Transitional care: the unintended consequence of hospitalists’ rise

Shortly after being discharged from the hospital, a patient receives a call from a hospital nurse, a medical group care coordinator and/or an insurance company representative.

While patient reactions may run the gamut—from appreciation to confusion to irritation—all have one thing in common:  the caller is a complete stranger. 

Welcome to “transitions of care,” as each stakeholder works to ensure that the patient and outpatient provider connect in an attempt to avoid readmission. Medicare has even codified this concept with reimbursement for the transitional care visit.

So how did we end up with yet another layer added to our healthcare delivery system?  It might be an unintended consequence of hospitalist programs.  

Hear me out:  My home group is part of a larger group of employed primary care physicians, and until four years ago, we cared for our own patients in the hospital. Several of my partners had young children, however, and those late calls and early morning admissions from the emergency department made life complicated, so we decided to use the hospitalists.

The result?  My life improved tremendously. Gone were the overnight ED calls, daily admissions, and weekend rounding.  Wonderful for me, but for my patients, it wasn’t so great. 

Think about it: when you are sick enough to be admitted to the hospital, the person who knows all of your health issues is nowhere to be found. Instead, you have multiple, rotating doctors who you’ve never met, and your own physician may have no idea you were admitted. No wonder we need this new army of transitional care people. Pre-hospitalist, I was the transition of care. I knew which consultants were involved, what meds were added or discontinued and what follow-up was needed.  

The hospitalist system emerged because care was often more expensive and time-delayed when doctors were not in-house 24/7, and it is folly to think that we will ever go back to the old way. You’d likely be unable to find many primary care physicians who would even be willing, but this is indicative of a problem that goes beyond one particular issue. 

In our quest to improve healthcare delivery, unintended consequences abound, and these need to be explored before new initiatives are implemented to avoid, or at least be prepared for unexpected outcomes and costs.  

Mary Ann Bauman, MD, is an internist practicing at INTEGRIS Health in Oklahoma City, Oklahoma, and a member of the Medical Economics Editorial Advisory Board. Do you agree with the author’s assessment of transitional care? Tell us at medec@advanstar.com