Primary Care Physicians (PCPs) play a critical role in patient care, more than just diagnosing diseases and prescribing medications. PCPs are the ones that explain medical problems to patients and coordinate care among many providers in an increasingly fragmented medical system. PCPs take into account everything that the specialists report and put them in perspective for the patient so they can be guided on what to do in managing their disease and staying as healthy as possible.
Unfortunately, time constraints in the regular clinical workday hinder PCPs from spending more time to care for their patients. There is just so much to do in very little time.
Improving Practice Efficiency Through Team-based Care
Studies suggest that a team-based care approach can markedly improve patient care and the productivity of primary care doctors. By utilizing and maximizing the skill sets of different medical professionals like Nurse Practitioners (NPs) and Physician Assistants (PAs), the entire care team can offer a better quality of care to patients.
So how does team-based care help primary care providers?
Team-based care offers valuable benefits not only to providers but to patients as well. This innovative care approach can address the many pain points of the healthcare system with a shortage of human resources, an increasing incidence of burnout among doctors, and a fee-for-service payment method that is keeping practices from thriving and staying independent.
Looking into Physician Time in Patient Care
PCPs are required to provide preventative care services and address acute care issues in a timely and appropriate manner. This would require extensive physician time spent on their patients aside from the paperwork that is often performed outside the clinical workday.
It is this physician time on patient care that became the focus of a recent study called “Revisiting the Time Needed to Provide Adult Primary Care” published last July in the Journal of General Internal Medicine. The researchers looked into how much time is needed by PCPs to effectively provide preventive, chronic disease, and acute care as well as perform the required documentation and inbox management activities. If PCPs follow the U.S. Preventive Services Task Force (USPSTF) guidelines on physician time on a standard patient panel representative of the adult American population of 2,500 patients, they would need as much as 26.7 hours each day to care for their patients.
Clearly, physicians do not have that much time. In addition, it further stresses the huge discrepancy between what was taught in medical school as opposed to the realities and restrictions of the clinical workday. To navigate this gap in care, doctors are now forced not to follow the guidelines or provide all its recommendations.
The study has discovered that PCPs are only doing about 50% of the guideline-based recommendations for their patient panel. Some doctors may be providing care not meeting the guideline recommendations. For instance, the USPSTF recommends for patients with obesity no less than 12 dietary counseling visits per year to see measurable benefits. The reality is that it becomes only a couple of minutes per year as opposed to the more time-intensive process recommended to effect positive behavioral changes.
How Team-Based Care Eases Workloads
In the same study, the authors reveal that a team-based approach to care can reduce the 26.7 hours to just 9.3 hours per day. This is possible by delegating tasks to different members of the team.
Every healthcare professional specializes in providing care that’s different from the physician. A clear example is that of a dietitian who may be more equipped than a PCP to offer better dietary counseling to patients. This does not mean PCPs cannot provide this type of service, but it shows that by collaborating with other specialists, they can ease their workload without compromising the quality of care. PCPs can be more productive and focus on treating their patients.
Many of the elements of preventive care do not require a medical degree like giving routine vaccinations that a nurse can easily do or the regular telephonic check-ins that trained care coaches perform very well. In a perfectly functioning team-based care model, PCPs can maximize the skill sets of nurses, nursing assistants, pharmacists, dietitians, mental health counselors, and social workers.
How Team-Based Care Outperforms Solo Care
Team-based care has been proven effective in elevating the role of the clinical staff, improving patient experience, and optimizing patient care, particularly in chronic disease management. A previous groundbreaking study published in Health Affairs in 2021 supports the effectiveness of a team-based approach.
The study has documented for the first time how team-based care management for chronic conditions outperforms solo care. It highlights the indistinguishable outcomes between care provided by NPs and PAs in relation to the care provided by physicians. The main outcome measure used was disease control within one year from the onset of the disease. Reviewing deidentified patient data from 2013-2018 of more than a million patients with three chronic diseases, team-based care management performs better than solo practitioner-based care management.
Hence, the recommendation to policymakers is to encourage and incentivize team formation, particularly in providing value-based care. Medicare acknowledged the importance of value-based care when it created the CPT codes for care coordination and remote monitoring services. Using telehealth technology, Medicare has introduced billable services like Chronic Care Management (CCM) and Remote Patient Monitoring (RPM), which requires a clinical team to effectively perform the many required activities.
Under CCM, care coaches enable physicians to provide multiple touchpoints in-between office visits through regular calls and check-ins to look into patient progress, particularly in complying with the care instructions. RPM is the perfect supplement to CCM with its cellular-integrated devices capturing patient data in near real-time for clinicians to ascertain the patient’s health status. Whenever preset thresholds are crossed, the physician is alerted for timely interventions like making changes in medications to prevent an escalation. CCM and RPM synchronize care that a physician cannot perform alone. Only with a clinical team can CCM and RPM stay true to their goal of providing a better quality of care with an emphasis on prevention.
Addressing the Challenges of Forming a Team
The fee-for-service payment model hardly entices providers to build their teams, but Medicare’s reimbursement programs offer a new revenue stream. However, providers are facing barriers to fully embrace CCM and RPM despite the benefits they bring in terms of improved care and additional income. For starters, it entails a considerable capital investment to build the program by hiring new staff, purchasing equipment, and building the needed infrastructure.
Ascent Care Partners (ACP) offer a lifeline to practices to stay innovative in their care delivery. We offer turnkey CCM and RPM solutions to help primary care physicians grow clinically and financially. Our clinical team becomes an extension of your team so you can boost your productivity and do what you do best, which is to care for your patients while you see your practice grow. With no upfront cost and set-up fees, we provide a risk-free opportunity and a full service that helps you from patient enrollment to the preparation of billing charges so you can get paid.
