South Carolina Department of Health and Human Services CHIPRA Quality Demonstration Grant

1. South Carolina Department of Health and Human Services CHIPRA Quality Demonstration Grant Going where no man or woman has gone before: ABP MOC Part IV/ NCQA PCMH

2. Board Recertification • American Board of Pediatrics • All pediatricians must be recertified every 10 years • Part I: Must maintain their license • Part II: Must do a self survey of competence • Part III: Must take a standardized exam • Part IV Must do at least two quality improvement projects certified by the ABP

5. QTIP MOC Offerings • Access: p. 3 • Asthma p. 4 • Developmental Screening p. 7 • Family Centered Care p. 8 • Well Child Visits p. 9 • ADHD p.10 • Behavioral health Services p. 11 • Emergency Department Use p. 12 • Oral Health Disease p. 13

6. Developmental Screening • Documentation of a PEDS or Ages and Stages developmental screening at 9 months of age, 18 months of age, and between 2 and 3 years of age at the time of a well child visit (Goal: 70 percent of eligibles) • Documentation of a screen for autism such as the MCHAT at the time of well child visits between 15 months and 3 years of age. • Documentation of service provision, further evaluation or referral for those children who screen as “at risk” • Documentation of screening for maternal depression and or psychosocial risk and or substance abuse and or domestic violence during the newborn period.

7. Behavioral Health Services • Completion of the AAP’s Mental Health Practice Readiness Inventory with Kristine Hobbs and development of a plan to address weak areas in the practice. Participating practices may substitute repeat measurement of their mental health readiness using the Inventory in lieu of chart audits. • Documentation of expanded mental health screenings using one or more of the following: Pediatric Symptom Check List, screens available from TeenScreen.org, depression screens, CHADIS system or other screens as approved by QTIP. • Documentation of service provision, further evaluation, or referral for those children who screen “at risk” • Documentation of mental health referrals and correspondence back from the mental health provider in the chart that assists with management of the child in the pediatric medical home. • Documentation of screening for one or more of the following: maternal depression, psychosocial risk, substance abuse or domestic violence during the newborn period. • Referral and documentation of parent to parent support through Federation of Families (www.fedfamsc.org or diane.flashnick@fedfamsc.org) • Audit of all patients in a practice discharged from a mental health facility for evidence of appropriate follow up in the pediatric medical home including an initial visit within 30 days of discharge (As specified in the CHIPRA Core Measure: Follow-up After Hospitalization for Mental Illness)

8. Optimal Access to the Pediatric Primary Care Office • Audit of Open Access by measuring number of same day appointment available at the beginning of the day for 5 straight days. • Audit of Clinical Call Response Time for telephone queries for 1 week with a stated standard for the office for the response time. • Audit of charts to ensure that telephone advice is recorded both during and after office hours. • Audit of chart to ensure that a personal clinician is recorded and audit to measure percentage of visits in which patient sees their personal clinician • Achievement of level 2 NCQA PCMH status or higher using 2011 criteria. • Development and documentation of improved transfer of referrals/ information in the pediatric record between the office and other agencies such as Baby Net, Head Start, First Steps and Family Connection on mutual clients/ patients in a HIPPA observant fashion

10. QTIP Current Approach • Builds on work from South Carolina Primary Care Association, Richland Palmetto ACO and some of our lead practices • Propose to provide a thumb drive application kit to assist practices with needed policies, assay tools and commentary • Have been meeting every four weeks to put this together

11. Policy • Insert name of practice: ABC Pediatrics • Insert Date: 3/3/2012 • Office Hours: • Insert Office Hours: 7:30 a.m. to 7 p.m. Monday through Friday • 8:30 a.m. to 1 p.m. Saturday • Sunday hours at the discretion of the on call doctor • Open Access Scheduling: Our practice reserves time for same-day appointments for routine and urgent care based on patient preference or triage. Patients with life threatening emergencies such as cyanosis, major trauma or seizures will be referred directly to the emergency room and the on call doctor will be notified. Patients with acute problems such as asthma, significant pain, etc. will be brought into the office as soon as possible. If the front office staff is not capable of making a determination they will immediately consult with the nursing staff to provide appropriate triage. Our office maintains sufficient same day capacity for acute problems and monitors our schedule to ensure sufficient appointment availability.

12. Policy • Insert Scheduling Policy: 40 percent of available time slots in the General Clinic are maintained open until day of service to accommodate acute problems • Timely Clinical Advice by Telephone During Office Hours: Insert: ABC Pediatrics nursing staff will endeavor to take clinical calls from our patients and their families at the time of the call. If there is no nurse availability, front office staff will take a message and nursing staff will respond within 2 hrs. Issues that need to be referred to the Doctor staff will be forwarded electronically, and the Doctor staff will respond within 4 hrs. • Periodic review of phone records will be conducted to ensure we are meeting our standard. • Access outside of regular Appointment Hours: Our pediatric practice offers extended hours for our patients in order to help take care of their urgent and routine problems in an expeditious fashion. If a patient needs to be referred to an urgent care center or Emergency Room, access to their clinical information will be provided by the doctor on call when necessary. Patients who require emergency advice after hours may call our on call number and will have their problems triaged by a nurse. The nurse will answer patient inquiries within 30 minutes. Once a month staff will monitor a sample of their after hours calls to ensure that patients are given advice within this standard. After hours advice will be documented in the patient record.

13. Tools

14. Notes • What kind of transformations do you want to make in practice for PCMH status? • What kind of documentation is required? • Standard 1: Enhance Access and Continuity • 1 A Transformations: Most of the standards here are met by most offices. Is all clinical advice documented in the medical record? • 1A Notes: 1A is 20 points, the biggest part of Standard 1. 1G is 4 points, B,C,D, E and F only 2 points each. We have not given suggestions for electronic communications as we do not believe many of our practices are capable of doing that yet, so NA would apply. • 1A Documentation: • Appropriate Policy • Audit of Open Access Same Day Appointments for 5 consecutive days (See Tool) • Audit of Clinical Call Response Time During Office Hours for 1 week • 3 Examples of Clinical Phone Advice recorded in the chart • 1B Transformation: Do you record after hours phone calls in the chart and have the ability to monitor response times?