Is the integration of urgent, emergent, inpatient and
care of patients with
acute medical conditions.
Post-discharge care including skilled nursing facilities, ambulatory care, primary care, and others. Specifically looking at the 30-day window as defined by CMS.
By Ted Kloth, MD, FACEP
The time is coming when consolidation and transparency will reign supreme, and the effects are already being felt throughout the healthcare arena.
Looking at the healthcare landscape and how the major players are reacting to the effects of reform, it is obvious to me that the need to consolidate is becoming a reality for many physician groups and service providers. Health systems are merging with larger health systems and clinical outsourcing groups are entering into joint ventures with their long-time clients to provide care at a lower cost. The rationale behind this shift is the belief that integrated systems reduce costs and increase profits for all parties involved. And with fewer reimbursement dollars at play, it seems most are looking for ways to increase profit margins by doing more for less.
By Scott Lopata, MD
So, I’m sitting in a restaurant overlooking our local Arizona ice rink (yes, we do have an active hockey establishment in the desert) and watching my son skating round and round at a school event. As I’m watching him, it occurs to me that the circular nature of the ice rink is a good parallel to the Acute Care Continuum. Lately, I’ve wondered about the growing importance of inpatients understanding their discharge instructions and medication side effects; or how and why we need to be concerned and anticipatory in regards to the prevention of readmissions.
The concept of the Acute Care Continuum can often be overwhelming. By dictionary definition, a continuum is “a continuous extent, series, or whole.” I read it as patient-centered care at every point in the healthcare process. As an individual healthcare provider, at times I have difficulty imagining how I can singularly make a difference in the entire continuum of care. As an emergency physician who manages just one instance of care, it seems even less likely that I can change a patient’s path – helping him or her avoid the rut in the ice and steering smoothly through the process.
By Josh Sheridan, MD, MS
The hospital system I work for has an ED and two Urgent Care Centers (UCCs) in the same city. Between the two UCCs, we serve all payer populations so that everyone in the community can access urgent care services when needed. In this way, we try to be highly available for everyone who needs immediate care. At the same time, we have also made the decision to have limited testing facilities in the urgent cares and to focus them on particular patient populations. While our UCC set up is not the standard, the results have been beneficial for both patients and the hospital.
Back in the old days medicine was practiced through home visits. In the early 20th century, as healthcare became institutionalized and medical insurance replaced ‘pay-as-you-go’, home visits became a thing of the past. Today there are a multitude of factors that are giving the practice of home visits a second look, and I think this is a positive development.
By Humayun Tufail, MD
Skilled Nursing Facilities (SNFs, often referred to as “sniffs”) provide an added dimension of care that can positively impact important patient metrics, including both length of stay and readmission. The prevention of readmission is receiving increased attention as the Affordable Care Act requires that in 2013, Medicare will penalize hospitals for what it deems as “excess readmission”. As a result, increased attention is being paid to the work in this post acute care setting that can be critical to reducing readmission. Statistics form HCUP (Healthcare Cost and Utilization in the United States) estimate that 13% of all patients are discharged to SNF’s and other long term care facilities. I started working with a SNF in February of this year and have seen up close the continuity of care that is provided.
SNFs are funded by Medicare and the distinction between a SNF and a “non-skilled” nursing facility are services such as occupational therapy, physical therapy, speech therapy, tube feeding, and treatment with antibiotics. There is a greatly improved quality of care when these skilled beds are available to patients. In being able to continue the level of care that would also happen at the hospital, I am able to help patients in and out of the hospital setting, an emerging hospitalist field referred to as “extensivists”.
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.
I read the recent CDC report on “Emergency Room Use Among Adults Aged 18-64: Early Release of Estimates From the National Health Interview Survey, January-June 2011”[PDF] and felt compelled to respond. As an emergency physician helping to lead a physician group which sees four million emergency patients per year, I had both an intellectual and emotional response to this article. My comments are about this specific article as well as the general issue – the widely held belief that there are too many ED visits. I hope my ED based perspectives will be viewed as helpful and not defensive.
I have doubts about the conclusions based on the data because of the retrospective design of the study and the small number of surveys used. Most of these studies were done retrospectively based on discharge diagnosis. One conclusion from the CDC study was that only 54.5% of visits required a hospital for their care, suggesting that only these patients had true ‘emergencies.’ The lay public are often very unaware as to what is a serious problem needing emergent or very urgent care versus a not so serious problem—especially prospectively.
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By Ted Kloth, MD, FACEP
The time is coming when consolidation and transparency will reign supreme, and the effects are already being felt throughout...
By Josh Sheridan, MD, MS
The hospital system I work for has an ED and two Urgent Care Centers (UCCs) in the same city. Between the two UCCs, we serve...
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