IMPROVING NEW PATIENT ACCESS:ORIENTATION CLINIC

Kit Chan, RNSF Quality Cultural Series

March 12, 2013

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”

ORIENTATION CLINIC(OC) = A SOLUTION?

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

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

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

DID OC MAKE A DIFFERENCE?

New Client Seen 1/2012-1/2013

Jan-

12

Feb-1

2

Mar

-12

Apr-1

2

May

-12

Jun-

12

Jul-1

2

Aug-1

2

Sep-

12

Oct-1

2

Nov

-12

Dec-1

2

Jan-

13

Feb-1

30

20

40

60

80

100

120

Started eCw, closed to new client

Open to new client

more OC appts

New Client Wait List

COPC P

rior

ity

COPC r

egul

ar

CPHC P

rior

ity

CPHC r

egul

ar0

200

400

600

800

1000

187

839

0 0171

908

0 085

894

0 0

11/20/2012

12/14/2012

2/22/2013

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

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