Evelyn Schumacher, MS, RD, CDE

Transcription

1 Evelyn Schumacher, MS, RD, CDE

2 Participants will be able to define Shared Medical Appointments Participants will be able to explain the possible role of an RD in a Shared Medical Appointment Participants will be able to discuss how RDs can generate revenue from participating in a Shared Medical Appointment

3 Group visit for follow-up or routine care Voluntary visits for patients Secure and interactive setting Improved access to providers Includes other members of health care team (behaviorist, dietitian, health educator) Shared experiences or advice with others

4 Physician and patient (relationships) Health care team (productivity and efficiency) Patient wanting holistic and therapeutic approach

5 Reduced isolation Peer education Increased satisfaction Increased time with providers Increased access to care

6 Patient retention Fewer ER visits/admissions Increased billable hours Increased satisfaction Efficiency Less isolation

7 In past to improve access Add space Add providers Decline in reimbursement for services demands greater productivity Shortages in key specialties Higher level of demand for best providers

8 Provide hope see examples of success Find others have same condition/health issue Sharing information eases anxiety Encourage regard for others welfare Promote behavior for positive role modeling Offer interpersonal and cognitive learning Provide group cohesiveness Peers offer support among themselves

9 Patient Privacy requires HIPAA documentation Regression toward didactic delivery Skill set of the staff Interruptions Space

10 Patient with need for routine follow-up care Stable/chronically ill patients requiring total mind/body care Patients who may require more time with provider Patients with frequent return visits Patients with extensive emotional, informational, or psychosocial needs The "worried well."

11 Initial evaluation One-time consultations Most medical procedures Treatment of acute, infectious illnesses Rapidly evolving medical conditions

12 Determine model best suited for practice and patient needs Consider: Target population for the group Health care team structure Frequency of meetings needed

13 Establish procedures for meeting Procedures may vary depending on shared medical appointment model Provider may invite a patient for a one-time visit Provider may establish group that meets weekly or monthly Develop standards for group to follow

14 Comfortable place with exam room nearby Room with space for chairs Equipment and forms available for provider and health care team for smooth session. Use exam room for initial part of meeting (vital signs, lab values, etc.) only If needed for individual patient needing to be seen after group session.

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16 Focus is on mind and body for group visits Shared medical appointments allow for a therapeutic dynamic to take place Potential for patients to share information that opens discussion of psychosocial issues related to their health

17 Address billing/other system issues before starting program Rapid payer changes in reimbursement - best to thoroughly explore billing options. Contact insurers to identify potential billing issues and gain clear understanding of your reimbursement possibilities.

18 Determine schedule best suiting patient and physician needs If offering multiple group disease specific visits consider regular schedule Examples: Diabetes group every second Tuesday morning Cardiac group every third Tuesday morning. Survey patients in practice may help determine schedule and frequency of visits

19 Recruit the patients included in program Consider number of patients needed to be financially feasible Typical size group: patients Physician may discuss group visit option with patient: During traditional office visit By phone or Participating patients must understand attendance is voluntary To ensure group visits are financially productive consider payment mix of patients recruited

20 Patients check in and directed to meeting room Worksheet for each patient-includes vital signs, meds, allergies, other issues patient states Qualified team member chosen to lead session if provider runs late Emphasize confidentiality of discussions Consider confidentiality form patients/family members complete This type visit may be ideal time for physician and team to bring in educator or speaker

21 Introductions (15 min) Speaker / education (30 min) Interactive time (30-40 min) with nurse/physician/educator Q & A (15 min) 1:1 visit time (30-45 min)

22 Few patients may require private consultation or exam Physician and patient generally meet after session As physician talks with/assesses specific patient- other team member may lead group discussion

23 After visit, patient records should include any changes in meds, prescriptions, problems discussed, and provider comments Make worksheet similar to traditional office visit forms Care team should meet to evaluate session and determine if changes needed

24 Evaluation is important component of any medical care Satisfaction of patient, physician and care team members has strong effect on current and future outcomes

25 Bill Medicare/other insurers for MNT if appropriate Ask vendor to support your session Ask provider to support your session

26 Bill each patient as individual appointment E & M codes or Code based on level of care delivered and documented Do not bill for counseling time

27 Cleveland Clinic Department of Defense Mayo Kaiser Permanente Dr. William L Carriere - Jacksonville

28 html Johnson & Johnson Diabetes Institute, LLC Participant Guidebook