Perspectives on the Acute Care Continuum

The Acute Care Continuum is the integration of urgent, emergent, inpatient and post-discharge care of patients with acute medical conditions. 

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The recently released report from the Department of Health and Human Services’ Office of the Inspector General (OIG) entitled “Access to Care: Provider Availability in Medicaid Managed Care” raised some serious issues about the fraudulent tactics many of these plans use to support state funding of their activities.
The OIG’s summary of their study to assess availability of Medicaid managed care providers indicated that:

“… slightly more than half of providers could not offer appointments to enrollees. Notably, 35 percent could not be found at the location listed by the plan, and another 8 percent were at the location but said that they were not participating in the plan. An additional 8 percent were not accepting new patients. Among the providers who offered appointments, the median wait time was 2 weeks. However, over a quarter had wait times of more than 1 month, and 10 percent had wait times longer than 2 months. Finally, primary care providers were less likely to offer an appointment than specialists; however, specialists tended to have longer wait times.”

1/29/2015 11:52:58 AM | 0 comments

I’m a scribe trainer, which means I train people — usually scribes, but also doctors, physician assistants and nurse practitioners — on electronic health record (EHR) systems.
Now to a lot of you, that probably sounds like one of those nightmare jobs akin to crime scene cleanup or sewer diving. But in many ways, being a scribe trainer is a bit like being a first responder—like an EMT or firefighter. Everyone hopes that won't need to call us, but when we show up, they're usually grateful. We get appearance requests at all hours. And sometimes once we’re on the scene, it’s tough to turn around and leave. Read More...
1/27/2015 3:11:15 PM | 3 comments

I'm going to be really honest here. I didn't become an emergency physician in order to interact with patients or change lives or make a difference. Not that those aren't incredibly good and worthy reasons to become a healthcare professional. But they weren't driving forces for me personally. I became a physician because I loved the practice and the study of medicine.

When people would ask me what I enjoyed most about my job, I would answer, “everything!" I loved the pace, the sounds, the smells (well, not all the smells). I loved managing multiple critical patients at the same time, dashing between a trauma in room 1 and a code in room 2. I feel great — truly alive — while doing my job.

Love of medicine for medicine's sake served me well for many years. But then I had a not-so-comfortable experience that made me realize something important was missing from my personal practice. Read More...
1/22/2015 12:34:16 PM | 5 comments

Up until December 2014, my Partners and I at Group Anesthesia Services (GAS) maintained a successful, five-decade-long practice at Good Samaritan Hospital in San Jose, California.
Our highly respected practice benefited from an informed and engaged patient population, a favorable payer mix and talented and collegial surgical colleagues.  We easily recruited from top residency programs and had great relationships with our facility administrators.  Most importantly, we provided safe and efficient surgical anesthesia to some of the sickest and most fragile patients. 
So, why did we choose to join an integrated acute care practice in which specialties such as emergency and hospital medicine could easily overshadow our own?  Read More...
1/20/2015 12:19:00 PM | 1 comments

Last time I posted on Perspectives in late 2013, it was to predict a New Year’s like no other.
Acute care providers everywhere were scrambling to prepare for an influx of newly insured patients on Jan. 1. The Affordable Care Act (ACA) had been designed to reduce ED crowding, yet most emergency departments (EDs) were bracing for increased volumes. Healthcare leaders knew that access to primary care could be a thorny issue for the newly insured, leaving only EDs to meet their needs. Read More...
1/15/2015 7:45:55 AM | 1 comments
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