1 Teams That Work: Developing Models of Care Coordination Marjie Harbrecht, MD Consultant MGHealthcare Insights, LLC Golden, Colo. Greg Pawson, CPA, CMA, CMPE Chief Financial Officer Women’s Healthcare Associates, LLC Portland, Oregon Marjie Harbrecht and Greg Pawson do not have any financial conflicts to report at this time.
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Teams That Work: Developing Models of Care Coordination
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Teams That Work: Developing Models of Care Coordination
Marjie Harbrecht, MD
Consultant MGHealthcare Insights, LLC
Golden, Colo.
Greg Pawson, CPA, CMA, CMPE
Chief Financial Officer
Women’s Healthcare Associates, LLC
Portland, Oregon
Marjie Harbrecht and Greg Pawson do not have any financial conflicts to report at this time.
Specialists - Raise your hand if these have occurred in your practice:
1. You don’t know provider that referred the patient.
2. You aren’t clear what question you’re supposed to be answering.
3. The patient doesn’t know why s/he was there.
4. You don’t get sufficient information with the referral – (i.e.,
pertinent history, workup done, etc).
5. You can’t access results from tests already performed.
6. You don’t get follow up on a patient you were concerned about.
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PCPs - Raise Your Hand if these issues are common in your practice
1. You don’t know the people you are referring patients to.
2. Specialists say they don’t get needed information with a referral.
3. Patients complain specialist didn’t know why s/he was there.
4. Tests you’ve already performed are duplicated.
5. You don’t hear back from a specialist after a consultation.
6. A referral doesn’t answer your question.
7. Your patient doesn’t come back to see you after a consultation.
8. You are unaware that your patient was seen in the ER/Hospital.
You’re Not Alone!
• 50% primary care didn’t even know patient saw specialist
• Say they received no information 60-70% of specialists
25-50% of primary care
• Dissatisfied with the information they receive 43% specialists
28% primary care
• Inappropriate referrals Unnecessary or wrong specialist
8% - average of 43 referrals /specialist/year
• Referral never completed
>20% - delayed/missed diagnosis and/or treatment1 O’Malley, A.S., Reschovsky, J.D. (2011) Referral and consultation communication between
primary care and specialist physicians: finding common ground. Arch Intern Med, 171 (1), 56-65.2 Mehrotra, A., Forrest, C.B., Lin, C.Y. (2011). Dropping the Baton: Specialty Referrals in US. The
Milbank Quarterly, 89 (1), 39-68.3 Forrest et.al Arch of Ped. Adol Med 2000
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…and then there is the Patient Experience
“I’m not sure why my doctor sent me, don’t you know?”
“I understood I was here to have the procedure today, not
just to talk about my stomach pain!”
“I had an MRI last month. Didn’t you get the information?”
“I waited 3 months for the appointment, took the day off of
work & after I was in the exam room learned I needed a
different type of specialist!”
WHY MAKE CARE COORDINATION A PRIORITY?
• Patients and families hate that we can’t make this work.
Multiple care plans - conflicting information
• Poor hand-offs lead to delays/confusion - patient safety
issues
• Enormous waste associated with unnecessary referrals and
duplicate testing
• It will make all of our work more effective
• Everyone will be happier!
Source: Ed Wagner, MD – MacColl Institute
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Some Reasons Why This Ain’t Easy… (particularly in a siloed system)
The typical primary care physician has 229 other
physicians working in 117 practices with which care
must be coordinated.
Pham et. al Ann Int Med. 2009
In the Medicare population, the average beneficiary
sees seven different physicians and fills upwards of 20
prescriptions per year
Partnership for Solutions, Johns Hopkins Univ. 2002
Key Elements• Clear Roles/Responsibilities with accountability• Highest level of licensure• Use team to help patients reach goals
Consider 2 to 1 ratios – MA/Nurse to provider
Consider additional co-located or integrated team members • Care Coordinators/Care Managers• Behavioral Health Professionals• Pharmacists• Others depending on population
Continuing Education ACMPE credit for medical practice executives…………... 1.5
*AAPC Core A credit ………………….………………………… 1.5
ACHE credit for medical practice executives…………..…. 1.5CME AMA PRA Category 1 Credits™……………………….. 1.5CNE credit for continuing nurse education …………….... 1.5
*CPE credit for certified public accountants (CPAs)……….. 1.8
CEU credit for generic continuing education………..……. 1.5
*AAPC CODE: 5 8 7 6 0 A Y Y*CPE CODE: 3 0 2 C C
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