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is a practice improvement initiative from the AMA designed to empower teams like yours to identify and attain appropriate goals and tactics well matched to your practice’s specific needs and environment. Wherever you find your team on the practice improvement continuum, the American Medical Association can help you take the next steps – the right steps – to improve your practice. Learn more
In 2008, North Shore Physicians Group (NSPG)—a 365-provider, 20-site organization—began a system-wide change from a traditional physician-centric delivery model, where the physician is responsible for all elements of care, to a team-based care delivery model, where the care is shared among a group of closely aligned professionals.
The model is based on an expanded role for MAs, “so that the physicians wouldn’t have to shoulder all of the work,” said Beverly Loudin, MD, MPH, former NSPG Director of Patient Safety and Quality and director of the initiative. She began by interviewing physicians regarding the skills and responsibilities they would want in a highly functional MA.
Once the role was designed, NSPG developed a week-long training program to assure that all MAs in the system would have the same skill set, which aligned with their new responsibilities.
During the summer of 2009, NSPG trained 80 MAs in the new model of care. They were taught basic clinical skills, critical thinking, health coaching, patient self-management techniques and population management. Because improving work while doing the work is seen as an essential strategy going forward, MAs are also trained in process improvement.
The MA role was transformed from someone who generally answers phones, escorts patients and obtains vitals to a partner capable of team-based care. Each day, the MA, physician, scheduler and nurse start with a morning huddle to review the day’s work and plan for a smooth workflow. What was previously a three-minute rooming process has been expanded to an eight-minute process, and now includes recording current medications and allergies, agenda setting, form completion and closing gaps in care (also known as “in-reach”). For example, the MAs review all health monitoring reminders, give immunizations and proactively book appointments for mammograms and bone density scans. The goal is to meet all of the patient needs while in the exam room, rather than leaving time-consuming loose ends to be addressed after the patient leaves.
The MA also assumes responsibility for entering a greater portion of visit note data. As one NSPG leader reports, “a huge part of the change has been having the MA put extensive information into the EHR.” The MA starts the note and performs most of the structured text data entry components of the visit. The provider will later edit these entries for accuracy and document the narrative portion of the note.
In-reach approachIn-reach approach: Planning in advance so that care gaps are closed at the time of each face-to-face visit.
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