Office Visit Care Teams in the Age of COVID - with Jim Jerzak, MD
I want to return to my blog series discussing with healthcare leaders about the impact of the pandemic on burnout. Today I'll share my discussion with Jim Jerzak, MD who spearheaded the practice of utilizing the office care team at Bellin Health in Wisconsin.
At Bellin, and other organizations, the office care team approach has been used to free up physicians for the work that they are trained to do instead of being mired in data entry and administrivia.
At Bellin, and other organizations, the office care team approach has been used to free up physicians for the work that they are trained to do instead of being mired in data entry and administrivia. This is done by uptraining medical assistants (MAs) and LPNs into a new role – care team coordinator (CTC).
With CTCs, the visit can run more smoothly and there is less charting at the end of the day. The CTC rooms the patient, collects vitals as usual and then initiates the visit by populating the problem list and gathering some of the history. Following this, the physician then joins the encounter and the CTC acts as a scribe throughout the encounter, and at the end helps the patient set up the follow-up appointment.
A frequent challenge to implementing team care is the cost of additional CTCs, which can hurt the bottom line if the practice can’t increase productivity by 10-15%. Financially, Bellin Health is realizing that long term sustainability is going to come not from increased visits but from enhanced efficiency of team-based processes in the era of value-based payments.
Using alternative (and less expensive) staff for visits – like RNs for BP checks, Pharmacists for diabetic med management, and the MA/LPN staff for enhanced roles in quality measure work – all adds up not only to increased reimbursements for quality measure attainment, and ultimately, to decreased cost of care – a key in value-based schemes.
In our post-COVID landscape new challenges have emerged. CTCs and other support staff are more difficult to recruit, train and retain since the pandemic. In fact, Bellin Health has implemented a significant pay raise to help retain staff. There have also been changing regulations and recommendations against having increased numbers of people in exam rooms.
Additionally, patients now are expecting more out of their visits, as patients’ issues are more complex and co-pays are higher. Virtual visits have now become more commonplace as well which shifts the dynamic of how rooming and charting come into play.
In our post-COVID landscape different challenges have emerged [...] staff are more difficult to recruit, train and retain since the pandemic[...] patients are expecting more out of their visits and their visits are more complex with higher co-pays.
Bellin has been addressing these issues and continued to refine their team-based care approach for virtual visits. Dr Jerzak notes his MA has begun to set up follow-up appointments for patients during the rooming process, another time-saving effort that has simplified the process of most encounters and has helped alleviate some of the short-staffing issues.
Other members of the care team, including pharmacists and nurse case managers, play a vital role in helping with the complex patient population by spending time with these patients. Bellin is also beginning to take this approach to specialty and sub-specialty providers to move the initiative beyond primary care.
A Place for Virtual Scribes?
While CTC availability is a real issue, there are exciting opportunities that virtual scribe technology brings to free up both physicians and medical assistants. Saykara is one of a number of virtual scribe options that use AI to generate a note by recording the conversation between physician and patient. It was recently acquired by Nuance, the company that provides the familiar voice-to-text charting tool Dragon and is promoting DAX, its “Ambient eXperience”. Nuance was also recently acquired by Microsoft which may open up an entirely new world of possibilities for the AI directed virtual scribe.
All of these practice changes are implemented most effectively when done so using the Lean Value Stream Mapping approach, to maximize the benefits of technology and workflow redesign.