How Your Colleagues Ease the Hassle of Nursing Home Care
Grandinetti, Deborah, Medical Economics
What makes caring for nursing home patients easier? According to your colleagues, the most useful strategy is limiting yourself to a few facilities. That's the answer we got from more than 60 percent of the physicians who responded to a Medical Economics poll asking, "Where do you stand on nursing home care?"
Next in order of helpfulness were scheduling visits in advance, so that patients and staff are ready; establishing treatment protocols; and assigning some visits to nurse practitioners or physician assistants.
The majority of our respondents do see nursing home patients, and a few even said they genuinely enjoy it. One went so far as to claim this is his "favorite part of practice" Another, who no longer does hospital work, said that nursing home care "keeps my skills at a higher level than I can achieve in the outpatient setting." Yet another couldn't understand why so many physicians consider it a big deal to drive "a mile to see a patient they've cared for for 15 years.
But physicians also told us about the problems. At the top of the list: low reimbursement, followed by paperwork hassles. Said one doctor: "I usually get $18 to treat patents with congestive heart failure or chronic obstructive pulmonary disease.' Another complained that he makes less per hour than a home health nurse.
Low pay isn't a problem for all physicians, however. One reported that "nursing home revenue has been a good source of income for our group. There's little overhead, and reimbursements have improved in recent years."
Another often-cited annoyance: frequent phone calls. One respondent complained of getting four calls per patient per month. Another simply labeled the calls "excessive," underlining the word three times.
But the unnecessary calls, and even the paperwork, can be kept to a minimum, according to Tacoma, WA, family physician Richard E. Waltman, author of the article that prompted our poll. He's pictured above and on page 16. (See "Do yourself a favor-take care of nursing home patients," Feb. 8, 1999, available at www.memag.com.) One of Waltman's strategies is to have his office staff write down all nonemergency questions or requests. Then he reviews them all at once, gives his answers, and has a staffer call back with the information.
Waltman also makes it clear to each facility that he doesn't want to be called at home on nights or weekends on nonemergency matters. And at nursing homes where he's confident in the facility and the staff, he tells the nurses they can write routine orders per his guidelines, and he'll support them. …