JAMA released a theme issue today, and the spotlight shines on readmissions. I will weigh in on the findings shortly as the issue contains a good deal of material. However, our own Mark Williams writes the featured commentary and I will let him cue the release:
The findings from these 3 reports also illustrate what experienced hospitalists, emergency physicians, and perhaps other physicians clearly recognize—the increasing fragmentation of patient care and consequent inappropriate use. Lack of coordinated care transitions has affected patients in the United States for half a century,12 but individual patients now see an increasing number of physicians, increasing the possibility of medical error, duplication of services, reduced quality, and increased cost. This has likely been driven, at least in part, by the marked expansion in the number of subspecialists, who now outnumber primary care physicians by about 2 to 1.13 Medicare beneficiaries and their families must navigate seeing a median of 2 primary care physicians and 5 specialists during a 2-year period, and about one-third change their assigned physician from one year to another.14 This fragmentation escalates as patients approach the end of their lives with numerous physicians involved in a patient’s care. A study of some of the “best” hospitals in the United States showed that 17% to 59% of patients saw 10 or more physicians during their last 6 months of life and averaged almost a month (27 days) in the hospital.15
Time to dig in….
Bradley Flansbaum, DO, MPH, MHM works for Geisinger Health System in Danville, PA in both the divisions of hospital medicine and population health. He began working as a hospitalist in 1996, at the inception of the hospital medicine movement. He is a founding member of the Society of Hospital Medicine and served as a board member and officer. He speaks nationally in promoting hospital medicine and has presented at many statewide meetings and conferences. He is also actively involved in house staff education.
Currently, he serves on the SHM Public Policy Committee and has an interest in payment policy, healthcare market competition, health disparities, cost-effectiveness analysis, and pain and palliative care. He is SHM’s delegate for the AMA House of Delegates.
Dr. Flansbaum received his undergraduate degree from Union College in Schenectady, NY and attended medical school at the New York College of Osteopathic Medicine. He completed his residency and chief residency in Internal Medicine at Long Island Jewish Medical Center in New York. He received his M.P.H. in Health Policy and Management at Columbia University.
He is a political junky, and loves to cook, stay fit, read non-fiction, listen to many genres of music, and is a resident of Danville, PA.