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Lecture lessons learned - pcmh presentation (2)

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Katy Smathers
Katy Smathers

This document summarizes the experience of the Center for Pediatric Medicine in Greenville, South Carolina in achieving recognition as a Patient-Centered Medical Home. It provides details on the practice, including its size, patient population, and services. It then discusses the practice's reasons for pursuing recognition, how it approached the process, and challenges encountered addressing each standard, such as developing electronic access and defining care management processes. The document concludes with lessons learned, such as using templates to ease workflow changes and continuously measuring performance.

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PCMH Train-the-Trainer Lessons Learned Greenville Health System Greenville, South Carolina April 2, 2014
Center For Pediatric Medicine’s Quest for PCMH Recognition Katy Smathers, Practice Manager V Tammy Gladson, Clinical Manager
Who is the Center for Pediatric Medicine?  Pediatric primary care – a.k.a. “The Peds Clinic”  Physician providers (7), Mid-level providers (4), Residents (48) & Faculty/Attending Physicians (25)  3 locations  Center for Pediatric Medicine – 20 Medical Ridge Drive  Pediatric Rapid Access – 57 Cross Park Court  North Greenville Outpatient Center – 807 N. Main St, Travelers Rest  QTIP Practice (Quality through Technology and Innovation in Pediatrics) – CHIPRA Demonstration Grant (SCDHHS & SC AAP partnership) focus – implementing quality measures in the primary care pediatric office THE CAMDEN GROUP | 2/26/2014 2
 Approximately 19,000 active patients  Approximately 40% Hispanic  96% patients Medicaid eligible  Annual Visits – 52,000ish (combined 3 locations) Patient Population THE CAMDEN GROUP | 2/26/2014 3
Ancillary Resources Available at CPM  Respiratory Therapy/Asthma Educator  Social Work  RN Case Management (Care Coordination)  Lactation support  Medicaid eligibility worker on site  Interpreters THE CAMDEN GROUP | 2/26/2014 4
Primary care – well visits/acute care ADHD subspecialty clinic Adolescent subspecialty clinic Centering Parenting Psychiatric care clinic Asthma subspecialty clinic Scope of Services High Risk/NICU clinic Foster Care Newborn clinic clinic THE CAMDEN GROUP | 2/26/2014 5
Recognition Achieved – Partially….  Purchased a multi-site PCMH application April 2013  Corporate tool submitted April 2013  Center for Pediatric Medicine site-specific tool submitted August 2013  CPM Level 3 Recognition awarded November 2013!  Rapid Access & North Greenville site-specific tools to be submitted this month THE CAMDEN GROUP | 2/26/2014 6
Why Become a Recognized Patient Centered Medical Home?  Piqued our interest in 2007 – attended NCQA training (2008 PCMH Standards)  These were things we were already doing, but needed to engrain into the clinic culture. PCMH standards aligned with CPM’s patient centered mission.  Elements/Factors aligned with several other ongoing projects  Carrots & Sticks  Carrot – potential for enhanced reimbursement  Stick – Dr. Schmidt (if anything less than level 3 was achieved) THE CAMDEN GROUP | 2/26/2014 7
Why PCMH?  Focuses on making QUALITY the forefront of everyday operations  Preparation for changing reimbursement methodologies  Importance of exposing residents to the Medical Home model of care  Systematic approach to coordinated care  Encourage the concept of a “Care Team”  Become a true “Medical Home” THE CAMDEN GROUP | 2/26/2014 8
Preparation  Project team formation  Doreen Patterson, MD, Provider/Faculty  Katy Smathers, Practice Manager  Tammy Gladson, Clinical Manager  Kristi Caballero, Office Supervisor  Sabrena O’Connor, Physician Practice Specialist  Cindy Garnett, EHR Technical Specialist  Cheri Yeargin, Office Coordinator  Established weekly meeting time  Began our assessment – What were we doing? What documentation existed? THE CAMDEN GROUP | 2/26/2014 9
How Do You Eat an Elephant?  We had to change our approach – looking at all the standards at one time became confusing and overwhelming!  Made the decision to work on each standard until completed before moving to the next  After participation in NCQA multi-site call, decided to focus on Corporate elements  Developed Sharepoint site & completion status grid to track each factors completion status  Each meeting began with updating completion grid/ended with assignment of new tasks THE CAMDEN GROUP | 2/26/2014 10
THE CAMDEN GROUP | 2/26/2014 11
PCMH STANDARD 1 - CHALLENGES Element C – Electronic Access Patient portal is not available for majority of our population, required website tweaks including building contact forms for secure electronic requests of prescription refills, referrals, test results, appointments & clinical advice. Development of a process for distribution/handling these requests was also necessary. Element G – Practice Team Determining how team members fulfilled the specific functions of a patient centered medical home (i.e. who does what?) THE CAMDEN GROUP | 2/26/2014 12
THE CAMDEN GROUP | 2/26/2014 13
14 THE CAMDEN GROUP | 2/26/2014 14
PCMH STANDARD 3 - CHALLENGES Element A – Implement Evidence Based Guidelines Wasted time and frustration would have been avoided had we looked ahead to the other elements in Standard 3 – and how the important conditions were to be used later. Element B – Identify High-Risk Patient How do you define “high risk patients” when all of your patients are high risk? Process of identification not previously documented; required involvement of other practice staff. Element C & D – Care Management/Medication Management Documentation of care plans for patients with ADHD required hand mining and a definition of what meet criteria for a “care plan”. Structured data fields would have been helpful. THE CAMDEN GROUP | 2/26/2014 15
PCMH STANDARD 4 - CHALLENGES Element A – Support Self-Care Process Defining what documentation met the intent of the factor (Record Review Workbook). Having a physician involved during this step was crucial! Templates would have been helpful. Record review workbook instructions were confusing – pay close attention to the inclusion of high risk patients in record review (lost points for CPM). We had difficulty enlisting physicians to assist with record review. Element B – Provide Referrals to Community Resources This is something we all do regularly – but is it documented? Referral tracking process developed & implemented to meet documentation requirements– included social work, case management. THE CAMDEN GROUP | 2/26/2014 16
Community Resource Referral Log THE CAMDEN GROUP | 2/26/2014 17
PCMH STANDARD 5 - CHALLENGES Element A – Test Tracking and Follow Up Cleaning up the multitudes of duplicate outstanding labs in eCW Element B – Referral Tracking and Follow Up Defining our process highlighted organizational issues with referrals (i.e. sending/receiving appointment dates/times and consult notes, definition of “outgoing” and “incoming” referrals, once addressed – difficult to track) Element C – Coordinate with Facilities and Manage Care Transitions We could not have done this without DMCN! Did not get credit for this element – reviewer felt our documentation did not demonstrate the intent of the element, only “spoke to the intent” because the lack of a “step-by-step process”. THE CAMDEN GROUP | 2/26/2014 18
PCMH STANDARD 6 - CHALLENGES Element A – Measure Performance Determining what data was available through eCW – What were we measuring that met the requirements? Element B – Measure Patient/Family Experience Patient satisfaction survey did not identify the provider – required change in the process. THE CAMDEN GROUP | 2/26/2014 19
PCMH STANDARD 6 - CHALLENGES Element C/D – Implement Continuous Quality Improvement PDSA cycles a must! Reviewer did not feel that adolescent depression screening addressed services for a vulnerable population. Measurement over time and the creation of run charts to demonstrate achieved performance. Element E – Report Performance Developed a QI bulletin board “Hall of Fame” to share results throughout the practice Posted QI results in waiting room to share with patients Challenges sharing results by clinician due to multiple providers THE CAMDEN GROUP | 2/26/2014 20
Outcomes  PCMH recognition and the process changed the way we care for patients  Increased awareness of the QI process & how the results of our efforts benefit our patients – continuous quality improvement!  Helped to define and organize care processes  Increased structure of patient centered care  Proactive care vs. reactive care  Strengthened team approach & reduced silos THE CAMDEN GROUP | 2/26/2014 21
Tips/Lessons Learned  Templates, templates and more templates! Build in prompts to ease workflow change implementation.  Include entire staff from the beginning to improve buy-in – “What is PCMH?”  Title all of your documents appropriately. Any data must include a date range.  Store and organize your documents in one place (i.e. Sharepoint). THE CAMDEN GROUP | 2/26/2014 22
Tips/Lessons Learned  Use techniques such as GE Healthcare CAP/Workout to facilitate change management  Establish a multidisciplinary QI team  Advantage – breadth of knowledge  Disadvantage – many opinions/interpretations  Measure continuously  Submit as many points as you can – just in case  Use text boxes and highlights to point the reviewer to the specific areas of a document that meets the intent of the factor – they will not dig THE CAMDEN GROUP | 2/26/2014 23
Q&A THE CAMDEN GROUP | 2/26/2014 24

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Lecture lessons learned - pcmh presentation (2)

  • 1. PCMH Train-the-Trainer Lessons Learned Greenville Health System Greenville, South Carolina April 2, 2014
  • 2. Center For Pediatric Medicine’s Quest for PCMH Recognition Katy Smathers, Practice Manager V Tammy Gladson, Clinical Manager
  • 3. Who is the Center for Pediatric Medicine?  Pediatric primary care – a.k.a. “The Peds Clinic”  Physician providers (7), Mid-level providers (4), Residents (48) & Faculty/Attending Physicians (25)  3 locations  Center for Pediatric Medicine – 20 Medical Ridge Drive  Pediatric Rapid Access – 57 Cross Park Court  North Greenville Outpatient Center – 807 N. Main St, Travelers Rest  QTIP Practice (Quality through Technology and Innovation in Pediatrics) – CHIPRA Demonstration Grant (SCDHHS & SC AAP partnership) focus – implementing quality measures in the primary care pediatric office THE CAMDEN GROUP | 2/26/2014 2
  • 4.  Approximately 19,000 active patients  Approximately 40% Hispanic  96% patients Medicaid eligible  Annual Visits – 52,000ish (combined 3 locations) Patient Population THE CAMDEN GROUP | 2/26/2014 3
  • 5. Ancillary Resources Available at CPM  Respiratory Therapy/Asthma Educator  Social Work  RN Case Management (Care Coordination)  Lactation support  Medicaid eligibility worker on site  Interpreters THE CAMDEN GROUP | 2/26/2014 4
  • 6. Primary care – well visits/acute care ADHD subspecialty clinic Adolescent subspecialty clinic Centering Parenting Psychiatric care clinic Asthma subspecialty clinic Scope of Services High Risk/NICU clinic Foster Care Newborn clinic clinic THE CAMDEN GROUP | 2/26/2014 5
  • 7. Recognition Achieved – Partially….  Purchased a multi-site PCMH application April 2013  Corporate tool submitted April 2013  Center for Pediatric Medicine site-specific tool submitted August 2013  CPM Level 3 Recognition awarded November 2013!  Rapid Access & North Greenville site-specific tools to be submitted this month THE CAMDEN GROUP | 2/26/2014 6
  • 8. Why Become a Recognized Patient Centered Medical Home?  Piqued our interest in 2007 – attended NCQA training (2008 PCMH Standards)  These were things we were already doing, but needed to engrain into the clinic culture. PCMH standards aligned with CPM’s patient centered mission.  Elements/Factors aligned with several other ongoing projects  Carrots & Sticks  Carrot – potential for enhanced reimbursement  Stick – Dr. Schmidt (if anything less than level 3 was achieved) THE CAMDEN GROUP | 2/26/2014 7
  • 9. Why PCMH?  Focuses on making QUALITY the forefront of everyday operations  Preparation for changing reimbursement methodologies  Importance of exposing residents to the Medical Home model of care  Systematic approach to coordinated care  Encourage the concept of a “Care Team”  Become a true “Medical Home” THE CAMDEN GROUP | 2/26/2014 8
  • 10. Preparation  Project team formation  Doreen Patterson, MD, Provider/Faculty  Katy Smathers, Practice Manager  Tammy Gladson, Clinical Manager  Kristi Caballero, Office Supervisor  Sabrena O’Connor, Physician Practice Specialist  Cindy Garnett, EHR Technical Specialist  Cheri Yeargin, Office Coordinator  Established weekly meeting time  Began our assessment – What were we doing? What documentation existed? THE CAMDEN GROUP | 2/26/2014 9
  • 11. How Do You Eat an Elephant?  We had to change our approach – looking at all the standards at one time became confusing and overwhelming!  Made the decision to work on each standard until completed before moving to the next  After participation in NCQA multi-site call, decided to focus on Corporate elements  Developed Sharepoint site & completion status grid to track each factors completion status  Each meeting began with updating completion grid/ended with assignment of new tasks THE CAMDEN GROUP | 2/26/2014 10
  • 12. THE CAMDEN GROUP | 2/26/2014 11
  • 13. PCMH STANDARD 1 - CHALLENGES Element C – Electronic Access Patient portal is not available for majority of our population, required website tweaks including building contact forms for secure electronic requests of prescription refills, referrals, test results, appointments & clinical advice. Development of a process for distribution/handling these requests was also necessary. Element G – Practice Team Determining how team members fulfilled the specific functions of a patient centered medical home (i.e. who does what?) THE CAMDEN GROUP | 2/26/2014 12
  • 14. THE CAMDEN GROUP | 2/26/2014 13
  • 15. 14 THE CAMDEN GROUP | 2/26/2014 14
  • 16. PCMH STANDARD 3 - CHALLENGES Element A – Implement Evidence Based Guidelines Wasted time and frustration would have been avoided had we looked ahead to the other elements in Standard 3 – and how the important conditions were to be used later. Element B – Identify High-Risk Patient How do you define “high risk patients” when all of your patients are high risk? Process of identification not previously documented; required involvement of other practice staff. Element C & D – Care Management/Medication Management Documentation of care plans for patients with ADHD required hand mining and a definition of what meet criteria for a “care plan”. Structured data fields would have been helpful. THE CAMDEN GROUP | 2/26/2014 15
  • 17. PCMH STANDARD 4 - CHALLENGES Element A – Support Self-Care Process Defining what documentation met the intent of the factor (Record Review Workbook). Having a physician involved during this step was crucial! Templates would have been helpful. Record review workbook instructions were confusing – pay close attention to the inclusion of high risk patients in record review (lost points for CPM). We had difficulty enlisting physicians to assist with record review. Element B – Provide Referrals to Community Resources This is something we all do regularly – but is it documented? Referral tracking process developed & implemented to meet documentation requirements– included social work, case management. THE CAMDEN GROUP | 2/26/2014 16
  • 18. Community Resource Referral Log THE CAMDEN GROUP | 2/26/2014 17
  • 19. PCMH STANDARD 5 - CHALLENGES Element A – Test Tracking and Follow Up Cleaning up the multitudes of duplicate outstanding labs in eCW Element B – Referral Tracking and Follow Up Defining our process highlighted organizational issues with referrals (i.e. sending/receiving appointment dates/times and consult notes, definition of “outgoing” and “incoming” referrals, once addressed – difficult to track) Element C – Coordinate with Facilities and Manage Care Transitions We could not have done this without DMCN! Did not get credit for this element – reviewer felt our documentation did not demonstrate the intent of the element, only “spoke to the intent” because the lack of a “step-by-step process”. THE CAMDEN GROUP | 2/26/2014 18
  • 20. PCMH STANDARD 6 - CHALLENGES Element A – Measure Performance Determining what data was available through eCW – What were we measuring that met the requirements? Element B – Measure Patient/Family Experience Patient satisfaction survey did not identify the provider – required change in the process. THE CAMDEN GROUP | 2/26/2014 19
  • 21. PCMH STANDARD 6 - CHALLENGES Element C/D – Implement Continuous Quality Improvement PDSA cycles a must! Reviewer did not feel that adolescent depression screening addressed services for a vulnerable population. Measurement over time and the creation of run charts to demonstrate achieved performance. Element E – Report Performance Developed a QI bulletin board “Hall of Fame” to share results throughout the practice Posted QI results in waiting room to share with patients Challenges sharing results by clinician due to multiple providers THE CAMDEN GROUP | 2/26/2014 20
  • 22. Outcomes  PCMH recognition and the process changed the way we care for patients  Increased awareness of the QI process & how the results of our efforts benefit our patients – continuous quality improvement!  Helped to define and organize care processes  Increased structure of patient centered care  Proactive care vs. reactive care  Strengthened team approach & reduced silos THE CAMDEN GROUP | 2/26/2014 21
  • 23. Tips/Lessons Learned  Templates, templates and more templates! Build in prompts to ease workflow change implementation.  Include entire staff from the beginning to improve buy-in – “What is PCMH?”  Title all of your documents appropriately. Any data must include a date range.  Store and organize your documents in one place (i.e. Sharepoint). THE CAMDEN GROUP | 2/26/2014 22
  • 24. Tips/Lessons Learned  Use techniques such as GE Healthcare CAP/Workout to facilitate change management  Establish a multidisciplinary QI team  Advantage – breadth of knowledge  Disadvantage – many opinions/interpretations  Measure continuously  Submit as many points as you can – just in case  Use text boxes and highlights to point the reviewer to the specific areas of a document that meets the intent of the factor – they will not dig THE CAMDEN GROUP | 2/26/2014 23
  • 25. Q&A THE CAMDEN GROUP | 2/26/2014 24