ACP Provides Guidance for Expansion of Physician-Led Team-Based Care

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Policy paper recommendations aim to improve patient outcomes, achieve efficiency, encourage communication and collaboration and expand access to care

Jan. 12, 2024 (ACP) -- In a new policy paper, the American College of Physicians makes recommendations to expand use of team-based care, which continues to face significant obstacles to its implementation despite links to better patient outcomes and lower burnout.

“Wider use of physician-led health care teams would be extremely beneficial for patients, physicians and the rest of the health care team,” said Dr. Omar T. Atiq, president of ACP. “As a practicing physician, I have seen how valuable it is to have all different types of my health care colleagues working with our unique skills and training to provide the best possible care for our patients under the leadership of a physician who has the training and experience to lead the team.”

The policy paper, titled “Principles for the Physician-Led Patient-Centered Medical Home and Other Approaches to Team-Based Care,” was published Dec. 26 in the Annals of Internal Medicine. It updates the 2013 ACP position paper “Principles Supporting Dynamic Clinical Care Teams” and “The Advanced Medical Home: A Patient-Centered Physician-Guided Model of Health Care” policy monograph, published in 2006.

“Health care teams work toward fulfilling the patient's needs -- promoting health and preventing and treating disease,” explained Ryan Crowley, ACP senior associate for health policy and senior author on the paper. “When done well, team-based care can improve patient outcomes, achieve efficiency, encourage communication and collaboration among clinicians and expand access to care.”

However, in the paper, Crowley and colleagues note that potential obstacles stand in the way of progress, such as “high implementation costs, insufficient financial incentives and scope of practice changes that permit nonphysician health care professionals to practice outside of the physician-led team-based model.”

In addition, the authors warn that the corporatization of health care and the rise of profit-driven medicine threaten physician-led clinical care teams.

In the paper ACP highlights the importance of proper team leadership. “Physicians have extensive education, skills and training that make them most qualified to exercise advanced clinical responsibilities within teams,” Crowley said. “Teams should be led by a physician.”

Other recommendations include:

  • Interprofessional training should be conducted “in effective communication, collaboration, recognition of professional boundaries and other fundamentals of team-based care,” and physicians should have “autonomy in determining adequate and appropriate supervision of nonphysician health care professionals.”
  • All health care professionals, administrators and other parties should refrain from using the term “provider” and refer to health care professionals by the professional title in which they are credentialed and licensed.
  • In terms of licensure, “the independent practice of medicine should only be performed by physicians.” As Crowley explained, “Licensure helps ensure that health care team members have the right skills and competencies to deliver safe and effective care to patients. It also acts as a safeguard to prevent clinicians from practicing beyond their capabilities. One way the licensure process can be improved is by making it easier for physicians to be licensed in multiple states so they can practice virtual team-based care.”
  • Health care delivery and payment should be redesigned to support physician-led, team-based care delivery models. These models include Patient-Centered Medical Homes and Patient-Centered Medical Home Neighbor practices. Research should also continue into the optimal workings of these kinds of models to achieve the best outcomes for patients.

Overall, the authors of the policy paper state that the principles highlighted in the paper “represent a renewed call on policymakers to ensure that all patients -- including those residing in rural and other medically underserved areas -- have access to a personal physician with leadership of a highly skilled clinical care team trained to deliver whole-person, comprehensive, and longitudinal care.”

More Information

The policy paper, “Principles for the Physician-Led Patient-Centered Medical Home and Other Approaches to Team-Based Care,” is available on the Annals of Internal Medicine website.

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