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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​You'll never find a bigger supporter of healthcare reform than me. My dad had a heart attack — while uninsured. My mom had chemotherapy — while uninsured. When my mom was able to enroll in an exchange plan in fall of 2013, our family breathed a monumental sigh of relief.
A year later, my mom lost her part-time retail job. From a healthcare point of view, this shouldn't have been a big deal. She was insured through the federal exchange, not her job.
Unfortunately, the insurance company didn't see her that way. They informed her that because of her decreased income, she was no longer eligible for an exchange plan. To stay on the exchange in 2015, she would first have to apply to Medicaid — and be denied. Read More...
2/12/2015 5:54:56 PM | 1 comments

In Tuesday's post, Gail Silver, MD, discussed the evolving role of the emergency department (ED) within the Acute Care Continuum. As an urgent care provider, she was concerned about the number of highly acute patients presenting to her practice when they clearly needed emergency care. She noted that in addition to providing life-saving care, EDs also offer care coordination services that connect high-risk patients with needed follow-up and community resources.
As an emergency physician, I strongly agree that EDs can and should play a pivotal role in facilitating transitions of care — and ultimately in breaking the cycle of repeated ED visits and hospitalizations that underserved patients often experience. I feel fortunate that my state (Oregon) is pioneering an approach that could serve as a blueprint for coordinated care programs nationwide. Read More...
1/8/2015 12:28:01 PM | 1 comments

As a physician whose practice straddles both acute and primary care, I fully support the goals of the Affordable Care Act. I'm all for patients having better access to high-quality care. And I do think that population health management (PHM) — the idea of actively guiding patients to appropriate care — has great potential to improve health outcomes and relieve the financial burdens of waste and fragmentation.
What I don’t like is when an 85-year-old with an altered level of consciousness is directed to our outpatient center in the name of cost containment. Unfortunately, this sort of thing has been happening a lot lately, and it has me worried. So while I agree with the goals of the law, I do have some concerns about how it's being applied. Read More...
1/6/2015 3:48:02 PM | 1 comments

​Engaging patients in their own health management is a perennial problem for healthcare providers — and for society as a whole. Preventable chronic illnesses like obesity and heart disease cost our country a trillion dollars per year in medical costs and lost productivity.
Study after study demonstrates that even modest lifestyle changes can slash the mortality and morbidity associated with these conditions — and curb the crippling costs of caring for these patients. However, providers can only do so much when an estimated 50 percent of patients don't adhere to their recommendations. Read More...
11/18/2014 5:31:50 AM | 0 comments

In Part 1 of this series on healthcare reform and healthcare costs, I discussed how implementation of the Affordable Care Act (ACA) has led to unintended consequences that appear to be driving up healthcare costs.
To recap: national healthcare spending increased 3.6 percent to $2.89 trillion in 2013 and is expected to increase by as much as 6.5 percent in 2014. By comparison, the United States GDP increased 3.4 percent in 2013. Healthcare spending already accounts for a staggering 17.9 percent of that GDP, which has serious economic implications for our country. Read More...
10/28/2014 10:34:08 AM | 0 comments
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