In most practices doctors already delegate some care, notes practice management consultant Margalit Gur-Arie, a principal in the consulting firm BizMed. However, the extent to which physicians delegate tasks and set up organized processes for their staff varies widely, she says.
According to Gur-Arie, care teams are designed to “make sure that the patient doesn’t fall through the cracks. This is whole-person care, not just the 15-minute visit.”
In her view, care teams help practices run like businesses. Instead of physicians having to track down staff members to ask questions or assign tasks, those team members can take on a lot of routine tasks on their own, using standing protocols.
When physicians empower their staff to do more, the doctors reduce their own workload. “Doctors are essential resources, and we still have them doing way more work than they should be doing,” Kilo says. “We need to leverage the clinician’s time, so the clinician is doing higher level knowledge management and relationship management, and not so many of the tasks that the less expensive staff member can do.”
Jennifer Brull, MD, a primary care physician in Plainville, Kansas, agrees. “I tell my nurses, ‘If it’s within your license, you better be doing it, because I don’t have time.’”
Allowing healthcare professionals to practice at the top of their licenses is the key to effective care teams, says Jillian Schneider, MHA, manager of practice support for the American College of Physicians. For example, she says, a practice could have a standing order for nurses to give patients flu shots if they meet certain criteria. A nurse could vaccinate the patient and note it in the chart. “That’s one less thing the clinician has to do,” she says.
Nurses or MAs can also scan a patient’s medical history prior to a visit, checking to see whether their preventive and chronic care needs have been met. If there are care gaps, they inform the physician. They can also perform medication reconciliation ahead of the visit, saving the doctor time in the exam room. And they can check to see whether lab results are in for patients with chronic conditions.
Greenfield Health’s care teams perform all of these tasks before patient visits, Kilo says. In addition, they do non-visit related work, such as refilling prescriptions, calling patients who are due for recommended care, obtaining hospital discharge information and even providing non-visit care when appropriate.
In Oregon and most other states, Kilo says, MAs can handle some conditions on their own, including prescribing under standing orders if they follow protocols.
Kilo adds that a practice’s electronic health record (EHR) should allow care team members other than doctors to document their interactions with patients in the same areas of the chart that physicians use. Such EHRs improve efficiency and enable clinicians to identify which additions to the record were made by other team members.
Practices that use care teams regard good communication among members as critical to efficient practice operations.
“The daily huddle is a huge benefit for the practice,” says Fakoory. “You can lower your visit time because you’re not having those catch-up discussions in the hallway or when the patient is sitting in the room. That huddle can improve the patient experience and also the throughput of your clinic.”
Co-location is also an important success factor, Fakoory and Gur-Alie say. This can be a problem for doctors who expect to have their own offices, but they need not give them up if they have care teams.