New York-Based, Large Physician Practice Increases Face-to-Face Counseling Time by 20%

Source: HIMSS

Established in 1999, Horizon Family Medical Group began with four locations and ten Providers. Since then, HFMG has grown to over 100 Physicians and 40 locations, comprising of 17 different specialties. In 2015, HFMG was recognized by NCQA for its consistency in practice management quality, continual patient satisfaction, programs to help reduce cost and yearly improvements in patient outcomes. HFMG was awarded PCMH Level 3 across all of their 15 Primary Care sites.

Local Problem Identified
On average HFMG’s provider slots range between 15 minutes to 20 minutes, depending on the visit type. As a result, the provider is limited to the time he/she had to review patient concerns, documentation, review tests with the patient, and answer any questions and providers wanted to spend more time talking directly to the patients.  Internally the group deemed adding three to four minutes per patient in counseling would make a positive difference in the patient’s health.  
Management dedicated weekly IT time to meet with each provider to help them increase the time spent with patients. First, IT worked with providers to consider the layout of the patient rooms and their computer hardware.  Next, HFMG worked on creating custom templates and order sets for each provider.  To ensure that their level of documentation was not a tradeoff to increase time talking to a patient, HFMG had their own billing department and hired a consulting group who specializes in medical documentation get involved with this issue. Analysis revealed providers spent countless hours ordering the same tests for multiple patients and queried each test over and over. Providers were taking, on average, three minutes to conduct a full overview on any outstanding tests, new test results, what was required for preventative care, any open referrals, any HEDIS/PQRS open gaps for the patient, and if there were any relevant scanned documents recently added into the patient’s chart. The EMR has an overview section that covered most of these items, but was lacking the HEDIS and PQRS gaps. They also noticed that providers were constantly changing filters in the overview section of the EMR, which made their use tedious and inefficient.  

After weighing many options to increase efficiency, HFMG determined a specific template,  which they named the Huddle Report, needed to be built to integrate within the EMR.  The Huddle Report extracted daily data automatically from multiple sources, such as the EMR, outside commercial vendors, patient gap reports, billing data from our Practice Management software, and combined it easy-to-read PDF page.

Solution Enacted
With the assistance of templates and order sets, HFMG created a process to help provide the physicians additional time with patients. Templates would help the provider preselect the sections of the body systems they wanted to work on during a visit. Incorporated into the template was the dictation software, which allowed providers to document using voice recognition technology. Order sets and favorites would also significantly save time during visits. Instead of the provider querying each lab test, DI, procedure, or medication each time, they would pick from a checklist of tests which have been typically ordered in past. To ensure helpful templates and order sets were created for providers, a report was run by IT for each provider on their top ten diagnoses. The average time saved within a visit using templates, favorites, and order sets was approximately two minutes per patient. 

The Huddle Report was a little harder to create as it was not built into the EMR. The Huddle Report would change processes within the group, allowing staff to review data while preparing for visits. Physicians would also use the Huddle Report to pull up certain patient information within the EMR. The Huddle Report would display outstanding tests, referrals that are outstanding, all the hospital admission dates for the patient, any new test results that came in from the last five providers they saw, the next five providers they are scheduled for, HEDIS gaps specific to that patients insurance, PQRS care gaps specific to that patient, and preventative care gaps specific to that patient. 

Using the Huddle Report, HFMG saved approximately two minutes per patient.  They increased face-to-face time by 27% for 15-minute appointment time slots and counseling face-to-face time increased by 20% for a 20-minutes appointment time slots. The Huddle report helped increase compliancy for PQRS and HEDIS programs which lead to increased financial reimbursements in incentive dollars.

Facility State/Region: NY
Facility Country: United States
Award: Davies 2016
Award link: 
Sub Classifications: Patient Engagement & Population Management-Patient Education
Facility Type: Ambulatory, Large Primary Care Practice 
Citation: HIMSS (2016).  HIMSS Davies Award Case Study