midlife smas

7/31/2019 Midlife Smas

1/17

MIDLIFE SHARED

MEDICAL APPOINTMENTS

Work Smarter Not Harder


2/17

History of SMAs

Dr. Noffsinger, Kaiser California

A way to streamline access to care

Designed specifically for the busy practitioner

Originally focused on primary care physicians

Varied applications

Same Day Appointments

Educational SessionsSubstitute for Phone Discussions

General vs. Gender, Age, Disease Based


3/17

Noffsingers Work

One 90 min group appointment late in theworkday

Accept All Takers with no limit to age,gender, symptoms

Eliminate complex and new patients

Requires Medical Assistant, GroupTherapist, Provider, Receptionist, Scribe


4/17

Midlife Womens Health Application

Pre-screening

Pre-visit screening and laboratory studies withresults available at visit

Age, Gender Parameters

Problem/Question list submitted prior

Eliminate complex problems

Requires 2 Medical Assistants/RN, Scribe


5/17

Basic Flow

PPB (Pap, Pelvic, Breast ExamCode#________ Basic CMSreimbursement available can be done in

6 minutes, if no counseling performedMost of time of PPB Visit is spentcounseling regarding midlife issues

Screening Tests ordered at visit usuallyscheduled after the visit, and then requirediscussion of results 2-4 weeks later.


6/17

Midlife SMA

What if we combined education,counseling, and discussion of resultsin one 90 min session, and grouped 10-12 patients together in one session?


7/17

ANSWER:

We could charge code #______ X 10 for a onehour session ($1___. )

We would be less likely to skip or miss an issue

due to provider boredomPatient satisfaction would generally improve,since patients (i.e., women) generally like theidea of group process and having their issues

heard unhurriedlyWe would save unreimbursed time on the phonediscussing test results and their significance


8/17

What About HIPAA?

Simple forms have been developed forparticipants to sign before each session torequest that What happens here, stays

here.Patients who dont work well in groups or

have highly personal issues they dontwish to discuss can be seen on anindividual basisYou really dont wantthem in a group setting, anyway


9/17

The BWH Experience

Since 2005, BWH Currier has been developingprograms for Midlife and DEXA result SMAs.

Most of the experience has been positive, with

many patients writing notes of appreciation, andeven deciding to meet with the same group nextyear.

Surprisingly, they seem to keep coming back eventhough the process/discussion is similar eachyear. They say they learn more each time.


10/17

Financials

$0

$200

$400

$600

$800$1,000

$1,200

$1,400

$1,600

Midlife

PPB Codes

DEXA

Codes

5 pts

10 pts

12 pts


11/17

Patient Satisfaction

Quotes from Notes from Patients

99% Office Pt Satisfaction


12/17

Time Study(Time is Money)

Provider Time: 2 hours

MA Time: 2 hours

RN Prep Time: 1 hour/patient Scheduling Tests

Chart Prep

Patient Contact

Clinical Time Scribe and Charting

Rx Prep and Writing


13/17

General Flow of Midlife SMA atCurrier Drive BWH

ReceptionistsPatient calling for routine PPBInvitation to SMA with positive slant

RNOrders routine screening tests

Rules out complex problemsInvites questionsLists issuesNotes meds, history, problemsPreps chart prior to visit

Gathers test resultsWrites routine prescriptionsPlaces Problem List on White Board in conference area


14/17

Day of Visit

Patients Roomed By MAVS, Weight, Height

PPB performed by Provider (6 minute goal)

Abnormals given appointment for additionalproblem visit or additional testingAll 10 Patients Escorted to Conference AreaConference and Discussion (40-60 min.)

First 5 Patients Check out, Last 5 are roomed forexams.Each woman is there for a little over 1 hour.


15/17

Conference Proceedings

Group Process ExplainedConfidentiality AgreementIntroductions Name Tags with First Names Only

Problem List on White Board

Test Results in Folder Marked with Patient NameInformational Materials in Folders

Calcium, Exercise, Womens Heart, HRT,

Information in Conference Room

Samples of Calcium, Vitamin D, VitaminsBrochures on Osteoporosis, Hormones, Bladder Issues,MammographyBreast models with lumps to palpate


16/17

Discussion Process

Discussion of Problem List on Board

Sweats/Flushes

Incontinence

Dyspareunia/Loss of Libido

Bone Health

Breast Health

Cardiovascular Health / Lipids

Weight Control

Discussion of Individual Test Results and how to interpret

Discussion of Prevention Techniques


17/17

Finishing Up

Patients desiring new or different Rx

Patients desiring referral to another program Womens Heart

Metabolic Clinic Weight Watchers

PT / Fitness Center

Charting continuously by Scribe

Encounter formsSigning of forms, prescriptions, referralsheets/tests

midlife smas

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