This ties in with the accountability gap that vexes our patients every day. Very likely, hospitalists will have to assume a role in managing the patients after hospital discharge. This might take the form of a few follow-up visits and continued support systems via the Web and telephone. It will probably require a new class of hospitalist—the ambulist or the subacutist—supported by dedicated ancillary staff and systems.
Once again, Medicare and insurers can drive to a better system of post-acute care by supplying incentives: a more robust discharge payment or rewarding successful completion of a hospitalization, possibly by bundled payment incentives. In addition, there could be clear standards set that would define when this is done well with associated rewards.
I know some of these ideas are radical and make us uncomfortable. They seem to assign more responsibilities to an already overburdened profession. To be successful, these innovations require an active participation and accountability of our patients. We as the providers of healthcare cannot do this alone. It also requires the evolution of the hospital as an institution from just the healthcare provider for the acutely ill, horizontal patient, but as more a part of a continuum from acute illness to return to function. And it cries out for a robust, capable, outpatient partner in a medical home or accountable care organization (ACO) that is equally dedicated, incentivized, and accountable.
We won’t get there tomorrow, even if Dr. Berwick reads this and acts on all of the ideas on his first day at CMS.
But if we don’t get started, we know we definitely won’t get there at any time in our future. TH
Dr. Wellikson is CEO of SHM.