Rethink the Essential Role of Primary Care Physicians in TEAM

With TEAM’s focus on improving surgical recoveries and costs in major hospital-based surgeries, it’s easy to miss the importance of primary care physicians. But their role is essential for meeting TEAM’s objective to improve patient recovery and lower costs in the five major types of surgery covered by TEAM. And perhaps not in the way that is written in the TEAM Final Rule.

The scope of primary care physicians for TEAM requires PCP referral only after surgery and upon patient discharge. That is too late for PCPs to help prevent patient complications by evaluating their conditions and treating them before surgery. TEAM’s goal is to repair fragmented communication and services in specialty care, but it will fall short if hospitals and specialists fail to recognize that primary care physician must be involved in perioperative as well as in aftercare.

There are functions within TEAM that fall solidly within the scope of primary care practices. Notably, ERAS evidence-based guidelines for cardiac and other surgeries include preoperative tests and treatments that provide a pathway to improved patient outcomes during and after surgery. Cardiac surgery recommendations include a wide range of tests, patient engagement, and functional improvements in the patient’s status prior to surgery. These include measurement of A1c and Albumin for risk stratification, as well as preoperative correction of nutritional deficiencies, patient counseling and prehabilitation, and cessation of smoking and alcohol.

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