PRACTICE PEARLS

One strategy for saving time during Medicare annual wellness visits is to leverage the required personalized screening schedule at the conclusion of the visit to create a patient summary. I created an EHR template for this that I complete using data my nurse and I collect before and during the visit. The template lists adult immunizations, screening tests, and labs with the date completed or due. I also include a brief summary of what we talked about at the visit with follow-up instructions and general counseling for healthy living. I send this as a comprehensive letter through the patient portal (or U.S. mail if they can't access the portal).

Patients love the summary because it serves as a reminder for things they need to do and can be shared with family members. The summary becomes my “worksheet” for the following year. In 12 months, I can print it off and my nurse and I only need to update it with new information. It's easy to identify the summary in the chart, so any physician who needs to see where the patient is with these items can find the information at a glance.

Teams that deal with conflict in a healthy way tend to have better results. Here's how to help team members feel safe to disagree:

1. Normalize conflict. Let team members know that conflict is OK, and develop norms for how to interact — e.g., “focus on the issue” and “respect different perspectives.”

2. Name tensions. Common tensions on a team might include speed vs. quality or innovation vs. status quo. Discuss how these tensions can be positive — e.g., by ensuring work is timely and high quality.

3. Depersonalize the problem. For example, ask team members to argue against their own position.

4. Stay calm. Model comfort when conflicts arise, and keep the focus on shared goals.

Q Our health system was recently purchased by another entity, and our new contracts offer family physicians lower payment per relative value unit (RVU) than internists. What can we do?

A You do not have to accept payment rates that undervalue family physicians, and you should attempt to negotiate your contract. Compensation per RVU varies across and within specialties. Compensation packages for family medicine should align with the value provided by primary care's core functions: first contact, continuity, comprehensiveness, and coordination of care.¹ Salary structures, levels, benefits, and policies should also foster internal equity.

The first step is to understand your value — what the fair market rates are for family medicine in your area, based on recent data. Most employers use compensation surveys, such as the Medical Group Management Association's (MGMA's) annual “Physician Compensation and Production Survey,” as one factor in setting compensation. The median compensation rates can vary by more than 15% based on factors such as employer type, geographic location, and years in practice. Use accessible data sources like the American Academy of Family Physicians' (AAFP's) Career Benchmark Dashboard or Resolve's rData, which gives you access to compensation offers being made to your colleagues and access to MGMA data.

Ensuring that your colleagues are also aware of fair market data can help you feel confident in approaching your new employer. Consider sharing the AAFP's “Principles to Optimize Family Physician Employment”¹ with your compensation team. Expressing your dissatisfaction with the offer, backed up by data, may lead to a revised compensation plan. To prepare for negotiations, outline your priorities and understand when you are willing to walk away. If you aren't satisfied with the offer, it may be worth investigating new opportunities with a different employer.