Continuity and Coordination of Care

Continuity and coordination of care is an issue that centers on the communication of patient care information from other care providers back to the member’s PCP. Because of the nature of this information, it is also viewed as an issue of patient safety.

The role of the PCP is to oversee and coordinate the care received by their patients. This process can become especially difficult since Gateway’s members are permitted to self–refer for OB/Gyn care as well as to behavioral health specialists. When patients are admitted to hospitals or skilled nursing facilities or are referred to home health agencies for care, managing their care can become even more difficult. Receiving reports of therapies provided and concerns identified by other care providers is essential to ensure that the patient’s care is safe, proper, and unduplicated.

Gateway monitors continuity and coordination of care during routine PCP medical record reviews (MRR), as well as through focus studies and the provider satisfaction survey. The three standards that are utilized to determine this level during MRR, especially as it relates to patient safety, are:

• evidence of physician review by initialing of lab/x-ray reports
• presence of reports of consultation
• notation of a time frame for the next office visit.

In 2003, the PCP MRR scores for these standards were above the required 85% for PCPs, with the lowest score being for return visit time frames. A MRR study of high volume skilled nursing facilities and home health agencies showed that they sent communications and discharge summaries to PCPs 100% of the time.

We see a very different picture when we look at communications from other providers back to PCPs. Based on the results of the latest Provider Satisfaction Survey, 74.1% of PCPs stated that specialists communicated back to them concerning their members, and 84.8% reported that hospitals had sent discharge summaries. In December 2003, a telephonic study was performed of a random sample of members who had received care in 2002 by seven specialties. The purpose was to verify if the member’s PCP had received communication from the specialist. The results were below the 85% standard, demonstrating a suboptimal rate of communication of our members’ care back to the PCP.

Those specialties included in the telephonic survey and their scores are as follows:

Help from all physicians is needed to improve this aspect of patient care. Some things you can do are:

• routinely have patients sign a form permitting the sharing of information between your office and any other provider involved in their care
• file all progress notes, orders, etc. received from other care providers, including skilled nursing facilities or home health agencies
• ask your patients if they are receiving any other medical services
• utilize a progress note or stamp that addresses follow-up at each visit
• instruct office staff to document on the progress note when patient is to return (from super bill) if physicians don’t include it.
• verify members’ PCP from their ID card
• locate PCP addresses in the new directory mailed out to all Specialists in December 2003, or at Gateway’s website at www.gatewayhealthplan.com (select Find a Provider)
• utilize the “Physician Communication Form” and the “Gynecology Patient Visit Summary” on Gateway’s website located in the Forms section.

It is each provider’s responsibility to ensure that all patient care information is communicated back to the PCP either in the form of a consultation report or shared verbally with the PCP who must document the conversation in a progress note. Utilizing these suggestions will help to ensure safe and proper patient care.