Editor's Note: which features contributions from members of the medical community. These blogs are an opportunity for bloggers to engage with readers about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The series continues with this blog by Lori E. Rousche, MD, a family physician in Souderton, Pennsylvania. She is also the hospice medical director for Grand View Health in Sellersville, Pennsylvania. The views expressed in these blogs are those of their respective contributors and do not represent the views of or UBM Medica.
As mentioned in a previous blog, the arrival of Comprehensive Primary Care Plus (CPC+), the new model for primary care in America, has contributed to significant changes in the roles of our employees. The job descriptions for both the clinical and the administrative staffs have been modified to include new and different responsibilities. These metamorphoses are allowing for better, more individualized care for our patients and for enhanced outreach to people. The front staff plays an integral role in providing this improved care.
FURTHER READING: Dipping a toe into the world that is CPC+
The front staff is the initial voice a patient hears upon calling the office. If a patient is enrolled in our chronic care management program and is followed by the CPC+ nurse, the receptionist no longer takes a message and has the patient wait for a call back. The dedicated CPC+ nurse is familiar with our sickest patients and the staff forwards the call directly to the CPC+ nurse for more timely care. We have also extended our telephone access hours in the morning and evenings and no longer go on service over lunch. The idea is to allow improved access to the practice for all patients.
Since in CPC+ we will be graded on several matters mentioned in my previous blog, we needed a better system of tracking quality incentives and recording them in the electronic medical record. There are 14 electronic Clinical Quality Measures (eCQMs) that will be scored for our involvement in CPC+. The front staff monitors all incoming correspondence and lab results to be sure the items we are working on bettering are entered into the computer in the correct manner. A front staff quality incentive specialist will be sent all PAP test results, diabetic eye exam results and hemoglobin A1Cs for entry in the proper way so the data can easily be captured by the EHR.
A much larger area of responsibility for the front staff is now pre-visit planning. We previously had the clinical staff doing this, but changed it to the front. The employees look at the upcoming appointments for the next week, and enter directly into the “chief complaint” if the patient is due for any health maintenance testing. The provider can quickly see if the patient is due for a mammogram, DEXA scan, HgbA1C, diabetic eye exam, colonoscopy or urine for microalbumin test and hopefully get it ordered at that visit, even if the visit is for an acute problem.
TRENDING ON OUR SITE: It's about time PCPs say enough is enough
Other quality metrics being targeted by CPC+ include mental status testing on patients with memory loss and follow-up testing on patients with a diagnosis of depression. CPC+ would like all patients with memory issues to have a yearly screening. If due, this will be entered into the chief complaint by the front staff, so the clinical staff can perform a mini-mental status exam before the patient even sees the doctor. Regarding depression, if a patient has been into the office and carries the diagnosis, the goal for CPC+ is to have the patient’s PHQ-9 (Patient Health Questionnaire with 9 depression related questions) at five or under after treatment. Again, the nursing staff will see the need for the repeat PHQ-9 and have it done when the provider enters the room so it can be addressed.
Obviously, the days of searching for missing paper charts and filing charts are long gone. The front staff has more important tasks to accomplish that directly impact the quality of care that our patients are receiving. Meeting our quality metrics would be impossible without a team effort. The front staff does a remarkable job in contributing to our ability to provide more individualized and enhanced care. They not only help record the required metrics, but also aide in reaching the quality goals set by CPC+. A big thank you to them for helping us help our patient population!