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3 ways to redesign annual well-woman visits

NASHVILLE, Tenn. — Lingering questions about yearly well-woman visits provided by the Affordable Care Act prompted a discussion at the American College of Obstetricians and Gynecologists Annual Clinical and Scientific Meeting.

“There has been so much controversy and so much discussion about whether or not we even need to do these exams,” Patrice M. Weiss, MD, chief medical officer of Carilion Clinic in Roanoke, Virginia, told attendees. “[Many have questioned] if we need to do Pap smears and have wondered what labs we need to do,” she continued.

In addition, previous CDC research has shown there was “much room for improvement in the receipt of preventive services among women” in the first 5 years of the act.

Weiss, Lee A. Learman, MD, PhD, senior associate dean for graduate medical education and academic affairs, Florida Atlantic University, and Holly S. Puritz, MD, an OB-GYN with The Group for Women in Virginia shared their experiences to improve the well-woman visits of others.

Employing emotional intelligence

Weiss said utilizing the concept of emotional intelligence will enhance patient takeaways from the well-woman visit.

“No matter how much has changed in annual exams, the one thing that has not changed, and the one thing that needs to be the core, is the patient and their experience. How that patient feels and how she is treated” are paramount, she said.

The first two domains of this principle, self-awareness and self-regulation, are how the patient sees you and how your moods and actions impact them, according to Weiss.

“This means no matter how bad the day has been, the patient needs to be the center of the visit,” she said.

“Do this by keeping your emotions in check and having a sense of your office’s tenor. Ask yourself: How does your staff answer the phone? Is the waiting room music too loud? How welcoming are you when you first see the patient?”

 

Lingering questions about the yearly well-woman visit provided by the Affordable Care Act prompted a discussion at the American College of Obstetricians and Gynecologists Annual Clinical and Scientific Meeting.

Source:Adobe

Another part of emotional intelligence, motivation, is the concept of being the best OB-GYN you can be for the patient’s gain, not your gain, Weiss said. Consequently, the patient will get the care she needs and understands what she needs to do to maintain or improve her health.

Empathy is another component of emotional intelligence, according to Weiss.

“I understand that our jobs are stressful and we’re often asked to do three things at one time. But we need to treat patients based on their emotional needs and put their needs first,” she said.

The final part of emotional intelligence, social skills, consists of ensuring the patient understands what she needs to do to ensure optimal health.

“Ask her how confident she is in understanding” whatever it is you have asked her to do.

“If on a scale of one to 10, she says anything less than an eight, you need to try explaining again,” Weiss said.

Quality, not quantity

Learman recommended looking beyond the “technical approach” of checking as many boxes off on the preventive services list as possible during the well-woman visit and to take a “long-view approach” instead.

“Many of our patients will experience threats to their health over time. You need to determine what it will take over their lifespan to ensure she does the things that are going to have a tangible impact on her health,” he said.

He said this can be best accomplished when OB-GYNs and their patients work together to develop a shared agenda.

“Ask her what her highest priorities are, but also ask if you can talk about the concerns you have noted too,” Learman said.

He also encouraged OB-GYNs develop a “to-go list” that is tailored to each patient’s needs or medical conditions. This list can contain websites the patient can visit or contact information for other medical professionals that can address the concerns that were not brought up or sufficiently addressed during the well-woman visit.

ACOG also has evidence-based guidelines that address how to approach nearly every medical situation that could be encountered, Learman said.

“Make sure the patient understands that you don’t have to address everything in one appointment. Explain that it is better to go deep and follow-up with additional visits. This will give the patient autonomy and the power of seeing her fingers all over her medical agenda,” Learman said.

“This approach develops trusting relationships, helps patients live longer, healthier lives and pays dividends over time,” he added.

Ensuring reimbursement

Puritz discussed how physicians can utilize Weiss and Learman’s strategies and still get properly reimbursed.

Since the patient does not have to pay out of pocket for these, “many patients see these visits as gold since she will often think she does not have the extra capital to come in for every ache and pain. She will bring many things up,” she said.

“You can take one of two approaches,” Puritz continued. “You can get the official well-woman visit papers out and do these well-woman visits by the book ... but just because you can do something doesn’t mean you don’t have to.”

This playing by the book approach often “leaves the patient feeling unsatisfied. Is she coming back to see you? Is she referring her friends to you? Is she trusting you? [Chances are] she’s not and chances are you will get paid at diminished rates,” Puritz said.

She said that by showing the patient sympathy with a simple comment that ensures you understand the patient has many medical concerns, the patient will feel that you can relate to their concerns, does not feel belittled or diminished, is more likely to come back for follow-up care and refer others to you and/or your practice.

 

"You can take one of two approaches [with well-woman visits],” a speaker at the American College of Obstetricians and Gynecologists said. "You can get the official well-woman visit papers out and do these well-woman visits by the book ... but just because you can do something doesn’t mean you don’t have to.”

Source:

Puritz acknowledged there will be exceptions and instances when the “book approach” is necessary but added that it is hard to pre-emptively define when it is warranted.

“Your gut is going to tell you when this is right approach and when it is the wrong one,” she said. – by Janel Miller

References:

Learman LA. “Well woman care: Redesigning the annual visit.”

Puritz HS. “Demystifying billing and reimbursement.”

Weiss PM. “Leading with emotional intelligence.”

All presented at: American College of Obstetricians and Gynecologists Annual Clinical and Scientific Meeting; May 3-6, 2019; Nashville, Tenn.

Also: Stolp H, Fox J. J Womens Health. (Larchmt).2015;doi:10.1089/jwh.2015.5552.

Disclosures: Learman and Puritz report no relevant financial disclosures. Healio Primary Care Today was unable to determine Weiss’s relevant financial disclosures prior to publication. Please see the study for those authors’ relevant financial disclosures.