Don’t have 26.7 hours a day to spend on patient care? Read this

Stop me if you’ve heard this: To care for an average number of patients according to national recommendation guidelines, primary care physicians need to work 26.7 hours a day.

It sounds like the punchline to a joke, but that is the unfortunate reality for physicians according to recent research conducted by the University of Chicago, Johns Hopkins University, and Imperial College London. How is it possible to meet national guidelines for patient care if physicians must dedicate 14.1 hours a day for preventive care, 7.2 hours a day for chronic disease care, 2.2 hours a day for acute care, and 3.2 hours a day for documentation and inbox management?

It’s not possible, and as many physicians know all too well, we are still struggling with the aftershocks of the global pandemic, which only worsened already oversize patient panels, practice staff labor shortages and the increasing level of patient communications demands—phone calls, texting and emails. Along with our nurses and office staff, many of us are facing overwhelming demand from increasingly complex patients while also dealing with burnout issues. So, where do we turn?

Can technology help?

Mentioning technology-based solutions to physicians can be conversation-limiting. Burned by electronic medical record implementation, documentation requirements and prior authorization technology that are still remnants of a bygone era, we are rightly suspicious of those who suggest technology can make our lives easier.

On the surface, remote patient monitoring offers some hope for a respite, but like many other solutions intended to help both patients and physicians, many RPM solutions end up adding to the work burden for physicians and their office staff. That’s because RPM devices monitor and alert physicians to changes in the condition of patients suffering from chronic conditions, but they leave it up to the physician to do the work of getting patients stabilized and on a better track with their health. Physicians in private practice simply don’t have the bandwidth.
But what if RPM technology gets paired with a novel type of clinical support provided for patients as an extension of the physician? In addition to RPM technology, providing a level of clinical oversight to help doctors better manage their patients with hypertension, heart failure, diabetes and COPD is the real game changer.

So, how does this work? Instead of relying on a patient’s primary care physician to triage and analyze all the reported health information, a dedicated clinical team not only monitors the patient’s daily vital information but also intervenes as soon as there is any escalation and provides the patient with virtual clinical support. Using this model, we’ve found only 1% of our interactions with patients escalate to the primary physician. Couple that with better patient compliance and satisfaction (90% of our patients use their daily devices), and you can successfully reduce avoidable hospitalizations, trips to the physician’s office and improve patients’ overall health. This innovative solution to managing patients with chronic conditions provides practice physicians more time to expand their panels, reduces their patient phone messages and email, and allows them to better focus on the patients in front of them.

Another important aspect to this innovative solution is that all of the clinical interventions and patient engagement are seamlessly fed into the EHR so physicians can review them at their convenience. This is critical, considering that over the past few decades, many technologies with the best of intentions have failed to deliver true value to physicians because of their lack of integration into physicians’ EHR. Indeed, in prior iterations of RPM, physicians would be left to review faxed results — which needed to be scanned into a computer­— or to log, review, download and transfer documents into their EHR from a separate site. In order for RPM technology to be truly helpful and reduce burden on physicians, it must be seamlessly integrated into the EHR.

But will RPM take care of patients better than me?

Any primary care physician knows patients with chronic conditions are difficult to manage. To stay out of the hospital, they need much more attention on an ongoing basis than regular office visits can provide.

But despite their overwhelming workload, some physicians worry about remote patient monitoring further distancing them from their patients. They wonder whether they’ll ultimately lose control of their patients.

In my experience, nothing could be further from the truth. Most of the patients we work with see us as an extension of their physician’s office — they’re happier because they’re getting the attention they need to manage their condition and their health improves. So not only are these patients healthier, but also, they are happier with the care they’re getting from the practice because our clinical staff is perceived as a vital part of services the local practice provides. Just as importantly, they’re staying out of the ER and the hospital, a critical concern given the high likelihood of admission and readmission for people with chronic conditions, and the potential financial penalties that can result.

It’s about improving health, preventing hospital stays

Ultimately, physicians are concerned with providing excellent care to their patients. However, given all the demands on their time, many physicians will admit providing exceptional quality care that meets guidelines can seem impossible. The vast majority of patients receive excellent healthcare in spite of physician support tools, not because of them. Using the advances described here, we are turning tools into true resources to improve patient lives and physicians’ quality of practice.In practice, with overstretched clinical and office staff and burnout concerns rampant, remote patient monitoring with clinical intervention can help provide a respite so practices can focus on other important issues.

And while an eight-hour workday still might be a bridge too far, when looking at remote patient monitoring partners, physicians should choose one that extends their practice, not one that just gives them more to do.

Randall Curnow Jr., MD, MBA, FACP, FACHE, FACPE currently serves as Medical Director of Cadence, a health technology company pioneering remote patient intervention for people managing chronic conditions. Cadence’s clinically led, technology-enabled platform personalizes patient care, predicts clinical risk, and intervenes as necessary, all outside the four walls of the hospital.