Integrating Physical Therapists Into Primary Care Within A Large Health Care System.

BACKGROUND: Bellin Health in Wisconsin has pioneered the colocation and integration of physical therapists into primary care pods. METHODS: This is an observational study based on one in-person visit and several interviews. RESULTS: For patients with musculoskeletal complaints, providers make warm handoffs to the physical therapist, who is a few steps away. The physical therapist performs most of the visit, providing diagnosis, treatment, and patient education. Research studies show that-compared with physician management-appropriate patients managed by physical therapists have better outcomes, lower costs, and higher patient satisfaction. In a fee-for-service environment, the business case for this innovation requires an increased number of follow-up referrals to the physical therapy department. In the Coronavirus disease 2019 (COVID-19) era, physical therapists can provide video visits with equal quality compared with in-person visits. CONCLUSION: The Bellin Health program is a blueprint for other primary care practices to integrate physical therapists into primary care teams.

Telemedicine and Team-Based Care: The Perils and the Promise.

The COVID-19 pandemic accelerated adoption of telemedicine visits into American medicine. It is commonly believed that, within a matter of weeks, telemedicine was widely and successfully implemented and that medicine is forever changed. The experience on the ground, however, is more nuanced, with both positive and negative experiences for patients and clinicians. Advanced models of team-based care with in-room support (aTBC) have developed over the past decade, with strategic delegation of tasks to uptrained support staff, allowing physicians to provide undivided attention to their patients and greater access to care for their populations. Herein, we describe our initial experiences with telemedicine in the context of many years practicing in aTBC models. Our experience demonstrates that when implementing telemedicine visits, it is important to avoid a reflex reversion to the outmoded model of the physician alone in the room with the patient and instead bring forth the safety, quality, and satisfaction advantages associated with aTBC. We provide a practical "how-to" guide for implementing telemedicine visits; outline logistical details of representative video and audio visits from our own practices; describe new opportunities for family engagement, care coordination, and comanagement across specialties; and outline a research agenda going forward to further knowledge of the risks and benefits and optimal application of health care on a telemedicine platform.

Advanced team-based care: How we made it work.

Our move away from a traditional practice model has improved quality metrics and enhanced our financial sustainability.

Working with scribes--the good, the surprising.

Misra-Hebert et al's study in this issue attests to the quality of scribes' notes. My personal experience is that charts are usually closed at the end of each half-day.