The American College of Physicians (ACP) this week released a toolkit to help improve communication and coordination between primary care and subspecialist physicians. As an observer, it's shocking to me that these resources are necessary in an era when communication and automation tools abound.
But here we are, spending 17 percent of our gross domestic product on healthcare, with up to 30 percent of it on unnecessary services, noted Molly Cooke, M.D., MACP, who is completing her one-year term as ACP's president, in an announcement. The ACP hopes its guidance will help reduce this wasteful duplication of services.
Whether all the answers lie in one toolkit or not, its creation is a step in the right direction--as the status quo not only costs the healthcare system money, but compromises physicians' ability to do their jobs.
"This is not a trivial problem" the ACP is working to address, Charles Cutler, M.D., chair of the ACP Board of Regents, told MedPage Today. "It's something that drives both the medical subspecialists and primary care docs crazy because on both sides the information isn't moving back and forth."
Indeed, specialists who want to become the "referral of choice" in their communities must prioritize strong communication with primary care physicians, noted consultant Marc D. Halley, MBA, in a previous interview with FiercePracticeManagement. Failure to engage physicians who send you business, he noted, will often lead to that business drying up.
But unfortunately, PCPs don't always have their pick of the litter when sending patients for more specialized care. For example, Jesse Hackell, M.D., FAAP, vice president and chief operating officer of Pomona (N.Y.) Pediatrics, PC, told FiercePracticeManagement in an exclusive interview that he commonly refers his young patients with diabetes to endocrinologists. The level of coordination depends on the specialist..
"Some are very good and send us letters each time they consult, and with others we just never have any idea what's going on, other than what we learn from the parents," he said. "But we don't have a lot of specialists to choose from, so I can't not send a patient to a practice just because they don't send a letter."
Furthermore, just because a specialist fails to send a letter to a PCP doesn't mean the patient isn't getting good care. The trouble is that there isn't a widely practiced system to optimize the efforts of all the clinicians to contribute to a patient's care, sort of like operating rooms running without checklists prior to the patient-safety movement.
To help practices standardize the way they approach referrals and follow-up, the ACP's High Value Care Coordination Toolkit includes five components:
- A checklist of information to include in a generic referral to a subspecialist practice.
- A checklist of information to include in a subspecialist's response to a referral request.
- Pertinent data sets reflecting specific information in addition to that found on a generic referral request. The information includes a referral for a number of specific common conditions to help ensure effective and high-value engagement.
- Model care-coordination agreement templates between primary care and subspecialty practices, and between a primary care practice and hospital care team.
- An outline of recommendations to physicians on how to prepare a patient for a referral in a patient- and family centered manner.
"Physicians need specific information to do their jobs effectively," said Cooke. "The High Value Care Coordination Toolkit facilitates clear communication between primary care and subspecialist practices so that doctors can provide seamless, coordinated, and quality care to their patients."
Nonetheless, adding steps to your current process may at first seem cumbersome, and there may be a learning curve to using tools like those suggested by the ACP. The perfect formula for referral coordination may be years away, but the time is now to examine these resources and work to customize them for your practice needs. - Deb (@PracticeMgt)