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GIM All-Hands Meeting

GIM All-Hands Meeting. 12/14/06 Tom Miller Betsy Bryant Shilliday. Objectives. New vaccines Review YTD Visit trends Dr. Miller- 5 min presentation Review clinic access data Dr. Miller- 5 min presentation + 5 min discussion Review new data, appnt “Age” and utilization

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GIM All-Hands Meeting

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  1. GIM All-Hands Meeting 12/14/06 Tom Miller Betsy Bryant Shilliday

  2. Objectives • New vaccines • Review YTD Visit trends • Dr. Miller- 5 min presentation • Review clinic access data • Dr. Miller- 5 min presentation + 5 min discussion • Review new data, appnt “Age” and utilization • Dr. Miller-  5 min presentation+ 10 min discussion • Discuss attending template changes • Dr. Miller- 5 min presentation+ 5 min discussion • Discuss the proposed DM Foot Initiative • Dr. Bryant Shilliday- 10 min presentation+ 5 min discussion • Next Meeting

  3. Announcements • Thank you Dr. John Buse • Congratulations Dr. Mike Pignone

  4. Three new vaccines • Zoster vaccine (Zostavax) • HPV vaccine (Gardasil) • Tdap

  5. Zoster and HPV • Medicare and Medicaid do not cover these vaccines • Most insurance carriers will cover them • Cost • Zostrix $167.00 • HPV $141.53 each (series of 3 needed)

  6. Policy • Patients will be asked to pay for the vaccine at the time of service • Nurse will ask patients to sign a waiver • Merck patient assistance program • Referral to financial counselor

  7. Vaccine brochure

  8. Waiver

  9. Tdap for Adults • Routine: Adults should receive a single dose of Tdap to replace a single dose of Td for booster immunization against tetanus, diptheria, and pertussis if they have not received their last dose of tetanus toxoid containing vaccine ³10 years earlier. • Shorter interval: Tdap may be given at an interval shorter than 10 years since receipt of last dose of tetnus toxoid containing vaccine to protect against pertussis. The safety of an interval as short as 2 years has been demonstrated.

  10. Cost • Tdap $70.00 • Td $20.00

  11. YTD Visit Trends

  12. Attending Visit Total

  13. Resident Visit Total

  14. Anticoagulation Visit Total

  15. Enhanced Care Visit Total (DM & Pain)

  16. SDC Visit Total

  17. All IMC Visits Total

  18. Clinic Access Data

  19. Resident New Patient Availability

  20. Resident New Patient Activity

  21. Attending New Patient Availability

  22. Attending New Patient Activity

  23. Resident Return Patient Availability

  24. Resident Return Patient Activity

  25. Attending Return Patient Availability

  26. Attending Return Patient Activity

  27. Percent No Shows (818, 819, SDC)

  28. Clinic Productivity Index: Attending ‘06-’07

  29. Clinic Productivity Index: Resident ‘06-’07 R2 R3 R1

  30. Goals • Improve access • New patients within 5 days • Return appointments within 1 day • Reduce cycle time by 20%

  31. How can we improve access? • More appointments? • Appointment transparency • Eliminate waste

  32. Clinic templates • Current template • AM: 10 twenty-minute appointments and 2 add-ons (12 appointments) • PM: 11 twenty-minute appointments and 2 add-ons (13 appointments) • New template – all appointments displayed • AM: 11 twenty-minute appointments • PM: 12 twenty-minute appointments

  33. Advantages of new templates • All appointments visible to PBA’s • Allows flexible scheduling • Start early and finish early • Add on at end • Mid-session add-on • Doctors will need to specify their preferred template • 2-3 months lead time required for implementation

  34. Sample templates

  35. Discussion or Comments

  36. Eliminate waste • No show rate is still too high • Interventions to date • No new appointments scheduled beyond 2 weeks • Exception: insured patients will be booked in advance in the faculty clinics • PBA’s keeping a call-in list • Cancellations made easy • Immediate recycling • Morning meetings with PBA’s to review appointment availability and strategies for scheduling patients

  37. Appt “Age” and Utilization

  38. Utilization by Age- Resident

  39. Utilization by Age- Attending

  40. Utilization by Age- DM & Pain

  41. Proposal • No follow-ups scheduled beyond 6 months • Enhanced Care: no follow-ups beyond 1 month • Continuity insurance • Rescheduling cards at check-out • Televox reminder calls

  42. Other Interventions • Identify repeat offenders • Restrict access to advance appointments • Charges for missed appointments • New patient only? • All patients?

  43. Discussion or Comments

  44. Reduce cycle time by 20% • Pilots • Preclinic huddles • Exam room check-in • Doctor/nurse teams • Room flexibility

  45. Discussion or Comments

  46. Upcoming Foot Care Initiative

  47. Discussion or Comments

  48. Next All-Hands Meeting 3/26/07Let us know if you have a topic you would like to see discussed

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