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Improve productivity, efficiency using a physician extender in the clinical environment
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In a previous column, I discussed the role of the assistant at surgery in providing a safe and efficient practice. In this month’s column, the focus shifts to a clinical practice. The emphasis remains on improving patient outcomes while increasing efficiency to enhance profitability. To achieve these goals, a careful analysis of system processes, workflow patterns and productivity must be assessed. There are certain responsibilities and tasks that the physician must perform, while other aspects may be delegated. Hiring trusted, qualified individuals who fit well within the culture of a specific practice is often a difficult task.
Traditionally, advance practice nurse practitioners and physician assistants have been hired by physicians or practices to help manage patient care responsibilities. These practitioners work in a semi-autonomous manner and typically have their own schedule of patients instead of working directly with the supervising physician. Based on the payer mix, patient volume seen by the mid-level practitioner, and type of encounter, there are some advantages to the supervising physician and practice about reimbursement and delegation. However, there are some commonly overlooked potential disadvantages that include decreased patient satisfaction from seeing someone other than the surgeon and potential surgeon liability that stems from supervising a mid-level practitioner.
Regardless of whether a surgeon or practice employs a mid-level practitioner, additional allied health members are needed to work with the physician in a clinical environment. Some of the choices include nurses, medical assistants, surgical technologists, surgical assistants, athletic trainers and orthopedic assistants (also known as orthopedic physician’s assistants). With limited exception, assistive personnel are not reimbursable in the office.
Identifying the ideal professional
Considering the goals of efficiency, providing high-quality patient care and maintaining profitability, what type of allied health care professional is ideal to work directly with the physician? Arguments can be made for any of the aforementioned allied health professionals depending on the needs of the practice, physician’s style of practice and comfort level with delegating tasks.
Jason Mazza
It is well accepted that many orthopedists work more than 60 hours per week including consulting, research and clinical, surgical and administrative activities. Having to spend copious time teaching the basics of orthopedic knowledge and skills to staff members does not fit well into the typical schedule of an orthopedist and it is not efficient or productive. Orthopaedic assistants (OA-C/OPA-C) and fellowship-trained athletic trainers are best suited to work with orthopedists in a clinical environment as they have received formal education and training in orthopedics beyond the typical 4-week to 6-week rotation offered in other health care professional programs. Both of these professions are representative of physician extenders who are trained specifically in orthopedics which allows them to make an immediate impact in a practice.
The training for orthopedic assistants and athletic trainers, however, does vary. Although today’s standard of training has moved to a master’s level of education in both fields, OAs complete more than 40 weeks of clinical rotation in various subspecialties of orthopedics. In addition, many of OAs hold additional certification in surgical assisting, orthopedic technology, wound care, clinical research and X-ray use.
When considering hiring an assistant for the clinical setting, many opt for the lowest cost provider. Choosing this option often comes with sacrifices in the areas of education, prior training — specifically in orthopedics — or necessary skills. This choice does not fall in line with the objective of providing the highest quality care.
If you could hire an employee who could save you an average of 5 minutes per patient, consistently optimizes the way clinic is run, minimizes distractions, develops good patient relationships, provides a better balance to workload and, with only a minimal investment in teaching office-specific procedures and personal preferences, how much would this person be worth? Unfortunately, some undervalue this looking at it from only the perspective of whether this person is directly reimbursable. Others see this type of scenario as extremely valuable in time savings, quality of care, indirect reimbursement and for simply making the physician’s professional life easier.
Potential roles
We are in the midst of shifting from a volume-based to a value-based health care system. Patients come to orthopedic offices looking for a timely appointment, minimal wait times, and a qualified professional to diagnose and treat their problems at a reasonable cost. Patients also come to the office armed with information from the Internet and are looking for someone to discuss their concerns and needs. This is not a 5-minute to 10-minute process in most cases. Having a well-trained physician extender who works directly with the physician can help give patients the experience they are looking for while keeping the physician productive and on schedule. Patient satisfaction is inherently tied in with outcomes. Patients who are given ample time to ask questions, get appropriate answers and are properly educated are more likely to be satisfied and have better outcomes.
The potential role of a physician extender in clinic includes the following tasks:
- initial patient workup/history;
- assist physician with exams and patient treatment;
- address patient questions after encounter;
- dictate or scribe office notes / EHR entry;
- manage patient phone calls / triage;
- collect patient data;
- apply and remove immobilization devices including casts, braces, and splints;
- perform injections and aspirations;
- wound care;
- coordinate patient care and treatment; and
- carry out treatment protocols as developed by the supervising physician.
While physician oversight is necessary, these tasks can usually be delegated in most states where there is no licensure for the specific physician extender.
In a well-structured clinic, the physician extender can work up the next patient, provide education to a patient previously seen by the physician or manage the necessary clinical documentation in electronic medical record while the physician is focused on providing care to a specific patient. There are many ways a clinic can be structured to use a physician extender to allow for a constant flow of patients, with little or no wait times. Defined protocols can be place whereby the physician extender automatically performs certain tasks for a given patient status.
In some orthopedic practices, a physician may employ a medical assistant in addition to other assistive personnel to put on casts, schedule procedures or to coordinate patient care. Each of these individuals, while valuable to the physician, has a limited scope of duties. There are salary savings of having one individual who is knowledgeable in all of these particular areas and can manage these duties. Considering the business model and overhead costs of a given practice, hiring a physician extender at 70% to 75% of the average salary of a traditional mid-level practitioner may be advantageous. The physician extender has more formal orthopedic training than most other mid-level practitioners and is able to fill several roles.
Traditional models of care utilized only mid-level practitioners to enhance performance and the quality of patient care, but those models are rapidly evolving with the changing climate of health care. Both physicians and patients benefit from a well-trained physician extender who has specialty specific training and is focused on providing high-quality patient care.
For more information:
Jason Mazza, MSc, OA-C, CSA, SA-C, OTC, CCRC, is director of external affairs and past president of the American Society of Orthopedic Assistants (ASOA). He can be reached at orthoopa@mindspring.com.
Disclosure: Mazza has no relevant financial disclosures.