Learn how certified medical assistants trained as “Encounter Specialists” alleviated physician burdens and improved practice satisfaction at Wake Forest Health.
About 10 years ago, Cornerstone Health Care (now known as the Wake Forest Health Network within Wake Forest Baptist Health) worked in a 1:1 ratio with medical assistants, more than 90% of whom are certified medical assistants (CMAs). One of the busiest and most profitable practices began using 2 CMAs per physician to allow them to see more patients, reduce appointment backlogs, and increase revenue. When Wake Forest Baptist Health moved to a value-based health care model in 2011, it quickly became apparent to the Health Network that the additional work to fulfill the value-based contract parameters would require more team members. Wake Forest Baptist decided to expand the 2:1 CMA-to-physician ratio to more practices within the Health Network and subsequently formalized its “Encounter Specialist” program.
Developing the Intervention
Encounter Specialists are CMAs who follow the patient through the entire encounter, starting before the visit to ensure that labs are done in advance and note the issues for health maintenance that need to be addressed at the visit. The Encounter Specialist accompanies the patient throughout the visit, including during check-in and rooming activities. When the physician is in the room, the Encounter Specialist acts as a scribe. When the physician leaves the room, the Encounter Specialist gives any necessary patient education and reiterates any physician's instructions during the visit. The physician then moves on to the next patient waiting with the second Encounter Specialist.
The Encounter Specialist Training Program
Along the way, there was resistance from a compliance perspective to having 1 individual acting as both a CMA and a scribe. The Wake Forest Health Network overcame this resistance with a comprehensive training program. Many of the existing CMAs transitioned into the Encounter Specialist role, and others were newly hired for these positions. Regardless of whether they are new or current employees, all Encounter Specialists must complete a formal training program.
The training program has helped address variations as they arise, ensure appropriate attestation is included in the record, and provide clarity for both the CMAs and the physicians about their roles, both during the encounter and for documentation processes. For example, CMAs do not pre-populate any note portions when the provider is not in the room.
Adaptation During COVID-19
Although retaining CMAs during COVID-19 was a major challenge, the Wake Forest Health Network did not discontinue the program or phase out the role. Because Encounter Specialists function as scribes, they remained in the room with the physician when COVID-19 restrictions were in place. Encounter Specialists support telehealth visits and perform the same tasks as a traditional CMA during these patient encounters.
When Cornerstone became part of Wake Forest Baptist and switched to the Epic electronic health record (EHR) system, expansion of this program slowed. Today, approximately 15% of primary care physicians within the Wake Forest Health Network utilize Encounter Specialists. However, now that Wake Forest Baptist Health has entered a strategic combination with Atrium Health, the goal is to evaluate further expansion across all Wake Forest Baptist and Atrium Health adult primary care practices and consider how other specialties, such as obstetrics and gynecology, might utilize the program.
One main outcome from the Encounter Specialist training program is that it has allowed providers to see more patients while still maintaining compliance. In an ear, nose, and throat (ENT)/otolaryngology practice where there was a lengthy wait for a visit with the single physician at the location, there was not enough volume to justify adding another physician despite the patient access challenges. After implementing a pilot Encounter Specialist program, the practice was able to increase the physician's volume and resolve the backlog without adding another physician.
Relieving Physician Burden
While the Encounter Specialist program initially began as a way for highly motivated physicians to increase their productivity further, it has become clear that it can be beneficial for all providers, especially those struggling with increasing documentation burdens. For example, a family practice physician was frustrated because she was sitting at the 39th percentile for work relative value units (wRVUs) and still going home every night with several hours of charting work. The physician was on the verge of complete burnout. Although her practice was previously resistant to the idea of Encounter Specialists, they decided to test the model in an effort to support the physician. The practice hired an additional CMA, trained the team, and began the program at the same time that the Epic EHR system went live for the practice. Despite the challenges, only a few weeks after implementing the Encounter Specialist program, the physician stated that she was as happy as she had ever been in practice. By the end of the day, all visit notes were complete, and, as a result, the practice opened up an additional half-day per week to see more patients. After 6 months, the physician had increased to the 72nd percentile for wRVUs.
Improving Practice Satisfaction
Many Encounter Specialists feel more empowered as valuable team members; thus, the hope is that turnover will be lower than the normal rate for these positions. Experience has shown that an extra 2 visits per day cover the cost of the additional team members, and the physician has little to no chart work to do after hours. The notes are complete, and the quality gaps (eg, colonoscopy, mammograms, diabetic eye exams, etc.) are addressed. The Encounter Specialist program was proven to enhance both physician and staff satisfaction, improve documentation, close gaps in care to achieve quality goals, and increase productivity. Once Wake Forest Baptist formalized the training program with the Health Network and provided clarity in roles and responsibilities, the Encounter Specialist program has become a win for everyone.
Wake Forest Baptist Health (www.wakehealth.edu) is a pre-eminent academic health system based in Winston-Salem, North Carolina. Wake Forest Baptist's two main components are an integrated clinical system – anchored by Wake Forest Baptist Medical Center, an 885-bed tertiary-care hospital in Winston-Salem – that includes Brenner Children's Hospital, 5 community hospitals, more than 300 primary and specialty care locations and more than 2500 physicians; and Wake Forest School of Medicine, a recognized leader in experiential medical education and groundbreaking research that includes Wake Forest Innovations, a commercialization enterprise focused on advancing health care through new medical technologies and biomedical discovery. Wake Forest Baptist provided a record-setting $580.8 million in community benefits during the 2019 fiscal year, including unreimbursed care, charity care, education and research, and community health improvement.