Hospitalists generally don’t have the benefit of a longstanding relationship with their patients, says Ashley Beard, MD, PhD, a pharmaceutical policy research fellow in the Department of Ambulatory Care and Prevention at Harvard University. “And they’re dealing with people who are at their most vulnerable and least able to communicate effectively about what is going on in their lives.”
The virtual impossibility of knowing Part D formularies for every patient, she says, only increases the importance of effective bedside discussions and open-ended questions. “I think that communicating about costs really has been, and continues to be, a taboo subject in direct patient encounters, even though it is widely talked about in the research and popular press,” she says.
Likewise, hospitalists can intervene during transition planning, Dr. Beard says, when “the goal of the hospitalist is to stabilize the patient to be able to go out into the community and then have community follow-up care, preferably by a primary-care physician.” For people who don’t seek care regularly, she says, part of that stabilization can be a medication review that eliminates nonessential or harmful drugs and alleviates a patient’s financial burden.
Christine Lum Lung, MD, medical director of the independent Northern Colorado Hospitalists group, says a proactive discharge-planning department can be a huge help in coordinating such transitions of care. Her privately run group, affiliated with two private nonprofit hospitals in Loveland and Fort Collins, works closely with a “very active and involved” department that regularly meets with patients to assess financial issues. “Then they will approach us oftentimes with any concerns or issues with the discharge plan and medication,” she says.
Patient advocates have proposed a combination of other incentives to encourage better coordination among healthcare providers, including penalties for preventable rehospitalizations and a faster rollout of e-prescribing and electronic databases. Many hospitalists are particularly enthusiastic about the potential of electronic health records to assist them and their patients, though researchers like Soumerai are far less convinced about the merits of such a billion-dollar investment.