ACP Prescription - Full Slide Set for 5.7.13

8/13/2019 ACP Prescription - Full Slide Set for 5.7.13

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StreamlinedStreamlined

Prescription Mgmt:Prescription Mgmt:Save an Hour per DaySave an Hour per Day

Thomas Sinsky, MDThomas Sinsky, MD

Christine Sinsky, MDChristine Sinsky, MD

[email protected]@mahealthcare.com

Medical Associates Clinic and Health PlansMedical Associates Clinic and Health Plans

Duu!ue, "o#aDuu!ue, "o#a


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AgendaAgenda

"ntroduction

Streamlined Prescription Mana$ement

%ne o& ' strate$ies in the Core Team model (ive ) * A


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How do you write scripts?How do you write scripts?
http://www.google.com/url?sa=i&rct=j&q=prescription+pad&source=images&cd=&cad=rja&docid=jFRE3KYTR48oFM&tbnid=k6BtPw7bl6lm7M:&ved=0CAUQjRw&url=http%3A%2F%2Fwww.realsimple.com%2Fwork-life%2Fmoney%2Fsaving%2Flive-life-less-00000000010739%2Fpage7.html&ei=vJt3UdOKFeyl2AX_n4GgDg&bvm=bv.45580626,d.aWM&psig=AFQjCNFc3dUEZ3X1O4a0MBgcIAp_aVQn_w&ust=1366879493779672


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How do you write scripts?How do you write scripts?


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Prescriptions are killing usPrescriptions are killing usmymynurse is spending sonurse is spending so

much time on refills thatmuch time on refills thatwe cant seem to get anythingwe cant seem to get anythingelse done.else done.

Minnesota Family PhysicianMinnesota Family Physician


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ObservationObservation

PCP practices+PCP practices+ 1-+ MDs1-+ MDs

Survey+Survey+ma/ority calls &or scriptsma/ority calls &or scripts

Systems+Systems+all scripts 1 yr at annualall scripts 1 yr at annual 0&&iciency+0&&iciency+ phone calls y 234 phone calls y 234


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Synchronized, undled!enewals

All scripts rene#ed, resynchroni5ed annual visitAll scripts rene#ed, resynchroni5ed annual visit 6i.e. Medicare Annual 7ellness 8isit96i.e. Medicare Annual 7ellness 8isit9

:3 d ; < re&ills 612 mo9:3 d ; < re&ills 612 mo9


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"o Prescriptions as Hoo#

Planned care appts tri$$er disease monitorin$Planned care appts tri$$er disease monitorin$ -e=t appt scheduled at conclusion o& appt

Pre>visit la

eminder phone call

Separate monitorin$ &rom rene#in$Separate monitorin$ &rom rene#in$

Avoid loadin$ interval visits #ithAvoid loadin$ interval visits #ith

unnecessary, redundant #orkunnecessary, redundant #ork


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"o Prescriptions as Hoo#

Sta&& time savedSta&& time saved ?e&ore+?e&ore+ si=si=calls or &a=esyearcalls or &a=esyear

A&ter+A&ter+ 5ero5ero Ma$$ies oservation+ onlyMa$$ies oservation+ only B24B24timetime

spent in previous practicespent in previous practice


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Study:Study: -urses #ith Stop#atches-urses #ith Stop#atches

(ean+ %ne #eek o& data 61< practices9(ean+ %ne #eek o& data 61< practices9 eceivin$ &a=eseceivin$ &a=es

Talkin$ to patients or pharmaciesTalkin$ to patients or pharmacies

evie#in$ chartevie#in$ chart

Addressin$ concerns # physiciansAddressin$ concerns # physicians

eturnin$ &a=eseturnin$ &a=es

Documentin$ prescription in 0HDocumentin$ prescription in 0H 6narcotics, en5odia5epines e=cluded96narcotics, en5odia5epines e=cluded9

Synchroni5ed B34 o& andom


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$he usiness %ase:$he usiness %ase:-ursin$ Time (ost-ursin$ Time (ost

Primary care providers+Primary care providers+ BB

-ursin$ time (ost-ursin$ time (ost

133,333yr 133,333yr

B primary nurses = < d#k = E hrd = call nurse B hr d = 2 d#k = 2B #kyr = FFhr

Physician Productivity (ostPhysician Productivity (ost B


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$he usiness %ase:$he usiness %ase:-ursin$ o Satis&action-ursin$ o Satis&action


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etter Medication Adherenceetter Medication AdherenceArch Intern Med. 2011;171(9):814-822. (Refill Conolid!tion")Arch Intern Med. 2011;171(9):814-822. (Refill Conolid!tion")


15/25Iam Prac M$mt -ovDec B31B


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%ore $eam Model%ore $eam Model

Planned Care ApptPlanned Care Appt 8isit Planner8isit Planner 0mpo#ered Team0mpo#ered Team

Pt. )uestionnairePt. )uestionnaire Annual 0=amAnnual 0=am Prescription Mgm&tPrescription Mgm&t apid Accessapid Access

"ntentional ?ehaviors"ntentional ?ehaviors elationship uildin$elationship uildin$ Sel&>m$mt supportSel&>m$mt support


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%ase:%ase: DM, HT-, (ipid, DepressionDM, HT-, (ipid, Depression

Met&orminMet&ormin

HCTJHCTJ

0nalapril0nalapril AtorvastatinAtorvastatin

CitalopramCitalopram


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'un'un

Synchronized, undled !enewalSynchronized, undled !enewal

P(P(

)ec)ec

SeptSept

Met&ormin

(isinopril

Atorvastatin

Iluticasone

Citalopram

*+*+A-c ./0A-c ./0

*+*+

*+*+

MarMar

1 !21 !2

- !2- !2

3 !2+3 !2+yryr

4A4A


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'un'un

!e5ills until "e2t 6isit!e5ills until "e2t 6isit

P(P(

)ec)ec

SeptSept

Met&ormin

(isinopril

Atorvastatin

Iluticasone

Citalopram

*+*+

*+*+

*+*+

MarMar

1 !21 !2

1 !21 !2

07 !2+07 !2+yryr

1 !21 !2

1 !21 !2

!2!2

!2!2

!2!2

01 !2+01 !2+yryr


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'un'un

!andom !enewals!andom !enewals

P(P(

)ec)ec

SeptSept

Met&ormin

(isinopril

Atorvastatin

Iluticasone

Citalopram

*+*+

*+*+

*+*+

MarMar

1 !21 !2

1 !21 !2

01 !2+01 !2+yryr

- !2- !2

- !2- !2

- !2- !2- !2- !2

- !2- !2


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'un'un

Multiply over PanelMultiply over Panel

P(P(

)ec)ec

SeptSept

*+*+

*+*+

*+*+

MarMar

1 !21 !2

1 !21 !2

1 !21 !2

1 !21 !2

- !2- !2

- !2- !2

- !2- !2- !2- !2

- !2- !2

-777 pt

8 meds+pt

98;call+yr


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Annual Prescription !enewalsAnnual Prescription !enewals

Physician timePhysician time 3.2 hourday3.2 hourday

-ursin$ time-ursin$ time 1 hourday per physician1 hourday per physician

'3 million PC visitsyear'3 million PC visitsyear

817,777 P%Ps 2 007d+yr 2- visit+d


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Sir William Osler, !"#

Medical care must beMedical care must be

provided with utmostprovided with utmost

efficiency. To do less is aefficiency. To do less is a

disservice to those we treat,disservice to those we treat,and an injustice to those weand an injustice to those we

might have treated.might have treated.

23


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)iscussion)iscussion


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!e5erences!e5erences

Sinsky TA, Sinsky CA. A streamlined approach to prescription

mana$ement. #!$ %r!ct M!n!&-ovDec B31B 11>12.

Sinsky CA. Practice Pearls+ Streamline processes #hen usin$ an

0H. #!$ %r!ct M!n!&.B311 Sep>%ctK1'629+Physician Partnerships ProvidePatient Centered Care at an "o#a Practice. Health A&&airs

B313KB:629+:>'

Lravit5 (. "mprovement Happens+ An "ntervie# #ith Christine

Sinsky, MD. en "ntern Med. B313 MayKB2629+

Documents

ACP Prescription - Full Slide Set for 5.7.13