Thursday, October 29, 2009

Hospitalists and comanagement---the debate continues

But the debate, as illustrated by a point-counterpoint piece in the October issue of The Hospitalist, is not about whether collaboration among hospitalists, surgeons and subspecialists is good for patient care. It's about the importance of dealing with unintended consequences and defining the relationships.

There are strong arguments in favor of comanagement as a model which benefits patients. It it's not done carefully, though, the adverse consequences for patient care are many and it is a driver of career dissatisfaction. Eric Siegal, M.D., a co-author of the piece, described a situation all too familiar:

In the wee hours of a recent busy call night, the ED called me to admit a patient whose automatic implantable cardioverter cefibrillator (AICD) had fired repeatedly. The patient had no other active medical issues. When called, the electrophysiologist, who was on staff, demanded that I admit the patient for “medical comanagement.” The specialist agreed that I probably would have little to add to the care, but his firm expectation was that hospitalists admit his patients and he “consults” … especially at 2 a.m.


Anonymous said...

I don't know if it's still in the health bills, but there was talk for a while about eliminating consultation codes (which always pay more) and having everything be a simple E&M code.

maybe the "you be primary so I can be consulted" scenario will lose some of it's power if that happened.

Anonymous said...

doubtful that removal of consultation codes would remove the 'you be the primary' for middle of the night admissions. at least imo.