Final Presentation December 13th 2016 IOE 481 Team 9 Karina Hudak Rachel Katz Erica Segre Erin Winn Agenda Introduction Findings Methods Conclusions Introduction Client and Coordinators ID: 703306
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Physician’s Assistant Staffing and Best Practice Analysis in Otolaryngology and UrologyFinal Presentation
December 13th, 2016IOE 481Team 9:Karina HudakRachel KatzErica SegreErin WinnSlide2
AgendaIntroduction
FindingsMethodsConclusionsSlide3
Introduction
Client and CoordinatorsIntroduction
Background
Key Issues
Goals and Objectives
Project ScopeSlide4
Client and CoordinatorsClient Marc
Moote, MS, PA-C Chief Physician’s Assistant, UMHSCoordinators Andreea Duma, Management Analysis Fellow Program and Operations Analysis, UMHS
Ian Perry, Management Engineer
Program and Operations Analysis, UMHSSlide5
IntroductionPA introduction crucial due to adaptability and lower cost
Introduction of wRVU data to observe productivity levelsOtolaryngology and Urology PAs at UMHS have high wRVU dataDiscover reasons behind high performance
Determine if best practiceSlide6
BackgroundPast PA performance was unmeasured in a comparable metric
wRVU data now available: able to compare PAs of all departmentsShared vs. Independent visitsUMHS PAs felt they were underutilized, multiple studies from 2009-presentOtolaryngology and Urology PAs have high
wRVU
values
Distribution of PA patient care from 2011
RadOnc
project: 2/4/11- 2/18/11 and 3/7/11- 3/11/11, N=27 forms
Direct Patient
Care
Indirect
Patient
Care
MiscellaneousSlide7
Key IssuesNo documented best practices
Unprocessed performance metrics Lack of visibility into clinic utilizationLimited understanding of clinic environmental factorsSlide8
Goals and ObjectivesTo determine why the PAs have higher wRVU data than other
clinics:
Observed PA practices in
Otolaryngology and Urology
Determined workload profile
Determined clinic schedule utilization and division of appointments
Tied workload profile findings to
wRVU
dataSlide9
Project ScopeIncluded:Outpatient PAs in
each clinicExamination of workload profileAnalysis of clinic utilization data from MiChartObservation of qualitative clinic environmentExcluded:Evaluation of process flows
Tasks not performed by PAs
Division of workload between PAs
and other clinic staffSlide10
Methods
Literature Review
Observations
Surveys
Beeper Study
Analysis of
MiChart
Scheduling Data
Excel Tabulation and Visualization of
wRVU
DataSlide11
Literature ReviewPrior IOE 481 ProjectsPA/NP Utilization Project in the Cancer Center
PA Utilization Project in Radiation OncologyNeuro Sleep PA Utilization studyGovernment resources on wRVU dataPublished literatureSlide12
ObservationsEach member observed for 3 - 4 hours in each clinic
Observed Shared and Independent visitsHelped to establish data collection sheetsSlide13
SurveysQuestions to address the qualitative aspects a beeper study could not capture
Included:Work outside clinic hoursTask delegationFactors that increase productivityFactors that decrease productivitySlide14
Beeper StudyOtolaryngology pilot study October 27th
– 28th Study ran November 1st – December 2ndUrology did not have a pilot studyStudy ran November 11th - December
7
th
Each PA completed the study for 10 full work daysSlide15
Analysis of MiChart Scheduling DataObtained data from January 2016 - June 2016
Able to gather different appointment types per PA CompletedCancelledNo showLeft without seenSlide16
Obtained Data from June 2015 - June 2016These dates apply to the date the charge was posted (not the date of service)Able to determine sum of
wRVU valuesAble to determine type of clinic visitIndependentSharedDirected
Excel Tabulation and Visualization of
wRVU
DataSlide17
Findings
Literature SearchObservationsSurveysBeeper StudyMiChart Scheduling DatawRVU
Summary of FindingsSlide18
Literature SearchExplanation of calculation of wRVU
metricDevelopment of the beeper studyCollection sheetsAnalysisNo previously established best practiceSlide19
ObservationsMultitasking versus waiting on patient
Impacted productivity and quality of preparationQuality of preparation prior to patient visitImpacted Direct Patient Care time, therefore no correlationSlide20
Surveys
71% of PAs complete Indirect Patient Care outside clinic
0
- 14 hours per week spent working from home
Factors that increase productivity:
Good support staff, collaborative environment
Appropriate patient scheduling and flexibility
Early obtaining of patient records
Adequate preparation time and data
Factors that decrease productivity:
New nurses and MAs
Tasks typically delegated:
FMLA / disability forms to administrative assistants or nurses
Normal lab results to nurses
Scheduling issues to administrative assistantsSlide21
Beeper Study: Division of TasksPAs are spending 32.1% and 31.7%
of time in Direct Patient CareTeam 9: Workload Beeper Study 11/11/16 - 12/7/16, N =70 Sheets
Direct Patient Care
Indirect Patient Care
MiscellaneousSlide22
Beeper Study: Top 10 Tasks OtolaryngologySpending the most time in
Administrative Work after adjusting for part-time PAs in Administrative Work*Admin work adjusted for PA #1 work in Clinical Affairs, not for Lead PA Admin timeTeam 9: Workload Beeper Study 11/1/16 - 12/2/16, N = 30 Sheets, N = 872 tick marksSlide23
Beeper Study: Top 10 Tasks UrologySpending the most time in Dictation-typingTeam 9: Workload Beeper Study 11/11/16 -
12/7/16, N = 40 Sheets, N = 1593 tick marksSlide24
Otolaryngology clinic has No Show rates of 5.4%Urology clinic has a
No Show rate of 4.26%Team 9: MiChart Scheduling Data, January 2016 – June 2016, N = 62,155 entries
Completed
Cancelled
No Show
Left without being seen
MiChart
Scheduling Data: Appointment TypeSlide25
wRVU Data: Clinic TypeOtolaryngology is spending 58.26% of time on Independent Visits
Urology is spending 70.91% of time on Independent VisitsTeam 9: wRVU data July 2015 – June 2016, N = 26,823 entries
Independent
Directed
Shared
No ModifierSlide26
Summary of Findings: Otolaryngology67% PAs performing charting outside clinic hours
Direct Patient Care is 32.1% which is consistent with previous studiesTop tasks include:Administrative Work (Lead PA)Dictation-typing in
MiChart
History Taking
No
Show rate of
5.4%
58.26%
Independent VisitsSlide27
Summary of Findings: Urology
75% PAs performing charting outside clinic hours
Direct Patient Care is 31.7% which is consistent with previous studies
Top tasks include:
Dictation-typing in
MiChart
History Taking
Patient Education
No
Show rate of 4.26%
70.91% Independent VisitsSlide28
Conclusions
ConclusionsRecommendationsSlide29
ConclusionsSignificant hours spent outside scheduled work hours yields higher productivity
4 PAs with higher wRVUs have higher% of Independent appointments
Higher %
Direct Patient Care does not correlate to a
higher
wRVU
Consolidated Team 9 data, sample size variedSlide30
Identified Best Practice
Indirect Patient Care delegated to support staffEffective Clinic Prep prior to seeing patients
Clinic
prep outside of
business
hours to streamline Direct Patient Care
High
percentage of Independent Visits for PAsSlide31
Recommendations
Perform further research on support staffAssess charge modifier workflow to assign SV, IV and DV to every charge
Consider compensation options for working outside business hours
Investigate opportunities to allocate Clinic Prep time in business hoursSlide32
?Thank you!
Questions?Slide33
Appendix
PA
Physician’s Assistant
wRVU
Work Relative Value Units
UMHS
University of Michigan Health System
Directed
Requires direct patient care from the PA and consultation from the supervising physician
Shared
Requires direct patient care from both the supervising physician and the
PA
Independent
Requires direct patient care from only the PA
Direct Patient Care
Tasks involving face-to-face interaction with patient
Indirect Patient Care
Tasks pertaining to patient that don't require face-to-face interaction
Miscellaneous
Tasks not pertaining to patients
FMLA
Family Medical Leave ActSlide34