Health care market trends and the evolution of hospitalist use and roles.
OBJECTIVE
To describe local health care market dynamics that support increasing use of hospitalists' services and changes in their roles.


METHODS
Semistructured interviews in 12 randomly selected, nationally representative communities in the Community Tracking Study conducted in 2002-2003. Interviews were coded in qualitative data analysis software. We identified patterns and themes within and across study sites, and verified conclusions by triangulating responses from different respondent types, examining outliers, searching for corroborating or disconfirming evidence, and testing rival explanations.


METHODS
Medical groups, hospitals, and health plans in 12 representative communities.


METHODS
One hundred seven purposively sampled executives at the 3-4 largest medical groups, hospitals, and health plans in each community: medical directors and medical staff presidents; chief executive and managing officers; executives responsible for contracting, physician networks, hospital patient safety, patient care services, planning, and marketing; and local medical and hospital association leaders.


RESULTS
We asked plan and hospital respondents about their competitive strategies, including their experience with cost pressures, hospital patient flow problems, and hospital patient safety efforts. We asked all respondents about changes in their local market over the past 2 years generally, and specifically: hospitals' and physicians' responses to market pressures; payment arrangements hospitals and physicians had with private health plans; and physicians' relationships with plans and hospitals. We drew on data on hospitalist practice structures, employment relationships, and productivity/compensation from the Society for Hospital Medicine's 2002 membership survey. Factors that fomented the creation of the hospital medicine movement persist, including cost pressures and primary care physicians' decreasing inpatient volume. But emerging influences made hospitalists even more attractive, including worsening problems with patient flow in hospitals, rising malpractice costs, and the growing national focus on patient safety. Local market forces resulted in new hospitalist roles and program structures, regarding which organizations sponsored hospitalist programs, employed them, and the functions they served in hospitals.


CONCLUSIONS
These findings have important implications for patients, hospitalists, and their employers. Hospitalists may require changes in education and training, develop competing goals and priorities, and face new issues in their relationships with health plans, hospitals, and other physicians.
Pham
Hoangmai H
HH
Center for Studying Health System Change, Washington, DC 20024, USA. mpham@hschange.org
Devers
Kelly J
KJ
Kuo
Sylvia
S
Berenson
Robert
R
D001130:Arizona; D002140:California; D004651:Employment / Q000639:trends; D005431:Florida; D019981:Health Care Sector / Q000639:trends*; D019538:Health Care Surveys; D018578:Hospital-Physician Relations; D020445:Hospitalists / Q000191:economics / Q000458:organization & administration / Q000706:statistics & numerical data / Q000639:trends*; D006801:Humans; D007325:Institutional Practice / Q000639:trends*; D008318:Malpractice; D010819:Physician's Role; D010821:Physicians, Family; D014481:United States