Comparison of hospital costs and length of stay for community internists, hospitalists, and academicians

Background: The model of inpatient medical management has evolved toward Hospitalists because of greater cost efficiency compared to traditional practice. The optimal model of inpatient care is not known. Objective: To compare three models of inpatient Internal Medicine (traditional private practice Internists, private Hospitalist Internists, and Academic Internists with resident teams) for cost efficiency and quality at a community teaching hospital. Design: Single-institution retrospective cohort study. Measurements and Main Results: Measurements were hospital cost, length of stay (LOS), mortality, and 30-day readmission rate adjusted for severity, demographics, and case mix. Academic Internist teams had 30% lower cost and 40% lower LOS compared to traditional private Internists and 24% lower cost and 30% lower LOS compared to private Hospitalists. Hospital mortality was equivalent for all groups. Academic teams had 2.3-2.6% more 30-day readmissions than the other groups. Conclusions: Academic teams compare favorably to private Hospitalists and traditional Internists for hospital cost efficiency and quality.