Paying Primary Care Physicians for Hospital Consults

AAFP Makes Persuasive Case to Biggest Private Payers

July 21, 2015 02:06 pm News Staff

Family physicians know their patients, and for that very reason, it's not unusual for a hospitalist or subspecialist physician to ask for a consult with a hospitalized patient's trusted FP as part of that patient's hospital care.

[Senior man in hospital bed with wife by side, talking with physician]

The problem comes with ensuring that family physicians get paid for providing those important services.

To get a conversation flowing, the AAFP recently sent letters to seven of the nation's largest private health insurers asking them to review their payment policies related to the provision of such consulting services.

The July 8 letter, penned by Brennan Cantrell, the AAFP's commercial insurance strategist, went to executives at Aetna Inc., Anthem Inc., Cigna, Humana Inc., Kaiser Permanente, UnitedHealthcare and the Health Care Service Corporation.

"We believe that there is value in paying primary care physicians to see their patients in a hospital setting and that there is some evidence to suggest that doing so has benefits in terms of both improved outcomes and cost savings to the health system," said Cantrell.

He pointed to an article( in the Jan. 22 issue of the New England Journal of Medicine in which researchers explored how to bridge the divide among the various physicians who collaborate to provide care to patients in the hospital.

Cantrell pointed out that some hospitals and insurance companies exclude primary care physicians from admitting their own patients, thereby "forcing patients to be admitted by hospitalists who are likely unware of a patient's history."

And all too often, poor communication between the hospital, the hospitalist and the patient's primary care physician results in unnecessary testing, use of unwarranted drugs that have proven ineffective for the patient in the past and overall poorer patient outcomes.

Bottom line: Hospitalized patients do better when their primary care physicians are part of the care team.

"Unnecessary testing, numerous specialty consultations and prolonged hospitalizations, in turn, generally lead to increased costs of hospitalizations," the AAFP pointed out.

Furthermore, when a hospitalist asks a primary care physician to consult on a patient's care, the primary care physician's service likely is downplayed as "medically unnecessary concurrent care," especially when the hospitalist and the primary care physician belong to the same specialty, said the AAFP.

Simply put, many private payers do not recognize the value that a patient's own primary care physician brings to the hospital situation and, therefore, are not willing to pay for those services.

The AAFP asked the insurance companies to "review and revise as necessary" their coverage and payment policies to address situations where primary care physician are called on to provide important and cost-saving inpatient consulting services to their patients.

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