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Weekend Access: Could it Work for You? Karen Waycott, CPC

Weekend Access: Could it Work for You? Karen Waycott, CPC. What we will cover. Introductions Overview of Practice (SMMC/PCPS) Why weekend access? Goal/Vision Implementation/Plan Financial structure Challenges What the future holds. Multi-specialty practice

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Weekend Access: Could it Work for You? Karen Waycott, CPC

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  1. Weekend Access: Could it Work for You? Karen Waycott, CPC

  2. What we will cover • Introductions • Overview of Practice (SMMC/PCPS) • Why weekend access? • Goal/Vision • Implementation/Plan • Financial structure • Challenges • What the future holds

  3. Multi-specialty practice Ancillary services, blood draw, x-ray, Mammo/Dexa, MRI and CT Family Practice, Internal Medicine and Pediatrics OB-Gyn,Cardiology, Gastroenterology, Neurology, Pulmonology, Endocrinology, Surgery, Sports Medicine, OT and PT Coumadin Clinics – POC testing Weekend Access Diabetic Education with CDE Group Visits Sites located in Biddeford, Kennebunk, OOB and Saco

  4. Practice Information

  5. Information Systems • EHR - eClinical Works • Meditech (SMMC) • Touch Every Life • Chronic Disease registry • ShoreTel – IP phone

  6. Internal Medicine

  7. IM Staff • 6 – Internal Medicine physicians • 1 – IM/Geriatrics • 1 – IM/Endocrinologist • 1 – NPP (CDE) • 2 RNs, 1 LPN, 7 MA’s • 9 – PSR’s, Medical records, phone

  8. Who am I… • Medical field for over 18 years • Started as collections agent • Billing specialist • CPC in 1999 • Billing Director – PrimeCare Physician Associates • Practice Manager IM • Quality Initiative projects • A Patient

  9. Why Weekend Access? • Business Case (SWOT) • “Doc-in-a-Box” • Quick Care Clinics (Wal-Mart, Walgreens) • Current PCP on-call status • Lacked revenue • Inconsistent among specialties • Patient referred to ER • Patient satisfaction • Access to care on weekends • Working population

  10. The way we were… • Current system inconsistent • IM 8-12 Saturdays only • FP no hours offered • Pediatrics – hours by phone only • Draw station at separate site • Fragmented • Staffing multiple sites

  11. WAC = Access & Efficiency • Goal • Primary Care access on weekends Sat/Sun • Consistency across primary care specialties • Convenience of single location • Efficiency of consolidated staffing • EMR implementation allows access to patient records anytime, anywhere

  12. Implementation Team • Team formed • 3 PCP’s • Rep from each specialty • Project manager • CEO • Director of Operations • IT • Management team

  13. The Plan • One single centrally located site • Hours of operation Sat & Sun 8-12pm • Phones 8-12 • Appointments 9-1pm • Staffing • 3 Providers ( 1-IM, 1-FP, 1- Ped) • 3 Clinical assistants • 2 Patient Service Reps • Start date 02/2008

  14. Plan into Action • Location • Staffing • Appointment schedules • Phones • Supplies (Medical and Clerical) • Advertising…Getting the word out • IT needs

  15. Location • Central location • New Building Biddeford • Draw Station/ Ancillaries • Central to all offices • Shared location negotiated • Cardiology office • Storage needs (Clinical supplies) • Check-in/Check-out • Visible to patients

  16. Staffing • Use on-call schedule for PC specialties • Peds will use own clinical staff • Volunteer pool established • Clinical • Clerical • Incentive • Current Differential pay • Previous Extra/OT hours

  17. Phones • Develop plan seamless to patients • IT will set up phones from PCP sites to roll to Cardiology (Central site) 8-12 • Phones roll to answering service at 12 • On-Call physicians paged after 12:00pm • Ability to see patients if needed

  18. Appointment Schedules • Template schedules (9 am -1pm) • First hour pre-booked slots • Used for PCP patient physicals • Follow-up appts needed • Second hour acute over-flow • Can be pre-booked by any primary care site • Book with Friday acute call over-flow • Third and Fourth hour • Acute same-day visits only

  19. Supplies (Clerical) • Established in current site • Computers • Phones • Printers/Copiers/Fax • Credit Card machine • Set up needed • Petty Cash, stationary and signage

  20. Supplies (Clinical) • Develop list of all supplies needed across three specialties • Storage room • Clearly labeled • List supplied (cross referenced) • Clear separation by host site vs. WAC supplies • Exam rooms stocked in mirror image • Physicians to bring assigned tablets

  21. Advertisement • Post signs at check-out windows • Posters in all sites • Info added to web-site • Local Newspapers • Word of mouth • Nurses during triage calls • Employees to family members

  22. IT (Information Technology) • Phones rolled using IP Phone system • Ability to update employee profiles • EMR – all patients records available • Windows Shared drive (access) • Schedules • Check off list • Contact names and numbers

  23. Financial Structure • Central Cost • Rent • Patient Service Representatives hours • Management • Charge back to physician/site • POC testing (Influenza, Rapid strep, immunizations, injectables, etc.) • Clinical assistant – expensed to physician/site • Break even visits per day 7-9

  24. Physician Incentives • Beyond 7 visits p/day yield financial gain • On-call schedule generates revenue • Better patient care • Improved patient satisfaction • Opportunity to work among peers

  25. Our First Month Totals

  26. Target: 12 visits/pd/pp Dual IM/Ped provider

  27. Weekly huddles… • What went well • Opportunities for improvement • Are we meeting patient needs • Staffing to match volume • Staff have all tools to do their job

  28. Patient reaction… • Patients surprised to to hear we are open • “They can see me today • Your open on Sunday? • Can I get my prescription filled?

  29. Focus Areas • Communication to rotating staff • Shared work stations • Physician buy-in to weekend access • Location of medical supplies • Work flow different from Mon – Fri • Patients education (going to PCP sites) • Signage • Filling schedule (staff education, pt education)

  30. Process Improvement • Communication to rotating staff • Hired PSR – anchor to the operation • Check off list • Shared work stations • Ensuring respect for work areas • Ensuring tablets are left as found • Physician buy-in to weekend access • Wanting to change structure of scheduling and calls

  31. Location of medical supplies • Cross reference of supplies by name and location • Work flow different from Mon – Fri • Quick reminder sheets • Patients education (going to PCP sites) • Signage • Remind patient when booking appts (location) • Filling schedule (staff education, pt education) • Management ownership during PCP call dates

  32. Our clinic today…

  33. Our Team at Work

  34. Q4;2008

  35. Avg. Visits p/wknd

  36. Pre-book vs. Same Day

  37. The Future • Expanding weekend hours • Consolidate Draw station w/ Clinic • Merger with SMMC offers expanded access to ancillary services • Bridge gap between patient registration • Holidays • Offices closed Black Friday – used clinic • Plan for July 3rd

  38. Cultivate Change Karen Waycott, CPC 30 West Cole Road Biddeford, Maine 04005 (207) 602-7220 kwaycott@smmc.org

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