- Assume the primary role of caring for the patient as of the time of discharge from the hospital;
- Provide a timely first post-discharge office visit consistent with the acute illness as documented in the discharge summary; and
- Ensure a handoff formally confirmed and documented by the hospitalist and PCMH.
The hospitalist should provide to the PCMH:
- An accurate and timely discharge summary; and
- The availability to the PCMH to answer questions about the hospitalization.
Further, discharge summaries should include:
- Primary and secondary diagnoses;
- Pertinent history and physical findings;
- Dates of hospitalization, treatment provided, brief hospital course;
- Results of procedures and abnormal laboratory tests;
- Recommendations of any subspecialty consultants;
- Information given to the patient and family;
- The patient’s condition or functional status at discharge;
- Reconciled discharge medication regimen, with reasons for any changes and indications for newly prescribed medications;
- Details of follow-up arrangements made;
- Specific follow-up needs, including appointments or procedures to be scheduled, and tests pending at the time of discharge; and
- Name and contact information of the responsible hospital physician.1
Obviously other aspects of the PCMH-hospitalist relationship must be considered, including when the PCMH would like to be informed (or involved) during their patient’s hospitalization, as well as how to manage the handoff of responsibilities and information when the patient leaves the hospital but does not go directly home (e.g., when they are sent to a skilled nursing facility or rehabilitation center). If we continue to look at solutions from the patient’s and family’s points of view, we can come up with a workable solution.
Part of the result of the growth of the hospital medicine movement is that, increasingly, PCPs are not directly managing their patients for acute illnesses. That said, the PCP still has a significant role in determining whether their patients get the best care available—even if other physicians (e.g., hospitalists, surgeons, subspecialists) deliver the actual care.
We are just at the beginning of performance measurement and reporting. Today, PCPs and their patients can log on to www.hospitalcompare.hhs.gov and look at any hospital’s performance for pneumonia, acute coronary syndrome, and heart failure. The era of disease-specific and institution-specific—even physician-specific—reporting grows on a seemingly monthly basis.
Armed with this information, the PCP’s role shifts from managing the acute illnesses of their patients to understanding the report cards on their local hospitals and specialists and using this information to direct their patients to the hospitals and physicians who have the best outcomes. The expanding role of the PCP as the informed guide for their patients further will drive hospitals and all physicians who rely on referrals to improve their feedback and communication with PCPs.
We will begin to see that best-of-breed hospitals not only will have excellent clinical outcomes but will be pushed to have better patient-satisfaction and PCP-satisfaction scores. This is an opportunity for enlightened PCPs to use their medical background and hands-on understanding of local healthcare to be a vital resource to their patients.
By the same token, this is an opportunity for product differentiation for hospitals and their hospitalists to reshape a healthcare referral world traditionally built more on geography and familiarity than on information and performance, and replace it with strong communication and better outcomes. The best thing about this approach is the patient wins. TH
Dr. Wellikson is the CEO of SHM