Hospitalists shape the future of American healthcare system

Leading hospitalist says that the work is just beginning

On March 21, 2010, Congress passed the most comprehensive healthcare reform bill since the formation of Medicare. While a monumental achievement, the bill leaves much of the critical work of healthcare reform unfinished, according to a new editorial by Dr. Robert Wachter, Chief of the Division of Hospital Medicine, University of California, San Francisco, and past president of the Society of Hospital Medicine, in the April issue of the Journal of Hospital Medicine.

"The legislation's greatest impact will be to improve access for nearly 50 million Americans who are presently uninsured. Yet the bill does little to tackle the fundamental problems of the payment and delivery systems -- problems that have resulted in major quality gaps, large numbers of medical errors, fragmented care, and backbreaking costs," said Wachter.

His article proposes that current practices in hospital medicine -- the fastest growing medical specialty in modern history -- could ease many of the uncertainties in healthcare and increase physician-hospital integration.

"The current debates about healthcare reform have often confused matters more than they have clarified," says Wachter. "This article is an attempt to 'connect the dots' for hospitalists, healthcare leaders and policymakers. Rationing, so-called 'death panels', comparative effectiveness, bundled payments - all these issues and controversies represent fundamental concerns and will need to be addressed."

Hospitalists will be in the center of efforts to improve quality, safety, and efficiency, and as such will be essential in shaping the future of the American healthcare system, argues Wachter. "It may be that hospitals and doctors need not look to Rochester, Minnesota or Danville, Pennsylvania for positive examples of physician-hospital collaboration in the name of improvement, but simply to their own local hospitalist groups."