More Pressure on PCPs to Reduce Hospital Readmissions

Paul Cerrato, MA


March 04, 2015

In This Article

How Will It Affect Your Workload?

Although these guidelines can help reduce needless readmissions, executing them in the real world can take time and resources, both of which are in short supply in physicians' everyday routine. And some practices are better equipped to deal with them than are others.

"The rate of readmission is highest in the first week or two after discharge," explained Richard Lopez, MD, chief medical officer of Atrius Health, a large independent physician group in Massachusetts. The single biggest cause of readmission, says Lopez, centers around problems with medication, including incorrect listing of the medication on the discharge instruction, the patient's inability to obtain the prescription, or taking the medication incorrectly. At Atrius, a nurse or case manager in the ambulatory practice calls the patient within a day of discharge from the hospital and tries to schedule an appointment with the PCP within 7 days of discharge to cover medication problems, review the discharge summary, and the like.

Some larger group practices also bring pharmacists into the mix to help newly discharged patients "make sure they understand how to take their meds, and means of a telephone consult," explained Megan Clark, practice manager, Research and Insights at The Advisory Board Company.

Unfortunately, many PCPs in smaller private practices can't afford to hire a case manager or pharmacist to handle this kind of follow-up. Making matters worse, many hospitals don't notify outpatient clinicians in a timely manner about patient discharges. So the physician may not even know until much later that his or her patient is home from the hospital. And the longer it takes to find out, the less likely the follow-up care will have an impact on readmissions.

Clearly, the kind of care coordination needed to reduce readmission can be a drain on medical practices. And currently, that type of care coordination work is not reimbursed well enough, if at all; thus, there's less incentive to do it.

There are Medicare billing codes specifically designed to cover postdischarge follow-up office visits, although some thought leaders question whether they're adequate. CMS says, "Medicare pays for two CPT [Current Procedural Terminology] codes (99495 and 99496) that are used to report physician or qualifying non-physician practitioner care management services for a patient following a discharge from a hospital..."[5] Those codes went into effect in January 2013. In January 2015, code 99490 will also be available to help reimburse physicians for the non–face-to-face time involved in the postdischarge management of patients with chronic conditions.

Robert Newman, MD, medical director of Ghent Family Medicine, part of the East Virginia Medical School Medical Group, believes most physicians don't resent being asked to do their part in keeping patients out of the hospital because it's the right thing to do. Having said that, Newman added, "The resentment comes from the fact that we are being asked to do more work without being paid for it. We need more incentives to do this work, maybe make the transitions of care codes pay better."


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