Pediatric hospitalist comanagement of surgical patients: Structural, quality, and financial considerations

Abstract

Comanagement of surgical patients is occurring more commonly among adult and pediatric patients. These systems of care can vary according to institution type, comanagement structure, and type of patient. Comanagement can impact quality, safety, and costs of care. We review these implications for pediatric surgical patients. Journal of Hospital Medicine 2014;9:737–742. © 2014 Society of Hospital Medicine

Pediatric Hospitalist Comanagement Survey of Clinical and Billing Practices

“…The financial viability of comanagement and pediatric hospital medicine program sustainability will be impacted by sound billing practice, which makes knowledge about billing an imperative. 5 Also, by not having clear guidelines and education for billing for comanagement, hospitalists could be putting themselves and their hospitals at risk for audits by payers and could inadvertently double bill, under bill, and/or increase costs for self-pay patients.…”

“…1 Comanagement services vary by hospital setting and availability of pediatric specialists and range from managing nonsurgical comorbidities to providing nearly all on-site preoperative and postoperative management. 5 There is emerging literature in which researchers suggest improved clinical outcomes for pediatric surgical patients who are comanaged by pediatric hospitalists. [6][7][8][9] The growth of comanagement is catalyzed by multiple factors, including the medical complexity of pediatric patients with multiple comorbidities, the need to provide bedside care and communication in cases in which surgeons may be off-site, and the need to provide pediatric expertise when surgeons or facilities may not have pediatric-specific training or expertise.…”

“…The Society of Hospital Medicine supports a written service agreement between hospitalists and surgeons to address issues, including which team writes orders and manages which aspects of care, and billing and reimbursement issues. 5 However, prevalence of written agreements and their impact on care has not been studied. In addition, because comanagement reimbursement varies from state to state for Medicaid and private insurance as well as by type of comanagement (sharing of global surgical fee, consultant care, comanagement), knowledge of such state and institutional guidelines is important for how pediatric hospitalists bill for their services.…”

Physician’s Role in Coordinating Care of Hospitalized Children

“…When comanagement is in effect, physicians need to respect protocols regarding the scope of their involvement and communicate regularly with the comanagers. 13,14 These protocols are institution specific and may even vary between services, but define the expected role of each service in patient care. When necessary, this communication should be verbal and not solely through the chart.…”

Hospitalists and Intensivists: “Just Like Peas and Carrots…”

“…In many children's hospitals across the country, greater numbers of children are being cared for by the hospitalists, rather than their primary care physician. In addition, there has been a growing trend for surgical patients to be comanaged by surgical hospitalists [6].…”