The corporate emergency-medicine landscape is seeing more entrants into hospital medicine all the time. Atlanta-based ApolloMD began providing hospitalists to hospitals in the middle of 2013.

“Many of our clients were actually asking that we provide both services,” CEO Mike Dolister, MD, said. “Hospitals are asking for this type of synergy much more than they were even a year ago.”

The key is the throughput time, and having the two sides tied together improves that, Dr. Dolister said: “Because the throughput has such a significant impact on clinical quality in a variety of clinical scenarios, when we improve the throughput, we know it improves the quality and patient experience.”

The Hybrid Model

The ultimate integration, of course, is the emergency physician who also takes care of patients who’ve been admitted, the “hybrid” model. This is almost exclusively done in thinly populated rural areas. The work is usually performed by physicians with a family medicine background or internal medicine background, and who also have emergency medicine experience.

With just a single physician present in a hospital, the possibility of acute situations arising in both an inpatient room and the ED does exist, but choosing the right facility for the model is crucial. “If you properly design the program based on the volume and acuity of the patients in both the EM and the HM programs, these situations should be rare,” he said. “Of course, you can’t always predict volume and acuity. And if you have the ability to flex up and flex down, that would be great, but you can’t always do that.”

At TeamHealth, the decision on whether to use a single doctor as emergency provider and hospitalist is calculated carefully. “We use a very algorithmic approach to how we staff and manage these programs,” Dr. Gundersen said. “We have not had an issue arise, but that’s because we’ve really looked at it mathematically.”

“Agreements with hospitals protect physicians from having to maintain a presence in the inpatient ward, and outlines how an acute situation in the inpatient arena might be handled in that scenario,” Dr. Proctor said.

The hybrid model is an advantage to the emergency physician who makes extra money for seeing the inpatients. “It can be advantageous and attractive to the emergency physicians and it’s something that they volunteer to do when they’re interested,” said Dr. Proctor of TeamHealth.