Under the current siloed, discrete process of delivering medical care, each physician that participates in the care process is driven by different and sometimes conflicting goals. Emergency physicians are driven to rapidly diagnose, provide initial management and prep patients for rapid movement from the department. The goal is to provide the care necessary to as rapidly as possible free up the emergency department bed for the next patient. They are working in a context of a continual flow of patients and limited time and resources.
Hospitalists want to make sure that every admission is necessary and directed to the correct inpatient bed, that the patient work-up includes the information necessary to determine all necessary next steps, that admissions are minimally disruptive to their scheduled work flow, and that hospitalized patients receive the care necessary to minimize their length of stay while providing adequate recovery to also minimize the likelihood of readmission.
Consulting physicians provide care specific to diseases under their domain. However, office practice and personal demands often dictate specialist availability which may compromise both the emergency physician and hospitalist’s ability minimize patient stay within their respective domains.
It is not surprising that this system has not led to optimal healthcare delivery efficiency, as meeting goals in one silo may create inefficiency in another. For example, the emergency physician may have the necessary information to disposition a patient to an inpatient setting, but the evaluation may still not contain the information necessary for the hospitalist to determine next steps. Or, the hospitalist may not want to break his work cycle to evaluate whether an inpatient admission of an ED patient is necessary, creating a delay in clearing the ED bed for other waiting patients.
Bundled payments for the entire acute care episode will at least create the demand for integration and efficiency across the acute care continuum and force siloed practitioners to work in a unified team environment. Integrated physician management and coordination across the Acute Care Continuum results in resource utilization efficiencies and improves care resulting in decreased healthcare expense.