Better use of physicians' time will increase patient access

mikebutlerMike Butler
President, operations and services, Providence Health & Services

June 19, 2014

As you know, we introduced 12 success measures that all leaders from across the system will be accountable for in 2014. I want to provide you with an update on how we are doing in one key area, and how it helps us achieve our core strategy of creating healthier communities, together.

Today we're taking a deeper dive on increasing the median size of the primary care patient panel (the total number of patients a physician is responsible for). This metric ensures we increase patient access to primary care and that our clinical model provides financial viability in the face of changing economic realities.

In the first four months of 2014, I'm delighted to say we have seen an increase of more than 9 percent in median panel size system-wide. The median panel is now 1,556. This is due to a variety of factors, including changes in clinic management practices. As an industry benchmark, high-performing clinical groups have a median panel size of 2,250. Getting to that benchmark level will be a three- to five-year process.

One of the key components of this project is making better use of all members of each care team, so physicians can focus on patient care that requires their hands-on involvement. As you probably know, the nation isn't producing enough primary care physicians to meet population demands, so optimizing their time has to be a priority.

Let me share three stories from the Providence Health Care Region of Eastern Washington. They are in various stages of progress, and all show promise for helping us make the best use of the clinical teams.

These projects are part of our transformation from traditional primary care to a patient-centered medical home. This transformation is meant to strengthen primary care and make it more attractive to current and future physicians, with the goals of making Providence a more attractive choice for those scarce primary care physicians and creating more access for our patients.

Advanced access scheduling
Primary care in Spokane worked with the Physician Services team in Renton on advanced access training. The goal of advanced access scheduling is to match a provider's schedule in terms of supply and demand. Clinics are leaving appointments open for same-day or near-same-day access. There are specific appointment slots for post-hospital follow-up and ED follow-up care. Physicians also "huddle" each morning with primary care teams to review schedules and determine who has openings and where patients can be worked into the schedule.

Shared medical appointments
The region is rolling out shared medical appointments in 2014. The advantage of these appointments is the physician sees eight to 12 patients with similar issues in 90-120 minutes and this improves patient access and increases provider panel size. Patients like this format; they learn from other patients with a similar condition and also they get more time for education than in a regular office visit. Currently patients with diabetes and chronic pain have been engaged in this way, and the team includes a registered nurse who leads 30-40 minutes of patient education.

Team-based care
Our clinics in PHC are looking at adding more registered nurses and advanced registered nurse practitioners to care teams, as well as increasing support from medical assistants and patient care coordinators. The goal of adding more support for the team is that administrative tasks (paperwork) can be completed or partially completed by staff, thereby opening up time for the physicians to see patients.

ARNPs are being used as physician extenders, but we are evaluating transitioning to a model where the ARNPs will have small panels of their own patients and also will work closely with a physician on co-managing patients. The goal is to have the physician available to consult with the ARNP and deal with more complex patients, and the ARNP will do more of the routine follow-up and patient education visits. This allows all members on the team to work to their strengths while improving patient care and access.

Other tactics we are looking at to help achieve our primary care access goals include:

  • Epic optimization to take away clerical work as much as possible from the physicians
  • Telehealth as a tool to manage a panel
  • Possible integration of behavioral health services, clinical pharmacists, care managers and others

Core leaders have an opportunity to learn more about these primary care initiatives during a strategy briefing on July 16. The presentation will be posted on the employee intranet.