Practice Management News

Practice Redesign

Taking the Leap ... Adding More Time with Patients

Tired of the burden of non-physician tasks that reduce time spent with patients? What if you could share some of this work with your team, freeing you to do more of what you were trained to do?

Frustrated by several pay cuts and constraints imposed by managed care, and with his back against the wall, family physician Peter Anderson in Newport News, VA decided he had to act.

To transform his practice, Dr. Anderson took several important steps. First, he increased clinical support staff to 3.5 FTEs (versus the national median of 1.56).[1] The extra team members could assist with several important parts of the patient visit:

Retrieve patient information from the electronic health record (EHR);
Update medication lists;
Document a thorough patient history and complete review of systems; and
Review diagnoses and treatment plans for each patient's previous two office visits.

The result? Dr. Anderson's schedule opened up significantly, which allowed him to spend more time with patients instead of completing forms and looking for missing patient information in the EHR. Both Dr. Anderson and his staff reported they would never go back to the old way of doing things. With 15-minute appointment slots, Dr. Anderson's visit volume increased significantly; he typically sees 30 patients per day.

The mechanics of the clinical encounter typically work as follows:

The patient is roomed.
When Dr. Anderson arrives, nursing staff reports patient information directly to Dr. Anderson in front of the patient.
Dr. Anderson examines the patient, discusses treatment options and dictates his findings and action plan.
As this occurs, staff concurrently enters the information into the EHR.
Dr. Anderson may also make brief visit notes on the EHR summary sheet for entry at the end of the visit.

During a typical work day, two Registered Nurses and one Medical Assistant assist Dr. Anderson, who believes this approach-increasing the involvement of the care team and shifting responsibilities-is essential to becoming a Patient Centered Medical Home. He says, "It's amazing how much medicine can be practiced when the patient is presented to you versus having to gather the information yourself."

Increasing staff training was an important component to this process. For newer nursing staff, a shadowing and training review process is essential. Shadowing typically occurs for a week and Dr. Anderson has taken the lead in developing training materials. After that week, nurses begin basic documentation; it typically takes three months to become an expert at the process. Nursing staff have also undergone additional EHR training to enable them to more proficiently obtain needed information.

For Dr. Anderson, the family team care model he developed has restored the physician-patient relationship. Being available to communicate with patients has renewed his job satisfaction. A recent site visit to Dr. Anderson's office, Hilton Family Practice, confirmed the findings. Dr. Anderson and his staff were very busy. The practice, however, ran efficiently and staff members appeared satisfied with the intentional design of workflow processes. Dr. Anderson is a member of the multispecialty Riverside Medical Group, which has more than 300 physicians in 132 locations in Virginia. His net revenues for 2009 were $630,000. His salary with benefits totaled $227,500 and he has five weeks of vacation per year.

For a brief "Instant Site Visit" with Hilton Family Practice, check out this YouTube link. In the video, Dr. Anderson describes how he decided to change the way he and his staff work and the positive effects to his practice that resulted. The site visit also includes operational, financial and satisfaction data. For more information on Hilton Family Practice, please click here.

Suzanne Houck serves as President of Houck & Associates Inc., a leader in ambulatory care redesign consulting and training. Sue is the author of What Works: Effective Tools & Case Studies to Improve Clinical Office Practice, the first comprehensive book on ambulatory care redesign. She also has experience as an ambulatory care manager and nurse practitioner throughout the United States and Africa.

DISCLAIMER

The articles provided in Practice Management News are general. They do not constitute legal, practice management or coding advice in any particular factual situation or create an attorney-client relationship. Consult your attorney or other professional for advice in your particular situation.

[1] Cost survey for Single Specialty Practices. (2008).Medical Group Management Association, p. 19.