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As an FQHC our midlevel providers have to forward a percentage of their visit notes to a supervising physician. Unfortunately, we have not found a way to be able to track if this is being done in CPS. What are some of the ways other clinics are able to track this? Thank you.
Posted : January 4, 2017 5:18 am
We have some of the items (document types) set to require additional signatures. Then in the contribution log, it will track this also in the document, it will show two signatures.
Posted : January 4, 2017 5:23 am
Just thinking about this, but could you write a Crystal Report to:
find all office visits where a mid-level (by user name or role) was responsible provider
then look thru the DOCCONTB file (in EMR) for CONTB-ACTION = 6 (initial signature) or 7 (final signature) or 8 (additional signature). set these up in columns so you can scan then list to see every office visit and if any of those codes were utilized. Output could be something like below. (If you get that far, then you have all needed data, just need to work on columns and logic to compute percents and such).
Jane Doe, 1/1/17, Betty Boop NP, 6 on 1/1/17, 7 on 1/1/17
John Doe, 1/2/17, Betty Boop NP, 6 on 1/1/17
Posted : January 4, 2017 7:08 am
Topic starter
Thank you for your responses. We will look into them. But, if anyone has anymore ideas, please pass them along. Thanks!
Posted : January 5, 2017 12:39 pm
Pamela,
we have a similar requirement and I'll provide three different options on how you might address it depending on your scenario.
Option 1 - Based on visit number for a certain time period (this only works if you see a specific patient a certain number of times in a year)
Our group's specialty is Endocrinology and all of our mid-levels see diabetic patients. The diabetic patients are generally seen 3-4 times a year. The requirement is for no less than 25% of the mid-level's notes to be sent to the physician for review. When the mid-level starts an encounter, they put a number at the end of the document summary identifying what number of visit this is for that patient within the past year (e.g. Office Visit - Diabetic Followup (1), Office Visit - Diabetic Followup (2), etc.)
Once they get up to the 3rd visit, they route that note to the physician and the process starts all over again for that patient. (i.e. the next time that patient comes in, they see the previous document's summary ends in (3) so they know the previous note was routed to the physician. We have them reset after the third note rather than the fourth to ensure we have the "wiggle room" to meet the 25% target.
Option 2 - Track on the mid-level's schedule
You might consider having your scheduling team trained to review the mid-level schedules a few days in advance and ensure that the provider has an appropriate number of appointments for that day that are "flagged" in some way so that the mid-level knows that encounter notes for those appointments need to be routed for review. There are a number of ways to flag these visits: you could include a note in the appointment record or consider setting up another appointment type e.g. "Follow-up (Review Required)". Appointments requiring notes to be reviewed could then show up as a separate color on the provider's schedule giving them a visual indication that the note needed to be forwarded to the physician for review.
Option 3 - Track programmatically
This solution would require some fancy coding but it is certainly doable. You could write some data to a file or unused OBS term so that you could proactively alert the provider (with a pop-up box) that they needed to route the note to a provider for review.
As already suggested, creating a custom report to monitor compliance would be a good idea too. This will give you some governance over the process so that you can make adjustments as necessary.
Hope this helps,
GK
Posted : January 6, 2017 4:03 am
Topic starter
Thank you, these are more options we can consider.
Posted : January 6, 2017 9:26 am
