Tim StapletonTeam-based care: This is a phrase you’ll see and hear a lot of over the coming months.
Here’s why: The Florida Medical Association (FMA) and the Florida Academy of Family Physicians (FAFP), representing 25,000 physicians across Florida, will advocate for the concept of team-based care throughout the coming legislative committee weeks and the 2014 Session. We strongly believe that this approach would make Florida’s primary care network as efficient as possible by fostering integration and coordination.
Team-based care is a way of providing medical care to Florida patients based on the following four pillars:
- Provide high-quality care
- Protect patient safety
- Ensure patients’ access to care
- Reduce costs to taxpayers by eliminating duplication
Background
Florida faces a growing health-care workforce shortage of both physicians and nurses. At the same time, we are experiencing a rapidly increasing demand for primary care. Longer-term solutions for addressing these workforce shortages should include loan forgiveness programs for medical students, increasing the number of residency slots in Florida, and improving reimbursement for primary care services. However, there are also steps that we can take now.
The FMA and FAFP believe that the increased use of team-based care can have a positive impact on Florida’s primary care needs.
A growing number of policy experts agree, recommending team-based approaches over solo and independent practice by physicians, nurses and other providers. A team-based approach would include physicians and other health professionals such as nurse practitioners (NPs) and physician assistants (PAs) working together, drawing on the specific strengths of each member, more efficiently sharing data, and eliminating duplicative services.
Current Law
Florida’s current laws provide significant flexibility when it comes to team-based care. For example:
- Florida physicians may supervise up to four off-site primary care offices. Specialist physicians may supervise up to two specialty offices under such protocol. Thus, there are no limits on the number of ARNPs that may be supervised by one physician.
- Second, there are no mile/radius requirements in law that limit the distance between a primary care physician’s on-site office and the off-site, supervised offices. The physician must be reachable in person or by communication devices.
- Third, under an ARNP protocol, the physician delegates which duties the ARNP may perform, and which medications the ARNP may prescribe, with the exception of controlled substances. These protocols are written to accommodate a broad range of patient needs.
- Finally, current law permits ARNPs to own retail clinics. This means that a nurse does not need to be employed by a supervising physician in order to set up a delegation protocol.
- The ARNP can go through the facility licensure process and set up shop as his or her own business, just as he or she would in states that permit “independent practice.”
Given this flexibility, team-based care can be achieved within the confines of current law, though policymakers may want to take additional steps to further increase patients’ access to care.
Who should lead the team?
Health care teams require leadership, just as teams do in business, government, schools, and sports. Nurses are indispensable, but they can’t take the place of a fully-trained physician. For example, physicians are trained to provide complex differential diagnoses, develop treatment plans that address multiple organ systems, and order and interpret tests within the context of patients’ overall health conditions. The training and education of NPs is appropriate for managing patients who need basic, preventive care or treatment of straightforward acute illnesses and previously diagnosed, uncomplicated chronic conditions.
What does team-based care look like?
One of the most successful and well-known examples of team-based care is the patient-centered medical home (PCMH). The patient-centered medical home is a primary care model built around patients and delivered by teams of healthcare practitioners. Each patient has an ongoing relationship with a personal physician trained to provide first contact, complex diagnosis, and continuous, comprehensive care.
Team-based care can dramatically improve the way we deliver health care in Florida. Using team-based care can reduce emergency room visits, reduce hospital admissions and readmissions, and shorten hospital stays. It also protects patient safety, as each patient has an ongoing relationship with his or her physician. Team-based care will reduce costs by eliminating fragmented care and duplication of services, as care is better coordinated with specialists and other providers. Finally, it will ensure access to care through expanded clinical hours and new options for communication. Team-based care is a smart solution for Florida patients and the health-care professionals who provide their care.
Timothy J. Stapleton is Executive Vice President of the Florida Medical Association, which advocates for 20,000 physicians across Florida in the policy, legislative, political, regulatory, and legal arenas. Jay Millson, a twenty-year medical society executive, serves as the Executive Vice President of the Florida Association of Family Physicians.
