Agenda

1. Agenda • Latino Clinic – Malinda Williams • Nurse medication review –Judy Martin • Vaccines, injections, and clinic procedures –Judy Martin • Cycle time – Dr. Colford • Travel clinic – Dr. Miller • On-line forms –Dr. Miller • Press Ganey focus group – Judy Martin • Spring party – Malinda Williams

2. Latino Clinic Malinda Williams

3. Latino Clinic • Multidisciplinary bilingual • To improve access, quality of care, and patient satisfaction for adult Latino patients cared for at UNC • Part of Investment for the Future (IFF) 3-year Grant award to Drs. Morgan, Alemán, Mauricio Cohen, and Reuland • Create Center for Latino Regional and Global Health • Clinical, education, research • Assist in serving specialty referrals from Piedmont Health Services

4. Multidisciplinary • IM • Alemán • GI • Morgan • Cardiology • M. Cohen • Surgery • B. Calvo • Others being considered for the future • Pulmonary, Dermatology, Ophtho, Rheumatology

5. Personnel and Logistics • Bilingual PBA, Nurse practitioner, Clinic Manager ( final hiring in process), Financial Counselor • Virtual clinic • Above personnel go to clinician’s usual clinic location e.g. Alemán on Tuesday am at ACC • Appointments will be made through the Latino Clinic PBA, special number pending

6. Goals and Metrics • Improve access of Latino patients to UNC specialty clinics • Improve communication of services to patients and providers • Scheduling of needed tests as recommended by specialists • Evaluate access, satisfaction and quality of care provided

7. Nurse Medication Review Judy Martin

8. Nurse medication review • Ask patient if he/she brought medications or a list of medications. • If not, then ask the patient to bring to the next visit. Explain that the only way to be sure we don’t make errors is to compare our list to what the patient is taking. • Ask if patient knows his/her medications and ask him/her to name them and give the dose and directions for use. Do not read the medications from the list and ask the patient to confirm.

9. Nurse medication review • Check each bottle, or drug on the patient list, against medications on WebCIS. • Check dose • Check directions • Ask patient whether he prefers a 1-month or a 3-month supply. • Update quantities or refills and allow refills for one year.

10. Nurse medication review • Make notes for the doctor about any difference between the patient’s medications and the WebCIS list. • Click the review button only if all medications can be reconciled. • Print prescriptions if requested by doctor • Narcotics, benzodiazepines and sleeping medicine: nurses will review use of these, but will not update refills. They will point out to the doctor discrepancies between the patient’s use and the med list.

11. Vaccines, Injections and Clinic Procedures Judy Martin

12. Billing for Vaccines/Injections • All vaccines/injections must have a billing code and injection charge. • Billing code example: B12 deficiency 266.2 • Vaccine/injection charge example: B12 deficiency J3420

13. Zoster Vaccine • Physicians can write prescriptions for Zoster vaccine for Medicare patients. • When Medicare is the primary insurer many secondary insurers are not covering the cost of the vaccine. • The patient can take the Rx to their pharmacy. • Patients can be seen as walk-ins to receive vaccine injections. • Nursing documentation: Use code G0377 for administration and diagnosis code V07.9

14. Clinic Lab Work • Urinalysis • Glucose • Wet prep • Diagnostic hemoccult

15. Procedures • Nurse procedures • Bladder scan • Physician procedures • Joint injections • Injections of bursa and tendon sheaths • Others • Modifier 25 • Depo-Medrol

16. Cycle Time Dr. Cristin Colford

17. Cycle time

18. Cycle time

19. Travel Clinic Dr. Tom Miller

20. Changes • Open to all callers • Payment at time of service for consultations • Very limited phone advice

21. Fee schedule • Diagnosis code: V70.0 - general medical exam

22. Vaccine injection charges

23. Travel Clinic Procedures • Scheduling • Collect information including itinerary • Inform patients of payment expectations • Mail letter with fee schedule • Fill out a referral form • Remind patient to bring itinerary and vaccination record

25. Travel Clinic Procedures • Check-in • Give patient letter and fee schedule • Inform patient that they will need to pay for the consultation, but that vaccines will be billed to their insurance carrier

26. Travel Clinic Procedures • Nurse consultation • Print out advice for healthy travel • Remind patient of payment policy • NEMB for Medicare patients (waiver)

27. Travel Clinic Procedures • Check-out • Collect for consultation • Submit claim for vaccines

28. Clinic Web Page Dr. Tom Miller

30. Clinic web page • Residents have trouble accessing administrative resources needed to support their clinic practice. This lack of support leads to inefficiencies, frustration, and inconsistencies in care including differing practices with regards to reporting lab results, refilling prescriptions, and arranging referrals. Much of the time residents feel forced to make all such arrangements on their own. • We have identified the following problem areas: • Appointments within Internal Medicine • Appointments to specialty referrals • Procedures and/or ancillary tests • Assistance from nurses • Add-on labs (to current specimen) • Patient return for additional labs • Patient letters to report labs / test results • Enhanced Care referrals • Diabetes class referrals

31. Clinic web page

32. Internal Medicine Referral Form

44. Press Ganey Judy Martin

45. Internal MedicinePatient Satisfaction Focus Group Edna Mark – Co-Chair Judy Martin – Co-Chair

46. Members • Amy Azzolino • Marilyn Bender • Katrina Farmer • Laura Hutchins • Faye Johnson • Tim Scurlock • Robin Woodford • Eva Wamgata

47. Press Ganey

48. Introduction • Group was formed in response to negative comments from the Press Ganey quarterly survey. Two meetings were held to discuss these comments. • Comments were categorized as behavioral issues, and a group goal for behavioral expectation was formalized.

49. Goal • The Internal Medicine clinic will have 0% negative behavior comments over the next quarter and on an ongoing basis.

50. Expectations To achieve these goals each member will address the expectations for the clinic. • Faye: The accountability of all staff members working in the Internal Medicine Clinic. • Laura: Professional behavior for the front desk staff. • Katrina: Professional behavior during the triage process. • Robin: Communication between nursing staff and front desk PBA’s. • Tim: Overall expectation and communication at front desk. • Eva: Communication with patients during wait time in clinic (exam room). • Amy: Communication / scheduling at the appointment office.