Mark J. Ault, MD
Potential Conflicts of Interest: None disclosed.
Ault MJ. The Relationship Between Hospitalists and Primary Care Physicians. Ann Intern Med. 2010;152:475. doi: 10.7326/0003-4819-152-7-201004060-00018
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Published: Ann Intern Med. 2010;152(7):475.
TO THE EDITOR:
As an academic general internist of similar vintage as Beckman (1), I sympathize with his sense of loss of the “old days,” when the general internist was the utility player seeing patients in the office, following them through the emergency department and in and out of the intensive care unit, and discharging them back to the office. Admittedly, those days are gone, and no rearrangement of incentives is going to bring them back. Medicine and hospitals have gotten too complicated. However, a relatively simple incentive with a modest financial investment may help shore up a more patient-centered health care team. If office-based physicians were required to provide, could bill, and could be fairly reimbursed for a hospital visit on the day of admission and the day of discharge, incentives would be established to encourage “skilled explicit transitions of responsibility” to integrate the primary care physicians as integral members of the health care team and to instill in patients a sense of continuity care. The explicit point of the visit would be to close information gaps that occur as patients move from one point of the system to another. Although the immediate response to this suggestion would probably focus on yet another cost in an already cost-prohibitive health care system, we need only examine the costs of fragmented patient care relative to the benefits of eliminating potentially detrimental and demoralizing “degrees of separation.” We can do better!
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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