Background: There is a huge desire to have hospitalist program in smaller community and rural hospitals. Few hospitals will be reluctant to have their own hospitalist program due to multiple issues. Bothwell Regional Health Center (BRHC) is a general medical and surgical hospital in Sedalia, MO, with 132 beds, located 68 miles west of Columbia, MO. BRHC administration wanted to develop a hospitalist program for their patient population but had several major constraints including recruitment, weekend, holidays and off time coverage, competitive compensation, limited specialist backup, and lack of experience in running a hospitalist program. In 2012-13 Hospital contracted a national hospitalist company to provide coverage. Even  with full support from hospital and a generous financial package, the hospitalist firm was unable to meet their expectations. Due to lack of permanent faculty and over reliance on locum physicians, quality of care, as well length of stay, re-admission rate, and patient satisfaction rates, declined considerably. So, the hospital administration reached out to nearest academic center, University of Missouri-Columbia for help.

The division of Hospital Medicine at the University of Missouri-Columbia decided to start an out-reach hospitalist program for BRHC in Sedalia, MO to help provide coverage, as well as provide medical coverage to community at their local hospital.

Description: A formal contract was signed between the Division of Hospital Medicine at the University of Missouri- Columbia and BRHC. The division of Hospital Medicine had multiple challenges to meet the requirements, the first of which was recruitment as it was not possible to hire new quality hospitalists immediately, and providing 24-7 coverage for a new service line (68 miles away) was a huge challenge. The division decided to provide coverage with existing faculty members on a voluntary basis. Weekend and holiday coverage was offered to internal medicine trained sub specialty fellows on moon lighting rates. The second issue was compensation; faculty hospitalists were offered extra salary at locum rates for coverage, so meal allowance and lodging was also provided in Sedalia, MO. The third challenge was education; change in by-laws at BRHC was requested to grant privileges to medical students and residents. Medical students and medical residents were offered electives at BRHC. Hospital Medicine Fellows were also offered full floor rotations at BRHC. A new residency training program for Non Physician Providers (NPP) was started and BRHC was declared their main training hospital.

Conclusions: The division of Hospital Medicine at the University of Missouri-Columbia has completed a successful year of providing 24-7 hospitalist service at BRHC in Sedalia, MO. Hospitalist coverage has resulted in better patient satisfaction rates, shorter length of stay, and reduced re-admission rates. Additionally, the hospitalists enjoy a very healthy relationship with local physicians and administration. After a successful year with BRHC, the University of Missouri-Columbia has received offers from three different community hospitals to provide hospitalist coverage with a similar model. Faculty has decided to hire two more faculty members to provide coverage primarily at BRHC and hire one outreach director to expand service. Financial Summary includes: operating cost of $27,250.28, salary expenses of $547,507.92, benefit expenses of $59,588.63, and total cost of $634,346.83.