Tag: INTERVIEW

As more and more practices adopt the TCM Model, we’ve begun a series of interviews with providers across the country to understand how their practices and their lives have been transformed.  In this edition we hear from Karl Sash, MD, Board Certified in Internal Medicine and Geriatric Medicine. He did his undergraduate work at the University of Regina, completing medical school in 1993 and an internal medicine residency in 1997 at University of Saskatchewan and a geriatrics fellowship at Duke in 1999. He is affiliated with St. Vincent Hospital Evansville (Indiana) and he adopted the TCM Model in 2017. What follows are his reflections.

Remembering his initial perception of the TCM Model

My first thought was – great concept. But then you wonder how do you take time from your busy practice for the execution? At the very base of it, there’s a cultural change required which includes educating patients as to why their exam room experience will be different. Plus changing protocols and routines related to the EHR. Then there’s staff training related to the new skills required, and in our case, some additional hiring. It’s an evolution that takes some time and energy, particularly with staff that weren’t originally hired for this kind of transformed exam room. But the benefits definitely outweigh the efforts.

Investing in teammates

Moving to the TCM Model focused on maximizing the roles of our medical assistants, specifically increasing their patient-related skills. Some were enthusiastic, others more hesitant, but it wasn’t long before it all started to gel. I would say that our MAs greatly prefer the team approach now and are very comfortable with their responsibilities. I would add that it’s important for the provider to show respect for what the Team Care Assistant is doing in the exam room.

Better patient care

I’m more focused on the patient now. There’s more direct interaction, more eye contact, and more opportunity for me to see the big picture. I am working 1.5 hours less per day, seeing 2 more patients per day (my goal was to cover the expense of the additional MA), seeing 20+ complex visits per day (almost all are legitimate 214s and a few 215s), all this while managing 500 nursing home residents with NPs and hospice. What’s happening is that an innovative approach is actually creating a more traditional feel. And it all translates to better care including increased screening rates. Outside the exam room, my quality of life is noticeably better. I’m getting more sleep and more exercise. I don’t feel beat up at the end of the day. The analogy that comes to mind is that if you’re in a hospital, do you want to be cared for by a provider at the beginning of his or her shift or during the last hour? With the TCM Model, I feel like I’m always at the beginning of a shift.

As more and more practices adopt the TCM Model, we’ve begun a series of interviews with providers across the country to understand how their practices and their lives have been transformed.  In this edition, we hear from Chelsea Doyle, FNP, who practices at the Community Health Alliance (CHA) in Washoe County, Nevada.

Before being trained using the TCM Model in May 2016, Chelsea hated working behind the computer and often worked 2-3 hours every night. She felt as though she was on a burning platform and could not sustain this routine. CHA implemented the TCM Model in Spring 2017 and we interviewed her 12 months later. What follows is her story.

More flexibility, better access

CHA is a Federally Qualified Health Center (FQHC) serving Nevada’s second-most populous county, including the cities of Reno and Sparks. As an FQHC we serve a vulnerable population with a large percentage of Medicare, Medicaid, underinsured and uninsured patients. We’ve always had a high, no-show rate.

In this environment, the extra support you get from having a coordinated system of backup, from working together as a team, gives us more flexibility. And even with that less-than-predictable workflow, productivity has increased to the point where we’re seeing 3-4 additional patients each day as a result of implementing the TCM Model.

Starting out as a team — the early days

Our approach to the TCM Model included maximizing the roles of our medical assistants, especially increasing their patient-related responsibilities in the exam room.  At first, they seemed hesitant, which wasn’t unexpected, but it didn’t take long before it all started to gel.  I would say that our MAs greatly prefer the team approach now.

How the patients see it

We’ve had some patients who said they didn’t like having another person in the exam room, but they were the distinct minority. Most of them appreciate having another pair of eyes and ears available.  It gives them confidence that they’re being heard and that their care is even more thorough. They also realize that they’re getting more uninterrupted time with me, particularly more face-to-face time. I don’t want to be the person sitting in front of a computer in the exam room. It’s not what I do, or rather it’s not what I do best. As a provider leading a TCM Model-based team, you have to give up a little control but you get a lot more accomplished at the end of the day. Literally and figuratively.

Reclaiming my personal life

Before we transitioned to the TCM Model I was working through lunch and probably doing an extra two to three hours every day outside of paid time – not a good situation for the mother of young children or anyone else for that matter. The thing is, I still tend to work through lunch. It must be part of my routine. But the big difference is that I’m not doing any work at home anymore and I don’t feel the kind of stress I used to experience.  The charts are signed before I leave the office and my completion rate is practically 100%. The change has been very positive for me and definitely for my family.

This blog and several to follow contain thoughts by providers who are currently using the TCM Model to create a more efficient exam room, with corresponding increases in access and improved quality of life. The initial observations come from Craig Miller, MD, a family medicine physician affiliated with St. Joseph Health System in Indiana.

Dr. Miller graduated from Indiana University and received his medical education from the Indiana University School of Medicine. He completed his residency at Memorial Hospital of South Bend and is board certified in Family Medicine. Dr. Miller has medical interests in obstetrics, skin procedures and diabetes. He’s been practicing medicine for the last 17 years.

Peter Anderson, MD, Founder and CEO, Team Care Medicine (TCM)

TCM: How has your personal life been affected by the adoption of the TCM Model? Are you experiencing any differences?

Dr. Miller: Before we transitioned to the TCM Model I never had enough time to complete administrative work without bringing it home.  No matter how hard I was working there just weren’t enough hours in the day to check all the boxes – so there’s been a dramatic and very positive difference in that area. I’ve been working with a well-trained and motivated exam room team for four years now [since adopting the TCM Model in 2014], and I feel like I have my life back. That’s been a great thing for my family, and I also think it’s made me a better physician.

TCM: How has patient access been affected since moving to the TCM Model?

Dr. Miller: As a practice, we’re seeing about 35 patients per day. I’m doing more chronic disease management as well as more health maintenance and preventive care. Overall, I would say that we’re doing a better job of taking care of the people in our community, and that’s very gratifying.

TCM: How have your patients responded to the change from a traditional provider-centric environment to one where assistants are doing most or all of the non-physician work inside the exam room?

Dr. Miller: I would call it a resounding success in that area. Our patients, including those who had been with us for quite a while, like the added interaction. They feel like they’re getting more time and attention overall.  A number of them also expressed the sense that the whole exam room experience felt more thorough.

TCM: How would you characterize the effort needed to adopt an exam room team model?

Dr. Miller: We had administration backing and a staff that enjoys learning new things and taking on new responsibilities during the patient visit. That’s not always the case so we were fortunate on both counts. There was definitely a learning curve up front that required an investment of time, energy, and financial resources. It also takes some effort to customize the TCM protocols and processes to more precisely fit your own practice. But it pays off quickly, and from what we’re experiencing, it keeps on paying off.

TCM: Could you envision yourself practicing again in a non-TCM exam room?

Dr. Miller: I could not and would not. I’d still practice, but not as a family medicine physician. There’s no going back to the way things were.