Clinic Offerings
Describe the type of patient who would be a good candidate for a behavioral health referral in the clinic?
Who is in charge of this?
How do you place the order?
Mild-moderate anxiety, depression
Marie White primarily but team also includes a psychiatrist and the clinic social worker Drew also helps out.
Ambulatory referral to behavioral health - collaborative care
Who attends IDRs?
What are the key points to cover? (need at least 3)
Attended by Charge Nurse, the Case Manager, a doctor, the bedside RN, and (optional)-- often an nurse leader (CNL), plus occasionally a pharmacist
1. brief reason for admission
2. brief plan for day
3. likely day and time of discharge
4. discharge destination and needs
You are planning to send your AIM clinic patient to rheumatology for closer follow up of their scleroderma. Describe, in detail, how you place that order in Epic.
(Hint: Include who "owns" the referral panel, and how you find them.)
Follow user "Joshua Gladieux"
"Rheumatology referral panel"
Then Select Location
What is a chart review?
How many does each resident class need?
TY: 6 inpatient chart reviews
PGY 1: 5 inpatient chart reviews, 5 outpatient chart reviews (2 of the 5 can be peer reviews)
PGY 2 and PGY 3: 5 chart reviews (can be inpatient or outpatient, 2 can be peer reviews)
A patient knows they want to enroll in hospice and you believe they will qualify (live less than 6 months). Who do you consult to help set it up?
Social work
What is the MSK clinic?
Describe who runs it, how often, where it's located, and what type of procedures do we perform in the MSK clinic?
Patients with specific MSK complaints
Thursdays with Dr. Dean. One resident seeing these patients specifically.
We do knee and shoulder steroid injections and ultrasound. Can also inject for hip bursa, carpal tunnel, and trigger finger.
(we do NOT do back or intraarticular hip injections)
What do these acronyms stand for, and more importantly, what does each really MEAN?
a. subacute rehab
b. skilled nursing facility
c. long term acute care
d. inpatient rehab
What needs to be fulfilled to bill a TOC 7?
What needs to be billed for a TOC 14?
For hospital follow ups - TOC 7: Adrienne Rosa needs to contact within 2 business days. We also need to document high medical complexity. Patient needs to be seen within 7 days
TOC 14 seen within 14 days.
*We do not do these for ED visits (have to be admitted).
What is a CEX? How many does each year need? How do you get them?
TY: 6
All categoricals: 10/yr
Request attending to fill one out for you in New Innovations right after the encounter. Can be based on communication or physical exam skills.
What are three ongoing quality improvement initiatives in clinic? (Hint: not cancer screenings)
hypertension, osteoporosis, HCC/OPA, continuity
Your patient wants to learn more about how to lower their cholesterol, so you would like to refer them to the Lifestyle Medicine clinic.
Describe how to get them scheduled.
In the Wrap Up - where you put your regular follow up, also put follow up with LSM. Communicate this at the front desk when checking patient out as well.
(this is NOT a referral order)3 things that case managers help with?
Price checks (DOACs, Lovenox, SGLT-2 inhibitors, Insulin, and other expensive medications)
Placement at other facilities (SNF/SAR, Select Specialties, IPR)
Arranges homecare IV antibiotics, Home PT/OT/nursing, Home equipment delivery, Home Oxygen
They (or their designee) can help make PCP appointments
Name at least 2 GLP 1 for weight loss and 2 GLP 1 for diabetes
1. Terzepatide: weight loss - Zepbound, T2D - Mounjaro
2. Semaglutide: weight loss - Wegovy, T2D - Ozempic
3. Liraglutide: weight loss - Saxenda, T2D - Victoza
4. Dulaglutide: T2D - Trulicity
When can you not take a wellness day?
How do you request a wellness day?
On service, when scheduled for clinic patients, right before/after vacation or holiday
Email one of the chiefs at least 1 week in advance.
What is one document that needs to be signed by the attending at a MWV?
What is one document to reference what the physician responsibilities are for MWV?
Can a visit be converted to a MWV by the MA if they notice a patient is due?
Patient questionnaire
MWV Checklist
Yes
What is the SMA clinic?
Describe what it's for in AIM, who runs it, who attends.
Shared medical appointment (group visit)
Specifically for diabetes in our office, run by Dr. Burman
Multiple patients are seen as a group -- voluntary, secure, interactive
Improves access to physicians (more time)
Interdisciplinary counseling (our SW Drew attends)
Opportunity for patients to share experiences and advice
What is Select and who should we consider sending there?
Select Specialty Hospital is an LTAC
Should send patients who are trach/vent dependent who are stable but need some additional hospital need that can't be done at a SNF (trach weaning)
What is the meaning of "collaborative care team" in AIM and who are the members?
Marie White - Behavioral Health
Drew Lewis - (Andrew Lewis) - Social Work
Adrienne Rosa - Care Management
Sarah Guy - Financial Assistance
What is the process for reimbursement?
What do you need to include if this is for your educational fund?
- Email your receipt to Rolanda Jackson
- MUST include 1 sentence about rationale for why it improves your education (ex: I plan to use this reference material to study physical exam techniques or use this laptop to access board study questions)
- Do NOT submit it yourself in Workday
How do you arrange for an away rotation?
Request it on your schedule request form prior to the new academic year
Chief blocks off time for you to be away on the master schedule
Then you contact hospitals and request they accommodate you for the dates you got
Email Rolanda for the forms to be filled out on both the Trinity side and that the accepting institution may need
You saw a patient in clinic and developed a good rapport with them. They haven't seen their assigned PCP in over 8 months.
Describe the steps to make sure they see you again in clinic, so you can improve your continuity %.
-Add yourself as the PCP
-Know when you'll be back in clinic for continuity or intensive AIM
-Walk with patient up to front desk
-Give front desk staff the folder
-"Please schedule them with me in about 4-5 weeks, I have 2 clinic days on Feb 1 and Feb 7 coming up."
What is a first fill SAR? What happens to the discharge med rec when they are first fill?
Towers will fill a 3-day supply of all of the medications a patient is on (new and old), and will be sent with patient when they go to their SAR. Need to have discharge in 2 hours early. It un-reconciles the med rec when Towers is in filling the medications.
What is "Pod E"?
P IHAHS Panel Coordinator Pod (E) can be a tool in AIM to help follow up on patient results from outside systems. Examples include: pap smear results, eye exams, colonoscopy results, prior hysterectomy....
Also, please route pap smear results to them this pod as they help us update our "Pap Tracker"
How many safety activities do you need per year, and how do you get credit for it?
Name 2 activity types that you can log.
2/yr, log in New Innovations (Portfolio -> Journals)
Examples
- Attending RCA
- Code blue debrief
- Learning from defects
- Placing a MIDAS report
- Giving an M&M (PGY-3s)
- Readmissions discussion
- Attend quality/safety meeting with an attending (ethics committee, Code blue CPT, infection prevention CPT, etc).
What is a 5th level benefit?
What clue in the social history should have you consider it?
Some private insurances cover a higher level of hospice care. This can mean room/board in a hospice facility.
Social history: employees of the Detroit auto makers such as Ford, GM, and Chrysler often have this benefit