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MIDLIFE SHARED
MEDICAL APPOINTMENTS
Work Smarter Not Harder
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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
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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
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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
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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.
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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?
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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
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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
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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.
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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
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Patient Satisfaction
Quotes from Notes from Patients
99% Office Pt Satisfaction
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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
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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
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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.
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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
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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
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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
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