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New ACP Policy Paper Provides Recommendations for More Effective Collaboration Between Primary Care Specialists, Specialty Physicians

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Paper aligns with the proposed ACP model of care, which includes principles for ensuring meaningful collaboration between multiple clinicians

May 6, 2022 (ACP) — Patients and physicians alike can encounter frustrations during the referral process and follow-up coordination of care. The American College of Physicians is now leading the way toward a healthier and more collaborative future between primary care and specialty physicians.

In a new policy paper titled “Beyond the Referral: Principles of Effective, Ongoing Primary and Specialty Care Collaboration,” ACP outlines how care coordination between clinicians should be improved to eliminate fragmented care, lower risks for errors and relieve patient and clinician frustration.

“Patients can find [the referral process] confusing and burdensome, specialty physicians can find that referrals are missing needed history or information, and primary care physicians may find the reports difficult to obtain after a specialist visit,” Dr. George M. Abraham, president of ACP, said during a press briefing at the ACP Internal Medicine Meeting, held April 28 to 30 in Chicago. “With visits to specialty care clinicians comprising more than half of all outpatient visits and the referral rate increasing, it's important that we make the system less frustrating for everyone. … If we can improve our collaboration with each other, we can help to improve the care of our patients.”

The policy paper and accompanying playbook outline four guiding principles that should underpin primary care and specialty care collaborations:

  • Patient and Family Partnering: Clinical care teams should work collaboratively with patients, families, and caregivers to empower them to be active partners in all aspects of their care. Their needs, preferences and limitations should be actively predicted, solicited and considered in all care encounters and decisions.
  • Defined Clinical Roles and Responsibilities: The roles, responsibilities and mutual expectations of primary care and specialty care team members should be clear and acceptable to all parties, including patients and families.
    “The specialist may be providing advice or input or may be taking a lead on a given patient's care. Those different roles need to be understood up front,” said Shari Erickson, ACP chief advocacy officer and senior vice president.
  • Timely, Productive Communication: All parties should engage in timely, informative, and focused communication with one another that highlights critical issues and/or items needing action.
    “There shouldn't be an overwhelming amount of communication, just the right amount at the right time to make sure everybody is on the same page,” Erickson explained.
  • Effective Data Sharing: Patient data should be shared in a timely, thorough, actionable, and well-organized manner.

The accompanying playbook defines what is needed for each specific role or working relationship when multiple clinicians are caring for a patient; it also outlines the critical elements of a referral request and response.

According to Erickson, the policy paper dovetails with the ACP focus on payment reform, specifically the payment model that ACP developed — the Medical Neighborhood Model of care — which focuses on care coordination between primary care specialists and specialty physicians. “Our proposed model, developed with the National Committee for Quality Assurance, works with any specialty that needs to interact with primary care offices,” she said. “The policy paper provides a general framework about how these arrangements can be successful in the payment model.”

During the press briefing, Erickson added, “the aim of our model is to strengthen relationships between primary care specialists and specialist physicians. We believe better coordinating care from internal medicine physicians who provide primary care and other primary care physicians with their specialist and subspecialist colleagues has the potential to open up access and allow specialist physicians to see more urgent cases sooner.”

More Information

The policy paper, “Beyond the Referral: Principals of Effective, Ongoing Primary and Specialty Care Collaboration,” and accompanying playbook are available on the ACP website.

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Back to the May 6, 2022 issue of ACP Advocate