Download Hospital medicine by Robert M. Wachter MD, Lee Goldman MD, Harry Hollander MD PDF

By Robert M. Wachter MD, Lee Goldman MD, Harry Hollander MD

Thoroughly up-to-date for its moment variation, Hospital Medicine bargains sensible, evidence-based instructions for the care of hospitalized sufferers. the one publication geared at once and solely to inpatient management—and edited by way of the nationwide leaders of the hospitalist field—Hospital Medicine comprises symptoms for admission, guidance for session, tactics for health facility discharge, diagnostic algorithms, and significant paths detailing potent, outcomes-oriented treatment options for a number of ailments and issues. New chapters during this version specialise in the hospitalist's expanding function in delivering severe care, coping with surgical sufferers with scientific co-morbidities, making sure sufferer safeguard and combating adversarial occasions, and directing sanatorium structures parts resembling informatics, caliber development, and perform management.

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FINANCIAL VIABILITY OF HOSPITALIST PRACTICE Survey data from 2002 show that 75% of hospitalists receive some financial support in addition to the collection of professional fees (3). This support usually comes from the hospital served by the hospitalists, but it may come 26410 ch 003 3/11/05 2:33 PM Page 20 20 Section I: General Issues in Hospital Medicine from other sources, such as a managed care organization or a large group medical practice. The median amount of this support was 30% of professional fee revenue for the practice (3).

For example, when hospital care is retrospectively reimbursed, having a greater number of hospitals in an area can result in greater competition among hospitals for doctors. This, in turn, can cause hospitals to overinvest in infrastructure, increasing costs in what is sometimes called a “medical arms race” (8). In contrast, greater competition among hospitals under prospective payment generally decreases costs by driving inefficient practices out of the market. Competition under prospective payment may also have a less desirable outcome because it can make it more difficult to cross-subsidize the care of costly patients with payments for the care of less costly patients in the same categories (9).

For example, the cost of staffing the pharmacy would be distributed among the number of medication doses provided. Because the vast majority of hospital costs are fixed (more than 80% in some studies (10)), understanding how a cost-saving intervention will affect fixed costs is essential. Assigning costs to a specific activity is often difficult in practice, so hospitals sometimes describe costs in terms of “direct” and “indirect” costs. Direct costs are costs that can be directly identified as being associated with an intervention, for example, the cost of the IV tubing, solution, and medication in the instance noted above.

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