The Acute Care Continuum is the integration of urgent, emergent, inpatient and post-discharge care of patients with acute medical conditions.
Bundled payments are the future, whether we like it or not. Even states who led the legal challenge against the ACA, such as South Carolina, have already implemented the concept of bundled payments. While it sounds great for cost savings and patient care, the details of how it will work are just now slowly emerging, and this is where it gets interesting.
A bundled payment is a predetermined payment for a defined “episode of care.” Doing this for a group of medical services is intended to reduce costs and to make the coordination of care across physician specialties and the hospital more efficient. Intuitively it makes sense that bundling payments could solve some of the inefficiencies of silos in healthcare. It creates substantial incentives for all involved healthcare providers and hospitals to organize each state of their process—diagnosis, treatment, recovery—as efficiently as possible with a single party taking responsibility for the allocation of resources. It also provides a financial incentive to avoid any complications and to create the most efficient team possible. Having physicians and hospitals communicate more directly with each other in order to coordinate an integrated approach for payments will theoretically lead to improved care quality as well as cost savings.
The coming widespread implementation of the physician reimbursement methodology, known as bundled payments, will require hospital-based physicians to find more objective ways to demonstrate value and seek leverage in the determination of how money will be distributed, from both commercial and government entities. The concept of bundled payments is not new. It was previously used for years on a limited basis in demonstration projects by CMS.
But today, healthcare reform is making it one of the more important elements to cost containment. Bundled payments, and the accelerating trend among hospitals and physician staffing companies to consolidate, will require true integration of the clinical care delivered by physician specialists across the Acute Care Continuum.
The practice of Medicine is changing. All physicians are facing the stresses of caring for an underinsured and aging population with higher health care needs in an era of decreasing reimbursement. Legislators are instituting reform initiatives in an attempt to help cut costs and decrease utilization of expensive acute services, while still maintaining the highest quality of care for our population.
Emergency Department (ED) doctors are at the forefront of the new demands and we cannot fulfill them alone. With the new measures regulating door to admission times, hospital lengths of stay, thirty day re-admission rates and overall patient satisfaction, hospitalists and ED doctors will need to better communicate and innovate.
What can ED doctors do now to assist in the long term success of medicine and healthcare reform? One helpful concept that is returning and driving change is the Medical Home, defined as a “model where a traditional doctor’s office is transformed into the central point for Americans to organize and coordinate their health care based on need and priorities.” As these needs and priorities evolve into the issues we face in the Acute Care Continuum, so too is the Medical Home.
“Daddy, I want an iPad.” This is a common request heard by parents, but this one was coming from my daughter in medical school, who already possessed a MacBook and an iPhone! Just beginning her clinical rotations in her third year, she noticed many of her peers using iPads to look up questions they had on a medication, the pathophysiology of the disease the attending was lecturing on at the moment, or even to study a lecture or required reading.
It is no secret that physicians have flocked towards the iPad for both work and play, with multiple surveys showing high penetration rates in this demographic. Mobile technology is clearly overtaking healthcare with the term “mHealth” achieving buzzword status. But, is the tablet the right tool for the job?
In John Commins’ article, Value of Rural Hospitals Linked to ED Utilization, he points out that the rural healthcare environment is vastly different from urban areas. He cites some very poignant reasons for these differences, including that rural hospitals do not enjoy the same economies of scale and leverage with vendors and insurance companies. Commins says that while rural hospitals are perceived to deliver a lower level of care than is provided in urban areas, he thinks this perception is incorrect. I would take this point one step further. I believe that, overall, the financial and operational efficiencies of rural EDs provide an insight into the model of how to survive in the new healthcare economy .
Ironically, rural EDs have become a blueprint for maximizing efficiency because of their lack of resources. Rural EDs are forced to optimize their efficiency, mostly because of the way they are reimbursed. In California, for example, rural EDs primarily have self pay and Medi-Cal payers. This reimbursement is much less than the PPO and HMO payers that support urban centers. This payment demographic forces rural EDs to be more efficient. There is an understanding by providers in rural California that they must see more patients per hour than their urban counterparts have to see, just to avoid going out of business.
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Congratulations on a job well done. Love your focus on the patient experience!
Great job. What a fantastic tool
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Thanks, Andrew. Appreciate the "goal specificity" discussion in particular.