{"id":7213,"date":"2017-01-23T12:04:34","date_gmt":"2017-01-23T19:04:34","guid":{"rendered":"https:\/\/www.uchealth.org\/today\/?p=7213"},"modified":"2022-09-06T08:03:31","modified_gmt":"2022-09-06T14:03:31","slug":"adding-value-visit","status":"publish","type":"post","link":"https:\/\/www.uchealth.org\/today\/adding-value-visit\/","title":{"rendered":"Adding more value to the visit"},"content":{"rendered":"<div style=\"margin-top: 0px; margin-bottom: 0px;\" class=\"sharethis-inline-share-buttons\" ><\/div><p>We\u2019ve all experienced it: waiting for our doctor in the lonely exam room only to get a few minutes to voice our most pressing health concerns. It\u2019s an old model of care and one that doesn\u2019t lend itself to the growing demands on doctors or the increase in chronic issues among their patients.<\/p>\n<figure id=\"attachment_7215\" aria-describedby=\"caption-attachment-7215\" style=\"width: 300px\" class=\"wp-caption alignright\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-7215 size-medium\" src=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2017\/01\/28144447\/EXT_APEX-model-1.webp\" alt=\"A docor examines a patient\" width=\"300\" height=\"200\" srcset=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2017\/01\/28144447\/EXT_APEX-model-1.webp 1200w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2017\/01\/28144447\/EXT_APEX-model-1-300x200.webp 300w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2017\/01\/28144447\/EXT_APEX-model-1-1024x683.webp 1024w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2017\/01\/28144447\/EXT_APEX-model-1-768x512.webp 768w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2017\/01\/28144447\/EXT_APEX-model-1-150x100.webp 150w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2017\/01\/28144447\/EXT_APEX-model-1-200x133.webp 200w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-7215\" class=\"wp-caption-text\">Dr. Robert Juhala, left, with UCHealth Internal Medicine in Fort Collins, examines James Waibel while Medical Assistant Noelle Encina documents Juhala\u2019s notes. Having an MA document allows providers more valued time with their patients. Photo by Kati Blocker, UCHealth.<\/figcaption><\/figure>\n<p>\u201cThe model of care for patients is well over 100 years old and suited to when major problems were acute illnesses, such as infections, or acute injuries,\u201d said Dr. Austin Bailey, a 30-year physician and now primary care medical director for UCHealth\u2019s provider group,\u00a0UCHealth Medical Group. \u201cThe concept of chronic disease wasn\u2019t prevalent at the turn of the century, but as we progressed through the Industrial Age, we\u2019ve taken on this huge burden of chronic disease, and it requires a different model of care.\u201d<\/p>\n<p>UCHealth has found a new model and will begin implementing it in several clinics starting Oct. 31. Every six months, the model will be launched in additional clinics, Bailey said.<\/p>\n<p>The Primary Care Practice Redesign model came from University of Utah Health Care and was adapted to fit the needs of UCHealth and its patients. A successful\u00a0<a href=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2017\/02\/28145343\/apex.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">pilot <\/a>recently wrapped up\u00a0at\u00a0UCHealth Internal Medicine (Snow Mesa)\u00a0in Fort Collins and\u00a0<a href=\"https:\/\/www.uchealth.org\/locations\/uchealth-family-medicine-a-f-williams-stapleton\/\" target=\"_blank\" rel=\"noopener noreferrer\">UCHealth Family Medicine <\/a>(AF Williams)\u00a0in Denver.<\/p>\n<p>\u201cYou feel like you are being treated the second they [the medical assistants] take you back to the room,\u201d said Rich Cortez, who\u2019s been seeing\u00a0<a href=\"https:\/\/www.uchealth.org\/provider\/cathy-l-ow-md-internal-medicine\/\" target=\"_blank\" rel=\"noopener noreferrer\">Dr. Cathy Ow<\/a>, an internal medicine physician in Fort Collins, for 20 years.<\/p>\n<p>The <a href=\"https:\/\/careers.uchealth.org\/\" target=\"_blank\" rel=\"noopener noreferrer\">redesign leans heavily on medical assistants<\/a>, an entry-level health care position.<\/p>\n<p>\u201cMAs really become navigators for the patients in this new model,\u201d said Dawn Maupin, operations director for primary care at CHMG.<\/p>\n<p>Each provider gets 2.5 MA support people. The half-time MA manages the physician\u2019s phone line and messages, while the other two work with the physician and the patients the minute they arrive.<\/p>\n<p>\u201cWe greet the patient by name and walk them back to the room,\u201d said MA Noelle Encina, who started working at UCHealth Internal Medicine in Fort Collins just prior to the redesign. \u201cBefore, we\u2019d call the patient\u2019s name from the door, work them up routinely and ask them what they wanted to been seen for. Vitals were the only thing we\u2019d enter in the chart. Basically, we were just rooming and taking vitals.\u201d<\/p>\n<p>In the new model, Encina stays with the patient during his or her entire visit. While waiting for the provider, she not only charts vitals but also records the main reasons for the patient\u2019s visit as well as information on family history, health maintenance and routine preventive care. She then guides the patient in prioritizing what he or she wants to discuss with the doctor and afterward schedules additional appointments.<\/p>\n<p>\u201cIt is team-based care opposed to an isolated physician working alone,\u201d Bailey said.<\/p>\n<p>The MA is scheduled for 20 minutes with the patient. Then there is a warm handoff, where the MA quickly updates the physician on the information obtained. The provider then has 20 minutes with the patient.<\/p>\n<p>Although the amount of time scheduled hasn\u2019t changed much, time is not wasted waiting, Bailey said.<\/p>\n<p>\u201cThe provider has 20 minutes with you not at the computer, typing or reading, but talking with you and coming up with a plan,\u201d he said.<\/p>\n<p>This is possible because the MA is documenting while the provider is talking. The MA then stays in the room after the provider leaves to go through the plan and make sure it\u2019s understood by the patient, schedules additional visits, such as preventive care exams, and handles any other details, such as giving a flu shot. Then the MA escorts the patient out.<\/p>\n<p>\u201cI noticed right away that Cathy [Ow] was able to spend a lot more time with me,\u201d Cortez said of his visit under the new model. \u201cShe\u2019s always done a really good job, but having a medical assistant there helps the process. It frees her up so she can talk face-to-face and get to the root of a problem.\u201d<\/p>\n<p><strong>Provider and staff perspective<\/strong><\/p>\n<p>The model has not only increased patient satisfaction, it has improved efficiency, quality of care, job satisfaction, and team dynamics and communication at its pilot clinics, according to an outside evaluation.<\/p>\n<p>\u201cWith the old model, every visit was cutting corners because you had to assume you were never going to be able to do everything. Having been a primary care provider for 30 years, I know that eats at you when you walk out knowing things are undone,\u201d Bailey said. \u201cWith this model, you see they are getting done. There is that fulfillment that you are doing a good job. It\u2019s not only easier but literally more fulfilling in every sense of the word.\u201d<\/p>\n<p>Providers reported more comprehensive and productive visits with more satisfied patients, according to the evaluation. And it showed improvements through better documentation, better follow-through on care plans and better delivery of consistent and reliable preventive and chronic disease care. Providers reported fewer after-hours charting and reduced burnout once the model was running smoothly, and MAs reported an increased level of empowerment and job satisfaction.<\/p>\n<p>It took a bit to get there, Bailey said, acknowledging that everyone needs time to get a feel for the new design.<\/p>\n<p>\u201cThe MA has to get used to my voice, what I do and how I do it,\u201d he said of the MA\u2019s role in documentation support during the provider\u2019s visit with the patient. \u201cThat team concept has to be developed. So, when you first roll out the model, everything slows down.\u201d<\/p>\n<p>Likewise, providers had to get used to someone else writing their notes.<\/p>\n<p>\u201cOne challenge was that trust level, especially with exam notes,\u201d Encina said. \u201cDoctors have always done them, so to allow us to go in there and document that note \u2014 what it was they were saying and their findings \u2014 took a lot of communication and going through after to make sure we did understand them correctly. But now, doctors compliment us on getting details of a visit that they may have not included in the note because of time. Once we started, they saw that the experience of us completing it was working, and now a lot of them will say they can\u2019t function without us.<\/p>\n<p>\u201cMy favorite thing is that I get to see and follow that patient through their whole visit,\u201d she continued. \u201cI don\u2019t get a complaint and wonder what happened. I actually see the reason why we ordered a CT or MRI. I\u2019m seeing the actual outcomes. The patients are more willing to open up to me because we\u2019ve established that relationship. This is important because we are at the front of the patient\u2019s health care team.\u201d<\/p>\n<p>There were still other challenges that Encina and her colleagues faced while implementing the model, Maupin said.<\/p>\n<p>The clinics nearly doubled the number of MAs on staff but didn\u2019t increase work space. As a result, MAs had to learn how to provide a balance between shared and personal space. There also was a period of worker fatigue as the changes were underway, she said.<\/p>\n<p>\u201cIt was difficult,\u201d Encina admitted. \u201cThere were team members who felt it was too much of an increase in expectations and work flow. But once we got into the swing of things, we started implementing our own education.\u201d<\/p>\n<p>And that has continued. Each Friday morning, the care team meets, learning about new information and evolving protocols and addressing questions.<\/p>\n<p>\u201cIt\u2019s great that it\u2019s going to be implemented across UCHealth,\u201d Encina said. \u201cI encourage people to embrace this change, to be fully on board and to understand that more education and opportunity comes with it. I encourage them to be excited and take the initiative.<\/p>\n<p>\u201cIt doesn\u2019t happen overnight, but the gratitude you get from this new model is amazing.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"<p>We\u2019ve all experienced it: waiting for our doctor in the lonely exam room only to get a few minutes to voice our most pressing health concerns. It\u2019s an old model of care and one that doesn\u2019t lend itself to the growing demands on doctors or the increase in chronic issues among their patients. \u201cThe model [&hellip;]<\/p>\n","protected":false},"author":2164,"featured_media":7215,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"categories":[5],"tags":[606,4750,278,351],"class_list":["post-7213","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-innovative-care","tag-a-f-williams-family-medicine-clinic","tag-access-to-care","tag-family-medicine","tag-primary-care"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.4 (Yoast SEO v27.4) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Adding more value to the visit - UCHealth Today<\/title>\n<meta name=\"description\" content=\"We\u2019ve all experienced it: waiting for our doctor in the lonely exam room only to get a few minutes to voice our most pressing health concerns. 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