Trendspotter: If Health Reform Demands Teamwork, When Does It Start?

With a new year comes a new set of initiatives taking effect under the Affordable Care Act and we move another year closer towards other undefined initiatives. But if there is one current theme among the majority of reform initiatives it is teamwork to improve care, a goal that may be as challenging as making reform a reality.

Like the murky makeup of some of these initiatives - like accountable care organizations (ACOs) and payment "bundling" under Medicare - the relationship between physicians, hospitals, nurses, and others who must work as a team is a little muddled itself.

Look no further than a recent report in the Archives of Internal Medicine, which found communication between primary care physicians and specialists when it comes to referrals and consultations is "often inadequate." Forget reform benchmarks down the road, this is a key factor in coordinated care today.

But it appears both groups say they are delivering the proper information, while their counterparts in turn disagree. The research indicates that physicians who did not receive timely communication regarding referrals and consultations were more likely to report that their ability to provide high-quality care to their patients "was threatened."

The research does provide some guidance for better communication, notably having adequate time to spend with patients during an office visit as a precursor to better information exchange. Physician-to-physician communication issues are nothing new, however.

Time will tell if that exchange improves, but even the research authors point out that time is of the essence, with healthcare IT adoption, ACOs, and patient-centered medical homes (PCMHs) - another key initiative of reform - looming on the horizon and requiring clear give-and-take among professionals.

Speaking of ACOs, the Washington Post points out this week that there appears to be some communication disconnect among those team members as well. The Post article deals mainly with how insurers differ on their views of ACOs versus medical professionals, but there is another issue at hand.

First, a brief recap: ACOs are an initiative under the Affordable Care Act with the goal of creating groups to allow doctors to coordinate care for patients while at the same time, improving quality of care and reducing costs at the same time. Sounds great, right? Many stakeholders agree, but here again we come back to the crystal ball question: What will they look like?

And here is where the discord begins. Doctors, hospitals, nurses and others are all on-board with the theory of ACOs, they just can't agree on the structure. Various groups have solicited their ideas to CMS, which will issue rules for what these new groups will look like in the coming weeks.

It's been said that with patient-centered medical homes, which also coordinates care but among physicians, that the primary care physician is essentially the "quarterback" of the care team. With ACOs, however, it appears that everyone wants to be the one in the huddle calling the plays.

Late last year, the American Hospital Association highlighted some key points on their stance on ACOs and how they should be implemented, pointing to a number of ways that hospitals can lead the effort. The American Medical Association also issued a series of recommendations, notably one that says the new groups "must be physician-led." And the American Nurses Association also stressed "the importance of nurse-led care models" in its letter to CMS on ACO structure.

Like the head coach of a football team, CMS will know have to look at everyone on its healthcare team and decide who gets the ball as the ACO's quarterback or if there is a way to share the leadership of this initiative among multiple leaders. Any sports fan can tell you that teams that utilize rotating quarterbacks find little to no success on the field and in the locker room in terms of team unity.

Teamwork, especially with the end goals of better patient care and reducing medical costs, is a key tenet of the Affordable Care Act. Much like the reform law itself, however, it may take a few years to start to see the effects.