Growth trends of the adult hospitalist workforce between 2012 and 2019.

BACKGROUND: Accurately identifying the number of practicing hospitalists across the United States continues to be a challenge. Characterizing the workforce is important in the context of healthcare reforms and public reporting. OBJECTIVE: We sought to estimate the number of adult hospitalists practicing in the United States over an 8-year period, to examine patterns in growth, and begin to explore billing patterns. DESIGN, SETTINGS, AND PARTICIPANTS: Retrospective study using national Medicare Part B claims datasets. We applied a commonly used 90% threshold of billing hospital visit-associated Healthcare Common Procedure Coding System codes to identify adult hospitalists in publicly available Medicare Provider Utilization and Payment data for 2012-2019. We then analyzed billing patterns for those identified hospitalists. MAIN OUTCOMES AND MEASURES: Identify trends in the number of identified adult hospitalists, including those self-identified. Compare hospitalists' billing to that of non-hospitalist Internal Medicine and Family Medicine physicians. RESULTS: We saw more than a 50% growth rate of practicing adult hospitalists between 2012 and 2019. In 2019, we identified 44,037 adult hospitalists. CONCLUSIONS: The number of adult hospitalists continued to grow at a consistent rate, such that hospitalists are in the top five largest physician specialties in the United States. In the absence of more formal identification and consistent use by hospitalists, a threshold continues to be a meaningful tool to characterize the workforce.

Hospital Medicine Has a Specialty Code. Is the Memo Still in the Mail?

The Centers for Medicare and Medicaid Services awarded Hospital Medicine a Medicare specialty code, "C6", in 2016. We examined the early uptake of C6 code using the 2017 Medicare Part B utilization data. We also compared the actual C6 specialty code usage against estimated rates of overall hospitalist billing using threshold-based hospitalist rates of Evaluation and Management codes to assess the integration of the newly introduced code. Billing activity associated with the C6 code was approximately one-tenth of expected rates.

Updating threshold-based identification of hospitalists in 2012 Medicare pay data.

In the absence of a unique identifier, it is difficult to assess the number of practicing hospitalists. We use a variety of thresholds of billing activity to identify hospitalists in a dataset of publicly released 2012 Medicare physician pay data. Our study updates previous estimates of the number of hospitalists practicing nationwide in 2012 and suggests the field continues to grow. This research also highlights a need for a more precise system of identifying hospitalists.

The Affordable Care Act's plan for consumer assistance with insurance moves states forward but remains a work in progress.

The Affordable Care Act provides support for state-run consumer assistance programs to help privately insured consumers who experience problems with their coverage. Its provisions signify the first national commitment to such assistance and to using cases aggregated by these state programs to inform policy. We interviewed state-level administrators and analyzed program documents to assess whether federal support for state-run consumer assistance programs achieved certain goals. We found that some federally supported programs made substantial progress in supporting and empowering patients by reorienting state agencies to become active advocates for their citizens. Yet progress across the country was inconsistent, and there was little evidence that programs addressed systemic problems experienced by consumers. On balance, the consumer assistance provisions of health care reform do not yet ensure protection for all privately insured Americans because of uneven implementation-a problem likely to be of further concern as coverage is expanded and health insurance exchanges come on line in 2014. At the same time, the demonstrated impact of consumer assistance programs in the most innovative states is arguably a useful "proof of concept" for this young federal program.