Beyond the Four Walls
As you aim for a high-value (high quality and affordable) discharge, your hospital medicine practice may consider new approaches to filling longstanding gaps in post-acute care. Forward-looking hospitalist groups have implemented the following approaches:
- Establish a post-discharge clinic where patients are seen after discharge, in the interim before they have an opportunity for primary care follow-up;
- Send teams to work in SNFs;
- Call patients after discharge to ensure they are following their plan of care;
- Leverage newer current procedural terminology (CPT) codes, like the Transitional Care Management or Chronic Care Management codes, to support your transitional care services;
- Provide home visits for high-risk patients; and
- Access waivers for G-codes for home visits and/or telemedicine outside of rural areas. These waivers exist under the BPCI initiative.
Shift from ‘Traditional’ Hospitalist to ‘Value’ Hospitalist
If some of the changes in practice needed to succeed in a bundled payment world seem daunting to you, it may be helpful to realize that with the challenge comes an opportunity. This opportunity for hospitalists parallels that of the early days of the specialty, when reducing length of stay created substantial support from hospital leaders and was a factor leading to the rapid growth in the number of hospitalists. In January, the U.S. Secretary of Health and Human Services set a goal to tie 50% of Medicare payments to ‘alternative payment models’ like bundled payments by 2018. In April, as part of the sustainable growth rate fix, Medicare announced it would create substantial new bonuses for physicians who have at least 25% of their revenue in such models.1
As healthcare policy aligns behind ‘alternative payment models,’ bundled payment programs are likely to be a potent driver of an evolving hospitalist specialty. Next-generation hospitalists will be asked to take a leadership role in addressing ‘value’ with responsibility for improving care coordination and affordability over an episode of illness.
Now may be the time to take to heart the words of computer scientist Alan Kay: “The best way to predict the future is to invent it.”
Dr. Whitcomb is Chief Medical Officer of Remedy Partners. He is co-founder and past president of SHM. Email him at [email protected].
References
- Mechanic R. Post-acute care–the next frontier for controlling Medicare spending. N Engl J Med. 2014;370(8):692-694.
- Kuo YF, Goodwin JS. Association of hospitalist care with medical utilization after discharge: evidence of cost shift from a cohort study. Ann Intern Med. 2011;155(3):152-159.
- Newhouse JP, Garber AM. Geographic variation in Medicare services. N Engl J Med. 2013;368(16):1465-1468.