How much time is needed to provide primary care?

A new study estimates physicians would need 26.7 hours per day to provide the recommended preventive, chronic, and acute care to a panel of 2,500 adult patients, including the related documentation and inbox work. But one strategy can dramatically reduce the time required, according to researchers.

Practicing in a team-based care model reduces the number of hours physicians would need to spend to 9.3 hours per day — still high, but far better than when physicians shoulder the burden alone. The most time saved is in the area of preventive care.

Researchers modeled their estimates based on the team members commonly found in the Comprehensive Primary Care Plus initiative. A separate study found that these practices started with the traditional staffing model of physicians with medical assistants, which they empowered, and then most commonly added care managers/care coordinators and behavioral health staff.

The key feature of advanced team-based care is that physicians perform only the functions they are uniquely trained and qualified to do, and they delegate other tasks to capable staff. For example, nurses and MAs can be trained to take on tasks such as agenda setting, history gathering, record retrieval, EHR navigation, updating charts, medication review, data entry, order entry, and the bulk of required visit documentation. Once the clinical support staff role has been optimized and tasks delegated, practices can add other roles — such as care coordinators, behavioral health professionals, or clinical pharmacists — based on their needs.

Researchers acknowledged the financial challenge of implementing team-based care models. However, some practices (see Hopkins and Lyon) have found that by having additional optimized staff, they are more productive, which offsets the additional expenses. In addition, some team-based tasks (such as care coordination) are not directly reimbursable on their own but are bundled into other billable services (such as transitional care management). Additionally, organizations participating in value-based payment models may be paid an upfront “care management fee” to help support the work of the team.

The crux, of course, is finding and keeping qualified staff. See "Don't Leave Me! Strategies for Medical Staff Retention."

Posted on Sept. 27, 2022 by FPM Editors