Many times complex patients bounce between multiple hospital stays and then see multiple specialists in the outpatient setting before finally getting in to see their primary care internist in the office. In most cases the primary care provider knows the patient better than the hospitalists tasked with providing the inpatient care.
As an Internist that cared for my patient’s in both the inpatient and outpatient setting in the years before hospitalists took over inpatient care, I would like to make the case for returning to a model where the complex patient can be cared for by a group of Internists that provide both inpatient and outpatient care. This model would be for complex patients not the general admission of less complicated patients.
In my own practice I see patients that have conflicting recommendations after discharge and I have to spend an inordinate amount of time and effort to sort out the issues. This often leaves the patient and family frustrated and anxious.
I would suggest that in large group practices a small core of Internists could care for the complex patient in both the inpatient and outpatient setting. This would probably require financial support from the group or hospital because it is doubtful this model would provide enough RVU production to adequately reimburse the physicians.