“Our main source of transitional care doctors are former hospitalists who are interested in more than a three-to-seven day relationship with their patients. It’s almost an art in itself. That’s why it’s not in the patient’s best interest to have a doctor who just dabbles in post-acute care.” —Scott Sears, MD, FACP
“Why does it matter to hospitalists?” Dr. Muldoon asks, rhetorically. “Everything in terms of acuity is being pushed down to lower-level settings. If hospitalists think they will only do hospital work in the future, well, they will miss much of inpatient care because of the shift from the hospital to other hospital-like settings.”
At HM15 in late March, the task force outlined its agenda for the coming year, including promotion of its toolkit, development of a web-based CME seminar, and creation of a web-based reference repository.
Scott Rissmiller, MD, chief hospitalist at the 43-hospital Carolinas Healthcare System in Charlotte, N.C., says the transformation now taking place in post-acute care is more than just hospitalists doing some or all of their work in long-term care facilities. Post-acute care is becoming less of a side job for moonlighting hospitalists, with more of a focus on integrated care. Dr. Rissmiller, a member of SHM’s Multi-Site Hospitalist Group Task Force, says hospitalists are bringing to the post-acute arena the same standardization, accountability, and quality improvement the field has brought to hospitals across the country.
For Carolinas Healthcare and other multi-site hospitalist groups, the goal is to elevate the quality of care in LTACHs and other long-term care settings.
“It’s upping the game in post-acute care. It’s looking at the whole continuum of care from a systems perspective, improving handoffs and transitions,” Dr. Rissmiller says. “For years, we tried to improve communication with post-acute providers. It wasn’t until we started partnering with these facilities that we started to see changes.”
Dr. Rissmiller believes the best practice is to have one cohesive team caring for patients in both hospital and post-acute settings, under the leadership of the hospitalist group. The goal is to ensure that patients go to the proper level of care—and only for as long as they need to be there—using the system’s resources correctly.
Not every member of the hospitalist group will go to post-acute care facilities, while others will choose to specialize in that setting, he says, “but they meet every month with their acute care counterparts to work on improving care.”
It’s important to be flexible and have a foot in many venues. I view myself as a hospitalist by personality and history. But experience working in post-acute care enables physicians to view the hospital in perspective—as part of the larger continuum of care and not the center of the universe.” —James Tollman, MD, FHM
What Should We Call This?
The amount of medical care being provided by hospitalists in post-acute facilities is growing, experts say, inclusive of physician assistants and nurse practitioners working as part of hospitalist groups. As many as 30% of SHM members are involved in post-acute care, according to the latest SHM survey, with large management groups like IPC, TeamHealth, and Tacoma, Wash.-based Sound Physicians, expanding rapidly in this area.1
“I don’t think that hospitalists have taken over from PCPs in post-acute care in general, but they make up a significant physician cohort,” Dr. Wilborn says.
IPC has a presence today in more than 1,700 post-acute care facilities, with 20% of its physicians working in both acute and post-acute care, more than 2,800 affiliated clinicians, and a third of the company’s revenue coming from the post-acute space, Dr. Wilborn notes.