CUTTING BACK HOSPITAL STAYS NEW SPECIALISTS HELP PATIENTS RECOVER FASTER, LOWER COSTS.

Byline: Brent Hopkins Staff Writer

BURBANK - Attached to an oxygen machine and wracked with painful coughs, Ted Flynn had other things on his mind than his medical care the last time he checked into the hospital.

The 78-year-old retired sales executive from Toluca Lake, who's suffered from chronic obstructive pulmonary disease for more than a decade, didn't want to think about what specialist he had to see or which test he was having next. He just wanted to get better. So he handed control over to a hospitalist.

``When you're in the hospital, you don't feel that good,'' he chuckled darkly. ``You don't want to talk to more people. In there, you're worried about enough things, so talking to the doctor is the last thing you want to worry about.''

Most people have trouble pronouncing the word hospitalist, let alone understanding what it means, but it's becoming an increasingly important part of the health care world. More than 64 percent of California medical groups and 46 percent nationwide employ the specialists to manage in- patient care, according to the Society of Hospital Medicine trade group. Though the specialty has only been around since the mid-1990s, the group counts 10,000 hospitalists in the nation and expects that number to triple within the next six years.

They work as go-betweens, communicating with various specialists to ensure an admitted patient's hospitalization goes smoothly. If a patient's going in for surgery, they make sure they eat the right foods; if they get sicker, it's the hospitalist who makes sure things don't get worse before the primary care doctor can attend to the patient.

``When we take over a case, they get an expert who's familiar with the situation,'' said Dr. Adam Singer, a practicing doctor and chairman and chief executive officer of IPC The Hospitalist Co. ``Your primary care physician is stuck in the office. The hospitalist is with you when you're sickest in the hospital.''

Doctors like Singer reduce patients' time in hospitals by 30 percent and cut the cost of their stay to hospitals by one-fifth, according to the SHM. As both a doctor and the head of a 400-physician company based in North Hollywood, Singer splits his time caring for patients and watching the industry. And from his corporate office and his examination room, the industry's looking pretty good.

In a market he estimates at around $6 billion annually, Singer's company is pulling in $100 million in revenue and keeping $6 million in profits before taxes and other charges. It currently operates in 12 markets across the country and expects to add three more by the end of the year, including expanding operations in Southern California.

Though other markets adopted hospitalists more quickly, they're now becoming much more of a staple in health care. UCLA Medical Center recently expanded its program to include five full-time and two part-time hospitalists, while Los Robles Hospital and Medical Center in Thousand Oaks hopes to contract for services within the next six months.

``It's getting more and more difficult to get our medical staff to take ER calls,'' said Dr. Bernie Klein, Los Robles' vice president and medical director. ``As their practices get busy, it's better for them to work in their office than come to the hospital.''

Which is where someone like Dr. Robert Nicoloff comes in. A hospitalist with the Glendale-based medical group Apollomed, he reports for duty at Glendale Adventist and Providence Saint Joseph Medical Center in Burbank to take care of patients.

``The old model was that your private doctor admitted you to the hospital and would try to see you in the morning, go to his office, then maybe come back later,'' he said. ``The hospitalist has no office - that's all we do. We never leave. We deal with all the subspecialists, the case managers, all the intricacies of hospital care so there's no disconnect with hospital management.''

Though their services aren't cheap - the SHM estimates they earn an average $155,000 a year - they do seem to save hospitals and insurers money. Though unable to quantify the amount of savings, Dr. Jeff Kamil, vice president and corporate medical director for Blue Cross of California, said the efficiency of using a hospitalist shaves costs off a hospital's bill and helps patients get home sooner.

``It improves the quality of care, and if there's a financial gain, that's nice,'' he said. ``Physicians can only see people limited numbers of times a day, but the hospitalist can see people many times and promote services that will get people better quicker.''

Brent Hopkins, [phone]

brent.hopkins(at)dailynews.com

CAPTION(S):

2 photos

Photo:

(1 -- color) Dr. Adam Singer examines Ted Flynn, 78, of Toluca Lake, who's had chronic obstructive pulmonary disease for more than 10 years. Flynn decided to use the services of a hospitalist to guide his care during a recent hospital stay.

(2 -- color) In his office, Dr. Singer, the chief executive officer and chairman of IPC The Hospitalist Co., a 400-physician company based in North Hollywood, goes over an X-ray.

John Lazar/Staff Photographer