New models of healthcare delivery emphasize team-based coordinated care, but a new idea being tested at the University of Chicago proposes a new, somewhat old-fashioned concept targeting high-risk patients: the comprehensive-care physician. Source: http://practicemax.com/ http://practicemax.com/solutions-we-offer/electronic-health-record-systems-ehrs/ http://practicemax.com/challenges-we-solve/patient-collections/

2. New models of healthcare delivery emphasize team-based coordinated care, but a new
idea being tested at the University of Chicago proposes a new, somewhat old-fashioned
concept targeting high-risk patients: the comprehensive-care physician.In a clinical trial
funded by the CMS Innovation Center, University of Chicago physicians are assigned
patients identified as high risk for hospitalization and follow them through inpatient,
outpatient and home-care settings.
“The traditional internist can no longer do that job,” said Dr. David Meltzer, chief of the
University of Chicago section of hospital medicine. “They just don’t have enough
hospitalized patients to make it worthwhile.”Meltzer and Dr. Gregory Ruhnke, an assistant
professor with the University of Chicago section on hospital medicine, summarized their
program in a Health Affairs report, but Meltzer said data on the effectiveness of the
program won’t be available until 2016.
“The reason why we published now is to get the idea out there,” he said. “We’re still
enrolling patients.”
The program’s key outcome measures are self-rated health status, limitations on activities
of daily living, and mortality. Its economic success will be judged by the cost of care to
Medicare.
While many argue that coordinated care depends on clinical teams with nurses, nurse
practitioners, physician assistants and other nonphysician professionals empowered to
“practice at the top of their license,” Meltzer warns that this is not always the best way.
“I think it’s an iconoclastic perspective,” Meltzer said. Team-based care, he said may add
fragmentation and communication errors during patient handoffs.
Under the University of Chicago’s “comprehensive-care physician model,” five doctors
visit patients in the hospital in the morning, while nurses and other professionals provide
noncomplex care at the physicians’ clinic. One doctor is assigned afternoon rounds and
weekend call. Hospitalists, meanwhile, may see patients on night rounds.

3. The physicians are each assigned panels of 200 patients expected to average about 10
hospital days a year. They are assisted by a clinic coordinator, registered nurse, nurse
practitioner and a social worker.
Meltzer emphasized that the concept was “not in any way a repudiation of hospitalists,”
but a “best of both worlds” model that combines the duties of a general internist and a
hospital medicine specialist.
“Providing these physicians with a high volume of inpatients and locating their clinics in
or near the hospital can allow them to offer many of the same benefits that hospitalists
provide in terms of inpatient experience and physical presence and to offer the
additional benefit of continuity across settings and over time,” Meltzer and Ruhnke wrote
in Health Affairs.
Nurse practitioner bills await governors’ signatures.
Nurse practitioners are still waiting to see if or when the governors of Connecticut and
Minnesota will sign bills that will grant them the authority to practice with greater
independence.The Minnesota bill was passed by the state Legislature last week and sent
to Gov. Mark Dayton. It calls for nurse practitioners to have 2,080 hours of training before
they can practice independently, forbids them from identifying themselves as doctors,
and doesn’t permit them to interpret advanced diagnostic imaging, according to the
Minnesota Medical Association.
“The final legislation is not what the MMA would draft, but we stopped contesting it after
we reached the compromise,” Dave Renner, MMA’s director of state and federal
legislation, said in a news item on the MMA website.
While there has been no word about Dayton’s intentions, Connecticut Gov. Dannel
Malloy is expected to eventually sign the bill approved by his state Legislature.
Nurse practitioners have had mixed success this spring. A bill advancing their
independence was enacted in New York, vetoed by the governor in Nebraska, and died
in the California and Florida legislatures.
Predicted doc shortages don’t materialize.
The physician shortages that many warned would materialize as millions of Americans
gained coverage under Obamacare are a no-show so far.
There have been few reports of newly covered patients having significant trouble getting
timely access to care, according to Kaiser Health News and USA Today.

4. The report notes some exceptions in areas of Colorado, Kentucky and Washington state.
The reason, story suggests, is that many of the policies are just now taking effect. Also,
severe weather this winter dissuaded many patients from seeking care, as noted in the
first-quarter financial results for several healthcare companies.
Another possible factor: An estimated 5 million people who would have qualified for
Medicaid under the healthcare law live in states that declined to expand their programs.
Source:
http://practicemax.com/
http://practicemax.com/solutions-we-offer/electronic-health-record-systems-ehrs/
http://practicemax.com/challenges-we-solve/patient-collections/