Wiki Clinic / Specialist / Hospital / Confused....

[mikesyzf]

A Cancer specialty clinic sees patients for care/treatment for Cancer at their clinic.
These same patients often have other comorbidities where they are treated in the ER and or Inpatient stays at the hospital located on the same campus.
Scenario:
-The Clinic Physician, who is not a hospitalist, treats a cancer patient at their (outpatient) clinic.
-The same patient ends up being admitted to the hospital for an unrelated condition.
-Because of the Cancer/Diagnosis the pt. has, the hospital staff physicians are not specialized to treat these patients.
-Due to this, our Clinic Physician will be called to manage the patient's cancer while they are inpatient at the hospital.
-Our Clinic Physician will dictate progress notes and sometimes a Discharge summary for the patient.
-Our Clinic Physician's progress note(s)/discharge summary will sometimes be directed at care of the pt's cancer. Other times, the Clinic Physician will treat the (non cancer related) current condition(s) the pt. has.
I've looked at the guidelines but I'm a bit confused on this.
Anyone care to comment?
Thank you!

 

[thomas7331]

I'm not sure I understand exactly what your question is here, but this is a common scenario really - patients in a hospital are often under the care of multiple providers and specialties. I see this too in cases where, for example, a patient is admitted by a general surgeon for a procedure but their care requires the participation of other specialists, e.g. pulmonologists or cardiologists. There should be one provider, though, that is designated as the attending provider during a stay, and that provider will be responsible for directing the care and deciding upon discharge. Any other specialties that participate during that stay would be considered consulting providers that have input on the care, but the attending is the one who coordinates this and makes the final decisions. In rare cases, care may be transferred to another specialty during a stay (e.g. one provider's work may be done and they will sign off and let another provider manage the rest of the stay), but that's something that should be well documented in the record. There may be cases where the documentation is not clear about who is attending and who is consulting, or who is responsible for the discharge summary, but that is something that I would suggest discussing with a manager or responsible party at the hospital, both to bring to their attention, and also to get direction from regarding what the facility policies are and how they wish this information to be represented on their claims. Hope this might help some.