THE AMBULATORY
ENTERPRISE:
SEVEN TIPS THAT WILL HELP YOU
RUN A SMOOTH CLINIC
Robert H. Hopkins, Jr., MD, FACP, FAAP
A M B U L A T O R Y O P E R A T I O N S A R E : S I M P L E B U T C O M P L E X …
P A T I E N T F O C U S E D B U T C A N B E I M P R O V E D … C H A N G E R A T E I S V A R I A B L E …
#1 KNOW YOUR PEOPLE
•
Medical Director + Department/Division Director
•
Approve clinic sessions
•
Review and approve clinic templates
•
Department/Division Administrator
•
Set up your template with your director/administrator
•
Interface with Clinic/Appt. Center
•
Oversee scheduling in areas where central scheduling
is not utilized…
•
Access/Appt. Center [UH, VA, ACH: Separate]
•
Communication with these people is critical!!!!
•
Some Departments do not use central access center
#1 KNOW YOUR PEOPLE (CONT’D)
•
Clinic Manager:
• Build and maintain a good relationship • Learn the policies already set in place • Staffing, Rooms, Clinic metrics
• E-Billing and Encounter Forms
•
Nurses:
• Communicate with them about your preferences • Facilitate effective/efficient patient check-in
• Facilitate overbooks
• Patient questions/triage
#2 KNOW “MCPG”
(FACULTY GROUP PRACTICE)
•
The UAMS operating division that administers the
business aspects of
physician
services, including
billing, payment
• “CUMG” Serves in this role for ACH-based services
•
Encounter Forms and Coding
• Encounter forms may be paper or [E-bill] within EMR now… • With UConnect [Epic] implementation [beginning 8/2013] all
providers will be responsible for e-billing for ambulatory + inpatient services.
•
Risk Management (deals with problems)
• Best to let them know about potential problems rather than
#3: LEARN THE COMPUTER SYSTEMS
CENTRICITY [Current Ambulatory EMR]
•
Not all clinical areas using EMR to its capability…
•
To be replaced by UConnect [Epic] in 2013-14
• Initial clinics go LIVE with UConnect 8/1/2013
• ALL Clinicians will use this system if practicing @ UAMS.
•
Advantages
• Communication between docs
• Review/sign-off ~all clinical data [minimize ‘miss’ potential] • Legible notes/orders
• Organized, [reasonably] user friendly
•
Disadvantages
• Typing vs. Dictating
• Current IP and OP systems communicate but don’t integrate • IT glitches can always occur
#4: KNOW YOUR CLINIC POLICIES
•
No shows
•
Late patients
•
Time allotted to each patient visit
•
Rules for canceling your clinic
• Minimum of 4-6 weeks notice except emergency… • Some departments have more stringent requirements
•
Administrative dashboard [EIS]
• Data on many clinic metrics
• Reviewed routinely by administration, Dean, department
and divison leadership.
#5: FGP COMPLIANCE
•
Learn [keep up with] changes in billing/coding
• Check with your administrator re: specialty-specific tools
• Please teach your learners how important/complicated this is
and can be!
•
Routine audits
• Initial audit in first quarter, annually and random
• I recommend you review your results, ask for a sit down if you
have concerns… Better to know and fix than to be ‘tracked down’ for problems later…
#6: STUDENT/RESIDENT EDUCATION
•
Most clinics serve insured and underprivileged
• Institutional policy on fees/payment for services
• Review specific clinic policies with your administrator
•
The majority of us are on an ‘educator track’
• We teach students, residents, fellows, [other learners]
• You should know the rules for documentation of services w/
learners
• What/how much of learner note you can refer to… • What is required in a ‘teaching physician statement’…
MAKE THE MOST OF TEACHING
MOMENTS..
•
We are all pressed by multiple demands on time
• REMEMBER we are here because we have a passion for
education, clinical care and/or research.
• Few of us are trained educators
•
Remember– to ‘reach’ our learners:
• Smile!!
• Many teaching strategies:
• Ask pertinent questions [without ‘pimping’] and wrap with knowledge ‘pearls’
• Pick one teaching point from each patient encounter • “One Minute Preceptor”
• Share your clinical dilemma
#7: GET INVOLVED
There are ALWAYS opportunities for improvement!
•
Consider involvement with standing committees
• Clinical Coordinating Committee • Medication Policy Committee
• Professional Standards Committee
•
Participate in Quality Improvement
• Champion an issue, work with your clinical team! • PDSA Cycles
• Avoid the temptation to use ‘its not my problem’- make
positive changes!!
•
Faculty Senate
•
EPIC development in your specialty area
OVERALL….
•
Introduce yourself
•
Consider volunteering for outreach-
• Publicize what you bring to UAMS and Arkansas
•
Get involved in UAMS and Central AR community
•
Ask questions
•
Be proactive for positive change
SHAMELESS PLUG…
PRIMARY CARE @ UAMS
• UAMS Center for Primary Care
Collaboration of 3 on-campus primary care disciplines- our physicians are happy to provide professional comprehensive primary care for you and your families in one of 5 [on and off campus] clinics:
• UAMS Internal Medicine South [Ages 16+]
• UAMS Internal Medicine West [Ages 16+]
• UAMS Internal Medicine North [Ages 16+]
• UAMS Family Medical Center [All ages]
• Incl. Student Health Center, Employee Health, Employee Walk In Clinic
• UAMS Center on Aging [ages 65 and older]
• ACH Pediatric Clinics
Skilled Pediatricians who provide comprehensive Pediatric primary care
• General Pediatrics Clinic [Birth to 18] • Adolescent Clinic [Ages 14-20]