1. I MPROVING N EW P ATIENT A CCESS : O RIENTATION C LINIC Kit Chan, RN SF Quality Cultural Series March 12, 2013

2. R ESTRAINING FORCES CURRENT PAYMENT ( NURSES ARE NOT BILLABLE ) RESISTANCE : PATIENTS, STAFF I NCREASED DEMAND (ACA, HSF), TIMELY ACCESS, DECREASE ACCESS INCREASE COMPLAINTS / WAIT TIME, PROVIDERS SHORTAGE HEALTH EXCHANGE IN 2014, PAY FOR PERFORMANCE IN 2015 DRIVING FORCES The Burning Platform

3. O RIENTATION C LINIC (OC) = A S OLUTION ?

4. How does it work? New patients scheduled to see RN - RN does the following: Intake: Medical, family, social, OB/GYN history, Med, IZ Preventive services per standing order: labs, IZs, mammo, etc.. Release of medical records Determine the need for provider visit Behaviorist: How to access services re: urgent need, med refills, etc. Medical Director: Reviews & signs OC notes - add more tests, med refill, etc. Reviews lab results All is normal –> pt notified, may not need PCP visit Abnormal –> diagnostic tests –> pt scheduled to see PCP

5. OC – Benefits demand for appts with PCP Not every patient needs to see PCP patients with normal lab results 11% did not see PCP 28% saw PCP once If do need to see PCP, at 1 st visit Up to date: labs-screening & diagnostic preventive services: IZs Medical/social/etc history already taken

6. OC – Benefits responsiveness to demand– easier to add appt slots for RNs than PCPs Expanded nurse role – nurses see how they can contribute uniquely (as nurses) to clinic efficient & timely patient care Shorter wait time -> higher show rate Front desk can Say Yes to the Patient No wait list at CPHC for new pts

7. D ID OC M AKE A D IFFERENCE ?

8. New Client Seen 1/2012-1/2013

9. New Client Wait List

10. What's needed to implement? Local clinic leadership Buy in (see the need & how this would help) Engage and involve staff in the changes For Nurses Training on standing orders Clinical support (i.e. provider of the day) For Providers Time to review lab results from OC

12. References Healtcare.gov (October 5, 2012). Whats changing and when? The U. S. Department of Health and Human Services. Retrieved from: http://www.healthcare.gov/law/timeline/index.html Healtcare.gov (November 23, 2012). Whats changing and when? Paying physicians based on value not volume. Retrieved from: http://www.healthcare.gov/law/timeline/ Kaiser commission on Medicaid and the uninsured (Kaiser Commission) (2011). Californias bridge to reform Medicaid demonstration waiver: Executive summary. [PDF]. Retrieved from: www.kff.org/medicaid/upload/8197- R.pdf