Pascal Crosley, DO, a Vice President of Business Development with Vituity posed this question to me about a year ago.
At the time, I was Hospitalist Medical Director at Saint Agnes Hospital in Baltimore. I was intrigued but also had some reservations. Would I enjoy being the only physician on my team? Did I have the right skills to care for seriously ill patients outside the hospital? Most importantly, what on earth would my wife say?
In the end, I took a leap of faith and accepted — and I'm so glad I did. Practicing post-acute medicine has been an incredibly rewarding experience. In this post, I'll share what it takes and how to decide if it might be a good fit for you.
Why Post-Acute Medicine?
When you consider the current healthcare landscape, it's no surprise that CEP is expanding into the post-acute arena. New regulations are forcing skilled nursing facilities (SNFs), long-term acute care facilities (LTACs), and rehabilitation hospitals to up their quality game — and they're looking for help.
In a way, post-acute medicine is where hospital medicine was 15 to 20 years ago. Until recently, primary care doctors rounded on their post-acute facility patients before and after office hours. They weren't immediately available to respond to emergencies, perform discharges, fill out paperwork, and attend family meetings. And they rarely had the bandwidth to lead quality initiatives that could improve facility-wide efficiency and outcomes.
Just as hospitals have embraced hospitalists, post-acute facilities are realizing that they need dedicated providers to help them succeed in the era of value-based care. Medicare's post-acute care spending doubled to $59.4 billion between 2001 and 2013. As a result, a growing percentage of post-acute reimbursement is now at-risk and tied to quality metrics.
Dedicated providers can help post-acute facilities avoid reimbursement penalties by reducing "bounce back" to the hospital. When patients do need to be readmitted, improved coordination between the hospitalist and post-acute physician can reduce average length of stay (ALOS) and improve transitions of care.
Bundled payment pilot programs are also increasing the value of post-acute providers. Under these schemes, hospitals receive a lump sum payment for each episode of care (for example, a hip replacement or coronary bypass) covering the patient's care for up to 90 days post-discharge.
Bundled payments incentivize the hospital to ensure that the patient is discharged to the right level of care. This requires careful planning and strong partnerships with post-acute providers. Experts estimate that improved integration between acute and post-acute facilities could reduce treatment costs 10 to 20 percent.
So there's a real need for talent in the field of post-acute medicine. But would it be the right choice for me?
The Leap of Faith
A little about me: when I joined CEP, I'd been a hospitalist for 12 years and Medical Director of our 20-physician group for four years. I was also halfway through my MBA.
My default plan had always been to climb the ranks and become a hospital executive. However, I was beginning to realize what a long road that would be.
Dr. Crosley proposed that I join Vituity as both Medical Director of the ventilator unit at Futurecare Irvington and as a practice-wide Quality Director. In this role, I'd have the chance to develop programs and best practices that would eventually be rolled out at future CEP post-acute sites.
It seemed like a dream opportunity. But it was also a little daunting, especially since I'd never worked in post-acute medicine.
And as I mentioned, I had some worries about the specialty itself. I was used to being surrounded by my hospitalist colleagues — not to mention the specialists and resources of a full-service teaching hospital. Would I be able to manage 50 ventilator patients under those conditions?
Also, was post-acute medicine really the best fit? Ventilator patients are a very chronic, very complicated population. Would it be difficult to work with that population exclusively? Would someone with more specialized background — a geriatrician, for example — be a better choice?
Finally, I worried about leaving the security of hospital employment. Working as a Partner in an independent practice seemed risky. CEP had done great things for the Saint Agnes ED, and they seemed like an engaged, highly motivated bunch. But what if the company had a bad year? How would I explain it to my family if I went broke or was let go?
So there were a lot of reasons to tell Dr. Crosley no thank you. But I took a leap of faith, one that I will look back on as a pivotal point in my career. And fortunately that leap paid off.
A Day in the Life
A year later, I can say with confidence that post-acute medicine is challenging, fun, and fulfilling.
In many respects, being a hospitalist was actually great preparation. As in the hospital, I'm part of a multidisciplinary care team that includes administrators, nurses, therapists, and social workers. We care for patients with complex conditions and work with families to help them stay involved in their loved ones' care.
And my fears about flying solo were largely unfounded. Futurecare receives many patients from Saint Agnes, so I'm in frequent contact with my Vituity ED Partners and former hospitalist colleagues.
I attend monthly ED meetings, and the ED team has visited our ventilator unit. By working together, we can often get patients worked up and discharged from the ED without an admission.
- Case Study: CEP America's Population Health Strategy Boosts Savings For a Fixed-Budget Hospital [PDF]
The job does require some new skills. They're generally things an experienced hospitalist can master in a few months.
As I expected, one of the biggest adjustments I had to make was operating without a physician colleague to back me up. For the first few months, when a patient had an infection or exacerbation, I'd worry over whether to hold them or transfer them to the ED. I didn't want to jump the gun, but nor did I want to delay needed care.
Thankfully, our incredible nursing team was there to guide me. They knew the patients well and had seen them through many ups and downs. They let me know when I was being a worrywart and when we were pushing our luck.
It's also been an adjustment working with very ill patients, many of who are approaching the end of life. In the past year, I've only discharged about six people home. On a positive note, my presence allows us to manage patients more effectively, respond to emergent needs, and avoid stressful hospital transfers. When appropriate, I can talk to patients and families about end-of-life options — a skill I honed as a hospitalist.
Post-acute care also has lifestyle benefits. My days working 12-hour shifts are over. I leave Futurecare at four, pick my son up from school, and spend the evening with my family. I usually pop in to see the patients on Saturday morning, then spend the rest of the weekend golfing or on family outings.
Finally, leaving hospital employment to work for CEP has really accelerated my path to leadership. Here, seniority and educational pedigree matter far less than your work ethic, talent, and accomplishments.
I've had opportunities to get involved with a number of initiatives from education to telehealth. And I've enjoyed great support from our practice management consultants, data team, and IT group. I'm confident that my job is secure, my contributions matter, and that I'll have many opportunities to advance and grow.
But don't just take my word for it. Here's Hospitalist Partner Anna Gelberg, MD, talking about why she chose Vituity and plans to make a career here:
How About You?
Does the above sound good to you? Well, CEP is looking for talented post-acute providers. It's a great choice for those with a few years of hospital medicine experience who are looking for a new challenge.
To learn more about career opportunities in post-acute medicine, call visit cepamerica.com or call 800-842-2619.
Acute care providers, what advice do you have about entering this field? Comment below to let us know!