While hospitalists make up the fastest growing subspecialty positions in U.S. hospitals, issues with continuity of care across the spectrum is leading the American Academy of Family Physicians to envision a new executive position to fill the gaps.
A proposal written by two physicians published in the Annals of Family Medicine suggests creating a "executive-level physician" charged with creating, implementing and managing primary care connections across the hospital system. The role would be known as chief primary care medical officer, and the authors proposed that the role be filled by a primary care physician who would work 25 percent of the time in an outpatient clinic setting, another 25 percent as a hospital clinician, and the remaining 50 percent in administration at the hospital leadership level.
Some of the methods a CPCMO might employ would include keeping inpatient and outpatient care teams connected, increasing communication and growing primary care's role in acute-care settings.
Funding for the position, the authors said, could come from savings realized through greater value. Meanwhile, the success of the role could be measured through metrics such as reduced readmissions and shortened hospital stays. They proposed that the role would help cut costs and improve care by addressing the gaps in the system that often trigger readmission.
"Under the current system, for example, details about a hospital visit might not be sent to a patient's primary care physician, or a patient might not even have a primary care physician," the authors said.
Consider one scenario: A patient recovering from a hip fracture has their discharge to a skilled nursing facility is prolonged because her primary care physician recently retired.
"A CPCMO would connect the patient with a primary care physician, supervise the referral to the skilled nursing facility and confirm that the patient schedules an initial primary care appointment," authors said.