Blood Pressure
145/90
Non Compliant Blood Pressure reading
Where is a resource to help with discharge summaries and other information
MD Portals
The provider has taken the patient off this and all other medications in the measure.
Medication Discontinued
what A1C level is considered non compliant and needs rechecked
>9%
If a Patient has moved/changed PCP what do you do?
Status Override
Bp is to be completed annually, If completed multiple times during the year- which test will inform compliance
the last most recent Blood pressure reading result
If a pt is in hospital/SNF what do you do?
snooze the task
When a Med Adh reopens, what should be your first step?
Call the Pharmacy
Blanket quality measures to get ahead of the chase
What is Proxy Quality?
what was Diamond so excided in a recent morning huddle?
TOC
You have 2 blood pressure readings at same visit date due to being elevated, diastolic is high on 1st reading and systolic is high on 2nd reading. What do you do?
take the lowest diastolic number and lowest systolic number of each reading even if they were taken at different times as long as it is done on the same day
1- Called Patient
2- Discharge Summary
3- Called Facility
Placed call to pt pharmacy, last med was filled was on April 10,2025 and is due for renewal. Nav. will have to navigate convo with Provider.
New Measure Note
what two test have to be completed to close the gap, does not have to be completed at the same visit but completed within the year
uACR & eGFR
during a functional status assessment over the phone what 5 things do you address?
do you need any help with:
1. Walking 2. Dressing
3. Eating 4. Bathing
5. Getting in and out of chair
Exclusions Controlling B/P?
ESRD, Dialysis, Nephrectomy, or Kidney transplant AND/OR patients with a diagnosis of pregnancy, hospice, patients who receive palliative services or expire during the measurement year.
How and where do you find the information on what is needed to close the TOC successfully
Put your mouse over the payer: (insurance plan) on the top right of the task.
What does it mean when a medication is grayed out at the bottom of the patients profile.
The claim was reversed, Pharmacy sent the claim to the insurance and then when the patient didn't pick it up they took the claim back.
What are the two new measures this year for quality?
COB - Concurrent use of Opioids and Benzodiazepines and Poly-ACH - Polypharmacy-Use of Multiple Anticholinergics Medications in Older Adults
How often does a DEE need to be done if a patient had retinopathy the prior year?
Once a year
If a patient has a non compliant reading can you retake the patients B/P
Clinical Staff can
Task will auto expire and close as a "lost" after how many calendar days have passed
30 days
This action will populate prompts to understand the root cause of the surplus and work with the patient to establish a plan to establish a routine.
Patient Refused: Surplus unknown
6 Months
How long does the provider have after a fall to order a DEXA Scan?
What are Main Street core Values
Love people, Purse the best, Have fun and decide with data