A new study published March 18 in JAMA Health Forum finds that hospitalists are more likely to bill at the highest level of clinical severity possible for their medical encounters with hospitalized Medicare patients, compared with nonhospitalist general medicine physicians who see similarly complex patients. This difference is growing.
The researchers examined large samplings of Medicare fee-for-service Part A and Part B medical claims for patients hospitalized between 2009 and 2018, asking whether their initial, subsequent, and discharge evaluation and management (E&M) encounters were being billed at the highest possible level of severity — and cost.
They confirmed that hospitalists are having more of these medical encounters in the hospital, replacing the "traditionalist" role performed by primary care physicians and reaching 76% to 78% of all such encounters by 2018. But they also suggest that this trend "may be contributing to rising national costs related to hospital care."
Leaders in the field say the former trend is well known but they question whether the latter conclusion is supported by this study's results. Not directly addressed in the research, but lurking in the background, is the question of whether rising rates of high-severity billing might be harbingers of inappropriate upcoding.
The study included a total of 3,121,260 patients treated by hospitalists — defined as generalist physicians who make at least 90% of their E&M claims for a given year in the inpatient setting — compared with 1,855,078 patients treated by nonhospitalist internal medicine, general practice, and family practice physicians.
