Several years ago, Confluence Health had a problem they needed to address. The integrated health care delivery system based in North Central Washington had a wait time for new patients that was long.
"Unacceptably long," said Jacob Espinoza, MSOM, primary care director at Confluence Health. "Patients were taking 45 days, 60 days, a couple of months to get seen for a new patient appointment."
In an effort to reduce that wait time, leaders of the health system turned to an unlikely outlet for support: retired and semi-retired physicians.
"In many communities I have lived in, retirement typically means what most expect, namely a shift from actively working to no longer working at all or focusing more on personal hobbies," Espinoza said. But Confluence Health “had retiring physicians who still wanted to do some work and help the community."
By leveraging the talent and time of this qualified community, not only was Confluence Health able to reduce its new patient wait time, but it also set the groundwork for a transitional care program that's providing needed support to patients and physicians alike.
Instead of focusing solely on new patients, the health system's transitional care program now provides assistance to patients recently discharged from the hospital or emergency department.
Confluence Health is part of the AMA Health System Member Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
The transitional care program plays a vital role in bridging care gaps for patients who do not have an established primary care physician or who are far away from their doctor.
"This is a win-win-win program," said Randal Moseley, MD, a retired hospitalist with more than 40 years of professional experience. "It gives patients timely and expert follow-up after hospital discharge, unburdens primary care, and allows late-career physicians the pleasure of meaningful part-time work."
A win for patients
The move to collaborate with retired or semi-retired physicians saw nearly immediate success, said Espinoza, who is the service line director for the program. These physicians who started with the transitional care program provided valuable support to an array of new patients, particularly those new to the area and with chronic conditions.
"They couldn't really wait a few months," Espinoza said.
Transitional care physicians met with new patients as needed and provided initial support while regular new-patient appointments were being established. The program was working effectively, but then a new need was discovered: hospital discharge support.
The transitional care physicians were quick to transition their type of support and now see patients within 72 hours of discharge.
"This is especially helpful for patients with complex illnesses vulnerable to deterioration," Dr. Moseley said. "Without the transitional care option, seeing a primary care physician as a new patient could otherwise take weeks. Delays of this magnitude in care continuity would increase poor outcomes and readmission rates."
The transitional care program “does allow for relatively rapid follow up compared to the amount of time it takes to get established with a new primary care physician and often even getting an appointment with an established physician,” said Brent Barber, MD, an internist and infectious diseases physician at Confluence Health who has been in practice for 30 years.
A win for physicians
In addition to providing support to patients, the transitional care program also alleviates work from practicing physicians. By allowing retired or semi-retired physicians to see patients in need of transitional care, Confluence Health reduces the number of patients full-time physicians would need to see. This reduction helps alleviate stress that can lead to physician burnout.
Additionally, health system leaders intentionally scheduled transitional care physician appointments for 50 minutes. This allows adequate time for new patients to go over their background and conditions and gives physicians time to listen and engage without worrying about the next appointment on their schedule.
"Many of these patients are very complex and it would be a significant challenge for a primary care physician to adequately sort out in the middle of a busy schedule," Dr. Moseley said. "The transitional care physicians are better positioned to fully assess their needs and create targeted care plans, organizing them for more streamlined subsequent visits when they do establish with primary care."
As the leader in physician well-being, the AMA is reducing physician burnout by removing administrative burdens and providing real-world solutions to help doctors rediscover the Joy in Medicine®.
A win for retired and semi-retired physicians
Espinoza has worked with multiple health systems, and he's never seen the type of interest in community support that exists among the retired and semi-retired physicians at Confluence Health.
Dr. Barber said the fit is natural.
"All the physicians have extensive hospital experience," he said. "These qualities allow for schedule flexibility and familiarity with hospital discharge associated problems."
Dr. Moseley agreed.
"These physicians have access that is unburdened by an existing practice panel, making timely follow-up appointments easy," he said. "As a retired hospitalist, this is a good fit for my own clinical experience. I feel very comfortable seeing the same kinds of patients in follow-up that I had been discharging for the previous 20 years. I think any physician with a history of caring for fragile patients with multisystem diagnoses would be comfortable as well."
