Not all post-discharge clinics are established by hospitalist groups or their parent hospitals. As Tallahassee (Fla.) Memorial Hospital’s experience with a collaborative approach shows (see “Is a Post-Discharge Clinic in Your Hospital’s Future?”), health plans might take an interest in successful discharge protocols to prevent unnecessary readmissions. In other cases, medical specialty practices have established clinics for patients with specific diseases—CHF, COPD, even post-ICU delirium.
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In Southern California, two large, established physician groups that assume financial risk or insurance functions see the potential benefit, given that their financial incentives are more obviously aligned to such clinics than are hospitals’. Cerritos, Calif.-based CareMore is a Medicare health plan that started out as a medical group and remains a care delivery system for Medicare Advantage patients, making significant use of hospitalists.
“We call ourselves ‘extensivists,’” says CareMore medical director and hospitalist Hyong Kim, MD. The company’s hospitalists generally work mornings at an assigned hospital, then spend their afternoons either making rounds on CareMore patients at a skilled nursing facility or staffing one of the group’s post-discharge clinics, located in its disease-management-oriented comprehensive clinics. Hospitalists might even make take over from primary-care physicians (PCPs) the ongoing management of the most difficult or most frail patients, Dr. Kim says. That demands a change in mindset by the hospitalist to accept responsibility for the patient’s care across settings.
“This approach wouldn’t work in fee-for-service, but it works well in pre-paid environments. We pay our PCPs a capitated rate, and they continue to receive capitation after the hospitalist takes over the care,” he explains. “Our extensivists are salaried, with incentives based on readmissions.”
The company uses chronic-disease managers, who check in daily with the hospitalists. “We also have a house-call physician program, sending physicians and social workers to patients’ homes after discharge,” Dr. Kim says.
Torrance, Calif.-based HealthCare Partners, a large, physician-owned multispecialty medical group, operates in many ways like a health plan, says Tyler Jung, MD, medical director for hospitalists, high-risk groups, and post-discharge clinics. “We’re fully delegated. We accept financial risk from virtually all of the major health plans in the area,” he explains.
—Tyler Jung, MD, medical director, hospitalists, high-risk groups, and post-discharge clinics, HealthCare Partners, Torrance, Calif.
Dr. Jung’s team views the first 30 days after patients leave the hospital as “the riskiest time period for our members. We’ve had hospitalists for 15 to 20 years, and just recently we began looking at the post-discharge clinic option,” he says. “I’m still undecided: Is it a Band-Aid or something we need to intervene in the post-discharge period?”