Texas EDs: On the Front Lines of Accountable Care

After more than two decades working in healthcare, I know my way around a hospital, and I’m well versed in our industry’s issues and needs. However, when an accident recently landed me in the emergency room with a fractured wrist, the experience opened my eyes in a very personal way to the challenges in our healthcare system.

Don’t get me wrong. I received top-notch care in the emergency department. But after the hospital discharged me with a cast on my wrist, I received no real guidance or help in connecting with a provider for the next steps of my care process. I did what most people do—asked a colleague for advice and called an orthopedic specialist whom he recommended. It took me a couple of weeks to get an appointment, and ultimately resulted in my being referred elsewhere for more treatment. Unfortunately, the hospital that took good care of me lost a patient and subsequent revenue opportunity.

To make matters worse,  the hospital did not communicate my workers’ compensation information to the ED physician group’s billing company in a timely manner because its systems were not set up to share this information, despite availability of clear technology standards for doing so. As a result, the emergency physician group that provided excellent care will not get paid by either my primary insurance or by workers’ compensation insurance.

My experience is not unique. Patients who are admitted to EDs every day across North Texas and around the country could tell a similar story of broken processes and uncoordinated care.

For a relatively minor injury like the one I had, the consequences are minimal, at least in the short run. However, the lack of follow-up care could cause significant complications for patients with more serious conditions and result in the patient being readmitted or worse.

There continues to be a serious lack of communication between many hospitals and physician practices. Too often, physicians are unaware that their patients were seen in the ED, and even when they do, they find it difficult to retrieve medical records for these visits.

The new health reform era demands that we shore up these communication processes and bridge gaps in care coordination to reduce unnecessary hospital readmissions (and ultimately unnecessary healthcare expenses). It is exciting to see that models for better continuity of care are spreading across Texas, with accountable care organization pioneers like Methodist Health System of Dallas, Texas Health Resources, and North Texas Specialty Physicians leading the way.

Fortunately, web-based ED referral management systems are available, and ED physicians at fast-growing hospitals like Texas Regional Medical Center at Sunnyvale are using these technologies to take better care of patients and ensure patients get the follow-up treatment they need after they leave the hospital. At TRMC, the referral system automatically alerts physicians via e-mail or text message any time their patients register in the ED, are admitted or discharged. The ED record is subsequently shared with that physician. In addition, the hospital is able to assign 60 percent of its 3,500 patients seen each month in its ED to a primary care physician (who is also in the hospital’s network) for follow-up care. Meanwhile, a call center promptly reaches out to patients to schedule follow-up appointments.

As my personal experience shows, hospital EDs must begin making the leap from focusing exclusively on discharging patients to managing smooth care transitions. Warm patient handoffs improve patient and physician satisfaction as well as clinical outcomes to ensure that the hospital becomes the most trusted name in its healthcare community.

Sunny Sanyal is CEO of Dallas-based T-System, Inc.