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’.