Winter and the holidays are fast approaching. These are typically times in which patients have trouble. Perhaps this year will stand out, with the stresses of weather, a potentially especially potent cold and flu season, and health coverage uncertainty.
Neither physicians nor patients wish to see preventable emergency department visits occur. Human concerns aside, physicians and patients now often share a degree of economic consequence to such visits, through affiliations with Accountable Care Organizations, for example. Close communication and coordination of care are essential elements to reducing preventable admissions. In our ACO experience, we have seen clearly the differences that simple communication can make.
- Same day (or next day, depending on the time of day of the call) access for appointments is critical to be able to meet patient needs when ill or injured.
- Making certain that patients understand that once the office is “closed” there is a method for after-hours accessibility via phone numbers or phone services. There seems to have been a cultural shift in recent years, where patients don’t expect personal physicians to be available for questions or concerns once office hours end, though such access commonly remains available. It is also a key means of coordinating care in manners which avoid unnecessary emergency department visits (or encourage necessary ones).
- Physicians can help elderly patients in winter by adjusting follow-up and routinely scheduled appointments with an eye towards avoiding an overlap of office visits with times of strong influenza prevalence as well as periods of strong weather and icy conditions. Nothing is more distressing than a patient breaking a hip on the ice when coming to the office for a check of controlled hypertension.
- As an increasing number of states are strongly ratcheting up the pressures and requirements on physician practices regarding the management of controlled substances, the importance of patients understanding office policies, and avoiding the 3 p.m. call on Friday for refills or, worse, the 10 a.m. Saturday call, cannot be overemphasized.
- As many patients continue to struggle from the economic downturn reviewing medication lists are now more than a matter of accuracy of the list and dosing. Compliance requires a review on a patient by patient basis for cost, generics and/or coupon options. Noncompliance with medications for acute or chronic conditions is a frequent factor inducing emergency department visits and admissions that what would otherwise be preventable.
- Since transportation can be an issue, particularly for the elderly, particularly in winter, reconsidering willingness to engage in house calls can be a great way to render proper care in a safe, comfortable setting, rather than perpetuating avoidable expenditures on EMS transportation and emergency/hospital services.
- Being clear with patients that should they make a trip to the emergency department that they should communicate, and follow up promptly with the office, rather than trusting the emergency department to communicate in a clear and effective medication is a key strategy to prevent repeated visits, or a preventable subsequent admission.
Coupling the trends of physicians using hospitalists for the admission and monitoring of their patients with the pressures on emergency physicians to disposition patients have contributed to an escalation of admission rates for some patient populations. In our experience, this can approach 90% admission rates for certain patient classifications in certain facilities, giving the appearance that passing through the automatic doors of the emergency department has become practically an indication for admission itself. If such trends continue to bear out, then the implications for the nation’s health economy are chilling themselves.