Some Suggestions Darcy’s Way Cheryl’s Way Annette’s Way Discussions of the ways we have our residents document encounters, mine, using NI. Annette’s using her fishbowls

Darcy’s Way FMC Patient encounters PGY 1 have 2 clinics per week PGY 2 have 4 clinics per week PGY 3 have 6 clinics per week 165 MUST BE 60 OR OLDER 165 MUST BE 10 OR YOUNGER Total encounter 1650 EHR INPATIENT 4 months Inpt – PGY 1 2 months Inpt – PGY 2 1 month Inpt – PGY 3 600HRS/SIX MNS AND 750 ENCOUNTERS ICU patients 1 month ICU rotation 100 hours/ 1 month OR 15 ICU patient encounters Online Mgmt Software by logged hours ED Adult patient encounters 200 Hours 24 Hours in Acute Care month 176 Hours during ED rotation 200 hours/ 2 months OR 250 Adult ED patients Online Mgmt Software by logged hours GERIATRICS 1.5 months of Geri rotation 100hours/ 1month OR 125 Older patient encounters Online Mgmt Software Logged Nursing Home visits PEDIATRIC Inpatient encounters: 1 month PEDS Inpatient rotation PEDS ED is part of ED rotation 200hours/ 2months AND 250 ill child encounter 75 Inpatient 75 ED PEDIATRIC Outpatient encounters: 1 month PEDS outpatient rotation Resident FMC patients 200 hours/2months OR 250 Child/Adolescent ambulatory setting encounters Newborn patient encounters 1 month new born nursery rotation 40 Newborn, pts. including well and ill (3% ill) Darcy, As soon as you advance this slide, acknowledge that we’ve broken the rule for too much info on any one slide, but we wanted to show in this format an easier way to make their determinations. Tell them to relax, that we have provided a copy of the file in the downloads/handouts portion of the conference ap. You will talk about how you took the new requirements, compared them to your curriculum and determined where rotations met the requirements, and what beans you determined you would have to count. Skim over column 3, as I will get into details of the “how”.

Primarily spend time in the OR as first assist for a variety of cases. Surgical Patient encounters PGY 2 surgical rotation - work with DOC of the week in hospital Primarily spend time in the OR as first assist for a variety of cases. Participate in Acute Surgical Patient Evaluations/Consultations. Participate in inpatient Pre- and Post- Op care Surgical Patient encounters -continued: PGY 3 surgical rotation – 25% Pre- and Post-Op care in clinic 50% Outpatient Procedures 100 hours/1 month surgical pt. encounters including hospitalized Online Mgmt Software Logging hours Sports Medicine/ Musculoskeletal patient encounters PGY 2 and PGY 3 1 month Sports Medicine rotations 200 hours/2months Online Mgmt Software Logging hours Gynecology PGY 2 1 month GYN rotation 100 hours/1 month OR 125 Patient encounters Care of women Online Mgmt Software Logging hours OB patient encounters PGY 1 6 week rotation PGY 2 2 week rotation Plus our program requirement is: 40 non-continuity deliveries 10 continuity deliveries Continuity delivery counts if you deliver the baby If not at delivery you must see baby and mother while they are in hospital and manage post-delivery care. We require this for two reasons: We have a lot of residents interested in OB and the fellowship We fill a need in our community for the “adopt a mom” program 200 hours/ 2 months dedicated to Prenatal Care, Labor management, delivery system New Innovation document deliveries

Health System Management PGY 3 Community Medicine Faculty are developing a new Practice Management curriculum with a component of Direct Primary Care 100 hours/ 1 month Online Mgmt Software Logging hours for rotation Elective time PGY 2- I month elective time PGY 3- 2 months elective time 300 hours/ 3months Tracking hours for rotation Resident schedule Scholarly Activity 1 QI project - required Journal Club, PEDS presentations, Case conferences 2 Online Mgmt Software enter data in Scholarly activities section NOTES: Encounters: are based on signatures. 2 residents can get credit from one patient encounter. PGY 1 does H&P and signs; UL amends and signs. Both residents get to count this encounter. These encounters are counted in the Department where visit occurred. EHR: writes programs to capture the needed data (typically numbers) so the resident does not have enter the encounter in EHR and then in Online Mgmt Software for tracking. Online Mgmt Software: is used for logging hours, procedures and scholarly activities.

Resident Productivity   Provider Notes Reporting Period: 11/1/2014 to 11/30/2014 Adult IP Adult ED Adult ICU Newborn Peds ED Peds IP All Peds All Encounters ADAMO, ELENA 7 BRADSHAW, SAMUEL L 54 157 14 68 COOK, JAYCE G 17 2 1 20 GRUNZ, RYAN 93 4 94 HAIRFORD, AMBER M 49 HESS, BRYAN R 86 83 HONIG, ERIN J 6 HUNTER, STEPHEN O JOYNER, JAMES 168 9 5 173 KARAMALEGOS, ALEXANDER 120 121 KUNEFF, RENEE A 12 LOSQ, STEPHANIE E 87 89 MARSH, MELANIE 64 MCINTYRE, BRITTANY J 81 3 85 MERRELL, DAVID J 50 NETTEY, RALPH 156 158 PILOTO DE LA PAZ, DAYARMYS 16 RIGBY, MICHAEL D 24 26 SCHMITZ, JEREMY E 62 35 36 100 SONNENBERG, ERIC G STREET, CHRISTOPHER M 10 13 THEKKEKANDAM, MARIA T 96 WIGHT, ANDREW WILLIAMSON, EDWARD V 38 Show them samples of reports, and say that for those of us who have good EHR’s you can rely on them for a large portion of your required bean counting.

Patient and Visit Volume Report by Level of Service Moses Cone Family Medicine Center 11/1/2014 – 11/20/2014 Patient Count Visit Count ADAMO, ELENA 43 43 23658 PR OFFICE OUTPATIENT VISIT 10 MINUTES 1 1 23660 PR OFFICE OUTPATIENT VISIT 15 MINUTES 41 41 23662 PR OFFICE OUTPATIENT VISIT 25 MINUTES 1 1 BRADSHAW, SAMUEL L 35 36 240 PR SUBSEQUENT PRENATAL CARE 2 2 242 PR POSTPARTUM CARE VISIT 2 2 23648 PR OFFICE OUTPATIENT NEW 20 MINUTES 1 1 23660 PR OFFICE OUTPATIENT VISIT 15 MINUTES 27 27 23662 PR OFFICE OUTPATIENT VISIT 25 MINUTES 1 1 23860 PR PREVENTIVE VISIT,EST, INFANT < 1 YR 3 3

Cheryl’s Way… For our clinic, we use the EHR as well. My Business Manager sends me a quarterly report of visit numbers that includes those patients that are 65 or older and under age 10. So I use that data for reporting to our faculty. GMEC, etc. I created a section in the Custom Data portion of our online management software so that the data is captured when we do quarterly reviews and CCC. BUT, my hospital doesn’t have a fully functioning EHR, and what does function usually buries everything except what is signed by the attending, so using it is not an option for us. So I added the required encounters to the procedures portion of our online software that allows residents to enter encounters on their phones, laptops or desktops, as “procedures” as they have the encounters. To make it easy, “ACGME” group, Dr. Kapoor only supervisor, so I don’t have to browbeat preceptors to confirm, but require basic pt data and the name of attending in comments, if there’s ever a question.

Visits/Encounters Ahmed Bahia Gelou Lester Manivannan Novales Pascual Bajwa Cooke Grenwood Jamison Jensen Madani Sitafalwalla Stringam Ballew Cooper Daji Johnson Pechon Richards Rivas-Orozco Sciarra Clinic 1302 1479 1406 1398 1392 1687 1598 649 668 610 577 654 735 605 652 105 102 103 125 178 156 77 Pt > 60* 255 288 326 383 324 366 145 160 176 140 172 197 24 28 14 29 32 38 22 Pt < 10* 67 58 51 50 41 69 39 21 26 47 49 17 7 9 6 2 4 5 Adult Inpt 10   302 376 251 68 70 329 53 340 194 457 429 185 216 191 580 443 ICU 45 18 54 36 46 19 1 12 20 33 30 11 23 Inpt Peds 128 64 13 93 106 131 Peds ER 61 NB 40 3 27 35 15 Prior to quarterly eval and CCC meetings, I run the data and enter into a spread sheet to give advisors and CCC members a snapshot of where each resident is in regards to meeting their requirements. Serves multiple purposes, in addition to the obvious intent, it also identifies areas of concern for pt visits, possible need to adjust remaining schedule. And gives some assistance in evaluating milestones, i.e., two residents who aren’t going to achieve level 1 on PROF-2, professional conduct and accountability; or level 2 on C-4, using technology to optimize communication.

Let me know if you have any questions. Cheryl Dear Resident, FYI, below are your patient visit statistics as of December 31, 2014. The top number is the total number of clinic patients you have seen since the beginning of residency. The three numbers below are percentages that show you where you stand in comparison to the number of visits you need to graduate and to your peers. Remember that a total of 1975 visits are required to graduate. These numbers reflect the "official" count per Jennifer Powell, Business Office Manager, and are based on office visits and charges. No other counting of visits will be used or acknowledged.   Also included below are the number of the required patient encounters you have documented.  Remember that regardless of your training level, all residents are required to document these encounters. In this graphic, the  numbers show the required number, the number of encounters you have documented and the average number of encounters logged by your class.  Encounter numbers as a whole are reported to the ACGME as a measure of resident progress and program quality.  For this reason, you are required to document all encounters, even after you have achieved the requisite individual requirement. Let me know if you have any questions. Cheryl This is the email I send out to each resident quarterly to show them where they stand, both in relation to their requirements and to their peers.

Pechon Clinic 125 Percentage 5 6 Expected Average Your Average Visits/ Encounters Pechon Clinic 125 Percentage 5 6   Expected Average Your Average Class Average Adult Inpt 750 255 345 ICU 15 14 10 Newborn 40 7 12 Peds Inpt 75 93 81 Required Your Count Relying on Residents??? Make it a competition!

Annette’s Way Annette will explain how her program documents encounters using these cards and fishbowls.

What do we do with the data once the beans have been counted?

ACGME Web Ads Annual entry of encounter numbers for each resident Just as we have been entering delivery numbers in Ads, we will enter encounter numbers.

Residency Performance Index Resident outpatient experience-On the survey, you may answer these 4 questions for up to 5 separate FMC sites. Describe your FMCs Certification Level (1,2,3) Average # of patient visits in the FMC for your graduating residents over the last 3yrs % of pts over the age of 60 seen by your residents in the FMC % of pts under the age of 10 seen by your residents in the FMC What is the RPI? AMFRD DARCY!!! Did you have the data required for the RPI? Now you will!

Residency Performance Index Resident inpatient and ER experience Average # of personally managed adult medicine inpatients for your residents during their 3 year residency Average # of personally managed ICU pts for your residents during their 3 year residency Average # of personally managed pediatric ER pts for your residents during their 3 year residency Average # of personally managed pediatric inpatients for your residents during their 3 year residency My PD

Thank you! Cheryl.Haynes@sr-ahec.org Darcy.Hitz@conehealth.com asheets@susquehannahealth.org