Redesigning Our Scheduling to Improve Provider and Staff Satisfaction

and our PPRNet CQM Performance

PPRNet August 23, 2014

Kristen DutterRipon Family Physicians

Why we needed a change:

Patient Satisfaction/Convenience

Inconsistent schedules-up to 5 providers at a time• Waiting room full or empty• Staff over-worked or under-worked

Only 2 exam rooms per provider

Little time for PPRNet reports

Our Providers• Full-Time, but plenty of travel Dr. Dutter

• Full-Time, plus SNF 2 Half-Days/weekDr. Hufford

• Full-TimeDr. Daley

• 3 days/week (2 days/wk for Ortho)Travis Wolf,

PA• 3 days/week (2 days/wk for Cardiology)

Ken Bowman, PA

• 3 days/week (2 days/wk RN at Hospital)Sarah Lilly, PA

Extended Office Hours

7AM – 7PM Monday - Thursday

7AM – 5PM Friday

Provider Adjustments Created some 6 hour shifts, instead of 8.

To keep the same # of patients per provider, per day

(22), we created some 10 minute slots for acute,

same-day appointments, and fewer breaks.

Never more than 3 providers in the office at a time.

3 exam rooms available for each provider

Provider Schedule – average week

Gray boxes mean that provider is out of the office.

7JD SL 20 TW KB 21 DD KH 22 KH JD 23 JD DD 24

8DD KH JD TW KB

9

10

11

12

1KH KB JD KB TW SL DD SL

2

3

4

5

6DD DD DD JD JD

Reception Staff Adjustments2 Staff for check-in/out from 7-8AM

Lab opens at 7AM 1 Staff for check-in/out from 5-7PMCross-Trained for check in/outPerk: All Staff get ½ day off each week (or 1 day

every other week)Phone hours remain 8-5, with special Voicemail box

for Cancellations and Appointment requests.

Shift Planning for Staff

Medical Assistant Adjustments5 Medical Assistants – Max of 3 Providers at a timeExtra MA’s not working with a provider are assigned to Refills,

Walk-Ins, lunch coverage and working PPRNet reports.No MA has more than one late shift/week.After 5pm, 1 MA rooms for 2 Providers. Acutes;No procedures.

7-48-5

10-7

2

1

Shift Planning – Monday

Shift Planning - Friday

Impact on Patient Outcomes (via PPRNet)Prior to our extended hours, working the PPRNet reports was sporadic at best. Now there’s scheduled time for that.

Started Extended Hours April 2013

Tracking our Work3/28/2014 9DM patients 18-75 with Microalbumin in 1 year BWATNEY4/11/2014 2014 Quarter 1 Received4/11/2014 44Made sure that ETOH counseling was in their HM. KDUTTER DONE5/14/2014 CKD 3BeGFR in past 3 months for pts with CKD stage 4 KDUTTER DONE5/14/2014 CKD 6BMost recent BP >130/80 for pts with CKD and high Alb/Creat ratio KDUTTER DONE5/14/2014 CKD 7ACE/ARB for pt with CKD and Alb/Creat ratio >300 KDUTTER STARTED5/16/2014 CKD 7ACE/ARB for pt with CKD and Alb/Creat ratio >300 KDUTTER DONE5/23/2014 IVD/CHD/Atherosclerosis patients 20-79 with anticoagulant/anti-platelet BWATNEY

6/2/2014 CKD 9Hemoglobin in past year in patients with CKD stage 3B-5 KDUTTER DONE6/2/2014 CKD 10CKD patients with rx for NSAID or Cox-2 Inhibitor KDUTTER DONE

6/30 - 7/1DM/CKD RegistryGot labs reports from Endo and Nephrology KDUTTER DONE

7/1/2014 Submitted Data to PPRNET KDUTTER7/18/2014 H2 blocker Appropriate dosages of H2 blockers in patients with CrCl < 50 ml/min KELLER DONE7/21/2014 57 Avoid Rx for thiazolidinedione in patients with Dx of heart failure KELLER DONE7/21/2014 58 Avoid Rx for metformin in pts with most recent serum creat in past year KELLER DONE7/21/2014 61 Patients with active Rx for any thiazide and Potassium measure KELLER DONE7/21/2014 55 Avoid Rx for NSAID or cox 2 inhibitor in patients with Dx of heart failure KELLER DONE7/21/2014 52 Appropriate dosages of Benzodiazepines in patients ≥ 65 years KELLER DONE7/21/2014 2014 Quarter 2 Received7/21/2014 54 Avoid Rx of anticholinergic in patients with Dx of dementia KELLER DONE7/21/2014 52 Appropriate dosages of Benzodiazepines in patients ≥ 65 years KELLER DONE7/21/2014 63 Glucose measured in past year in patients with Rx for any antipsychotic KELLER DONE7/21/2014 64 Patients with active Rx for Warfarin with INR measured in past 45 days KELLER STARTED7/21/2014 15 HTN pts with Glucose in past 3 years KDUTTER STARTED7/22/2014 15 HTN pts with Glucose in past 3 years KDUTTER Still working the list

DM Patients with BP in 6 monthsDM pt with BP in 6 months

Due for Appt? Lab? BP?

Reminder (WV, Letter, Call)

Note on spreadsheet

Up to date

Note on spreadsheet

ACE/ARB for CKD patientsNo ACE/ARB for CKD pt with alb/creat ratio > 300

On ACE/ARB, but Not active RX

Refill needed?

Filled by Specialist? Renew?

No ACE/ARB

Message provider toReview/Consider

AHA/ACC Cholesterol Guidelines

AHA/ACC Guidelines

Filter by Concordan

ce = N

Filter by Age < 75

Filter by Risk

> 7.5%

Re-Identify patients

Print the list for each provider, with their patients names high-lighted for review.

PPRNet Message Template||PAT_FNAME|| ||PAT_LNAME|| appears on PPRNet report for: «*»

Measure Description/Criterion:  «*»

Eligible patients: «*»

Comments: «DEL» «*»

Please review.  If changes need to be made or you have questions - please forward them to your nurse.  Thank you.

Positive OutcomesWaiting room is less crowdedPatients love the convenienceProviders like having more time with their familyStaff has adjusted and now likes their new hoursPPRNet reports are worked on more regularlyAdded appointment slots and percent of unfilled

slots went down slightly.More available same-day appointments

Contact Info:

Kristen Dutter

kdutter@RiponDocs.com

(209) 599-4211 x 111