Thanks to Sophie Quinton at Stateline, published in Politico 10/25, for a nice feature article about Care Redesign at UCHealth:
And 10/26, in HuffPo!
DENVER — When patients go to see Dr. C.T. Lin for a checkup, they don’t see just Dr. Lin. They see Dr. Lin and Becky.
Becky Peterson, the medical assistant who works with Lin, sits down with patients first and asks them about their symptoms and medical history—questions Lin used to ask. When Lin comes in the room, she stays to take notes and cue up orders for tests and services such as physical therapy. When he leaves, she makes sure the patient understands his instructions.
The division of labor lets Lin stay focused on listening to patients and solving problems. “Now I’m just left with the assessment and the plan—the medical decisions—which is really my job,” Lin says in a quiet moment after seeing a patient at the Denver clinic where he works.
We’ve been trying lots of things in our clinics at UCHealth because there is a national crisis of physician burnout, a national imperative to improve patient satisfaction, a national push towards electronification of healthcare, and a national imperative to improve quality.
We are of course, continuing our work on EHR 2.0 Sprints: see past posts Epic Sprint! Or, how we learned to love the EHR (part 1), Patients come second (so that everyone does better)! Addressing Physician Burnout, EHR Sprint team: work hard, persevere, sometimes you get to build a dream team, and stay tuned for future posts to come.
This is, so far, a separate initiative of improving teamwork, team-based care, returning joy to healthcare work. In short, we:
- Added Medical Assistants to a primary care clinic to invert the usual ratio of 1 MA to 2.5 MD’s, to 2 MA’s per 1 MD.
- Created an MA academy to retrain MA’s to work at the top of their certification (about tripling the usual tasks they do in the care of a patient)
- Added scheduled time BEFORE a physician visit for MA interview and documentation
- Asked the MA to stay in the room and scribe the patient’s history, examination and some parts of the assessment and plan, pend any orders or referrals or prescriptions for the physician
- Asked the MA to retrieve any equipment or education needed by physician
- The MA then completes post-visit tasks, vaccinations, education, after-visit summary printing, reminders, phlebotomy, followup appointments.
- Physicians then move room-to-room as MA’s stay 1 patient ahead
As a result,
- Physician burnout falls from 55% to 13%,
- MA satisfaction and engagement improves,
- Patient satisfaction improves,
- Cost-per-visit DOES NOT CHANGE,
- Access to care improves (more new patients, shorter wait times)
- Quality metrics improve (non-physicians pay more attention to consistent screening for vaccines, colonoscopy, PAP smears, foot exams, prescription renewals, standard monitoring for chronic illness).
I have to acknowledge the hard work of our Family Medicine colleagues at AF Williams Stapleton Family Medicine and the Snow Mesa Poudre Valley Internists clinics in the University of Colorado “UCHealth” system, who pioneered this work, based off of the Care by Design model from Utah. Thank you to those who blazed a trail.
CMIO’s Take? What’s not to like? Despite “who moved my cheese” change-management issues, we’re finding that we run out of qualified MA candidates, we are hiring so many. Is this the doctor of the future? Team-based Healthcare of the future? Was healthcare supposed to be a team-sport from the beginning? It is one vision, and a darned good one so far.