Cardiologist vs. hospitalist: Who curbs more readmissions?

Despite the trend of hospitalist-led care, a new study by the Minneapolis Heart Institute Foundation found that cardiologists curb more readmissions of heart failure patients than hospitalists, according to research presented at an American Heart Association scientific meeting in Los Angeles.

Even when patients' severity of illness is higher, attending cardiologists reduced readmissions more than hospitalists, with 16 percent readmission rates, compared to 27.1 percent, respectively, according to a research announcement last week.

The study is somewhat controversial, given that many hospitals employ a hospitalist-led discharge process.

For instance, Pennsylvania's PinnacleHealth System cut readmissions with its hospitalist team that communicates the discharge plan, Dana Kellis, senior vice president for medical affairs and chief medical officer, wrote in a Hospital Impact blog post last month. The hospitalists care for up to 70 percent of the inpatient volume at PinnacleHealth and identify a person who can answer a patient's questions after discharge and help ensure follow-up arrangements.

Out of more than 2,300 patients in the Minneapolis Heart Institute study, hospitalists treated 65 percent of patients, while cardiologists only treated 35 percent.

"We became much more involved in the post-discharge care by phone call within 24 hours of discharge, establishing provider follow-up within three to five days post discharge and having a nurse follow-up with patients identified as high risk," Casey Lawler, a cardiologist at the Minneapolis Heart Institute, said in the statement.

Although the study found cardiologists improved readmission outcomes, length of stay was similar for both cohorts--4.8 days for cardiologist-led care and 4.2 days for hospitalist-led care. However, there was about a $2,000 difference in patient costs. Cardiologist-led care cost a mean $9,850, compared to $7,741 for hospitalists.

For more information:
- read the announcement (.pdf)
- read the Hospital Impact blog post