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    Michelle Burris
    Michelle Burris, MBA, FACMPE

    We’re all familiar with the adage “It takes a village to raise a child.” Is providing quality, effective care to a patient much different? It may not take a village, but it does take a team. 

    Traditionally, physicians have been the primary providers of patient care with assistance from clinical support staff. But this system can unnecessarily burden the provider and create a bottleneck in patient care delivery. As the healthcare industry transitions from volume-based to value-based healthcare and population health management, this traditional care delivery model is being challenged.  

    Volume to value and population health can be vague concepts, even for many of us in healthcare. Providers continue to face daily challenges when caring for patients: What more can they do in a given day? How can they possibly manage the health of entire community populations? 

    The answer lies with the clinical support staff, which is often underutilized in rooming patients and taking vital signs. This staff must now redefine the care team for the provider, which in one case boosted team members’ satisfaction with their work.

    Implementing wellness-based programs

    In every medical practice, the clinical support staff — registered nurses (RNs), licensed practical nurses and medical assistants — should be encouraged to work to the top of their licensure and be an integral part of the care of each and every patient. 

    As a primary care office works toward value and implements wellness-based programs such as Medicare Wellness, transitions of care (TOC) and chronic care management (CCM), the nursing staff becomes the primary contact for patients. While the provider is responsible for each program’s care plan, the clinical support team executes the plan and coaches the patient based on the physician’s plan. The overarching goal is to improve patient wellness and outcomes.  

    With Medicare Wellness, the medical assistant spends 30 minutes — two-thirds of the office visit — with the patient. The provider spends the other third of the visit reviewing notes and findings with the patient, as well as addressing more clinically advanced topics such as the depression screening, advance directives and the overall care plan.   

    The goal of the TOC program is to help the patient avoid hospital readmission. The RN is the patient’s point of contact from the time a patient has been discharged from an acute care setting until approximately 30 days post-discharge. During this period, the RN contacts the patient at specific intervals (or more often, if necessary) to assist the patient with medicine reconciliation, dietary concerns, scheduling follow-up appointments and other questions or concerns. 

    CCM is an ongoing program that helps a patient manage chronic diseases. The RN is also the point of contact in the CCM program, ensuring that the patient has the tools needed to manage health issues effectively. The Centers for Medicare & Medicaid Services has outlined a plan for administering this service based on required monthly touchpoints with the patient, as established in the physician’s care plan.

    For example, diabetics need routine bloodwork. The nurse will ensure that the appropriate documents for the bloodwork are provided to the patient, follow up with the patient regarding results and contact the patient throughout each month to be a resource in managing the chronic condition. 

    Staff benefits

    Aside from improving patient wellness and outcomes, a team-based care delivery model can lead to significantly improved employee satisfaction, especially for the clinical support staff. Despite the disruptive innovation of moving to the team-based care approach, one organization I observed experienced measurable improvement in employee satisfaction during this transition. Participation in an employee satisfaction survey reached 81%, a 23% increase from the previous survey. General satisfaction was rated at 5.08 out of a possible 7, which was 1.08 above the national norm.

    Categories with the biggest increases in the survey included organizational communication, development and advancement, co-worker and interdepartmental cooperation, and support from their supervisor. The scores signal that employees believed issues were addressed when management was made aware of them; supervisors communicated through regular meetings; the training employees received met their needs and included good patient and customer service techniques; and employees have complete trust in their team and their direct supervisor. 

    The final question of the survey asked employees whether they plan to stay with the organization. The score for this question was above the national norm. Given that the survey was conducted at a timReimbursement by visit typee of major disruption — switching from a traditional care delivery model to a team-based approach — that impacted most staff, the score demonstrates that staff were resilient and receptive when presented with a challenge to improve the care provided to their patients.

    Profitable outcomes

    These three programs also present an opportunity for meaningful reimbursement to improve a practice’s bottom line. The graph (below) illustrates the reimbursement for Medicare Wellness by visit type, including a comparison to a routine office visit.

    Reimbursement in the TOC program is also significant — $180 to $233, depending upon the level of medical decision making (moderate or high) with the prescribed sequence of events established by Medicare. The majority of this work is performed by an RN.

    Similarly, the CCM program can enhance a practice’s bottom line with a typical reimbursement of $35 per month per patient enrolled. This program is a little more involved to manage because it requires ongoing patient contact, however, care is largely provided by an RN. 




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