Aren’t healthcare acronyms fun? ACA, MU, PQRS, HIPAA, ACO… and most recently, MACRA. Learn it, live it, love it: Medicare Access and CHIP Reauthorization Act. Oh wow, an acronym in an acronym! And if you think that is confusing, wait until you to try to decipher and understand how payment reform can simultaneously promote fee-for-service as well as value-based medicine.
As I was reading up on MACRA here, I was pleasantly surprised to see one of MedAptus’ customers, Cornerstone Health Care, prominently featured for its work transitioning to value-based care as far back as 2011 as we were all just wrapping our heads around that concept:
“Maintaining a patient-focused viewpoint is essential to switching from volume to value, CEO Dr. Terrell said. For example, her group focused on patients with severe chronic obstructive pulmonary disease and teamed them with a respiratory therapist, particularly after hospitalizations. Their efforts reduced 30-day hospital readmissions from 12% to 6%. They also created clinics for patients who have five or more chronic conditions; physicians are linked with nurse navigators, social workers, and other professionals to offer a more holistic approach.”
“All of these different models focused foremost on patients,” Dr. Terrell said. “They also focused on teamwork. Even though physicians were leading the team, it involved integrated medicine. It also involved integration across the spectrum of care so we had to work very carefully with our hospital partners.”
Two key points to Dr. Farrell’s explanation of the results they experienced around outcomes are firstly, the notion of the patient and secondly, the notion of the team. With many medical groups today, particularly in the acute care setting, the patient is not always at the center of decision making. And what is the first decision that is made typically in the acute care setting? Who is going to see the patient. Whether the setting is the ER or the medical floor, the ‘who’ of the provider is largely dictated by the day of the week, volume, and/or time, and rarely influenced by the ‘what’ or ‘why’ of the patient (with the exception of peds versus adults).
Here is a very simple analogy. Think of going to Supercuts for a haircut. Most of the time a customer gets whoever is free to cut his/her hair. Maybe one stylist has long, thick, curly hair just like you do – instead you get the stylist with the short pixie cut. Sure, anyone could cut your hair, but who could give you the best cut and really make you feel fabulous? The person who knows something about your hair.
The same is true in hospitals. Everyone knows that the best surgical outcomes happen when there is volume. But what about continuity? What about the care that is delivered when someone knows a lot about a condition or a patient? But often these factors aren’t taken into consideration during the patient assignment process. Maybe I’m a hospitalist that has experience with ESRD but I’m on a different floor today when a serious case is admitted. Or maybe I took care of that case last time, which was three months, ago but I am off today (but hey – I am on tomorrow). There is great opportunity to make patient assignment the first step of a highly patient-centric episode – but instead it is often related to an administrative task that needs to get done so rounds can start.
We think there is a better way – contact us if you agree.
