Hospital medicine physicians may provide advantages in inpatient care compared with traditional ambulatory‐based primary care physicians (PCPs) because of hospitalists' greater focus and experience in inpatient care. However, hospitalists have disadvantages in inpatient care compared with traditional PCPs because PCPs generally have a more established relationship with the patient. Our prior research has shown that the growing use of hospitalists is partially explained by the decreasing inpatient volume of PCPs. We hypothesized that physicians who focus their practices on patients at increased risk of hospitalization would have sufficient inpatient volume to be able to provide both ambulatory and hospital care for these patients, combining the advantages of both the traditional PCP and hospitalist models. We call such physicians comprehensive care physicians (CCPs) or primary care hospitalists (PCHs).
We report progress on a $6.1 million grant from the Center for Medicare and Medicaid Innovation (CMMI) to develop and test the effects of the CCP/PCH model on outcomes and costs for Medicare patients at increased risk of hospitalization.
We have hired 6 CCPs who each provide inpatient care for their own patients each morning most weekdays of the year and have clinic most afternoons. Each CCP covers the inpatient service on afternoons and weekends about 2 months per year. A team of APNs, social workers, and other professionals individualized to the patient's needs works with the CCPs across the inpatient and outpatient settings. Patients are identified as at increased risk of hospitalization based on having at least 1 prior hospitalization in the past year. Each CCP is being assigned a panel of about 250 patients versus about 2500 for a typical PCP. The CCPs are developing health IT interventions, educational programs for providers and patients, and other innovations in care processes to support the practice. Continuous quality improvement methods are being used to refine the model. A rigorous evaluation of effects on outcomes and costs is being performed that randomizes 2000 patients to either CCP care or to care from an ambulatory‐based PCP and a hospitalist. The initial subjects enrolled have substantial limitations in health status and average hospital costs that average > $50,000 per year in the year prior to admission, suggesting there is potential for large improvements in outcomes and costs if the program is successful. Collaboration with other Chicago‐area medical centers is using Medicare data to develop prospective payment models for use by accountable care organizations and to assess the potential for dissemination of the model.
The CCP/PCH model seems likely to offer many of the best elements of both the traditional PCP model and the hospital model and appears possible to be implemented successfully. The ongoing CMMI evaluation will provide data on effects on outcomes and costs.
To cite this abstract:Meltzer D, Ruhnke G, Whelan C, Arora V, Paesch E, Tangri S, Vinci L, Press V, Reddy S, Puri T, Kurd S, Coltri A, Zhang J, Flores A, Cardin T, Chivu A, Schram A, Best T, Brieze C, Shah R, Williams M, Hinami K, Gallanter W, Silverstein J, Hohmann S. Comprehensive Care Physician/primary Care Hospitalist Cmmi Innovation Challenge Award. Abstract published at Hospital Medicine 2013, May 16-19, National Harbor, Md. Abstract 515. Journal of Hospital Medicine. 2013; 8 (suppl 2). https://www.shmabstracts.com/abstract/comprehensive-care-physicianprimary-care-hospitalist-cmmi-innovation-challenge-award/. Accessed May 24, 2019.