Part 1: Clinic Organization
In functional medicine, we want to offer more support to patients than they receive in the conventional model. You can get closer to this ideal without overextending yourself by working with allied health care providers, using a clear communication policy, and keeping all electronic communication in your electronic health record (EHR). Read on for specifics on how to organize patient communication to provide better care.
Many patients have horror stories about how they were treated in conventional settings: rushed appointments, rude staff members, or long waits for answers to simple questions. As functional medicine practitioners, we want to offer a better experience. We strive for what I call “high-touch care”: a more supportive patient experience, where the patients are invited to play an active role in their own healing and have access to all the help they need along the way.
It can be challenging to achieve this ideal of care, especially when many of our patients are too sick to be fully served by 30-minute appointments every six to 12 weeks. Patients may benefit from bi-weekly check-ins and answers to questions between appointments. However, we cannot realistically provide all of this support on our own. We need to care for other patients, run our practice, manage our staff, and take care of our own health and happiness.
So, how do we achieve high-touch care without running ourselves into the ground? Organizing your clinic to efficiently manage patient communication can go a long way toward realizing this goal.
Allied health care providers can help you provide high-touch care with less of your time
Strategic use of allied health care providers can make it easier to provide more frequent appointments for patients. This is especially helpful for patients making significant diet and lifestyle changes and for patients on complex treatment protocols.
Allied providers include:
- Nurse practitioners (NPs)
- Physician assistants (PAs)
- Registered dieticians (RDs)
- Health coaches
At the California Center for Functional Medicine, we are updating our care model to use allied providers for:
- Initial consults
- Bi-weekly check-ins
- Follow-up appointments
- Group visits
- Electronic health patient portal support (PPQ support)
- Phone calls
Different allied providers may be used for each of these services, based on the expertise and legal requirements of the task. Laws vary by state, but in general, nurse practitioners and physician assistants are licensed to do things like refill prescriptions, order labs, make diagnoses, and prescribe treatments. Health coaches and nutritionists can answer questions about nutrition, lifestyle, and behavior change.
Bi-weekly check-ins are best handled by health coaches. Their specialty is keeping patients on track and holding patients’ hands throughout their health journey. Health coaches are also more cost effective than NPs and PAs.
Feeling overwhelmed by patient care? Read these strategies for avoiding burnout.
If you’re just starting out, you will likely want to offer all your services yourself for long enough to understand how each part of your practice works and to learn how to train others. And of course, you will need some funds to start hiring allied providers.
However, I suggest you make hiring allied providers a priority once you can afford it. It’s a win-win for you and your patients. This is one of the best ways you can grow your practice, do less administrative work, make money on services that don’t require your time, and focus on the parts of your work you love and do best. For your patients, their questions get answered faster and they get more connection and support along the way.
A clear communication policy protects your time
Inevitably, questions will come up between appointments. Some of these are reasonable to address outside of a paid appointment, but others are more unwieldy and should not be answered without charging for your time in some way. A clear communication policy sets boundaries that minimize time-consuming messages. This written set of guidelines helps patients better understand when they should ask their question in a message versus when they should schedule a follow-up appointment or e-consultation.
Post your communication policy where patients will regularly see it. It is helpful to have new patients read and acknowledge the policy as part of your intake process. You may also want to post the policy on the login page of your online patient portal.
The policy should note examples of questions that can be answered outside of an appointment, such as clarifying a treatment protocol, refilling a supplement, or addressing a reaction to a treatment. The policy should also explain that some questions will require an e-consult or a follow-up appointment. These include health issues that weren’t discussed at a previous appointment, questions that require a chart or lab review, or any other questions that require more than a few minutes to answer. When you do receive the occasional out-of-scope question, you can gently refer the patient to the communication policy and suggest that he or she schedule an appointment.
The communication policy that we use at my clinic is shown below. The wording has been refined over time and works very well. Note that we developed this policy prior to bringing allied healthcare professionals onboard at CCFM and we will be updating this policy to include the option of phone calls with allied providers between appointments.
We specify that questions should be brief, concise, and ideally be answerable with a yes or no. Of course, many questions will require more than a simple yes or no, but this wording invites the patient to simplify the question as much as possible. Before this policy, we would often receive two- to three-page messages that were impossible to answer in a virtual format and tedious to manage. The current wording has been successful in saving significant time, and most patients do follow the guidelines.
Consider the pros and cons of paid e-consults
When answering more involved questions, you can be compensated for your time with either a follow-up appointment or an e-consult. I prefer not to offer e-consults, as they are time consuming and I find that many of the questions could be more effectively answered in a real-time conversation.
However, Dr. Schweig, my co-director at CCFM, does offer e-consults, and they seem to work well for him and his patients. Dr. Schweig charges for e-consults at his prorated hourly rate with a $30 minimum charge.
Phone calls are best handled by allied health care providers
Patients calling clinicians is a slippery slope. Phone calls can easily become lengthy and take up clinician time that would better be spent elsewhere. Furthermore, they may end up covering out-of-scope advice and treatment that you should be paid for.
However, if you have allied providers at your practice, it may make sense to have them available for short phone and video calls between appointments. They will be able to handle most questions and can consult clinicians for the rest.
Phone consults are only practical if you are compensated. You can either charge per phone consult or use a membership model. In a membership model, each patient who is part of your practice pays a small monthly fee in addition to regular appointment fees.
Keep all electronic communication in the electronic health record (EHR)
I strongly suggest that you keep all electronic communication in your EHR system, if you have one. First of all, the EHR is HIPAA compliant, unlike email. It also provides an organized, central reference place for all patient communication. Just as important, the EHR can serve as a powerful tool to protect your time. Messages sent through the EHR can be fielded by staff members, and many will be resolved before they ever reach you. Administrative staff can handle administrative questions directly, forward clinical questions to an appropriate allied health care provider on your team, or help the patient schedule a follow-up appointment if the question is out of scope. Furthermore, if you post your communication policy on the login page of the EHR, the patient will be reminded of it every time he or she sends a message. Patients who send messages in the EHR are less likely to abuse the communication policy than they would be using your personal email address.
Taking steps like keeping all electronic communication in the EHR and integrating allied health care providers can help you offer a higher level of care to your patients, all while freeing up your time for important things like business development and—of course—self-care.
Stay tuned for Part 2 of this series, where I cover the communication skills needed to establish a good patient rapport.
Now I’d like to hear from you. How do you use allied providers in your practice? What tricks have helped you keep patient communication organized and efficient? Let us know in the comments below.