Increasing productivity in a primary care practice without expecting physicians to work even longer hours is an ongoing challenge.
Some practices have found a solution by training medical assistants to handle more patient care tasks that do not require a physician's direct involvement. Representatives from two such practices discussed their experiences at a recent Brookings Institution webinar, Transforming Practices to Promote Population Health and Improve Workforce Retention.(www.brookings.edu)
An estimated 500,000 medical assistants are employed nationwide. Their scope of practice is defined in only six states, however, and low pay and limited opportunity lead to high turnover.
Sharon Lucie, B.S.N., vice president of operations for the North Shore Physicians Group in Massachusetts, discussed during the webinar how the group enhanced the role of medical assistants to reduce turnover, improve patient care and ease physicians' daily work load across 12 primary care offices. The group estimated that each of its physicians is responsible for seven hours of patient care and 14 hours of administrative work each day.
The transformation required redesigning the medical assistant job. Instead of being responsible only for room preparation and taking vitals, medical assistants were trained to act as patient coaches and process advocates. These changes were part of a larger workflow adjustment needed to meet the increased responsibilities required of medical homes with Level 3 certification.
- Some practices have aimed to increase patient and staff satisfaction by giving medical assistants more training.
- Medical assistants at one health system became patient coaches and process advocates.
- Another system built on the strong relationship between health coaches and patients.
"The medical home is not the goal," Lucie said. "It's the strategy to achieve the goal."
According to Lucie, 2009 was a watershed year for the group, marking the launch of its transition to medical home status. As local retail clinics began absorbing more people with simple health needs, the various practice sites found themselves receiving more complex patients. Patient and employee satisfaction scores started to slip. Physicians wanted to improve scores in both areas.
"Our primary care medical director felt like a lone cowboy who has to manage a list of things by herself, and the list kept growing longer," she said. "Today we have a NASCAR pit crew of primary care."
Staff members begin the day with a team huddle during which they discuss the patients they will be seeing that day. To create consistency across the entire practice group, a medical assistant council with representatives from each site meets bimonthly.
Previously, medical assistants had been overloaded with administrative work, which left them feeling dissatisfied with their ability to interact with patients. Now they are "workflow managers," and they are trained to be coaches and conduct thorough patient interviews.
In addition, the practice group provides as much as $2,500 in education reimbursement to employees who commit to stay for two years. With the stipend as an incentive, some medical assistants pursued further training.
Lucie said the changes help employees, as well as patients.
The turnover rate dropped from 25 percent in 2007 to 10 percent in 2014, she said, adding, "Our waiting rooms are empty not because we have lower volume but because we don't have patients waiting."
Another speaker, Steven M. Blumberg, senior vice president and executive director for AtlantiCare Health Solutions, said the system, which has 33 primary care practices, sought to increase productivity by building on the close relationship health coaches develop with patients.
In the system's Special Care Center, which treats 2,600 individuals with chronic conditions, patients are assigned a health coach who is responsible for maintaining regular contact and delivering patient education. More than 50 percent of patient encounters are with coaches, AtlantiCare estimates.(www.brookings.edu)
Blumberg emphasized that coaches are efficient only when they are working in a managed population group. At AtlantiCare, they target "rising-risk" patients, individuals whose health habits could become worse without close supervision.
Because coaches -- many of them trained initially as medical assistants or social workers -- continue communicating with patients between and after office visits, they have strong influence on patient behavior.
"At the end of the day, the patient does not want to let the coach down," Blumberg said.
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