By David M. Pariser, MD
As many of you have been anticipating, in the coming year there will be a lot more people who have insurance as a result of the Affordable Care Act (ACA). If we’re going to be seeing more patients in 2014, it’s important to focus on practice efficiency.
Undoubtedly, most dermatologists are already working at maximum output. So how can you accommodate more patients when you feel like you’re already working at your peak? The single-most effective way I have found is to use non-physician clinicians (NPCs), which include physician assistants and nurse practitioners, as part of my dermatology care team.
You’ll be hearing more about the dermatology care team approach this year as more in the specialty begin to implement this concept. At the heart of the dermatology care team is the dermatologist, who acts as the team captain. Other team members, such as NPCs, estheticians, and even your administrative staff, are all part of the team.
The care team
The team care approach is becoming more prevalent in dermatology because it enables more appropriate use of a physician’s time, and makes it easier for the dermatologist to delegate procedures, patient education, and other diagnostic procedures. According to the AAD's projections, by 2015 more than half of dermatologists in the United States will employ an NPC.
As the captain of my care team, I always make sure the diagnosis is confirmed and the treatment is appropriate.
Just like a good team captain would do, it’s important to define the goals of the team, as well as the responsibilities. You also need to make sure your team is appropriately trained, licensed, and supervised. When setting up your team, make sure roles and responsibilities are clearly defined and documented. Look to the Academy’s position statement on the practice of dermatology for guidance on the standard of care for delegation and supervision of care team members.
Making sure this team is properly supervised is the single most important way to provide good-quality care to patients. I employ seven NPCs, in addition to the 11 dermatologists on my practice staff. I delegate tasks to staff that don’t require an MD, such as gathering medical histories, minor diagnostic tests, patch tests, and removal of skin tags (in some states where this is permitted). But as the captain of my care team, I always make sure the diagnosis is confirmed and the treatment is appropriate.
In addition, if you are employing NPCs and non-dermatologist physicians in your practice, make sure they are appropriately identified to reflect their credentials to patients. Non-dermatologist physicians should not be represented as dermatologists. If you have medical school residents working with your practice, like I do from the Eastern Virginia Medical School, make sure they are appropriately represented to your patients as well.
In addition to having a well-coordinated team, it’s important to have an efficient back office so your practice runs as smoothly as possible with added patient load. If possible, reconfigure the way your staff works so that as much is done in advance of when new patients walk through your doors. In my practice, patient demographic information and insurance is obtained and verified ahead of time. I have staff members who conduct precertification so it doesn't disrupt the office flow.
We also make it easy for patients to request appointments online, as well as refills and other routine tasks. We provide directions to our office on our website to cut down on the time our staff has to spend on the phone. In our practice, we receive up to 1,500 calls per day, so any efficiency in this area is critical.
As you’re thinking about ways to ramp up practice efficiency this year, consider adopting the dermatology care team approach for smoother operation of your practice to help provide quality patient care.
Dr. Pariser is in private practice at Pariser Dermatology Specialists in Norfolk, Va. He serves as chair of the AAD’s Dermatology Care Team Implementation Workgroup.
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The Academy offers a "Coding and Practice Updates for 2014" live webinar on Jan. 16. Learn more about the webinar here.
Watch your mail for the February issue of Dermatology World, which will include an in-depth feature on the evolution of the care team approach in dermatology.