1. Patient-Centered Medical Home & Multi-Payer Demo Training Webinar # 4 David Halpern, MD, MPH July 6th, 2011

2. Acknowledgements

3. Let’s Review What are the “Must Pass” Elements? Which Ones Should we Focus on First? –PPC1A: access and communication (4 points) –PPC2D: organizing clinical information (6 points) –PPC2E: important diagnoses/conditions (4 points) –PPC3A: evidence-based guidelines (3 points) –PPC7A: referral-tracking (4 points)

4. Today’s Agenda PPC 1B (Finish Standard 1) PPC 2A, 2B, 2C, & 2F (Finish Standard 2) What is the “Record Review Workbook”

5. PPC 1B: Access and Communication Results

6. PPC 1B: Example of Factor 1 “Assigned Visits” = patients who are assigned to that PCP “Unassigned Visits” = patients who are not assigned to that PCP

7. PPC 1B: Example of Factor 2 Brown SmithJones

8. PPC 1B: Example of Factor 3

10. PPC 1B: Example of Factor 5

11. PPC 2A: Basic System for Patient Data

12. PPC 2A: Example

14. PPC 2B: Has Electronic System for Clinical Data

15. PPC 2B: Example

18. PPC 2C: Uses Electronic System for Clinical Data

19. PPC 2C: Example – Report From EMR

20. Record Review Workbook

21. What Is the “Record Review Workbook”? Elements PPC 2C, 2D, 3D, 4B Require medical record abstraction of data Need % of patients meeting the element (based on a numerator and a denominator) Two methods to collect and submit patient data –Method #1 - report from the electronic system –Method #2 - Record Review Workbook Excel workbook in the Survey Tool Tool to identify a sample of patients and abstract data needed for Elements 2C, 2D, 3D, 4B

22. Using The Workbook 1. Find Workbook in Survey Tool 2. Download and save file to computer 3. Review instructions and data needed from patient records 4. Select patient records to review 5. Review patient records for data 6. Enter data in Workbook 7. Enter numerical result in Survey Tool 8. Link Workbook to Survey Tool

23. Selecting Patients for Workbook ~Use same 36 patients for EACH Workbook Element~ STEP #1. START DATE = Today’s date July 6th STEP #2. Go back 30 days = June 6th STEP #3. Use appointment or billing system to identify patients with visit on June 5th Choose patients with any of 3 clinically important conditions who had a visit on this date that was related to the important condition STEP #4. Continue choosing patients going back on consecutive dates until you have selected 36 patients

24. Selecting Patients for Workbook 1. Start date to select patients should be 1 month prior to the day you begin your audit 2. Use appointment or billing system to locate patients 3. Select patients with one of three clinically important condition(s) AND a visit related to that condition 4. Go backwards consecutively (April 30, April 29, April 28 etc.) until you reach 36 patients. Do not “skip” patients with one of the chronic conditions or include the same patients more than once 5. Use the same 36 patient records for each element in the Record Review Workbook 6. Create list of patients using unique patient identifiers; number the patients 1-36. Keep this master list in case NCQA has questions

25. Workbook Instructions

26. Record Review Worksheet

27. Demonstration

28. PPC 2C: Example – Record Review Workbook

29. PPC 2F: System for Population Mgmt

30. PPC 2F: Example of Factor 3 (names of patients blinded for HIPAA) List of patients in the practice taking Toprol XL

31. PPC 2F: Example of Factor 3

32. PPC 2F: Example of Factor 4 Patient list is blinded for HIPAA

33. Applaud Yourselves You’re well on your way! We’ve covered 3 of the 9 Standards We’ve reviewed 37 points out of 100 –That’s more than enough for Level 1! We’ve discussed 6 of the 10 must-pass

34. Next Steps (Homework) Review Elements 1B, 2A, 2B, 2C, and 2F and decide which ones you’d like to tackle Begin work on those Elements Find, download, and look at the Record Review Workbook –Excel file and FAQ document will be posted on the CCNC webpage for easier access As always, save/organize all of your documentation as you go!

35. Community Care PCMH Team David Halpern, MD, MPH Community Care of North Carolina (CCNC) R.W. “Chip” Watkins, MD, MPH, FAAFP Community Care of North Carolina (CCNC) Brent Hazelett, MPA North Carolina Academy of Family Physicians (NCAFP) Elizabeth Walker Kasper, MSPH North Carolina Healthcare Quality Alliance (NCHQA)

36. Partners

37. Questions? Feel free to contact me: David Halpern, MD, MPH (215) 498-4648 dhalpern@n3cn.org