The American Academy of Family Physicians (AAFP) has appealed to some of the nation’s largest insurers, asking for coverage of hospital consults conducted by PCPs on behalf of hospitalists for their patients who are in the hospital.
“We believe that there is value in paying primary care physicians to see their patients in a hospital setting and that there is some evidence to suggest that doing so has benefits in terms of both improved outcomes and cost savings to the health system,” says AAFP’s commercial insurance strategist Brennan Cantrell. Cantrell’s letter to the insurers asks them to review their coverage and payment policies.
Some insurers have downplayed the value of a hospital consultation by the outpatient physician, but advocates have emphasized its value in improving communication and enhancing care transitions.
“Payors’ responses to our letter have been positive,” Cantrell tells The Hospitalist. The seven companies indicate that they have policies to permit separate payment for consults done by hospitalists and by PCPs brought in for hospital consults.
Hospitalist Claudia K. Geyer, MD, SFHM, chair of SHM’s Family Medicine Committee, says AAFP’s consultation initiative could help to formalize the social consult visit for primary care physicians, turning it into a true multidisciplinary approach to managing transitions. However, which patients are most appropriate for this type of consult, how it is initiated, and how many PCPs would be willing and able to provide the service—even if it were billable—require further clarification.
“The key would be for the hospitalist and PCP to work together as a team,” Dr. Geyer says.