Faces of EviCore: Eddra Marchand
In a recent edition of the Physician's Roundtable series, Dr. Eddra Marchand described a situation where a patient was admitted for subacute care after acute treatment. Upon her review, she noticed that the patient was both hypotensive and had elevated sodium levels, and she suggested they stay in acute care until those issues were resolved. In so doing, the patient was able to move home care shortly after rather than possibly face a longer stay in the hospital setting. "Sometimes another set of eyes on a case will help build the rapport with other physicians and help to make the right decisions for the health of the patient," says Dr. Marchand. She comments that "we are still an advocate for the patient no matter what level of care they are currently at, and because of that this patient got the best care for the best outcome.”
NOLA Roots
Dr. Marchand grew up in New Orleans, where she graduated valedictorian from Xavier University of Louisiana. Not long after, she moved to Atlanta, where she attended medical school at Emory University and did her residency. Dr. Marchand still lives in the area with her daughter Mallory, son Zachary and her dogs. She received her training in internal medicine, and has spent 25 years in the field, including 12 years as an internist with Kaiser Permanente.
Making a Move
Around the time Dr. Marchand’s children started high school, a colleague introduced her to the idea of transitioning to case reviews at MedSolutions (now EviCore) because of her background in quality management. Thinking it might be a good fit for her, she interviewed with Dr. Steven Israel, and a new chapter of her life was ready to begin. Dr. Marchand had reviewed cases at Kaiser with sometimes negative outcomes, and she realized that her position at EviCore would enable her to help avoid those kinds of negative outcomes for the patients she cared for. In addition to the appeal of this kind of attentive patient care, she notes, "To continue seeing the volume of patients daily and managing all of the behind the scenes work made it very challenging to have a work/life balance, despite loving the doctor/ patient relationship ."
The best benefit of moving to EviCore, she says, is how much she has learned from her peers since making the change. She has become “much more knowledgeable about various other disciplines in the medical field, in addition to the foundation I already had developed when working in internal medicine.”
She has also touched on multiple areas of patient care, bringing her expertise to our radiology and post-acute care (PAC) specialties. Dr. Marchand is enjoying her clinical and patient-focused experiences working with the PAC team and believes she is still able to help patients secure the safest and most successful care after acute treatment. "I feel like I still have some direct impact on patient care; I still feel relevant in caring for patients."
The Ideal Peer-to-Peer Conversation
The best situation for a peer-to-peer, remarks Dr. Marchand, is when "we both can recognize that we are colleagues with a mutual patient—our goals are the same." In order to show respect for the ordering physician's knowledge, Dr. Marchand explains that you cannot "go in as if your decision is final and [the] only [option], but rather as introducing a discussion." There are a few ways to accomplish this:
- Re-introduce the case
- Ask for the ordering physician's reason for diagnosis/treatment and listen without interrupting
- Seek consensus
To build a "team-like" rapport, try to reach a mutual agreement.
Calls don't always work out that way, but she emphasizes that either way, it is important to get off the phone amicably. Her final tip is to always provide options even if she and the ordering physician do not agree in the end. That way, she says, "they have another step they can take to get to their end result, and don't feel like I've left them stuck."
Fulfilling Outcomes
Seeing an improvement in a patient's quality of life is the best experience that Dr. Marchand has faced working with the PAC program.
Many patients are older, live alone in large cities, and often live in walk-ups with several floors.
Seeing situations where a patient has had an accident and is no longer able to safely ambulate, can illuminate the new normal for members and the need for additional equipment and access to various home health needs upon their return. Recognizing that these patients are human beings is very important in our business, because it allows us to make their transition to home safe while recognizing and combating the challenges proactively.
When she sees these cases, she explains, a PT or OT may not be focusing on stair training in rehabilitation, but she often works with nurses to help suggest that, so the patients may achieve an even better quality of life once they return home.
We must carefully weigh the risks and benefits of keeping the elderly patients in the subacute setting longer than necessary, she says. Extended stays can increase the risk for nosocomial disease such as pneumonia and often in the elderly, the longer they are outside of their “normal” environment, there is increased likelihood of cognitive dysfunction.
"A familiar space is better for them on the whole," says Dr. Marchand, "Seeing a patient who's alert and oriented be able to get home and live a good quality of life is the most fulfilling part of my job."