Physician-Driven, Patient-Centered: Much More Than Words

As health care increasingly moves away from episodic, hospital-centric care to population health, there is increasingly a need for physicians and providers to take a lead in managing patients across the continuum. This requires communication and data-sharing between settings, the ability to both lead and support team members, a broad knowledge of regulatory issues and compliance, and a relationship with patients that goes well beyond a name on a chart. This last point is especially notable, as physician-driven care also needs to be patient-centered.

The benefits of physician-driven care, particularly for rehab and restorative care, are numerous:

• Physicians can focus on restoring function to patients, address barriers to progress in therapy, and diagnose/manage neurological or orthopedic conditions. For instance, at Community Physicians, we assign a dedicated physiatrist to round at a facility twice weekly at set times. Consistency and timeliness are essential to keeping patient progress on track and ensuring that any complication or acute changes are recognized and addressed promptly.
• Specialty care. Pain is very common in our patients, and our physiatrists are pain management specialists. They are trained in electrodiagnostic medicine, tests that measure the efficiency of nerve and muscle functions. They also manage pain medications/opioids and perform ultrasound-guided injections with their portable ultrasound machines to help wean patients off pain medications. This is especially significant as the misuse/overuse of opioids has become a public health emergency. The Centers for Medicare and Medicaid Services (CMS) has made reducing opioid prescribing a policy issue and priority in recent years. Between 2017 and 2019, the agency sent 25,000 letters to Medicare clinicians to compare their prescribing practices to those of their peers and to emphasize patient-centered care and safety. Just last year, the agency introduced a “roadmap” strategy to fight the opioid crisis, with a focus on prevention, treatment, and data. Having physicians who are experts on pain management is an essential component of any strategy to maximize patient function and quality of life, while reducing opioid use.
• Reduction in readmission rates. Physician-driven care means increased patient contact and coordination/communication with the care team. As a result, acute/emergent issues are caught and addressed early. This helps avoid emergency room visits and readmissions. Our physicians work closely with staff, so that they have the resources and skills they need to address acute changes of condition, adverse events, and emergent problems. Lower readmission rates not only are better for patient outcomes, they also help improve facilities’ Star ratings and drive more referrals.
• Data that matters. Physician-driven care means physician-generated data. For instance, we track all unplanned discharges and provide quarterly statistics and analysis to discover root causes and help implement procedures to reduce readmission rates and identify opportunities for quality improvement.
• Provider communication. One key lesson from the COVID pandemic has been the importance of communication and information sharing. When we interact and communicate with local surgeons, hospitals, clinics, and social workers, the result is better, more patient-centered care across the continuum.

Physician-driven care means we wear a lot of hats, but we’re also team players. We work closely with the facility’s interdisciplinary team. We participate in Medicare meetings, utilization review meetings, family meetings, and peer-to-peer reviews. We also provide appeals to insurance denials and assist social work, nursing, and the rehab team with discharge planning, advance care planning, and signing of orders.

Our vision of physician-driven care means that facilities get a dedicated physiatrist to run a comprehensive rehab program and hospital-level care, all within their buildings. We can help discharge patients quicker and safer, and we add a layer of clinical oversight and capabilities to skilled nursing facilities and a patient population that has been historically underserved.