When Annuals Turn into Everything Visits: The Reality of Outpatient GYN Care
2 min read
Why Does it Keep Happening?
Patients frequently raise additional problems at preventive screening visits because these visits may be their primary, or only, point of contact with the healthcare system. 20% of patient personally considered their ob/gyn clinician as a primary care and up to 28% of patients did not have a primary care clinician at all (Mezzoni, et al., 2017)
A patient's primary care clinician may not evaluate and manage gynecology concerns or not include it in a way that feels part of usual care
A patient may have felt dismissed by other clinicians and felt trusting enough to ask
Decreased access related to insurance networking
Patient perception that a preventative screening is a comprehensive visit
Patient perception that a screening visit may cost less than a copay for a E/M visit
Inability for patient to distinguish between a health problem and preventative health measures (ACOG, 2018)
Patient perceives increased efficiency as there are barriers to ideal access including decreased availability of appointments, time off work, childcare needs, decreased access to appropriate or chosen clinician, etc (Adler, et al., 2023)
Why do Clinicians Hesitate to Address Problems at Preventative Visits?
Lack of clarity surrounding billing and reimbursement concerns for the patient (Davidson, et al., 2022)
Time constraints in schedule
Lack of clarity around documentation for a visit that contains both preventative and E/M components
Practical Approaches
Collaboratively prioritize with the patient what can be evaluated and recommend a follow up visit for additional health concerns or preventative screening, "I want to give this the attention it deserves, so let's schedule dedicated time for it"
Document with clarity that both a preventative and E/M visit occurred so that the biller/coder specialist can add a modifier
Create workflow of care so that pre-visit questionnaires are sent to patients preceding the visit to help patients prioritize time and health concerns (Davidson, et al., 2022)
Offer personalized care options when appropriate for follow up, such as a telehealth visit, nurse check-in to follow the visit or visitation with a community/social health worker to navigate health system or medication needs
Offer longer visit time slots for patients with multiple needs
Adler A, Biggs MA, Kaller S, Schroeder R, Ralph L. Changes in the Frequency and Type of Barriers to Reproductive Health Care Between 2017 and 2021. JAMA Netw Open. 2023;6(4):e237461. doi:10.1001/jamanetworkopen.2023.7461
US Preventive Services Task Force. Collaboration and Shared Decision-Making Between Patients and Clinicians in Preventive Health Care Decisions and US Preventive Services Task Force Recommendations. JAMA. 2022;327(12):1171—1176. doi:10.1001/jama.2022.3267
Mazzoni S, Brewer S, Durfee J, Pyrzanowski J, Barnard J, Dempsey AF, O'Leary ST. Patient Perspectives of Obstetrician-Gynecologists as Primary Care Providers. J Reprod Med. 2017 Jan-Feb;62(1-2):3-8. PMID: 29999273.
In most systems, there is no protected time built into the week for chart documentation. Clinicians often work after hours and between patients to document and this contributes to burnout (Goldberg,…
For clinicians working to refine outpatient gyn care, a model of learning with CoP creates a space to move beyond theory and into practical implementation. CoP have been shown to move knowledge into…
Stay Informed
Be first to know when new courses open.
Join our email list for early access to new courses, monthly clinical letters from our founders, and enrollment notifications. No noise, we only send when we have something to say.
