Is the integration of urgent, emergent, inpatient and
care of patients with
acute medical conditions.
By Robert Hamilton, MD, FAAEM
There's an urgent need today for better integration in healthcare. Unfortunately, training and practice haven't quite caught up with reality.
Suddenly we're asking hospitalists and ED physicians to team up in ways they never imagined. We're asking them to think with one mind and act as part of an integrated team when they've been conditioned from medical school to side with their respective specialty's interests and to view each other with suspicion.
The concept of professional "silos" — and the barriers to change they present — have been on my mind lately. A few months ago, the hospitalists at one of the facilities I work at opted to join CEP America as Partners. Since we'd been striving for greater integration, I was thrilled by the news.
I'll admit part of me secretly hoped that uniting us under one organizational structure would work miracles. However, fostering trust and communication between our teams has been far more challenging than I anticipated. Even matters as simple as finding common times when we could all attend meetings and social events has been a challenge, but even more challenging has been working toward a common culture.
Whenever I catch myself wondering why we can't all just put our differences aside, I think back to my first clinical rotations in medical school. As medical students, we gravitate toward specialties that fit our personalities and preferences; and these traits are further refined and hardwired into us as we advance through residency and practice. It is at this point that "battle lines" get drawn between specialties.
Our biweekly news updates are designed to keep you up to date with current developments relating to the Acute Care Continuum. Feel free to share your perspective on these stories or link to articles that you have found relevant to today's healthcare environment.
State Health Exchanges Experience Own Set of Problems
As President Obama's administration works to fix the problems plaguing the federal Health Insurance Marketplace's website, states implementing their own health insurance exchanges are reporting both successes and glitches. California, Connecticut, Kentucky, New York and Washington have all seen "robust enrollment" since the October 1 launch, with California reporting nearly 80,000 individuals signing up in the first month. However, Colorado and Oregon are reporting low enrollment and website issues respectively.
By Pamela McCord, RN, BSN, MBA
As a nurse leader, I once overheard staff talking about a certain nurse who was abrupt with a patient when he tried to give her a lengthy explanation of his condition. In the past, I had observed this same nurse being somewhat curt with colleagues, and several patient surveys had described "rude" behavior by this person.
Though red flags were waving, I was reluctant to act. Rarely does a leader take their role because they excel at or enjoy confronting members of their team. Even those of us with years of experience can think of reasons to postpone a conversation with a team member who is derailing our team's success:
However, I've learned over many years of experience that problem avoidance does not improve the behavior or the situation. Addressing issues requires courageous conversations. What's more, the coming sea change in healthcare demands fundamental shifts in organizational culture. To meet the challenges of reform, physician, nursing and administrative leaders must prepare to confront values, customs and processes that do not serve the goals of the organization.
On the bright side, when managed with empathy and consideration, "courageous conversations" can improve performance for the team at large. Concurrently, in this era of value-based performance, ensuring that everyone is striving toward the same goal can ensure an organization's ongoing success.
Perspectives on the Acute Care Continuum wishes you and your loved ones a happy Thanksgiving!
As we express our gratitude, we must never forget that the highest appreciation is not to utter words, but to live by them.
~John Fitzgerald Kennedy
By Jim Strafford, CEDC, MCS-P
The Centers for Medicare and Medicaid Services' (CMS) proposed assault on emergency department (ED) and outpatient facility levels has been well documented in Perspectives on the Acute Care Continuum. CMS claims its proposed move to a single facility level will simplify claims management and coding, while also deterring some of the "upcoding" CMS claimed hospitals were undertaking.
However, recent increases in acuity levels coded by EDs nationwide — and the costs associated with that increase — are certainly additional factors.
The fact that CMS failed to develop guidelines for ED facility coding — or adopt sound guidelines created by private industry (Lynx) and professional societies (ACEP) — only added to the pressure facing hospitals. Coincidentally, we at Healthcare Administrative Partners (HAP) have been tracking trends in ED leveling for several years; and there is no denying that the acuity of ED levels (99281-5) has increased on both the physician and facility side during this time.
When the "coding implosion bomb" was dropped by CMS, HAP personnel were completing research for a white paper analyzing ED facility coding trends. Surprisingly, our data pointed to a different conclusion than the one drawn by CMS.
Rather than grabbing for a bigger piece of the payment pie, hospital EDs that had historically undercoded their acuity levels now appeared to be correcting those errors. Their overall acuities were moving upward to become more in line with national benchmarks.
By Nancy Carlson, RN, BSN, MBA
If there's a constant in today's healthcare environment, it's change.
Earlier this year, I was working with a group of CEP America partner hospitals to reduce emergency department (ED) turnaround time to discharge to 115 minutes. Several facilities were hovering at 150 to 180 minutes and doubted they could shave away an hour.
When our organization's program director suggested that I gather staff from the various sites to discuss strategy, I hesitated. After all, each ED has its own challenges, goals, desires and culture. I didn't think the problem lent itself to a one-size-fits-all solution.
But then I wondered: could our organizations accelerate change by working together? I thought back to my experience with the Institute for Healthcare Improvement's (IHI's) second Breakthrough Series Collaborative.
Where Do Physician Groups Stand on Healthcare Reform?
At the Becker's Hospital Review 5th Annual CEO Strategy Roundtable on November 14, panelists discussed how healthcare reform affects ambulatory surgery centers and physician group practices. Wesley A. Curry, MD, CEO of CEP America, noted that he believed there will only be a slight uptick in patient collections as a result of the Affordable Care Act. "The ACA will not manufacture more patients, but it will shift the representation of our payer mix," he said. Dr. Curry also reiterated that many hospitals will look to emergency department physicians and hospitalists to stand as leaders in the push for integrated care. "ER physicians are the first point of patient contact. Combine this with hospitalists, and this accounts for 85 percent of hospital admissions," he said. "I think most forward thinking hospital administrators will see ER physicians and hospitalists as a unit."
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