tag:blogger.com,1999:blog-13495125.post5157219083151665296..comments2009-10-23T22:12:32.298-05:00Drew Rosielle MDhttp://www.blogger.com/profile/04345646798042773615drosielle@gmail.comBlogger3125tag:blogger.com,1999:blog-13495125.post-75315759967202968492009-10-23T22:12:32.298-05:002009-10-23T22:12:32.298-05:00John, <br /><br />Certainly my hope is that palliative care principles will disseminate amongst all medical specialties (eg being able to determine and honor a patient&#39;s preference for location of care from the time of ED evaluation when possible). As I said, I see the world through the lens of a palliative care physician, and a geriatrician/family med doc/general internist/NP/PA could fit into the role as well. Who knows what our health care system will look like in 2022? Do you think that 20-30 years ago primary care physicians would have predicted the hospitalist movement?<br /><br />There would be many logistics to be worked out in order for this to become commonplace, and as Drew said, reimbursement schemes would have to change dramatically. <br /><br />Let&#39;s just say that you can see more patients in the hospital in four hours than I can.<br /><br />Thanks for your comments.<br /><br />LyleLyle Fettig, MDhttp://www.blogger.com/profile/00710388898582754749noreply@blogger.comtag:blogger.com,1999:blog-13495125.post-39305721875514229072009-10-23T18:23:46.428-05:002009-10-23T18:23:46.428-05:00Hi John. Given that these are hospital at home patients, and not &#39;routine&#39; home visits (e.g. for patients receiving skilled nursing visits, or hospice care, etc.) I think there is a heightened role for physicians here compared to how most of us conceive of as home care. Your point is well taken though, and I don&#39;t know either how this would work in the US with our current reimbursement system, etc. NPs, PAs, etc would certainly play a vital role. <br /><br />I&#39;m curious about your statement of the principles of PC &#39;trickling down&#39; to primary care specialists (ignoring the whole H@H question)? Are you seeing that?Drew Rosielle MDhttp://www.blogger.com/profile/04345646798042773615noreply@blogger.comtag:blogger.com,1999:blog-13495125.post-64246595892822754832009-10-22T12:28:27.480-05:002009-10-22T12:28:27.480-05:00Interesting ideas, I just have a few concerns. #1 Why a &quot;Palliative Care Specialist&quot;. Don&#39;t you think that the principles of Palliative Care will &quot;trickle down&quot; to the primary care specialists? #2 Why isn&#39;t the Palliative MD not out there making the daily hospital-at-home care calls himself? (or for that matter, the emergency MD for the initial complaint.) Home visits have their place, but are NOT an efficient use of MD (think high $) time.<br /> This morning I (a family MD) saw 16 patients in a not-too-busy 4 hours. In the hospital I can probably see 16 general (not ICU) patients in a similar length of time. Home visits - maybe 4 if there isn&#39;t too much driving. Italy likely has more underemployeed MD&#39;d than the USA.<br /><br />John Bohlen, MDAnonymousnoreply@blogger.com