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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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.

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8/28/2012 6:19:23 PM | 1 comments

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.

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8/23/2012 6:27:12 PM | 0 comments

Health care spending now represents greater than 16% of our Gross Domestic Product, up from 13% in 2000.  It is continuing to grow, some say at the rate of  1.5 times GDP.  As we approach the 20% benchmark, we need to be concerned that this could cripple our country’s ability to export goods and services and can bankrupt our country unless systematic changes are made. And along with the financial danger comes the subsequent challenge to hospitals to continue to provide the same or better quality of care for more people but with diminished resources. We need to accept the fact that reimbursements will not go up, and that the only way to prosper will be through increased efficiency.

The integration and collaboration of hospitals with their physicians and outpatient referral sources triggered by new health care legislation are leading to a paradigm shift in health care—a change that can help with the challenges of the future. For example, with bundled payments, many will be paid in lump sums which could lead to more sharing of responsibility.  In this way, bundled payments can not only streamline the cost of healthcare but can also help to improve efficiency and quality of care.

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7/23/2012 8:46:49 PM | 2 comments

Now It’s All About Leverage

Bundled payments will be a game changer for every hospital-based physician specialty in the future. This brings to mind the age old analogy of three wolves and one lamb discussing what’s for dinner. It takes little imagination to realize that “leverage” will be perhaps the most important factor in determining who is on the menu, and who gets the biggest portion of the bundled payments for specific patient care episodes proposed by Medicare. 

As fee for service evolves to fee for value, the relative leverage of each hospital-based physician specialty will be crucial. Alignment with other specialists at the same hospital will also be an important factor in physician future reimbursement. Fortunately at least for emergency physicians, it appears that they will not be included in bundled payments for the foreseeable future. This does not diminish however the need to prepare for it appears to be an inevitable payment methodology that will include all physicians across the Acute Care Continuum in the future.

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7/3/2012 5:57:10 PM | 1 comments

The patient navigator shows how a small scale change and modest expenditure could quickly yield improvements in ED resource utilization while at the same time providing much needed support to patients. This could be a “win win” for patients, hospitals and ED staff.

Patient navigator programs, an example of which is currently in use at Sutter Health emergency departments in Sacramento, attempt to broaden the help given to ED patients. The program at Sutter General and Sutter Memorial Hospitals is still very new, with the pilot phase just completed in the fall of 2011.  It places patient navigators, usually trained social workers, in the ED.  Their job is to assist patients who do not have access to follow-up care. 

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6/26/2012 8:27:16 PM | 0 comments
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