TCPI EXEMPLAR PRACTICE FOCUSES ON IMPROVING PATIENT EXPERIENCE

Improving care and empowering patients Lisa Lewis, DO, practice owner, Sustaina Center for Women Transforming Clinical Practice Initiative, which worked with close to 200 practices during its four-year time frame, submitted roughly 20 “exemplar practice” stories to the Centers for Medicare and Medicaid Services directory. TCPi is a federally funded, governor’s office initiative that ended Sept. 30, 2019. The following is an edited version of that story that illustrates some of the work Sustaina Center for Women did to earn the “exemplar” designation.

Sustaina Center for Women is a small practice in Lakewood. Our team includes myself, a gynecologist; a women’s health nurse practitioner (NP); two medical assistants; and a part-time behavioral health specialist. Our patients are busy working women who are providing multigenerational care and can’t spend extra time in a doctor’s waiting room. We are focused on our patients’ needs and experience. In the end, our focus on patient experience has improved patient outcomes, saved or avoided unnecessary health care costs and inspired team members to work to the top of their scope.

Our patients can “swing by and get things done by people who care” and we take pride in our work. In addition to our cost reductions, increased patient access and better health outcomes, the team’s efforts have improved team morale, attracted providers from across the country (Elizabeth, our NP, moved from Chicago to work in our environment) and caught the attention of the Centers for Medicare and Medicaid Services, which funded TCPi. Sustaina Center for Women has been featured during several national conferences and I was named to the national TCPi faculty to help replicate the success we’ve seen with our practice transformation efforts.

A FEW SUCCESSES: • Drop-in appointments for existing patients with symptoms of UTI, vaginitis or a sexually transmitted disease “scare.” • Same-day urgent appointments for more acute needs such as pain, bleeding or Bartholin cyst drainage. • Improved access to lower cost generic hormone intrauterine contraceptive devices (IUDs) by improving the method of insertion and creating a faster decision-to-placement time; by providing a lower cost yet potentially more effective device, we saved over $72,000 in 2019. • Treated abnormal bleeding with medication instead of surgery in 90 percent of cases in 2018. • Transitioned all surgeries to outpatient with length of stay measured in hours, not days, as patients recover better at home. • Lowered prescriptions for post-op narcotics to six pills with rare refills (none in 2018).

IMPROVING ACCESS We revamped the office schedule to include daily drop-in availability for low acuity visits; daily “9-1-1” higher acuity open slots; one-week open slots so patients can be seen within the week; and two-week appointment slots for improved availability over time. There is a patient portal and secure text messaging, and patients use a smart phone application to message the team directly.

Our friendly and empathetic environment also helps ensure women feel comfortable asking for the kind of help they need. Empathy and understanding improve access when patients feel comfortable. The team asks every patient if she has a health goal and helps her achieve it. Other patient engagement tools include checklists that help patients determine insurance benefits for procedures and high-cost contraceptive devices.

The team recently embedded a mental health provider in the office. The hope is that convenient, onsite access to mental health services will help women and their families get the care they need when and where they need it. This work was supported by Sustaina’s participation in the Colorado State Innovation Model, another health reform initiative funded by the Centers for Medicare and Medicaid Services.

PATIENT EXPERIENCE We engage our patients with checklists to help them navigate their insurance benefits. Our most popular checklist is given to all patients who desire long-acting contraceptive devices. It reminds women to call their insurance companies to confirm benefits before the procedure, which costs $650 to $1,200 per device, is performed. We have nearly 100 percent usage of this checklist.

We have improved our patient surgical experience by creating an atmosphere of comfort and openness in which patients and their families can ask questions to help them reach their goals for surgical outcomes. Patients appreciate the fact

2018 savings $481,936

 Emergency department visits: 192 in 2018= $257,908 Increased generic IUD access= $27,900 All outpatient surgery-length of stay= $124,128 Surgical tray change = $72,000 90% abnormal bleeding in 2018 treated w/o surgery

that our services help them reduce time away from work, lower copays for outpatient procedures, and minimize opioid use so they feel empowered to return to their usual routines and are home sooner.

The following patient engagement tools help with this process:

• A checklist to prepare for surgery: • Things to arrange for before surgery – childcare, rides, eldercare. • Instructions for checking benefits and understanding the financial aspect of surgery. • A checklist for the day before and day of surgery for patients: • We have initiated a care coordinathat are focused on patient experience

tion agreement with the surgical center that is given to patients so they know what we expect the surgery center to have ready on the day of surgery, what they expect us to have ordered and what the patient will do before surgery. • An information sheet on “how to recover faster from surgery” for patients and families.

COST SAVINGS The team’s focus on patient experience generated up to $481,936 in cost savings during 2018 as detailed above.

Our same-day, open appointment slots improve patient access and reduce urgent and emergency room visits. Carefully coordinated, cost-effective services have resulted in significant health care

cost savings. The team is building a

health neighborhood to provide stream

lined health care delivery experiences

for patients, and we want to partner with

highly efficient primary care physicians. ■

This is the second of a series of articles that highlights the work practices engaged in TCPi do to earn “exemplar” status with the federal CMS.

LEARN MORE ABOUT THIS FEDERALLY FUNDED, GOVERNOR’S OFFICE INITIATIVE AT www.co.gov/healthinnovation/tcpi, a website that will be maintained as an archive through July 2020.

To see how MINES can help your practice create a happier and more productive workforce while reducing healthcare costs, call us at 1-800-873-7138 or visit minesandassociates.com

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INSIDE CMS

CEO reveals one simple trick to improve your CMS membership experience Bryan Campbell, FAAMSE, CEO, Colorado Medical Society

Wow. Don’t you hate those clickbait articles that pop up on Facebook or in Google Ads? Your brain knows that there’s no simple trick for most things … but sometimes … you just click to be sure. And I promise you this, at the end of the article, I WILL give you one simple trick to look into those deceptive ads without clicking through the sometimes dozens of pages, only to be disappointed.

But for now, hopefully I have your attention for just a minute or two for the “obligatory get-to-know-me” article from the new CEO.

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I’m Bryan Campbell, husband, father of two, and grandfather of one. I’m also a fan of the Oxford comma, as you can see. I joined the Colorado Medical Society team in January 2020 following the retirement of Alfred Gilchrist. I am a Nebraska native but come to Colorado via Jacksonville, Fla. I served as the CEO of the Duval County Medical Society, one of the largest and oldest county medical societies in America, from 2012 until December 2019. Prior to that, I served as the Director of Public, Media and Industry Relations for the American Association of Clinical Endocrinologists (AACE; try putting all of that on a business card) from 2006-2012.

My path to organized medicine is atypical: mechanical and nuclear engineering major who decided to change his major to broadcast journalism. After a 14-year television career that earned me numerous awards and accolades, I decided to get out of the business in 2006 and stumbled into the public relations job at AACE.

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One of the things that I am most passionate about in organized medicine is the opportunity to create community. Our CMS membership of more than 7,000 physicians range from residents to retired, rural to urban, and from every type of practice model imaginable. Your CMS is here to be a place for your voice to resonate. If you haven’t participated in a committee or work group yet, there’s almost certainly something that meets your personal passion. And if there isn’t, we are here to help make that a reality for you, whether you have the desire to form community with other physicians who are young parents, or who love hiking, or any other interest available.

In my experience, we’ve helped create robust communities for such important membership groups as residents, women in medicine, and physician wellness champions. We’ve also set up NCAA March Madness pools and fantasy football leagues … obviously significantly less important in the grand scheme of things, but REALLY important to those involved.

Honestly, the one simple trick to improve your membership is this: Just ask! If there’s something you are interested in, it’s a virtual certainty there are more physicians who share that idea – and we can help.

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Because CMS is you. CMS is the 7,000+ physicians working to improve their patients’ lives every day. Who I am really doesn’t matter. I’m just here to ensure that your voices are heard and represented. If I do that well, then CMS will thrive as engaged physician members continue to help us fulfill your mission to champion health care issues that improve patient care, promote physician professional satisfaction and create healthier communities in Colorado.

And now, as promised, truly one simple trick for getting through those annoying clickbait articles. Subscribe to the Reddit thread “Saved You A Click” (www.reddit.com/r/savedyouaclick). The moderators on that site take most of the popular clickbait articles and summarize them in one post that you don’t even have to click to get the answer.

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Thanks for a few moments of your

attention. I am truly excited to be a part

of the CMS team and look forward to

helping your voice be heard. Please

feel free to reach out to me directly at

bryan_campbell@cms.org with any

thoughts. I’d love to hear from every

member what we are doing right, and

how we can be even better. ■

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