The Uncoordinated Care Problem in America and How We Can Fix It

“American medicine is the best in the world when it comes to providing high-tech care. If you have an esoteric disease, you want to be in the United States…But if you have run-of-the-mill chronic diseases like congestive heart failure or diabetes, the system is not designed to find you the best possible care. And that’s what has to change.”

Dr. Sandeep Jauhar, cardiologist at Long Island Jewish Medical Center, in a recent interview with Terry Gross of NPR’s Fresh Air

It Starts with Primary Care

By Bill Bunker, Executive Vice President, SCI Solutions

Coordinated care, or the lack thereof, has continued to stand in the forefront of the healthcare debate. Dr. Jauhar, author of Doctored: The Disillusionment of an American Physician, discussed how primary care physicians (PCPs) often refer patients to multiple specialists, but are left out of the loop afterwards:

“…they [specialists] make recommendations based on their own expertise and these recommendations are frequently not coordinated and so you get a whole host of recommendations and suggestions for care. But no one is really talking and trying to coordinate this care, so it makes it very difficult for the physician who is trying to manage the whole patient and treat the whole patient and getting these multiple inputs to know what to do.”

Shift in Payment Model is Not Enough

Historically, PCPs are reimbursed a fraction of what specialists receive for their services. On top of that, PCPs have not always been paid for following-up on their patients. This discourages PCPs to track down referred patients when they already have a busy practice full of patients to see. While the Centers for Medicare and Medicaid Services (CMS) announced that Medicare will cover care coordination services for chronically ill patients starting in 2015, they have not stated how patient information will be shared back to PCPs. Because most practices and health systems use different electronic medical record systems that do not speak to other practices, they still rely on fax machines to send referrals out to specialists. This creates a huge communication block, as PCPs typically do not receive information back through their fax machine. Therefore, PCPs are often in the dark to what happened to their patient.

Standard Communication is Key

A vital step in improving physician communication is moving away from fax-based technology and adopting web-based technology, particularly during referral transitions. A study by the Journal of American Medicine shows that only 54 percent of fax-based referrals ever get scheduled, compared to the 83 percent that get scheduled when the referral is sent electronically on a web-based platform, such as Clarity Health. Electronic communication offers real-time patient insight and the opportunity for effective collaboration among the patient’s entire care team. While the current state of coordinated care is lackluster, the future looks much brighter when pairing reform in coordinated care payments with web-based technology. Contact us today to learn more.

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