A patient with multiple chronic conditions can see as many as three primary care physicians and eight specialists in seven different places. That's a lot of information for a patient to manage. If the patient's caregivers aren't talking to each other, the patient could receive conflicting treatment plans, duplicative tests and even prescriptions for drugs that don't work together.
Hospitals across the country are increasingly collaborating with other caregivers to try to ease the burden on patients and ensure better-coordinated, higher-quality and more efficient care—they're working toward what's known as "clinical integration."
One hospital, for example, has created specialized "care packages." Each package covers a set of clinical best practices for a particular condition such as diabetes. These bundled care plans create more consistent, high-quality care and also pay providers based on a single "package" fee that covers an entire group of services, instead of paying for each test or visit individually.
The result is a win-win: better care for patients and cost savings for patients and providers.
While clinical integration is the future of health care, regulation hasn't kept pace, making the legal hurdles tricky to navigate. For example, complicated antitrust laws hinder caregivers' ability to work together to improve quality and efficiency. Also, payments tied to quality and care improvement instead of just hours worked could violate strict mandates under the Stark Law.
Further, evidence-based medicine used as a guide for delivering care can violate the Civil Monetary Penalty Law, and antikickback laws can prohibit rewarding physicians for following evidence-based protocols that benefit patients. Originally well intentioned, these laws and regulations need to be updated to encourage clinical integration, not shut it down.
As our country moves into a new era of health care, it's time to remove these outdated roadblocks.
For more on clinical integration, visit the American Hospital Association website at www.aha.org and click on Clinical Integration under the Issues tab.
Stephen Smart, D.D.S. (firstname.lastname@example.org), is COG chair and chair of Medical Center of South Arkansas in El Dorado, Ark.