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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Perspectives on The Acute Care Continuum gives a tip of the cap to Myles Riner, MD, for his prodigious year of blogging, including our number 2 most popular blog from 2012:

One of the topics that attracts a lot of attention when emergency physicians and those interested in ED practice management get together to discuss how emergency medicine can remain relevant in, and become integrated into, the new health care reform and value based purchasing paradigms, is the concept of care coordination.  In theory, since the ED is linked to such a wide range of diagnostic testing resources, care facilities, and providers, and sits at the intersection of outpatient and inpatient care for many of the patients who are hospitalized:  emergency physicians ought to be able to play an important role in the coordination of care, both for the acutely and for the chronically ill.  In practice, many of the systems support structures that need to be in place to facilitate this role have often been ignored or neglected, or deferred on the assumption that they will be addressed with the adoption of the electronic medical record.  

If emergency physicians and EDs are going to assume the role of master care coordinators (something that family physicians staffing the medical home might consider within THEIR scope), they are going to have to define this role carefully, invest in the systems and staffing to support it, and integrate the concept into everyday practice.  Until now, few payers have been willing to pay for this service, and few hospitals and ED groups have been willing to invest significantly in the systems and staff to support it.  Suddenly, care coordination is the latest buzzword, and the presumptive salvation for what is often perceived as a frequently too expensive and often inappropriately utilized drain on the health care system:  the ED as poster-child for ‘the ‘failure of health care’.

5/29/2012 8:34:13 PM | 0 comments

Here are recent news items that address trends within the Acute Care Continuum in a colorful and striking manner. One makes the claim that, aside from the patient, the entity most in need of emergency care is the ED itself and calls attention to four solutions. The other is a documentary film about an Emergency Department that also describes larger issues effecting the system.    

Emergency Care for the ED

This article in HealthLeaders points to a 2007 report by the Institute of Medicine that calls the ED a “growing national crisis”. Author Joe Cantlupe touches on many subjects previously addressed in this blog, such as the importance of Urgent Care Clinics, while highlighting four areas of opportunity for future success: taking pressure off the ED, EMR in the ED, frequent fliers, and collaboration with competitors.

Excessive pressure on the ED, in particular, has long been recognized as a major barrier to care and led to the creation of Rapid Medical Evaluation®(RME). It is clear in today’s environment that optimizing the operational efficiency of the ED is a necessary and critical component in ensuring that the best possible care is provided to the greatest number of patients; and RME is one of the tools that can be used to meet the ED’s needs.

5/25/2012 1:36:28 AM | 0 comments

In the United States many people feel it is their God given right to sue anyone, anytime for anything. Whether you are successful or not may be another story. So what are the cost implications for healthcare in the United States? Few other developed countries rely upon this method for resolving malpractice issues. What is the cost-benefit equation? To protect themselves, American physicians practice what is called defensive medicine designed to ward off the attacks of plaintiff’s attorneys. There was a recent study which concluded that the additional cost for defensive medicine in this country was only about 2.4 percent for 2008. That is a very low number if you have anything to do with healthcare, but this is at least a number that someone has come up with to quantify the cost.

If I were an attorney (and I am not), I would argue that the value of malpractice cases are many: injured parties should be compensated in some manner for material loss of work, comfort and pain and suffering; expenses for rehabilitation and subsequent health maintenance should be paid by the injuring party; attorneys who take on these cases must be compensated for their diligence; cases won by defendants act as a deterrent to further injuries to patients and improve the quality of health care; and whether there is fault or not should be decided by an independent analysis of the case-like a jury.

5/22/2012 11:34:53 PM | 1 comments

We are at a critical juncture where the collaboration between emergency physicians and hospitalists is imperative for a hospital to achieve financial success in the future. These two hospital based specialties touch almost every one of the hospital’s entire patient population of hospital admissions each year. Yet there has in the past been an inherent conflict of interests in their clinical practices based on the drastically different priorities they each must manage.

This is no longer the way we can do things; there is a new paradigm of practice for both of these physician specialties. The integration of the clinical practices of emergency physicians and hospitalists is accelerating rapidly as hospitals increasingly seek shared financial and operational responsibility for patients and performance metrics across the Acute Care Continuum. As the healthcare crunch to reduce costs and increase revenue builds, perhaps Ben Franklin summed it up best when he said, “We must all hang together, or assuredly we shall all hang separately.”

5/17/2012 9:39:10 PM | 2 comments

We are beginning to see changes in healthcare delivery in the United States as the Healthcare Reform Bill is implemented. As anticipated, there is tremendous interest nationally in understanding and strategizing how to provide access to care for all Americans, and to deliver that care in an efficient and cost effective manner. While one of the stated goals of the Healthcare Reform Bill is that every patient should have a ‘Medical Home’, the projected shortage of primary care physicians will make the attainment of that goal a distant hope, rather than an imminent reality. Urgent Care Centers (UCCs) are starting to proliferate as health care delivery systems begin to respond to that need.

UCCs can help fill the access gap for patients whose conditions do not require the level of care provided by Emergency Departments. UCCs provide expanded hours, walk-in care that often includes many primary care services in addition to treatment for minor emergencies and acute illnesses. Many UCCs have on-site x-ray capability and point-of-care lab testing. Many also offer immunizations, sports physicals, pre-employment physicals, immigration physicals, as well as care for injured workers.

UCCs can serve as a resource to ensure that patients who have been hospitalized or discharged from the ED can get necessary follow-up and further outpatient evaluation in a timely manner. This role as the outpatient interface with the ED and the hospital is a critical piece of the Acute Care Continuum. Having a place that can provide guaranteed follow-up whenever it is needed can reduce hospitalizations for ED patients, length of stay for hospitalized patients and decrease the costs of care while maintaining patient safety and satisfaction.

5/15/2012 11:38:24 PM | 2 comments
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