Home From The Editor Deja vu all over again

Deja vu all over again

April 2011

Published in the April 2011 issue of Today’s Hospitalist

As I read this month’s cover story, I couldn’t help but feel a sense of deja vu. While the story looks at hospitalists running post-discharge clinics, the reaction from primary care physicians takes me back to the mid-1990s.

Back then, primary care physicians worried that hospitalists were going to deprive them of inpatient income, never return their patients and generally ruin their outpatient practices. Stoking those passions was the bigger fear that hospitals would force all physicians to hand their inpatients off to hospitalists, hurting PCPs not only financially, but taking away their autonomy.

Most of those concerns disappeared as outpatient physicians learned to embrace the benefits of hospital medicine. Many took it a step farther and begged their hospitals to bring a hospitalist service on board.

But now some of those fears are resurfacing as a small number of hospitalists experiment with treating patients who have been discharged. Hospitalists are hanging onto some patients just a little longer to make sure they don’t fall apart after discharge.

There’s a strong business and quality case for post-discharge clinics. Hospitals are about to get dinged for readmission rates, and some are betting that having the same hospitalists who saw patients in the inpatient setting provide some follow-up care will help drive down unnecessary readmissions. And some hospitalist groups even argue that complex patients need a higher-acuity medical home than primary care can provide.

Will post-discharge clinics work? The concept faces some obstacles, to be sure, but I find it interesting that primary care physicians are still worried about protecting their turf and view hospitalists as potential competitors.

edoyleEdward Doyle
Editor & Publisher