Hospitalists and healthcare costs
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Thirty years ago, the general internist was a full service provider, involved in outpatient preventive care, inpatient management, ICU treatment and nursing home care. At that time, management decisions were at the discretion of the physician and his/her patient, with little influence from hospitals and insurance companies. By the mid 1980's, healthcare began to change dramatically as HMOs entered the scene, attempting to cut cost by contracting with employers to provide service at standardized rates; of course, this also led to HMO-imposed restrictions on patient care and, if you, as a physician, did not join their legion of providers, many of your patients would soon be lost to the network. This trend has continued and the physician-patient relationship is constantly assaulted by a variety of cost-conscious parties, from Medicare to private insurance companies to Utilization Review Committees.