Page 42 - issue
P. 42
Doctors
included interns, residents, and physician assistants (PAs). He
was able to check on his patients and be kept in the loop.
The hospital no longer provides this infrastructure. “Sinai
does not tell doctors they cannot come in,” said Dr.
Jakobovits. “They are welcome. But for that to work, [commu-
nity doctors] need to have that team of people who will work
with them. The hospital staff members are no longer answer-
able to private doctors. They can communicate, of course,
but there is no official hierarchy. This is tantamount to not
having privileges.”
Without an infrastructure where he would be directing his
patient’s care, he cannot manage a case. If he did visit, he
would have to defer to the hospitalist, who writes the orders
and guides the case. Therefore, Dr. Jakobovits rarely goes to
the hospital any more, other than for social visits. As a mat-
ter of fact, if he did want to officially visit a patient, he would
not be able to bill for his services. Since the patient is under
the care of a hospitalist, that would be considered double
billing.
Dr. Cooper sometimes tries to follow-up with a hospital-
ized patient from afar, and may take phone calls from the
patient’s family during his stay even though he does not get
reimbursed for it. But when he does not follow up, he needs
to spend a lot of extra time after the patient’s discharge to
see what changes are made and whether he thinks the
changes were appropriate to ensure continuity of care.
Communication Matters
According to Dr. Jakobovits, “The degree of communication
with private doctors is less than perfect. There is an opportu-
nity for poor or no communication when a patient enters or
leaves a hospital.” The hospitalist does not know the patient
personally or his past history. A major concern of doctors is
not only that they have been left out of the loop but that it
can take a lot of extra time to get back in the loop. Both Dr.
Jakobovits and Dr. Cooper have reported problems with
receiving discharge summaries. Dr. Jakobovits says,
“Sometimes I get a call, most times a written report, but
sometimes I get nothing.”
Dr. Gunderman writes, “Practically speaking, increasing
the number of physicians involved in a patient’s care creates
opportunities for miscommunication and dis-coordination,
particularly at admission and discharge. Gaps between com-
munity physicians and hospitalists may result in failures to
follow up on test results and treatment recommendations.”
Dr. Cooper says that upon a patient’s discharge, the hos-
pital often expects him to get on the computer and download
pages and pages of notes. Doctors with hospital privileges
can get into the Sinai and Lifebridge computer systems to
read the EMRs (electronic medical records). However, this
takes a long time to go through and is very time consuming
for him or his staff. He used to get an automatic discharge
summary, whether the patient was under his services or
38 u www.wherewhatwhen.com u
included interns, residents, and physician assistants (PAs). He
was able to check on his patients and be kept in the loop.
The hospital no longer provides this infrastructure. “Sinai
does not tell doctors they cannot come in,” said Dr.
Jakobovits. “They are welcome. But for that to work, [commu-
nity doctors] need to have that team of people who will work
with them. The hospital staff members are no longer answer-
able to private doctors. They can communicate, of course,
but there is no official hierarchy. This is tantamount to not
having privileges.”
Without an infrastructure where he would be directing his
patient’s care, he cannot manage a case. If he did visit, he
would have to defer to the hospitalist, who writes the orders
and guides the case. Therefore, Dr. Jakobovits rarely goes to
the hospital any more, other than for social visits. As a mat-
ter of fact, if he did want to officially visit a patient, he would
not be able to bill for his services. Since the patient is under
the care of a hospitalist, that would be considered double
billing.
Dr. Cooper sometimes tries to follow-up with a hospital-
ized patient from afar, and may take phone calls from the
patient’s family during his stay even though he does not get
reimbursed for it. But when he does not follow up, he needs
to spend a lot of extra time after the patient’s discharge to
see what changes are made and whether he thinks the
changes were appropriate to ensure continuity of care.
Communication Matters
According to Dr. Jakobovits, “The degree of communication
with private doctors is less than perfect. There is an opportu-
nity for poor or no communication when a patient enters or
leaves a hospital.” The hospitalist does not know the patient
personally or his past history. A major concern of doctors is
not only that they have been left out of the loop but that it
can take a lot of extra time to get back in the loop. Both Dr.
Jakobovits and Dr. Cooper have reported problems with
receiving discharge summaries. Dr. Jakobovits says,
“Sometimes I get a call, most times a written report, but
sometimes I get nothing.”
Dr. Gunderman writes, “Practically speaking, increasing
the number of physicians involved in a patient’s care creates
opportunities for miscommunication and dis-coordination,
particularly at admission and discharge. Gaps between com-
munity physicians and hospitalists may result in failures to
follow up on test results and treatment recommendations.”
Dr. Cooper says that upon a patient’s discharge, the hos-
pital often expects him to get on the computer and download
pages and pages of notes. Doctors with hospital privileges
can get into the Sinai and Lifebridge computer systems to
read the EMRs (electronic medical records). However, this
takes a long time to go through and is very time consuming
for him or his staff. He used to get an automatic discharge
summary, whether the patient was under his services or
38 u www.wherewhatwhen.com u
