All Asthma, All the Time

Vol. 16 •Issue 2 • Page 30
Doing Business

All Asthma, All the Time

A family physician packs more patient care into monthly asthma days.

Asthma care requires focus, which can be hard to accomplish in the primary care environment where clinicians are treating everything from sore throats to diabetes.

Kurtis Elward, MD, FAAFP, realized this critical focus was lacking at Family Medicine of Albemarle, a four-physician practice in Charlottesville, Va., where he’s a partner and family physician.

“Nurses were having to go from one type of patient to another,” he said. “Care wasn’t as organized as it could have been. When I looked at my own asthma care, I realized it could be better.”

Only 25 percent of his asthma patients were classified. Just 10 percent had action plans. Of persistent asthmatics, only 45 percent were on proper controller medication, and these patients typically weren’t being seen in the office frequently enough.

So Dr. Elward organized asthma days. For one morning and one afternoon each month, his practice is dedicated to the care of asthma patients. Quality of care quickly improved, as did his bottom line.

“We really had success with it,” he said. “My nurses loved it. They thought better about the care they delivered. They got to focus.”

Structure of a visit

An inspiration for asthma days was a local allergist to whom Dr. Elward had referred some patients. Despite the fact the allergist had a smaller staff than Dr. Elward, patients told of how organized and efficient his office was. Dr. Elward wondered if “maybe we can do something similar with a primary care flair.”

For asthma days, Dr. Elward thought hard about the type of experience he wanted his asthma patients to have during an office visit. Desiring care that was uniform and streamlined, he planned what would happen during a typical appointment from start to finish.

Asthma day patients, for instance, are first given an asthma control test survey to fill out when they arrive. That way, instead of flipping through old magazines, their time in the waiting room is put to good use. “From the minute they hit the door, the message they receive is it’s an asthma visit,” Dr. Elward said.

When patients go into the treatment area, nurses question them again about their asthma. All these inquiries put patients in the mindset of thinking about asthma care and its importance to their health. Patients also perform peak expiratory flow and spirometry when needed.

Collecting this comprehensive information helps Dr. Elward individualize care. He spends about 20 minutes talking with patients about medication changes, goal setting, and asthma action plans. “I come into the room much more prepared for them,” he said.

Importantly, on their way out the door, patients are scheduled for another asthma day. This makes sure that patients with asthma are seen as often as the severity of their conditions dictates.

Impressive results

Starting up asthma days involved some groundwork. Training was held for staff members so they could understand their roles. A record sheet was developed for patient visits and has been fine-tuned continually. Dr. Elward’s staff sent out mailings and made calls to alert all the practice’s asthma patients to the program and to schedule appointments.

Now, nearly two years after asthma days were first offered, they’ve produced some impressive results. Ninety-five percent of Dr. Elward’s asthma patients are classified. Of persistent asthmatics, 90 percent are on controller medications, and 93 percent have action plans.

With patients making more frequent visits, and Dr. Elward able to charge a higher paying reimbursement code for the in-depth appointments, asthma days also have realized an increase in revenue for the practice. In just the initial two months of the program, Dr. Elward received an additional $5,500 in reimbursement.

John Crawford is a freelance writer based in the Boston area.