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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Much has been written about the Affordable Care Act (ACA) and one of its ongoing experiments is known as Accountable Care Organizations (ACOs). Recently The Wall Street Journal published an opinion with the headline “The Coming Failure of ‘Accountable Care’”. While I agree with the authors that many ACOs will fail, I believe that they will fail for different reasons.

I have two different perspectives on this. One is based on 30 years of experience as an emergency physician in clinical practice, remembering the early days of managed care when HMOs were created to do much of what is expected from ACOs. A second perspective is as the CEO of a physician management company with almost 100 client hospitals. I believe that physicians and hospitals will indeed change their behaviors, and rapidly, once the ACA takes effect and they get paid based on value and not for the number of billable services provided. Otherwise, they simply won’t be able to compete with physicians and hospitals which are more efficient and provide better quality at a lower cost.
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2/28/2013 5:53:53 PM | 0 comments

In this time of rapid change and financial challenges in healthcare, there is a need for change management.  Process engineering, also called management engineering, can be a valuable resource in negotiating these challenges across the Acute Care Continuum.  

Process engineering, an offshoot of industrial engineering, looks at the big picture of an organization and utilizes a number of tools to create improvements that will help the organization operate more efficiently. For example, the Lean process was first devised by the manufacturing industry, used to identify methods to streamline workflow processes. The process engineer uses tools, like Lean, to look at all the people involved and translate their different activities into metrics that can be reviewed, measured, and assigned goals.

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2/25/2013 9:55:40 PM | 0 comments

Our bi-weekly news updates are designed to keep you up to date with current developments relating to the Acute Care Continuum. Feel free to share your perspective on these stories or link to articles that you have found relevant to today’s healthcare environment.

This week, we highlight articles that focus on the difficulty hospitals are having in transitioning from a fee-for-service payment system to one that is based on clinical outcomes and patient experience.

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2/25/2013 8:11:03 PM | 0 comments

Managing an Acute Care Continuum physician services organization that sees approximately five million patient encounters annually requires data.  Lots of data.  This includes information on meeting defined clinical guidelines, such as the Centers for Medicaid and Medical Services (CMS) performance metrics, resource utilization, practitioner productivity, patient flow, quality metrics and risk are all necessary. 

Physicians are trained to first ‘do no harm’; and we typically don’t adopt medical practices until they have been proven through research that shows “statistically significant” improvement in clinical outcomes.  We expect and demand a high degree of certainty that recommended changes in our clinical practices will make a meaningful difference in patient care and outcomes.  Our practice lexicon is peppered with terms such as “triple-blinded,” “evidence-based” and “meta-analysis.”
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2/21/2013 6:09:44 PM | 1 comments

The Centers for Medicare & Medicaid Services (CMS) just published some newly proposed rules that enable States to impose increased cost sharing on Medicaid patients for non-emergency care in the ER.  These rules open the door even wider for these States to abuse ER providers and hospitals, and discourage Medicaid patients from seeking needed care.  Sadly, CMS did not even bother to consult with the American College of Emergency Physicians before drafting these rules, which makes it a lot more difficult to put some of the more problematic provisions back into Pandora’s box. There is a good article on these proposed rules in the NY Times if you want a thousand foot view.  I’ve done a pretty thorough review of these rules, and will try to highlight the pertinent language and possible consequences of the provisions related to emergency care; so lets get into the weeds:

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2/19/2013 9:00:06 PM | 0 comments
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