Issue link: https://beckershealthcare.uberflip.com/i/821337
50 Executive Briefing Sponsored by: Interdisciplinary Rounds: The Key to Redesigning Care for Value T he days of solo-physician rounding are numbered, and value-based care is hastening the end. Instead, interdisci- plinary rounding is taking hold. "We believe that healthcare is now — and will be in the future — a team-based sport," said Dennis Deruelle, MD, vice president and national medical director for the Bundled Payments for Care Improvement initiative at TeamHealth. "It will be delivered in teams and if you can't work well in teams, then you won't succeed in the future of healthcare." Interdisciplinary team rounds are dedicated interactions that occur on a regular, ongoing basis throughout the patient stay between the physician and other members of the care team, which may include nurses, physical therapists, pharmacists, case managers and family members or caretakers. IDT rounds are becoming more common because they build a strong foundation for the care coordination that is essential to success in value-based care models such as CMS' BPCI and Comprehensive Care for Joint Replacement programs. They also help make care more efficient and cost effective by allow- ing for fluid decision making with the most accurate, up-to-date information available. It's not just about the physician-patient relationship any- more The traditional healthcare delivery system centered on the one-physician to one-patient theory, but that model has be- come increasingly obsolete in an era of team-based medicine and outcomes-based reimbursement. The one-to-one relation- ship is simply not reflective of care teams today — nor should it be, according to Dr. Deruelle. "As we look at shared decision making in healthcare, we really look at it between the patient and the doctor. We discuss it and design it and look at that relationship as a one-to-one relation- ship," Dr. Deruelle said. "But the reality is healthcare is delivered by teams of teams, and in particular the team around the pa- tient — their caregivers, family members and the patient — that team is not always present for rounds." Care coordination is enhanced significantly when all the im- portant decision makers — including the patient and their family members — are present to discuss care, answer ques- tions and troubleshoot potential barriers to post-acute treat- ment. For example, a physician may tell a patient that return- ing directly to the home is the best post-discharge option. The physical therapist supports the idea, and the decision appears to be made. However, if the case manager and fam- ily members were not present during the decision-making process, they may have information that precludes the pa- tient going home. By the time that additional information is available, the care team may already be blindly planning for a care pathway that is unachievable. IDT rounds can help improve clinical decision making by giv- ing caregivers access to more patient information, thereby re- ducing the need for course corrections and ultimately making care more efficient. "IDT rounds provide an opportunity for key members of the team to get together in real-time to communi- cate, to make decisions and to interact in a unique way that can- not be replicated by a series of phone calls or uncoordinated hallway conversations," Dr. Deruelle said. Coordinated communication is essential to successful care redesign Hospitals are seeing increasing value in using IDT rounds to enhance post-acute care coordination under value-based reim- bursement models. "When we undertook care value redesign, we looked at all the key touch points of a patient's stay in the hospital, including their discharge, possible readmission and possible second re- admission," Dr. Deruelle said. "In doing the care redesign, we identified interdisciplinary rounds as a key touch point for com- munication and setting the stage for the appropriate setting after the hospital." By improving communication between providers, IDT rounds can help support three integral components of value-based medicine, according to Dr. Deruelle. "IDT rounds provide an opportunity for key members of the team to get together in real-time to communicate, to make decisions and to interact in a unique way that cannot be replicated by a series of phone calls or uncoordinated hallway conversations." — Dr. Dennis Deruelle, TeamHealth Vice President and National Medical Director of BPCI