Course 1B: Value-Based Health Care Delivery (Modules 4-5) > 4.Care Coordination from the View of a Primary Care Physician

4.Care Coordination from the View of a Primary Care Physician

MODULE 4 | Section 4 of 10

Care Coordination from the View of a Primary Care Physician

Lack of coordination is not only costly for patients, but also for health care professionals. In 2014, Dr. Matthew J. Press wrote in the New England Journal of Medicine about his experience attempting to coordinate care for “Mr. K,” a “stoic 70-year-old with a few minor medical problems,” after a scan for kidney stones revealed cholangiocarcinoma, or bile duct cancer.

Source: Press MJ. Instant Replay — A Quarterback’s View of Care Coordination. New England Journal of Medicine. 2014;371(6):489-491. doi:10.1056/NEJMp1406033. Used with permission.

“Over the 80 days between when I informed Mr. K. about the MRI result and when his tumor was resected, 11 other clinicians became involved in his care, and he had 5 procedures and 11 office visits (none of them with me). As the complexity of his care increased, the tasks involved in coordinating it multiplied… In total, I communicated with the other clinicians 40 times (32 e-mails and 8 phone calls) and with Mr. K. or his wife 12 times. At least 1 communication occurred on 26 of the 80 days, and on the busiest day (day 32), 6 communications occurred.”

The typical primary care physician coordinates care with 229 other physicians working in 117 practices.1 Indeed, these numbers are from a study that looked at fee-for-service Medicare patients, and the authors of the study agree that they are probably an underestimate. With this slew of peers, local and distant, with whom a clinician must coordinate the care of his or her patients, the potential for communication error is staggering.

 

The consequences of miscommunication are many and profound. Patients may die or suffer serious injury, clinicians and their institutions may become targets for malpractice lawsuits, and physicians may lose their jobs and reputations.

 

According to the Controlled Risk Insurance Company (CRICO)’s 2015 Benchmarking Report, 49% of all medical malpractice cases that resulted in hospital payout were caused by mistakes in clinician-clinician communication and averaged $484K. The total cost of the 7,149 cases studied for this report totalled $1.7 billion, and communication failure was found as the cause of 44% of all high-severity cases, including patient death.2

REFERENCES

  1. 1- Pham HH, et al. Primary Care Physicians’ Links to Other Physicians through Medicare Patients: The Scope of Care Coordination. Ann Intern Med. 2009;150:236-242.

 

  1. 2-Crico Strategies. Malpractice Risks in Communication Failures: 2015 Annual Benchmarking Report. Report for the Risk Management Foundation of the Harvard Medical Institutions Incorporated. 2015. Retrieved from https://www.rmf.harvard.edu/~/media/0A5FF3ED1C8B40CFAF178BB965488FA9.ashx (link will download). Accessed December 7, 2017.

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