In her view, care teams help practices run like businesses. This is whole-person care, not just the 15-minute visit.” However, the extent to which physicians delegate tasks and set up organized processes for their staff varies widely, she says.Īccording to Gur-Arie, care teams are designed to “make sure that the patient doesn’t fall through the cracks. In most practices doctors already delegate some care, notes practice management consultant Margalit Gur-Arie, a principal in the consulting firm BizMed. During visits, it may include patient education, vaccinations and even prescription refills following clinical protocols. This may include pre-visit care, such as medication reconciliation, chart reviews and lab result checks. The physician still has the ultimate responsibility, but he or she delegates part of the care and the logistics that support it to other team members. “From the perspective of job satisfaction, the retention rate for advanced practice clinicians and other clinicians is a lot higher in an environment where they’re doing what they were trained to do, rather than just manage in-basket work all day,” says Krista Fakoory, MBA, senior manager with ECG Management Consultants in San Diego.Īnother important feature of care teams is that members share responsibility for patient care. In most cases this requires additional on-the-job training, but experts say working this way is good for staff morale. Instead, the group has trained their MAs to do most of what RNs can do in ambulatory care.Ī key characteristic of a care team is that its members are expected to work at the top of their licenses. Greenfield Health in Portland, Oregon, an 11-provider group where Kilo practices part-time (he’s also a consultant), has decided not to hire RNs because it can’t afford them, he says. But care managers don’t have to be RNs, who are an expensive resource for small and medium-sized practices. RNs most often function as care managers for chronically ill patients. Some practices, mainly larger groups, have expanded their care teams to include behavioral health specialists, nutritionists, physical therapists and social workers. Generally anchored by a physician, a care team includes registered nurses (RNs) and/or licensed practical nurses (LPNs), medical assistants (MAs) and front-office staff, such as receptionists and schedulers. But he and other experts maintain that, even under fee-for-service, care teams can improve practice efficiency, increase patient access and produce better outcomes. The biggest reason, Kilo says, is that value-based reimbursement has not fully taken hold, and a fee-for-service practice doesn’t need this kind of care team to succeed financially. But relatively few practices have organized and enhanced their care teams to increase efficiency and the likelihood that every patient will receive recommended care, says internist Charles Kilo, MD, who formerly led the Institute for Healthcare Improvement’s practice improvement initiative. Care teams exist in nearly every medical office.
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