Finance and Time Use Implications of Team Documentation for Primary Care: A Microsimulation

Sanjay Basu; Russell S. Phillips; Asaf Bitton; Zirui Song; Bruce E. Landon

doi:10.1370/afm.2247

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Team Documentation in practice
James T Jerzak

Published on: 19 July 2018

Published on: (19 July 2018)
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Team Documentation in practice
James T Jerzak, Family Physician
It was encouraging to see a serious article about the financial aspects of team documentation. At Bellin Health, we have about 100 teams live on the advanced team-based care model, where our CMAs and LPNs take on additional roles, including documentation duties.
In our experience, this thoughtful article may overlook some additional financial issues that may lead to higher estimates of redirected time needed...
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It was encouraging to see a serious article about the financial aspects of team documentation. At Bellin Health, we have about 100 teams live on the advanced team-based care model, where our CMAs and LPNs take on additional roles, including documentation duties.
In our experience, this thoughtful article may overlook some additional financial issues that may lead to higher estimates of redirected time needed for financial sustainability than are seen in practice.
Though Bellin is moving into value based payments, we are nowhere near fully capitated. However, the enhanced involvement of our CMAs and LPNs in care gap closure as part of their expanded duties, has lead to a significant improvement in quality measures, and a significant increased in value based payments for these improved measures. We figure that accounts for about half of the funding for our team-based care transformation.
We have also noticed an increase in the complexity of our patients in our primary care practices. That is due to a variety of factors, including earlier hospital and Skilled Nursing facility discharges, aging of the population, increase in rates of chronic diseases such as diabetes, and the development of alternative places of care for more straightforward patients, such as urgent care, fast care, employer clinics, and even virtual care. Because of that, we have not seen as much of an increase in the number of office visits as we expected, but have seen a trend toward higher billing levels, thanks in large part to the in room support of our CMAs and LPNs during the office visit. This enables physicians to focus more completely on their patients, and more fully meet their needs.
It is very helpful for articles such as this one to point out the two different models of documentation support. At Bellin, we believe that up training CMA and LPN staff for these duties provides significant enhancements, not only in alleviating physician burnout related to EHR issues, but also in providing better care for our patients.
Competing interests: None declared
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Competing Interests: None declared.