My family and I moved from Alaska in 1998 to Utah for only one reason — to be closer to the family who needed our help. It was a tough decision which you can appreciate if you have ever spent time in Alaska. You can leave, but a piece of your heart will always reside there. My grandfather, Delbert, had Alzheimer’s disease and needed extra care so we packed up and left. That experience contributed to my passion for caring for those who can’t help themselves.
At that time medicine was different. As a family physician I cared for my patients from birth to death. I delivered the babies, cared for the children and their parents and grandparents. That care was delivered in my office, at the hospital including the ICU, and in the nursing home. I knew my patients well and what their needs were. When I admitted them to the hospital I saw them there. When I discharged them I knew what I had done for them there. The same applied to nursing-home care. Care was directed by me with specialists helping when needed. It was demanding work and meant my days were long and often my nights were longer. I loved it.
About 12 years ago a change occurred. Hospitalists were hired by hospitals to “simplify” caring for hospitalized patients as governmental regulations were instituted that affected how hospitals were reimbursed and held accountable for outcomes. They wanted physicians that they controlled to be in charge so that those regulatory requirements could be more easily achieved. To the physicians who were used to doing it all, it sounded like a blessed idea — No more middle of the night calls to go to the ER to evaluate and admit patients, no more all night stints in the ICU caring for a very sick patient, no more calls and visits to the hospital in the middle of clinic to care for a critically ill patient. I could now stay up after 9 pm as the fear of losing sleep to the middle of the night ER or medical floor call was gone.
It was a nice change for me and my primary care colleagues, but was not without its consequences to patients. What ensued was a lack of continuity in care. My patients could not understand why I didn’t oversee their hospital care any more. They could have surgery or a life threatening illness and hospitalization without me knowing about it until they showed up for follow up a couple of weeks later. Often I was clueless to help them as I had no information about what had occurred during their illness. I did notice that more studies were ordered by the treating hospital professionals because they didn’t know my patients, their social situation or past medical histories.
The rise of electronic medical records that couldn’t communicate with each other also came into being at about the same time which complicated the sharing of patient information even more. Regulations that were instituted with the aim of improving patient care and cutting costs, unfortunately, resulted in the opposite.
We now are at a critical juncture as we have a health system in which patients in the post-hospital setting are falling in the cracks. Those cracks include: medication errors, difficulty getting an appointment with their primary care providers in a timely manner, being handed off to home health, skilled Nursing facilities and assisted living facilities in which there is no guarantee of receiving quality care, and often being “too sick” or disabled to easily access the medical system. Primary care physicians are now chronic care clinic physicians which makes it difficult for them to engage in non-clinic based care and acute care issues.
Health systems are attempting to solve these problems using administrative programs to follow patients and encourage patients to seek care when appropriate. While these can yield some good results it doesn’t solve the disruption of the patient-physician relationship. It only puts more people and processes between the patient and physician further disrupting that relationship.
Bridge Medical Group’s vision of the solution to this problem is vastly different. We are hiring and training physicians and physician extenders to re-engage with patients and their families in the post-hospital setting. We coordinate patient care physician-to-physician solving problems efficiently. We have specialists in Rehabilitation medicine, Family medicine, Geriatrics, Palliative care, Hospice and Pharmacy who are knowledgeable in the intricacies of facility and post-hospital care. We have Nurse practitioners and physicians who see patients, who find it difficult to leave their homes, in their homes. We collaborate with community home health and hospice companies, skilled nursing facilities and assisted living facilities to improve the care they provide their patients. AS we like to say, “we are connecting the dots”.
Our goal is to improve the care our elders are receiving after hospitalization by revitalizing the patient-physician relationship and increasing the quality of care provided in our communities through physician oversight.
If you are interested in learning more about what we do and how you can be a part of it contact us. Let us know what inspires you to improve medical care. Has there been a “Delbert” in your life? Together, I know we can make our visions reality.
Author: R. Mark Firth, MD, LePont’s Chief Medical Officer for Education, is board certified in
Family Medicine and Hospice and Palliative Medicine.