Interestingly, what to call these providers seems to be a problem.
“Hospitalist groups are employing people who, strictly speaking, aren’t really hospitalists, although the post-acute setting marries up very well with the hospitalist model, mindset, and historical leadership role,” Dr. Rissmiller says. “It requires a different skill set.”
He prefers the term “post-acute specialist.”
Others refer to these providers as “SNF-ists,” although that word doesn’t exactly roll off the tongue, nor does it convey the scope of post-acute care.
“If hospitalists are doctors who round in acute-care hospitals, the parallel term for doctors who round in post-acute facilities is not well established,” Dr. Wilborn says. “It’s site-specific care. I call them post-acute care providers. This certainly is a specialty, for a lot of different reasons. It’s post-acute care medicine, and the hospitalist term isn’t going to stick.”
Scott Sears, MD, FACP, chief clinical officer of Tacoma, Wash.-based Sound Physicians, which has physicians deployed in roughly 100 post-acute settings, labels his providers “transitional care physicians.” Most of them are dedicated full time to post-acute care.
“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,” Dr. Sears says.
“It’s almost an art in itself,” he adds. “That’s why it’s not in the patient’s best interest to have a doctor who just dabbles in post-acute care. That’s where the dedicated provider with a passion and vision for the work is so valuable. We also have more success with people who have more experience.”
General Medicine PC, a Novi, Mich.-based company of physicians, NPs, and PAs who specialize in treating geriatric and chronically ill patients in long-term care settings, calls itself “the post-hospitalist company.” It claims its primary customers tend to be payers and managed care systems.
“We use the term post-hospitalist, and we are the country’s largest provider of post-hospitalist services,” explains CEO Thomas Prose, MD, MPH, MBA, who founded the company in 1983. “We tailor services to the needs of each accountable care organization, hospital, and integrated health system we contract with, in order to improve patient care and reduce hospital readmissions, ED visits, and overall spending.”
The company has posted readmissions rates lower than 95% of the industry, with higher quality metrics, he says, adding that the majority of General Medicine’s physicians are not transitioning hospitalists but doctors who were drawn to geriatrics and long-term care settings from the outset.
What’s Driving the Post-Acute Space?
A significant portion of healthcare expenditures is in post-acute care, and that money hasn’t always been well spent, experts interviewed for this article emphasized. Without adequate physician involvement in their care, many of these patients would be sent back to the hospital for complications that might have been managed outside of the hospital. Often it is payers, managed care plans, health systems, medical groups, and other risk-bearing entities that are driving the growth of physician involvement in post-acute care—just as insurers had a role in pushing the early growth of hospital medicine—and accountable care organizations (ACOs) are more often acting and contracting like payers.
In fact, spending on post-acute care overall, not just the physician’s role, is growing rapidly enough to attract the concerns of policymakers, reflected in a recent hearing by the U.S. House Energy and Commerce Committee that found drastic variations in payment rates across settings, with overall Medicare spending of $59 billion on post-acute care in 2013.2 The Bundling and Coordinating Post-Acute Care Act, a bill first introduced last year by Rep. David McKinley (D-W. Va.) and reintroduced in 2015 as HR1458, aims to address these growing costs while preserving patient choice by requiring a single bundled payment for post-acute care services under Medicare parts A and B.