PATH ALONG Model Friend To The Wisconsin Hospitalist

Many Wisconsin hospitals have employed a hospitalist staff to care for the inpatient population.  Hospitalist is a term used for doctors who specialize in the care of patients in the hospital.  A person must be quite ill to be admitted to a hospital.  Hospitalists are challenged to care for higher numbers of people with more complicated conditions.  Hospitalists are trained to better meet the increasing need for more specialized and coordinated care for hospital patients.

The Centers for Medicare and Medicaid (CMS) have enhanced current procedural terminology codes (CPT) to more accurately capture billable services related to a hospital stay.  Today the hospitalist is responsible for collecting the medical data required to insure the hospital is reimbursed for all the good care.  The hospitalist provides over sight to process that results in appropriate electronic medical documentation.  Five important data checks include:

1. Collected information supports the diagnosis for the hospital admission.

2. Collected information gives insight into justification for the treatment and procedures.

3. Collected information provides the reviewer a chronicological sense of the course of care.

4. Collected information lists the diagnostic test results and defines treatment.

5. Collected information demonstrates the promotion of continuity of care among needed provders both inpatient and beyond the hospital door.

Hospitalists are challenged to comprehend  medical necessity and proper setting and tactfully communicate this to both staff and consumer.   In today's hospital services and treatments may be medically necessary but if the services could also be performed in a less intense setting, this leaves the hospital at risk for reduced reimbursement. 

A person must be quite ill to be admitted to a hospital today.  Factors that may result in an inconvenience to a patient or the family do not by themselves justify an inpatient admission.   When a hospitalist is unsure about the patients need for inpatient services and needs additional time for evaluation the person can stay in the hospital but not actually be admitted. 

The patient may be placed in out patient observation (OBS) rather than admitted as inpatient.  There must be medical necessity for the observation services, and the medical necessity must be documented in the persons electronic health record.  The hospital would like the patient to remain in the room for at least 8 hours, which seems to be the magic number to demonstrate a reimbursable stay.  The codes can remburse at a higher amount cause the required discharge (to prevent hospital readmissions) service is included in the payment.

Today's hospitalist participates in discharge planning that promotes continuity of care throughout the community.  Medical necessity and proper setting encourages the hospitalist to develop a referral practice that utilizes an evidence based (PATH ALONG) model capable of reducing hospital readmissions.  Get the patient the medical service through the appropriate level of care delivery to best meet the defined need.  Facilitate access to supportive services designed to keep the person safe upon discharge (PATH ALONG) and reduce hospital readmissions.

PATH ALONG is an original Wisconsin model that connects inpatient providers to community staff who support the patient during health system transitions.  For additional information on PATH ALONG http://www.homecarepath.com/Pages/PRESSRELEASEOriginalWisconsinModelToReduceHospitalReadmissionRates.aspx