The American Academy of Family Physicians (AAFP) is calling upon major insurers to revisit how they reimburse for primary care physicians consulting with hospitalists caring for their patients, AAFP News reported.
"We believe that there is value in paying primary care physicians to see their patients in a hospital setting and that there is some evidence to suggest that doing so has benefits in terms of both improved outcomes and cost savings to the health system," Brennan Cantrell, the AAFP's commercial insurance strategist, wrote in a letter to executives at Aetna, Anthem, Cigna, Humana, Kaiser Permanente, UnitedHealthcare and the Health Care Service Corporation.
Under the current model, communication--or often the lack thereof--between hospital clinicians and primary care providers often results in poor care coordination after discharge and a greater chance of patient readmissions, FierceHealthcare reported previously.
However, many insurers will deny coverage for PCP-hospitalist consults as "medically unnecessary concurrent care," especially when the hospitalist and the PCP belong to the same specialty, noted the AAFP. As part of its plea to insurers to "review and revise" such payment policies, the AAFP cited an article published in the New England Journal of Medicine in which researchers explored strategies to improve care collaboration for hospitalized patients.
Within the NEJM article, authors Allan H. Goroll, M.D., and Daniel P. Hunt, M.D., proposed a collaborative inpatient care model that involved the PCP meeting with the patient, family members and hospitalist team shortly after admission and just before discharge, with the ability to provide support and counseling to all parties in between. The hospitalist team would still retain full attending-physician responsibilities.
Key challenges to such a program include PCP time restrictions to fulfill the role, as well as limitations of many current reimbursement models. But with strong communication systems and payment adjustments to reward collaborative care, they argued, savings would accrue from improved diagnostic efficiency and accuracy; from reductions in lengths of stay, unnecessary testing, preventable readmissions and inappropriate discharges; and from enhanced compliance, follow up and patient satisfaction.
To learn more:
- read the article from the AAFP
- see the NEJM article