This is the story of how one neurology practice dialed up efficiency, shortened wait times, and increased profitability, all while increasing the opportunity for patient eye contact and decreasing physician burnout.

Enrique Alvarez, MD, PhD

We first heard this story at a talk given at the 2019 annual meeting of the Academy of Neurology. We later spoke with one of the presenters, Dr. Enrique Alvarez, director of outpatient adult neurology services at the University of Colorado Hospital, where this share-worthy program is in place.

Like many neurology practices, Alvarez and his team were dealing with EHR issues and greater-than-three-month patient wait times. They also had efficiency challenges: rooms often standing empty and medical assistants sitting around waiting for their next assignment.

Then, in 2017, they implemented a pilot program adapted from a primary-care efficiency model out of the University of Utah. The program took six months to a year to put in place and involved greater use of MAs.

“Normally you’d have one MA for every three or four providers in the clinic,” says Alvarez. “The model basically flips that on end so that every time I’m in clinic, I have two MAs that I work with exclusively.”

In this model, the MAs spend more time than usual with each patient and work much more in tandem with the physician.

“In the old model, [the neurologist is] basically running the show, and everybody else kind of follows. Here, there’s a little bit more choreography involved and teamwork,” Alvarez says.

The MA is given a full 20 minutes with each patient. During that time, they do their usual duties like rooming the patient, taking vitals, and reconciling medications. Beyond that, they take a history, start a review of systems, and begin setting the agenda for the visit.

The MA then does what Alvarez calls a warm handoff.

“The way I think about that step is a little bit like when you work with a medical student or resident and they come back and they explain what they found from that patient,” he adds. “And then you both go into the room.”

Because of the extended rooming and the warm handoff, Alvarez is able to dive right into the issues most important for that patient: “The best thing I like about the model is I get to sit in front of the patient face to face. The MA is the one that sits in front of the computer and starts to scribe.”

Then, while Alvarez is spending time counseling the patient, the MA begins to put in orders. All the while, the second MA has been rooming the next patient and the process repeats.

The model allows physicians to deliver a more personal level of care while also seeing more patients each day. This has resulted in shorter wait times, increased revenue, and better use of clinic space. The cost of hiring additional MAs needed for this model is offset by an increased use of billing by complexity and the boost in patient volume, according to Alvarez.

Since implementing this new model, the practice sees 30 percent more patients. Surveys done among the staff 18 months after implementation and since have also shown increased job satisfaction and decreased burnout.

This model is not for all types of practices, Alvarez stresses, and it does take a lot of work to train everyone and fully implement. But in his experience the pros outweigh the cons.

“When we asked our providers if they’d like to go to the old model, uniformly for people who have done this model for at least a year it’s a pretty solid answer – ‘I’m not going back.’”