Changing primary care physician while in hospital question?

[Orchidflower]

I am the first to admit that I have absolutely no experience with Medicare or hospitals or physicians, so can someone please help me with this one:

My mother is in the hospital on an emergency basis again. The G.P. physician who we were using forgot to renew her meds during her first office visit, and she ended up back in the hospital with symptoms from it; and he has visited her probably 2X only during 3 visits (visit #1 3 weeks, visit #2 1 week and 2 weeks so far for this 3rd time), so that isn't much. I am less than enthralled with his service, and want him off the case which I did today by declaring the in-hospital Dr. as her physician for the duration of the stay.
I want to change to an Internal Medicine physician. I called one that was recommended to me, and his nurse relayed that he would not see her in the hospital as he was "afraid Medicare would not pay him, and Medicare would wonder why she is switching physicians in the middle of her care."
She is fully insured with Cigna insurance, which picks up the balance of what Medicare part A & B does not.
According to gossip from some nurses that spoke with the admin. people, it seems to NOT be true that Medicare will not pay the Internal Medical Dr. if he comes in the middle of her visit and exams her (after dropping the original G.P. from the case). The nurses are whispering among themselves, and seem so flabbergasted as I am that he won't come to the hospital and take over the case.
Can someone give me a reason he won't take her case that makes sense? Nobody seems to be able to make sense of his reasoning for not wanting to take on this case and examine her in the hospital, and it appears his "not getting his pay from Medicare" is strictly an excuse that doesn't seem like a reality.

Anyone understand that Internal Medicine physician's thinking as to why he doesn't want to take this case over?
Anyone know any reason Medicare would not pay the physician that comes to the hospital and takes the case over during the stay (in other words, do they not pay if you switch physicians in the middle of a hospital stay)? The higher ups that deal with Medicare at the hospital seem to think the whole thing is baffling and does not make sense to any of us.

 

[OAG]

Profession Courtesy? CYA (actually someone Else's)? I am sure neither of these "make sense" but, they may be the reality of the situation. Maybe Rich in Tampa will respond as I am sure he has a lot more insight.

 

[Moemg]

I would think he doesn't want to offend DR. #1. I would tell the in house Physician ( not really sure who that is ) that I want an internal medicine consult .

 

[A854321]

Medicare probably will deny payment of the internist unless a consult is specifically requested by the hospitalist. If the patient has a hospitalist caring for her, MC will not allow an internist's fees unless there is a very specific condition that can be documented.

The internist may not want to add additional Medicare patients to his/her practice. The internist may not want the responsibility of hospital patients.

Three weeks in the hospital is a long long time. I really doubt her problem was caused by an omitted prescription.

 

[Rich_by_the_Bay]

... he has visited her probably 2X only during 3 visits (visit #1 3 weeks, visit #2 1 week and 2 weeks so far for this 3rd time), so that isn't much. ...
I want to change to an Internal Medicine physician. I called one that was recommended to me, and his nurse relayed that he would not see her in the hospital as he was "afraid Medicare would not pay him, and Medicare would wonder why she is switching physicians in the middle of her care."
She is fully insured with Cigna insurance, which picks up the balance of what Medicare part A & B does not.
According to gossip from some nurses that spoke with the admin. people, it seems to NOT be true that Medicare will not pay the Internal Medical Dr. if he comes in the middle of her visit and exams her (after dropping the original G.P. from the case). The nurses are whispering among themselves, and seem so flabbergasted as I am that he won't come to the hospital and take over the case.
Can someone give me a reason he won't take her case that makes sense? Nobody seems to be able to make sense of his reasoning for not wanting to take on this case and examine her in the hospital, and it appears his "not getting his pay from Medicare" is strictly an excuse that doesn't seem like a reality.

Complicated and I'm a little confused about the circumstances, but maybe this will help:

1. For every hospital admission there is an "attending physician" who runs the show. That physician is expected to see the patient at least daily. Since the GP seems to be stopping in sporadically at best, I suspect he or she is not the attending physician. Maybe it's a specialist or a hospitalist.

2. With the exception of when I have special knowledge or expertise to offer, I am reluctant to take over from another doctor under these circumstances. Has nothing to do with Medicare or money (though that gets complicated). First, it breaks continuity and is difficult to come up to speed without lots and lots of time. Second, it can get tricky between colleagues (which is why the request is best generated from Doctor A).

3. Most awkward, is the fact that these situations are usually associated by frustrated patients and families who harbor hostility and anger - perhaps very justifiably. If the family has a reputation as "difficult" many doctors will shy away. Not saying it's right, but such is human nature. For the record, I am not referring to Orchid's situation at all, just a general observation.

What do do? I would find out who the attending is. See out the remainder of this hospitalization under that attending doctor, and communicate that you no longer desire the services of the GP; if the GP stops by, so be it. Then I would set up a new patient appt with the internist for shortly after discharge and start from scratch then.

Just curious, why didn't Mom call his office for refills after she realized she was running low?

 

[Orchidflower]

1. After hospital stay #1, G.P. did not renew the meds after the 15 days ran out, but had us visit on day 16. He never mentioned she needed to continue taking the meds and I didn't know to ask (lesson: never assume the physician knows what he is doing). I just kept giving her the meds she was on before she went to hospital visit #1, and, in fact, mentioned this to the visiting nurses. Nobody questioned anything including me not questioning that G.P.
2. If the G.P. had renewed the meds after visit #1, she would have been okay and not had visit #2. It was her spacey behavior that alarmed one of the visiting nurses, and caused her to call the G.P. who said to rush her to the hospital, which I did. Do I hold the G.P. at fault? You bet I do.
3. I took the G.P. off the case, she was assigned to the hospital physician who examined her meds and took some history down recently. I feel as if she is getting better service than when we used the G.P. who visited, at most, 3 times in all those weeks of staying at the hospital (say, 5-6 weeks). Boo hiss!
4. The Internal Medicine Drs.' nurse did say that he was afraid Medicare would not pay if he came into the hospital in the middle of a case, so I get your messages loud and clear. Go figure Medicare, but she will be visiting him when she gets out. It was hard to wrap my head around their rules, but I get it now.

 

[Meadbh]

Orchid, get a look at Mom's chart (or get Mom to ask) and find out who is the MRP (Most Responsible Physician).

Next, check out the website of the Institute for Healthcare Improvement at http://www.ihi.org/IHI/Programs/Campaign/Campaign.htm?TabId=1

Note that

Prevent Adverse Drug Events (ADEs)…by implementing medication reconciliation

has been a key initiative of the 100,000 lives campaign, which started several years ago. The medication snafu you describe would not have happened if MedRec had been properly done at each stage in your Mom's care.

I suggest you meet with the MRP and point out your concerns. If you are having trouble, call the office of the Patient Advocate or Patient Representative at the hospital. I would expect that any healthcare institution which does not have its head in the sand should do its best to ensure that this error does not occur again. As always, you are your Mom's best advocate.

If you get nowhere, and feel the physician is negligent, your next step would be to call the State Licencing Board and complain.

 

[Orchidflower]

Thanks, Meadbh. I have told the hospital staff and the hospital physician about it, so it must be recorded somewhere. They all know it, and really encouraged me to fire that G.P., which I did. The hospital physician is doing a fine job so far, too.
No kidding I am my mother's best advocate. She is a few days from 90, has some dementia, walks poorly and...well, is just plain really old now. If she didn't have me there to watch out for her even on little things (like the nurses forgetting to put the call button within her reach instead of dangling on the floor where she can't get at it), she would be up the old proverbial creek without a paddle.
I pity those oldsters who really have nobody watching over them. And my heart goes out to them now that I see how difficult life can be for them.