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ACCESS

ACCESS. SCAAP QTIPP PROJECT JULY 23, 2011. ACCESS REVISITED. THE MUSINGS OF YIDD AND YODD. YODD. YE OLD DOCTOR DUDE. YIDD. YOUNG INEXPERIENCED DOCTOR DUDE. YIDD.

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ACCESS

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  1. ACCESS SCAAP QTIPP PROJECT JULY 23, 2011

  2. ACCESS REVISITED THE MUSINGS OF YIDD AND YODD

  3. YODD YE OLD DOCTOR DUDE

  4. YIDD YOUNG INEXPERIENCED DOCTOR DUDE

  5. YIDD YOUNG INEXPERIENCED IDEALISTIC DOCTOR DUDE

  6. WE BOTH AGREE: THE AVERAGE PEDIATRICIAN MAY BE THE BEST EXPERT IN ACCESS.

  7. BUT WE DID NOT AGREE ON EVERYTHING-- LIKE HOW TO TAP INTO THAT EXPERTISE.

  8. YIDD AND YODD ON A QUEST… FIND THE AVERAGE PEDIATRICIAN

  9. 70% OF PEDIATRICIANS ARE GENERALISTS.

  10. PEDIATRICS IS NOT JUST A SPECIALTY FOR THE YOUNG.

  11. IT IS A SPECIALTY OF THE YOUNG. PEDIATRICS HAS A GREATER PERCENTAGE OF PRACTITIONERS UNDER 45 THAN ANY OTHER SPECIALTY.

  12. PEDIATRICS REQUIRES BROAD KNOWLEDGE.

  13. PEDIATRICS HAS PRACTICITIONERS THAT ONLY SEE PATIENTS PART TIME.

  14. PEDIATRICS IS MORE THAN 50% FEMALE.

  15. ?AVERAGE PEDIATRICIAN

  16. WE DECIDED TO GO WITH A SURVEY… AND A FEW THOUGHTS OF OUR OWN.

  17. THE CHIPPRA QUALITY INDICATOR ON ACCESS

  18. So, in each of 4 age groups: KIDS WITH AT LEAST ONE VISIT KIDS CONTINUOUSLY ENROLLED

  19. THE YODD PERSPECTIVE

  20. PRODUCT LINES?

  21. PRACTICES MAY BE ABLE TO DESIGNATE WHO IS AN ACTIVE PATIENT, BUT MAY HAVE A LOT OF TROUBLE TELLING WHO HAS BEEN “CONTINUOUSLY ENROLLED” FOR 1 OR 2 YEARS.

  22. THE MAXIMUS FACTOR

  23. GLADIATOR PEDIATRICIANS 1. HAVE THE PATIENTS THEY KNOW TAKEN AWAY. ASSIGNED PATIENTS THEY DON’T KNOW. ALWAYS FEEL LIKE THEY ARE FIGHTING FOR THEIR LIVES. 1. HAD THE PEOPLE HE KNEW AND LOVED TAKEN AWAY. 2. THROWN IN WITH PEOPLE HE DIDN’T KNOW. 3. ALWAYS FELT LIKE HE WAS FIGHTING FOR HIS LIFE.

  24. MAXIMUS IS THE COMPANY HIRED BY SC TO ASSIGN MEDICAID PATIENTS TO MANAGED CARE PLANS. WHILE THINGS ARE BETTER, MANY PEDIATRICIANS STILL HAVE LONGSTANDING PATIENTS ASSIGNED TO OTHER PRACTICES AND ARE ASSIGNED PATIENTS WITH WHICH THEY HAVE NO RELATIONSHIP.

  25. WE SURVEYED THE GROUP TO SEE IF ANYONE WAS DOING OUTREACH TO MEDICAID PATIENTS NEWLY ASSIGNED TO THEM. THE ANSWER WAS UNANIMOUS- NO! THIS IS FELT TO BE DIFFICULT FOR A NUMBER OF REASONS INCLUDING LACK OF HELP FROM THE MCOs.

  26. BOTTOM LINE THE NUMERATORS ARE EASY DENOMINATORS WILL BE UNRELIABLE

  27. CHIPPRA MUSING(CONCLUSION) THIS INDICATOR MAY NOT BE VERY USEFUL TO PRACTICES, BUT COULD IT BE A MEASURE THE MEDICAID MCOs SHOULD LOOK AT WORKING ON? IF THEY DID, IT MIGHT ACTUALLY IMPROVE ACCESS.

  28. NCQA AND ACCESS

  29. ACCESS ELEMENTS OF STANDARD 1 ELEMENT A: ACCESS DURING OFFICE HOURS ELEMENT B: AFTER- HOURS ACCESS ELEMENT C: ELECTRONIC ACCESS

  30. YIDD AND YODD EXAMINE OFFICE ACCESS

  31. MUST PASS ELEMENT

  32. “OPEN ACCESS SCHEDULING”

  33. SAME DAY APPOINTMENTS

  34. HOW DO YOU DECIDE THE NUMBER OF SAME DAY APPOINTMENTS TO RESERVE?

  35. ANSWERS FROM GROUPS VARIED SIGNIFICANTLY- FROM 3-4 PER PROVIDER PER DAY TO EVERY OTHER APPOINTMENT. SOME PRACTICES DO NOT VARY THE NUMBER BY SEASON, OTHERS DO. ALMOST EVERY PRACTICE SEEMS TO HAVE A PLAN TO WORK IN SICK KIDS EVEN AFTER ALL OPEN APPOINTMENTS ARE FILLED.

  36. NO ONE SEEMED TO OFFER SAME DAY WELL APPOINTMENTS UNLESS THEY HAPPENED TO HAVE AN UNFILLED SPOT. IT IS CLEAR THAT NO ONE CAN AFFORD TO HAVE UNFILLED APPOINTMENTS AND THAT PEDIATRICIANS MUST TARGET SAME DAY APPOINTMENTS ON THE LOW SIDE.

  37. CRITICAL FACTORS

  38. SAME DAY APPOINTMENTS ARE A “CRITICAL FACTOR”- IT MUST BE MET TO PASS THE ELEMENT.

  39. TELEPHONE ACCESS

  40. ELECTRONIC MESSAGING

  41. PROVIDING CLINICAL ADVICE BY SECURE MESSAGING IS SUPPOSED TO BE N/A IF THE PRACTICE DOES NOT HAVE THE CAPABILITY. BUT EVEN IF WE CAN DO IT, IS IT A ROAD WE OUGHT TO TAKE?

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