In 1991, when Adam Singer answered an ad for a physician to take care of hospitalized patients, he never imagined that he was on the cusp of an emerging industry.
Fresh out of a fellowship program in pulmonology, he was just looking for a way into the profession. "I just wanted to make hay for my practice," Singer said.
What Singer ended up with was an entirely new business, a medical practice that specializes in the care of acutely ill patients. North Hollywood-based IPC The Hospitalist Co., one of a still-small group of practices in the so-called "hospitalist" field, provides physicians who oversee patient care from the time of admission in a hospital through discharge. These doctors handle all facets of the stay, from ordering tests to writing treatment plans and supervising follow-up nursing care or other services needed when the patients return home.
Since the company was founded in 1995, it has grown at a blistering pace; from $3.5 million in 1997, it grew to $10 million in revenues by 1999 and this year, company officials are projecting revenues of $45 million. It now operates about 30 hospitalist practices in five states California, Arizona, Missouri, Illinois, Texas and Colorado and openings in another six markets are planned for next year.
"Over the next three years, we will be across the country and we will be fairly well-saturated (nationally) in five years," said Singer, who is president and chief executive of the company.
IPC's doctors may substitute for a primary-care physician during the patient's hospital stay, or they may be assigned to patients who have no primary-care doctor. The company is paid for its services by the patient's insurer or by a referring agency, such as the hospital itself or a skilled nursing care facility where the patient resides.
The field emerged during the 1990s as managed care cut the time and conditions allowed for hospital stays, sending more patients to the doctor's office for treatment. With their waiting rooms full, doctors had less time to attend to those patients who did require hospital care. Many also found that the expertise they needed for treating acutely ill patients was markedly different from the skills required to handle a typical office visit.
The National Association of Inpatient Physicians, a professional group for hospitalists, estimates that there are more than 5,000 such practitioners nationally, but most are small, local operations.
IPC has taken the practice a step further by virtue of its size and a proprietary technology that allows the company to collect and generate data about treatment and follow-up care.
"They are broadly based, so they have a lot of experience in this," said Robert Elk, chief medical officer for Pacificare of Arizona, which has been working with IPC for about two years. "Number two, they have a good infrastructure. I can find out how efficiently, and from a quality standpoint (how well, patients) are taken care of."
Shortly after taking his first hospitalist job with the Lakeside Medical Group in Los Angeles, Singer found he had almost 200,000 patients under contract. "By 1995, the demands were so great, I had to make a decision whether to stay in the (current) practice or expand," he said.
Singer formed IPC on a shoestring, subcontracting with other medical groups to provide doctors, until 1997, when another physician coined the term "hospitalist" and the investment community began to take notice of the field.
With venture funding in tow, Singer developed a business plan, began building a full-time team of doctors and professional administrators and engaged companies like Microsoft Corp. and Oracle Corp. to refine what he calls, "a computer technology that drives the company."
Using personal digital assistants, the doctors capture all the information regarding a patient's hospital stay personal data, medications, tests taken and results, etc. at bedside, and transfer it to a central database in the company's headquarters, where the information is analyzed.
"The beauty of that step is, I'm able to improve the performance of the doctors," Singer said.
Virtual second opinions
Doctors typically arrive at their treatment decisions by calling on their own experience and informal consultations with their colleagues. But with IPC's network and reporting capabilities, each doctor has the benefit of a wide range of experiences to draw on. They can better determine which treatments are most effective, use the data to develop protocols for doctors to follow, and report back to primary care physicians and specialists.
That's particularly important in today's health care environment, some say.
"It used to be you could take your time about proceeding with a diagnostic or treatment course," said Elk, referring to earlier days when patients were routinely admitted to hospitals when doctors didn't know what was ailing them. "But these days, patients who are in the hospital are all very acutely ill, and their condition is rapidly changing. They may require changes in the therapeutic approach more than once a day, and these doctors become very familiar with the kinds of illnesses (they handle)."
Some industry observers wonder whether employing hospitalists runs the risk of short-changing patients for the sake of efficiency and cost. But Singer and others point out that the hospitalists improve the level of care patients receive because they spend more time with patients than a primary care physician could, and because they are more experienced in the types of acute illnesses hospitalized patients typically have.
At the same time, Singer said, the company's doctors must be even more receptive to the needs of the patients because they are so ill.
"The demand is greater on us," he said. "Managing such acute illness, you have to be sure that what you do is always best for the patient."
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