American College of Physicians. Practice Advisor SM. Point Your Practice in the Right Direction with ACP Practice Advisor

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American College of Physicians

Practice Advisor

SM

Point Your Practice in the Right Direction

with ACP Practice Advisor

ACP Practice Advisor, formerly Medical Home Builder, offers:



Tools to

improve clinical or office operations

in your practice  A path to

meet

patient-centered medical home standards

established by the NCQA, Joint Commission, and URAC 

ACP member discounts

!

Now Offering MOC Points for Practice Improvement

Beginning January 2014, in order to be listed as "Meeting MOC Requirements," internal medicine

physicians must earn a minimum of 20 MOC points for assessment of their clinical practice every five

years.

Two modules are now available at no additional cost: Diabetes and Adult Immunization. Each module is

worth 20 points towards Self-Evaluation of Practice Performance.

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Each ACP Practice Advisor

SM

_{module contains:}

Introduction:

Outlines the content and explains the importance of each module.

Module Background:

Provides context and an explanation of the key principles, research and important

concepts for the practice team.

Case Study:

Describes the efforts of one practice as it works through identifying opportunities for improvement and

making corrections.

ACP Practice Biopsy

®

:

Is a self-assessment tool that helps identify your practice’s opportunities for

improvement— or validates the efforts your practice has already undertaken. Clinical team members complete

the modules independently or as a group. The “Practice Administrator” can see the average score for each

module, as well as the individual scores for each practice member. Significant variation in the scores likely

merits further discussion and evaluation that can lead to creative problem solving by the office team. Once

improvements are identified, the practice decides in what order—over what time period—to address them.

Premium license subscribers can download the results of their self-evaluation to develop customized reports

and graphs.

Resource Library:

Each Practice Biopsy report provides links to key resources in that specific module based on

a user’s responses to the questions.

ACP Practice Advisor Modules

BUILDING THE FOUNDATION

 Quick Start: NCQA: Designed to give a jump start to practices applying for PCMH recognition from the NCQA. This module’s 35 questions correlate with NCQA’s “must pass” elements and will focus your attention on those elements deemed essential by NCQA.

 Organize Your Practice: How your practice is organized is fundamental to good office operations and the quality of care that you deliver. This module provides information about good practice organization processes and how to make sure your office is performing effectively and efficiently.

 Work as a Team: Effective practice teamwork is an essential aspect of providing high quality, effective, efficient and safe patient-centered care. This module addresses the functions that are central to a high performing practice such as: improving internal communication; including staff in the decision-making process; empowering everyone in the

office to make changes that will improve job performance and satisfaction; providing staff training and creating a mechanism for accountability, such as job descriptions and performance evaluations.

 Communicate With Patients: Achieving good health depends on actively engaged patients, families and caregivers. This collaboration between the practice team and the patient depends on helping him or her understand the care and treatment plan, which depends on good communication skills. Good patient communication includes spoken, written, pictorial and electronic information presented to the patient in a way that he or she can understand.

 Enhance Patient Access: Whether patients are trying to make an appointment or ask a question, they can become

frustrated when they feel that their concerns are not being addressed. Enhancing patient access is important in obtaining

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new patients as well as retaining existing patients. Easy access to care and the clinical team for patients, families and other clinicians is critical to providing high quality care. Data suggests that patients who have a good relationship with their physicians are more likely to follow their care plans.

• Deliver Patient-Centered Care: Providing patients with information about their care, the medical team and your practice (in a communication format that is understandable and easily accessible to them) helps to engage and

empower them. Engaged patients are more likely to take actionable steps toward improving their health.

 Coordinate Care: Coordination of patient care across the health care system helps ensure that patients receive appropriate care at the appropriate time. Without an organized, proactive approach to care, patients may get lost within a highly complex and fragmented health care system. This confusion may cause patients to delay—or not obtain—necessary tests and consultations.

 Facilitate Transitions I: Facilitating transitions helps ensure that patients receive appropriate care. By prioritizing standards of care for implementation, your practice will be able to better support your patients and help you improve the patient and clinician care

experience.

 Facilitate Transitions II: This module further addresses best practices in care transitions, including transition of at-risk populations, coordination with hospitals, home health care teams and family members. Standardized communication formats and transition records are also highlighted. Alicia Arbaje, MD, MPH; Honora Englander, MD; Luke Hansen, MD, FACP; Patience White, MD, MA, and Mark Williams, MD, FACP, FHN, wrote this module.

Use of Technology I: The term “health IT” can refer to practice management systems (PMSs), electronic health records (EHRs), e-prescribing, secure e-mail communication, web visits, patient portals/personal health records (PHRs) and peripheral technology such as automated blood pressure cuffs, cardiac monitors, etc.

 Use of Technology II: This module assesses how well your practice uses more sophisticated elements of health IT systems and helps you understand how these

technologies can improve care and increase office efficiency.

 Improve Quality: Quality improvement is an important factor in your practice achieving and maintaining high standards in patient care. Improve Quality will help you quickly measure your current practice, design and

implement change processes and re-assess your operations.

 Manage Populations: This module ensures that patients with specific chronic conditions receive appropriate care. Links are provided to reports and guidelines, including ACP’s PIER® decision support system—over 460 modules focusing on clinical topics, an extensive drug database and patient information.

 Engage Patients: Engage Patients helps you understand health behavior change, how to describe the activities performed by a care team to help patients adopt healthier behaviors and manage chronic conditions with greater success. Patient engagement expert, Judith Schaefer, MPH, wrote this module.

Specialty Practice Recognition

 Track and Coordinate Referrals: Central to good care is a well-designed and implemented referral process that enables specialty practices to track and coordinate referrals.

 Provide Access and Communication: While highly-functioning specialty practices cannot solve the national issues with access to care, well-organized specialty practices can significantly contribute to the overall efficiency of local and regional health care.

 Identify and Coordinate Patient Populations: Practices must collect the right information in a way that is searchable for the purposes of identifying groups of individuals that may need specific elements of care (e.g., medication

management, laboratory monitoring, preventive/screening procedures).

 Plan and Manage Care:Not only must specialty practices engage patients and their family/caregivers, but the team also needs to coordinate and collaborate with referring clinicians and their teams. To do so effectively requires planning and careful management of patient care.

 Track and Coordinate Care: The vast majority of patients seen in a specialty practice will have other health care professionals involved in their care. As a consequence, the role of the specialty practice in contributing to seamless, coordinated care requires a level of performance and consistency that goes beyond what most practices currently achieve.

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 Measure and Improve Performance: Most clinical teams have received almost no training on how to identify opportunities for improvement, let alone systematically achieve increasingly better performance on measures of quality, efficiency, effectiveness, safety, and financial metrics. Change is difficult, and changing a practice can be overwhelming – especially without the appropriate preparation, tools, or leadership.

IMPROVING CLINICAL CARE

Manage Patients’ Medications: The focus is on the

treatment of chronic diseases because adherence rates are typically acceptable for acute diseases if patients are given adequate education. Medication adherence experts, Lars Osterberg, MD, MPH, and Terrence Blaschke, MD, of Stanford University, wrote this module.

Depression Screening & Care: Depression is a chronic condition that requires long-term management. Practices need to be prepared and proactive in order to deliver excellent depression care. This module introduces methods of screening for depression and tools and resources to help most primary care practices implement a team-based, collaborative approach to helping people with depression. This module is based on an American College of Physicians' Clinical Practice Guideline written by: Meghan Gannon, MSPH; Steven Hahn, MD; Wayne Katon, MD; Theresa Kanya, MBA; Amir Qaseem, MD, PhD, MHA, and Melissa Starkey, PhD.

 Manage Diabetes Mellitus: Optimal management of diabetes can reduce complication rates, but care is complex, requiring preventive treatment across multiple domains, frequent screening and the potential for a variety of disease

complications that must be diagnosed and treated. The tools and resources included in this module will help your practice organize to care for people with diabetes. An expert in diabetes mellitus, Dr. Sandeep Vijan was a major contributor to this module.

• Immunize Adults: This module concentrates on tools that staff in the typical primary care office—including physicians, physician assistants, nurse practitioners, nurses, medical assistants and office managers—can implement to improve immunization rates in their practice. The focus is on improving the way that immunization services are provided, which ultimately will help to improve immunization rates. This module is based on content developed for the American College of Physicians' Adult Immunization Portal by: Doron Schneider, MD, FACP; Kim Dixon, MD FACP; Kathryn Eiler,

CMM, and Cara Reynolds, MHS.

Chronic Pain Management: Managing patients who experience chronic pain can be challenging. Developing and maintaining an office procedure to guide the care for patients with chronic pain can help minimize risk and ensure that they receive optimum care. This module will provide you with steps and resources. Daniel P. Alford, MD, MPH, and Leanne M. Yanni, MD, were major contributors to this module.

Opiod Risk Management Chronic pain is both a common and challenging problem in primary care settings. Approximately 100 million Americans have chronic pain. Pain accounts for up to 20% of all outpatient visits costing over $600 billion dollars per year in direct medical treatment and lost productivity costs, This module will help practices mitigate risks related to caring for patients with chronic pain who need to be

prescribed extended release / long acting opioids.

Osteoarthritis (OA) is the most common form of arthritis. Three-quarters of all Americans with arthritis have OA and most Americans are expected to have OA in at least one joint by age 65. Progressive joint pain from OA leads to functional limitations, fatigue, depressed mood and loss of independence. This module will help practices apply the medical home attributes to the care of patients with osteoarthritis. Gillian Hawker, MD, FRCPC wrote this module.

Rheumatoid Arthritis Rheumatoid arthritis (RA) is the most common chronic inflammatory arthritis,affecting

approximately 1% of adults. RA patients because of their immunosuppressive medications and their substantial propensity for cardiovascular morbidity, infections and osteoporosis can provide unique challenges to primary care physicians (PCP). This module will address the important aspects of providing optimal primary care for this important patient population. James R. O'Dell, MD, FACP wrote this module.

Gout Gout is an ancient and common form of inflammatory arthritis, and is the most common inflammatory arthritis among men, effecting more than 3 million Americans. This condition and its complications occur more often in men, women after menopause, and people with kidney disease. It is strongly linked to obesity, hypertension, hyperlipidemia, and diabetes. This module will help your practice provide optimal care for these patients. Tuhina Neogi MD, PhD, FRCPC wrote this module.

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MANAGING YOUR PRACTICE

 Practice Basics—Managing Your Practice: Without a solid foundation to support day-to-day office operations, even the most well-intentioned health care teams can get distracted from their core clinical activities by business and financial issues. This module identifies a core set of issues that every practice needs to address and covers several important facets of managing an independent private practice. Many of the resources provided in this module were identified by the ACP Council of Young Physicians based on the needs of residents going into practice.

 CLIA – Waived Lab Testing: Laboratory test results influence approximately 70% of medical decisions. Increasingly, these decisions are based on simple tests performed at the point-of-care using devices that are waived from most federal oversight requirements (and are thus designated as “waived” tests). Waived tests, including whole blood glucose and dipstick urinalysis, are commonly performed in outpatient settings such as the physician’s office. Facilities that perform only waived tests have no routine oversight or personnel requirements. They are only required to obtain a Certificate of Waiver (CW), pay biennial certificate fees, and follow the manufacturers' test instructions. However, surveys have revealed that 50% of waived laboratories do not follow or even have the current manufacturer’s instructions. Most of these surveyed staff wanted to do the right thing, but lacked the resources or training to do so. This module can help!

 Patient Centered Laboratory Excellence: The Centers for Medicare & Medicaid Services (CMS) regulates all laboratory testing (except research) performed on humans in the U.S. through the Clinical Laboratory Improvement Amendments (CLIA). In total, there are approximately 230,000 clinical laboratories possessing CLIA certificates. Each practice must assess the laboratory testing available to their patients, whether performed on site or performed by a reference laboratory to assure quality and value. It must be determined that the testing performed is clinically necessary, economically sound and the results obtained are accurate.

 Code Effectively: Whether you care for patients in a private practice, a hospital, hospice, nursing home, clinic, or academic medical center, learning how to code – and document - accurately and efficiently is the bread and butter of practice. While physicians may wish it otherwise, billing is a reality of modern medicine as is scrutiny by outside entities to ensure all

rules are followed. The module covers procedural and diagnosis coding, E&M coding, using modifiers, documentation, and level of service. This module will help you make sure your practice charges correctly for the services rendered, and is not at risk for breaking any rules.

Bloodborne Pathogens & OSHA: Protecting patients and staff while complying with federal, state and local

regulations is the focus of this module. Proper handling and disposal of blood, infectious materials and other hazardous medical waste are addressed. This module was written with extensive contributions by Elaine Pappamihiel, MT (ASCP), technical specialist in the ACP Medical Laboratory Evaluation (MLE) program.

Human Resources: Recruiting and hiring an employee, whether a physician, nurse or file clerk, is an investment— of time, money, training and even trust. This module provides tools and resources for every stage of the employee life cycle for both clinicians and staff. While there is no way to predict every situation that a practice will encounter in every state (where employment laws vary), there are many common elements to personnel management. Articles, tools and Web sites that you might need to manage the people in your practice are included. This module was written with extensive contributions by Margo J. Williams, MHA, CMPE, senior associate in the ACP Center for Practice Improvement and Innovation.

Medical Waste Management: Management of medical (hazardous) waste is guided by federal and state regulations. This module was written with extensive contributions by Elaine Pappamihiel, MT (ASCP), technical specialist in the ACP Medical Laboratory Evaluation (MLE) program.

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American College of Physicians. Practice Advisor SM. Point Your Practice in the Right Direction with ACP Practice Advisor