Brull’s office, for instance, is two doors down from her practice’s care managers, and either she or they may pop in to each other’s offices to discuss a case. They also exchange internal electronic messages (commonly an internal message in the EHR). Brull sits just a few steps from one of the nurses who supports her in patient care, she says.
Practices that have adopted the patient-centered medical home model—the most likely places to find care teams—should have 4.25 full-time-equivalent (FTE) staff members to each FTE physician, according to a 2013 study in the American Journal of Managed Care. This ratio is 59% higher than the average primary care staffing ratio of 2.68 FTE staff per FTE physician, the researchers noted.
Kilo’s and Brull’s practices—both patient-centered medical homes—have ratios of between 4 and 4.5 FTE staff members per FTE provider. The ratio is higher than in traditional practices because their clinical and front office staff are required to do the additional work of population management.
By absorbing many tasks that typically fall to physicians, care teams can increase the capacity of practices to see patients and tend to their needs. Some primary care groups Fakoory has worked with have increased productive capacity by 10% to 20% the year after introducing care teams.
This additional capacity could be used to see more patients or to do more of what each patient needs. Increasing volume could help cover the extra overhead of care teams, but Gur-Alie strongly objects to this notion. “It’s not about seeing more patients. It’s about having more time with each one,” she says.
Kilo concurs. “If the patients feel they’re not being heard or you’re slamming through 25-30 patients a day, it’s good for your financial model, but it’s not so great for your patients.” Nevertheless, he says, it’s possible to use care teams to increase visits and revenue to some degree while also doing a better job for each patient.
Brull says she has seen year-over-year revenue increases since introducing care teams. But that isn’t necessarily because she sees more patients. The practice’s two care managers generate enough income to cover their own salaries just by doing annual Medicare wellness visits and meeting the requirements of Medicare’s Transitional Care and Chronic Care Management Programs. In addition, the group conducts a foot clinic for people with diabetes, arthritis and other issues, which covers her salary.
The financial message is that physicians in practices with care teams can sustain their net incomes while providing better care. “It’s the work that the population needs, delivered in a highly efficient and effective manner to get the best possible outcomes,” Kilo says.