Preventive Services Improvement Initiative

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• Practice Management Improvement
• (PMI)
• Orientation Session

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PMI Orientation Objective

• Increase SBHC teams knowledge and understanding
  of practice management
• and practice management improvement process for
  SBHCs

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Background to Practice Management Improvement
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Quality Improvement Collaboratives
Over 6 years, NASBHC has implemented quality
improvement collaboratives with 99 SBHCs from 16
states. These efforts have positively effected
the health care of over 150,000 students annually.

• California
• Colorado
• Connecticut
• Florida
• Illinois
• Louisiana
• Maine
• Maryland

• Massachusetts
• Michigan
• New Jersey
• New Mexico
• New York
• North Carolina
• Washington
• West Virginia

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NASBHCs SBHC Quality Improvement Collaboratives

• Adaptations of
• Institute for Healthcare Improvements (IHI)
  quality improvement model
• HRSAs Bureau of Primary Care Health Disparities
  Collaboratives
• With funding from
• CDC, Division of Adolescent and School Health
• HRSA, Maternal and Child Health Bureau
• HRSA, Bureau of Primary Health Care

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NASBHCs SBHC Quality Improvement Collaboratives

• Preventive Services Improvement (risk
  assessments, physical exams and STDs/HIV
  prevention) 3 cycles
• Mental Health Education and Training (mental
  health screening, interventions, and
  documentation) 2 cycles
• Practice Management Improvement (coding, chart
  documentation, clinic operations) 2 cycles
• Adolescent STD/HIV Avoidance Project (STD/HIV
  Prevention activities) 1cycle-four states

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• Cycle 1 - 2004-2005
• Cycle 2 - 2005-2006

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What is Practice Management Improvement?

• It is a process which describes the whole
  spectrum of operating an entire health care
  entity from then the patient walks in the door
  until the bill is paid.

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Why Practice Management Improvement?

• PMI will improve the
• Quality
• Efficiency
• Effectiveness /outcomes
• Of patient care

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Why Practice Management Improvement?

• The PMI process will also help identify
• Improvements in billing and coding
• Resulting in increased revenue through a billing
  system

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How is Practice Management Improvement
Accomplished?

• Through a series of
• Steps
• Processes and
• Activities

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Steps in the PMI Process
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• Orientation
• Data Gathering
• Self Assessment 1
• (Pre-Assessment)
• SWOT
• skill building sessions and work plan
  implementation
• Self-Assessment 2
• (Post Assessment 2)
• Document Results

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Orientation and Data Gathering

• Familiarize staff with PMI process
• Complete staff profiles, demographic information,
  service and patient profiles, payors information
  and
• Gather data sources for use during
  self-assessment, such as charts, manuals, billing
  records, and encounter forms.

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Self-Assessment 1

• Includes the following
• Completing the SCORE Model
• Conducing the chart review process
• Completing the coding compliance review

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SWOT Analysis

• Analyzes the
• S strengths
• W weakness
• O opportunities
• T threats
• That exist within and surround the SBHC

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Practice Improvement Plan

• Includes producing a set of
• 1 5 year short term, intermediate and long term
  objectives for the SBHC in the following areas
• Facilities
• Business Operations
• Human Resources
• Care Management
• Practice Compliance

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Skill building and Improvement Plan implementation

• Provide skill building and training sessions as
  identified in Pre-Assessment 1
• Implement the Improvement Plan and do regular
  progress updates

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Self-Assessment 2 (post assessment)

• After implementing the improvement plan for 6
  months to a year, start the assessment process
  over to determine level of progress and change.

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Document Success

• Time to Shine and Share
• Storyboards
• Articles in newsletters
• PowerPoint presentations
• Tell the story of your improvement to
• funders, foundations, press, parents,
• school, and community

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Tools for the PMI Process

• Web Tutorial
• PowerPoint presentations
• Word Documents
• Excel Workbooks
• Instructions for sessions and processes
• Technical Assistance from NASBHC

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Practice Management Improvement (PMI) Initiative
- NASBHC

• 1st Cycle (Beta Test)
• 6 school-based health centers from 4 states
  (California, New York, Texas, West Virginia)
• 2nd Cycle
• 7 SBHCs in MA and 4 SBHCs in WV w/ 330 funded
  sponsoring organizations
• In MA and WV learning sessions were open to SBHCs
  statewide

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PMI Activities during the NASBHC initiative

• 3-4 Learning Sessions
• 2 Site visits (pre and post SCORE model, chart
  review, and coding compliance review)
• 1 Site visit (mission statement, SWOT analysis,
  outline practice management improvement plan)
• Workplan for each objective
• Quarterly progress reports
• Monthly conference calls
• Storyboards
• Celebration

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PMI Results for the NASBHC Initiative

• All 17 sites
• Completed Strengths, Weaknesses, Opportunities,
  and Threats (S.W.O.T.) analysis of their SBHC
• Developed a practice management improvement
  plan/strategy with short and long term objectives
  to support the SBHC mission
• Demonstrated improvement in SCORE Model ratings
  on all 5 domains (facilities, business
  operations, human resources, care management, and
  practice compliance) from pre to post site visits

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PMI Results for the NASBHC Initiative

• Demonstrated improvement from pre to post chart
  reviews /coding compliance audits in appropriate
  documentation and coding of evaluation and
  management visits, preventive health visits, and
  mental health visits
• Incorporated CQI tool sentinel conditions, chart
  audit criteria, and resources into the care
  management and practice compliance activities

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PMI SCORE Model Ratings Cycle 1 (pre and post)
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PMI SCORE Model Ratings Cycle 2 (pre and post)
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PMI and NASBHC

• Web tutorial available September 2008
• www.nasbhc.org

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Questions and Evaluation