Friday, August 16, 2013

Beyond Making the Rounds: Hospitalists
& Quality of Care Under ACA: Part II

In an earlier post, I discussed how hospitalists play a vital role in meeting ACA’s quality of care standards for the inpatient setting. Now, let’s take a look at how PCPs must also work to meet these same standards.

A PCP’s Evolving Role for Inpatient Care
Of course, the industry cannot rely on hospitalists alone to meet ACA standards. It takes a village. PCPs still play a key role in establishing quality inpatient care. When a patient is admitted to the hospital, the PCP’s role in the patient’s care has not ended. Instead, PCPs should see the inpatient stay as a momentary transition in care for which they are responsible for retaining oversight. PCPs should step up, not step back, to ensure continuity of care.

If a PCP is concerned about an aspect of a patient’s medical history or a fact with which the patient may not be forthcoming, the PCP should alert the hospitalist to this information. While a hospitalist may be better equipped to care for a patient in the hospital, a PCP’s knowledge and history with a patient cannot be discounted. Often the admitting physician, a PCP is in the best position to know the patient’s current and past medical condition.  PCPs should make their contact information known, both to hospitals and patients, so that hospitalists know how to reach them if the need arises.

No matter how great the care they offer inpatients, an individual will never refer to a hospitalist as “my doctor.” Once out of the hospital, patients can no longer call hospitalists or follow up with them for care. PCPs must be ready to resume their role fully and knowledgeably.

After an inpatient is discharged, PCPs should expect a complete discharge summary. After all, like an emergency department doctor, a hospitalist’s role ends at the hospital door. PCPs will need to know test results, medications, and future treatment plans. PCPs should collaborate with hospitalists about when and how discharge summaries should be received.

Fortunately, electronic health records are greatly improving the ability for physicians to stay abreast of an inpatient’s care, even if they are not physically present in the hospital. As emphasis on EHR increases and more providers implement EHR systems in their practice, collaboration between PCPs and hospitalists will also increase. The better the information contained in the EHR, the easier it is to provide efficient and proper care after a hospital discharge.

To meet ACA demands, hospitalists and PCPs must work with, not against, each other. As demand for hospitalists rapidly increases, PCPs need to make sure they are on board with this emerging role in health care. It will take teamwork to stay afloat in the ACA’s waves of change. To ensure quality and continuity, we must have all hands on deck.

Molly Nicol Lewis
McBrayer, McGinnis, Leslie & Kirkland, PLLC.
Lexington, Kentucky

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