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Primary Care Providers Finding New Ways To Connect Patients With Specialists

On Thursday, primary care providers outlined several new approaches to transform the way specialty care can be expanded to areas that need it.

That includes a pilot project started earlier this year at Open Door Community Health Centers, a collection of federally qualified health centers in Humboldt and Del Norte counties.

Bill Hunter, medical director for the centers, spoke yesterday as part of a panel discussion on specialty care access at a conference of the California Primary Care Association in Sacramento. The conference wraps up today. 

“The original idea of Project ECHO was to distribute specialist information to far-flung areas in New Mexico. Now it’s all over the country,” Hunter said.

That now includes the two northern-most counties in California, since Open Door centers earlier this year started a pain-management pilot project with UC-Davis Medical Center in Sacramento, Hunter said.

“It has been working really well,” Hunter said. “It has been a wonderful thing to present complicated patients to a multidisciplinary team. It makes such a difference.”

The idea of Project ECHO, he said, is to consult on common pain-management problems, and to develop expertise in how to treat them. Part of that consultation includes case presentations of particularly hard-to-treat patients.

Recently, Hunter said, he had a patient with numerous pain problems — someone who was getting a huge daily dose of a strong opioid.

“I had no idea what to do with her,” Hunter said. “And they said to hospitalize her, they gave us this long protocol, we got her off the opioids and she is so much better. It was a totally helpful thing.”

Panelist Paul Giboney had a different story for a similar problem. He is director of specialty care for the Los Angeles County Department of Health Services. He said his service area is huge, with hundreds of underserved clinics spread out across 4,700 square miles of the county. 

At one point, he said, there were 350,000 specialty care referrals in the system and wait times for referral appointments were months long. For a neurological consult, he said, it was a 225-day wait.

His department set up workgroups to bring primary care providers and specialists together to work out expected practices, and set up patient-centered scheduling for specialist appointments, to cut down on no-show rates.

But the biggest change, Giboney said, was eConsult.

“That made huge differences in our care,” Giboney said. “It’s a portal that facilitates a conversation between someone who needs specialty assistance with a specialist. You can attach pictures, labs, it’s a clinician-to-clinician dialogue. It allows us to connect with a large number of specialists.”

It cuts down on specialists’ time because it helps direct primary care providers to spell out what the issues are and makes sure all the groundwork for a specialist visit is already done when a patient does go to a specialist. It cuts down on primary care providers’ time by efficiently scheduling specialist referrals and eliminating the need to constantly reschedule them. And it means patients get specialist care in a timely manner, Giboney said.

“This is my absolute favorite statistic,” Giboney said. “In the old days it would take weeks or months to get a response and, to date, we’ve had about 130,000 specialty-care submissions — and the average response time is 3.1 days. In three days, specialty care has begun.”

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