Steven A. Yarows, MD, FACP, FASH, FAHA, Clinical Professor of Internal Medicine, Michigan Medicine
Chelsea Family and Internal Medicine, Chelsea, Michigan, USA
Chelsea Family and Internal Medicine is part of Integrated Healthcare Associates (IHA), headquartered in Ann Arbor, Michigan. With more than one million patient visits per year, and approximately 70 practice locations, IHA is one of the largest multispecialty medical groups in Michigan.
Primary care physician (PCP) offices encounter a high volume of patients, making efficient practices crucial to reducing overhead and streamlining operations. In 2015 alone, 53% of the estimated 922.6 million physician office visits were PCP encounters.1 The most common reason for a PCP visit during this time was hypertension-related.2
As is true with many practices, cost is a major consideration when primary care facilities are interested in acquiring new equipment. This raises a few questions. When it comes to vital signs devices, which are used during every PCP visit? And are there cost and efficiency advantages between an automatic electronic device and the traditional manual method?
A study conducted at a primary care facility in Michigan explores these questions and demonstrates the cost savings and benefits of utilizing an automatic vital signs device.
In 2015 alone, 53% of the estimated 922.6 million physician office visits (461.3 million) were PCP encounters. Hypertension-related issues were the most common reason for visiting during this time.1,2
A study conducted by Dr. Steven Yarows of Michigan Medicine explores two different methods for acquiring blood pressure readings and the time and costs associated with each method.
Dr. Yarows conducted this quality-improvement study in his primary care office at Chelsea Family and Internal Medicine. Throughout the study, medical assistants conducted more than 800 blood pressure readings using either an automatic oscillometric device or the manual auscultation method.
Research Study Parameters: At a single outpatient practice, approximately six medical assistants measured 827 patient blood pressures during physician office visits over a period of 43 days. The first 411 patients were measured with a Welch Allyn Connex® vital signs device. The second round of 416 patients were measured with a Tycos® wall-mounted sphygmomanometer.
Patient Demographics: The average age of patients in each group was approximately 64 years old. Patients in the study had a higher-than-average BMI, making this group more susceptible to hypertension, heart disease, stroke, and other complications that are associated with being overweight or obese. Due to the increased likelihood of such complications, access to accurate and reliable screening tools is important in detection, diagnosis and management of these conditions.
The study concluded that measuring blood pressure via the manual method with a Tycos wall gauge took an average of 58.6 seconds. The automatic method used a Welch Allyn Connex device, which produced blood pressure readings at an average of 29.3 seconds after users gained device experience.3
To understand the ROI for an automatic device, Dr. Yarows calculated the cost of a medical assistant’s time. Including salary and benefits, a medical assistant at his practice earns $21.37 per hour, or less than $0.01 per second. Using this framework, the manual blood pressure method costs $0.34 per measurement, versus the automatic method that costs $0.17 per measurement after the learning effect took place. This results in a savings of $0.11 per measurement with the automated method.4
Dr. Yarows notes that although this does not appear to be a major cost savings per measurement, the implications across a year at his practice tell a different story. Blood pressure is measured for every patient at every visit. Therefore, with over 25 patient visits per day, 5 days per week, for 52 weeks, the savings provided by use of a Welch Allyn automated device equates to more than $1,000 per year.5
With over 25 patient visits a day, 5 days per week, use of a Welch Allyn automated device equates to a savings of more than $1,000 PER YEAR 5
Improved Measurement Skills: As medical assistants became more familiar with the Welch Allyn device, their measurement times decreased for the last third of patients recorded. “The automatic [Welch Allyn] method averaged 39.8 seconds; however, with device experience, this decreased to 29.3 seconds,” explained Dr. Yarows.
Quantifiable ROI: Based on the study’s findings, Dr. Yarows estimates that the potential return on investment for an automatic measurement device is as little as one year.6 Further efficiency gains can be realized if the vital signs device is connected to an EMR, thus streamlining workflows and helping to improve data accuracy.
Shifting Clinician Time: Measuring blood pressure more efficiently can enable practitioners to focus on what is most important: patient care. Dr. Yarows describes manually measuring blood pressure as tedious and time-consuming, and estimates that he has spent more than 500 hours performing routine blood pressure measurements throughout his career.7 Reducing these measurements by a few seconds per patient could result in long-term time savings for practitioners.
Overall Practice Efficiencies: In addition to the direct cost savings of a medical assistant’s time for blood pressure readings, Dr. Yarows theorizes that faster readings would also result in shorter rooming times. With limited exam rooms in a PCP office, increased turnover in each room could provide substantial benefits for a primary care facility.8
The automatic [Welch Allyn] method averaged 39.8 seconds; however, with device experience, this decreased to 29.3 seconds.
—Dr. Steven A. Yarows
The automatic oscillometric method for blood pressure measurements provided Dr. Yarrows’ practice with clear time savings and cost efficiencies. Additionally, as his medical assistants became more accustomed to the automatic device, they also became more efficient and skilled with their technique. The same benefits and learning effect were not seen with a traditional manual gauge.
Beyond time savings and workflow improvements, automatic vital signs devices can provide clinicians with advanced features to help support diagnoses and treatment decisions. For example, the Welch Allyn Connex Vital Signs Monitor includes blood pressure averaging technology. Blood pressure averaging has been shown to reduce misdiagnosis of hypertension by up to 56%, thus providing additional decision support to improve the accuracy of hypertension diagnoses.9
Considering the implications for similar PCP offices across the country, it may be time to standardize blood pressure measurement and utilize automatic oscillometric devices in primary care.