5 ways to improve practice efficiency, increase revenue, and reduce burden

By Kate Freeman, MPH
AAFP Quality Improvement Strategist

Primary care in the United States is becoming increasingly complex. The compiling evidence-based medicine practices, along with increased and disparate reporting requirements of quality measures to multiple payers, task family physicians with seemingly insurmountable responsibility during each patient visit and oftentimes leads to work after clinic—WAC.

This can result in burnout, which is a critical concern as family physicians suffer from significantly higher rates of burnout than physicians in most other specialties. While there is no magical pill that increases physician wellbeing, improves practice efficiencies, and immediately generates a return on investment, here are five strategies you can consider implementing to whack the WAC!

Agenda setting
Physicians see many patients with multiple complex chronic conditions daily. Physicians’ time is already limited during the patient visit, and the number of tasks family physicians are expected to cover in an office visit continues to grow. Best practices suggest setting a mutually agreed upon agenda between the physician and patient at the beginning of the appointment allows for an effective visit. Here are five steps to help you AGREE on the visit agenda.

1. Acknowledge patient’s list of concerns
2. Get on the same page
3. Recap top priorities
4. Ensure no additional concerns
5. Execute plan for next visit

Inbox management
A physician’s inbox can be unruly and difficult to manage during the workday, resulting in multiple hours of WAC to complete burdensome clerical work. Most inbox messages can be handled by other team members in between patient visits, thereby reducing the administrative burden and WAC that physicians experience. Consider the three following categories when determining how to redistribute inbox workload.

1. Requests that require direct physician management
2. Messages that can be routed to other care team members, such as refills, referrals, patient questions, and portal messages
3. Messages that are not related to patient care or practice business and can be deleted

Expanded rooming
Expanded rooming protocols allow physicians to delegate tasks that an MA or nurse can do and frees up precious time during patient visits to focus on higher priority patient and physician concerns. Based on state specific scope of practice laws, an MA or nurse may:

1. Help the patient prioritize their list of concerns and begin the agenda setting process;
2. Perform medication reconciliation;
3. Screen for conditions or social needs based on practice protocols;
4. Update medical, family, and social history;
5. Provide immunizations per standing orders;
6. Identify and arrange preventive care based on gaps through standing orders; and
7. Ensure room is prepared with necessary medical equipment for visit.

Team member co-location
Effective communication between care team members is essential to delivering high-quality care, but many important conversations in traditional practices often must occur at the end of the day. Co-location of care team members is a strategy that allows for verbal communication between the team in real time and results in a decrease in inbox clutter from electronic communication that would otherwise occur. Even if this strategy is not a reality for your current clinic layout, you may be able to implement other non-inbox communication tactics to increase efficiency. Some practices use walkie-talkies, instant messaging, or secure text messaging services to allow more rapid responses to questions that may arise during triage, rooming, and scheduling.

Team documentation
Team documentation, or “scribing,” is a care model where a staff member assists a physician in real-time during an examination by documenting notes, orders, and referrals, and by queuing up prescriptions, thereby allowing the physician to be face-to-face with the patient. This model allows physicians to use their medical expertise to focus on patients while members of their teamwork at the top of their training and capabilities. Team documentation may be a solution for your practice—interested in learning more? The AAFP TIPS on Team Documentation is free to AAFP members.