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    Ciara Lewin
    Ciara Lewin, MBA
    Bringing in additional hands to your practice should be effortless, profitable and stress-free, but plugging in new resources in different offices, regions or time zones can create discomfort.

    Here are key considerations for successful outsourcing to boost the support your clinical team gets while avoiding added headaches.

    Mitigating burnout

    Burnout affects providers and office staff across all specialties, whether you are facing decreased revenue, increased administrative tasks or unrealistic patient loads.

    Operating in a mental state of exhaustion, depression or hopelessness impacts professional and personal relationships and directly impedes the success of your practice. Technological advancements that aid in workload distribution via seamless workflows can be just as helpful in alleviating the pressures of running a practice as offering traditional mental health resources and programs.

    Understand your needs

    To outline a successful plan of action, you should understand how operational gaps contribute to burnout and practice inefficiency. Here are a few questions to determine whether your practice should consider remote clinical support:
    1. Is your daily provider-to-patient ratio greater than 1:25?
    2. Are more than 30% of visits done via telehealth?
    3. Are physicians responsible for charting as well as treating patients?
    4. Is there value in seeing more patients if the workload can be reduced?
    5. Is it difficult to spend more time with patients?
    If you answer “yes” to any of these questions, it’s time to take steps to attain the relief you need and deserve.

    Optimizing clinician workflows

    Incorporating remote clinical support can be achieved with the right process and goals in mind. Your outsourcing vendor can help determine where your practice can reap the most benefits (e.g., front office, triage, examination, post-visit). Let’s take Dr. Smith’s practice as an example.  

    Dr. Smith’s family practice has served his community for more than 10 years. His wife works as practice manager, and he has one nurse practitioner (NP), two nurses and one medical assistant (MA) who also serves as front office rep. Each staffer feels overwhelmed amidst the COVID-19 pandemic and desperately needs a vacation, which Dr. Smith recognizes. Dr. Smith was recently informed that a nearby practice will be closing and he hopes to bring on some of those patients in the upcoming months.

    Working in the practice’s EHR, Dr. Smith has created templates that work for him. After trial and error, he has established a process of ensuring timely billing. His wife understands basic coding and billing and can answer patient billing and appointment questions when the MA is unavailable.

    After sitting down with their outsourcing partner, Dr. Smith begins with a tiered implementation to help alleviate the burden on his team while also preparing to see new patients from the other practice.  This involves 3 phases: tele-health clinical support, specialist and referral followup and patient after hour services.

    The first phase involves having two full-time remote RNs whose education and experience aligns with general medicine. The hourly rate for these RNs is 45% less than his current staff’s compensation. While the current nurses support complex cases and patients seen in the office, the two remote RNs assist the providers in their telehealth visits. The RNs’ role is to begin every telehealth visit with a comprehensive assessment, which includes patient demographic updates, reason for visit, history, review of systems and current medications. As the visit begins, the RN starts charting in the EHR using secure credentials and permissions and clearly documents the visit using the preferred provider template. Once charting is nearly complete, she notifies Dr. Smith that the patient is ready and goes on mute as the examination and medical decision making takes place. Dr. Smith listens to the patient’s complaints and then summarizes the patient’s history and performs his assessment. Charting within the system, the RN takes note of all plans of action including new medication dosage and Dr. Smith’s specialty referral. Dr. Smith ends his discussion with the patient by emphasizing that the RN will provide more education on the medication and recap the plan of action. Jumping off the telehealth visit, Dr. Smith moves on to the next patient, who is almost finished meeting with the second RN.

    The first RN continues the visit with the first patient by recapping the assessment, medication changes, specialty follow-up and answers the patient’s questions. Via the EHR, she also sends the referral request to the specialist and sends the prescription order, which was signed by Dr. Smith during the examination, to the preferred pharmacy. She continues by sending educational materials to the patient through the patient portal and shares the summary of the visit with the referring specialist. The RN ends the visit by ensuring the patient can access the patient portal so that any additional questions can be directed to her first before reaching Dr. Smith.

    By incorporating this workflow, Dr. Smith has gone from a 14-hour workday to just eight hours. With the assistance of his remote RNs, his charting is complete and only requires a few moments of review and authentication. Rather than spending time in selecting the applicable billing codes, the RNs capture such data in the EHR and only requires his input if he disagrees with the said codes. His previous workday that 30% of the time was being spent in administrative tasks related to charting, coding and specialist referral has now been significantly reduced. Taking work home is now a thing of the past and he can once again enjoy the feeling of relief. As more patients are scheduled, he utilizes a strategic ratio of one RN to each 25 patients to ensure quality care and scalability.

    The next article will focus on Phases 2 and 3 of clinical support: serving patients after hours and ensuring specialty follow-up efficiency.

    Learn more

    • Read Part 1 of Ciara Lewin's article series on outsourcing.
    Ciara Lewin

    Written By

    Ciara Lewin, MBA

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