By Donald H. Crane, president and CEO, California Association of Physician Groups
The passage and implementation of the Affordable Care Act has made health care a topic of everyday conversations around our dinner and conference tables. However, most of the discussion is political and not about whether our healthcare system works for its intended audience–patients.
An important story lost in the clutter of healthcare politics is the patient’s experience when he or she leaves the hospital and returns home. For the millions of Americans who are too often readmitted to the hospital, the story does not have a happy ending. However, with a common-sense change in the delivery of health care, we can improve these health stories and save money in the process. What we need to do is better coordinate the hand-offs that go on all across our healthcare system. And we know this because, for millions, these hand-offs are being done successfully.
So what is the problem? How and where does the fumble happen? After a patient is admitted to the hospital with a serious condition, he or she is treated by more than a dozen physicians, nurses and other providers, many of whom do not seem to speak to each other as they come in and out of the room asking the same questions over and over. The patient is then sent home without clear instructions and maybe not even feeling better. The patient is confused and alone–left to navigate a complex maze of choices on his or her own. This fumble is our healthcare system’s dirty little secret; it is the way the healthcare system works for too many Americans.
But, millions of patients in pockets across the country are telling a dramatically different story. A system exists that eases them through the transition of hospital to home. There is no fumble with these patients because care coordination ensures a smooth handoff.
Imagine a patient who is sent home from the hospital in a coordinated model. Before the patient even leaves the hospital, a care team springs into action. At an appointment with the care team, the patient and any family caregivers are given written, clear instructions on whom to call if they have questions or if the unexpected arises before their follow-up visit. The care team calls the patient the day before the appointment to reconfirm.
At the follow-up visit, the team works to ensure the patient’s total care needs are addressed. A pharmacist reviews all medications the patient is taking, including herbal supplements, over-the-counter medication and medication prescribed before the patient was in the hospital. A social worker and case manager address coordination of various health insurance coverage plans, as well as emotional, social and other issues that may impact a patient’s recovery. A physician reviews the hospital stay and the patient’s medical history and provides personalized education for the patient. The entire physician-led team generates a summary of what they have done and sends one complete note to the patient’s primary care physician.
To be sure, this doesn’t happen every time a patient goes to the hospital across the United States. But, for the more than 18 million Californians our physicians treat, care coordination is no secret.
So how do we create these smooth handoffs all across America? First, we have to get rid of fee-for-service payment as a dominant payment model. In fee-for-service, the physician receives a payment for each procedure done or test ordered. This system of payment simply encourages more tests and more procedures, without an eye on the most effective, high quality care for a given patient. This model must go.
Second, we have to pay for the type of care we want. If we want team-based, forward-thinking, prevention-focused health care, we have to pay doctors to work in teams, think ahead and keep their patients healthy. Instead of paying each individual physician for each medical procedure performed, Medicare and other payers should make defined payments to physician organizations based on quality, taking into account who they treat and how sick their patients are — the higher the quality, the higher the pay.
Finally, we have to look for and encourage what works in health care. A number of physician payment experiments are currently under way, including Medicare and commercial accountable care organizations (ACOs) and patient-centered medical homes. Testing these models to determine what works is incredibly important. In addition, attention must be paid to Medicare Advantage, where care coordination is currently under way and producing better outcomes for patients.
Coordinated care is no secret for millions of patients. But we must continue to work to ensure that care coordination is a reality across the United States. We need to listen to the patient’s stories, work to ensure that the dirty little secret of health care is no more and ensure the smooth hand-off from hospital to home.
Donald H. Crane is president and CEO of California Association of Physician Groups, which represents groups in 20 states with more than 60,000 members providing care to more than 18 million Americans.