Med­i­cal groups should work col­lab­o­ra­tively with non-physi­cian providers to im­prove ac­cess

Modern Healthcare - - COMMENT - Dr. Halee Fis­cher-Wright In­ter­ested in sub­mit­ting a Guest Ex­pert op-ed? View guide­lines at Send drafts to As­sis­tant Man­ag­ing Editor David May at

Healthcare— the way it’s de­liv­ered, the way it’s im­ple­mented, the way it’s talked about—has changed. And so have the pa­tients we’re serv­ing.

Med­i­cal group prac­tices are si­mul­ta­ne­ously ser­vic­ing the needs of five gen­er­a­tions, and this poses a se­ri­ous is­sue for physi­cians who want to pro­vide in­di­vid­u­al­ized care. How do we bridge the gap?

As in­di­vid­u­als who have cho­sen the care of oth­ers as a pro­fes­sion, it’s still our duty to adapt and shift to the evolv­ing de­mands of mod­ern healthcare, de­spite these changes. It’s time we got back to think­ing about pa­tient care first.

The best health sys­tems and med­i­cal groups rec­og­nize that ex­cel­lent healthcare is the re­sult of co­or­di­nated, thought­ful team­work. The 2015 Med­i­cal Group Man­age­ment As­so­ci­a­tion Cost and Rev­enue Sur­vey re­vealed that the use of nurse prac­ti­tion­ers, physi­cian as­sis­tants and other non-physi­cian providers (NPPs) in­creased more than 40% be­tween 2010 and 2014.

These NPPs rep­re­sent an as­sort­ment of per­son­nel—in­clud­ing mid­wives and so­cial work­ers—all work­ing to­gether to pro­vide full ser­vice of care for the pa­tient.

NPPs are ex­tremely valu­able mem­bers of the healthcare de­liv­ery team. They im­prove pa­tient care by in­creas­ing the ef­fi­ciency of physi­cians, al­low­ing doc­tors to fo­cus on more acute needs. NPPs also im­prove pa­tient sat­is­fac­tion by cre­at­ing greater ac­cess and ap­point­ment avail­abil­ity. And frankly, they also re­duce the di­rect and over­head costs of a prac­tice. It might not be in the best in­ter­ests of time or re­sources to have a sur­geon per­form a phys­i­cal when a physi­cian as­sis­tant is per­fectly qual­i­fied to do so.

The Cost and Rev­enue sur­vey found that physi­cian-owned sur­gi­cal prac­tices that spe­cial­ize in one branch of medicine em­ployed 0.85 non-physi­cian providers for ev­ery full-time doc­tor in 2014. That was up from a ra­tio of 0.59 non-physi­cian providers per full-time physi­cian in 2010 at those clin­ics. The num­ber of NPPs em­ployed is only go­ing to in­crease as more pa­tients are in­sured un­der the Af­ford­able Care Act.

Yet some physi­cians aren’t com­pletely on board with utiliz­ing these pro­fes­sion­als. They may feel a loss of con­trol or may not be con­fi­dent in the work be­ing done by oth­ers. The sim­ple truth is, when you have a team­based model, you need to learn to build trust. NPPs have com­pleted ex­ten­sive ed­u­ca­tional train­ing and are highly qual­i­fied to con­trib­ute to the care of pa­tients. In fact, many small, ru­ral crit­i­cal-ac­cess hos­pi­tals and med­i­cal prac­tices are run by NPPs, with physi­cians step­ping in as needed for more crit­i­cal cases.

Doc­tors are still pro­vid­ing most of the care, but it’s im­por­tant to re­al­ize that there is a role for ev­ery prac­ti­tioner to play. Utiliz­ing ad­vances in tech­nol­ogy is an ex­cel­lent way to pro­vide a full scope of care. The Cost and Rev­enue Sur­vey also re­vealed that spend­ing on tech­nol­ogy has in­creased by al­most 12% since last year. In some hos­pi­tals and med­i­cal prac­tices, nurses are us­ing apps that al­low them to re­port pa­tient is­sues faster. Oth­ers are us­ing FaceTime with pa­tients in their reg­u­lar of­fice hours.

This is just one way of bridg­ing the gap be­tween in­di­vid­u­al­ized care and the re­sources that are read­ily avail­able. It’s ev­i­dent that many med­i­cal prac­tices are re­al­iz­ing that times are chang­ing, and they are do­ing some­thing about it.

Rather than be­ing com­pet­i­tive, let’s be col­lab­o­ra­tive. When doc­tors, ad­min­is­tra­tors and NPPs work col­lab­o­ra­tively, they can pro­vide bet­ter so­lu­tions than when they act sep­a­rately. We are start­ing to see an in­flux of physi­cians who un­der­stand that some­thing wasn’t right with the old way of prac­tic­ing medicine—too many si­los, too much op­po­si­tion. We’ve got to do it dif­fer­ently.

If we can bring these healthcare pro­fes­sion­als to­gether, we can cre­ate a move­ment—which is ex­actly what we need now. Pro­vid­ing the best for our pa­tients al­ways needs to be the end goal, re­gard­less of how many hands need to help.

If we can bring all healthcare pro­fes­sion­als to­gether, we can cre­ate a move­ment— which is ex­actly what we need now.

Dr. Halee Fis­cher-Wright is pres­i­dent and CEO of the Med­i­cal Group Man­age­ment As­so­ci­a­tion, based in En­gle­wood, Colo.

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