Thursday, February 12, 2009

The Realities of Coordinating Care

From time to time, I comment on releases on The WSJ’s Health Blog as a means of restoring reality.

Here is an example.

In “Sobering" Finding , Care Coordination Doesn’t Save Money

Posted by Sara Rubenstein

When it comes to finding ways to cut costs form the health-care system, an idea that’s becoming popular among health-quality gurus, medical organizations, and insurers is “coordination of care.”

The theory goes like this: Get a nurse or another health professional to keep track of treatments and doctor visits for patients with complex, chronic diseases such a diabetes or heart disease. The coordinator should communicate with doctors to help the patients keep on top of things like their drug regimens. Then the patients won’t end up with as many costly hospitalizations.A study out in JAMA has some disheartening results.

Among 15 randomized trails of care-coordination programs involving Medicare patients , only two showed significant differences in hospitalizations between those who care was coordinated and a control group. And one of those two say more hospitalizations among the coordinated group. Meanwhile, ponly one program ended up saving money. Ouch

Medinnovation Comment

Why did a coordinating care nurse working in isolation by phone fail to save costs?
In his comment on the article in JAMA, Dr. John Ayania of Harvard nails it.

1) “Care coordinators must interact in person and not simply educate or assist them by phone.”

2) “Care coordinators must collaborate closely with physicians to have a reasonable prospect of influencing care.”

The secret to success, according to Dr. Don Copeland, who helped found and run the FP residency training program at Bowman Gray, is to have the FP take care of the comprehense needs of a panel of patients during residency, then, upon finishing training, work alongside an RN is the office, who helps the doctor coordinate care , both working with patients personally and face-to-face.