Restructuring care delivery can improve access, streamline workflow
At MedAxiom’s CV Transforum on April 12, physician assistant Ginger Biesbrock and nurse practitioner Jacob Turmell presented examples of how health systems around the country are reorganizing their care delivery models to boost patients’ access to services while improving care coordination and collaboration.
At the center of many of these models are advanced practice providers (APPs) like themselves who can relieve some of the workload from busy physicians. Another theme is expedited care.
It’s important to remember that even if a clinician doesn’t deem a condition serious, a patient might, Biesbrock said.
“You might think … palpitations are not life-threatening so you can handle this in two to three weeks, but in their mind this is an emergency,” said Biesbrock, PA-C, MPH, MPAS, a vice president with MedAxiom Consulting. “They’re losing sleep over it until they get to see you. … So, I think there is some benefit and value to opening yourselves up to seeing patients same-day, next day, within three days. If you’re not doing it and your neighbor is, you’re losing patients to your neighbor.”
Here is a summary of some of the programs Biesbrock and Turmell highlighted in their presentation:
- Centra Lynchburg General Hospital in Virginia has designed a clinic with the goal of seeing all patients on the same day they call in with a symptom change. A supervising physician is assigned to the patients but is supported by an APP. There is some variation on which slots are filled and a risk of unused slots, but benefits of the program include improved referring physician and patient satisfaction as well as increased outpatient revenue. “We’re utilizing an APP so it’s very similar to what we do in the hospital setting,” Biesbrock said. “In some cases, the physician sees the patient and in some cases they’ll review how the care is facilitated.”
- Biesbrock also highlighted a system that uses registered nurses (RNs) to triage and return patient phone calls within the same day. The RNs can help a physician make quicker decisions to send the patient in the right direction. This model requires strong organization and communication between nurses, physicians and APPs. Ideally, Biesbrock said, it would lead to fewer emergency department (ED) visits and increased patient satisfaction because people are quickly able to establish contact with a healthcare professional.
- Chronic disease management clinics—such as those for diabetes and hypertension—can be effectively run by APPs, Turmell said. They can also improve access to care in a cost-effective manner, partially because APP salaries are significantly lower than those of physicians.
- Turmell shared data from Cardiology Associates of Mobile, Alabama, after the network implemented a shared care model between APPs and physicians. Small teams of three physicians and two APPs were assigned panels of patients for secondary prevention, medication titrations and hospital follow-up visits from the APP. In one year the system led to a 21.4 percent increase in new patients (11,353 to 13,788) and a 4.7 percent increase in established patients (72,877 to 76,303), leading to a nearly $2.9 million bump in revenue.
Biesbrock said facilitating fast healthcare access and establishing preventive clinics are doing what’s right for the patient and health systems’ bottom lines.
“Anytime we can eliminate ways to provide unnecessary care, we’re eliminating opportunities for unnecessary costs,” she said.
Daniel joined TriMed’s Chicago editorial team in 2017 as a Cardiovascular Business writer. He previously worked as a writer for daily newspapers in North Dakota and Indiana.