Quit Wasting My Healthcare

Strategy #4 to Improve Healthcare Value: Follow up on transfers-of-care

Assume something will go wrong with every transfer-of-care. 

When a person visits the ER, assume the lab and x-ray results never make it back to the primary care physician.  When a person is discharged from the hospital, assume that they do not fill half the prescriptions that are written.  When a person is referred by their primary care doctor to a specialist, assume the pertinent medical information is not communicated to the specialist.  When a person goes back to their primary care doctor after seeing a specialist, assume the specialist does not tell the primary care doctor what they think.

If you make all these assumptions, you will probably be right.  Dr. Bob Wachter from the University of California at San Francisco–one of the nation’s formost experts on hospital-based medicine–has written about the abysmal hand-off process in healthcare and it’s negative results (http://www.the-hospitalist.org/blogs/wachters_world/archive/2007/12/25/fixing-fumbled-handoffs.aspx).

When people move from Healthcare Provider A to Healthcare Provider B, they need to have an advocate/case manager/family member follow up with both A and B to make sure the transition is well coordinated.  It currently is not and this lack of coordination results in repeat visits to the ER, re-admissions to the hospital, repeat tests and diagnostics and worst-of-all, progression of disease and suffering on the part of the patient.

Yes, health plans have case managers, but their effectiveness has been limited for multiple reasons… their processes are getting better, but there is still a long way to go.

Facilitate the transfer-of-care and you will facilitate healthcare value.