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    Here's how to tackle the challenges of care coordination

    On paper, care coordination looks simple: primary care physicians and specialists collaborating to provide the best treatment for patients.

    Virtually all primary care physicians engage in coordinated care to some degree, but the extra emphasis placed on it now by healthcare policymakers, along with new reimbursement models and reporting requirements, has primary care doctors looking for ways to improve how they coordinate care.   

    Policymakers say care coordination can cut costs and improve patient outcomes, but if it is to realize its promise, primary care doctors will have to overcome a number of obstacles to implementation, such as incompatible electronic health records (EHRs), poor communication with specialists, egos, a lack of resources and polypharmacy.

    And those are just the things they get paid to do.

    “It would be fair to say more than 50% of my time is spent in uncompensated care coordination,” says Susan Osborne, DO, a solo primary care physician located in Floyd, Virginia.

    Here are five major obstacles regarding care coordination and how primary care physicians can overcome them. 

     

    1. EHRs and coordination

    Sharing medical records among providers is essential to coordinated care, but the promise of seamless digital exchanges is still far from reality. 

    In a recent survey from healthcare research firm Black Book, 41% of hospital medical record administrators report difficulties exchanging records with other healthcare providers and 25% say they are  unable to integrate into their EHRs any patient information received electronically from outside sources. 

    The problem is particularly acute for independent primary care doctors, who are less likely to be tied into larger digital networks. “Physician groups continue to lack the financial and technical expertise to adopt complex EHRs, which are compulsory to attain higher reimbursements by public and private payers,” according to Black Book.

    Some physicians have upgraded their EHRs to improve interoperability and their resulting ability to collect and analyze the patient data they need for care coordination and coding and reporting. If doctors find themselves referring patients mostly to a single healthcare system, they should make sure their EHR is compatible with the one that system uses. 

    Some physicians rely on their accountable care organizations (ACOs) for help collecting, analyzing and exchanging data. Melissa Weakland, MD, a physician in a small primary care practice in Seattle, pays $900 a year to a neighboring hospital to use its EHR system to get emergency department notes and discharge notices, but she and others say they still routinely print out paper records for patients to take with them when they see specialists.

    Primary care doctors also can, where available, join Health Information Exchanges, which allow member providers to securely exchange patients’ data. These can be expensive, however. The Healthcare Information and Management Systems Society offers a calculator (visit bit.ly/HIE-HIO) for practices.

     

    2. Dealing with specialists

    One of the greatest challenges to care coordination, primary care physicians say, is working with specialists.

    “Many of the specialists I work with are great to collaborate with. There are other specialists who don’t want to collaborate and think they know it all and don’t understand my role as a primary care doctor,” says Weakland.

    A 2011 study of specialty referrals found numerous problems, including varying thresholds among primary care physicians for making referrals, poor communication, incomplete data transfer and missing follow-through. “PCPs and specialists also frequently disagree on the specialist’s role during the referral episode (e.g., single consultation or continuing comanagement),” researchers noted.

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