GE Healthcare Camden Group Insights Blog

Primary Care at a Crossroads

Posted by Matthew Smith on Jul 25, 2016 2:42:30 PM

By Marc Mertz, MHA, FACMPE, Vice President, GE Healthcare Camden Group

Most primary care practices still operate based on a model developed decades ago: the hours of operation, appointment scheduling rules, staffing, patient flow, and office design were all determined based on physician preference. In an attempt to provide physicians with a more convenient practice model, we created a system that forced patients to accept long waits for appointments, inefficient office flow, and limited ability to communicate with their physicians outside of the exam room.

Yet physicians hardly fared any better in these offices that were actually designed with them at the center. Complex appointment scheduling rules and templates inherently led to mistakes and double booking, phone messages piled up, administrative work increased, patient appointments ran behind, and physicians inevitably spent hours working in the clinic long after patients had left.

While the typcial primary care practice doesn't really work for patients or physicians, in the absence of alternatives, we came to accept this model for what it was. But times are changing. A plethora of new providers are entering the primary care marketplace, and their growing popularity is as much an indictment on traditional physician-centric primary care practices as it is a reflection of new reimbursement models and rising consumerism.

To contunue reading "Primary Care at a Crossroads," please click the button below. You will instantly be directed to the online article published in CAPG Health's Summer 2016 issue.

Primary Care, Practice Management, Practice Transformation

MertzM.jpgMr. Mertz is a vice president with GE Healthcare Camden Group and has 18 years of healthcare management experience. He has 15 years of experience in medical group development and management, physician-hospital alignment strategies, physician practice operational improvement, practice mergers and acquisitions, medical group governance and organizational design, clinical integration, and physician compensation plan design. He may be reached at  

Topics: Practice Management, Primary Care, Primary Care Providers, Primary Care Access, Marc Mertz, Practice Transformation

Are Your Primary Care Practices at Risk?

Posted by Matthew Smith on Aug 28, 2015 12:56:41 PM

By Marc Mertz, MHA, FACMPE, Vice President, GE Healthcare Camden Group

If your primary care practices are like most traditional medical offices, they have been designed with the physicians’ preference and convenience in mind. The physician decides which days they will work, the hours they will see patients, the types of appointments they will see, as well as when they will see them. As a result, patients might wait weeks for an appointment. When they do get an appointment, the patient’s experience does not get much better: they wait to be seen, they have to fill out long forms, and they have little face time with the physician. Patients are not the only ones dissatisfied with the status quo. Despite being at the center of the current practice model, primary care physicians are not satisfied with the way their practices are structured; increasing burdens to provide care coordination and quality monitoring while improving patient access makes them feel increasingly overwhelmed and dissatisfied.

An Increasing Pressure to Change

The medical office described above has not changed much in the last 30 years, aside from perhaps the addition of electronic medical records (“EMRs”) or other technologies. Practices have felt little pressure to change their business model, and patients really have not had any other options. That is changing, however, and it is changing very quickly. Retail giants such as Walgreens, CVS, and Walmart are aggressively expanding their clinical services, including primary care. Urgent care centers are popping up seemingly on every corner. The reason for such rapid growth is that these new providers offer patients everything that traditional primary care practices do not: access, convenience, and efficiency.

Is it so farfetched to think that these new providers could ultimately replace primary care as we know it today? Blockbuster probably thought it unlikely that Netflix and its online movie downloads and streaming would drive them out of business. Kodak did not foresee digital photography essentially eliminating the film camera industry. But if these dominant players in long-established industries can be replaced, why not primary care practices?

New Options for House Calls

A primary care practice that continues the status quo ultimately faces a slow death spiral. Every time an established patient gets sick, and they cannot get in to see their physician for several days or even weeks, they are going to go to an alternative provider. And they may never come back. Rather than take the afternoon off from work to see their primary care physician, a patient might stop in and see a nurse practitioner at their drug store after work and be in and out in 20 minutes. Or in some markets, they might use an app on their phone like Amwell to have a virtual visit without leaving their home, or even request an on-demand home visit from an Uber-like service. Patients in major U.S. cities now have multiple options for house calls. Pager is a new service that allows patients in New York to schedule a house call within 2 hours and pay a flat fee per visit. Will your primary care practices be blindsided by Pager just as taxi companies were by Uber?

Retail clinics and other alternative delivery models currently offer a limited scope of services but are expected to expand their services. They will also continue to introduce remote monitoring and telemedicine devices that allow them to engage and monitor patients, as well as manage their chronic conditions, increasingly competing with traditional primary care practices for patients.

Patients are not the only ones looking for alternatives to the current primary care delivery model. Dissatisfied primary care physicians are also looking for more rewarding practice models that do not overwhelm them with long days, an inefficient EMR, and ineffective work flows. Primary care groups risk losing their current physicians and face increasing recruitment challenges.

Where Should You Start?

So where should a primary care practice start? By expanding patient access? Increasing the efficiency of their office and patient flow? Improving patient service? Implementing enhanced technology such as a patient portal and home monitoring devices? Partnering with retail clinics and other innovators? The answer is all of the above. And fast.

Appointment scheduling should be easy, both via telephone and online. Patients should be able to get an appointment when they want it, and that includes the same day. To achieve this, practices must reevaluate the number of types of appointments they offer. They may also have to expand their office hours to include evening or weekends. Physicians need to let go of their perceived control over daily schedules. Rather than cling to a system that does not work for anyone—the patient, physician, or the staff— primary care practices should start over with no more than four appointment types: long and short new patient visits and long and short established patient visits; in many cases this can even be boiled down to two appointment types. Not every appointment will fit perfectly into one of these slots, but the flexibility and simplicity of the scheduling will save time and improve access and satisfaction.

Primary care physicians already use advanced practice clinicians (“APCs”), typically nurse practitioners or physician assistants. In many offices, several physicians will share an APC, who will see the physicians’ sick patients or routine cases. By flipping the ratio of physicians to APCs, a practice can expand access at a lower cost. A single primary care physician can supervise a team of two or three APCs, each of whom manages his or her own panel of patients. The physician handles the complex patients and is available to support the APCs whenever necessary.

Patients do not like to spend two hours in your primary care office, especially when they get just a few minutes with the physician. Every aspect of the patient’s visit and experience should be assessed with a critical eye for any waste or delays. Time studies that track each component of the visit can help identify bottlenecks. Once inefficiencies or waste are identified, engage a multidisciplinary team to redesign the process. Then test and redesign again continuously to improve.

The greatest influence on patient satisfaction is not the physician or the office décor. It is your staff. Recruit employees with this in mind. Train your staff on customer service skills. Physicians must also lead by example. Patients are being seen to receive clinical care, but they must also be treated like customers and human beings.

Optimize the EMR

One of the biggest barriers to office efficiency, as well as a major source of physician dissatisfaction, is the EMR. As new systems have been implemented, practices have modified their procedures and processes to adapt to the EMR design and structure, rather than the other way around by adapting the EMR to serve as a tool to help meet the needs of the practice. This case of the “tail wagging the dog” typically means more work for the physicians and staff— often a lot more work. As a result, efficiency and patient volume have declined, which also reduces patient access. System inefficiency also leads to physician and staff dissatisfaction. Practices need to assess how they use their EMR and identify ways to optimize the system based on efficient work flows and an appropriate delegation of tasks to the lowest cost individuals whenever possible.

Furthermore, consider how your primary care practice will deliver care without requiring patients to come to the office. Relying solely on the traditional face-to-face office visit is quickly becoming archaic. Determine what fits best in your practice: patient portals for secure e-mail messaging, televisits, group visits, home visits, use of other support staff such as educators and pharmacists to respond to patient questions, or partnering with innovators to extend your reach to retail or other settings all must be considered as potential venues for extending the access points for your patients.

Overhauling your primary care practices is no small undertaking. However, failing to do so puts your organization at significant risk, as patients will increasingly seek out providers who offer greater access, convenience, and service. Inefficient and ineffective primary care practices will also make the recruitment and retention of primary care physicians even more difficult than it already is. More than just a defensive effort, redesigning your practices with the patient in the center is good for care delivery and for business.

Mr. Mertz is a vice president with GE Healthcare Camden Group and has 18 years of healthcare management experience. He has 15 years of experience in medical group development and management, physician-hospital alignment strategies, physician practice operational improvement, practice mergers and acquisitions, medical group governance and organizational design, clinical integration, and physician compensation plan design. Mr. Mertz has managed private practices, hospital-affiliated practices, and academic physician practices. The Medical Group Management Association (“MGMA”) has identified practices under his management as “Best Performing.” He may be reached at

Topics: EMR, Primary Care, Primary Care Access, Primary Care Provider, Marc Mertz, EMR Optimization

Six Strategies to Improve Primary Care Access

Posted by Matthew Smith on Jul 1, 2014 1:29:00 PM

By William K. Faber, MD, MHCM
Chief Medical Officer
Health Directions

Primary Care Provider, Health DirectionsPrimary care providers are the heart of clinical integration. Ready access to primary care services is fundamental to disease prevention, chronic illness management and the reduction of unnecessary testing and treatment. Unfortunately, primary care physicians are scarce and getting harder to find.

Approximately 40% of primary care physicians are over the age of 55, and many will retire before age 65. Fewer medical school graduates are going into primary care. Most primary care physicians feel stretched to capacity and often work 12-hour days, and financial incentives alone are inadequate to entice these physicians to add more patients to their schedules..

Given these constraints, health care systems need to expand primary care access through other means. Following are six strategies to increase primary care access by improving staffing models and practice operations.

1. Hire more non-MD providers

Physician Assistants (PAs) and Nurse Practitioners (NPs) can meet the needs of most primary care patients and both are more plentiful than primary care physicians. Integrating these providers into a practice will expand access for patients and allow physicians to focus on more challenging cases that require a more skilled level of expertise.

2. Sync the practice schedule to patient demand

Many practices are open from 8:30 a.m. to 4:30 p.m. (and closed over the lunch hour) Monday to Friday, but many patients prefer early-morning, evening or weekend appointments. Adjusting practice office hours to match patient demand will accommodate more volume, even if the total hours of patient appointments remain the same. Monday is typically the busiest day of the week in doctors’ offices; therefore, the greatest number of physician appointment hours should be provided on Monday. Similarly, patient demand is usually greatest during the winter flu season, so limit adult care providers vacations during this time. Similarly, pediatricians should be most available during school physical season.

3. Simplify appointment types and frequency

Practices create many different appointment types—well visits, sick visits, physicals, pap visits, follow-ups, etc. To better manage patient flow, reduce the number of appointment types to two: 15 minutes and 30 minutes (or any base appointment length and one twice as long). You can determine what kind of patient is best suited to each of these two types, rather than letting the name of the appointment determine whether a patient fits in that slot. Providers should also reconsider the interval at which they recommend follow-up appointments. Some physicians routinely tell their hypertensive or diabetic patients to return every three months. This clogs their schedules unnecessarily so they have inadequate appointments for those that are acutely ill. A better practice is to tailor the follow up interval to the specific patient. If they are well-controlled and self-monitored, certain patients may only need to be seen twice a year. Some patients should be seen more frequently than quarterly to keep them out of the hospital. 

4. Fix practice bottlenecks

All practices can stand to improve patient throughput and efficiency by identifying bottlenecks. Conduct a time-flow study on a sample of patients as they move through each phase of their visit. Reduce delays by redesigning processes and redeploying staff. For example, give patients a clipboard to fill out while they are in the waiting room, so they can list their concerns for the day and verify the medications they are currently taking. Better yet, let them do this through an advanced patient portal. Better patient flow can increase patient access without extending the workday.

5. Create standing orders

Staff members often ask physicians questions for which the answer is always the same. When this is the case, everyone would benefit from standing orders. An example would be a nurse waiting for a doctor’s signature on an order for a mammogram or diabetic retinal exam when it is documented that the patient is due for one of these tests. The physician can designate that they always approve under certain circumstances by creating standing orders. Rooming protocols can also improve throughput. For instance, assistants should always have diabetic patients remove their shoes and socks while rooming the patient, so the doctor can examine the patient’s feet without delay.

6. Break the “face to face” pattern

Clinical integration aims to reward physicians for improving patient outcomes. In the fee-for-service world, physicians are rewarded only for face-to-face encounters, so they have become accustomed to having patients come in to the office when it is not actually necessary. To succeed in new systems of payment, physicians must become comfortable with managing low-risk patients outside of the face-to-face visit, so they are available to see the high-risk patient who truly needs to be seen. In many cases, diagnosis and treatment over the phone is entirely appropriate.

What about patient satisfaction?

Implementing these strategies can help physicians increase their availability to patients. A more efficiently run office can actually expand that amount of “face time” a patient has with their doctor. This also opens up appointments when patients actually want to be seen, which is a big satisfier.

About the Author

William K. Faber, MD Health DirectionsDr. William K. Faber, Chief Medical Officer for Health Directions, is a physician executive with progressive senior leadership experience. He most recently served as Senior Vice President of the Rochester General Health System in New York, where he guided the development of the system’s Clinical Integration program and assisted more than 150 providers at 44 sites through the conversion process from paper records to an Electronic Health Records system (Epic). Dr. Faber formerly participated in the governance of the Advocate Physician Partners (APP) Clinical Integration program and directed APP’s Quality Improvement Collaborative.

Topics: Clinical Integration, William K. Faber MD, Patient Satisfaction, Primary Care Providers, Primary Care Access

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