American College of Physicians: Internal Medicine — Doctors for Adults ®

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Patients, not Medicare HMOs, should choose hospitalists

From the April 2000 ACP-ASIM Observer, copyright 2000 by the American College of Physicians-American Society of Internal Medicine.

Medicare+Choice health plans should be allowed to use hospitalists only when patients and their primary care physicians agree to the practice in writing, ACP-ASIM told HCFA's Center for Health Plans and Providers.

In a Feb. 9 letter, the College acknowledged that hospitalists can play important roles in managing inpatient care. But Cecil B. Wilson, FACP, chair of ACP-ASIM's Medical Services Committee, said that hospitalists should be used only when patients have signed documentation indicating that they have been informed of the consequences of delegating their care to a hospitalist. The College wants HCFA to require that Medicare+Choice plans issue detailed explanations to patients describing how hospitalists will handle their care, and it wants these plans to explain that when patients choose a hospitalist, their primary care physicians will not be actively involved in their care.

The letter from Dr. Wilson also said that in the case of elective admissions, enrollees should be able to choose between their primary care physician and the Medicare plan's hospitalist to both decide on the necessity of admission and oversee treatment. In the case of emergency admissions, the College said, patients should be able to choose between their primary care physician or a hospitalist to oversee their care until they are discharged.

ACP-ASIM opposes language in a draft letter from HCFA saying that a primary goal of hospitalist programs "is to reduce the number of inpatient days" to achieve "cost savings from reduced hospital stays." The letter from Dr. Wilson said that HCFA should instead identify improving quality of care as the primary goal of using hospitalists. The National Association of Inpatient Physicians sent a similar letter to HCFA opposing mandatory hospitalist programs.

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