All Entries Tagged With: "pcp"
Reform: Quality, Cost and Access… Access to what?
I have been extremely interested in watching the debate on health ______ reform. I intentionally did not fill in the blank because this has become a bit of a moving target. Of course, this debate began as a discussion on healthcare reform. But somewhere along the line, someone changed the terminology. Now, we no longer hear President Obama discuss healthcare reform, but health insurance reform. I am perfectly okay with this term because I believe it more accurately depicts what the current proposals have become.
Most would agree that early on in the reform debate, three main issues were identified as being central to any meaningful reform—quality, cost, and access. The current bills under consideration in both the House and the Senate contain some elements of all three. However, they all place heavy emphasis on access and do precious little to address quality and almost nothing to address cost (except increase the cost, but that is another blog post). But these bills also beg the question: Access to what? Access to actual healthcare or access to health insurance? Clearly, if you study these bills, they are more focused on providing access to health insurance, and thus, the appropriate shift in the terminology by President Obama and others.
Hospitalists’ prescribing habits call for better communication with PCPs
According to the June 2009 issue of Today’s Hospitalist, hospitalists write 44 prescriptions during an average 11-hour shift, which means one prescription every 15 minutes. Hospitalists change about 30% of patients’ existing prescriptions. That’s a lot of prescriptions—and a lot of opportunity for risk.
The Today’s Hospitalist survey also asked hospitalists how they enhance patients’ compliance with their prescription regimen. On average, hospitalists use between four and five methods to help patients comply, including educating patients on their medical condition (96%), clearly explaining instructions (88.4%), asking patients if they understand the instructions (76.1%), writing down instructions for patients (75.4%), providing the patient with educational material (73.4%), and following up with patients (36.2%).
New bill aims to save primary care
Congress took on the national shortage of primary care providers (PCP) with a new bill, Preserving Patient Access to Primary Care Act of 2009 (H.R. 2350), that was introduced last month by U.S. Rep Allyson Schwartz (D-PA). Offering education incentives and Medicare-related provisions, the bill aims to reform primary care, according to a May 20 press release from Schwartz’s office.
Right now, only 2% of fourth-year medical students plan to pursue primary care internal medicine, causing a shortage of 45,000 PCPs, according to the American College of Physicians (ACP), an endorser of the bill.
The bill would offer new scholarships, grants, and loan repayment programs for primary care services, as well as create new residency positions for primary care and general surgery trainees.
First NP granted privileges: A new twist to the hospitalist-PCP relationship
We’ve covered the hospitalist-PCP relationship extensively in recent months, including an article in Hospitalist Leadership Advisor, an insert to Medical Staff Briefing, that discusses how good communication between hospitalists and PCPs enhances patient care.
Here’s a new twist to the hospitalist-PCP relationship: According to Medical Biznow, a nurse practitioner in Washington, D.C., opened her own practice in 2004 and became the first nurse practitioner in private practice to be granted hospital privileges in 2007.
As the shortage of PCPs deepens, I think we are going to see more advance practice professionals, such as nurse practitioners and physicians assistants, take on different roles in patient care and even open private practices. There are certainly pros and cons to consider, but given the current crisis surrounding quality and access to care, doesn’t it make sense to give someone who is trained as a nurse and a clinician the authority to treat patients to take some of the pressure off of PCPs?
The necessary evil of hospital medicine
I was talking to a physician last week about a hospitalist program when he referred to it as “a necessary evil.” I have been thinking about the ways in which hospital medicine is both necessary and evil.
The necessary part comes about from the rapidly disappearing traditional primary care practice in the United States. Few new physicians are choosing to practice primary care, whether it is internal medicine, pediatrics, or family practice. Those who remain in the field are squeezed financially and must concentrate on office practice to make an adequate income. The financial strain is the reason that is most often cited as the necessity of hospital medicine.
Discharge planning: It’s not the patient’s job
About a year ago, I went to the ED with stomach pain. Luckily, it wasn’t anything a round of antibiotics and some rest couldn’t take care of. When I saw my PCP a week later, I was surprised (and a little impressed) that she was up to speed—she knew what tests the hospital ran and my diagnosis, which enabled her to deliver appropriate follow-up care. But should we, as patients, be surprised or impressed when our PCPs and those who care for us in the hospital communicate with each other effectively? Personally, I think good hospitalist-PCP communication should be a given.
Hospitalist movement opens new doors for PCPs
Some PCPs love that hospitalists have taken over the responsibilities associated with providing inpatient care, while other PCPs long for the good old days when they followed their patients from admission to discharge. Last week, we addressed some of the negative effects the hospitalist movement has had on PCPs, but for every dark cloud, there is a silver lining. For those PCPs who have embraced the hospitalist movement, they find it allows them to take advantage of opportunities they may not have had in the past, such as: [more]
Is primary care losing its appeal?
Last week, we wrote about how one PCP said that the hospitalist movement could have a devastating effect of primary care since fewer residents and medical students were choosing careers in primary care.
Here are some other reasons why PCPs might not refer their patients to hospitalists.
When PCPs choose to refer patients to a hospitalist program, it’s a mixed bag. These referring PCPs may be able to extend their office hours or eliminate the daily drive to the hospital, but jumping on the hospitalist bandwagon leaves some PCPs feeling nostalgic for the good old days when they followed their patients throughout their hospitalization. Consider these drawbacks: [more]
A shout-out to primary care: From the voice of the “pre-hospitalist”
You may remember a blog post, “I’m rebranding” from In My Humble Opinion: A Primary Care Physician’s Thoughts on Medicine and Life about a PCP who, overworked and underpaid, decided to call himself a “pre-hospitalist.” We spoke to Jordan Grumet, MD, and author of the blog about PCPs in an emerging world of hospitalists.
Although the hospitalist movement has provided individual primary care physicians (PCP) with an opportunity to focus on outpatient care and possibly earn more money, it may have a more devastating effect on the primary care community as a whole, says Jordan Grumet, MD, a PCP in Highland Park, IL. [more]
Updates of the hospitalist model
Primary care physicians (PCP) drive the hospitalist model, according to Laurence Wellikson, MD, CEO of the Society of Hospital Medicine in an article for Current Clinical Practice, published in October. Many older physicians or office-based doctors might prefer referring their patients to hospitalists who may be up to date on inpatient regulations, according to the article. In addition, most PCP incomes increase as PCPs are able to spend more time in their primary care office. Wellikson says organizations are working toward improvement in hospitalist care:- SHM received a $1.4 million grant from The John A. Hartford Foundation in 2007 as part of a three-year project to create clinical and training tools, including a discharge planning tool, according to a SHM press release
- SHM recommends that physicians receive Medicare reimbursement for the time they dedicate to information coordination, including patient or colleague telephone calls. Currently, Medicare does not reimburse for such duties.
- The American College of Physicians, American Academy of Pediatrics, American Academy of Family Physicians, and American Osteopathic Association are developing a Patient-Centered Medical Home, a healthcare setting that bridges hospitalists with patients and their primary care providers.
Physician shortage continues
Although the physician workforce remains stagnant, numbers of potential patients continue to grow, leading to a low physician-to-population ratio in the health care industry, according to “The global health workforce shortage: Role of surgeons and other providers,” published in the 2008 Advances in Surgery.
“The emergency room has become the primary care physician after 5 p.m. for much of the population,” states the article. Because nearly half of primary care practices lack after-hour care, patients instead seek emergency care. This physician shortage is evidenced by long patient wait times for appointments and an expanding hospitalist movement.
The paper recommends medical schools expand their class sizes, and that students choose a medical specialty aside from primary care.
Improve communication with PCPs
Inpatient and outpatient providers depend on each other to optimize patient care and clinical outcomes, but that relationship comes with challenges. The downfall of many hospitalist programs isn’t necessarily poor-quality care. Rather, a failed program might result from lack of planning, lack of infrastructure, and unmet expectations on the part of customers (patients and referring providers/PCPs).
Conversely, the success of the practitioners’ partnership comes from the careful planning and implementation of the hospitalist program. Develop an integrated delivery system that is complete with policies, procedures, and protocols, assigning responsibilities to each side of process. Some hospitalist deliverables include the following protocols:
- Give referring physicians and PCPs patient brochures that explain the hospitalist program and services provided. Have the referring physicians and PCPs place patient brochures in their office waiting rooms.
- Make confirmation calls to the PCP on the day of admission. If the admission occurs after hours or on a weekend or holiday, call on the next business day.
- Transmit admission history and physical exam results to the referring provider/PCP within one hour of evaluation.
- Call the PCP with updates and significant changes in the patient’s status.
- Involve the PCP in any major diagnostic or treatment plans.
- Coordinate a discharge plan with the PCP.
- Coordinate a patient/family conference before discharge to answer questions, review the discharge medications, and outline the outpatient treatment plan.
- Transmit a summary discharge sheet to the PCP stating discharge diagnosis, discharge medications, and follow-up recommendations.
- Provide priority dictation and transmit discharge summary to PCP within three hours of patient discharge.
- Follow-up with the patient by telephone within 24 hours of discharge.
The above excerpt is adapted from Hospitalist Case Studies: Tactics and Strategies for 10 Common Hurdles, by Kenneth G. Simone, DO, published by HCPro, Inc.
