Hospitalists’ Impact on the ACO
Posted by Kara S. Aplin, MD, FACP on May 29, 2019
Patients who are hospitalized are sicker and more complex than ever. As more care is provided in outpatient and alternative locations, the patients who do make it into the hospital are those with high acuity illness and multiple serious chronic conditions. As Hospitalists, we specialize in the acute care of this population. In an ACO model, Hospitalists are key partners with our Primary Care Physician colleagues. We work together as a team to manage the care of a population of patients who are transitioning among multiple settings. Within this ACO framework, there are six key opportunities for Hospitalists to have an impact.
1. Work together with our PCP colleagues to decrease admissions for conditions that could be managed in an outpatient setting
2. In conjunction with the Transitional Care team, start planning for discharge needs at the time of admission and ensure communication of key information to outpatient providers at the time of discharge
3. Remain committed to Cooper’s “7 Day Pledge” to have staff schedule all hospitalized patients with an outpatient appointment within seven days of discharge
4. Within inpatient plans, include measures to help decrease readmissions
5. Prescribe home health heart failure protocols which enable visiting nurses to actively manage heart failure patients at home after they are discharged, in conjunction with their cardiologist
6. Incorporate advanced planning discussions into hospital care
By championing these six key initiatives, Hospitalists have a direct impact on providing high value, safe, and timely care for the ACO patients who have entrusted us with their care.