Critical Care Plus: Care Plans Moving to Hospitalist Contracts
December 1, 2000 3 minutes read
Critical Care Plus
Care Plans Moving to Hospitalist Contracts
System Based on Voluntary Participation
By Julie Crawshaw
Aetna u.s. healthcare has become the fourth health care plan in the Orlando, Fl, area to contract with Cogent Healthcare for a voluntary hospitalist program. Michael L. Howell, MD, Senior Medical Director for the Aetna U.S. Healthcare plan in Orlando believes the program will provide a higher level of services for Aetna’s hospitalized patients. "We had worked with a similar program and liked the benefits a well-implemented hospitalist program provides," Howell says.
Ronald A. Greeno, MD, one of Cogent’s co-founders and vice-president of network development, says the key to his company’s success lies in consistently applying a proven model. "Once we have a program that’s up and running in a community, we go out and market our program to other payers."
Greeno says that successful hospitalist-primary care physician programs and relationships must have voluntary participation, clearly delineated responsibilities, and complete, open communications between hospitalists and primary care physicians (PCPs).
Cogent begins by identifying an institution that needs hospitalists. "We work with large managed-care payers and approach their health plans in major markets," Greeno says. Then I interview physicians already practicing at that hospital and explain the benefits Cogent offers. Those physicians who want to participate then become independent contractors with Cogent, taking care of particular patient populations in that hospital. Because these physicians are already known in their community, they have immediate credibility plus familiarity with the staff, systems, and facilities. All physicians must have inpatient management experience and credentials verified by an organization approved by the National Commission on Quality Assurance.
Once physician contracts are in place, the company then hires and trains the nurses who coordinate clinical care. "We want the physicians free to see patients, not have to track down lab tests, hunt old medical records, or handle the details of discharge planning," Greeno says. "The model is designed to make doctors more efficient, and to put processes and people in place support them."
Nursing Shortage Not a Problem
Cogent appears to be an exception to the current difficulties in finding enough qualified nurses for critical care. "It’s hard to find nurses to do the standard hospital nursing care," Greeno says. "It’s not particularly hard to find nurses to do what we’re asking them to do. Our nurses are basically case managers who help organize the processes around the patient’s hospitalization to make sure that patient moves through the hospital efficiently."
Nurses who contract with Cogent deal with patients families, communicate with specialists, develop action plans, and handle discharge planning. "They make the hospitalist physicians more efficient," Greeno says. "It’s a completely new job description for a nurse, and we’ve not had trouble finding people." The company provides specialized training and performs ongoing mentoring for nurses as well.
As a part of its hospitalist package, Cogent also puts in information systems and operations people. Greeno cites Cogent’s standardized system for communicating with the PCP when the patient leaves the hospital. "All of our hospitalists call an 800 number and dictate a discharge, a note that’s in a database format at the time of discharge," Greeno says. The note is transcribed in Cogent’s corporate offices and goes simultaneously into a Web-enabled database and by fax to the PCP. "That process also drives a follow-up phone call that every patient receives the day following discharge. We gather data on what happens to patients in the hospital at the same time we are improving their care," Greeno says.
Greeno adds that in a good hospitalist program, the PCP has very clear expectations of the hospitalist team for both the patient’s clinical management and the process issues that surround hospitalization. "The only way to do this is for the participating physicians to agree on what the expectations will be, educate everyone as to what the expectations are, then put a system in place that allows tracking to see if they were met. That’s what we’ve done to standardize care across a network of hospitalist physicians," Greeno says.
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