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Improving New Patient Access: Orientation Clinic

Improving New Patient Access: Orientation Clinic. Kit Chan, RN SF Quality Cultural Series March 12, 2013. The “Burning Platform”.

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Improving New Patient Access: Orientation Clinic

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  1. Improving New Patient Access:Orientation Clinic Kit Chan, RN SF Quality Cultural Series March 12, 2013

  2. The “Burning Platform” Restraining forcescurrent payment (nurses are not billable) resistance: patients, staff Increased demand (ACA, HSF), timely access, decrease accessincrease complaints/wait time, providers shortage health exchange in 2014, pay for performance in 2015 driving forces

  3. Orientation Clinic(OC) = A Solution?

  4. How does it work? • New patients scheduled to see RN - RN does the following: • Intake: Medical, family, social, OB/GYN history, Med, IZ • Preventive services per standing order: labs, IZs, mammo, etc.. • Release of medical records • Determine the need for provider visit • Behaviorist: • How to access services re: urgent need, med refills, etc. • Medical Director: • Reviews & signs OC notes - add more tests, med refill, etc. • Reviews lab results • All is normal –> pt notified, may not need PCP visit • Abnormal –> diagnostic tests –> pt scheduled to see PCP

  5. OC – Benefits •  demand for appts with PCP • Not every patient needs to see PCP • Of patients with normal lab results • 28%did not need to see PCP • 72%saw PCP only once to establish care • If do need to see PCP, at 1st visit • Up to date: • labs-screening & diagnostic • preventive services: IZs • Medical/social/etc history already taken

  6. OC – Benefits •  responsiveness to demand– easier to add appt slots for RNs than PCPs • Expanded nurse role – nurses see how they can contribute uniquely (as nurses) to clinic •  efficient & timely patient care • Shorter wait time -> higher show rate • Front desk can “Say Yes to the Patient” • No wait listat CPHC for new pts

  7. Did OC Make a Difference?

  8. New Client Seen 1/2012-1/2013

  9. New Client Wait List

  10. What's needed to implement? • Local clinic leadership • Buy in (see the need & how this would help) • Engage and involve staff in the changes • For Nurses • Training on standing orders • Clinical support (i.e. provider of the day) • For Providers • Time to review lab results from OC

  11. References Healtcare.gov (October 5, 2012). What’s changing and when? The U. S. Department of Health and Human Services. Retrieved from: http://www.healthcare.gov/law/timeline/index.html Healtcare.gov (November 23, 2012). What’s changing and when? Paying physicians based on value not volume. Retrieved from: http://www.healthcare.gov/law/timeline/Kaiser commission on Medicaid and the uninsured (Kaiser Commission) (2011). California’s “bridge to reform Medicaid demonstration waiver: Executive summary. [PDF]. Retrieved from: www.kff.org/medicaid/upload/8197- R.pdf

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