PULLING IT ALL TOGETHER Practice Managers Linda Mallard, GPMG~Westbrook Mary Filieo, GPMG~Cape Elizabeth
How Do You Get Your Physicians Involved? How Do You Get Your Staff Involved? How Do You Find The Time To Do All That Needs To Be Done? Where Do You Find The Time For Meetings? How does the physician get everything done in an office visit? What kind of patient feedback have you received? FREQUENTLY ASKED QUESTIONS
PHYSICIAN INVOLVEMENT • Access to Clinical Improvement Registry • Educate physicians in outcome driven 3rd party reimbursement. • Designate a Physician Champion. • Participation in Anthem Quality Insights program impacts the physician’s Adjustment-to-Fee Schedule
PHYSICIAN INVOLVEMENTcont. • MD compensation is partially determined by outcome measures. • PHO financial incentive. • Develop competition. Run a “trend data report” on a monthly basis. • Retain Staff 1. Teamwork generates respect and improves communications. 2. Developing standing orders empowers the staff to participate in patient care.
STAFF ENVOLVEMENT • COMMUNICATE, COMMUNICATE, COMMUNICATE, COMMUNICATE. • Educate Staff to the value of what they are doing • Establish group and individual goals from the Collaborative and tie outcomes to performance reviews. • Give clinical staff access to the CIR so they can track their own patients.
STAFF INVOLVEMENTCONT • Encourage the importance of TEAM work. Value everyone’s opinion. • Involvement is a professional incentive. • Use “opportunities” as “learning experiences.” • Know your staff and focus on their strengths • Depending on your culture, you may want to initiate competition from monthly progress reports • Use games, graphs, awards, and food.
TIME INCREASE EFFICIENCY~STANDARDIZE • Create workflows that allow everyone to work at their highest skill level. • Cross-Train staff so projects don’t fall behind. Develop “our” attitude. • Supplies & equipment uniform in every exam room. • Rooming protocols uniform.
TIMECONT • Standard protocols related to all patients, not just those in the collaborative. • Use the tools available in CIR. Target Reports Lab Orders Due Eye Exam Letters Office Visit Review
MAKE TIME FOR MEETINGS • Meetings are important to focus on “achievements” and “opportunities.” • Include every position in your Leadership Steering Group. • Use Leadership Steering group to analyze reports, determine PDSA, and discuss responsibilities related to their subgroups.
MEETINGSCONT • Weekly staff meetings are important to relay information from the Leadership group, plan the process for PDSA, and brain storm. • Manager needs to touch base monthly will all subgroups individually focusing on their role in the PDSA. • Encourage anyone to call a 1 to 5 minute HUDDLE when needed.
HOW DO YOU ACCOMPLISHMENT EVERYTHING IN AN OFFICE VISIT? • Start preparing for visit at the time of appointment. • Use CIR Target report as a tool to determine metrics to address. • Instruct patient to arrive early. • Complete workflow prior to appointment time. • Run monthly cycle time reports to find any barriers.
PATIENT FEEDBACK • Patients like report card format of Target Report. • Appreciate acknowledging successes. • Enjoy the feeling of being part of the team. • Like the attention and one-on-one rapport with case manager.
Roles in Diabetes Care at Greater Portland Medical Group(adapted from Family Medicine) Clinical Wt. Ht., BP, P & R Shoes & socks off; inspect at each visit Monofilament per standard Pneumovax Influenza ?smoke? Document PSR Confirm appts Remind pts to bring glucose readings Remind pts to bring medications Assist with diabetes registry entry & retrieval RN: Case Management Use of Registry/order per standards Education:Point of care, Nurse Visits (expanded Diabetes ed), Phone Learning Resource Labs: Check Registry/standards: order Patient Self Management Glucose Monitoring Target Cards Goal: Every diabetic pt. will self monitor, know what numbers mean, and aware of standards Chart Prep Updated Registry form Diabetes Documentation sheet Target Card Foot sheet Providers Utilize Diabetes Collaborative Registry Support use of Diabetes standards Collaborate with clinical team to provide complete diabetes care Community Diabetes Group Visit ADEF (Referral needed) Community Nurses Exercise Programs