MAXIMIZING EFFICIENCY IN YOUR PRACTICE · MAXIMIZING EFFICIENCY IN YOUR PRACTICE O l iid dPi MP ractice Models and Organizations Customer Service and Marketing Registration and Recordkeeping

MAXIMIZINGEFFICIENCYEFFICIENCY

IN YOUR PRACTICE

Karen Clancy, MT, MBAAssociate Director, University Health ServiceAdjunct Instructor, College of Public Health

University of KentuckyUniversity of Kentucky

S thi hSome things change

Some things never changeSome things never change

Dr. Daniel DrakeD B j i D dlDr. Benjamin Dudley

Dr. William Richardson

MAXIMIZING EFFICIENCYMAXIMIZING EFFICIENCYIN YOUR PRACTICE

Physician LeadershipThe Power of Connectedness


P i M d l d O i iPractice Models and OrganizationsCustomer Service and MarketingRegistration and RecordkeepingFinance and BillingFinance and BillingHuman ResourcesOperationsInformation TechnologyInformation TechnologyRisk Management and ComplianceContractingAccreditation


Practice Models


Finding Yourself• Mission, Vision, Values• SWOT Analysis• Objectives, Strategies

University Health Service

Our MissionThe mission of University Health Service is to provide preventive and primary health care and education to the students and other members of the University of Kentucky community in a manner which exhibits compassion professionalismand other members of the University of Kentucky community in a manner which exhibits compassion, professionalism, and excellence.

Our VisionUniversity Health Service will be recognized as a leader and an innovator in the field of college and university health, and is committed to meeting the evolving health care needs of the campus community through its responsibilities for student primary and preventive care employee health care and campus public healthprimary and preventive care, employee health care, and campus public health.

Our ValuesThe University Health Service values:•Pursuit of excellence by high quality, easily accessible services •Ethical practices in patient care and confidentiality p p y•Integrity on the part of our employees earning trust from our patients •A nonjudgmental secure environment for students and employees •A diverse workplace which is supportive and encouraging to staff, treating all staff with fairness, respect and honesty •Responsibility and accountability to other staff, to our patients, and for our sources of support •Continued professional education and development for all staff •Public service, both in the form of public health activities, and other activities as appropriate for the University community and the community at large •Support of the academic mission of the University to improve educational performance and improve retention of students •Further overall improvement of student life by efforts in primary and secondary prevention and programs in cooperation with the University’s Division of Student Affairs


UHS Goal: Retain accreditation through the Accreditation Association for Ambulatory Healthcare (AAAHC). Indicators (Assessment Method) • Attend AAAHC meeting on accreditation.Attend AAAHC meeting on accreditation.• Communicate new AAAHC standards.• Conduct AAAHC self study process.• Complete and submit accreditation survey application.

UHS Goal: Expand health care facilities available to support University of Kentucky students. UK is currently k d t th b tt f 20 b h k f t d t h lth f t t d tranked at the bottom of 20 benchmarks for student health square footage per student.

Indicators (Assessment Method) • Complete construction of the new student health center.• Prepare for and occupy the new facility. • Provide on-going information to the community.

UHS Goal: Implement pre-matriculation immunization requirements to support a safer environment for students.

Indicators (Assessment Method) • Communicate immunization requirements to students and parents.• Provide on-line capabilities for students to comply with the requirements.

f• Educate the university community about the needs for immunizations.

UHS Goal: Continuously improve the quality of the clinical process through ongoing review, evaluation, intervention, and re-evaluation. Conduct and use benchmark studies to assess and improve student access to health care.

Indicators (Assessment Method) ( )• Conduct a minimum of four peer review, benchmarking, or safety monitoring quality studies per year.


Show Me the Money•Business planBusiness plan•Operating budget, capitalbudget, balance sheetbudget, balance sheet•Cash flow and revenue cycle•Containing expensesContaining expenses•Contract negotiations,outsourcing, relationshipsoutsourcing, relationships


Know What You Don’t Know• Explore resources• Empower people


First Things First – ManageY H RYour Human Resources

•Organizational structureR i d •Recruitment and compensationHi i l i•Hire, train, evaluate, retrain

•Job descriptions and PEsO i t ti•Orientation




First Things First – Manageg gYour Human Resources (cont.)

•Best fit•Work groups•Rewards and incentives•Staff meetings


UHS Management Committee (Mondays, 8:30 a.m. - 9:30 a.m.)Chair:Director• The UHS Management Committee is comprised of senior management staff and clinician representatives and the charge is to:

Ad i th di t• Advise the director. • Provide leadership for UHS staff.• Determine the mission, goals, objectives and long-range plans of the organization.• Provide feedback for operation, performance and financial oversight.• Review and approve policies, procedures, and standards of practice.• Help to ensure that facilities and personnel are adequate and appropriate to carry out the mission.• Assure that quality of care is evaluated and that identified problems are appropriately addressedAssure that quality of care is evaluated and that identified problems are appropriately addressed.• Maintain effective communication throughout the organization including ensuring a linkage between quality management and

improvement activities and other management functions of the organization.• Disseminate information.• Ensure compliance to university, local, state, and federal policies, rules, laws and regulations and the standards of the

Accreditation Association for Ambulatory Health Care.• Ensure adherence to contractual agreements.• Operate the organization without limitation because of race creed sex or national origin• Operate the organization without limitation because of race, creed, sex or national origin.• Develop a policy on continuing education for personnel.• Ensure that the organization operates in a safe manner.• Adopt policies and procedures to resolve grievances and patient complaints.• Establish processes for identification, reporting, analysis and prevention of adverse incidents.

Management Subcommittee (Wednesdays, 7:30 a.m. – 9:00 a.m.)g ( y , )Chair:Associate DirectorThe UHS Management Subcommittee comprised of UHS mid-level supervisors and the charge is to:• Be comprised of UHS mid-level supervisors.• Make policy recommendations to Management Committee and other appropriate committees regarding computing, EMR,

medical records, forms, registration, billing, employee health, student health and other service initiatives, space utilization,patient flow and other issues impacting UHS.

• Develop and implement strategies to meet the day-to-day operating goals of the Health Service.Develop and implement strategies to meet the day to day operating goals of the Health Service.• Disseminate information to and solicit feedback from UHS staff.


Operation OperationsOperation Operations•Supervisors Team•Policies ProceduresPolicies, Procedures•Protocols and Standing OrdersOrders

•Reform Your Forms


AccessR ti A i t t• Routine Appointments

• Urgent CareAft H• After Hours

• Prescription RefillsQ ti d C ll B k• Questions and Call Backs

• Referrals


Patient Flow Designat e t o es g•Where does the flow begin and end?g

•What is best for the customer?


Quality Assurance•Safety•Clinical outcomes and peer review


Quality Improvement/Assurance (3rd Thursday, 8:15 a.m. – 9:00 a.m.) Chair: Quality Assurance Coordinator

Chaired b a ph sician and ha ing the req isite n mber of ph sicians to f nction as a peer• Chaired by a physician and having the requisite number of physicians to function as a peer review committee; includes additional representatives from mental health, medical records, nursing, and billing. The charge of the committee is to recommend and carry out studies (with the assistance of other Health Service staff as appropriate and necessary) and to make recommendations to Management Committee based upon the results of their findings. This committee’s basic responsibilities include establishing or recommending g p g gpriorities for the study of problems or problem resolution to develop means to actually perform certain studies, which include surveys, time studies, safety studies, chart reviews, peer reviews, and benchmark studies. The Quality Improvement/Assurance Committee has the following general responsibilities to:

• Identify current or potential problems, issues, or trends for study A l id tifi d i b d ti i t t di• Analyze identified issues by conducting appropriate studies

• Recommend action or corrective measures to solve identified problems • Prepare findings and recommendations in the forms of minutes which are available to staff

and for presentation to distribution for the Management Committee for appropriate review and action C d t f ll t di i t t l t h th ti• Conduct follow-up studies as appropriate or necessary to re-evaluate whether corrective measures are taken

• Maintain a written record of all activities


Key elements of the program include:• Quality improvement studies that address clinical• Quality improvement studies that address clinical,

administrative, patient flow, cost of care, and similar issues from which come recommendations to the Management Committee for improvement in qualityManagement Committee for improvement in quality of care in its broadest sense.

• A peer review program in which physicians, nurse practitioners, and other designated personnel review p , g pmedical records and other data to monitor appropriate aspects of care and/or service delivery.

• Periodic surveys to determine patient satisfaction y plevels and appropriateness/adequacy of services.

• Assurance of licensure and credentialing of all clinical personnel.


The goals of the quality improvement/assurance program are:• To assure general compliance with the mission, vision, and values of the

U i it H lth S i d Ch dl M di l C tUniversity Health Service and Chandler Medical Center• To assure excellence in patient care within the broadest definitions applicable

to a college health setting and within the context of available resources• To determine and apply clinically valid criteria to improve patient care and

clinical performanceclinical performance• To provide accurate and objective methods of documentation of quality

improvement activities• To identify and resolve known or suspected problems affecting patient care• To provide accurate and objective methods of documentation in quality p j q y

improvement activities• To insure confidentiality of quality assurance findings in accordance with

appropriate local, state or federal regulations• To provide continuing education for affected Health Service personnel related

to quality assurance findingsto quality assurance findings• To reduce liability exposure and improve overall management and cost

effectiveness in patient care• To monitor corrected problems to assure sustained resolution• To avoid duplication of quality improvement activitiesTo avoid duplication of quality improvement activities


Accreditation Association for

Ambulatory Health Care

www.aaahc.org


Accreditation•Marketing•State requirements (CA, FL, NY, IN, etc)

•Medicare deemed status for ASCs


AccreditationSelf Study & Site Survey1. Rights of Patients1. Rights of Patients2. Governance and Administration3. Clinical Records4. Quality of Care5 Q lit I t QA d P R i5. Quality Improvement, QA, and Peer Review6. Facilities and Environment7. Surgical and Anesthesia Services8. Pharmaceutical Services9. Path, Lab, Rad, PT, & Ancillary Services10. Immediate/Urgent Care Services


Most Important Key to Meaningful

Accreditation


Compliance – Non NegotiableF d l l l l d•Federal, state, local laws andregulationsM di id M di•Medicaid, Medicare

•Fraud and abuseA i ki kb k•Anti-kickback

•Anti-discriminationHIPAA•HIPAA


To Be or Not to Be –Information TechnologyInformation Technology

•Clinical management systems – registration billing data – registration, billing, data management

•Electronic medical records•Electronic medical records•Intranet services•IT support•IT support


Communicate,Communicate,,

Communicate•Staff, peers, administration, p ,•External customers•Patient feedback•Marketing•Management teamg


Resources

H L “7 St t i f C ti M Effi i t P ti ” F il P tiHo, Lynn. “7 Strategies for Creating a More Efficient Practice” Family PracticeManagement. September 2007.

Renz, Anne. American Medical Association. Integration Strategies for the Medical Practice. The Coker Group. Norcross, GA. 1996.

Satinsky, Marjorie; Curnow, Randall. Medical Practice Management in the 21st Century. Radcliffe bli hi f d 7Publishing. Oxford, NY. 2007.

Stahl, Michael.; Dean, Peter. The Physician’s Essential MBA. Aspen Publishers, Inc. Gaithersburg, Maryland. 1999.

Wright, John D. Jr. Transylvania Tutor to the West. University Press of Kentucky. 1980.

Wikipedia. http://en.wikipedia.org/wiki/Daniel_Drake

Wolper, Lawrence. Physician Practice Management. Jones and Bartlett Publishers Inc. Sudbury, MA. 2005.

www.aaahc.org

Documents

MAXIMIZING EFFICIENCY IN YOUR PRACTICE · MAXIMIZING EFFICIENCY IN YOUR PRACTICE O l iid dPi MP ractice Models and Organizations Customer Service and Marketing Registration and Recordkeeping