With an additional 30 million people to be added to the rolls of the medically insured in this country over the next year, common wisdom is that they will all be going to the emergency department (ED). That’s what happened when Massachusetts added more enrollees to their state funded insurance program, to the tune of 3 million additional ED visits between 2004 and 2008. A key driver behind this was that there were not enough primary care physicians (PCPs) to meet the need. As the Affordable Care Act (ACA) now rolls out across the country seniors will increasingly feel the pinch. Their numbers are increasing as the baby boom ages, while at the same time many PCPs are becoming reluctant to take on Medicare patients due to payment reductions.

I predict that non-physician providers and new models of providing primary care will present themselves to fill the gap in primary care.  Nurse practitioners (NPs) are already trying to rewrite state laws to allow themselves to practice independently, and several states already give NPs many of the powers the physicians have. The American Association of Colleges of Nursing is also proposing that they add a "PhD" to their training; and California Healthline is reporting that California State Senator Ed Hernandez is planning on introducing legislation this month to enable nurse practitioners to establish independent practices.  Physician Assistants (PAs) will also see new opportunities to increase the scope of their practices in the reports of this proposed legislation. Over forty percent of CEP America’s clinical hours are already provided by PAs and NPs, and I believe we will surpass 50% or more in the very near future.

Our bi-weekly 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.

This week, we focus on what has been happening in Washington, DC, including what will be affected by the budget sequestration and CMS’ purported victory over readmission rates.

By Brian Bearie, MD

I regularly exchange my white coat for a jacket and tie as I take off my clinical hat and put on my administrative hat.  When doing this, my perspective changes slightly─to how I can best serve my patients while at the same time keeping a sustainable business. 

Upon learning of the “triage out” concept, my initial visceral reaction was strong opposition.  This practice, which sends low acuity ED patients to primary care venues, seemed to conflict with my commitment to patient care.  But as the landscape changes and there is an overwhelming increase in primary care patients presenting to the ED, I  now see the triage out option as a viable way to not only serve the needs of the ED, but also to steer patients towards the primary care they need.

By the year 2020, when many in my generation of physicians are no longer practicing, healthcare will look very different due to the Affordable Care Act (ACA). The road ahead will require a lot of collaboration between physicians, hospitals, health plans, patients, and more. Physician leadership is now needed and wanted at all levels. And I think it is very important that younger physician leaders—the physicians who will actually be practicing in the future—join in the planning for and leadership of that future.

I am never surprised at just how talented and well-rounded physicians are. And I am not just talking about physicians that I work with, but all who successfully navigated med school.  So the question is not whether there are enough good young leaders, but how they can most effectively be engaged and then empowered to lead?

Much has been written about the Affordable Care Act (ACA) and one of its ongoing experiments is known as Accountable Care Organizations (ACOs). Recently The Wall Street Journal published an opinion with the headline “The Coming Failure of ‘Accountable Care’”. While I agree with the authors that many ACOs will fail, I believe that they will fail for different reasons.

I have two different perspectives on this. One is based on 30 years of experience as an emergency physician in clinical practice, remembering the early days of managed care when HMOs were created to do much of what is expected from ACOs. A second perspective is as the CEO of a physician management company with almost 100 client hospitals. I believe that physicians and hospitals will indeed change their behaviors, and rapidly, once the ACA takes effect and they get paid based on value and not for the number of billable services provided. Otherwise, they simply won’t be able to compete with physicians and hospitals which are more efficient and provide better quality at a lower cost.

By Tim Wagner

In this time of rapid change and financial challenges in healthcare, there is a need for change management.  Process engineering, also called management engineering, can be a valuable resource in negotiating these challenges across the Acute Care Continuum.  

Process engineering, an offshoot of industrial engineering, looks at the big picture of an organization and utilizes a number of tools to create improvements that will help the organization operate more efficiently. For example, the Lean process was first devised by the manufacturing industry, used to identify methods to streamline workflow processes. The process engineer uses tools, like Lean, to look at all the people involved and translate their different activities into metrics that can be reviewed, measured, and assigned goals.

Our bi-weekly 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.

This week, we highlight articles that focus on the difficulty hospitals are having in transitioning from a fee-for-service payment system to one that is based on clinical outcomes and patient experience.