“The reality of today is that the healthcare world as we know it is changing more than any time since the advent of Medicare. Think about how much those rules and regulations, guidelines, etc., have impacted our practice lives,” says Terry McGeeney, MD, MBA, director at BDC Advisors. Communicating with other physicians, whether they are primary care or specialists, and being accountable for outcomes are just two of the ways physician practices have been impacted.
There’s significant change in expectations for physician practices, both primary care and specialists. We are now expected to function as a team. We are now expected to focus and function at the top of our license and training and interest. A primary care physician doesn’t have the time or the capacity anymore to necessarily see a sore throat when the note on the door already says, ‘strep test positive’. A cardiologist doesn’t have the time or capacity to be screening a patient for chest pain that’s actually gastroesophageal reflux. An orthopedist doesn’t necessarily have the time to be seeing sprained ankles and doing initial back evaluations. The list goes on and on, but we want to focus at the top of our license and training.
Practices are now expected to communicate; it’s no longer acceptable for specialists to not have the appropriate information when they see a patient. It’s not okay for the primary care physician not to get information back from the specialist in an appropriate amount of time. It’s not okay that a patient is discharged from the hospital and the discharge summary follows weeks later, instead of hours. Again, the list goes on and on.
We are now expected to move data around. We are expected from members of the team to have access to that data and, more and more, for patients to have access to that data. The expectation is that we see the right patients at the right time. And the patient has the right to be seen at the right time for the right reason.
We need to have aligned incentives as I noted—not only externally from payors and Medicare, but internally, so that we create the incentives and feedback for our staff around outcomes, quality and cost.
And finally, we are expected to have accountable care as everything moves forward. There’s a catch word here, ‘accountable’. We are going to be accountable for outcomes, we are going to be accountable for quality, and we’re going to be accountable for cost. While many of the ACO initiatives in the early stages are related to shared savings, there’s no doubt in anyone’s mind that shared savings will ultimately be coupled with shared risk. And that risk will trickle down to multiple levels throughout the health system.
Blueprint for a Medical Neighborhood: Building Care Coordination Between Specialists and PCPs describes the landscape of the medical neighborhood, from the value-based payment realities of healthcare today to identifying and engaging specialists in a medical home neighborhood.