As Hospital-Based Medicine Grows, JHCP Providers and Patients Reap the Benefits

 

In 1998, the Johns Hopkins Health System acquired its first community hospital, what’s now known as Johns Hopkins Howard County Medical Center. The physicians providing care for patients in the hospital were largely in private practice.

Johns Hopkins Community Physicians (JHCP) created a new hospitalist program to improve the quality and cost of care, and those hospitalists were the first to join what is now a robust hospital-based medicine program within JHCP.

The concept of JHCP hospital-based medicine is simple: Clinicians in the program are Johns Hopkins employees who care for patients in Johns Hopkins community hospitals.

Since then, the program has grown from the 30 or so doctors at Howard County to one that includes about 270 clinicians across the system’s three community hospitals, says Leo Rotello, chief of hospital-based medicine for JHCP.

Nearly all are physicians, though the program also includes advanced practice providers like nurse practitioners and physician assistants, he says. About 20% have faculty appointments, including Rotello, assistant professor of medicine.

JHCP’s hospital-based medicine section now includes hospitalist and intensivist programs at all three Johns Hopkins community hospitals — Johns Hopkins Howard County Medical Center, Sibley Memorial Hospital and Suburban Hospital — as well as endocrinology programs at the three hospitals, the infectious diseases team at Sibley, and the palliative care department at Suburban Hospital.

And the section is still growing: The most recent group to make the switch was the intensivist program at Sibley. The process took a relatively quick eight months, ending in August 2024, says Rotello.

As with other groups moving to JHCP, Sibley’s catalyst was the push-pull of needing the right resources to meet increased demand for hospital-based care while protecting against staff burnout.

“Sibley had an intensive care unit program, but they weren’t there 24 hours a day,” says Rotello. “They covered at night from home. Sibley’s leadership asked us to take a look because they’re increasing their volume of complex care, including cancer care and bone marrow transplants.” Hospitals in general would like 24/7 intensivists and hospitalists.

The Process

Rotello says the process for folding community-based hospital physicians into JHCP typically begins with a request from hospital leadership for information. He and his team begin their research, weighing the pros and cons of various staffing models and coming up with a proposal.

For the Sibley intensivist transition, he says, “We talked with the nursing staff, the emergency department staff and other stakeholders in the intensive care unit to understand what the needs would be for the ICU service. And then we structured a program around that, and we added quality and financial parameters.” 

After Johns Hopkins leaders approved the proposal, JHCP began hiring, starting with clinicians who were already working in the hospital.

“We talked to the staff members who were currently there about what they feel the needs are and how this model would fit into their current lifestyle, workload and all of that,” Rotello says.

The shift to hospital-based medicine, he says, is always a work in progress. “The important thing about each of these programs is that they are living, breathing organisms,” he says. “We’re constantly working with administrations to update things, to change things, to see what the strategic priorities are for JHCP in general and to align ourselves with those. You can’t just build a program and forget about it. It takes continued work.”

A Better Fit

Eric Park, director of the hospitalist program at Suburban Hospital, pushed for his group of physicians to become part of JHCP in 2010, shortly after the hospital became part of the Johns Hopkins Health System. He has never looked back.

Park had been with a private practice in Montgomery County that provided hospitalists to several hospitals in the region, including Suburban. Then he was hired by Suburban Hospital before it became part of Johns Hopkins.

The move to JHCP meant Park and the other hospitalists, as well as intensivists, were Johns Hopkins employees. “It was a better fit for us,” Park says.

For Park, the change meant more opportunities to learn from Johns Hopkins colleagues. “Having access to others in the Hopkins system who practice hospital medicine and call themselves hospitalists was extremely valuable,” he says.

Perhaps more important was the increase in staffing and ancillary support, says Park. “Before, we didn’t even have administrative coordinators. Being under Johns Hopkins, and JHCP specifically, they did a nice analysis for staffing and resource needs, and in a relatively short period of time, they delivered on that."

JHCP also increased its recruiting capacity, adding, in July 2022, Geralyn Azizkhan for hospital-based medicine hires at Johns Hopkins Howard County Medical Center, Sibley Memorial Hospital and Suburban Hospital. [see related article]

The change also made it easier to collaborate with Johns Hopkins specialists, improving care for patients.

Park believes there’s less turnover as a result. “We have hospitalists who have been here 10 years, 15 years, and that only happens when you’re part of a group that is actually mindful about making sure that the tools and the resources you need day to day are there.”