System of Shared Care (COPD)Learning Session 3

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Share ideas Billing Next steps in collaborating with services in your

community Sustainment

Agenda

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A mind that is stretched by a new experience can never go back to its old dimensions.

-Oliver Wendell Holmes, Jr.

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What have you tried in the last action period What has gone well? (bring data!) What has not gone well? What can help to move this work forward?

Sharing our experiences

Storyboard Template

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Our team aim statement:

Our team members (photo encouraged)

Our team aim statement:

Our Team

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Insert numeric data, include run charts on key measures for the module.

Our Results so far

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Changes Tested or Implemented

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Other changes we couldn’t resist testing

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From all this testing, we have learned

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We are surprised by

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Next, we wonder if we should

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What is one idea that you want to try? What is one thing you still have questions about?

Reflections

Billing

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GXXXXX (Number to be assigned) – Advance Care Planning Fee› Coming soon› To support effective Advance Care planning

Specialist Physician Billing Codes

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Community Patient Conferencing (G14016)› 4 groups of patients:

Frail Elderly Multiple Co-morbidities (including COPD) Palliative/End-of-life Mental Health

› Billed per 15 minutes or greater portion thereof, for conferencing to develop/revise plan to care for patient

Urgent (< 2 hr) Telephone Advice with Specialist or GP with Specialty Training (G14018)› Patient medical acuity requires urgent telephone advice to manage

patient in current environment (home, LTC, hospital in home community) – not just based on response time

from specialist.

Family Physician Billing Codes supporting Shared Care

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Telephone advice fees with other Physician (GP or Specialist):› G10001 (G14021) – Physician to Physician Urgent

Telephone Advice (< 2 hour response time)› G10002 (G14022) – Physician to Physician Patient

management Telephone Advice (Up to 1 week response time)

Telephone Follow-up with Patient› G10003 (G14023) – Scheduled Telephone Patient Follow-up

Fee

Specialist/GP with Specialty Training Billing Codes Supporting Shared Care

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Effective way of leveraging existing resources Improving quality of care and health outcomes Increasing patient access to care and reducing costs. Provide patients with support from other patients Physicians can also benefit by reducing the need to repeat the

same information many times and free up time for other patients.

Billed per patient, per half hour or greater portion If more than 1 physician participating, divide patients into

equal groups to share the number billed – DO NOT bill both physicians on same patient(s)

Group Medical Visits – FP and Specialist

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Family Physician codes

Specialist codes

Group Medical Visits – FP and Specialist

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Fee Code # Pts Fee Code # Pts

G78763 3 G78773 13G78764 4 G78774 14G78765 5 G78775 15G78766 6 G78776 16G78767 7 G78777 17G78768 8 G78778 18G78769 9 G78779 19G78770 10 G78780 20G78771 11 G78781 > 20G78772 12

Fee Code

# Pts Fee Code

# Pts

13763 3 13773 1313764 4 13774 1413765 5 13775 1513766 6 13776 1613767 7 13777 1713768 8 13778 1813769 9 13779 1913770 10 13780 2013771 11 13781 > 2013772 12

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G14017 Acute Care Discharge Planning Conferencing - Family Physician› D/C Planning conference with at least 2 other AHPs (includes

specialists)› Per 15 min or greater portion thereof › Must attend in person› FPs with active or courtesy/ associate privileges› To ensure smooth transition to community or LTC.

GXXXXX Acute Care Discharge Planning Fee - Specialists› Coming Soon› Details to come

Transition from Acute Care – Discharge Planning Codes

Improving Local Systems of care for COPD patients

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Insert description…

Improving Local systems of care

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Step 1:

Who is in your local System of care for COPD patients› Clinical Services – community based and specialty

services› Educational services› Support services/support groups› Patient groups› Patients and their families

Allocate 1 group to each box

What is our Local System

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Step 2:

What is the role of each of these groups?› List primary purpose of organization› Any inclusions/exclusion criteria

Add description where prompted

What is our Local System

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Step 3:

What are the natural connection points between each group› Connect groups who have existing, active connections › Put a few words describing the connection

What is our Local System

GP Respirologist

Referral request

Consult letter

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Step 4 What are connections that need to be developed

between these services› Insert a dashed arrow between the groups› Add a few words describing the new connection

What is our Local System

GP Better

Breathers

Education at COPD group visits

Referral

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Step 5

List the actions required to test the new connections in your local systems› Identify who needs to be involved› Who will do what› When will you test this

What is our Local System

Are there any new connections that you would like to test?

Sustaining your gains

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Up to 70% of change initiatives fail, impacting:› Best possible care› Staff and provider

frustration› Reluctance to engage in

future

Why focus on sustainability?

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The involvement of families and community members in your improvement work will help you sustain› More partners in care› Recognition and encouragement from team mates› Maximizing community and family support

You’ve had a head start!

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You can all work as one to sustain changes in practice

and community!

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With your community team discuss what you would like to sustain in the practice and community, is it:

› A specific change?› A measured outcome from your efforts?› An underlying culture of improvement?› Relationships established in the community?› A combination?(5 min)

What are you trying to sustain

Source: NHS Improvement leader’s Guide: Sustainability, NHS Institute for Innovation and Improvement, 2007

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Be clear about the benefits (use measurement) Establish and document standard processes and have a

plan for ongoing training Establish an ongoing measurement processes Make changes to job descriptions and procedures to reflect

change Celebrate success!

Strategies to sustain the changes

Adapted from: NHS Improvement leader’s Guide: Sustainability, NHS Institute for Innovation and Improvement, 2007

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Staff, providers and patients can describe why they like the change and it’s impact

Providers and staff are confident and can assist in explaining to others

Job descriptions reflect new roles Measurement is part of the practice and used to monitor

progress The change is no longer ‘new’, but ‘the way we do

things around here’

Predictors of sustainability

Adapted from: NHS Improvement leader’s Guide: Sustainability, NHS Institute for Innovation and Improvement, 2007

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At your table, develop a plan for increasing the probability of sustaining your improvement work

Use one or more of the strategies outlined in the previous slide, or come up with others

Share your ideas with the group

Sustainability activity

Thank you!