The rise of interdisciplinary care—healthcare provided to a single patient by what can, at times, seem like a slew of specialists—is a sign of the times. Patients are older, and many have chronic health issues that require planned, coordinated care by a team of experts over the long-term.
The problem is, the healthcare system of old isn’t actually set up to accommodate the type of care coordination today’s Americans need, according to Stephen C. Schimpff, MD, FACP, former CEO of the University of Maryland Medical Center, and author of the book The Future of Health Care Delivery.
“We don’t have a health-care system; we have a medical-care system, one that was developed to care for patients with acute problems such as pneumonia or gall stones. For the former an internist gave an antibiotic, and for the latter the surgeon cut out the gall bladder. In both cases, the patient was cured,” Schimpff maintains.
“Not so with chronic illnesses, which really require a multidisciplinary-team approach to care that includes various specialists.”
Schimpff points to the hand-off from primary care to the hospitalist—and later, from the hospitalist back to primary care—as a common point of care coordination breakdown, and a reason for high readmission rates.
A 2013 article produced by Kaiser Health News in collaboration with The Washington Post suggested the same. “Health Care’s ‘Dirty Little Secret’: No One May be Coordinating Care” contains example after example of communication breakdowns among multiple providers caring for patients. Marsha Wallace, a retired internist from Washington, DC, shared her experience during a recent hospitalization overhearing conflicting messages delivered to her roommate, an elderly woman with cancer:
“First the surgeon came in and told her he hadn’t found anything,” Wallace recalled. “Then the gastroenterologist came in and said, ‘I just did a CT scan; you have an obstructed kidney.’ Then the internist came in and said, ‘We don’t know what’s wrong, so we may send you to [Johns] Hopkins.’ Then the social worker came in and said, ‘We’re going to discharge you to a rehab hospital.'”
Where was the hospitalist who was supposed to be coordinating her care? While there’s no mention of that, the report explained that many hospitalists work 10- to 12-hour shifts 7 to 15 days straight to provide “continuity” to patients. It added that four out of ten hospitalists surveyed said their workloads are often unsafe, accommodating more than 15 patients per shift.
Thankfully, strong interdisciplinary care, complete with effective care coordination, is gaining increased attention in today’s healthcare arena.
“Well-designed, targeted care coordination that is delivered to the right people can improve outcomes for everyone: patients, providers, and payers,” the Agency for Healthcare Research and Quality explains on its website.
Initiatives such as Accountable Care Organizations (ACOs), patient-centered medical homes and effective electronic health record systems are combating costly, confusing fragmented care as the reimbursement landscape shifts from what one report called “fee for service” to “fee for value.”
“In a nutshell, coordinated care has to deliver value. That means higher quality care at a lower cost,” said Tom Croyle, president of Lehigh Valley Business Coalition on Healthcare. “We have to get rid of the fragmentation, inefficiencies and wide variations in both cost and quality inherent in our current system.”