Straight to the top:  The right kind of “top of credentials”

Posted by Michael Renzi, DO, FACP on Nov 29, 2016 11:02:00 AM

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One of the key requirements of VBC success—and one of the components of Industrial Strength medical practices—is the notion of all organizational staff working at the “top of credentials.” The most basic, agreed-upon definition of this idea has its roots in the medical home world, and essentially boils down to this: it’s an effort to offset workflow inefficiencies by getting theiStock_000033508044Large-1.jpg existing staff working mostly within their skillset. That seems like common sense, but practices tend to limit what a team member can do based on their certification, rather than what they could do based on their capabilities.

There’s a prerequisite before a practice even starts this top of credentials journey: to get these new tasks done by the right people, the right people need to be in the office in the first place. As practices struggle to maintain financial stability and fight margin erosion, adding more capable (and expensive) staff simply isn’t an economic option. Instead, we’ve got to look to how to increase capacity within the capability confines of the existing team.

Providers are challenged to innovate in this space because our focus has been how to most effectively ensure that medical staff—MDs, NPs, RNs, MAs, and the like—are doing tasks appropriately suited to their license. Instead, we’ve got to think about top of license as more like “top of capability.” Not every task in the value based world requires a credential or a license to get done.

To learn more about the  Next-Generation Physician Practice,  DOWNLOAD OUR WHITEPAPER NOW .It’s a tall order—like I said in my last blog, if the business case isn’t there, a practice’s motivation to meet quality measures to drive costs down simply won’t exist. But let’s say we have the financial opportunity secured and we need to retool how staff handle the requirements of value based care.

For instance, consider medication reconciliation. For years, this was the domain of the MD or nurse. Can a MA do it with some training? Of course they can—in fact, in our experience, they often do the reconciliation with better accuracy and greater tolerance to the patient. Now the RN is freed up to help phone triage to get patients access to care at the right time

The greater challenge may be with non-clinical personnel. Every single employee of the practice—from its founder to the front desk—needs to be operating at the top of their capabilities. How can we accomplish this?: 

  • Understand the shift: Office staff must increase quality by driving gap closure at every patient touch. You’re going to have to get good at hitting your quality measures without overburdening staff or bogging down office workflows—or else you’re going to lose money.
  • Get the right people in the right seats: Take your existing staff and build the quality measures into their workflows. Don’t assume that every task requires a “clinical person” to complete it.
  • Look creatively at the “things we have always done” and see if they can be enhanced. In our practice, the MAs room the patient with a task list that includes traditional vital signs as well as medication reconciliation, fall risk assessment, depression screenings, and vaccine administration with standing orders.  

The top-of-capability practice has every employee focused on getting every patient the right care, at the right time, at the right price to maximize quality and revenue. Aligning every part of your practice to enhance and optimize the value-based experience matters. For more about how to build the top of capability practice and industrialize the healthcare system, take a look at our recent white paper, “Industrial Strength: Powering the Next Generation Physician Enterprise”.

To learn how our value-based team can help your practice operate at peak performance, please call (856) 782-3300 x2419 or email us at

Topics: Patient-Centered Medical Home, PCMH, top of credentials


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