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May 29, 2009 – Jill Wooldridge P.A.-C. Boynton Health Service, University of Minnesota, Minneapolis, MN
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May 29, 2009 – Jill Wooldridge P.A.-C. Boynton Health Service, University of Minnesota, Minneapolis, MN.

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Page 1: May 29, 2009 – Jill Wooldridge P.A.-C. Boynton Health Service, University of Minnesota, Minneapolis, MN.

May 29, 2009 – Jill Wooldridge P.A.-C.

Boynton Health Service, University of Minnesota, Minneapolis, MN

Page 2: May 29, 2009 – Jill Wooldridge P.A.-C. Boynton Health Service, University of Minnesota, Minneapolis, MN.

Topics to be Covered: Define Convenience Care How we came to develop/improve Gopher

Quick Clinic How Gopher Quick Clinic Functions Display data about utilization of GQC Impact on Providers, Primary Care, Urgent

Care Financial Impact Future Considerations and Plans Challenges to the Model

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Page 3: May 29, 2009 – Jill Wooldridge P.A.-C. Boynton Health Service, University of Minnesota, Minneapolis, MN.

“CONVENIENCE CARE”WHAT IS IT?

Provides care for Minor Acute Illness (strep throat screens, bladder infections, sinus infections, warts, impetigo etc.), some basic vaccinations and basic testing.

A Walk-in patient centered model usually staffed by Advance Practice Clinicians.

Patients evaluate their own needs and pick care time that is convenient to their schedule.

One Stop Care. Total patient interaction is in one location and usually a single face-to-face interaction with a single Clinician.

Since the first Convenient Care clinics opened in 2000, the industry has grown quickly – today approximately 1,200 such clinics are in operation (many in retail locations)

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Page 4: May 29, 2009 – Jill Wooldridge P.A.-C. Boynton Health Service, University of Minnesota, Minneapolis, MN.

HOW WAS THE BOYNTON PROJECT IDENTIFIED?

An effort to support the University’s strategic mission to improve services to the student population.

Community trends and patient expectations for more choice and control over how they access care – and Boynton’s and University Human Resources’ desire to meet these.

An identified internal challenge in our current Urgent Care model to optimally serve acute care patients.

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Page 5: May 29, 2009 – Jill Wooldridge P.A.-C. Boynton Health Service, University of Minnesota, Minneapolis, MN.

PURPOSE OF COMMITTEE

October 10, 2006 - Committee charged by COO to evaluate:The benefits of providing a “Convenience Care” model of service.The appeal of “Convenience Care” to our patients and third-party payers.The impact of this service on Urgent and Primary Care.Over-all financial impact.

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Page 6: May 29, 2009 – Jill Wooldridge P.A.-C. Boynton Health Service, University of Minnesota, Minneapolis, MN.

COMMITTEE MEMBERS Chair: Mary Alderman - Director Clinic Operations Co-chair: Dave Dorman – Health Promotion Beverly Carpenter – Administrative Assistant Joyce Fortier – Executive Secretary Jill Wooldridge, PA – Provider BJ Anderson, MD - Provider Britt Bakke - Marketing and New Program Development Paula Miller, RN – Student Health Advisory Committee

member Barb Rangel, LPN – Supervisor Patient Assistance and

Information Virginia Tranter, RN – Lead Nurse Immunization Clinic

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Page 7: May 29, 2009 – Jill Wooldridge P.A.-C. Boynton Health Service, University of Minnesota, Minneapolis, MN.

QUALITY IMPROVEMENT PROCESS

DMAIC:DMAIC is a basic component of the Six-Sigma methodology (Business Management Strategy) - a way to improve work processes by improving efficiency and eliminating defects.

In its methodology, it asserts that in order to achieve high quality business processes, continued efforts must be made to reduce variations.

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Page 8: May 29, 2009 – Jill Wooldridge P.A.-C. Boynton Health Service, University of Minnesota, Minneapolis, MN.

DMAIC MODELDEFINE PHASE:

What are the issues and desires for improvement

MEASURE PHASE:

Data collection to direct improvement efforts

ANALYZE PHASE:

Clarify and identify root cause of issue

IMPROVE PHASE:

List of all potential solutions and their impact with implementation plan and milestones

CONTROL PHASE:

Pilot plan, process control, implementation of solutions and transition control plan

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Page 9: May 29, 2009 – Jill Wooldridge P.A.-C. Boynton Health Service, University of Minnesota, Minneapolis, MN.

Define Phase COLLECTING THE VOICE OF THE

CUSTOMER

oConducted informal focus groups with the Student Health Advisory Committee (SHAC).oConducted informal focus groups with Boynton Health Service (BHS) staff: Providers, RNs, Pharmacy, Lab, Front Desk and Support staff.oCreated open message board for comments from BHS staff on shared network drive.

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Page 10: May 29, 2009 – Jill Wooldridge P.A.-C. Boynton Health Service, University of Minnesota, Minneapolis, MN.

Measurement Phase

Measured interest in a “Convenience Care” model

•An online survey sent to 4,000 students, with a return rate of 32%, showed 68% were interested.

•An online survey sent to 2,000 faculty and staff, with a return rate of 38%, showed 53% were interested.

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Page 11: May 29, 2009 – Jill Wooldridge P.A.-C. Boynton Health Service, University of Minnesota, Minneapolis, MN.

Measurement Phase (continued)PROBLEM: Urgent Care process of dealing with Minor acute illness is inefficient and lengthy for the patient.

Measured current process efficiency for treatment of minor acute illnesses in Urgent Care.

Urgent Care Cycle-time study:Urgent Care Provider Average Cycle Time = 80.5 minutesRN Average Cycle Time = 54.5 minutesRUC Average Cycle Time = 66.0 minutes

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Page 12: May 29, 2009 – Jill Wooldridge P.A.-C. Boynton Health Service, University of Minnesota, Minneapolis, MN.

Measurement Phase (continued)Reviewed 12-Month (9/05 - 8/06) Total MinuteClinic® Utilization

U of M Student Benefit Plan (SBP) – 61 visitsU of M Graduate Plan – 75 visitsU of M Staff/Faculty Benefit Plans – 1,885 visitsOf the total Staff/Faculty MinuteClinic® visits, 389 were seen at the Coffman site (just under 50/month).

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Page 13: May 29, 2009 – Jill Wooldridge P.A.-C. Boynton Health Service, University of Minnesota, Minneapolis, MN.

Analyze Phase Analyzed results of student, staff and faculty online

surveys. Reviewed list of factors identified in the formal focus

groups. Performed a Root Cause analysis on current model of

care. Consulted with Boynton Health Service Chief

Operating Officer (COO) to examine fiscal implications of implementing a “Convenience Care” model.

Toured the University of Minnesota Duluth QuickCare Clinic.

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Page 14: May 29, 2009 – Jill Wooldridge P.A.-C. Boynton Health Service, University of Minnesota, Minneapolis, MN.

Improve Phase In March 2007 the Committee recommended that

BHS provide a “Convenience Care” model service as a pilot, effective fall 2007.

The service was named “Gopher Quick Clinic”.

The hours of service were to be Monday through Friday , 9 a.m. to 5 p.m. with no coverage over the lunch hour (1-2pm).

The service was not offered during holidays/breaks.

Unless year-round fees were approved and a need for summer services was established, the service would not be offered during the summer.

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Page 15: May 29, 2009 – Jill Wooldridge P.A.-C. Boynton Health Service, University of Minnesota, Minneapolis, MN.

GQC IMPLEMENTATION TEAM Chair: Mary Alderman - Director Clinic Operations Co-chair: Jill Wooldridge, PA – Provider Britt Bakke - Marketing and New Program Development Margaret Dahl, RN - Nurse Supervisor Primary Care Davin Hedin - Principal Accounts Specialist Sue Jackson - Director Student Health Benefit Plan Amy Murphy – Executive Accounts Specialist Barb Rangel, LPN – Supervisor Patient Assistance and

Information Deb Sandberg, MD – Medical Director Karen Strauman-Raymond, RN – Nursing Director Gina Tran – Supervisor Patient Accounting

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Page 16: May 29, 2009 – Jill Wooldridge P.A.-C. Boynton Health Service, University of Minnesota, Minneapolis, MN.

Improve Phase (continued) BHS Marketing Department implemented

the “Marketing Plan” during spring and summer 2007.

During March 2007 through August 2007 the Implementation Committee: • defined flow and location of clinic, • equipped and stocked the clinic, • hired Advanced Practice Clinician providers (to

split time between primary care and GQC) • trained staff on new processes.

On September 4, 2007 the new clinic service was opened.

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Page 17: May 29, 2009 – Jill Wooldridge P.A.-C. Boynton Health Service, University of Minnesota, Minneapolis, MN.
Page 18: May 29, 2009 – Jill Wooldridge P.A.-C. Boynton Health Service, University of Minnesota, Minneapolis, MN.

Gopher Quick Clinic ServicesGopher Quick Clinic is limited to addressing one of the following concerns per patient visit.

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Common Illnesses:Bladder InfectionBronchitisCold/CoughEar InfectionLaryngitisMononucleosisRespiratory Flu(without vomiting or diarrhea)Seasonal AllergiesSinus InfectionStrep ThroatSwimmer¹s Ear

Skin Conditions:Athlete's FootCold SoresImpetigoMinor SunburnPoison IvyRingwormWarts (three or fewer, does not include genital warts)

Vaccines:Tetanus Vaccines (Td and Tdap)Flu Vaccine (when flu shot clinics not running)

Additional ServicesPregnancy Test

Page 19: May 29, 2009 – Jill Wooldridge P.A.-C. Boynton Health Service, University of Minnesota, Minneapolis, MN.

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Page 20: May 29, 2009 – Jill Wooldridge P.A.-C. Boynton Health Service, University of Minnesota, Minneapolis, MN.

Boynton Gopher Quick Clinic

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Page 21: May 29, 2009 – Jill Wooldridge P.A.-C. Boynton Health Service, University of Minnesota, Minneapolis, MN.

HOW DOES IT WORK?

FRONT DESK STAFF:

Checks in patient, “schedules” them for next available slot (every 15 minutes), tells patient approximate wait time, gives them Short Health History form to fill out.

Handles any co-pay/insurance issues

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Page 22: May 29, 2009 – Jill Wooldridge P.A.-C. Boynton Health Service, University of Minnesota, Minneapolis, MN.

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Page 23: May 29, 2009 – Jill Wooldridge P.A.-C. Boynton Health Service, University of Minnesota, Minneapolis, MN.

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Page 24: May 29, 2009 – Jill Wooldridge P.A.-C. Boynton Health Service, University of Minnesota, Minneapolis, MN.

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Page 25: May 29, 2009 – Jill Wooldridge P.A.-C. Boynton Health Service, University of Minnesota, Minneapolis, MN.

HOW DOES IT WORK? GQC PROVIDER (Team of 6 PAs, 2 NPs):

Calls patient from schedule on computer, brings back to room

Interviews patient (uses paper form)Obtains vitals (Spot Vital Signs)Examines patientPerforms any point-of-care labs [Strep, Mono,

Flu, Urine dip, urine pregnancy test; Throat cultures, Urine cultures sent to lab]

Writes any Rx, educates patient, uses pt. education materials

Patient leaves room, provider finishes any documentation

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Page 26: May 29, 2009 – Jill Wooldridge P.A.-C. Boynton Health Service, University of Minnesota, Minneapolis, MN.

Boynton Gopher Quick Clinic Exam Room

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Page 27: May 29, 2009 – Jill Wooldridge P.A.-C. Boynton Health Service, University of Minnesota, Minneapolis, MN.

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Page 28: May 29, 2009 – Jill Wooldridge P.A.-C. Boynton Health Service, University of Minnesota, Minneapolis, MN.

HOW DOES IT WORK?

MEDICAL RECORDS:Collects paper encounter forms dailySorts for billing, clinical recordScans the paper visit for our EMR (usually

within 1 day)Abstracts pertinent data directly into our

EMR: Reason for Visit, Vitals, Labs done, Assessment, Medications prescribed (usually within 1-2 days)

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Page 29: May 29, 2009 – Jill Wooldridge P.A.-C. Boynton Health Service, University of Minnesota, Minneapolis, MN.

Control Phase (Fall 2007)

The week of October 22-26, 2007 BHS sent a survey to all current Gopher Quick Clinic patients to assess satisfaction with the service.

Katie Lust, PhD, Director of Research and Surveillance, evaluated all surveys

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Page 30: May 29, 2009 – Jill Wooldridge P.A.-C. Boynton Health Service, University of Minnesota, Minneapolis, MN.

October 2007 Survey Results

Compare Satisfied vs. Not so SatisfiedSatisfied = Excellent, Very Good and Good

Not so Satisfied = Fair and Poor

81.2% of the patients surveyed rated the entire visit as satisfactory. Target is 90% satisfaction rate.

Patient concerns identified were:1)wait time in the lobby2)time spent with the provider in the exam room3)privacy

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Page 31: May 29, 2009 – Jill Wooldridge P.A.-C. Boynton Health Service, University of Minnesota, Minneapolis, MN.

OCTOBER SURVEY PROCESS IMPROVEMENT PLANWAIT TIME : Added appointments over the 1-2 p.m. lunch time Changed marketing material to indicate that GQC was:

1)first-come-first serve and

2)capacity for the clinic may be reached prior to the 5 p.m. closing

TIME SPENT WITH PROVIDER:Changed marketing material to say “Visits last approximately 10 minutes.”

PRIVACY:•Performed a second survey asking more specific privacy questions•Changed location of urine sample drop-off from Lobby to Front Desk

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Page 32: May 29, 2009 – Jill Wooldridge P.A.-C. Boynton Health Service, University of Minnesota, Minneapolis, MN.

Control Phase (Winter 2008)On January 22, 2008 BHS sent a 2nd survey to all current Gopher Quick Clinic patients to assess the following:Wait Time expectationsSatisfaction with amount of time spent with the provider in the exam roomLevel of comfort with:

1)check-in procedure

2)location of waiting room

3)location of exam room

Level of comfort with the process for giving a urine sample as it related to:

1)location of restroom

2)privacy of restroom

3)walking from restroom to drop-off box

4)location of drop-of box and overall urine collection procedure

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Page 33: May 29, 2009 – Jill Wooldridge P.A.-C. Boynton Health Service, University of Minnesota, Minneapolis, MN.

JANUARY 2008 SURVEY RESULTS

Compared Satisfied vs. Not so SatisfiedSatisfied = Excellent, Very Good and Good

Not so Satisfied = Fair and Poor

89.0% of the patients surveyed rated the entire visit as satisfactory. Target is 90%.

Patient concerns identified were:1) location of lobby in relation to exam room,2) location of restroom in relation to drop-off box and3) wait time

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Page 34: May 29, 2009 – Jill Wooldridge P.A.-C. Boynton Health Service, University of Minnesota, Minneapolis, MN.

JANUARY SURVEY PROCESS IMPROVEMENT PLAN

Exam Room Location: Moved exam room from off of Lobby to

interior exam room within Primary Care South (PCS)

Restroom and Drop-off Box Location: Changed restroom and drop-off box

location to be within PCS clinic space

Wait Time: Added second GQC provider in the PM.

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Page 35: May 29, 2009 – Jill Wooldridge P.A.-C. Boynton Health Service, University of Minnesota, Minneapolis, MN.

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Page 36: May 29, 2009 – Jill Wooldridge P.A.-C. Boynton Health Service, University of Minnesota, Minneapolis, MN.

Fall of 2008 – Opened Coffman Satellite Opportunity arose to utilize the Minute Clinic

site across the street in the Union Hired 3 new staff to accommodate new full-

time GQC clinic and have back-up, as well as rotate into primary care to make the position more appealing.

Front desk to be staffed from Patient Assistance Dept

Challenging new workflow to get supplies, equipment (LN2), labs, etc. back and forth

Set up remote access via computer as well Marketing!

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Page 37: May 29, 2009 – Jill Wooldridge P.A.-C. Boynton Health Service, University of Minnesota, Minneapolis, MN.

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Page 38: May 29, 2009 – Jill Wooldridge P.A.-C. Boynton Health Service, University of Minnesota, Minneapolis, MN.

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Page 39: May 29, 2009 – Jill Wooldridge P.A.-C. Boynton Health Service, University of Minnesota, Minneapolis, MN.

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Page 40: May 29, 2009 – Jill Wooldridge P.A.-C. Boynton Health Service, University of Minnesota, Minneapolis, MN.

COFFMAN GOPHER QUICK CLINIC Specific Challenges to the satellite site:

Tried to make it as much like the original GQC as possible for provider staff and patients

Had to set up courier drop off in AM, pick up in PM for supplies/labs

Slightly more complicated transfer of patients to Urgent Care if needed – more hassle for patients

Much less privacy, both in the “lobby” and the public restrooms

Had to determine which site to close if providers are absent?

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Page 41: May 29, 2009 – Jill Wooldridge P.A.-C. Boynton Health Service, University of Minnesota, Minneapolis, MN.

Visit Statistics for 2007-08 vs. 2008-09

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Page 42: May 29, 2009 – Jill Wooldridge P.A.-C. Boynton Health Service, University of Minnesota, Minneapolis, MN.

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Page 43: May 29, 2009 – Jill Wooldridge P.A.-C. Boynton Health Service, University of Minnesota, Minneapolis, MN.

Cycle Time Statistics for 2007-08 vs. 2008-09

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Page 44: May 29, 2009 – Jill Wooldridge P.A.-C. Boynton Health Service, University of Minnesota, Minneapolis, MN.

SUMMARY OF GQC STATISTICS(from previous slides)

From 2007-08 to 2008-09, GQC visits from a comparable period increased from 3787 to 6459.

Average total cycle time decreased from 37 to 29 minutes.

Average wait time in the Lobby decreased from 25 to 18 minutes.

Time with provider remained essentially constant.

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Page 45: May 29, 2009 – Jill Wooldridge P.A.-C. Boynton Health Service, University of Minnesota, Minneapolis, MN.

NOVEMBER 2008 SURVEY RESULTS

Compared Satisfied vs. Not so SatisfiedSatisfied = Excellent, Very Good and Good

Not so Satisfied = Fair and Poor

Again, 89.0% of the patients surveyed rated the entire visit as satisfactory. Target is 90%.

Issues identified were:1) wait time satisfaction improved from Spring 082) Significant concerns regarding Privacy/Comfort at Coffman GQC,

especially with regard to waiting area and urine sample collection3) Patients who rated overall visit as fair or poor were expecting or

would have liked to have more time with the provider

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Page 46: May 29, 2009 – Jill Wooldridge P.A.-C. Boynton Health Service, University of Minnesota, Minneapolis, MN.

NOVEMBER ‘08 SURVEY PROCESS IMPROVEMENT PLAN

Wait Time: Front Desk staff continue to offer Coffman as an

option if the wait time is > 30 minutes at BHS

Coffman Privacy/Comfort Concerns: In talks now with Coffman Building services about

possible remodeling of the space to allow private waiting area. Unable to change restroom location.

Expectations regarding time with provider: Make sure marketing materials and those

encouraging the service are clear as to its limitations

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Page 47: May 29, 2009 – Jill Wooldridge P.A.-C. Boynton Health Service, University of Minnesota, Minneapolis, MN.

IMPACT ON PROVIDERS Gopher Quick Clinic Providers

Simple, easy visits? Or mind-numbingly boring after 25/day?

Mix of GQC time with Family Practice is seen as a job satisfaction issue from a provider perspective, but results in possible “Excess Access” in clinic schedules

Primary Care Providers Initial skepticism regarding continuity of care Concern over loss of quick visits that allow for “make-up”

time for more involved visits. Perception that the complexity of visits has increased in Primary Care, though RVUs via coding has not yet borne that out.

All agree “Quick” must not sacrifice “Quality” – evidence-based guidelines and judicious use of Antibiotics important

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Page 48: May 29, 2009 – Jill Wooldridge P.A.-C. Boynton Health Service, University of Minnesota, Minneapolis, MN.

Code Descr CountOfCode

462 ACUTE PHARYNGITIS 2,149

465.9 ACUTE URI NOS 1,815

599.0 URIN TRACT INFECTION NOS 811

461.9 ACUTE SINUSITIS NOS 617

078.10 VIRAL WARTS NOS 404

466.0 ACUTE BRONCHITIS 365

788.1 DYSURIA 249

463 ACUTE TONSILLITIS 244

477.9 ALLERGIC RHINITIS CAUSE UNSPECIFIED 207

034.0 STREP SORE THROAT 179

786.2 COUGH 152

382.00 AC SUPP OTITIS MEDIA NOS 150

381.4 NONSUPP OTITIS MEDIA NOS 131

V72.40 PREGNANCY EXAM/TEST UNCONFIRMED 82

V06.1 VACCIN FOR DTP 80

054.9 HERPES SIMPLEX NOS 78

075 INFECTIOUS MONONUCLEOSIS 69

380.10 INFEC OTITIS EXTERNA NOS 68

919.4 INSECT BITE NEC 62

381.81 DYSFUNCT EUSTACHIAN TUBE 58

Top 20 Diagnoses for 2008-09Gopher Quick Clinic

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Page 49: May 29, 2009 – Jill Wooldridge P.A.-C. Boynton Health Service, University of Minnesota, Minneapolis, MN.

IMPACT ON PRIMARY CARE VISITSPercent of minor acute illness was reduced from 18% to 15%

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Top 10 DX for 0607 Top 10 DX for 0708

Screen for Venereal Disease 1838 Screen for Venereal Disease 2236

Routine Medical Exam 1805 Routine Medical Exam 1725

Routine GYN Exam 1548 Routine GYN Exam 1427

Acute Pharyngitis 1517 Acute Pharyngitis 1024

Nonspecific Skin Eruption 833 Pap and Pelvic 1005

Viral Warts 715 Nonspecific Skin Eruption 745

Pap and Pelvic 710 Acne 604

Acne 594 Dysuria 585

Joint Pain – Ankle and Foot 538 Backache 513

Fatigue 538 Viral Warts 513

Page 50: May 29, 2009 – Jill Wooldridge P.A.-C. Boynton Health Service, University of Minnesota, Minneapolis, MN.

IMPACT ON URGENT CARE Percentage of visits for minor acute illness was

reduced from 51% to 20%. Target was to reduce the percentage by 50%.

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Page 51: May 29, 2009 – Jill Wooldridge P.A.-C. Boynton Health Service, University of Minnesota, Minneapolis, MN.

GOPHER QUICK CLINIC AND URGENT CARE VISITSACADEMIC YEAR 0708 VS. ACADEMIC YEAR 0809

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Page 52: May 29, 2009 – Jill Wooldridge P.A.-C. Boynton Health Service, University of Minnesota, Minneapolis, MN.

SUMMARY OF CHANGE IN VISITS(from previous slides)

GQC visits have continually increased in the same ratio as Urgent Care visits have fallen.

Total GQC visits have increased.

Total UC visits have decreased.

Overall total visits to combined departments have increased.

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Page 53: May 29, 2009 – Jill Wooldridge P.A.-C. Boynton Health Service, University of Minnesota, Minneapolis, MN.

Financial Impact:Visits and RVUs

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DepartmentVisits

(2006-07)RVUs

(2006-07)RVUs per

VisitPRIMARY CARE 23,778 51,240 2.15URGENT CARE 3,991 9,665 2.42

DepartmentVisits

(2007-08)RVUs

(2007-08)RVUs per

VisitGOPHER QUICK CLINIC 3,822 5,971 1.56PRIMARY CARE 28,150 60,659 2.15URGENT CARE 5,446 11,608 2.13

DepartmentVisits

(2008-09)RVUs

(2008-09)RVUs per

VisitGOPHER QUICK CLINIC 7,770 13,273 1.71PRIMARY CARE 31,390 64,752 2.06URGENT CARE 4,893 10,534 2.15

Page 54: May 29, 2009 – Jill Wooldridge P.A.-C. Boynton Health Service, University of Minnesota, Minneapolis, MN.

FINANCIAL MODELING

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GOPHER QUICK CLINIC

PRIMARY CARE

URGENT CARE

Patients per Hour 4 3 2Average Office Revenue per Visit $63 $95 $119Average Ancillary Revenue per Visit * $8 $15 $25Revenue per Hour $284 $329 $287

Average Provider Cost per Hour $51 $67 $95Nursing Support Cost per Hour $0 $23 $63Other Cost per Hour ** $45 $55 $55Total Cost per Hour $96 $145 $214

Margin per Hour (full booking) $188 $184 $74

* Lab, Radiology, Pharmacy** Facility, Med Rec, Billing, Admin, Misc

Page 55: May 29, 2009 – Jill Wooldridge P.A.-C. Boynton Health Service, University of Minnesota, Minneapolis, MN.

FINANCIAL ASPECTS

The breakeven point for visits is three visits per hour.

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Page 56: May 29, 2009 – Jill Wooldridge P.A.-C. Boynton Health Service, University of Minnesota, Minneapolis, MN.

CONCLUSIONS AND FUTURE CONSIDERATIONS1. We have met our goal of an average cycle time of 30

minutes or less.2. We have met our goal of reducing the percentage of

minor acute visits in Urgent Care by 50%.3. We have not met our goal of reaching an over-all

satisfaction rate of 90% (but so close at 89%!).4. We need to balance access and/or services to

remain financially sound. New Services? How to increase utilization of Coffman site?

5. Anecdotally, there has been a slight shift in acuity in visits in Primary Care, requiring more people staying late.

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Page 57: May 29, 2009 – Jill Wooldridge P.A.-C. Boynton Health Service, University of Minnesota, Minneapolis, MN.

Looking Forward – What‘s next? Remodel of Coffman Gopher Quick Clinic

to allow for private waiting area

Move another Gopher Quick Clinic into our St. Paul clinic for ½ day Monday-Friday. (Dropping 2nd PM provider at BHS)

Looking at financial feasibility and/or profitability of adding some preventive services (Cholesterol screen, BP screen)

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Page 58: May 29, 2009 – Jill Wooldridge P.A.-C. Boynton Health Service, University of Minnesota, Minneapolis, MN.

CHALLENGES to the CONVENIENCE CARE MODEL

Balancing schedule – having back-up to remain open as advertised, but avoiding excess access

Appropriateness (or not) of self-triage Repeat visits for same issue Higher acuity or complexity than GQC can handle, and

subsequent “re-triage” of patients If desires of patient don’t fit GQC model (wanting more

time, more than one concern, etc.) Getting all information into EMR in a timely way

EMR wasn’t quick enough for pilot, but templates are in development that are more user-friendly, quick-templates – will still likely have to abstract some historical medical information

H1N1 “Swine Flu”…

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Page 59: May 29, 2009 – Jill Wooldridge P.A.-C. Boynton Health Service, University of Minnesota, Minneapolis, MN.

[email protected]

Special Thanks to Mary Alderman, Director of Clinic Operations, and Carl Anderson, Chief Operations Officer!

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