From 'ninjas' to nurses, practices re-think primary care

care team

The ongoing physician shortage and massive changes across the healthcare industry have practices thinking further and further outside the box as they seek new ways to provide high-quality care more efficiently.

Practices feeling pressure to reduce costs and improve outcomes as the industry moves from volume-based fee-for-service models to payment models that pay for quality have naturally looked toward wringing additional efficiency out of their existing staff members.

These shifts have some providers rethinking the way they structure nurse practitioner and registered nurse roles, according to an article in the New England Journal of Medicine, giving them enhanced responsibilities in patient care. New training programs have sprung up to make nurses more comfortable taking responsibility for patient panels, and payers have gotten better about reimbursement for services provided by RNs, according to the article. The authors write that the move away from volume-based care will likely move practices to “reallocate more and more responsibilities to RNs and other team members.”

While many practices have sought to expand care teams to diversify the mix of providers and to expand the scope of care each staff member can provide to the limits of their licenses, they can only go so far with that approach, write Logan Ferrie, Caroline Sommers and Griffin Myers, all of Oak Street Health, in NEJM Catalyst. In their view, increased quality and efficiency will only come from further innovation.

To that end, Oak Street has pioneered the use of staff members they call “ninjas,” who support physicians by handling the flow of information in a practice. Their role on care teams involves providing timely data to physicians, as well as collecting and documenting new information for future analysis. The authors report high satisfaction among patients and physicians, plus “meaningful improvements in Healthcare Effectiveness Data and Information Set metrics as well as operational efficiency.”