Know Your Colon:
CRC Screening
CRC Screening
Gut Instincts:
CRC Facts
CRC Facts
Consistency Counts:
Standard Work
Standard Work
Eyes on Diabetes:
Retinal Screening
Retinal Screening
Glucometer Games:
A1c all the time
A1c all the time
100
Name three screening options for Colorectal Cancer.
Colonoscopy, iFOBT (stool kit), Cologuard.
Note: We now have Spanish stool kits in all clinical areas! We noticed that our Spanish speaking patients are less likely to have had their CRC screening done.
Also, all of these can satisfy the QM tab when labeled properly!
100
Colorectal Cancer is the ____ leading cause of cancer related death in the US (combined men and women)?
Bonus: What is the first?
2nd
Bonus: Lung Cancer
100
How often should we ask a patient if they smoke and fill out the social history?
Every visit!
Former smokers often relapse and need to be updated as current smokers. Pack years change over time so we need to update it frequently. The QM tab only shows the LDCT if we update pack years.
100
Diabetes Retinal Screening shows due on the QM tab at a patient visit. What should the MA do?
1. Ask the patient if they have seen their eye doctor in 2025. If yes, get the records and document in the A&P.
2. If no, encourage them to schedule a full eye exam, AND ask if they would be willing to schedule with our retinal screening clinic.
3. If they agree to the clinic, put in the QM order, and the provider signs the order. Add to the checkout slip. This way if the patient does not stop at check-out, they can be outreached to schedule.
100
What happens in insurance land if a patient has not had an A1c in the calendar year?
They consider the A1c to be over 9% and this counts negatively against us.
200
At what age do we start screening for Colorectal Cancer?
45 years old, unless the patient has other risk factors such as family history.
Note: If we order a colonoscopy at this point in the year, the patient will not be scheduled until 2026. Consider ordering a stool kit now while they are waiting for the colonoscopy in 2026.
200
Of our four cancer screenings (LDCT, CRC, Breast, Cervical), which two are early detection and which two are considered cancer prevention?
Cancer prevention - cervical cancer screening, colorectal cancer screening
Early detection saves lives also! Breast cancer screening, LDCT screening
200
What should the Medical Assistant or provider do if a patient declines a test or QM item?
Use the ".decline" macros and document IN THE NOTE! We put in the QM tab order - and close out the actual test order, while documenting under the diagnosis section.
We cannot just document in the QM tab. This does not carry over to the note or the patient care summary. The macros have the appropriate language that we recommended a test and the patient understands the risks of declining. We honor their decision to decline - AND it is our responsibility to make sure they understand what they are declining.
200
What percent of patients with diabetes will have retinopathy in their eyes over their lifetime?
Nearly 50%
This is the leading cause of blindness in the US in working aged adults, and there are treatments!
200
Name three complications that diabetes is associated with?
Eye - retinopathy, glaucoma, cataract
Kidney disease
Vascular - heart disease, stroke, peripheral arterial disease
Erectile Dysfunction
Dementia
Infection
300
How does a Cologuard test (FIT-DNA) differ from a iFOBT test (stool kit)?
Bonus points: How frequent is a Cologuard test compared to a iFOBT test?
The Cologuard tests for blood in the stool like the iFOBT, but it also tests for altered DNA.
Bonus: 3 years versus 1 year
300
What is the survival rate of CRC when detected early (stage 1)?
50%
75%
90%
90% 5 year survival rate - early detection matters and SAVES LIVES!
300
If a patient tells me that they had a screening test done, where do I mark this in the chart and what are my next steps?
The QM tab does not carry over to patient notes, care summaries, or insurance companies. The best place to document information is in the note under the screening diagnosis (and NOT just the QM tab).
The next step is to request the document. We cannot just note the test was done - we need the report! Physician Gateway and PVIX are great places to find these tests.
Putting in a patient case to remind yourself later is most effective!
300
Why is it so important that we get records from the patient's eye doctor showing that they have had an exam?
Many patients have an eye care insurance that is separate from their medical insurance. Therefore, the medical insurance requires the screening but does not know it was done. We submit the eye exams directly to the insurance. This is one of our quality measures for our risk contracts. Please get records when the patient says they say their eye doctor!
300
Which two CGMs are insurance covering the most now?
Dexcom G7 and Freestyle Libre 3 PLUS
If starting on a new CGM, these are the two we should choose from.
Reasons for coverage: needle phobia, dexterity issues from retinopathy or neuropathy, vision issues, frequent insulin use, hypoglycemia, frequent medication dose adjustments. Some commercial insurance covers for just having diabetes.
400
What is the next step when a patient has a positive stool kit?
We recommend a colonoscopy to evaluate for high grade pre-cancerous polyps or cancer. Use the order set called "Occult blood" which is marked a stat referral.
Consider if the patient has any symptoms that need to be evaluated sooner, or if you should order labs to look for anemia.
400
Name three risk factors for Colorectal Cancer.
1. Age
2. Family history
3. Obesity
4. Lifestyle - lack of exercise, red meat and processed meats, alcohol use, low fiber diet
5. Smoking
6. Inflammatory Bowel Disease - Crohn's, Ulcerative Colitis
400
Name the items on the QM tab that the Medical Assistant is responsible for queuing into the chart during an office visit?
ALL of them!
Diabetes - Retinal Screen order, POC A1c if due, get a urine in the clinic if due for a microalbumin, set up diabetic foot exam
Vaccines
Hep C Screening
Bone Density
Cancer Screening - LDCT order, mammogram, pap smear, CRC screening
400
Which ONE diagnosis prevents a patient from getting their retinal screening with us?
Significant cataracts block the view of the retina on our camera.
Patients with mild retinopathy, glaucoma, and other eye conditions can still have the screening the majority of the time.
400
When a patient is in the office for a visit and has not had an A1c in the last six months, what is the best next step?
A POC A1c!
The goal is 100% of patients who are due for an A1c have them when in the office. Often times we send them to the lab and they do not go - the lab is busy, closed or the patient is in a rush. It is also more work to discuss labs after the visit rather than in the visit.
500
Why do we prefer the iFOBT (fecal occult blood test) compared to the Cologuard test?
1. Cologuard is much more expensive (around $500-$600 compared to $15 for stool kit). This is part of VMG's commitment to help control the costs of healthcare.
2. Cologuard results in more false positive tests, which means more unnecessary follow up colonoscopies and stress for the patient.
If it is the only test the patient will do, it is the best test for that patient!
500
Name some factors that studies have shown lead to lower colorectal cancer screening uptake?
Lower socioeconomic status - time, fear of medical bills, focus on other stressful life factors
Belief that they are not at risk
Smoking
Patients of color
Lack of recommendation/encouragement by their PCP - if a patient continues to not return their stool kit, we need to discuss it with them.
Lack of reminders by their PCP office (this is why we keep reminding patients!)
500
How does a "standard work" approach help improve health equity?
This removes any bias from the process, where providers or MAs decide who they should discuss each measure with, and which patients will consent or find it important (implicit or explicit bias). ALL patients are offered ALL screenings and exams equally.
500
Which patients with diabetes can have SAME DAY retinal screening in our clinic?
Medicare patients
Patients with commerical insurance need to have the exam done on a separate day from a family practice visit. Consider bundling the visit with a lab, specialty, radiology service to encourage attendance.
500
Which patients with diabetes should have a glucometer at home and know how to use it?
All of them!
Any patient on any medication for treatment of diabetes has some small risk at least of hypoglycemia. It is best for a patient to know how to use the glucometer so they can test when having symptoms, even if you are not having them regularly monitor their glucose.
Hypoglycemia and insulin use is a leading cause of ER visits in the U.S. This medication is high risk!