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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Most of the press has been focusing on the individual mandate. What a victory for Obama! Yet the Medicaid decision could be a much bigger issue than the one regarding the individual mandate. The Supreme Court has ruled that the Federal government cannot coerce the states into expanding their Medicaid programs to cover all people (not just the elderly, blind, pregnant women, and children) below a certain income level by threatening to withhold existing Federal funds as it would violate the Spending Clause of the U.S. Constitution and exceeded Federal authority to encourage states to regulate. This would have been a big stick. Now states are free to do as they choose and several have already said they don't have the money to increase Medicaid enrollees.

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7/3/2012 10:50:24 PM | 0 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

While the rest of the country debates the political and legal ramifications of the Supreme Court’s decision to uphold the Accountable Care Act (ACA) almost in its entirety, what’s next for those of us on the front lines of providing care?

Hospitals, physicians, and other providers have had mixed strategies for responding to the ACA as we all waited for the Supreme Court’s decision. Some organizations have moved full steam ahead with implementing some of the changes required by reform, while others – already overwhelmed with other initiatives – have waited for this decision before making any moves.

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6/29/2012 6:26:25 PM | 6 comments

It goes without saying that most patients arrive to the ED in a flurry of chaos, stumbling over their words, embarrassed about the circumstances that brought them there, and about the lack of planning that led to the emergency in the first place. The majority of the time, their “emergency” is stabilized and they are sent home (as Mark Spiro noted in his post, not all ED visits are emergencies). Yet, the stress of the visit will linger, the trauma or drama will cloud their understanding of their condition and the discharge instructions.

Emergency Medicine research studies show the patients’ retention of discharge and medication instructions from EDs ranges about 25-30% at best. These same patients are asked to take that 30% of retained information and try to engage in follow up care, fill the prescriptions and understand our verbal and written return precautions.  But do they?  The same studies show that patients rarely make follow up appointments, only fill prescriptions half of the times, and some even return within a few hours or days to go through it all again.
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6/28/2012 9:43:45 PM | 0 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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