Projects in a Box: Or how to do a PI-CME project

Transcription

1 Projects in a Box: Or how to do a PI-CME project Amy K Mosman, PA-C SLU Division of Nephrology American Academy of Nephrology PAs Disclosure: None Outside the Box Kidneys in a Box Bugs in a Box Objectives 1) Understand the new NCCPA requirements for self-assessment (SA) and performance improvement (PI) CME 2) Recognize and discuss criteria that place diabetics at risk for development of chronic kidney disease (CKD), discuss health disparities commonly found in practices and risk factors for infectious disease 3) Identify opportunities within your practice to adjust for modifiable risk factors for CKD, infectious disease or decrease incidence of health disparities

2 Passed PANCE/PANRE Passed PANCE/PANRE CME 1 and CME 2 Year 1-2 Year 3-4 Year 5-6 Year 7-8 Year 9-10 CME 1 CME 2 How to Maximize Credit

3 SA - CME Q&A type questions Can be done in a weekend Offered at normal CME 1 Readily available: PA conference (AAPA, state meetings,etc) Online (AAPA Learning Central) For-profit programs PI - CME Can be more costly or difficult to find Can take anywhere from 4 weeks to 6 months to complete dependent on PI program True butt in chair time is 5 hours* Offered at 2X normal CME 1 Worth 40 CME 1 for the first project in a 2 year cycle Worth 20 CME 1 for the 2nd project in a 2 year cycle * As calculated by NCCPA Incredible, inexpensive options!

4 26 million Americans have CKD: Most don t know it Every 5 minutes someone s kidneys fail 10 people die every day waiting for a kidney transplant Why pick CKD? More than 100,000 people are waiting for a kidney transplant Early detection and TREATMENT can slow or prevent CKD progression CMS wants 90% of Medicare payments as feefor-value by 2019 Health disparities increase health insurance premiums for everyone Many populations who experience health disparities are invisible Why pick Health Disparities? More deaths occurred due to health disparities than were saved by medical advances Martin Luther King Jr: 'Of all the forms of inequality, injustice in health care is the most shocking and inhumane Unvaccinated adults cost the US >$26 BILLION in 2013 Handwashing decreases infections by 20-30% yet health care providers only wash their hands ½ the time Although the CDC mandated universal HIV screening in 2013, 51% of practitioners did not do it Why pick Bugs? Oral health has been shown to have a link with: Alzheimer's, Heart Disease Kidney Disease, Diabetes Osteomyelitis, Pregnancy And more.

5 Tell me more about Kidneys Pick 1 of the proven 6 modifiable risk factors: CKD staging UACR A1C Smoking Statins OTC medications Tell me more about Outside Pick 1 of the 5 modifiable risk factors: Race/Ethnicity Gender Identity/Sexual orientation Socio-Economic Disabilities Literacy/Numeracy Tell me more about Bugs Pick 1 of the proven 5 modifiable risk factors: HIV testing Oral Health Travel Vaccines Handwashing

6 How do I pick which one to do? Outside The Box You need to finish in 30 days You do pediatrics You want to evaluate yourself for any unknown biases You do not see diabetics in your practice Kidneys in the Box You have 90 days You want to compare yourself against national guidelines You see diabetics You are interested in learning more about kidney disease Bugs in a Box You have 60 days to finish You are trying to decrease infections in your practice You need to do a MIPS Medicare project You see all types of patients Example: Outside After logging into the computerized pretest, you find you are weak in 4 out of the 5 modifiable factors You realize that your office staff inputs race into the EHR Project = practitioner reviews race per patient choice You put an asterisk (*) next to your SOAP note to mean that you, personally, confirmed race Now when you order screening or calculate GFR, you are using the correct race! Example: Kidneys After filling out the pre/post test, you find you are weak in 4 out of the 6 modifiable factors You are a hospitalist and have no control over A1C or urine so you decide to code AKI Project = When you look at daily labs, you code AKI (N17.9 for ICD-10) if SCr changes By adding N17.9, the discharge summary includes AKI The hospital summary goes home with the patient and to the primary who double-checks the SCr after discharge

7 Example: Bugs After the pre/post test, you find out you are weak in 2 out of the 5 modifiable factors You decide to concentrate on oral health Project = your staff adds dentist name/addresses to the practitioners who receive your SOAP notes The patient asks why you want to know their dentist Your reply that the healing fracture can become infected from oral bacteria The patient actually follows up with their dentist for a teeth cleaning! Pick 1 of the folders and let s go!! Be sure you write your name And Which project you are doing! Questions?