Is the integration of urgent, emergent, inpatient and
care of patients with
acute medical conditions.
The move toward care integration is intensifying, and some of the solutions I see emerging right now might have looked like science fiction a few years back. I don’t think anyone envisioned so many departments coming together under one umbrella in a hospital setting and working with agile outside entities such as a Federally Qualified Healthcare Center (FQHC). But scenarios like this are being fueled by both the government and hospitals.
The Federal government sees cost savings associated with integration and uses incentives such as bundled payments to bring departments together. With the budget crisis and patient boom, hospitals are harnessing this power of collaboration and working to build the seamless transfer of care between departments.
Imagine this: an integrated team that includes the ED, hospitalists, intensivists, primary care physicians (PCPs) as Chronic Disease Management specialists, and even post-acute care done though a FQHC. FQHCs are publicly-funded health clinics that provide primary care services for underserved patients. They also provide, or have an agreement with another organization to provide, dental services, mental health services, as well as hospital and specialty care. FQHCs are quickly entering the healthcare landscape as they gain financial resources. The Affordable Care Act in 2010 included $11 billion for FQHCs over a period of 5 years. Considering this influx of money, you can understand why FQHCs are gaining prominence and emerging in the hospital setting.
There are many different ways that a FQHC could collaborate with an emergency department. After an ED visit, outreach case managers could provide patients with information about follow-up care in an FQHC; ED staff could schedule FQHC appointments through shared software; or hospitals could let an FQHC locate its clinics next to the ED. Because FQHCs must offer a sliding scale payment based on income as part of their requirements, it would be a challenge to integrate payments equitably. But the benefits of this post-acute care option outweigh the costs of these types of issues, and may even help answer the question of how patients with limited resources and insurance can be treated.
An integrated team of emergency physicians, hospitalists, intensivists, PCPs, and a FQHC would create an excellent opportunity for controlling costs and improving medical quality. For example, intensivists could stabilize the critically ill in the ICU, coordinate with hospitalists to pass those stabilized patients to a lower level of hospital care, and then discharge to a post-acute care setting. This could be especially useful in serving a Friday or weekend patient who is released from the ED because the FQHC would be open to provide follow-up over the weekend and to avoid the “soft” admits. And why not integrate the age-old concept of an Observation Unit under this team umbrella? ED physicians and hospitalists could coordinate this with the possibility of reducing inefficiency that can occur in the emergency physician to hospitalist hand off.
As the pace of integration is quickening, we will be measured by our response to these sorts of opportunities because, as we all know, an opportunity mismanaged or ignored has a way of becoming a threat.
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