Practice Management Practice Management Improvement Improvement

(PMI)(PMI)

Orientation SessionOrientation Session

PMI Orientation Objective

Increase SBHC team’s knowledge and understanding of practice management

and practice management improvement process for SBHCs

Background to Practice Management Improvement

Quality Improvement Collaboratives

California Colorado Connecticut Florida Illinois Louisiana Maine Maryland

Massachusetts Michigan New Jersey New Mexico New York North Carolina Washington West Virginia

Over 6 years, NASBHC has implemented quality improvement collaboratives with 99 SBHCs from 16 states. These efforts have positively effected the health care of over 150,000 students annually.

NASBHC’s SBHC Quality Improvement Collaboratives

Adaptations of ● Institute for Healthcare Improvement’s (IHI) quality

improvement model ● HRSA’s Bureau of Primary Care Health Disparities

Collaboratives With funding from:

● CDC, Division of Adolescent and School Health● HRSA, Maternal and Child Health Bureau● HRSA, Bureau of Primary Health Care

NASBHC’s SBHC Quality Improvement Collaboratives

Preventive Services Improvement (risk assessments, physical exams and STDs/HIV prevention): 3 cycles

Mental Health Education and Training (mental health screening, interventions, and documentation): 2 cycles

Practice Management Improvement (coding, chart documentation, clinic operations): 2 cycles

Adolescent STD/HIV Avoidance Project (STD/HIV Prevention activities): 1cycle-four states

Cycle 1 - 2004-2005 Cycle 2 - 2005-2006

What is Practice Management Improvement?

It is a process which describes the whole spectrum of operating an entire health care entity from then the patient walks in the door until the bill is paid.

Why Practice Management Improvement?

PMI will improve the :

● Quality● Efficiency ● Effectiveness /outcomes

Of patient care

Why Practice Management Improvement?

The PMI process will also help identify:

● Improvements in billing and coding

Resulting in increased revenue through a billing system

How is Practice Management Improvement Accomplished?

Through a series of:

Steps

Processes and

Activities

Steps in the PMI Process

Orientation

Data Gathering

Self Assessment #1(Pre-Assessment)

SWOTskill building sessions and work plan

implementation

Self-Assessment #2(Post Assessment #2)

Document Results

Orientation and Data Gathering

Familiarize staff with PMI process

Complete staff profiles, demographic information, service and patient profiles, payors information and

Gather data sources for use during self-assessment, such as charts, manuals, billing records, and encounter forms.

Self-Assessment #1

Includes the following:

Completing the SCORE Model

Conducing the chart review process

Completing the coding compliance review

SWOT Analysis

Analyzes the:S = strengthsW = weaknessO = opportunitiesT = threats

That exist within and surround the SBHC

Practice Improvement PlanIncludes producing a set of:

1 – 5 year short term, intermediate and long term objectives for the SBHC in the following areas:● Facilities● Business Operations● Human Resources ● Care Management● Practice Compliance

Skill building and Improvement Plan implementation

Provide skill building and training sessions as identified in Pre-Assessment #1

Implement the Improvement Plan and do regular progress updates

Self-Assessment #2 (post assessment)

After implementing the improvement plan for 6 months to a year, start the assessment process over to determine level of progress and change.

Document Success

Time to Shine and Share StoryboardsArticles in newslettersPowerPoint presentations

Tell the story of your improvement tofunders, foundations, press, parents, school, and community

Tools for the PMI Process

Web TutorialPowerPoint presentationsWord DocumentsExcel Workbooks Instructions for sessions and

processesTechnical Assistance from NASBHC

Practice Management Improvement (PMI) Initiative - NASBHC

1st Cycle (Beta Test) 6 school-based health centers from 4 states

(California, New York, Texas, West Virginia)

2nd Cycle 7 SBHCs in MA and 4 SBHCs in WV w/ 330

funded sponsoring organizations In MA and WV learning sessions were open to

SBHCs statewide

PMI Activities during the NASBHC initiative 3-4 Learning Sessions 2 Site visits (pre and post SCORE model, chart

review, and coding compliance review) 1 Site visit (mission statement, SWOT analysis,

outline practice management improvement plan) Workplan for each objective Quarterly progress reports Monthly conference calls Storyboards Celebration

PMI Results for the NASBHC Initiative

All 17 sites: Completed Strengths, Weaknesses, Opportunities,

and Threats (S.W.O.T.) analysis of their SBHC Developed a practice management improvement

plan/strategy with short and long term objectives to support the SBHC mission

Demonstrated improvement in SCORE Model ratings on all 5 domains (facilities, business operations, human resources, care management, and practice compliance) from pre to post site visits

PMI Results for the NASBHC Initiative Demonstrated improvement from pre to post

chart reviews /coding compliance audits in appropriate documentation and coding of evaluation and management visits, preventive health visits, and mental health visits

Incorporated CQI tool sentinel conditions, chart audit criteria, and resources into the care management and practice compliance activities

PMI SCORE Model Ratings Cycle 1 (pre and post)

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7080

90

100

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Overall Facilities Bus Ops HR Care Mngt Prac Comp

Pre Post

PMI SCORE Model Ratings Cycle 2 (pre and post)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

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Total Overall Facility BusinessOperations

HumanResources

CareManagement

PracticeCompliance

Pre Post

PMI and NASBHC

Web tutorial available September 2008

www.nasbhc.org

Questions and Evaluation