Delivery System Reform Incentive Payments
Dr. Michael J. Romano, Associate Dean for Clinical Affairs
Mr. Oscar A. Perez, Project Manager, DSRIP-Texas Tech
EXPANDING
NEUROLOGY CARE
Salvador Cruz-Flores MD MPH
Founding Chair, Neurology
Region 15 RHP Meeting
El Paso First Healthplan, 1145 Westmoreland Drive
June 28, 2013 @ 1:00pm
To improve the general health of the population in El
Paso by increasing access to quality neurological
health care services locally
MILESTONES
 Recruitment of providers (physicians and non physicians)
 To expand services to include satellite ambulatory sites for
outpatient visits and inpatient consult service.
 To establish an ACGME accredited residency Program in Neurology
Background
I.
Nearly half of the Department’s ambulatory encounters are
Medicaid and/or No Insurance
II. Population is aging and the burden of neurological disease
like stroke, Alzheimer’s, and Parkinson’s disease is
increasing
III. Increase in workforce related to Neurology is a better
predictor of mortality related to strokes (leading cause of
death and disability in USA)
-----Desai A, Bekelis K, Zhao W, Ball PA, Erkmen K: Association of a higher density of specialist
neuroscience providers with fewer deaths from stroke in the United States population. Clinical Article.
Journal of Neurosurgery, published ahead of print November 30, 2012; DOI: 10.3171/2012.10.JNS12518
Background
I.
Currently there is a limited number of neurologists in
El Paso (about 10 in El Paso excluding those who serve
the military)
II. Ideally 6.76 neurologists per 100,000 population
(Kurtzke, Bennett, et al 1986) or 54 Neurologists for a
city this size of 800,000
III. Time to appointment is a good surrogate of service
need (in the community currently is 4-6months for
new appointment)
Benefits for the region
I.
Increased access to general neurological care in the
ambulatory and inpatient settings
II. Increased access to subspecialty care in neurology
such as epilepsy, stroke, movement disorders (i.e.
Parkinson’s disease)
III. Form basis for creation of a Comprehensive Stroke
Center
IV. Facilitate the training of physicians in neurology that
may choose to stay in El Paso
Progress
• Hired 2 FTE neurologists in Year 02 of DSRIP
 Future plans to include current increase from 4.2 FTE Faculty (2013) to
10-12 FTE within next 4 years (2017)
• Increased outpatient volume by adding additional
clinic sessions and adjusting clinic grids
• Improvement of telephone access and referrals
 Began servicing more inpatient consults at UMC and
Neuro intervention
 In the process of creating Stroke Program; Neuro ICU
• Plans have started to create residency program
 Residency Coordinator to complement in 2013-14
 3 PGY 1 residents in 2015
Progress
• Risk areas: Attracting and recruitment of physicians to El
Paso
• Mitigation strategies: within the constrains of academic
medicine try to offer competitive compensation and a
professional life that candidates may value
• Anticipated outcomes:
o Increased number of neurologists
o Creation of residency program in neurology as planned
o Increase number of new and established outpatient and inpatient encounters
• Connection with other initiatives (DSRIP or otherwise):
o Could be connected to the Family Medicine initiative by creating a neurology
satellite clinic in one or more of the family medicine sites
ENHANCING &
EXPANDING
COMPREHENSIVE
BREAST CARE SERVICES
Rene Vallejo
Region 15 RHP Meeting
El Paso First Healthplan, 1145 Westmoreland Drive
June 28, 2013
1:00pm
Description of the Project
Synopsis
Expand and enhance access to specialty care for women with breast
disease. Develop a Fellowship Program and provide increased access to
surgeons with special expertise in breast surgery. Establish a Survivor’s Program
at UBCC with an emphasis on objective measures of quality of life and strategies
to improve this matric.
Department Involved:
Department of Surgery- University Breast Care Center (UBCC)
Major Milestones DY2:
•
•
•
•
•
Baseline Report Time-to-3rd Appointment
Survivor Program-(40 enrolled) Program starting to see enrolled patients
Hire Breast Surgeon
NAPBC Program Accreditation
2 RHP Seminars
Benefits to the
Community
Established in 1994, primary focus was to help the
indigent. UBCC treats 1/3 of all breast cancer in El Paso.
4,500 patients seen annually @130 are diagnosed with
breast cancer. UBCC has Multi-disciplinary team
approach from diagnosis to end of treatment (5 yrs).
UBCC is NAPBC- National Accreditation Program for
Breast Centers. DSRIP Project will create more access to
UBCC services and improving quality of life to those
patients. UBCC patients are 45% Medicaid or uninsured
Progress
Milestones:
•
•
•
•
•
Baseline Report Time-to-3rd Appointment
Survivor Program
Hire Surgeon- Hired Search firm
NAPBC Program Accreditation
2 RHP Seminars
Complete 100%
In-progress 40%
In-progress 30%
Complete 100%
In-Progress 50%
Risk Areas:
o Hire Breast Surgeon- Hired Search firm
Anticipated outcomes:
o Meet all other milestones
Connection:
o Working with Texas Tech Internal Medicine Oncology
Department
Innovations
• Developed an implemented a new schedule Matrix
to track Survivor patients in Centricity Business.
• Completed contract services for Survivor Program.
• Kick off Survivor Program is July 1, 2013 at UBCC.
• UTEP Health fair July 11, 2013.
INCREASING
ACCESS TO
SURGICAL SERVICES
Rene Vallejo
Region 15 RHP Meeting
El Paso First Healthplan, 1145 Westmoreland Drive
June 28, 2013
1:00pm
Description of the Project
Synopsis:
This project will increase the number of surgical providers serving
the region. Surgery will expand the number of sites at which the performing
provider offers outpatient general surgery clinic services and implement an
electronic referral system.
Department Involved:
Texas Tech Department of Surgery
Major Milestones:
•
•
•
•
•
•
Increase clinic volume
Increase Specialty locations
Hire Provider
Needs Assessment
E-Referral
2 RHP Seminars
Benefits to the
Community
Each new surgical provider, when established, will
provide services to a minimum of 250 unique patients each year.
Benefit to Medicaid / Indigent Patients: Given that 60% of our
enterprise ambulatory encounters are to patients with Medicaid
or no insurance, this project will be a direct benefit to that
population.
Milestones:
•
•
•
•
•
•
Progress
Increase clinic volume
Increase Specialty locations
Hire Provider
Needs Assessment
E-Referral
2 RHP Seminars
Risk Areas:
o None
Anticipated outcomes:
o Meet all Milestones
In-Progress 90%
In-Progress 40%
In-Progress 40%
In-Progress 80%
In-Progress 40%
In-Progress 50%
MINIMALLY INVASIVE
GYNECOLOGY SURGERY
FELLOWSHIP
J. Salvador Saldivar, MD, MPH
Assistant Professor Gynecology Oncology
Department of OB/GYN
Region 15 RHP Meeting
El Paso First Healthplan, 1145 Westmoreland Drive
June 28, 2013
1:00pm
Description of the Project
• AAGL approved Fellowship in MIGS
o 2 year program with 1 Fellow per year
o Faculty preceptors from Texas Tech and the community
• Supported internally by the Dept of OB/GYN
• Milestones
o Increase the number of residents choosing MIGS specialties (shortage).
o Design workforce enhancement initiatives to support access to MIGS
providers in El Paso region (underserved)
o Expand MIGS training.
Benefits to the Community
• Provide gynecologic services to patients at
Texas Tech, UMC and the community
•Production of an independent provider for the
greater El Paso community
•Increasing the pool of outside applicants to our
Program and in turn, retention to the El Paso
area
•Benefits of minimally invasive surgery
Progress
• Milestones
o Quarterly evaluation for Fellow advancement
• Risk Areas / Mitigation strategies
o Faculty preceptors role as supervisors
• Anticipated outcomes
o Successful completion of an independent MIGS
• Connection with other initiatives (DSRIP or
otherwise)
Innovations
• Innovative ideas implemented
o Advanced minimally invasive endoscopic instruments
o Robotic technologies
• Improvements to processes
o Ability to apply MIS technology to patient care where the
availability was scarce or non-existence
INCREASING
ACCESS TO OCULAR
CARE
Rene Vallejo
Region 15 RHP Meeting
El Paso First Healthplan, 1145 Westmoreland Drive
June 28, 2013
1:00pm
Description of the Project
Synopsis
Improve utilization rates of clinical preventive
services (testing, preventive services, treatment) in target
population with identified disparity
Departments Involved:
Texas Tech Surgery- Ophthalmology
Milestones DY2:
• Baseline data- Performance indicators-established and
implemented Patient Questionnaire
• E Referral- IT team working with EMR to create referral
• 4 Hire Ocular Providers currently Recruiting
• 2 RHP Seminars
Benefits to the
Community
El Paso community consist of large Hispanic
population with many having Type II diabetes and a
significant number are indigent or have Medicaid. The
importance of this exam is underscored by it being a
core HEDIS marker. In addition, the lack of access to
primary care creates more barriers to receiving this
screening exam.
Progress
Milestones:
o
o
o
o
Baseline data- Performance indicators
established and implemented Patient questionnaires
E Referral- IT team working with EMR to create referral
4 Hire Ocular Providers currently Recruiting
2 RHP Seminars
In-Progress 80%
In-Progress 40%
In-Progress 20%
In-Progress 50%
Risk Areas:
o Hiring of Providers prior to deadline- added more resources
to recruiting.
Anticipated outcomes:
o Milestones will be met
Innovations
• Improvements to processes:
o Educated team on CQI/Rapid Cycle Improvement
o Formulated Action Plan
Results of Survey
st
1 Quarter Survey
OPHTHALMOLOGY PATIENT
SATISFACTION SCORES
Poor
How long you waited to get an appointment
Convenience of the location of the office
Getting through to the office by phone
Length of time waiting at the office
Time spent with the physician you saw
Explanation of what was done for you
Technical skills of the physician you saw
The professional manner of the person you
saw
The visit overall
Fair
Good
Very Good
Excelle
nt
7
1
4
12
3
1
1
33
14
13
33
11
6
4
31
45
40
30
32
24
17
21
27
31
20
29
29
35
31
36
35
28
48
63
66
42.3%
51.2%
53.7%
39.0%
62.6%
74.8%
82.1%
1
1
4
5
18
25
25
36
75
56
81.3%
74.8%
Quarterly Process Improvement Meeting
June 21, 2013
Project Leader: Ceci Sambrano/ Michael Maldonado
Clinic: Ophthalmology
Contact Phone: 545-6999
Team Members: Rene Vallejo-Facilitator, Esther Estrada-Scribe, Sandra Alderete, Sandra Villagran, Belinda Sanchez
Purpose: Review Quarterly Patient Satisfaction Scores and develop an Action Plan to improve scores.
Opportunity Statement: Decrease Length of time waiting at Office
Root Causes: (Analyze with Brainstorming-Select 1-2 Root Causes)
1. EMR Implementation
2. Registration Process
3. Schedule Matrix
Follow Up
Action Steps
Person Responsible
Est. Completion Date
Changed Schedule
Matrix
Esther Estrada
July 5, 2013
Registration Process
Improvement,
Preloading and
Flagging Charts
Ceci Sambrano/
Esther Estrada
Aug 31, 2013
All Staff
Aug 31, 2013
EMR Proficiency
Date Completed
(results, outcomes,
observation, trend data)