A few years ago, my partners and I worked with an open-access pediatric Medicaid clinic that had a very creative approach to helping as many patients as possible. Their ingenious ideas helped them bust many of the assumptions about Medicaid (especially the big one: that patients can’t be served without losing lots of money).
One of their biggest gambles was investing in a small bus to transport people who couldn’t get to the clinic because they lacked transportation or child care. Ultimately, the bus wasn’t much of a financial risk at all, since it brought patients in when the clinic was typically less busy. Plus, if a parent had one sick child and one well child, everyone could come to the clinic on the bus. The well child could be seen for an overdue check-up at the same visit as the sick sibling. This allowed the clinic to deliver more timely preventive services to more of its at-risk patients, while also generating more revenue. It helped address a clinical challenge while also improving the clinic’s financial picture.
With the list of preventive screenings always seeming to grow, finding creative ways to accomplish more in less time—without putting more pressure on clinicians or the budget—is essential for any busy clinic. Of course, providing open access or transportation for patients is not an appropriate solution for every pediatric or family medicine clinic. But every practice can discover novel ways to do more with the same team by thinking creatively and questioning long-held assumptions.
Here a few ideas that are a bit more conventional than adding a shuttle bus, but still might spark your practice team’s creativity about how to provide more services without adding stress:
Group visits. Transportation and child care are common obstacles for Medicaid patients. Establishing evening group visits might make it easier for families who are in the same neighborhood to travel together for wellness checks.
Because everyone in the group attends everyone else’s visit, messages about the importance of screenings and vaccines can be amplified. For example, if the nurse or physician asks one parent about lead testing and explains the importance of the test, the other parents can hear the message as well. Preparing to conduct screenings or administer vaccines for a group of 6-12 patients in one session can also be done very efficiently.
The administrative side of group visits can be intimidating at first, but the process may be easier than you expect. Keys steps include identifying patients who would value and benefit from meeting in a group setting; securing proper documentation and permissions related to HIPAA; defining roles of nurses/MAs and clinicians, to execute the visit efficiently; and billing each patient for their own, complete visit.
Expanded physician support. MGMA recently published an excellent podcast about a multi-clinic family practice that adopted a model they call ‘co-visits.’ Under the co-visit model, the patient sees a nurse prior to the physician encounter to gather history and other details, and sees the nurse again after the encounter for needed education. The nurse also helps with needed chart documentation, with the physician reviewing, editing as needed, and approving all notes.
This approach allows the physicians and NPs to be more productive. They can complete their encounters in about seven minutes, with patients perceiving no loss of attention. But setting up this model does require planning to set expectations, and there will be a learning curve.
Another way to support clinicians: scribes. An eight-provider pediatric practice we worked with added scribes recently to its clinic workflow. Their physicians and NPs love it! They’re able to see more patients and consistently complete their documentation by the end of the day.
Proactive scheduling. Pediatric practices are often justifiably frustrated by parents’ habits of bringing a sibling along who might be coming down with the same illness or have a different complaint, expecting the physician to examine the second child without an additional appointment. This is a common reason why many pediatric practices fall behind schedule.
But what if you tried to head the problem off in scheduling, by training staff to spend a bit more time checking how many siblings are in the family, asking the parent if anyone else is ill, and learning whether the entire family is current on preventive screenings and vaccinations? This extends the scheduling call a bit, and will require staff training to ask the question in a positive way (e.g., “we want to be sure to allow enough time”). But this little extra time investment can solve many problems. You may find, for example, that you can schedule a “slot-and-a-half” when a second child needs to be seen, rather than two separate appointments – allowing your clinicians to make more efficient use of their time, without the stress of working in unplanned appointments.
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