Many of the Accountable Care Act’s initiatives focus on improving access to primary care and preventing hospital admissions. So what does that mean for the hospitalists who treat patients in the hospital? Logic may lead one to believe that a successful reduction in hospitalizations will decrease demand for hospitalists. However, hospitalist leaders say that is not the case. Although initiatives such as patient-centered medical homes (PCMH) may reduce the number of unnecessary hospital admissions, patients with complex medical needs will still require inpatient admission. Fewer unnecessary admissions will cause a shift in the ratio of simple to complex patients meaning hospitalists will focus more on managing serious cases. The aging American population means the number patients with complex medical needs will likely increase in the next 20 years and hospitalists will be responsible for their care. By 2030, there will be about 72.1 million persons over the age of 65, which is more than twice their number in 2000. In the July 2012 issue of The Hospitalist, SHM immediate past president Joseph Ming Wah Li, MD, SFHM, said hospitalists can expect to see sicker patients more frequently; several times a day rather than just once or twice. “I think what hospitalists will have to do is they will have to adapt,” Dr. Li said. Also, the estimated increase in individuals seeking primary care services will put significant strain on outpatient primary care resources. Hospitals that have a strong hospitalist program alleviate the need for primary care physicians to admit and round on patients so they can focus on treating patients in the outpatient setting. One can expect that the number for hospitalist programs and hospitalist positions will continue to grow as the demand for outpatient primary care increases. Hospitalist role in reform initiatives Although primary care providers have been targeted as the major contributors to healthcare reform initiatives, hospitalists play a big role as well. Initiatives such as, PCMH, value-based purchasing (VBP), and accountable care organizations (ACO) require hospitalist participation and in some cases give hospitalists the opportunity to interact with the healthcare system beyond the walls of the hospital. For example, the PCMH and ACO models will require hospitalists to collaborate and communicate with primary care providers and other specialists about changes to the patient’s condition and coordinating care. Other initiatives reinforce the hospitalist’s role in delivering quality care within the hospital. The VBP program will make it more important than ever for hospitals to invest in high quality hospitalists to ensure they receive high quality marks and therefore be eligible for incentive payments. Here at Barton we expect the demand for locum tenens hospitalists to continue to rise. These initiatives coupled with the aging population mean hospitals simply cannot afford to go without these valuable care team members. Quality locum tenens providers who can step in and deliver excellent care will be highly sought after by hospitals who wish to maintain top quality scores and ensure they can meet the needs of increasingly complex patients.