Continuity Visits by Primary Care Physicians Could Benefit Inpatients

Beyond Academia

How would the consultation visit play outside of the academic medical center? Randy J. Ferrance, DC, MD, FAAP, SFHM, medical director of the hospitalist service, hospice, and hospital-based quality at Riverside Tappahannock Hospital in Virginia, says few PCPs in his locale would be interested in making such visits.

“They say they are willing to work in our area only because there is a hospitalist service,” says Dr. Ferrance, “and, therefore, they never have to come to the hospital.”

For some PCPs, the hospital is a one-hour drive, each way, from their office.

“We have a few PCPs who really don’t want to keep in touch with us at all about their hospitalized patients,” he says. “When we’ve tried to contact them, they tell us that the history and physical and discharge summary are plenty of communication.”

Others call their patients in the hospital daily to check in, Dr. Ferrance says, and then will call the hospitalist.

“Or, we call them every other day or so to keep them up to date,” he says.

Brian Bossard, MD, FACP, FHM, founder and medical director of Inpatient Physician Associates in Lincoln, Neb., says he thinks the consultation visits are not viable and would place an unnecessary burden on already overworked PCPs in the community. He also worries about scope creep.

“A PCP consultant could confuse the chain of command,” Dr. Bossard says.

Continuity at the time of discharge remains an important concern, he says. A follow-up physician contact within 72 hours and a discharge summary, including medication reconciliation within 24 hours, are essential to ensure excellent continuity of care. But a PCP visit to the hospital is “wildly impractical.”

“PCPs won’t do it because they know their patients receive outstanding patient care from hospitalists without this interaction,” he says.

—Larry Beresford