improving new patient access: orientation clinic
DESCRIPTION
Improving New Patient Access: Orientation Clinic. Kit Chan, RN SF Quality Cultural Series March 12, 2013. The “Burning Platform”. - PowerPoint PPT PresentationTRANSCRIPT
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-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
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
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