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Team approach to health care means new role for doctors

Sophie Quinton, Stateline.org on

Published in Health & Fitness

But most doctors will have to adapt, said Randall Wilson, an associate research director for Jobs for the Future, a nonprofit that advocates for increasing job skills. "People see the writing on the wall."

Americans spend more on health care than people in other wealthy nations. Yet Americans live shorter lives and are more likely to be obese or hospitalized for chronic conditions, such as asthma or diabetes.

One culprit, health experts say, is America's fragmented health care system. Americans rely on a mix of specialists and settings for care, but those pieces of the health care system don't necessarily communicate or coordinate with each other.

The fee-for-service payment system, which rewards hospitals, clinics and doctors for the volume of procedures they provide, is another contributor. Health insurers will pay for a patient to sit down with a doctor. What they sometimes don't pay for are other services, such as a visit from a community health worker or a phone call with a nurse, which can prevent medical emergencies and save patients and insurers a lot of money on expensive treatments.

New payment models encourage health systems to deploy their workers more efficiently -- while also avoiding unnecessary services and costly errors. For instance, Medicare will now issue some hospitals a single payment to cover everything that happens to a patient from the moment they enter a hospital for knee replacement surgery to three months after they go home to start recuperating.

Distributing work across team members can help keep costs down, relieve doctors of the busywork that jams up their day, and make everyone more productive.

Most state Medicaid systems are shifting to "managed care" models and paying organizations a set fee per patient per month to cover all the services they provide. In a 2016 survey of state Medicaid directors, nearly half of states said their top priority for the coming year was changing the way health care is delivered and payments are structured.

Major physician associations also support improving teamwork and collaboration among health care professionals. So do medical school leaders. For some years now, accreditors have required colleges and universities that train doctors, nurses, pharmacists, dentists and public health experts to teach students to work in teams.

But many doctors aren't comfortable with the idea that they don't always need to be in charge.

Medical associations have pushed back against proposals to expand the medical decisions non-doctors are able to make on their own. Health professionals' "scope of practice" is governed by laws that vary from state to state. "While some scope expansions may be appropriate, others definitely are not," the American Medical Association says on its website.

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