Why health systems should elevate the hospitalist role | Viewpoint

At its core, the shift is simple but important. Historically, hospital performance was judged by: “Was this hospital stay efficient?”

The more recent CMS models have reframed the hospital performance question to: “What happened to the patient after they left, and what did their overall care cost across settings?”

Newer models like the Transforming Episode Accountability Model (TEAM) hold hospitals accountable not just for admissions but also for what happens afterward, including post-acute utilization, readmissions, emergency department revisits, and preventable complications.

This evolution reflects CMS’s broader push toward value-based care, which focuses on outcomes, prevention, and the total cost of care over time. For health systems, success in this environment requires more than adapting to new payment models; it demands a fundamental change in mindset. The hospital is no longer a standalone place where care begins and ends; it’s part of a much longer patient journey that spans multiple settings and providers.

Since the inception of the hospitalist model, hospitalists have played an important role in inpatient care. Because they sit at the center of clinical decision-making in the hospital, hospitalists coordinate across teams, align care plans, and set in motion everything that affects what happens after discharge. One important area where hospitalists can directly influence value, both cost and quality, is reducing low-value consults.

While specialty input is essential in many cases, low-yield consults can add cost, delay care, and contribute to fragmented decision-making without improving outcomes. As clinical leaders, hospitalists are uniquely positioned to ensure that consults are purposeful, appropriately timed, and aligned with the patient’s overall care plan.

As accountability and expectations for health systems increase, so should the hospitalist's role. Delivering high-quality care during admission remains essential, but it’s no longer sufficient on its own. Health systems now need to think ahead by identifying high-risk patients early, starting discharge planning from day one, and ensuring smooth, well-coordinated transitions.

The hospitalist role should expand beyond the four walls of the hospital, working closely with case managers, primary care providers, specialists, and community resources. Post-acute care, in particular, should become a major focus for health systems, which are now, in many care models, accountable for outcomes and costs beyond discharge.

A large portion of the total costs in these models comes from services such as skilled nursing, rehab, and home health. Health systems should invest in operating processes and technology to improve visibility into these areas and should create strong partnerships with PAC providers. Health systems should build preferred networks, coordinating the handoff to the PCP through effective communication and collaboration, and more standardized discharge pathways.

Hospitalists should play a critical role in this expanded ecosystem. As they are the clinicians directing care at the point of discharge, they have the opportunity to influence post-acute utilization decisions, ensure appropriate site-of-care selection, and set the clinical trajectory that determines downstream resource use. By identifying high-risk patients early, aligning discharge plans with evidence-based pathways, and communicating clearly with post-acute and outpatient providers, hospitalists help reduce avoidable variation, prevent readmissions, and improve total cost-of-care performance.

In one example, a health system elevated the hospitalist role from inpatient physician to the orchestrator of the inpatient episode through multidisciplinary rounds with a shared focus on next-site-of-care decisions, reducing avoidable delays, and improving discharge readiness. The approach was associated with stronger discharge-to-home performance, improved throughput metrics, and more coordinated transitions of care. This example demonstrates how operational alignment around the hospitalist translates into both clinical and financial value for a health system.

As coordinated care reaches beyond the hospital stay, the definition of quality is now expanding. Traditional inpatient metrics such as mortality, complications, and length of stay are only part of the equation. Performance for health systems increasingly encompasses total cost of care, readmissions, emergency department utilization, chronic disease management, preventive care, and patient-reported outcomes. These changes place new demands on data infrastructure, interoperability, and clinical documentation, particularly around risk adjustment and social determinants of health.

For hospitalists, this expanded view of quality reinforces the importance of their role within health systems. As clinicians who are most consistently present throughout a patient’s hospitalization, they are uniquely positioned to influence not only immediate clinical decisions but also the trajectory of care beyond discharge. Health systems should equip hospitalists with risk-stratification tools, real-time dashboards, and interoperability platforms to enable the identification of care gaps and proactively coordinate interventions.

Even compensation models can be used to align the hospitalist with performance. Health systems should tie hospitalist incentives to broader outcomes, such as episode performance and care coordination, making it clear that their role extends beyond hospital walls.

In summary, as healthcare moves toward value-based care and the definition of quality care expands, health system and hospital medicine are being redefined. The focus is shifting from what happens during the hospital stay to what happens before and after it.

And throughout this transformation, hospitalists should remain the captains of the ship, guiding not just the inpatient course, but the patient’s journey across the full continuum of care. That’s where both quality and total cost of care can be impacted to accelerate high performance for health systems. The role of the hospitalist in today’s healthcare environment should be recognized as foundational to delivering consistent, high-quality, high-value, patient-centered care.

Sean McLaughlin, MD, is chairman of the board of Esse Health. Jeff Gleason, MD, MBA, is chief medical officer of Navvis.