More than in the inpatient setting, post-acute care offers opportunities for nurse practitioners and physician assistants to play important clinical and administrative roles. Physician assistant (PA) Edwin Lopez, PA-C, is chief of an eight-member HM group—four doctors, four PAs—that provides coverage at St. Elizabeth, a rural critical access hospital in Enumclaw, Wash., population 10,669, and in the 80-bed SNF located across the street. Lopez was recruited to establish the HM group “in the shadow of Mt. Rainier” about eight years ago, at a time when the hospital’s parent, CHI Franciscan Health System, was trying to rebuild its quality and reputation while planning a new building.
“I began to realize, with our little facility’s large population of elderly patients with multiple chronic problems—typically the highest cohort for readmissions—all the gains we had made could be lost if we didn’t do something about this problem,” Lopez says. “I ran the numbers and found that the nursing home across the street readmitted 35% of patients discharged from our hospital.”
It took a year to get the larger system’s approval, but Lopez’s hospitalist group manages all the patients transferred to the nearby nursing home, with daily visits by the doctor and/or PA on duty.
“We started the program in January 2014, and, in one year, readmissions went from 35% down to 7%,” he says. “We developed culturally from the very beginning as a PA/MD collaborative model. The doctor doesn’t need to see the more routine patients with more common conditions but instead is freed up to focus on higher-acuity, more complex patients.”
In Dr. Tollman’s opinion, physician extenders “own” the post-acute realm, because of the demand for their care.
“There just aren’t going to be enough doctors for all of the patients who need to be seen,” he says, “and the amount of money for this care isn’t enough for these facilities to employ groups of doctors.”
Emily Rosenbaum, PA-C, works for Northwest Community Healthcare in Arlington Heights, Ill. She is the lone PA working with eight physician hospitalists. Much of her work is in a rehabilitation facility across the street from Northwest Community Hospital.
“I see all of the new admissions, although under my scope of practice I can’t bill for the initial visit. But I do the follow-ups, see patients that have been in rehab for 30 days or less, and put out [clinical] fires in the facility,” she says.
Rosenbaum works at the hospital part of her day taking care of acute patients, then works with the hospitalist assigned to the rehabilitation facility.
“It’s easier for me to go back and forth and keep my finger on the patients’ pulse,” she says. “As there are more demands on doctors on the acute side, it’s natural for the NP and PA to step up and take a larger role on the post-acute side.”