The ACC Corner: Team-based Care Silver Lining of Healthcare Reform

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 - Jack Lewin, MD
Jack Lewin, MD

U.S. healthcare is undergoing massive changes. While it's often easy to focus on the negative side-effects of this transformation, healthcare professionals should not lose sight of its many opportunities. One of the biggest opportunities, particularly for cardiology, is a movement towards team-based care, which involves using non-physician practitioners and clinical staff to participate in the decision-making, coordination of care and shared responsibility for quality.

While team-based care can offer solutions for increasing workforce shortage, it also has the potential to enhance patient care in terms of quality and safety, expand physician productivity and improve job satisfaction by reducing workloads and preventing burnout.

According to the American College of Cardiology's (ACC) 2010 Practice Census, 57 percent of cardiovascular professionals reported that their care delivery is already team-based. Collaboration with nurse practitioners or physician assistants in outpatient clinics with physicians is the most popular type of model (49 percent). However, other models also are being employed, including the use of nurses or nurse practitioners to run an outpatient clinic service (33 percent). However, it is less common for practices to use physician extenders as independent billers, such as billing "incident to" (18 percent), having independent outpatient clinics and billing independently (17 percent), providing inpatient care and billing for services (18 percent) or serving as rounding nurses for inpatient or outpatient services with physicians (18 percent).

Of the practices operating in a team-based care environment, the primary improvements reported were increased efficiency (63 percent), improved quality of care (53 percent) and increased patient satisfaction (50 percent). Other benefits included improved staff satisfaction (36 percent) and financial outcomes (19 percent). Team-based care providers also were most likely to implement patient education (69 percent) and internal communications (63 percent) as a part of the care protocol. Performance improvement (56 percent) and data monitoring (56 percent) also were popular practices, followed by patient adherence (50 percent), objective feedback (47 percent) and clearly defined roles (41 percent).  

Despite these benefits, however, implementing team-based care in practice can be challenging, particularly in smaller private practices. The 2010 Practice Census found solo practitioners are less likely to employ a team-based care model compared with hospital-based, multi-specialty and academic centers, which are more likely to use physician extenders. Hospitals and medical schools also were more likely to engage in quality improvement types of team-based care. Of the 43 percent not using team-based care, reimbursement and an inability to break with more traditional views of practicing medicine were cited as the primary reasons.

While many cardiovascular providers are practicing team-based care, opportunities exist for more interdisciplinary roles, increased tools for feedback and quality improvement, as well as increased responsibility for non-physician members of the team. To that end, the ACC is working to identify team-based practice models for the practice and hospital settings. For hospitals, providing practice teams with a greater understanding of the contract process and the know-how to best ensure the cohesiveness of their "team" is an important part of the education process.

In addition, the college is working to ensure that these care models are possible within a new payment system. Given current efforts to reform physician payment and move away from fee-for-service, the ACC is working with health policy makers to define and/or test novel payment models that reward team-based care. Only clinical teams working together can improve medication adherence, reduce unnecessary heart failure readmissions and reduce chronic disease morbidity.

Helen Keller once said, "Alone we can do so little. Together we can do so much." Team-based care offers opportunities for cardiovascular professionals to enhance patient care and improve patient outcomes, while providing a means to meet the challenges of the changing healthcare system in a proactive way.

Dr. Lewin is CEO of the American College of Cardiology.