Ensuring Continuity and Coordination of Care
Posted on February 12, 2010
Confidentiality of patient information has always been foremost in the minds of HNE. The advent of HIPAA has actually simplified the process for those providers caring for a specific patient by permitting the sharing of pertinent information without the need for the patient’s signature. The PCP’s role is to not only provide first-line care, but also to oversee and coordinate the care that his or her patients receive from other providers. Communicating patient care information from other care providers back to the member’s PCP is very important to help ensure safe care. Failure to share information about a patient’s care can result in suboptimal outcomes, increased costs, and medical errors. This process can become especially difficult for the majority of HNE members since they are permitted to self–refer to most specialists, including behavioral health specialists. Whenever patients are admitted to hospitals or skilled nursing facilities or when they are referred to home health agencies for care, managing their care can become even more fragmented for PCPs. Receiving reports of therapies and medications provided and concerns identified by other care providers is essential to ensure that the patient’s care is safe, proper, and unduplicated. This does not always occur, even when the referral process is utilized.
HNE monitors continuity and coordination of care annually through medical record review of PCPs, high-volume specialists and OB/GYNs, skilled nursing facilities, and home health agencies; the provider satisfaction survey; and through focus studies. During medical record review, HNE assesses continuity and coordination of care by reviewing three key pieces of information in medical records: 1. Presence of reports of consultation 2. Evidence of physician review by initialing of lab/x-ray reports 3. Notation of a time frame for the next office visit.
To improve the communication process, we need help from all providers.
We ask all PCPs to:
· File all progress notes, visit and discharge summaries, and other care documentation received from other care providers, including skilled nursing facilities or home health agencies.
· Ask your patients if they are receiving any other medical services.
· Document any verbal communications with other care providers in the patient’s chart.
Specialists should:
· Verify with the member the member’s PCP
· Send a report of consultation or speak with the PCP.
o Locate PCP addresses in the PCP Provider Directory on HNE’s website
Good communication will help to ensure safe and proper patient care.
