A woman sick in bed calling her doctor

commentary

(The Hill)

November 17, 2016

Need a Doctor Now? Solve the Acute Care Crisis

Photo by Photographee.eu/Fotolia

by Mahshid Abir and Brendan G. Carr

When you're sick, you don't want to wait months, weeks, or even days until the next available appointment at the doctor's office. Whether it's a cold, or sudden worsening of a chronic condition like asthma or diabetes, or an injury, what matters is that you need acute care now. The acute care system should be available to guide your decision-making in getting the care you need.

But countless Americans struggle to receive acute care promptly, because they don't have health insurance, money, a doctor (or a doctor with an available appointment) — a system just hasn't been built that is adequately focused on meeting unscheduled needs.

The health care system has historically focused on chronic disease management. More recently, focus has shifted to address the importance of preventative care. While both may reduce the need for acute care, emergency room visits have consistently increased in the United States. With baby boomers aging and health care costs rising, the challenge of getting acute care is not going away. Solving this crisis requires a new way of thinking about how acute care is provided and how costs can be contained to make acute care more accessible and affordable. A good place to start would be to recognize the importance of making acute care a health reform and policy priority. Making acute care a health policy reform priority will affect both daily care and care provided during catastrophic settings, such as terrorist attacks and disasters, and is critical to our national health security.

Without backing away from efforts to prevent and manage diseases and to increase primary care capacity to address acute care needs in office settings, efforts to address the needs of patients who end up in urgent care, emergency rooms, and hospitals for acute care should be a priority. This work has begun. The Emergency Care Coordination Center in the Department of Health and Human Services funded work that developed a conceptual model of acute care, and the National Quality Forum is examining how to create effective transitions into and out of the acute care system. Health care providers, researchers, and other stakeholders have come together in the recently instituted Acute Care Research Unit at the University of Michigan to bridge these silos and find acute care solutions. Among the key challenges this unit will address is the lack of coordination in acute care delivery. This includes poor communication among doctors' offices, emergency rooms, and hospitals, which may result in duplicated lab tests, medical imaging and medications, poor patient follow-up, and, ultimately higher costs, reduced accessibility, and poor patient outcomes.

Unfortunately, researchers looking for solutions have created silos and often ignore the continuum of care, preferring to focus on only one setting. Effective solutions for multifaceted, complex issues related to acute care delivery will require accounting for the challenges of all settings concurrently, leveraging setting-specific strengths, and carefully examining patient preferences.

This can only be done if the full complement of care delivery sites — doctors' offices, urgent care clinics, emergency rooms, and hospitals — are at the table partnering with other key stakeholders such as payers and patients exchanging ideas on how to solve acute care challenges.

This coordinated approach is more likely to result in effective solutions for increasing urgent and emergency care capacity, preventing hospitalizations for acute care and hospital readmissions, finding alternatives to hospitalizations, and ensuring timely patient follow-up. These solutions could include asking doctors' offices to have same day appointments, building more urgent care sites, using the emergency room as a focus for efforts to reduce hospitalizations, and making homecare affordable.

Efforts such as the Center for Medicaid and Medicare's recent announcement that primary care physicians will be reimbursed at a higher rate are promising. Other solutions may lie in strategies now being tested in local communities by accountable care organizations (PDF).

Reforming acute care delivery will require making it a policy and research priority, financial commitment from government and the private sector, and building bridges between care delivery silos to consider solutions that span the acute care continuum. These are the critical first steps toward solving the acute care crisis.


Mahshid Abir, M.D., is an emergency physician and Director of the Acute Care Research Unit at the University of Michigan, and an adjunct natural scientist at the nonprofit, nonpartisan RAND Corporation. Brendan G. Carr, M.D. is an emergency physician, vice chair of health policy, and Associate Dean of Healthcare Delivery Innovation at Thomas Jefferson University.

This commentary originally appeared on The Hill on November 16, 2016. Commentary gives RAND researchers a platform to convey insights based on their professional expertise and often on their peer-reviewed research and analysis.