Providing better care without breaking the bank

By Shannon Geis, MA
September 7, 2017
Body of Knowledge Domain(s):

Many practices are looking at ways to implement better patient-centered care without drastically affecting their budget, but it can be difficult to figure out where to start. For Rachael Vasko, RN, BSN, MHI, MGMA member, clinical director, Thunderbird Internal Medicine, Glendale, Ariz., she wanted to find ways to provide better care while cutting down the increasingly long hours her providers worked.

Her physician-owned, 30-provider internal medicine practice decided to implement a care coordination department that centralized all the non-face-to-face work conducted by medical assistants (MA). “This freed the MAs to work more closely with doctors and patients,” she explains. The MAs in her office assist with the collection of history of present illness and review of systems, as well as depression and alcohol screenings. This has increased provider satisfaction and work-life balance.

But before the practice decided to implement care coordination, Vasko considered a few other options. One option she explored was a team-based care model using nonphysician providers, however, space was an immediate barrier and it was unclear that spreading out the work would make the practice more efficient.

Another plan Vasko considered was to hire scribes to work with each provider to free the providers from most of the documentation work. However, the providers in her practice had a wide range of productivity and it was not feasible to institute the plan in a budget-neutral way. The practice did incorporate some of the scribe model, however, by training the MAs to do some documentation.

Vasko first piloted the care coordination program with a few providers before implementing it across the organization in May 2016. “We are still working through the kinks, but it is a lot smoother now,” she says.

For Vasko, there has been a few major takeaways. “From my perspective, the physician satisfaction has increased significantly,” she says. Before the model was implemented, providers often needed to come in hours before their first appointment to make sure charts and other documentation were ready. Now they come in just in time for their 7 a.m. appointments.

Another important improvement has been the decrease in patient complaints about wait times for test results and other information from providers. It used to take several days — now calls and test results often are returned the same day.

It hasn’t all been easy, of course. Vasko says one of the biggest challenges was getting physician buy-in. Regardless of the project, she advises, “make sure you identify your stakeholders and get their buy-in early.”

You can learn more about how Vasko instituted this new system and hear her top tips for doing it in a budget-neutral manner during her MGMA 2017 Annual Conference session, “Implementation of Care Coordination in Primary Care Without Breaking the Bank.” Find out more about this session and how to register for MGMA17.

Shannon Geis, MA, Staff writer/editor, MGMA

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