The American Hospital Association estimates that hospital care accounts for one-third of every health care dollar. Thus, a reduction in these costs could aid overall health care costs through hospitalists.

Hospitalists are physicians who specialize in caring for patients from hospital admission to discharge in place of primary physicians following their patients through the process, said Dr. Amir Bacchus, co-founder of Inpatient Physicians Network, which is a subsidiary of Pinnacle Health System LLC in Las Vegas.

Bacchus and Dr. Sherif Abdou formed Inpatient Physicians Network in 1999 to improve patients' outcomes and reduce health care costs in Las Vegas Valley hospitals. The company also operates in Phoenix, Tucson and Colorado. The Las Vegas Valley has about 100 hospitalists in its hospitals, 35 of whom work for Inpatient Physicians Network.

Inpatient Physicians' hospitalists are internal medicine physicians who work with an intensive care unit nurse case manager and a clinical field manager.

Insurers, self-insured employers or hospitals hire hospitalists to be the primary physicians who oversee patients' care. Inpatient Physicians Network provides care for PacifiCare Health Systems Inc., Sierra Health Services Inc.'s Health Plan of Nevada and Aetna health plan members to reduce the insurers' costs and is talking with self-funded employers and unions in Las Vegas to help them reduce their double-digit cost increases.

Most primary physicians "see 20 to 25 patients in their office and then see X number in the hospital," Bacchus said. In contrast, hospitalists see 15 to 22 hospital patients per day and are familiar with the hospitals since that's the only place they practice.

They also are available 24 hours per day, meaning patients' test results are analyzed quicker and their admission times are shorter, while primary physicians are able to keep outpatient appointments without being interrupted by mid-day emergencies of hospitalized patients, Bacchus said.

University Medical Center has on-call hospitalists who are paid per diem to treat uninsured patients and patients who don't have a primary care physician, hospital spokeswoman Cheryl Persinger said.

Other Las Vegas Valley hospitals are considering hiring hospitalists to reduce the wait time in emergency rooms and hospital costs, while improving patient care, Bacchus said.

He said hospitals also could benefit from hospitalists because the number of uninsured patients is increasing dramatically and many of them lack primary physicians.

"Hospitals are looking for practices to manage the uninsured better," Bacchus said. "Indigent patients stay longer because they don't have primary care."

By expediting hospital care, hospitals can treat more patients and reduce the chance of infecting patients, which sometimes occurs when patients are in the hospital too long, Bacchus said.

"Hospitals can bring in more patients, their volume, and therefore more money," he said. "(Hospitalists) can reduce excessive testing and the cost per patient can go down."

An Inpatient Physicians' study of hospitalists in Tucson showed a 17 percent reduction in overall costs per patient, Bacchus said.

A study in the January 23, 2002, issue of the Journal of the American Medicine Association reported that hospitalist programs could decrease hospital costs by an average of 13.4 percent and patients' lengths of stay by an average of 16.6 percent.

The journal report estimated that hospitalist programs could reduce costs for the nation's more than 5,000 hospitals by $2.4 billion per year.

The American Medical Association, which represents physicians, said it supports hospitalists as long as patients are given a choice of whether to use them or their primary physicians.

The American Hospital Association doesn't have a formal position on hospitalists but says they could be useful to patients and hospitals.

"What we have said is that this could be the answer for a whole series of issues about improving patient safety and patient care," said Rick Wade, senior vice president of the association. "It's important for hospitals, it's important for patients."

In addition to aiding hospitals, hospitalists can help physicians. Hospitalists enable physicians to focus on their private practices without the added stress of visiting and caring for patients in multiple hospitals across the Las Vegas Valley, Bacchus said.

"As hospitals continue to be spread out it's becoming more difficult to manage patients at several hospitals," he said.

Hospitalists consult with patients' primary physicians and send them a summary of the patients' care.

Bacchus said some primary physicians aren't receptive to hospitalists because they are afraid of losing business even though both physicians would work together. But most are receptive to the assistance once they understand how a hospitalist can aid their outpatient practices, he said.

Another potential drawback of hospitalists is that patients may be unreceptive to seeing anyone but their primary physicians, however Bacchus said that might be a moot point.

"Eighty percent to 90 percent of doctors are in a group practice," Bacchus said. "The chance of you seeing your own physician is rare."

North Las Vegas resident Mitchell Rivers was treated recently by an Inpatient hospitalist team at Summerlin Hospital when he was having a tumor removed and said it didn't bother him that his primary physician wasn't treating him.

"The doctors were great and what really eased my mind and made me more relaxed is they told me what was going on and why they were doing it," Rivers said. "Every question that popped in mind they answered it like that."

He said his only other major hospital experience, which was in Los Angeles, was less comforting because the physicians didn't tell him what was going on with his care.