In spite of all the gadgets and technologies available to hospital-based physicians nowadays, Jerome Wilborn, MD, FCCP, sees a much simpler symbol of patient care. Dr. Wilborn, national medical director for post-acute care services at IPC Healthcare, Inc., in North Hollywood, Calif., believes stethoscopes are key to post-acute patient care, and hospitalists are the ones “redefining” the practice. It’s not just a metaphor for working in settings that lack access to the specialists, equipment, and other resources of the acute-care hospital, he explains. A stethoscope, he says, reflects on the physicians’ clinical acumen and listening skills.
“Acute-care doctors need to understand that in the post-acute setting, it’s not about ordering labs. It is important to talk to the family,” he says. “Over the next 14 to 30 days, you can really dig into relationships with patients, optimize their medical care, reduce poly-pharmacy, and even prevent readmissions.”
These are among the sickest of patients, with multiple co-morbidities and limitations in activities of daily living (ADLs), Dr. Wilborn notes.
“Many internists and hospitalists who come to the nursing home are astounded by the clinical acuity of the patients and don’t appreciate how, even without the hospital treatment armamentarium they are used to, they can still make a big difference in the care,” he explains. But the key, he adds, is for doctors to go into the facility often enough to have an impact, with regularly scheduled presence and a commitment to standardizing the care.
“Acute-care doctors need to understand that in the post-acute setting, it’s not about ordering labs. It is important to talk to the family. Over the next 14 to 30 days, you can really dig into relationships with patients, optimize their medical care, reduce poly-pharmacy, and even prevent readmissions.” —Jerome Wilborn, MD, FCCP
For hospitalists who are more accustomed to the high-intensity, fast-paced world of the acute hospital, post-acute care may not seem very sexy.
“But that’s changing, along with the medical landscape,” Dr. Wilborn says. “For those who can appreciate the opportunity to build relationships with patients and to practice more independently, it could be a great place to change your career trajectory and have an immediate impact on the quality of patient care.”
What Is the Post-Acute Space?
Although post-acute care could refer broadly to all settings for care following the patient’s discharge from the hospital, including home care, three post-acute settings, defined by their licensure, are more likely to involve physicians such as hospitalists:
- The inpatient rehabilitation facility (IRF) , which is a freestanding rehabilitation unit or hospital inside an acute hospital for patients who need rehabilitation care in order to function effectively and are medically stable and able to participate in rehabilitation therapies;
- The long-term acute-care hospital (LTACH), a hospital that specializes in treatment and recovery of medical patients who require prolonged lengths of stay, typically measured in weeks;
- The The skilled nursing facility (SNF), which focuses on the health, social, and personal needs of chronically ill or disabled patients, either for rehabilitation stays of two weeks to a month or longer stays for chronic illness.
Although hospital medicine began as a practice specific to the inpatient setting, increasing numbers of hospitalists are spending at least part of their working lives outside of the hospital, visiting patients in post-acute settings. IPC is just one of the many national hospitalist management companies, medical groups, and hospital-employed practices that are defining new roles for their physicians, nurse practitioners, and physician assistants in these settings.
The presence of hospitalists in post-acute care is growing, according to the Society of Hospital Medicine, with 25.4% of adult hospital medicine groups in its most recent survey saying that they see patients in post-acute care facilities.1 In response to this trend, SHM in 2012 impaneled the Post-Acute Care Task Force, chaired by Sean Muldoon, MD, MPH, senior vice president and chief medical officer of Kindred Healthcare’s Hospital Division, Louisville, Ky. The task force was formed to help SHM members explore post-acute care and learn about what to expect. The task force developed a toolbox and a transitions quality improvement toolkit, and a new white paper, “Primer for Hospitalists on Skilled Nursing Facilities.”