The Utility of PPRNet Reports in a Federally Qualified Health Center and Residency Program

1. The Utility of PPRNet Reports in a Federally Qualified Health Center and Residency Program Kimberly Williams, MD August 22, 2014 Smoky Hill Family Medicine Residency

2. Outline • Setting • Requirements for residency • Requirements for faculty • Requirements for Federally Qualified Community Health Center (FQHC)

3. Who We Are • Salina, KS • Rural, community based unopposed family medicine residency • Affiliated with University of Kansas School of Medicine-Wichita • 6 faculty physicians • 12 resident physicians

4. Who We Are • Federal Qualified Community Health Center • 4 full time providers (2 NPs, 2PAs, 1 MD) • Level 3 NCQA-certified patient-centered medical home • Services offered in house • Dental, behavioral medicine, pharmacy, diabetes education, lab, x-ray

5. Our Patients • Patient mix by payer • Self Pay- 27.46% • Medicaid- 35.78% • Medicare- 13.03% • Private Insurance- 23.73% • Spanish Speaking • Self-reported 10%

6. Residency • RRC Requirements • Residents must receive regular reports of individual and practice productivity, financial performance and clinical quality basis, as well as the training need to analyze these reports • Each FMP site must involve all members of the practice in ongoing performance improvement, and must demonstrate use of outcomes in improving clinical quality, patient satisfaction, patient safety and financial performance • Residents should complete two scholarly activities, at least one of which should be a quality improvement project • Residents must complete part IV maintenance of certification prior to sitting for boards

7. Residency • RRC Requirements • Residents must receive regular reports of individual and practice productivity, financial performance and clinical quality basis, as well as the training need to analyze these reports • Each FMP site must involve all members of the practice in ongoing performance improvement, and must demonstrate use of outcomes in improving clinical quality, patient satisfaction, patient safety and financial performance • Residents should complete two scholarly activities, at least one of which should be a quality improvement project • Residents must complete part IV maintenance of certification prior to sitting for boards

8. Residency • Monthly Resident/Faculty Meetings • Choose several metrics each month from reports • Rotate metrics each month • All providers data handed out

9. Monthly Provider Feedback

10. Monthly Provider Feedback

11. Residency • RRC Requirements • Residents must receive regular reports of individual and practice productivity, financial performance and clinical quality basis, as well as the training need to analyze these reports • Each FMP site must involve all members of the practice in ongoing performance improvement, and must demonstrate use of outcomes in improving clinical quality, patient satisfaction, patient safety and financial performance • Residents should complete two scholarly activities, at least one of which should be a quality improvement project • Residents must complete part IV maintenance of certification prior to sitting for boards

12. Residency • RRC Requirements • Residents must receive regular reports of individual and practice productivity, financial performance and clinical quality basis, as well as the training need to analyze these reports • Each FMP site must involve all members of the practice in ongoing performance improvement, and must demonstrate use of outcomes in improving clinical quality, patient satisfaction, patient safety and financial performance • Residents should complete two scholarly activities, at least one of which should be a quality improvement project • Residents must complete part IV maintenance of certification prior to sitting for boards

13. Residency • Quality Improvement Projects • One project per PGY class • Teaching, lit review, choice of project • Preventive health for women • Pap/Mammo/Dexa • Adult Immunizations • Tdap, pneumovax

15. Residency • RRC Faculty Requirements • The faculty must establish and maintain an environment of inquiry and scholarship with an active research component. • Faculty should encourage and support residents in scholarly activities • Two scholarly activities over the course of 5 years

16. Residency • RRC Faculty Requirements • The faculty must establish and maintain an environment of inquiry and scholarship with an active research component. • Faculty should encourage and support residents in scholarly activities • Two scholarly activities over the course of 5 years

17. Residency • QI competition • Improvement in diabetes outcomes • On average improved 8% • Working on provider dashboard for tri-annual review

18. Residency • RRC Faculty Requirements • The faculty must establish and maintain an environment of inquiry and scholarship with an active research component. • Faculty should encourage and support residents in scholarly activities • Two scholarly activities over the course of 5 years

20. FQHC • Healthcare Plan • Some measures dictated by federal government • Unified Data Set • Choose some measure within a category • Pediatric, chronic care • Annual report • Denominator is very specific • Usually done by chart audits • Track numbers on quarterly basis with PPRNet reports

21. Clinical Coordinator • 16 metrics, deals with 1-2/month • Generates patient lists • Sends provider message, or contacts patient directly • Examples • Ischemic vascular disease and ASA • Pap smears

22. Summary • Residency • Resident Scholarly Activity • Faculty Scholarly Activity • Foster a culture of QI • FQHC • Helps us regularly track numbers we report annually • Improve patient care