In response to worsening physician dissatisfaction, burnout and turnover, Via Christi Health in Wichita, Kansas, began a team-based care documentation pilot project in seven of its clinics. The pilot project deployed two different approaches to team documentation:
The Team Care Assistant Model utilizes highly trained medical assistants (MAs) to provide enhanced team-based patient care services during the ambulatory care office visit. The MAs work at the top of their license by completing tasks that are typically completed by the physician, such as recording history, review of systems, scribing, and order entry. In this model, the MA becomes the “workflow manager” of the patient visit. This frees the physicians from clerical work and allows them to focus on providing patient care that is person-centered, efficient, high-quality, and cost-effective.
The Scribe Model utilizes an independent contractor to provide clinical documentation staff. The scribe assists with documenting visit notes in real time while in the exam room with the physician and the patient. The scribe thus frees the physician to focus on the patient instead of the electronic health record (EHR).
The preliminary results of the pilot project were positive. After nine months, physician satisfaction increased by 31 percent and staff satisfaction increased by 10 percent over baseline. Daily visits increased 42 percent under the Team Care Assistant Model and overall physician revenue increased with both team documentation models. Although the pilot project lacked the statistical rigor of a true experimental research study, the organization has chosen to expand its efforts based on both available evidence and anecdotal praise:
“The team care model has reinvigorated both me and my practice. I feel almost guilty when I look around at my colleagues who are frustrated and burned out with the conventional practice model while I feel energized and excited by my practice.”—Physician
“The clinic has changed the way they are doing things. The nurse is staying in the room during my visit and I feel the doctor has time to slow down to take care of me, and is not worried about the person in the next room over.”—Patient
“The program has enhanced my relationship with our patients. I'm able to spend more time with them, in turn providing better care.”—Staff
“The new model allows me to remember why I went into medicine to begin with: to take care of the patient and not the chart.”—Physician
Although it may be too early to decide which team documentation model works best at Via Christi, one thing seems clear: there may not be a one-size fits all answer. Some of the more autonomous providers in the clinic prefer the Scribe Model, while other providers thrive under the Team Care Assistant Model.
Via Christi also learned some important lessons along the way:
Bringing the compliance and information technology (IT) departments into new documentation model projects early on is necessary to address stringent documentation regulations and workflows.
Open up panels early! Doctors working with mid-level providers saw enhanced access so quickly that their mid-level providers were left seeing significantly fewer patients during the initial stages of the pilot project.
At minimum, block schedules and conduct regular meetings to discuss the project during the first month. This allows time for continuous process improvement and communication that is vital to the success of either model.
Both models require consistent, high-functioning support staff, which can be hard to recruit and retain in certain markets.
Collect and track relevant data and compare to baseline to measure results. Some key metrics to consider include:
Work relative value units (WRVUs)
Patients seen per day
Specific preventive health metrics
As Via Christi continues to expand team-based care, the lessons learned from the pilot projects will be used to improve team documentation across the system.
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