More Pressure on PCPs to Reduce Hospital Readmissions

Paul Cerrato, MA

Disclosures

March 04, 2015

In This Article

More Responsibility for Primary Care

As if primary care physicians (PCPs) didn't already feel overloaded with responsibilities ranging into increasingly more areas, another head of pressure for them is gaining steam. That's the growing focus on PCPs to help lower patient readmissions to the hospital.

When the federal government first implemented the Readmissions Reduction Program, requiring the Centers for Medicare & Medicaid Services (CMS) to cut payments to hospitals if they had excessive 30-day readmissions,[1] many hospital executives cried foul. "Why should we be held responsible for what patients do after they're discharged? That's between patients and their PCPs."

That objection has not stopped CMS from imposing heavy penalties on hospitals for what it considers avoidable readmissions for acute myocardial infarction, heart failure, and pneumonia. But the hospitals' objections have nonetheless made PCPs in office practice more prominent players in lowering these statistics.

The controversial CMS program raises the questions: What exactly can PCPs do to have an impact on hospital readmissions, and will such efforts disrupt their workflow or become a financial burden?

Can PCPs Make a Difference?

There's little doubt that physicians in ambulatory practice can have a positive effect on readmissions—at least in certain circumstances. One study has found, for instance, that among a large group of patients who underwent surgical repair of an aortic aneurysm, early follow-up with a PCP significantly reduced the risk for readmission, but only if patients had perioperative complications.[2] The same study found that follow-up with a PCP had no impact on a separate group of patients who were hospitalized for ventral hernia repair.

A pilot program that involved four primary care clinics in Oregon has also shown that improved care coordination between inpatient and outpatient clinicians reduced 30-day readmissions from 27% to 7.1%.[3]

Such findings echo a call to action by the American Medical Association in 2013 that outlined what it considers the responsibilities of ambulatory practices to ensure high-quality transitions of care.

The guidelines, outlined in "There and Home Again, Safely,"[4] list several recommendations that many physicians in office practice probably already follow. Among them: Conduct a baseline health assessment before initial admission, encourage patients to self-manage their condition, communicate with all members of the medical team to promote effective medication use, and synchronize the efforts of the entire care team to improve care coordination.

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