SIM practice optimizes staff, prevents ER visits, boosts payment

By Heather Grimshaw


Testing new ways to optimize team members, which expands patient access, has paid off for Sustaina Center for Women in Lakewood. A practice that participates in the Colorado State Innovation Model (SIM) and Transforming Clinical Practice Initiative (TCPi), Sustaina Center for Women successfully renegotiated one of its payer contracts after explaining how the practice had retooled its processes to offer “ER visits” that reduced 302 avoidable emergency room (ER) visits, which saved $257,908 in one year.

These visits are offered mainly by the practice’s medical assistant (MA) for non-urgent, non-acute issues, such as urinary tract infections and sexually transmitted disease screenings and allow patients to be seen on the same day they call the office, says Lisa Lewis, MD, practice owner.

“They love it,” she says. “It conveys a message that ‘We are here for you as a practice for your visits.’”

In addition to expanding patient access and reducing avoidable costs, these so-called ER visits build skill sets for the practice’s MA, which encourages longer tenure and enables Lewis to focus on tasks that only she can do.

“I still signoff all the charts; I’m still making sure those orders are right,” but the work itself can be handled by the MA, which is a $10-$20 visit, Lewis says. “She generated $8,000 bucks that goes toward her salary,” Lewis adds.

From a practical standpoint, Lewis created templates and continues to train her MA on different procedures to expand patient access to care. 

“Josephine [MA] is so efficient, sometimes I don’t even know a patient’s there,” Lewis explains. “They come in, check in, pay their copays, she takes them back, runs through her section of the chart and gets their samples and ‘whamo’ [they’re done]. Patients love that.”

Lewis read about training MAs to handle some of the non-acute patients’ needs in a recent medical study and has shared her process changes with colleagues. The most common question she and Josephine field is “Is that legal?”

The answer is yes, and more information can be found on the COPIC website, which has a list of all of the procedures that MAs can do — and bill for — with the proper training. She also attended a TCPi course with Carol Greenlee, MD, FACE, FACP, state and national faculty for TCPi, who outlined how to get the most out of your MA.

“TCPi said, ‘You want your staff to work at the highest level,” Lewis says, and she took that advice to heart.

That approach to care has not only enhanced her team’s experience, it has attracted high-level providers to the practice. A new nurse practitioner, who accepted a salary reduction, was attracted to Sustaina because of Lewis’ involvement in innovation programs like SIM and TCPi. 

“She took a significant pay cut to work at our office because she wants to experience this stuff,” says Lewis, who included her SIM and TCPi participation in the job posting. “I’m now able to recruit at a higher level. We are practicing medicine in a different way and that’s appealing to a lot of providers.” 

It’s also appealing to health plans. 

After Lewis attended a SIM-funded business support session on how to articulate a practice’s value-proposition to health plans, she approached one of the health plans she works with, outlined the different ways that she has saved money through innovative approaches to care, like the ER visits, and received a 5% payment increase. 

It didn’t take long, Lewis explained. “I wrote a one-paragraph explanation about the fact that we’re a small practice doing quality initiatives, started MA visits and that we are doing all out-patient surgeries and patients go home the same day.”

After that they had a short meeting and shortly thereafter Lewis received an email with the increase and an explanation that it was one of the highest reimbursements for practices in the area. 

Lewis’s innovative approaches to patient care have generated positive feedback from all corners, including invitations to share her story during conferences hosted by the Center for Medicare and Medicaid Innovation (CMMI), which funds TCPi and SIM.

During a recent national conference, a CMMI representative commented on Lewis’s ability to achieve such impressive savings. “He was shocked that a small practice could make such a difference,” she recalls.