patients with chronic conditions, including diabetes, high blood pressure and high cholesterol.

Those family practice doctors don’t see congestive heart failure, pneumonia and other serious illnesses as often as hospitalists do.

Also, primary care doctors increasingly consider traveling between the office and hospital – or hospitals in the case of Fort Wayne and other larger cities – as a time waster.

Modern medical practices don’t resemble those found on TV dramas from the 1970s, Grover said.

“It’s a lifestyle issue,” he said. “There’s no Dr. (Marcus) Welby anymore with a 24/7 schedule.”