1. 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

2. 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
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”.

3. 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

4. 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.

5. 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.

6. 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
PR OFFICE OUTPATIENT VISIT 10 MINUTES
PR OFFICE OUTPATIENT VISIT 15 MINUTES
PR OFFICE OUTPATIENT VISIT 25 MINUTES
BRADSHAW, SAMUEL L
PR SUBSEQUENT PRENATAL CARE
PR POSTPARTUM CARE VISIT
PR OFFICE OUTPATIENT NEW 20 MINUTES
PR OFFICE OUTPATIENT VISIT 15 MINUTES
PR OFFICE OUTPATIENT VISIT 25 MINUTES
PR PREVENTIVE VISIT,EST, INFANT < 1 YR

7. 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 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.

8. 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.

9. Let me know if you have any questions. Cheryl
Dear Resident,
FYI, below are your patient visit statistics as of December 31, 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 I send out to each resident quarterly to show them where they stand, both in relation to their requirements and to their peers.

10. 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!

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

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

14. 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.

15. 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!

16. 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

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