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IMPROVING NEW PATIENT ACCESS:ORIENTATION CLINIC
Kit Chan, RNSF Quality Cultural Series
March 12, 2013
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RESTRAINING FORCES CURRENT PAYMENT (NURSES ARE NOT BILLABLE)
RESISTANCE: PATIENTS, STAFF
INCREASED DEMAND (ACA, HSF), TIMELY ACCESS, DECREASE ACCESS INCREASE COMPLAINTS/WAIT TIME, PROVIDERS SHORTAGE
HEALTH EXCHANGE IN 2014, PAY FOR PERFORMANCE IN 2015
DRIVING FORCES
The “Burning Platform”
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ORIENTATION CLINIC(OC) = A SOLUTION?
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How does it work?New patients scheduled to see RN - RN does the
following:Intake: Medical, family, social, OB/GYN history, Med,
IZPreventive services per standing order: labs, IZs,
mammo, etc..Release of medical recordsDetermine the need for provider visit
Behaviorist: How to access services re: urgent need, med
refills, etc.Medical Director:
Reviews & signs OC notes - add more tests, med refill, etc.
Reviews lab results All is normal –> pt notified, may not need PCP visit Abnormal –> diagnostic tests –> pt scheduled to see
PCP
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OC – Benefits demand for appts with PCP
Not every patient needs to see PCPpatients with normal lab results
11% did not see PCP28% saw PCP once
If do need to see PCP, at 1st visit Up to date:
labs-screening & diagnosticpreventive services: IZs
Medical/social/etc history already taken
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OC – Benefits responsiveness to demand– easier
to add appt slots for RNs than PCPsExpanded nurse role – nurses see
how they can contribute uniquely (as nurses) to clinic
efficient & timely patient careShorter wait time -> higher show
rateFront desk can “Say Yes to the Patient”
No wait list at CPHC for new pts
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DID OC MAKE A DIFFERENCE?
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New Client Seen 1/2012-1/2013
Jan-12
Feb-12
Mar-12
Apr-12
May-12
Jun-12
Jul-12
Aug-12
Sep-1
2
Oct-12
Nov-12
Dec-12
Jan-13
Feb-13
0
20
40
60
80
100
120
Started eCw, closed to new client
Open to new client
more OC appts
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New Client Wait List
COPC Pr
iority
COPC re
gular
CPHC Prio
rity
CPHC re
gular
0200400600800
1000
187
839
0 0171
908
0 085
894
0 0
11/20/201212/14/20122/22/2013
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What's needed to implement?Local clinic leadership
Buy in (see the need & how this would help)
Engage and involve staff in the changes
For NursesTraining on standing ordersClinical support (i.e. provider of the day)
For ProvidersTime to review lab results from OC
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ReferencesHealtcare.gov (October 5, 2012). What’s changing and when?
The U. S. Department of Health and Human Services.
Retrieved from:
http://www.healthcare.gov/law/timeline/index.html
Healtcare.gov (November 23, 2012). What’s changing and when?
Paying physicians based on value not volume. Retrieved
from: http://www.healthcare.gov/law/timeline/
Kaiser commission on Medicaid and the uninsured (Kaiser
Commission) (2011). California’s “bridge to reform
Medicaid demonstration waiver: Executive summary.
[PDF]. Retrieved from:
www.kff.org/medicaid/upload/8197- R.pdf