Hospital Medicine (continued)
Communication key to success
Although it appears hospitalists are here
to stay (and most industry observers agree they have brought
some improvements to various sectors of health care), not
everyone is leaping on the bandwagon with both feet.
The American Academy
of Family Physicians (AAFP),
while remaining neutral on hospital medicine itself and saying
that family practice physicians are well trained and highly
qualified for the new practice opportunity, has issued
guidelines for family physicians who use the services of
hospitalists. (See sidebar below, “Achieving Seamless
Care,”.) The AAFP stresses that as health-care systems
“experiment” with models of inpatient care
management, the decision to utilize a hospitalist should be
voluntary and made by the patient and her family doctor.
The AAFP also cautions
that there may be mid- and long-term implications if a
physician relinquishes hospital privileges. It warns its
members that they could have difficulty being credentialed
and/or reimbursed by managed care companies for ambulatory care
services or procedures if they do not have hospital privileges.
It offers to assist members whose health-care system or managed
care organization has removed their opportunity to provide
hospital care.
hospital care.
SHM board member
Gorman says most primary care physicians do not elect to resign
from hospital medical staffs. She said most maintain their
hospital privileges even though they refer patients to
hospitalists.
The president of the
AAFP, family physician Michael Fleming, MD, who practices in
Shreveport, Louisiana, says seamless communication between
primary physicians and hospitalists is
paramount—”equally on the front end when a patient
is admitted to the hospital and on the back end when the
patient is discharged’’—for the model to be
successful.
Fleming is one of 10 family
physicians who comprise the Family
Doctors group, which is
affiliated with a five-member group of hospitalists. He says
the hospitalists attend to all of the group’s
hospitalized patients and are included in practice meetings. He
and the other family physicians in his group have not
relinquished their hospital privileges.
“The reason our
system works—and the only reason—is because of
communication. I want it to be just as though I were providing
the care in the hospital,” he says. “We work at it.
Every piece of paper, every electronic document is transmitted
between physicians, and when a patient is discharged, every
document in the hospital comes back to me.”
The use of
hospitalists was a financial reality for his group, Fleming
says. “We found we weren’t being reimbursed when we
had a consult involved with a patient in the hospital. And
there’s almost always a consult involved now, because of
the severity of illness of hospitalized patients.”
Fleming turns over the
hospital care of his patients somewhat reluctantly, and he
continues to make courtesy calls while they are hospitalized.
The hospitalist arrangement grants Fleming longer office hours
to see patients, but he misses being involved with his
inpatients. “It’s a personal issue of fulfillment
for me, not being able to handle all of their care,” he
says, adding that being a hospitalist would not interest him
personally. “It’s episodic care,” says the
53-year-old physician. “What I like is being my
patients’ personal physician. I like being involved in
their lives long term.” n
SIDEBAR
Achieving Seamless Care
Noting that it is especially concerned
about continuity of care, the American Academy of Family
Physicians offers these guidelines for its members working with hospitalists:
4 The objective should always be the best possible
care for the patient.
4 At the request of the primary care physician,
the inpatient care physician should admit and coordinate the
care of all patients admitted to the hospital regardless of the
admitting diagnosis or type of insurance coverage.
4 If patients present to the emergency department,
the ED physician should contact the primary care doctor after
assessment to determine if admission is necessary or if close
follow up or outpatient treatment is appropriate.
4 If admission is necessary, the primary care
doctor should communicate all patient information to the
hospitalist who will assume the patient’s care.
4 The hospitalist will assess the patient at
admission and determine the best course of treatment.
4 During the patient’s hospitalization,
decisions regarding care, consultation, transfer and discharge
are the sole responsibility of the inpatient care physician in
consultation with the patient, and as appropriate, the
patient’s primary care physician and/or family.
4 The inpatient care physician should be readily
available to discuss the patient’s medical problems and
hospital course with the family and should provide timely
updates to the primary care doctor.
4 The inpatient doctor should communicate the
treatment plan and follow-up recommendations to the
patient’s family physician or covering physician upon
discharge.
4 Family physicians who refer patients to
hospitalists should maintain ongoing communication with the
patients and their families throughout the hospitalization.
Family physicians should provide written communication to the
hospitalist after the patient’s first post-hospital
office visit if there is an educational benefit.
4 Health-care systems that use inpatient care
management should seek to constantly monitor and improve their
processes through ongoing surveys of patient and physician
satisfaction. Data on health-care outcomes is essential to the
ultimate evaluation of the inpatient care model. n
SIDEBAR
Quick Facts about Hospitalists
Number in U.S.: Approximately 8,000
Average age: 37
Median number of annual patient encounters: 2,236
Usual employment arrangements: Hospital employee; large
multi-state or small private practice medical group;
multi-specialty group; or academic setting
Median total compensation: $155,000
Usual training: General internal medicine: 83 percent;
Family practice, pediatrics, and internal medicine
subspecialties such as pulmonology or critical care: 17
percent
Cindy Murphy McMahon is a regular contributor
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