Hospitalists and PCPs, a potentially formidable force

We as hospitalists have been missing a huge piece of the puzzle when it comes to readmissions. With such a huge push to reduce the readmission rate at our hospitals and avoid the resultant penalties, have we been too internally focused?

In a recent article in, titled, "A primary care physician’s ideal transitions of care – where’s the evidence?" Dr. Ning Tang gives a PCP’s perspective on how outpatient providers can greatly facilitate our common goal of optimizing patients’ transition from hospital to home (J. Hosp. Med. 2013;8:472-7). After all, most of our patients do have a PCP, who has known them for a long time and who will have much more insight into their values and support systems, their idiosyncrasies, what they will and won’t follow through on, and even their pet peeves. When we who may interact with them for only a couple of hours try to use a cookie-cutter approach to care, it simply may not be received well, if at all.

Dr. Tang suggests that PCP communication begins at the point of admission. While some ERs and admissions offices have automated systems in place to contact PCPs when their patients are admitted, for most of us, this communication comes by way of a phone call or as an electronic or faxed copy of the admission note. While I do not think anyone would argue that early involvement by the PCP has a tremendous potential to improve both the patient’s transition from home into the hospital and vice versa, in real life doctors are frequently too busy and stressed to meet this basic expectation. Hopefully that will change in the future.

Some PCPs have no desire to talk with a hospitalist each time a patient is admitted because it takes them away from seeing patients in their office. Yet others would welcome the opportunity for early involvement. It is an individual preference, one we should strive to understand in order to optimize our patients’ experience – and the experience of the physician who has entrusted patients to us.

Medication reconciliation is but the tip of the iceberg of issues the PCP could assist with, and the realization that their patient may not actually be taking all the medications they prescribed (or taking medications they didn’t) can help improve the level of care patients receive once discharged.

In the midst of brutal day, we have all had medication nightmares that make us cringe, as we slowly count to three while practicing deep-breathing exercises. You know, the patient who pulls out a crumpled list of medications. Some have been crossed out and others are too illegible to read. Then, the spouse pulls out another "updated" list, and the physician and pharmacist each have their own list, and no two lists are exactly alike.

But these nightmares could soon end. I was surprised to find out that in January of this year, the Centers for Medicare and Medicaid Services introduced new codes to reimburse primary care providers for care coordination after hospital discharge. These codes, 99495 and 99496 reimburse a substantial fee, carrying weights of 3.96 and 5.81 RVUs (relative value units), respectively, a lot more than we typically make for even an extended history and physical.

So, I have to agree with Dr. Tang. We, PCPs and hospitalists alike, are missing a huge potential to optimize care transitions, decrease our readmission rate, and lower medical costs. Dialogue needs to take place between hospitalist and the PCPs they serve to bridge some of these gaps.

Dr. Hester is a hospitalist with Baltimore-Washington Medical Center who has a passion for empowering patients to partner in their health care. She is the creator of the Patient Whiz, a patient-engagement app for iOS.

We as hospitalists have been missing a huge piece of the puzzle when it comes to readmissions. With such a huge push to reduce the readmission rate at our hospitals and avoid the resultant penalties, have we been too internally focused?

In a recent article in, titled, "A primary care physician’s ideal transitions of care – where’s the evidence?" Dr. Ning Tang gives a PCP’s perspective on how outpatient providers can greatly facilitate our common goal of optimizing patients’ transition from hospital to home (J. Hosp. Med. 2013;8:472-7). After all, most of our patients do have a PCP, who has known them for a long time and who will have much more insight into their values and support systems, their idiosyncrasies, what they will and won’t follow through on, and even their pet peeves. When we who may interact with them for only a couple of hours try to use a cookie-cutter approach to care, it simply may not be received well, if at all.

Dr. Tang suggests that PCP communication begins at the point of admission. While some ERs and admissions offices have automated systems in place to contact PCPs when their patients are admitted, for most of us, this communication comes by way of a phone call or as an electronic or faxed copy of the admission note. While I do not think anyone would argue that early involvement by the PCP has a tremendous potential to improve both the patient’s transition from home into the hospital and vice versa, in real life doctors are frequently too busy and stressed to meet this basic expectation. Hopefully that will change in the future.

Some PCPs have no desire to talk with a hospitalist each time a patient is admitted because it takes them away from seeing patients in their office. Yet others would welcome the opportunity for early involvement. It is an individual preference, one we should strive to understand in order to optimize our patients’ experience – and the experience of the physician who has entrusted patients to us.

Medication reconciliation is but the tip of the iceberg of issues the PCP could assist with, and the realization that their patient may not actually be taking all the medications they prescribed (or taking medications they didn’t) can help improve the level of care patients receive once discharged.

In the midst of brutal day, we have all had medication nightmares that make us cringe, as we slowly count to three while practicing deep-breathing exercises. You know, the patient who pulls out a crumpled list of medications. Some have been crossed out and others are too illegible to read. Then, the spouse pulls out another "updated" list, and the physician and pharmacist each have their own list, and no two lists are exactly alike.

But these nightmares could soon end. I was surprised to find out that in January of this year, the Centers for Medicare and Medicaid Services introduced new codes to reimburse primary care providers for care coordination after hospital discharge. These codes, 99495 and 99496 reimburse a substantial fee, carrying weights of 3.96 and 5.81 RVUs (relative value units), respectively, a lot more than we typically make for even an extended history and physical.

So, I have to agree with Dr. Tang. We, PCPs and hospitalists alike, are missing a huge potential to optimize care transitions, decrease our readmission rate, and lower medical costs. Dialogue needs to take place between hospitalist and the PCPs they serve to bridge some of these gaps.

Dr. Hester is a hospitalist with Baltimore-Washington Medical Center who has a passion for empowering patients to partner in their health care. She is the creator of the Patient Whiz, a patient-engagement app for iOS.

We as hospitalists have been missing a huge piece of the puzzle when it comes to readmissions. With such a huge push to reduce the readmission rate at our hospitals and avoid the resultant penalties, have we been too internally focused?

In a recent article in, titled, "A primary care physician’s ideal transitions of care – where’s the evidence?" Dr. Ning Tang gives a PCP’s perspective on how outpatient providers can greatly facilitate our common goal of optimizing patients’ transition from hospital to home (J. Hosp. Med. 2013;8:472-7). After all, most of our patients do have a PCP, who has known them for a long time and who will have much more insight into their values and support systems, their idiosyncrasies, what they will and won’t follow through on, and even their pet peeves. When we who may interact with them for only a couple of hours try to use a cookie-cutter approach to care, it simply may not be received well, if at all.

Dr. Tang suggests that PCP communication begins at the point of admission. While some ERs and admissions offices have automated systems in place to contact PCPs when their patients are admitted, for most of us, this communication comes by way of a phone call or as an electronic or faxed copy of the admission note. While I do not think anyone would argue that early involvement by the PCP has a tremendous potential to improve both the patient’s transition from home into the hospital and vice versa, in real life doctors are frequently too busy and stressed to meet this basic expectation. Hopefully that will change in the future.

Some PCPs have no desire to talk with a hospitalist each time a patient is admitted because it takes them away from seeing patients in their office. Yet others would welcome the opportunity for early involvement. It is an individual preference, one we should strive to understand in order to optimize our patients’ experience – and the experience of the physician who has entrusted patients to us.

Medication reconciliation is but the tip of the iceberg of issues the PCP could assist with, and the realization that their patient may not actually be taking all the medications they prescribed (or taking medications they didn’t) can help improve the level of care patients receive once discharged.

In the midst of brutal day, we have all had medication nightmares that make us cringe, as we slowly count to three while practicing deep-breathing exercises. You know, the patient who pulls out a crumpled list of medications. Some have been crossed out and others are too illegible to read. Then, the spouse pulls out another "updated" list, and the physician and pharmacist each have their own list, and no two lists are exactly alike.

But these nightmares could soon end. I was surprised to find out that in January of this year, the Centers for Medicare and Medicaid Services introduced new codes to reimburse primary care providers for care coordination after hospital discharge. These codes, 99495 and 99496 reimburse a substantial fee, carrying weights of 3.96 and 5.81 RVUs (relative value units), respectively, a lot more than we typically make for even an extended history and physical.

So, I have to agree with Dr. Tang. We, PCPs and hospitalists alike, are missing a huge potential to optimize care transitions, decrease our readmission rate, and lower medical costs. Dialogue needs to take place between hospitalist and the PCPs they serve to bridge some of these gaps.

Dr. Hester is a hospitalist with Baltimore-Washington Medical Center who has a passion for empowering patients to partner in their health care. She is the creator of the Patient Whiz, a patient-engagement app for iOS.