Download MN310 APRIL 28, 2014

MN310
WHAT TODAY’S HEALTHCARE LANDSCAPE MEANS TO YOUR
PRACTICE
ROBERT W. YELVERTON, MD
APRIL 28, 2014
MCCORMICK PLACE LAKESIDE CENTER
CHICAGO, ILLINOIS
TABLE OF CONTENTS
FACULTY ........................................................................................................................... iii
COURSE OBJECTIVES ........................................................................................................ v
SCHEDULE ....................................................................................................................... vii
DISCLOSURE OF FACULTY AND INDUSTRY RELATIONSHIPS, ACCREDITATION, AND COGNATES .. ix
INTRODUCTION .................................................................................................................. xi
ROBERT W. YELVERTON, MD
WHAT TODAY’S HEALTHCARE LANDSCAPE MEANS TO YOUR PRACTICE .................................. 1
ROBERT W. YELVERTON, MD DORIMAR SIVERIO-MINARDI, MPH, MBA
EDUCATIONAL OPPORTUNITIES ......................................................................................... 44
COURSE DIRECTOR
Robert W. Yelverton, MD
Women’s Care Florida
Tampa, Florida
FACULTY
Dorimar Siverio-Minardi, MPH, MBA
Women’s Care Florida
Tampa, Florida
Course Objectives
After attending this course, the practitioner should be able to:

Acknowledge the current status of healthcare reform

Acknowledge current challenges for ob/gyn medical practices
o Clinical systems
o IT
o Reimbursement

Identify current practice and reimbursement models

Identify new trends and how they will impact the business model

Discuss the impact of insurance exchanges

Provide information on anticipated changes in office-based care to promote,
enhance, and verify patient safety and quality
WHAT TODAY’S HEALTHCARE LANDSCAPE MEANS TO YOUR PRACTICE
APRIL 28, 2014
CHICAGO, ILLINOIS
ROBERT W. YELVERTON, MD
SCHEDULE
MONDAY, APRIL 28, 2014
PM
2:00
Welcome, Introduction of Faculty, Review of Learning Objectives,
Announcements
Dr. Yelverton
2:15
4:30
The Current Status of Healthcare Reform
Drs. Yelverton and Siverio-Minardi
Current Challenges for Ob/Gyn Medical Practices
Drs. Yelverton and Siverio-Minardi
Current Practice and Reimbursement Models
Drs. Yelverton and Siverio-Minardi
SCOPE Certification
Drs. Yelverton and Siverio-Minardi
4:50
5:00
Question-and-Answer Period
Adjournment
3:00
4:00
Faculty and Participants
DISCLOSURE OF FACULTY – INDUSTRY RELATIONSHIPS
In accordance with College policy, planning committee members have signed a conflict of
interest statement in which they have disclosed no financial interests or other relationships
with industry relative to topics they will discuss at this program. All faculty members have
signed a conflict of interest statement in which they have disclosed any financial interests
or other relationships with industry relative to topics they will discuss at this program. At
the beginning of the program, faculty members are expected to disclose any such
information to participants. Such disclosure allows you to better evaluate the objectivity of
the information presented in lectures. Please report on your evaluation any undisclosed
conflict of interest you perceive. Thank you!
College Committee on Continuing Medical Education
ACCME ACCREDITATION
The American College of Obstetricians and Gynecologists is accredited by the
Accreditation Council for Continuing Medical Education (ACCME) to provide continuing
medical education for physicians.
AMA PRA CATEGORY 1 CREDIT(S)™
OR
COLLEGE COGNATE CREDIT
AMA PRA CATEGORY 1 CREDIT(S)™
The American College of Obstetricians and Gynecologists designates this live activity
for a maximum of 27 AMA PRA Category Credit(s)TM Physicians should only claim
those credits commensurate with the extent of their participation in the activity.
College Cognate Credit(s)
The American College of Obstetricians and Gynecologists designates this live activity
for a maximum of 27 College Cognate Credit(s) toward the Program for Continuing
Professional Development for the Annual Clinical Meeting. The College has a
reciprocity agreement with the AMA that allows AMA PRA Category 1 CreditsTM to be
equivalent to College Cognate Credits.
Please refer to the Annual Clinical Meeting Final Program for an additional breakdown
of credits.
MN310
WHAT TODAY’S HEALTHCARE LANDSCAPE
MEANS TO YOUR PRACTICE
APRIL 28, 2014
ROBERT W. YELVERTON, MD
MCCORMICK PLACE LAKESIDE CENTER
CHICAGO, ILLINOIS
In accordance with ACOG policy, all planning
committee members and faculty have declared
any financial interests or other relationships
with industry relative to topics they will discuss.
This disclosure allows you to better evaluate the
scientific objectivity of the information
presented.
ACCME ACCREDITATION
AMA PRA CATEGORY 1 CREDIT(S)™
The American College of Obstetricians and Gynecologists designates this live
activity for a maximum of 27 AMA PRA Category Credit(s)TM Physicians
should only claim those credits commensurate with the extent of their
participation in the activity.
College Cognate Credit(s)
The American College of Obstetricians and Gynecologists designates this live
activity for a maximum of 27 College Cognate Credit(s) toward the Program
for Continuing Professional Development for the Annual Clinical Meeting.
The College has a reciprocity agreement with the AMA that allows AMA PRA
Category 1 CreditsTM to be equivalent to College Cognate Credits.
Please refer to the Annual Clinical Meeting Final Program for an additional
breakdown of credits.
Introduction of Speakers
• Robert W. Yelverton, MD
– Women’s Care Florida
– Tampa, Florida
• Dorimar Siverio-Minardi, MPH, MBA
– Women’s Care Florida
– Tampa, Florida
• Robert W. Yelverton, MD –This speaker has relevant financial
relationships with the following commercial interests: Speaker: Reckitt
Benckiser.
• Dorimar Siverio-Minardi, MPH, MBA – This speaker has no
conflicts of interest to disclose relative to the contents of this presentation.
Role of Course Director
The course director is responsible for:
• Selecting speakers.
• Reviewing the lecture content.
• Analyzing course content for potential
conflicts of interest.
Conflict of Interest
• Circumstances reflect a conflict of
interest when an individual has an
opportunity to affect CME about
products or services of a commercial
interest with which he/she has a
financial interest.
www.accme.org
If a Conflict of Interest is Determined,
the Course Director will:
• Resolve the issues pertaining to the
conflict of interest prior to the educational
meeting.
• If a conflict of interest becomes apparent
during the meeting, the Course Director
will resolve this issue during the meeting.
Evaluations
A course evaluation can be submitted once the
course has ended. Completion of the online
evaluation is mandatory in order to receive CME
credit for each course attended.
To obtain an official certificate, click on the Print
Certificate button AFTER completing evaluations
for all courses attended.
Any questions, contact College staff at
[email protected].
+
What Today’s
Landscape Means to
Your Practice
ACOG - MN310
April 28, 2014
Robert W. Yelverton, MD, District XII Chair, Course Director
Dorimar Siverio-Minardi, MPH, MBA
+
Conflicts of Interest
The faculty of this course disclose
no conflicts of interest
+
Contacts
Robert W. Yelverton, MD
The Yelverton Group LLC
ACOG Chair District XII Florida
Robert,[email protected]
Dorimar Siverio-Minardi, MPH, MBA
Women’s Care Florida, LLC
[email protected]
Agenda
+
 Welcome
 Objectives
 Introduction
 Background
 Current

– How We Got Here?
Status of Healthcare Reform
Insurance exchanges
 Current
Challenges for OB/GYN Practices
Reimbursement
 Information Management

 SCOPE
Certification
 Questions
+
& Answers
Objectives
At the end of this presentation, participants should be able
to:

Describe the current status of healthcare reform and the
impact of marketplace exchanges

Identify current challenges for OB/GYN medical practices

Discuss current practice and reimbursement models

Discuss anticipated changes in office-based care to
promote, enhance, and verify patient safety and quality
How we got here?
How we got here?
How we got here?
How we got here?
How we got here?
+
How we got here?
+
Medicare Part B Expenditures per
Service
13
Gulzar Natarajan, Dec. 2010
+ Share of under-65 population with
employer-sponsored insurance 20002011
Economic Policy Institute 2012
+
14
Towers Watson March 2014
+
+
Sources of health coverage for the
under-65 population 2000, 2007,
2011
Economic Policy Institute 2013
18
+
+
Gaps in Current System
 No
reward for outcomes/quality and cost savings
 Wide
practice variation
protocols
 Inadequate/inconsistent treatment plans
 Clinical
 Little
data exchange
hospital and physician
 Between payer and physician
 Between
 Limited
focus on wellness, prevention and education
 Lack
of incentives for patients to:
 Obtain preventive services
 Keep appointments
 Fill prescriptions
 Avoid high cost services (ER)
+
No Decrease in Decades in:
 Cerebral
palsy
 Brachial
Plexus Injury
 Maternal
 Preterm
Mortality
Birth
 Cesarean
Delivery Rate
Ranks 47th in Infant Mortality (2/3 is Perinatal
Mortality)
 USA
+
Current Environment
Health Care
Reform
Triple Aim
Primary Care
HEALTH CARE REFORM IS HERE
Access
WHAT’S A DOCTOR TO DO?
Pay for Performance
ACO
Medical Home
Bundled Payments
Health Information
Technology
Hospital Physician
Relations
Meaningful Use
+
Simplifying Health Care (PPACA)
It is about…
 Insurance
changes
mandate
 Individual
 Expanding
 Creation
Medicaid
of a Marketplace (Insurance Exchanges)
+
Healthcare Reform - PPACA
 For
individual and small group coverage on or after
1/1/2014:
 Insurance Exchanges
 No preexisting conditions
 Guarantee issue
 Guarantee renewability
 Essential health benefits
 Out of pocket maximum limits
 Premium tax credits – available based on
household income to assist in purchasing health
insurance
Healthcare Reform - PPACA
+
 Essential
Health Benefits:
patient services
 Emergency services
 Hospitalization
 Mental health and substance use
disorder services
 Rehabilitation services and devices
 Laboratory services
 Pediatric services, including oral and
vision
 Preventive and wellness services and
chronic disease management
 Maternity and newborn care
 Prescription drugs
 Ambulatory
+
PPACA – Woman’s Health Services
 58%
of women already have coverage
 Largest
barrier to coverage is affordability
+
PPACA – Woman’s Health Services
 Preventive
and wellness services
effective” prevention services as defined by
the U.S. Preventive Services Taskforce as an A or B
rating
 Certain immunizations
 1 annual well visit
 “highly
 Oral
Contraceptives
plan response: Coverage limitations (mostly
generics), quantity limits & authorization
requirements)
 Health
+
PPACA – Woman’s Health Services
 Maternity
and newborn care
benefit also for males
 Breastfeeding support
 Screening for HPV, STDs, gestational diabetes and
domestic violence
 Support services like treatment for postpartum
depression
 Essential
+
Healthcare Reform - Marketplace
 New
entity intended to create more organized and
competitive market for private health insurance
 Rules
regarding the offering and pricing
 Information
for consumers to better understand their
options


Covered services
Cost sharing
 Mechanism
 Moving
for electronic enrollment
towards portability of insurance
+
Healthcare Reform - Marketplace
Pros
 Expanded
Cons
coverage
protection
 Consistent benefits
 Focus on price
 Eases enrollment
process
 Future impact on
insurance portability
 Consumer
+
 Would
it be a cheaper
alternative?
 How will costs be
managed?
 Potential adverse
selection – mostly
high-risk individuals
will participate
 Higher Administrative
costs
32
Accountable Care Organization
Fairness in Profit Distribution
1. Performance
2. Equality
3. Systemic Disadvantage
4. Luck
5. Beyond Performance
JAMA 3/14/14
+
Healthcare Reform - Marketplace
 Individual
Mandate
M enrolled as
of 2/1/2014
 11.5% of those
eligible
 Penalties start in
2014
 3.3
 Employer
 Penalty
2015
Mandate
delayed to
+
Healthcare Reform – Marketplace

Goals:
Focus competition among plans on price and
minimize a plans tendency to change benefits to
attract healthier patients
 Reforming the insurance market
Same essential benefits for all

P
G
S
Higher Premium
B
Lower Premium
Metal levels are based on differences in cost-sharing and
out-of-pocket expenses
+
Healthcare Reform – Marketplace

Enrollment as of January 2014:
P
G
S
B
7%
13%
60%
20%
Source: Assistant Secretary for Planning and Evaluation - Office of Health Policy
+
Healthcare Reform - Marketplace
Source: Assistant Secretary for Planning and Evaluation - Office of Health Policy
Healthcare Reform - Marketplace
+
Source: Assistant Secretary for Planning and Evaluation - Office of Health Policy
+
Healthcare Reform - PPACA
 Medicaid
Expansion
all under 65 with income up to 138% FPL
 Package includes essential health benefits
 Supreme Court decision that it is up to the states to
implement Medicaid expansion
 As of January 2014
 26 States – Implementing expansion
 6 States - Open debate
 19 States - Not moving forward
 Florida – Opted out
 1.1 M would be eligible
 $51 B in funding over 10 years
 To
+
Healthcare Reform - PPACA
 Medicaid
Expansion - Issues
of the program
 Funding
 States will receive 100% federal funding for 2014
through 2016
 95% federal financing in 2017
 94% federal financing in 2018
 93% federal financing in 2019
 90% federal financing for 2020 and subsequent years
 Where are these funds coming from?
 More spending by the Medicaid population
 Access to care
 Transformation
+
Healthcare Reform - PPACA
 Medicaid
Expansion - Pros
for states programs
 More people will be covered
 State economic activity
 Protection for certain populations
 Mental health
 Funding
How we got here?
+
Healthcare companies rethink their role
1.
2.
2014 Top Healthcare Issues

Sutter Health in CA – HMO License

Walgreens – New concept stores
Start-ups being funded by corporate venture capital
Adopted from Pricewaterhouse Coopers, LLC - Healthcare Research Institute
+
2014 Top Healthcare Issues
Employers using exchanges as a way to offer coverage
3.
Increase in price transparency
4.
$400 M towards start ups in the transparency business

Employer steerage to more cost effective providers

Healthcare is going mobile
5.
Adopted from Pricewaterhouse Coopers, LLC - Healthcare Research Institute
+
2014 Top Healthcare Issues
Use of technology to define how medicine is practiced
6.
Population health management

Consumer insight on clinical trials
7.
New ways of getting insight

Pressure to be innovative
8.
Kaiser Permanente Garfield Innovation Center

9.
Medicaid Expansion
10.
Pharmaceutical supply chain security

Eliminating counterfeit medications in the drug
supply chain
Adopted from Pricewaterhouse Coopers, LLC - Healthcare Research Institute
+
Current Challenges - Reimbursement
“Health industry organizations that don’t measure up on
new metrics will be penalized”
PwC Health Research Institute

Employers are demanding performance

Physicians will be:
 Paid for value/outcomes
 Penalized for not accomplishing value/outcomes

2015 – Medicare - Penalties scheduled to start for
hospitals
New Trends Will Change the
Business Model
+
Focus on Quality
& Value
•
•
•
•
Payment Reform
• Pay for value/outcomes
• Providers bear more financial risk in order to attain
savings with managing patients
Aging Population
• Larger percentage of hospital based comprise of
Medicare patients, impacting reimbursement
Medicaid Expansion
Increase in
insured
population
Demonstration of value
Increased transparency
More clinical and administrative standards
Focus on primary care
• Economic landscape
• Health Reform – Increased enrollment
• Will individual mandate increase number of insured?
+
Paid for Value
Quality
Satisfaction
Cost
Value = Q/C
+
Current Practice Models
Independent
Practice
• Solo / Small
• Large Group
Hospital Owned
• Physicians as employees
Integrated
Delivery System
• Hospitals / Physicians / Other Ancillaries (Lab,
Radiology)
• Physicians as employees
Patient Centered
Medical Home
ACO
• Patient belongs to a physician managed home that
coordinates integrated care
• Independent multi-specialty / primary care focus group
or hospital affiliated
• Patient belongs to an ACO including physicians,
hospitals and other providers that coordinate
integrated care
+
Challenges – Reimbursement
OB/GYN Traditional Payer Mix
9%
Commercial
10%
Medicaid & Medicare
Other
81%
Independent Practice
Reimbursement Challenges
+

Fee for service
Value = Q/C
 Rewards volume not value
 How are you going to get paid in the future?
 Can you accommodate those models?
 How do you maximize the model?

Sustainable Growth Rate (SGR)
 Medicare fee schedule
 Reductions

Shift on payer mix
 More Medicaid and Medicare
 Less fee for service / private insurance
 Competition - Alternatives available
Hospital Employment
(all specialties)
+
5%
Private
Employee
42%
53%
Source: American Medical Association 2013
Independent
Contractor
+
Hospital Employment for OB/GYN
+
Employed Physicians
Reimbursement Challenges
 Top
4 challenges (Medscape 2013)
decision making authority
 Not being able to make hiring decisions
 Loss control over billing and charge coding
 New equipment and facilities requirement
 Administrator
Employed Physicians
Reimbursement Challenges
+
 With
salaries ranging between $465,000 to $715,000
(2010 MGMA), how do you make decisions?

More emphasis on primary care specialties
 More
emphasis on value not productivity with
performance scorecards determining salary and bonuses
 Productivity
 Required

to take roles in administration
Is there compensation for this?
 Other

– how are RVUs determine?
considerations
Contractual relationship
+
Sample Scorecard
+
Reimbursement Challenges
Other Models
 Need
for increased partnership
Physicians & hospitals
 Physicians and health plans

 Patient

centered medical home or ACO affiliation
Capitation or shared savings model
 Less utilization and volume rewarded?
 Controlled access?
 Is quality being sacrificed?
 Transparency

Patient Cost Estimators
 Narrow
networks
+
Reimbursement Challenges
Other Models
 Increased
costs in administration
a health plan to control cost
 Authorizations and referrals
 From
 Penalties
 For
failure to meet government mandates
 eRx
 ICD-10
conversation
payment
 Implementation issues
 Denied
+
Reimbursement Challenges
Other Models
 Increase
 More
 Bad
volume?
are covered
debt?
patients paying their share?
 Are
+
Marketplace
Reimbursement Challenges
 Marketplace
 Eligibility
issues
grace period
 Reimbursement issues
 Typically placed on lower paid networks
 Exclusion issues
 Narrow networks
 Increased administrative costs
 Authorizations, referrals & formularies
 90-day
+
Challenges – Reimbursement
 The
Future
payments for services
 Episode of care - (providers paid to treat a specific
condition over a period of time)
 Physician Quality Reporting System
 Shared savings programs
 Bundled
+ Challenges – Information Management
 Little
data exchange
hospital and physician
 Between payer and physician
 Between
 Lack
of expertise and IT resources in practices
 Fractionated
 Immature
 Variety
and volatile supplier market
solutions
of specialty-specific needs
 Perceived
cost-barrier
 Requires
behavior change for optimal workflow
integration
+ Challenges – Information Management

Electronic Health Record facilitates:



Decision support

Evidence-based medicine

Order entry / sets
Safety

Alerts (ex. contraindications)

Documentation
Communication / coordination

Remote connectivity


Safety Issue – having information at point of
decision
Connectivity with other providers and hospitals
+ Challenges – Information Management

Electronic Health Record are not being used to their
full capacity

Need for optimization

Issues:

Data entry

Inability to exchange information

Lack of support

Lack of analytics expertise
+ Challenges – Information Management
 Does the support infrastructure exist?
 Does your organization have the necessary skills
and capabilities?
 Necessary implementation roles?
 Have you identified any 3rd party vendors?
 Have you considered physician retention and
relationships?
Policies and procedures?
Workflow changes?
Rollout strategy?
Training needs?
Financial support?
How would ROI be measured?
What success benchmarks will be used?







+ Challenges – Information Management

Lack of measurement

Outcomes

Cost

Access

Wait time

Time to next available appointment

No-show rate

Cancellation rate
+ Challenges – Information Management
 Need
or data to achieve incentives:
Use
 Pay for Performance / Pay for Quality
 Accountable Care – Shared savings
 Patient centered medical home
 Population health / patient registries
 Chronic disease management
 Meaningful
+ Challenges – Information Management
 Meaningful
Use – Stage 1 - Data Capture and Access
way of capturing information
 Using information to track critical conditions
 Care coordination
 Quality measure reporting
 Patient engagement
 Standardized
Issues:
 Adoption
of clinical-evidence based guidelines
 System
 Data
collection and analytics
 Reporting
structure
+ Challenges – Information Management
 Meaningful
Use – Stage 1 - Data Capture and Access
 Demographics
 Vital
signs
lists
 Problem
 eRx
 Medication
list
quality metrics (3)
 Clinical records
 Clinical summaries
 Clinical
+ Challenges – Information Management
 PQRS
 Breast
cancer screening
cancer screening
 Chlamydia screening
 Osteoporosis management
 Urinary incontinence
 Cervical
Issues:
 Adoption
 Data
of clinical-evidence based guidelines
collection and analytics
 Reporting
structure
+
Challenges – Information Management
 Lack

Patient connectivity
Laboratory results
 Registration
 Message
on including requests for prescription
refills and appointments
 Ask general questions to clinical and administrative
staff
 Obtain education materials
 Pay their bill
+
Challenges – Information Management
 Smartphone
 Document
 PM
 A/P,
apps
image management
and RCM (clearinghouse services plus)
G/L, P/R
 Voice
recognition
 Disease
 Nurse
management registries
call documentation
 Interactive
practice web services and patient portals
+
Women Health Safety Certification for Outpatient Practice
Excellence Program
SCOPE
+
73
Objectives
At the end of this presentation,
participants should be able to:
 Identify
the components of safety and
quality as it applies to ambulatory
settings
 Discuss
the process for Safety
Certification for Outpatient Practice
Excellence (SCOPE)
ACOG Patient Safety and Quality Improvement
+ Focus on Office Safety: Part of a
Long history of Safety and
Quality initiatives in Ob/Gyn
 Begun
under ACOG presidency of Dr. Douglas
Kirkpatrick
 Response
to increasing movement of surgical
procedures into the office setting
 Presidential
Task Force convened in 2008
ACOG Patient Safety and Quality Improvement
+
Release of Task Force
Report
ACOG Patient Safety and Quality Improvement
+
Areas Addressed
 Office
Medical Director
 Time-outs
 Mock
and checklists
drills
 Policy
and Procedure manual
 Anesthesia
and ability to rescue
 Credentialing
, privileging and accreditation
ACOG Patient Safety and Quality Improvement
+
Office Surgery Checklist
ACOG Patient Safety and Quality Improvement
+
Office Patient Safety
Assessment (OPSA)
 OPSA
workgroup formed April 2009
 Create
an evaluation tool for assessing patient
safety in office-based women’s healthcare
 Recommend
ways to collect data from ACOG
Fellows
 OPSA
self-assessment survey
ACOG Patient Safety and Quality Improvement
+
Office Patient Safety Assessment
(OPSA)
 The
OPSA Workgroup:
current office practice patient safety
self assessments
 Developed an obstetrician-gynecologistspecific self assessment tool for the evaluation
of office-based care
 Discussed how this assessment tool would be
marketed and distributed among Fellows.
 Made recommendations concerning the
collection of data and its use in benchmarking.
 Reviewed
ACOG Patient Safety and Quality Improvement
+
OPSA Survey Results
 Approximately
80 responses received from February
‘10 through January ‘11
 Included responses from all ACOG Districts
 The
self-assessment survey is still available to
Fellows to complete and analyzing 2011 now.
 Participants
receive:
report of practice responses, with
comparisons to national results
 Recommendations for improving care with reference to
ACOG and non-ACOG resources
 Customized
ACOG Patient Safety and Quality Improvement
+
National Results
 Areas
for possible improvement
of surgical privileges and monitoring
competency (41% compliance)
 Quarterly drills for emergency response to untoward
events (39% compliance)
 Logging of dispensed medication samples (43%
compliance)
 Tracking whether patients referred to other physicians
were actually seen and a report received (43%
compliance)
 Granting
ACOG Patient Safety and Quality Improvement
+
Evolution
 Using
what was learned both from the
Presidential Task Force on Patient Safety in
the Office Setting and the OPSA survey, the
Safety Certification in Outpatient Practice
Excellence for Women’s Health (SCOPE)
was created.
+

Developed to evaluate and certify high-quality,
safe women's health care processes in the
outpatient setting.

NOT JUST FOR outpatient surgery! ANY
women’s health office setting.

Two‐step process: Application with data
submitted and Site Review to document Quality
and safety measures in practice
+
ACOG ahead of the group!

ACOG SCOPE:

1/9/2012 AMA “widespread patient safety problems in
ambulatory care such as incorrect prescribing, misdiagnosis,
and poor communication”

NQF action to expand its serious-reportable events list to cover
office-based settings
+
 A CONGRESS
activity (allows certifying function)
 Falls
within Division of Women’s Health but
crossover to Practice
 Application
includes demographics similar to OPSA
application
 WEBSITE:
www.scopeforwomenshealth.org
+
SCOPE – What?
 Launched
by ACOG Pilot Stage 2011
 1st
Women’s Health Focused Safety & Quality
Certification Program
 Participation
is Voluntary
 Assists
OB-GYN’s in Instituting Processes
Specific to their Individual Setting and Needs
 Gives Assurance
to OB-GYN’s that their
Ambulatory Setting is Operating in Line with
Current Safety Criteria
+
SCOPE - Why?
 70
Million OB-GYN Visits Occurring Each Year
 30%
Gynecological Surgeries now Preformed in
the Office Setting
 Hysteroscopy,
Transvaginal Tubal Sterilization,
Global Endometrial Ablation, LEEP
 Adverse
Office
Incidents 10x More Likely to Occur in
+
SCOPE - How?
 Voluntary
 Specific
for OB-GYN Office Practice
 Practices
Request a Survey
 SCOPE
Sends Request for Information
of Practice
 Provider Information
 Written Policies and Procedure on Safety
Measures & Procedures within Practice
 Characteristics
+
SCOPE - How?
 Submitted
 Site
Information Reviewed
Visit Follows
 Certification
 Suggestions
+
Opportunities for Improvement
SCOPE - Why?
 Improves
Office Safety & Quality by Verifying
Gaps
 Allows
ACOG to Set the Standard for Patient
Safety in Women’s Health
 Will
Highlight practice in Value Added
Reimbursement Strategies
 Will
provide personal practice recommendation
letter to health and liability insurer on request.
+
SCOPE - Certifications
 Written Application
 Request
 Site
Visit
 Post
Site Visit Evaluation
 Report
 Full
to Provide Documents
on Certification Status
Summary on Status of Safety Evaluation
 Opportunities
+
for Improvement
SCOPE - General Standards
 Medical
 Written
Director Appointed & Identified
Safety Manual with Safety Goals
 Documented
Safety Training for all Office
Personnel
 On
Going Safety Drills Quarterly
 Documentation
of Regular Staff Meeting on
Clinical Matters and Safety
 Scope
of Practice Competency & Maintenance
+
SCOPE - Related to Medications
 Verbal
Orders Repeated Back
 Double
Confirmation of Patients Identity
 Double
Check all Injections, Medications
 List
 Up
“Do Not Use” Abbreviations
to Date List of Medications
+
SCOPE

Related to Medications

E-Prescribing

Accurate List of Allergies

Double Identification of Patient before Injection
or Immunization

Drug Expiration Date Check

Medical Sample Log
SCOPE - Related to Office-based
Surgery
+
 Informed
 Pre-Op
Consent
Pregnancy Status
 Escort
Driver
 Check
List/ Time Out
 Written
 ASA
Post-op Instructions
Class 1 & 2 Only
 Equipment
 Staff
Training Checklist
 Availability
+
Check Logs
of Emergency Cart
The Future OB-GYN Practice
 Flexible
 Less
Design
Waiting Room
 Check-in
Replaced with Kiosks, Finger Scanned
Ins.
 Patient
Paged Silently from remote sight
when care giver is ready to see patient
 Records
System all Digital with connectivity to
the remainder of integrated organization and
beyond.
+
The Future OB-GYN Practice
 Virtual
Office Visits/Telemedicine Technology
 Replacement
 Routine
of the Routine Pelvic Exam ?
Endovaginal Sonography for Wellness
Exam?
 Same
Day Diagnostic Sonography
 Design
+
of the Future Office
The Future OB-GYN Practice
 Patient-Centric
 Same
Day Appointment as standard option
 Evening
and Weekend Hours
 Routine
Remote Medicine E-mail; telemedicine
 Future
of Hospitalists- Laborist
+
Contacts
Robert W. Yelverton, MD
The Yelverton Group LLC
ACOG Chair District XII Florida
Robert,[email protected]
Dorimar Siverio-Minardi, MPH, MBA
Women’s Care Florida, LLC
[email protected]
+
Questions & Answers
UPCOMING COLLEGE FREESTANDING POSTGRADUATE COURSES
2014
December 4-6
Update on Cervical Diseases
Mark Spitzer, MD
The Sheraton Times Square
New York, New York
December 11-13
Practical Obstetrics and Gynecology
Patrick Duff, MD
Hyatt Regency Chicago
Chicago, Illinois