In an old-fashioned practice model, the physician is solely responsible for most, if not all of the work undertaking of his facility, which also involves charge entry, to medical billing and coding till the time of claims reimbursements.
Sharing the workload
With the team care model, however, the physician and clinical assistant share these responsibilities. The clinical assistant handles much of the data gathering, including documenting the patient’s complaints and gaining additional detail through questioning. The physician can develop protocols and templates based on specific patient complaints and chronic conditions that direct the clinical assistant’s questioning.
Team-based care has been promoted as one essential component necessary for meeting the supply and demand imbalance in the workforce and as well serving as a crucial element of improving health care delivery. For instance in oncology, team-based care takes many forms: inpatient care management teams or multidisciplinary disease-oriented care programs, for example. Teams may be large or small and may be located in a variety of practice settings, from the private oncology office to the academic medical center.
It is, therefore, difficult to define team-based care, but the structure of such a definition can be found in the conceptual description of health care delivery by the Institute of Medicine: “All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team, emphasizing evidence-based practice, quality improvement approaches, and informatics.”
Patient-Centered Medical Home
One practice model that has been promoted as able to improve patient care delivery is the patient-centered medical home (PCMH). In this model, a physician-directed network of care is provided for the individual patient; that care may be provided by other physicians, non-physician providers, or allied ancillary health services.
Although the model was initially promoted for effective management of chronic disease, it has been demonstrated to be an effective model for the delivery of oncology care.8 Team-based care is an essential element of the PCMH model, but building successful teams may be difficult in the face of provider shortages. One focus on meeting provider workforce shortages in oncology has been on the role of physician assistants (PAs) and nurse practitioners (NPs). Along with that, the support of specialty medical billers and coders in the team is also vital.
Today, as both clinicians and patients integrate new technologies into their management process, the overall rapidity of change in healthcare systems will continue to accelerate.
The U.S. National Guideline Clearinghouse has listed over 2,700 clinical practice guidelines now, and, each year, the results of more than 25,000 new clinical trials are published. No single practitioner can handle, absorb and use all this information, and the need for specific knowledge in specialized areas of care by different team members has become a necessity.
Now, more than ever, there is an obligation to strive for perfection in the science and practice of inter-professional team-based health care. Each clinician relies on information and action from other team members. Yet, without explicit acknowledgment and purposeful cultivation of the team, systematic inefficiencies and errors cannot be addressed and prevented.
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