Team Care: ACP Outlines Framework

Marcia Frellick

September 16, 2013

As healthcare shifts from single-provider to a team-based model, the American College of Physicians (ACP) has outlined more than a dozen principles for encouraging collaboration and smooth transitions among providers.

"These principles offer a framework for an evolving, updated approach to health care delivery, providing policy guidance that can be useful to clinical teams themselves in organizing their care processes and clinician responsibilities consistent with professionalism," said Molly Cooke, MD, president of the ACP, in a related news release.

The college's policy paper, published online September 17 in the Annals of Internal Medicine, includes these guidelines:

  • Patients should be matched with the most qualified team members who are available at the time to deliver care.

  • The patient should have access to a personal physician trained in the care of the "whole person."

  • Teams should assign responsibilities to advanced practice registered nurses, other registered nurses, physician assistants, clinical pharmacists, and other healthcare professionals commensurate with their skills.

  • Clinicians within a care team should be permitted to practice to the full scope of their professional licenses.

  • Advanced practice registered nurses and physician assistants cannot substitute for or replace the expertise of physicians, but when they practice to the top of their licenses, they can provide complementary and unique approaches.

  • Especially in geographic areas with a shortage of physicians, the patient should have access to a "virtual" clinical care team through use of telemedicine, electronic health records, and telephone consultations.

  • Reimbursement and compensation should appropriately reflect the complexity of the care provided.

  • Payment systems that require the team to accept financial risk must account for differences in the risk and complexity of the patient population.

  • State legislatures should conduct an evidence-based review of licensing laws to ensure they recognize that the skills, training, clinical experience, and competencies of physicians, nurses, physician assistants, and other health professionals are not equal and not interchangeable.

Mixed Reactions

"We hope to encourage positive dialogue among all healthcare professions to advance team-based and collaborative models that are organized for the benefit and best interests of patients," Dr. Cooke said.

However, the policy statement drew varied reactions for stakeholders, as evidenced by several accompanying editorials. For example, in one editorial, the American Association of Nurse Practitioners takes issue with many of the principles, primarily the assertion that physicians are best suited to lead healthcare teams.

In another editorial, titled "Taking One for the Team," Anna Reisman, MD, from the Yale School of Medicine in New Haven, Connecticut, acknowledges that although some nurse practitioners will not cheer the ACP's recommendations, the position paper adds an important voice in calling healthcare teams to understand and appreciate the role of each member.

A third editorial, by Thomas S. Huddle, MD, PhD, from the University of Alabama at Birmingham School of Medicine, says the paper is a useful first step in addressing barriers to team-based care, including reimbursement issues and shifts in physician culture.

Annals Intern Med. Published online September 17, 2013. Abstract

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