In my near-decade of practicing emergency medicine I have yet to receive a letter from a hospital congratulating me on how few CT scans I’ve ordered. Nor have I ever received a special award for diverting a potential admission to an outpatient referral instead. Rather, the push has always been the opposite. Fee-for-service models encourage the opposite behavior, and trying to do the most evidenced-based or cost-effective thing is not only not rewarded, but in many cases financially penalized.
Health care reform aims to change that dynamic. Fundamentally, hospitals and healthc are systems are tasked with delivering high quality health care to individuals and populations in the most efficient and cost-effective way possible, all while improving the patient experience — the triple aim.
But how can we meet all three of these goals (quality, cost and satisfaction) when the goals are inherently misaligned? Trying to be cost conscious and preserve quality doesn’t always improve patient satisfaction, and trying to improve patient satisfaction doesn’t always mean providing the most evidenced-based or cost- effective care.
As we move away from a fee-for-service health care system to a value-based system we are finally having the right conversations and taking the first steps to truly affect delivery of health care in this country. Clinically integrated networks, or CINs (yes, another acronym), are a great first step. Simply put, CINs are a group of physician and physician groups across multiple specialties using proven protocols and best practices to improve patient care. They encourage collaboration between members to meet quality benchmarks that improve outcomes and demonstrate value to the market. In exchange for meeting these benchmarks, physician groups can negotiate with insurance companies for better payment rate and bonuses.
There is a lot of benefit in this model. First, groups are no longer encouraged to “do their own thing.” Instead they are incentivized to talk to each other and collaborate. Using case managers and social workers, better use of outpatient referrals facilities and better chronic disease management are all good value propositions. Effecting change in end-of-life-care and being better stewards of imaging studies are other examples of value. Preventing hospital admissions and readmissions by adhering to best practices and better coordination of outpatient care is now also incentivized.
CINs are a way for a group of physicians to align themselves to give the most efficient and cost-effective medicine as possible, all while maintaining or exceeding the current quality of care. It’s a way for physicians and hospitals to improve the cost efficiency and effectiveness of care delivery to patients — the bedrock of the healthcare system.
As emergency physicians, we play a central role in the success of these networks. Given that over half of all hospital admissions come from the emergency department, we suddenly find ourselves in a great position to effect change. We now can tangibly show that that by being more efficient with our care delivery we can have an enormous impact on a successful CIN. What more value can we provide as a hospital partner then by showing we can practice efficient medicine, prevent costly admissions, all why maintaining the same quality
It is an exciting time for emergency medicine. It seems that the groups of physicians that embrace this new model and strive to balance cost and quality will ultimately be the most successful. As emergency providers we are not only central to the success of these networks, but can be true drivers of change in this new era of health care.
Vipul Kella is vice-chairman, emergency medicine, Southern Maryland Hospital, Clinton, MD. He blogs at The Shift.
