Role of the PCP in 30-Day Readmission Reduction
PCPs, otherwise known as general practitioners, or in times past referred to as the family doctor, are central to the health care delivery for most patients. These doctors provide regular checkups and preventative health care as well as referrals to specialists and the utilization of acute health care facilities when needed.
It is sometimes pointed out that the best way to reduce readmissions is to prevent admissions in the first place. Routine physicals, HbAlC levels, Blood pressure monitoring, EKGs, cholesterol monitoring, education, and lifestyle counseling are all essential elements of the PCP’s mission to prevent sickness. These routine, standard efforts should help prevent onset of disease or determine need for early intervention. The frequency and nature of PCP visits will vary according to each patient’s needs and condition. A healthy patient with minimal risks may need no more than an annual physical, while the COPD or CHF patient may require a visit every month. Patients with complex chronic diseases must be adequately monitored. Failure to do so increases the burden placed on acute care facilities and further involves specialty services.
Many specialists are available for referral from the PCP. Often, they are an adjunct to the preventative health care mission. A gastroenterologist performs routine colonoscopies, for example, or a cardiologist might test and evaluate a patient reporting chest pain. Specialists also play a role in the world of acute care, either with elective procedures, such as hip or knee replacement, or with emergency intervention when a patient is stricken with appendicitis or cholecystitis. Most often, these interventions involve a trip to the Emergency Department. Patients with good monitoring, preventative care, healthy lifestyles, and early interventions are less likely to be the cause of a readmission.
I remember doing an analysis of each PCP’s 30-day readmission rate at a hospital I worked at. What amazed me was the marked interest physicians had in their particular rate. Physicians are a highly competitive group of individuals. Providing them valid, accurate data on their performance is extremely important in getting changes in behavior. An example is a follow-up visit for a PCP’s patient who was in the hospital for 4 or 5 days. Trying to fit this patient into a packed schedule for a 15-min visit will do little to impact a readmission. Patients may have had multiple medication changes or other identified issues that require more investigative follow-up than a 15 min how are you doing kind of visit.