Part 2: Medical Office Management in an Era of Administration Overload

Posted: February 1, 2024 | Category: News

By Clark Veet, MD, MS

In Part 1 of this story, we covered some basic steps independent physicians can take to reduce or manage the pressures associated with a modern-day medical practice. For both the independent and employed physician, administrative duties top the list when speaking of the chronic fatigue they’re feeling. Results from a recent Doximity poll show that 46% of physicians believe decreasing administrative burden would be the most effective intervention in reducing exhaustion, followed by improving work-life balance (27%), and reducing clinical caseload (21%). (1)

While the pressures are largely the same for both independent and employed physicians, they each have different methods for coping and different resources at their disposal. In this Part 2 of the story, we explore the employed physician’s environment and how they uniquely manage the burdens brought on by metrics, administration, and office operations.

Working Within a System

The advantages of being an employed practitioner and part of a large health system mirror the age-old notion of “It takes a village.” The upside is you always have backup, resources, and assistance when you need it and everything doesn’t fall in your lap. This “community” concept is also the basis for changes that are currently being made across many health systems in the name of efficiency and necessity.

In the traditional ambulatory practice, most office tasks and general patient care duties are handled within the individual practice. However, some health systems are turning to what is referred to as the “Patient Partnership Model (PPM),” which takes a big-picture view of practice activity. This model consists of remote regional roles that form interdisciplinary support teams that can take on administrative tasks that do not need to be done in the practice setting. This allows more evenly distributed “indirect work” and creates a centralized workflow.

“We found that when remote teams supported a region of practices, workflow efficiencies were gained,” says Molly Thompson Chavez, MHL, Administrator of Operational Excellence and Director of Relationship Centered Communication at Lehigh Valley Health Network. “Internal staff were not being pulled to perform priority tasks for patients present in the office; they therefore had the time to extend the reach and scope of their efforts into connecting with patients outside the practice walls.”

New Patients and Pre-Visit Planning

After Covid changed working styles to hybrid and remote, the PPM model made perfect sense as a solution to maximize efficiency among separated personnel. When newly adopted, the first component was a welcome video or telephone visit. It came about considering the onboarding patient questionnaires and basic practice information could easily be completed by a central staff. Intake includes a template, developed along with the clinician, so that the information gathered is pertinent to a particular patient.

The process begins when a new patient makes a call to a practice which rings at a regional hub. They are directed by a phone tree to select the type of visit they are requesting. Choices might be new patient, hospital follow-up, acute visit, patient care, or scheduling future appointments. If the call is from a new patient, the patient call representative shares information about the practice and schedules a telephone or video visit with the intake team. The intake call can take anywhere from 10 to 45 minutes depending on the patient’s medical history and is conducted one to two weeks before a visit is scheduled.

“Patient engagement is so important, so we also ask what the patient would like to address with the doctor,” says Thompson Chavez. “We want patients to feel warmly welcomed and convey that we can assist with whatever their needs might be. This regional welcome call strategy helps the practice tremendously by taking those preliminary activities out of the office mix.”

This same concept is applied when evaluating care gaps: those routine screenings and visits that patients may have skipped from year to year, or health care for those with diabetes. Through “met” and “not-met” reports, the team finds out if, for example, diabetic patients missed their appointment or didn’t show positive lab results at their last appointment. The team will call the patient and follow up with key questions, perhaps bringing the patient back for care sooner. Sometimes an RN on the team can order the labs and save the clinician more time.

Other Successful PPM Efficiencies

Along similar lines, pre-authorizations (PAs) required by insurance companies have historically been a huge consumer of time inside a practice. Before PPM, the internal staff would try to complete them in between rooming patients and all the other activities for which they are responsible. PAs can take anywhere from 15 minutes to 1 hour because they entail a number of steps: calling the insurance company, making sure you have the information you need, getting the information you need if you don’t have it, and often waiting on hold on the phone for long periods of time. This kind of juggle for internal staff was universally unsustainable.

Under PPM, someone – or several people – are entirely devoted to PAs. They can be on hold with an insurance company and still complete other desk-oriented tasks while waiting. It’s estimated that handling PAs in this manner can save medical assistants six to eight hours of phone time.

The same is true for in-basket or messaging management since practices can get thousands of messages, requests, and questions in the course of one day, either from the patient portal or from phone calls.  PPM has been able to successfully pull this activity from the practices to give the health care providers breathing room. A regional team triages inquiries: those that can be answered by looking at the medical charts or through research are handled by the team; those that require input from the provider are sent on. The physician may communicate back to the team or answer those inquiries independently. Either way, this approach cuts down substantially on time spent .

Integrating New Technology

The concept of a scribe is nothing new. However, in the past, a scribe was an actual person who was in the exam room taking notes, saving the doctor from “pajama time,” transcribing the notes he or she compiled that day after hours at home. Now, virtual scribes are fairly common. Rather than joining the clinician onsite, they listen into patient encounters via video conferencing or phone from an offsite location.

This comes with a number of advantages over traditional medical scribes, including a smaller price tag, greater sense of privacy, and increased flexibility even in rural areas. There can also be drawbacks. One is that virtual scribe services are delayed 12 to 24 hours and many times, providers want their notes right away. In addition, the “voice” of the scribe’s notes will be different than that of the physician. However, the bottom line is that scribes have been shown to increase efficiency and allow more direct provider-to-patient opportunity.

“Of course, we have to edit the notes but virtual scribes still save time,” says one physician. “I estimate they save me 30 to 40 minutes a day. That might not seem like much until you realize that could mean taking a lunch versus not taking a lunch or making it to my kid’s baseball practice in time.”

Also staking its claim in efficiency is using AI to capture patient visit information. As this technology ramps up, manufacturers say these products can, “filter out small talk, identify key medical information, and generate complete, EHR-ready notes.” This industry-wide intentional move toward more reliance on technology, which includes the efficiency of the patient portal to collect information pre-visit, accomplishes another goal that is equally important for health care providers, both independent and employed.

“Finding ways to increase efficiency reflects the changing nature of access to health care,” says the physician quoted above. “If we can improve efficiency, we can compete against virtual, direct-to-consumer health care practices: the ones where you simply call a number a get medical advice. We can be successful by adopting a digital front door yet have a community presence and knowledge about local resources and expectations. We will certainly be more successful than a virtual company in California telling us how to do things in Allentown.”