Do you have a shortage of primary care physicians? Rarely do we find a client or community where the answer is no. This reality is creating challenges for patients, hospitals, and specialists alike. By aggressively restructuring your staff, modifying the mix, and modifying the physician’s role, you can start to address underlying issues.
It makes sense that MGMA research shows high producing practices have greater expenses than their lower producing counterparts (and are more likely to be independent rather than hospital-owned). But a deeper review reveals two key differences. First, these physicians tend to surround themselves with a talented and skilled staff that performs most preliminary and follow-up work. Second, the practice and its’ schedule are organized around not only the types of patients, but also the types of visits.
Depending on those types of patients and visits, the right staff may include Nurse Practitioners, Physician Assistants, Dieticians, RNs (and those with disease management expertise), Physical Therapists, and even Acupuncturists. Oddly, in some ways, this model mirrors the Patient Centered Medical Home (PCMH) concepts.
These high performing practices have a goal to bill 80% of the physician’s time. Today’s typical practice bills 59% of the physician’s time. The lower performing model generally consists of a physician, an extender, and several office staff members.
So what strategy should you utilize to get from 59% to 80%? In our experience, the key is to evaluate the practice’s types of patients seen and the types of visits. Then physicians must decide which provider can best serve the patient’s needs. For example, patients with diabetes or congestive heart failure can typically be seen by extenders, except for most acute visits.
With this model, the physician becomes the conductor of his practice/orchestra. The physician may have 60 patients scheduled per day. He/she reviews the schedule and the patients’ stated reason for the appointment. Colds, flu, and other acute cases are directed to the NP or PA. Diabetic visits go to the nurse specializing in diabetes. Preliminary work is coordinated and performed by extenders, making it the physician’s role to review the information with the patient and extender, answer questions, and then proceed to the next patient. Referrals are made by a referral specialist.
Building the structure of a practice on the needs of the patients appears logical, but most physicians haven’t been trained to act as the conductor. They are trained to be the entire orchestra. This fundamental change in physician behavior and role can occur by following these steps:
• Commit to the idea that focusing on patient type will increase benefits for the office and the patient
• Analyze the practice and the market (visit types, patients in the practice, age, gender, and community health)
• Determine staffing mix and levels needed to service patient visits
• Develop an implementation plan with timelines and accountability
• Over communicate during implementation
• Evaluate and measure the goal that 80% of physician time is billable activity
Caution: Do not merely evaluate on cost. Costs will increase. The goal is to improve overall financial performance.
This model also increases the specialized resources in the physician office, which will likely increase in value as reimbursement models move to value-based purchasing and shared risk. For once, a solution that helps in the current reimbursement world will produce value in the new world as well.