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 potential is almost endless right now for data collection and aggregation to push efficiency and cost savings forward across the Acute Care Continuum. The process of analyzing large data sets has reached buzzword status with the term “big data”, and the McKinsey Global Institute (MGI) recently listed healthcare as one of the five domains they studied when calling big data the “next frontier for innovation.” MGI estimates the sector could create $300 billion in savings per year. Dr. Nigram Shah of Stanford agrees with this, arguing, “biomedical informatics stands ready to revolutionize human health and healthcare using large-scale measurements on a large number of individuals.”

With such promise for the future, the state of data collection today could be at a similar point in medicine as when electricity was first entering the mainstream; and one means to harness this power is through Electronic Medical Records (EMR). Yet a lack of standardization is preventing the type of data enlightenment that could be taking place.

When electricity was introduced to households in the late 19th century there were different outlets for different appliances. The maker of an appliance dictated what kind of electrical outlet you had to have in your home. You couldn’t plug a lamp into just any socket and expect to get electricity out. This new technology was in its infancy, with one-off appliances finding new applications regularly.

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9/10/2012 5:27:47 PM | 0 comments

The patient population in Emergency Departments (EDs) has been steadily increasing and this trend will only rise in the years to come. The U.S. Centers for Disease Control and Prevention reports that ED visits rose 9.9% to 136 million over the calendar year in 2009 from 2008. Furthermore, factors such as population growth, the physician shortage, and hospital closures should exacerbate this patient growth in the future.  As a result, there is an immediate need to increase efficiency in the ED. Quick Emergency Disposition (QED) is a program to improve ED patient throughput. It is a simple concept that has been leading to turn around times plummeting at our pilot sites. QED could also be applicable outside the ED in the Acute Care Continuum and play a role in the general movement towards efficiency in hospital integration.

QED’s first component focuses on immediate written communication needed for the next disposition. It is a process where the provider immediately documents the information needed for the next decision point so that the team can unite around the goal of moving the patient efficiently through the ED. The upshot is that the ED staff works with higher cohesion with the series of decision points that result from having a preliminary plan in writing.

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9/4/2012 9:46:17 PM | 0 comments

Bundled payments are the future, whether we like it or not. Even states who led the legal challenge against the ACA,  such as South Carolina, have already implemented the concept of bundled payments.   While it sounds great for cost savings and patient care, the details of how it will work are just now slowly emerging, and this is where it gets interesting.

A bundled payment is a predetermined payment for a defined “episode of care.”  Doing this for a group of medical services is intended to reduce costs and to make the coordination of care across physician specialties and the hospital more efficient.  Intuitively it makes sense that bundling payments could solve some of the inefficiencies of silos in healthcare.  It creates substantial incentives for all involved healthcare providers and hospitals to organize each state of their process—diagnosis, treatment, recovery—as efficiently as possible with a single party taking responsibility for the allocation of resources.  It also provides a financial incentive to avoid any complications and to create the most efficient team possible.  Having physicians and hospitals communicate more directly with each other in order to coordinate an integrated approach for payments will theoretically lead to improved care quality as well as cost savings.

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8/31/2012 9:24:08 PM | 1 comments

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
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