Thursday, October 27, 2011

Family Medicine: What Happened?

Something happened.  Medicare patients are now admitted to hospitals by strangers, discharged in 2.2, or so, days and readmitted 20-30% of the time within 30 days.  Both admissions are paid by Medicare.  Sounds like a good business model if you like to maximize profits.

We family doctors used to admit them ourselves if they needed it.  They might be in for four days, but not readmitted.  We wrote or gave the admitting orders for hospitalization and orders every day in the hospital.  At the time of discharge, we wrote the list of discharge medications and the prescriptions for any new ones.  The patient saw us in our office in 3-7 days to clarify their progress.  The admitting history and physical was our work, as was the discharge summary.

What happened?  We left private practice, opting for employment with reduced hours and responsibilities.  Hospitalists were invented as a consequence, to have someone to do the inpatient work in hospitals.  Five or six new processes are used to replace what we used to do, as the system strives for the quality we used to have.

Replacing Family Physicians has been very profitable for many.  Now it's going to get expensive, as the government initiates penalties for re-admission within 30 days.  Profit is the quest of the Medical Industrial Complex, but America is paying dearly with, by some accounts, 195,000 deaths yearly generated by medical errors.  What happened?

Is it fixable?

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