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Increasing Access, Outcomes, and Value: Health Workforce Panel at NPA Annual Meeting Teaches Nuts and Bolts of Building Multi-Professional Teams

Posted by Kate Tulenko, MD, MPH, MPhil December 4, 2013 at 6:05 AM

The National Physicians Alliance is the first national physicians organization to adopt a health workforce policy that addresses the need for team-based care with non-physicians providers.  This type of reform is increasingly needed as the US faces an aging population and an increase in access to health care under the Affordable Care Act.  As part of the NPA’s work to implement the policy, a workshop was held during the NPA’s Annual Meeting entitled “Workforce Challenges in Team-Based Care”.  The purpose of the session was to give participants practical knowledge on how to effectively hire and manage high functioning multi-profession health teams.

NPA board member Dr. Kate Tulenko started the session with a review of the evidence of the effectiveness and value of care provided by non-physician providers such as physician assistants, nurse practitioners, advanced practice nurses, midwives, emergency medicine technicians, and medical assistants.

Dr. Soma Stout then presented the Cambridge Alliance’s model of using Medical Assistants (MAs) as an integral part of the health team.  The Cambridge Alliance places MAs in charge of monitoring quality of care indicators such as percent of women who have received annual pap smears.  This critical responsibility incentivizes this often under-utilized profession, making them truly feel part of the team.  MAs have the time to check to see if patients have received their recommended screenings and labs, such as hemoglobin H1C levels for diabetes and colon cancer screening for older adults.  Dr. Stout also revealed one of Cambridge Alliance’s strategies for retaining high performing workers: their MAs are recruited from the communities Cambridge Alliance serves and therefore tend to both speak their patients’ home languages and understand their attitudes and barriers regarding health and healthcare.

Dr. Jeff Beeson from MedStar EMS presented an exciting approach that is rapidly gaining evidence of significantly improving clinical outcomes for people with multiple chronic diseases while saving tens of millions of dollars by preventing unnecessary ER visits and hospitalizations.  The approach uses Emergency Medical Technicians (EMTs) to visit frequent 911 callers in their homes and help them learn to manage their conditions at home or how to access their regular physicians in a timely manner.  The approach takes advantage of the fact that EMTs and paramedics work under a physician’s license and therefore have incredible flexibility in their scope of practice which allows them to provide needed services in patients’ homes such as education and flu vaccination.  The approach has been recognized by the Agency for Healthcare Research and Quality as a healthcare innovation.

Dr. Seph Morrison from Children’s National Medical Center in Washington, DC, presented on working with physician assistants and nurse practitioners to provide care to children in an emergency room setting. Dr. Morrison’s talk highlighted the fact that physician clinical and legal responsibility for the care provided by non-physician providers on the team varies greatly state by state, especially for nurse practitioners.  In some states  nurse practitioners work completely independently whereas in other they need to work with a physician to either practice or to prescribe medicines.  She also made the important point that different physicians will have had different experiences working with NPs and PAs and that this needs to be taken into account when onboarding new physicians and orienting them to the practice level of the NPs and PAs. PAs are especially skilled at low-risk but time consuming procedures such as wound cleaning, suturing, and splinting which enables physicians to focus on diagnosis and treatment of higher-risk patients.

The final speaker, Dr. David Wheeler, a neurologist from Casper, Wyoming spoke about his success building and managing multi-professional teams to provide high-quality sub-specialty care in rural settings in which there is a severe shortage of sub-specialists.  Dr. Wheeler spoke about how the physician was most needed at the initial visits in which the diagnosis was made and the treatment plan designed. Non-physician providers could then monitor the patient during the treatment and assist with compliance with the regimen. Dr. Wheeler is also starting to use mid-level providers to provide patients with high quality sub-specialty care in communities where it would be a great burden for them to travel to larger cities.  Mid-level providers travel to remote clinics, take a history and conduct a physical and then connect via Skype with the physician for more detailed history, more detailed discussion, diagnosis and treatment planning.

It’s estimated that the Affordable Care Act will add an additional 40 million to health insurance roles, greatly driving up demand for health services and health workers.  If you are interested in volunteering or partnering with NPA on the important issue of ensuring every American has access to a high quality healthcare team, please contact policy@npalliance.org or ktulenko@yahoo.com.

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