In theory, care coordination seems like a rather obvious idea, involving as it does consistent collaboration between primary care physicians and specialists in the name of providing the best treatment for patients.
In practice, however, things can quickly get very tricky, and between various reforms involving new reimbursement models and reporting requirements, even the systems designed to enhance collaboration can get in the way.
A recent article at Medical Economics, for example, describes several common obstacles, including those that were intended to make life easier for providers.
First up, EHRs. “Sharing medical records among providers is essential to coordinated care,” the article notes, “but the promise of seamless digital exchanges is still far from reality.” It points to a recent survey from healthcare research firm Black Book which found that 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.”
Then, ironically, there’s the trouble PCPs have actually working with the specialists who are supposed to be helping them. The article describes 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.
Finally, there’s the matter of getting paid for all this helpful coordination. Reimbursement takes work, say doctors, and according to one doc while care coordination has been an “unofficial mandate” for years, “it’s only now that the primary care physician is being recognized for all the work they do in coordinating care.”