Hernandez, Alejandro, MD

Mathieu, Susan S, MD

Mcneill, Kevin, MD

Sell, Susan, BSN, RN

Wilson, Lynn M, DO

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksDepartment of Family MedicineImplementation of a Sustainable Medicare AnnualWellness Visit Workflow Into a Primary CareSetting Quality Improvement Project.Alejandro Hernandez MDLehigh Valley Health Network, Alejandro.Hernandez@lvhn.orgLynn M. Wilson DOLehigh Valley Health Network, lynn_m.wilson@lvhn.orgKevin Mcneill MDLehigh Valley Health Network, Kevin_A.Mcneill@lvhn.orgSusan S. Mathieu MDLehigh Valley Health Network, Susan_S.Mathieu@lvhn.orgSusan Sell BSN, RNLehigh Valley Health Network, susan.sell@lvhn.orgFollow this and additional works at: https://scholarlyworks.lvhn.org/family-medicinePart of the Medical Education Commons, and the Primary Care CommonsThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtHernandez, A. Wilson, L. M., Mcneill, K. Mathieu, S. S., Sell, S. (2018, May). Implementation of a Sustainable Medicare Annual WellnessVisit Workflow Into a Primary Care Setting Quality Improvement Project. Poster Presented at: The Society of Teachers of Family MedicineAnnual Spring Spring Conference, Washington, DC.LVHN.org© 2018 Lehigh Valley Health NetworkImplementation of a Sustainable Medicare Annual Wellness Visit Workflow Into a  Primary Care Setting: a Quality Improvement ProjectAlejandro J. Hernandez, MD; Lynn M. Wilson, DO; Kevin A. McNeill, MD; Susan S. Mathieu, MD; Susan Sell, BSN, RNBACKGROUND  In 2011, the Affordable Care Act introduced Annual Wellness  Visits (AWVs).   AWV allow for PCPs to update medical history, review preventative care recommendations, improve HCC coding, close care gaps, and Advance Care Planning (ACP) discussions.   Little data has been available on AWV utilization.  Recent study by Camacho et al. (2017) showed that AWV non-recipients were less likely to receive any of the 7 preventative services.   Best practices for completion of AWVs have not been established.   The multiple components of the visit have been seen as a barrier  to implementation into a busy outpatient practice. OBJECTIVE  To develop a workflow design that could be implemented efficiently and effectively within an outpatient clinic setting. This workflow  would allow for the visit to be completed within the allotted time for an outpatient office visit and be sustainable over time.SETTING  Urban, academic residency clinic  Quality Improvement project   Providers, CRNP, PA-C, Nursing StaffMETHODS  Trained Family Medicine Provider Model:•  Patients were called in advance to schedule and pre-visit planning completed. •  Patients arrive 20 minutes prior to their appointment for completion of the health risk assessment. •  Clinician see patient, review recommendations and complete visit.   Site goal: 5% of eligible patients complete AWV.PDSA CYCLE 1TIME: 4 WEEKS PROVIDERS INVOLVED: 2  Assessed capture rate of scheduling AWV-only visits versus adding them to pre-scheduled chronic follow-up visits (“Combined Visits”).  Improved understanding of the required elements of an AWV.  Reviewed coding/billing elements for Combined Visits.  Reviewed use of smart sets within Epic EMR.PDSA CYCLE 2TIME: 5 WEEKS TRAINED 3 NEW PROVIDERS (TOTAL 5)  All clinical staff trained.  Answered additional questions regarding coding/billing.  Created a document with detailed instructions on coding/billing Combined Visits.PDSA CYCLE 3TIME: 6 WEEKS  TRAINED 5 NEW PROVIDERS (TOTAL 10)  All providers reviewed the workflow, required elements, questions answered.  Instructional video reviewed.  Experimented with allowing providers to individualize work flow. •  This created inconsistencies resulting in required elements  being missed.•  Returned to a single workflow to be used by all providers and clinical staff.PDSA CYCLE 4TIME: 7 WEEKS TRAINED 5 NEW PROVIDERS (TOTAL 15)  Single uniform workflow  3 weeks of assistance by nurse-led model sponsored by the ACO  and LVPG, billing provided by clinician  Reviewed workflow with members of other clinical sites at GWEP small networking meeting, sponsored by The Hartford Foundation.CONCLUSIONS  AWVs have the potential to be incorporated within the allotted time frame in a busy outpatient primary care practice.   Completion of AWVs increased significantly over 5 months in our practice.   Scheduling AWVs along with pre-scheduled visits had an increased capture rate.   Post implementation analysis also noted that, with minimal change to the workflow, the number of completed visits more than doubled over 5 months.FUTURE PROJECTS  Accurate identification of eligible patients and completion of pre-visit planning  Education of patients on benefit of AWVs to improve capture rates  Finalization and standard training on nursing workflow within the EMR  Determine if AWV improve completion of preventative services in a residency clinic patient population  Assessment of completed visits utilizing the resident/attending model compared to the nurse-led modelREFERENCE Camacho, F., Yao, N., & Anderson, R. (2017). The Effectiveness of Medicare Wellness Visits in Accessing Preventive Screening. Journal of Primary Care & Community Health, 2150131917736613.We would like to thank the Hartford Foundation, HRSA GWEP, and Nyann Biery, MS for their assistance.01020304050607080TrainedNot TrainedPSDA Cycle 1 PSDA Cycle 2 PSDA Cycle 3 PSDA Cycle 4NUMBER OF VISITS COMPLETED BY PROVIDERS PER  PDSA CYCLEAWV RATES RELATED TO PDSA CYCLES0510152025303540April ’17 March ’18PSDA 1 PSDA 2 PSDA 3 PSDA 40 148.714.937.1N05230_AlejandroHernandez_Poster.indd   1 4/26/18   10:46 AM

Implementation of a Sustainable Medicare Annual Wellness Visit Workflow Into a Primary Care Setting Quality Improvement Project.

https://scholarlyworks.lvhn.org/cgi/viewcontent.cgi?article=1519&context=family-medicine

Implementation of a Sustainable Medicare Annual Wellness Visit Workflow Into a Primary Care Setting Quality Improvement Project.

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