Message from Picis Leadership – Dr. Mark Crockett

Today I am focusing on transitions. Transitions in care are part of life in the emergency room; there is never a time when a patient arrives in your ED to stay, they are always going home, going upstairs, or in some way headed elsewhere. Disposition is the word we usually use, but for the many patients that we see more than once (some quite often) that disposition is temporary.

Focusing on transitions is part of the work we all have to do to provide the more accountable, more coordinated care that is going to be required of us as we look to a future of healthcare that is filled with more patients to cover, declining reimbursements, bundled payments, and value based purchasing. The experiments with "pay for performance" have been reasonably successful, and with new tools available for providing great care at the bedside we are better prepared than ever for a transition in the way healthcare is delivered and paid for. Many of you use the Insight ED rules processor to make sure care opportunities are highlighted, and you are providing care that ED physicians in the 70s would not recognize. Bedside ultrasound? Therapeutic hypothermia? Fiber optic intubation? Zofran wafers? We have truly changed the expectations of what can be done pre-disposition in the ED, and our team at Picis is proud to be a part of it.

In this era of accountable care, you’ll notice that many hospitals and health systems are already driving towards a more collaborative workflow. The integrated delivery network (IDN) is changing significantly, and for the better. But in high-acuity care areas, like the emergency department (ED), the challenge of treating patients more holistically in what is already a rapid-paced environment is concerning for physicians evaluating the pay-for-performance model.

In today’s ED, patients may enter with a chronic condition that could be better managed by a primary care physician (PCP), but because ED physicians are incented to treat sick people in a fee-for-service model, they continue to take these patients on instead of referring them outside the ED walls. If, instead, both ED and primary care physicians operate as part of a team of care givers that are incented to ensure patients stay healthy and avoid hospital readmissions, they are headed in the same direction in terms of focusing on better patient outcomes vs. reimbursement dollars.

ED physicians used to be some of the only physicians employed by the hospital, but that’s changing dramatically as IDNs snap up physician groups. The larger group working together will help make sure the ball isn’t dropped anywhere throughout the spectrum of care. If a patient with a laceration comes into the ED with diabetes, and that ED doc doesn’t think to check blood sugar – because that’s more of a PCP issue – that oversight will be visible in an ACO environment and that physician might be under the microscope in terms of the role they play in ensuring quality outcomes.

Part of this movement requires implementing integrated technology solutions that provide greater visibility into the types of care needed in your community, allowing the health system to build care facilities that catere to the populations they serve, ultimately enabling the sustainable health community. But the real lynch pin for success is the collaboration between people, not just IT systems. This means choosing metrics to support each constituency who has a stake in the game – providers, payers, physicians and patients – so that they buy into the new strategy and are empowered to make changes that support lower costs, increased efficiencies and higher quality care. It takes strong leadership, demanding teamwork across clinical, administrative and even third-party vendors, along with a shared passion for making sure patients are cared for in the best possible way to make this happen.

I will be making a transition as well in the next few months. Accountable, coordinated care is too critical a concept to be ignored. I have been working with my colleagues at Optum to take the lessons we have learned over the last few years working with the top health systems in the country (you) to craft a vision of the Accountable Care Organization that delivers exceptional care, at lower cost, and with a better patient experience. The ED is a core part of that care, with some of the most important transitions and care opportunities happening there. I have accepted a position as the Chief Medical Officer for accountable care solutions at Optum, which will occupy more of my time as of the beginning of 2012. You can't take the ED out of me (or me out of it since I still intend to practice) and I will still be working with the best team of people I have ever had the opportunity to work with at Picis. You cannot have effective coordinated care without empowering your interoperability and managing a great ER, OR, and ICU. I will be carrying that message in a different role, but with no less passion and clarity. There will be a time in which we all will need more healthcare, and I hope to be a part of making sure it is better coordinated and more interoperable. I look forward to working with you in a different way as we all rethink the way we work together to change healthcare for ourselves and our families.