Team Presentation

Enhancing Access to Care

Altamonte Pediatric Associates

Learning Session 2April 27-28, 2012

Disclosure

I have no relevant financial relationships with the manufacturers of any commercial products and/or

provider of commercial services discussed in this CME activity. I do

not intend to discuss an unapproved/investigative use of a commercial product/device in their

presentation.

Altamonte Pediatric Associates

• 3 offices in central FL• Altamonte Springs, Lake Mary, Apopka

• 6 MDs, 6 NPs• Our Core Improvement Team:

• Phyllis Zissman – Office Manager• Corie Opdyke – ARNP• Jaime Candelori – MD• Jennifer Roberts – Care Coordinator• Tammy Hadley – Parent Partner

Aim Statement

• By March 2012, our practice aims to improve our medical home by focusing on potential ways to improve our processes for providing comprehensive and coordinated care for our patients.  

1.  Identify the primary care provider for 90% of patients with complex medical needs, and educate the staff so that these patients are scheduled and roomed with their PCP and allotted the appropriate amount of time for the visit.2.  Create, update and discuss with the parent the patient's medical summary and, if necessary, the comprehensive care plan for 90% of all patients.3.  Improve processes that will allow us to systematically track, follow-up and document test results, vaccinations, referrals and schedule appointments to discuss findings with parents and patients if indicated.

• Saturday appointments• established for many years• newborns, sick visits, main office only

• Evening hours• established a few years ago• parent survey completed to assess need at various

times• sick visits, main office only• as need increased, added extra appointments

• Same Day Appointments• almost half of all appointments are sick visits• nurse triage line

Enhancing Access to Care

• 24/7 coverage• Nurse/MD on call, protocols established

• Sunday visits• MD will often see patients if needed

• Facebook/Website/Email• patients can access general information electronically• Email is occasionally used

Enhancing Access to Care

But In a practice where we all share all the patients, and we rotate to different offices, how do we improve access to a specific care provider team?

Improving Access to Care - GOALS

• Create Patient Registry – 4 levels• Focus on our most complex patients, labeled level 4

• Establish PCP team for Level 4 patients

• Establish Care Coordinator• A contact person who gathers information and whose

main purpose is to help our most complicated patients

• Expand Medical Summary into Comprehensive Care Plan

• A copy to chart and a copy to parents

Changing our Workflow

• Initially, 12 complex (level 4) patients identified• Appointments made, introduced to the project• Chart color (RED) was a visual indicator• Level designated in chart and in computer – all visits double slotted

• After 3 months, most of the visits were scheduled• Sick visits harder to schedule with requested PCP (providers are in

different offices on different days, some work evenings or PT)• More patients needed Level 4 status• More providers would need to be designated as PCP

• Extending the project to all providers and all offices• Continuously adding Level 4 patients to our registry

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Reflection – initial concerns

• Changes would result in slower workflow• anticipating extended visits with more complicated

patients allows us to schedule the extra time we need• Nurses know to divert other patient traffic elsewhere

when needed

• Scheduling difficulty• How to get patients with their preferred provider

• MDs have individual templates, but NPs schedule generic

• Still working out the kinks, but vast improvement

Reflection – success and challenges

• Reciprocal Appreciation• Patients, parents and families appreciate our efforts

• Care Plan in chart and in hand• Establishing a PCP team (a work in progress)• Having a dedicated Care Coordinator

• We have discovered their strengths• Coordination and organization• Some even bring their own “care plan” to us!

• Challenges - The “Business” Side• How to effectively bill for our efforts• Educating patients to avoid urgent care centers, retail based

clinics, ERs

Reflection

ACCESSSPECIFICPROVIDER

FINDING BALANCE

Remember….

• SURVEY PARENTS ABOUT THEIR PREFERENCES• Early morning vs. lunch vs. evening

hours

• INFORM PARENTS OF ANY CHANGES• use follow up visits from urgent

cares or ERs to educate• update website, facebook, etc.

• CONTINUE TO REEVALUATE• need for additional

appointments and providers?• can the patient be seen by their

requested provider?

Our next steps…

• Implement parent survey• Prefer Access vs. PCP? Sick vs. well?• What more can we offer our complex

patients?

• Continue to expand project• Satellite offices• Patient Registry

• Improve our tracking systems• Referrals• Labs, Imaging, etc.