Dr Jennifer Sturgill: How Hospitalists as PCPs Have a Global View of Patient Health Care

Jennifer Sturgill, DO, inpatient medical director of population health, Central Ohio Primary Care, co-presented “Value-Based Care: What Is It and Why Should We Care?” at our most recent Institute for Value-Based Medicine® event with the Zangmeister Cancer Center of Columbus, Ohio, on September 14.

Transcript

Can you help to define value-based care?

It is focused on reducing health care waste and, in turn, reducing patient suffering. Waste is defined as both overutilization and underutilization of health care services. As a hospitalist, I’ve worked in a hospital for 20 years, and in that time, when a patient was admitted to the hospital, there was never a question of that's where they need it to be. And that's changed in the last several years. We have great advances in health care where we can treat patients in an outpatient and ambulatory setting. So now it's become part of my process when I'm evaluating a patient, not only creating a differential diagnosis or a plan, but also looking at, is the hospital where they need to be treated or can I safely treat them in another setting? So that's been very exciting.

How does the role of a hospitalist compare with that of a physician who also works outside of the hospital?

Historically, when a patient was admitted to the hospital, their PCP [primary care physician] would care for them; they would stay in the office, see patients, but before or after their office hours, they would go and see a patient and mostly manage them remotely over the phone. For a variety of reasons, that’s changed. PCPs are so busy in the office. One of the areas of health care waste is that patients don't always have access to health care, and so we need the PCPs in the office to be available for these aging patients.

Also, patients are sicker, more chronically ill, complicated these days, and so it's harder to manage them remotely. You really do need a specialist in the hospital who's comfortable managing an acutely ill or decompensating patient. When a patient is in a hospital, they’re at their sickest, their most vulnerable, and they don't necessarily have their PCP there guiding them, giving them advice, and so that's where the hospitalist steps in. I take the role of a PCP. I'm able to talk with a specialist; create a coordinated, comprehensive plan; and take the time and explain it to the patient and the family, where somebody else may not have that ability.

With Central Ohio Primary Care, or COPC, that’s even nicer because I have access to the PCP records. When a patient comes into the hospital, I can pull up their records for years, I can pull up all of the telephone encounters, I can text their PCP or their PCP can call me and we can coordinate care. And that's important because it's able to give me a global view of the patient's health care. I can see they've been declining for the last year, they're losing weight, they're not eating or getting more confused and weaker. And so it helps me to pause and really talk with the patient and the physicians and decide, do we continue treatment? Do we change and focus more on palliative care? And I think that's been very important and gratifying to the patients, because they are comfortable. When I walk in the room, I know their history. I don't have to ask them everything, and that's been reassuring to them.