Clinical Practice Transformation is touted as the path to achieving the best care delivery model of the future– A team-based care delivery model…A care delivery model that utilizes clinical support team members at the top of their license and capabilities during the patient care delivery process…A care delivery model that shifts some of the patient care burden from the shoulders of direct care providers…A care delivery model with specific roles, responsibilities, and structure…A care delivery model that represents a significant paradigm shift…A care delivery model that will require the investment of time, money, and personnel resources. So, why should we embrace this call to change?


Consider the following six anticipated benefits that collectively predict more comprehensive, more proactive, more personal, higher quality patient care:


Enhanced staff satisfaction

Staff members feel more valued and professionally fulfilled in a team-based model of care as their defined roles and responsibilities more closely align with their reasons for pursuing their professional career and are more central to the care of the patient. Enhanced staff satisfaction translates into less staff turnover and greater patient satisfaction.

Less staff turnover avoids the costs and hassles associated with staff replacement, such as recruiting and advertising expenses; paying overtime or overextending remaining staff to cover the gap; and disrupting the practice and adding costs related to training new staff members.

Enhanced staff satisfaction predictably results in greater patient satisfaction as numerous studies indicate that patient satisfaction is directly correlated with staff satisfaction.



Enhanced patient access

Utilizing support staff members to assist with care they are competent to deliver – and supported by standing orders and protocols – permits greater access to care and frees direct care providers for care more consistent with their licenses and capabilities. Thus, more care can be delivered in the same amount of time without overburdening either the providers or the support staff.

In addition, as practice schedules reliably run more efficiently, direct care providers become more willing to either add scheduled appointments to the template or work in additional patients around the fringe.



Enhanced provider satisfaction and well-being

Utilizing support staff members to assist with care they are competent to deliver permits direct care providers to:

  • Focus on patient care (and other activities) more consistent with their license, capabilities, and desires;
  • Achieve greater patient access and care in less provider-invested time
  • Attain greater work-life balance

A more efficient, less hectic, more rewarding, and more balanced office routine reduces the risk of burn out as the providers have their professional days more under control.



Enhanced patient satisfaction

Beyond the positive impact of receiving care from highly satisfied, engaged staff members and providers, patient satisfaction is directly improved through more efficient practice operations.

Office visits proceed more efficiently and effectively since required information is available at the start of the encounter – and that information is shared and known by all those involved in the patient encounter. The encounter is not interrupted by the need to retrieve information that could have been anticipated prior to the appointment, such as items generated from the last visit. As a result, appointments are more likely to run on time – a great patient, staff, and provider satisfier.

Furthermore, patients tend to feel that they receive more time and attention from the practice – all while maintaining the direct involvement of their principle provider. They are also likely to receive more comprehensive review and delivery of preventive services. These interactions allow patients to feel more involved (engaged) in their care.



Enhanced performance on “quality” metrics

Developing processes that reliably incorporate quality metric emphasis and capture during normal practice operations promotes better practice performance on those metrics – and easier tracking and reporting. For example, incorporating review of preventive services (e.g., immunization status) and early detection screenings (e.g., breast, colorectal cancer screenings) into the pre-visit review process, the rooming in process, and the patient encounter agenda – especially if backed by standing orders – predicts superior performance on these quality metrics. This positively impacts publicly reported and/or pay-for-performance and/or other risk contracting initiatives … while more reliably providing comprehensive patient care.



Enhanced patient care revenues

All of the above interventions and outcomes can result in greater patient care revenue for the practice. In addition to better reimbursement realized through better pay-for-performance execution, the practice can realize increased reimbursement associated with redirecting provider time toward greater revenue generating activities. Utilizing support staff for care they are competent to deliver retains revenues associated with this lesser level of care while freeing direct care provider time for other care that is more consistent with their licenses and capabilities – care which also tends to generate greater patient care revenue. Examples of using qualified, adequately supported staff in this fashion include performance of Medicare Annual Wellness Visits (AWV), transitional care management activities (TCM billing), chronic care management functions (CCM billing), and minor acute provision (e.g., strep screens, UTI complaints, pregnancy testing).

Increase patient care revenues can also be realized by accomplishing more comprehensive preventive services – both for services rendered onsite, such as immunization administrations; in the associated employed network, such as increased colorectal screening compliance; and in the associated health system, such as increased mammography rates.

Finally, as previously mentioned, providing care more efficiently allows more care to be provided in the same time interval, which generates increased practice revenue.


With these significant benefits readily attainable through the clinical practice transformation process, how can we *not* choose to engage and invest in a team based care delivery model?






Terrence R. McWilliams, MD, FAAFP

Chief Clinical Officer and Managing Director, Employed Provider Networks