Patient-Centered Medical Home

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Patient-Centered Medical Home Multi-Payer Demo

• Training Webinar 4
• David Halpern, MD, MPH
• July 6th, 2011

2
Acknowledgements
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Lets Review

• What are the Must Pass Elements?
• Which Ones Should we Focus on First?
• PPC1A access and communication (4 points)
• PPC2D organizing clinical information (6 points)
• PPC2E important diagnoses/conditions (4 points)
• PPC3A evidence-based guidelines (3 points)
• PPC7A referral-tracking (4 points)

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Todays Agenda

• PPC 1B (Finish Standard 1)
• PPC 2A, 2B, 2C, 2F (Finish Standard 2)
• What is the Record Review Workbook

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PPC 1B Access and Communication Results
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PPC 1B Example of Factor 1
Assigned Visits patients who are assigned to
that PCP
Unassigned Visits patients who are not
assigned to that PCP
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PPC 1B Example of Factor 2
Brown
Smith
Jones
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PPC 1B Example of Factor 3
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PPC 1B Example of Factor 3
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PPC 1B Example of Factor 5
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PPC 2A Basic System for Patient Data
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PPC 2A Example
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PPC 2A Example
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PPC 2B Has Electronic System for Clinical Data
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PPC 2B Example
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PPC 2B Example
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PPC 2B Example
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PPC 2C Uses Electronic System for Clinical Data
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PPC 2C Example Report From EMR
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Record Review Workbook
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What Is the Record
Review Workbook?

• Elements PPC 2C, 2D, 3D, 4B
• Require medical record abstraction of data
• Need of patients meeting the element
  (based on a numerator and a denominator)
• Two methods to collect and submit patient data
• Method 1 - report from the electronic system
• Method 2 - Record Review Workbook
• Excel workbook in the Survey Tool
• Tool to identify a sample of patients and
  abstract data needed for Elements 2C, 2D, 3D, 4B

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Using The Workbook

• 1. Find Workbook in Survey Tool
• 2. Download and save file to computer
• 3. Review instructions and data needed from
• patient records
• 4. Select patient records to review
• 5. Review patient records for data
• 6. Enter data in Workbook
• 7. Enter numerical result in Survey Tool
• 8. Link Workbook to Survey Tool

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Selecting Patients for Workbook Use same 36
patients for EACH Workbook Element

• STEP 3.
• Use appointment or billing system to identify
  patients with visit on June 5th
• Choose patients with any of 3 clinically
  important conditions who had a visit on this date
  that was related to the important condition

STEP 1. START DATE Todays date July 6th
STEP 4. Continue choosing patients going back
on consecutive dates until you have
selected 36 patients
STEP 2. Go back 30 days June
6th
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Selecting Patients for Workbook

• 1. Start date to select patients should be 1
  month prior to the day you begin your audit
• 2. Use appointment or billing system to locate
  patients
• 3. Select patients with one of three clinically
  important condition(s) AND a visit related to
  that condition
• 4. Go backwards consecutively (April 30, April
  29, April 28 etc.) until you reach 36 patients.
  Do not skip patients with one of the chronic
  conditions or include the same patients more than
  once
• 5. Use the same 36 patient records for each
  element in the Record Review Workbook
• 6. Create list of patients using unique patient
  identifiers number the patients 1-36. Keep this
  master list in case NCQA has questions

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Workbook Instructions
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Record Review Worksheet
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Demonstration
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PPC 2C Example Record Review Workbook
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PPC 2F System for Population Mgmt
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PPC 2F Example of Factor 3
List of patients in the practice taking Toprol XL
(names of patients blinded for HIPAA)
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PPC 2F Example of Factor 3
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PPC 2F Example of Factor 4
Patient list is blinded for HIPAA
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Applaud Yourselves

• Youre well on your way!
• Weve covered 3 of the 9 Standards
• Weve reviewed 37 points out of 100
• Thats more than enough for Level 1!
• Weve discussed 6 of the 10 must-pass

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Next Steps (Homework)

• Review Elements 1B, 2A, 2B, 2C, and 2F and decide
  which ones youd like to tackle
• Begin work on those Elements
• Find, download, and look at the Record Review
  Workbook
• Excel file and FAQ document will be posted on the
  CCNC webpage for easier access
• As always, save/organize all of your
  documentation as you go!

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Community Care PCMH Team

• David Halpern, MD, MPH
• Community Care of North Carolina (CCNC)
• R.W. Chip Watkins, MD, MPH, FAAFP
• Community Care of North Carolina (CCNC)
• Brent Hazelett, MPA
• North Carolina Academy of Family Physicians
  (NCAFP)
• Elizabeth Walker Kasper, MSPH
• North Carolina Healthcare Quality Alliance
  (NCHQA)

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Partners
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Questions?

• Feel free to contact me
• David Halpern, MD, MPH
• [phone]
• dhalpern_at_n3cn.org