Marianne Sumego, M.D

Transcription

1 Marianne Sumego, M.D Internal Medicine / Pediatrics Director of Shared Medical Appointments Medical Director: Mentor Medical Office Building Cleveland Clinic The Challenge ahead of us 1

2 Reality Patient Education What if patients drove the care model?? 2

3 Enter Innovation. SMA program overview Cleveland Clinic Initial efforts 2003 Enterprise wide initiative began 11/2010 Goals: Umbrella for development of all SMA s Standardization of tools, process Organization of a Program Team (3) 3

4 SMA Program Cleveland Clinic YTD Active Appointments 60 Providers 47 Locations 20 Pediatric Diabetes SMA Categories (non-inclusive) Cardiology (Preventative) Pre-Diabetes care Osteoporosis Asthma Menopause Wellness Pain Management Adolescent weight PMSF Macular degeneration Diabetes Bariatric Sleep Medicine (CPAP) Pediatric Rheumatology CHF and Discharge Weight Management Diabetic foot care Medical Nutrition Stroke Heel pain Psychiatry : Mood Disorders 4

5 What is a Shared Medical Appointment (SMA)? 90-minute appointment patients seen together with a similar condition or chronic disease combines the traditional one-on-one physician visit with participation in shared discussion Physician Buy-in Operational Benefits Improved patient access Leverage additional resources Opportunity: Maximize scope of practice Workflow efficiency, documentation Remove redundancy Staff/Provider Satisfaction Quality Visits 5

6 Operational Benefits: Comparison Next Available Appt. Patient Benefits Prompt Access to Care Extended physician time Access to additional learning resources (adding value) Learning enhanced through repetition Patient Satisfaction Quality of care 6

7 Sound Crazy??? SMA: The basics. 90-minute appointment patients (check in early) Common condition (diabetes) HIPAA reviewed Individual appointments conducted in sequence (refills, orders, results, care plan) Documentation during visit 7

8 SMA team Clerical Schedule, identify and encourage patients Clinical Intake Room patients/intake, name tags, flip charts, pre SMA work (calls, letters, etc.) Primary Medical Provider (MD, DO, NP) Conducts visit, documents exam, close and billing Facilitator (NP, RN, PA, Nutritionist, Social Worker). Room prep, patient HPI, opens charts, education Administration Coordination and Support 8

9 Marianne J. Sumego, MD SMA Set-up 9

10 Marianne J. Sumego, MD Exam Dr. Holly Thacker: Women s Health 10

11 Does it work? SMA Metrics Census: (percent fill rate) Goal : access, added value Financial: Down stream referrals Change in Access to Care Satisfaction: Provider /Team/Patient/P t Quality/Outcome measure Sustainability Metric: Leverage Resources Illustration Per 2 Hour Time Block (Including prep time) Staffing 1:1 SMA Difference APN/Physician Budget Neutral Medical Asst. (2) Facilitator/RN (2) Budget Neutral PSR Total Time !! Minutes gained 11

12 Metric: Quality Aycinena - Diabetes: Average HbA1c SMA +/ Non SMA +/ Linear (SMA +/- 1.47) Linear (Non SMA +/- 2.17) Metric: Quality CHF Re-admissions Overall Total # Re-admitted Percentage % % % Sma % No-show % Admission Reason: hyperglycemia Euclid Hospital 12

13 Marianne J. Sumego, MD Chihuly in the Garden: Change takes some work Patient recruitment, promotion Scheduling Engaging all staff How to best leverage staffing resources Designing your quality metrics Competing priorities with staff time It s new and unique!!!! 13

14 Take-aways aways Busy providers work best Target high volume conditions: IBD Identify common education goals: celiac, hepatitis, esophageal disease Common follow-up needs; post-op, review of results, bariatric surgery High complexity needs: transplant eval, monitoring Work efficiently, Add value, Have fun!!!! 14

15 Anne Maggiore: Program Manager Jennifer Muehle: Program Coordinator Annette Zeldin: Clinical Resource Expert 15