The Evolving Role of Virtual Hospitalists

While hospital medicine is a relatively new specialty, in the last nearly 30 years its practitioners have become a staple for acute patient care. Today, hospitalists’ roles are evolving by expanding their reach into patients’ homes. As home hospital models are becoming more widely adopted, more and more of these physicians are seeing new aspects of their role become virtual – and for the betterment of all involved. 

Why hospitalists are a perfect fit for high-acuity care in the home 

The role of the hospitalist was defined in response to the unique circumstances involved in delivering hospital-level care. According to the Society for Hospital Medicine, hospitalists have a particular focus on clinical care for high-acuity patients in the hospital, while also facilitating continuity between outpatient and post-acute care.  

It is these qualities that make hospitalists best suited to growing hospital-at-home programs. For patients to access acute care in the comfort of their homes, having a specialist dedicated to their needs is essential. Hospitalists are well-versed in high-acuity, complex cases and understand how to proactively improve hospital outcomes like length of stay, readmissions and mortality. 

Frequently, they come by this knowledge thanks to an emphasis on internal medicine or family medicine in their training. This helps them to understand both inpatient and outpatient processes, a facet vital to care at home — which delivers inpatient-level care in an outpatient setting. 

In addition, health systems that seek to implement a scalable model of care delivery in the home must set their sights on a comprehensive program of care that extends beyond hospital at home and includes a continuum of care such as post-acute and palliative care in the home, another arena that hospitalists are naturally suited for.  

Virtual hospitalists and a team approach to care 

Delivering hospital-level and post-acute care in patients’ homes requires innovative approaches to executing care. A combination of in-person and virtual care requires a coordinated care team model, with physicians working as virtual hospitalists via telemedicine. Highly trained registered nurses, physically present in the patient’s home, can round with physicians through a telehealth platform, allowing these providers to guide care, interact with patients and reach more patients spread over a geographical area more quickly.  

This is familiar territory for hospitalists, who coordinate care across specialties within the hospital. In care at home, hospitalists assess the patient for admission to the program and then work with a team whose services wrap around the patient, providing end-to-end care coordination and reducing fragmented care. This is done by helping to ensure patients have appropriate education on their condition and are supported in appropriate follow-up care.  

As the continuum of care evolves, hospitalists will have even more opportunities to use this skillset to manage care for patients who will travel seamlessly between care-at-home service lines. By working with a consistent team inside the patient’s home, virtual hospitalists can safely and effectively lead the care delivery process — a process that intimately includes the patient and (with their permission) their families. 

The care continuum at home benefits hospitalists 

The connection between hospitalists and acute care in the home is also a two-way street. Physicians who take on the role of virtual hospitalist find themselves in a niche that gives them the resources and tools they need to hone their clinical skills and improve patient satisfaction and outcomes. It also allows them to connect with overlapping services more easily like palliative care in the home, which supports hospitalists in many facets of longitudinal patient care. 

As this approach to the continuum of care continues to advance, early data on virtual care delivery highlights these positives as well. In one survey, 85.7% of physicians serving as “virtual rounders” expressed satisfaction with this modality of care.  

In an era of staffing shortages and physician burnout, one factor implicated in growing job dissatisfaction for hospitalists is high numbers of patient encounters per shift. In a traditional setting, this is a rapid-fire approach to patient visits, often missing the element of family collaboration (what are the odds of family being available for goals of care discussions in the hospital?) with time required to physically round on patients.  

In contrast, hospital-at-home and other virtual care approaches improve the ease of rounding (with patients a click away) and better connection to identified patient support systems and social determinants of health in the home. With more time to deeply connect with patients and the factors that impact their care, both physicians and patients experience higher satisfaction. 

As one patient put it, “[The] doctor, he didn’t just ask you one or two questions, he went into a series of questions. My own primary care doctors, they don’t spend as much time with me as he did. He spent at least 15-20 minutes on that monitor with me.” 

What’s more, the skills that virtual hospitalists must focus on for care delivery in these models transfer back to brick and mortar settings with them as they provide inpatient care. These include increased time spent communicating with patients, better collaboration with clinical staff and critical thinking skills that together promote improved hospitalist performance across care settings. 

A clear next step in the evolution of the hospitalist role 

With innovative advanced models of in-home care, the concept of a virtual hospitalist as a specialty of its own is one that is the next logical step in the evolution of the hospitalist. As this evolution of the hospitalist role continues, it’s anticipated the virtual reach of hospital medicine will become more common. Models of care like Contessa’s are the next evolutionary step and as our systems continue to grow, we anticipate that the virtual home hospitalist will become more of a mainstay in the healthcare continuum.