SPO Training Workbook for OBP/OBR in HPG

OACCAC Education October 2013

SPO Training Workbook

for OBP/OBR in HPG

SPO Training Workbook for OBP/OBR in HPG

[ii]

Revision Table

Date Version Author Comments

October 1,

2013

1 Darlene Scott

OBP/OBR Crossword and

Word Search were

created by Stacey

Grammick


[iii]

Table of Contents

1. Introduction .................................................................. 1

1.1 Learning Objectives for this workbook ...................................... 1

1.2 The Workbook ....................................................................... 1

2. Outcome Based Service Information ................................. 2

2.1 OBP Information Contained in the Service Offer ......................... 2

2.2 Additional OBP Information Contained in the Service Referral ...... 2

3. Navigating to the SPO Pathway Details „Action‟ Page ........... 3

3.1 Exercise 1 - Navigating to the Outcome Based Pathways Tab ...... 3

3.2 Exercise 2 – Explore the Outcome Based Pathways Tab in Detail . 3

3.3 Section 3 Quiz ....................................................................... 4

4. SPO Activity – Add New Pathway ...................................... 5

4.1 Exercise 3 – Add a New Pathway ............................................. 5

5. SPO Activity – Correct a Pathway ..................................... 5

5.1 Demo 4 – SPO Interval Outcome – Request to Change to the „Correct‟

Pathway........................................................................................ 6

6. SPO Activity – Submit Pathway Report .............................. 6

6.1 Exercise 5 – Submit SPO interval outcome with activity notification and

additional information. .................................................................... 7

6.2 Exercise 6 – Submit Second Interval Report with unmet outcomes,

variance and activity request ......................................................... 10

6.3 Exercise 7 – Resubmit Interval Report for the Second Interval .. 12

6.4 Exercise 8 – Submit Last SPO Outcome & Discontinue SPO Report13

6.5 Print Pathway Report ........................................................... 14

6.6 Section 6 Quiz ..................................................................... 14

6.7 Demo 9 - Discontinue – Supervening Event ............................ 15

7. Notifications in HPG ...................................................... 15


[iv]

7.1 SPO Notifications ................................................................. 15

7.2 OBP/OBR Cross Word ........................................................... 17

7.3 OBP/OBR Word Search ......................................................... 18

8. Quiz Answers .............................................................. 19

8.1 Section 3 Quiz ..................................................................... 19

8.2 Section 6 Quiz ..................................................................... 19

8.3 OBP/OBR Cross Word Answers .............................................. 20

8.4 OBP/OBR Word Search Answers ............................................ 21


OACCAC Education October 2013 Page 1 of 21

1. INTRODUCTION

This workbook is intended to be used as a companion to HPG Module 7: Outcome

Based Pathway and Reimbursement and contains activities and review questions to

support your learning. Active learning (which refers to techniques where learners do

more than simply listen to a lecture or instruction) is a very important part of

achieving the learning objectives. You will have the opportunity to hear, see,

discover, explore, and apply the information that you are learning.

Your instructor will provide you with information through lecture, demonstration,

discussion, quizzing and guided practice.

1.1 Learning Objectives for this Workbook

After this training session, the participants will:

Understand the information presented in an Outcome based service offer and

referral

Know how to navigate in CHP to the Outcome Based Pathway Information

o Details

o History

o Reimbursement Status

o Interval Outcomes

o Interval Reports

Know about SPO Activities

o Submit Pathway Report

o Print Pathway report

o Add New Pathway

Know and be able to demonstrate how to submit Pathway Report Content

o Discontinue

o Interval outcomes

o Variances and Risk Factors

o Activity Notification/Requests

o Additional Information

Understand where and when notifications are generated

1.2 The Workbook

This workbook is composed of a series of scenario-based exercises designed to

provide you with the opportunity to systematically practice and apply the HPG OBP

OBR functionality as you learn it in the classroom.

The Instructor can choose to complete this training by demo only or hands on.

How will you use the workbook?

Your Instructor will guide you through the activities in the workbook using the client

prepared for you in Training HPG.



The instructor may modify the content and instructions to suit the needs of individual

training situations.

Note: To have HPG prepared for this training; the surgical wound pathway must be

initiated first in CHRIS by the CCAC Educator. Make sure that the Surgical Wound

pathway is the first service authorized for training patients so that it is OBR. You

may find it easier to complete the offer with verbal acceptance completed so that the

pathway is initiated and in a ready state for SPO entry.

In each exercise, you will be provided with specific information to enter in a field

when that information impacts on exercises to follow. You will not be provided with

information to be entered in every field that must be completed on a page. In this

case, you can draw from your experience and enter information that you feel is

appropriate. (Be sure not to enter any personal information)

2. OUTCOME BASED SERVICE INFORMATION

2.1 OBP Information Contained in the Service Offer

1. Offer Details indicate Outcome Based Service Delivery Type

Outcome Based Wound

Outcome Based Ortho

Outcome Based Palliative

2. Outcome Based Pathways Information

Title of the Pathway with URL to the pathway details

Start Date

Additional information

Interval Due Dates

3. Possible Billing Codes are provided for billing if the pathway is fee for Service or

for shadow billing if the pathway is reimbursed based on outcome achievement.

Note: OBP/OBR offers are accepted the same way as any other offer and will result

in the receipt of a service referral along with “NEW” activation of CHP outcome

Based Pathways view in HPG

2.2 Additional OBP Information Contained in the Service Referral

1. Pathway Reimbursement Type, FFS or OBR

2. Possible Billing Codes are provided for billing if the pathway is fee for Service or

for shadow billing if the pathway is reimbursed based on outcome achievement.



3. NAVIGATING TO THE SPO PATHWAY DETAILS ‘ACTION’ PAGE

Outcome Reporting is available for both pathways that are reimbursed as fee for

service and those that are reimbursed based on outcome achievement.

3.1 Exercise 1 - Navigating to the Outcome Based Pathways Tab

1. Navigate to Client View in HPG, Client search, search for the client name you are

provided by your instructor, and then open the Outcome Based Pathways Tab.

3.2 Exercise 2 – Explore the Outcome Based Pathways Tab in Detail

The Pathway Details page displays the details, history, reimbursement status,

Interval and outcome status, and submitted pathway reports for the pathway that

have been submitted by the CCAC and/or SPO.

In each section on the Pathway Details page, there are a number of actions that you

can complete and/or review.

Explore the pathway Details Tab using the diagram and chart below as a guide. Do

not complete any actions at this time, rather press cancel to exit a screen without

making changes.



The Outcome Based Pathway Tab:

Provides the ability for SPOs to add a new Pathway

Submit a pathway report including Exceptions (variances and risk factors);

Activity Notifications/Requests; Supervening Events

Provides the ability for SPOs to print a pathway report summary

Provides notification and tracking for follow-up during Pathway course of

treatment

Section Links and/or Activities

1. Details Submit Pathway Report

Print Pathway Report Summary

Link to detail information about the Pathway<Name>

2. History Review all events that have occurred during the course

of the OBP

3. Reimbursement

Status

View the list of the Core Payments and Final Payment

associated with the pathway and the status of each

payment

4. Interval outcomes Expand or collapse each interval to view the outcome

types, value, and submitted date

5. Interval Reports Review interval reports submitted by both SPO and

CCAC

Generate a pathway report to print

3.3 Section 3 Quiz

1. True or False

The Pathway Details page is called the „action‟ page as all communication and

action is generated from this page in both CHRIS and HPG

2. In CHP a SPO is able to:

a. Add a New Pathway

b. Submit a Pathway Report

c. View a Pathway Report Submitted by the CCAC

d. All of the above



4. SPO ACTIVITY – ADD NEW PATHWAY

4.1 Exercise 3 – Add a New Pathway

A second pathway may be requested by the CCAC or SPO

When a second pathway is added by a SPO and authorized by the CCAC to an

existing OBP-OBR, the second pathway:

is OBP-FFS

has NO FFS visit payments released during the period the second pathway

overlaps with the OBR (until Day X)

Has FFS payment released on the start date of the warranty period

1. Navigate to the outcome Based Pathways Tab in HPG

2. Choose Add New Pathway Button

Message: Please Note that adding a new pathway is not intended to be used to

correct an inappropriate pathway assignment

3. Fill out the required fields

Field Description

*Requested Pathway Choose from Drop Down “Diabetic Foot ulcer

*Start Date Choose Today‟s Date Using Calendar

Additional Info Diabetic Foot Ulcer found on Left foot

*Requested By Your name first name with Provider as your last name

*Indicates required field

4. Your action of adding a new pathway will generate a Task in CHRIS for the CCAC

to review your request and agree or disagree with adding the pathway.

5. SPO ACTIVITY – CORRECT A PATHWAY

When the pathway is incorrect i.e. Surgical Wound vs. Venous Leg Ulcer:

In the Discontinue Report, the SPO selects;

A Request is sent to the CCAC to Agree or Disagree with the Request

o Discontinue Reason = “Pathway incorrect‟

o Requested Action= “Discontinue Pathway and add new Pathway”

Scenario:

You as an SPO have identified a second wound that requires treatment and wish to

add a second pathway to the plan of care



A Request is sent to the CCAC to Agree or Disagree with the Request

When you transition to the correct pathway, the new pathway will have the

same start date as the previous pathway

5.1 Demo 4 – SPO Interval Outcome – Request to Change to the

‘Correct’ Pathway

Caution: This is Demo only. Do not actually follow through with this action in

Training as it will impact the rest of the exercises.

1. Navigate from the Outcome Based Pathway Details screen to Submit Pathway

Report

2. Choose Discontinue

3. Note the required fields – but cancel rather than submit when you reach the

bottom of the screen

Field Description

*Reason Pathway Incorrect

*Requested By Your name first name with Provider as your last

name

*Requested Date Choose Today‟s Date Using the Calendar

Additional Info At your discretion

*Requested Action Discontinue Pathway and add new Pathway

Requested Pathway Venous Leg Ulcer


4. Cancel

5. This request to correct a pathway would generate a CHRIS task for CCAC to

review and confirm the request.

6. SPO ACTIVITY – SUBMIT PATHWAY REPORT

A single pathway report may contain a combination of different types of OBP

reporting data such as outcomes, exceptions, activity notifications/requests,

additional information, discontinue provider, or discontinue pathway requests.

You can expand and collapse each section of the pathway report independently by

selecting the section check-box, and you can enter data for one or many of the

outcomes, risk factors, activities or requests available in the report.

Resubmission is possible for any interval for which there are unmet outcomes.



The following activities will provide opportunity to practice various combinations of

data entry in pathway reports.

6.1 Exercise 5 – Submit SPO interval outcome with activity

notification and additional information.

Each Pathway outcome is identified as belonging to a single “Responsible Partner”.

The Partner is the CCAC or SPO who is responsible for achieving the Interval

Outcomes and submitting the Interval Reports by the Interval Due Date

Interval Outcomes:

define Interval Goals

contain a collection of Service Outcome Types for each Pathway Event

defines the Outcomes that are reportable in a Pathway Report and must be met

to complete the related Interval

have a status of „Complete‟ or „Incomplete‟

Add SPO First Interval Outcomes

1. Observe the Instructor Submitting a SPO interval outcome report

2. In the Pathway Details section, select the „Submit Pathway Report” button

HPG opens the Submit Pathway Report page

Scenario:

The SPO has confirmed that the pathway is correct and proceeds to complete and

submit the outcomes for the 1st interval



3. Check the box for the first SPO interval report

HPG expands this section

4. Complete the fields

Outcomes Value Performed By Performed Date

Holistic patient &

wound assessment

completed

Yes Your name first name with Provider as your last name

Today’s Date

Correct Outcome-

based pathway

confirmed

Yes Your name first

name with

Provider as your

last name

Today‟s Date

Wound therapy

Initiated


Today’s Date

Patient Discharge

Planning Initiated

for Patient

Independence and

Prevention


Today’s Date

Wound

Measurement

Value (4x4x4)

Your name first name with Provider as your last name

Today’s Date

Note: You can enter a 0.5 value or if a wound is protruding like a blister or

other protruding wound it can be captured as a negative „Depth‟.

Negative depth being -2

Add an SPO/Patient Activity Notifications Report

Activity notifications are intended to notify the CCAC that the SPO and/or

Client is arranging an activity such as an inter-professional referral

1. Observe the Instructor Submitting a SPO Activity Notifications/Requests report

2. Check Activity Notifications/Requests in the pathway report

HPG expands the section


Activity Referred By Referral

Date

Additional Information

Chiropody under SPO Column


Today’s Date At your discretion



Add Additional Information

Additional information (unlimited free text) can be submitted in an interval

report by either partner SPO or CCAC.

1. Select the Additional information section of the pathway report

HPG expands the section


Field Description

Additional Information At your discretion e.g. “Patient reports that if his wound is not healed by the weekend he will be going to his daughters to stay”

*Reported By Your name first name with Provider as your last

name

*Reported Date Today‟s date

3. Select the SUBMIT button

Return to the Outcome based pathway overview page

Expand each section of the Pathway Details page to see if there are any

changes

Pathway Details

Sections

Questions? Answer the questions

History Has a new event been added?

Yes/No

Reimbursement Status Has a core payment been made?

Yes/no

Interval Outcomes Has an Outcome Interval report been submitted?

Hint: Open the First

interval to view details

Yes/No

Interval Reports Has a report been

submitted? Yes/No

What is the Status for

the report? Review Not Required/

Pending Review

What type of report was submitted (check under the Content column)?



6.2 Exercise 6 – Submit Second Interval Report with unmet

outcomes, variance and activity request

Surgical Wound Outcome-Based Pathway second interval outcome is due 21 to 28

days based on the pathway Start Date and there must be a 20 to 30% reduction in

the wound size

Add Outcomes

1. In the Pathway Detail section, select the „Submit Pathway Report‟ button


2. Check the box for the 2nd SPO interval report

Enter the same measurements as the 1st report (4x4x4) i.e. no wound healing

When submitting unmet outcomes a Variance report must be completed

Scenario:

The SPO submitted the outcomes for the 2nd interval (Incomplete outcome: In

this exercise, to submit an incomplete report, you are going to submit the same

wound measurements reported in the first outcome report)

Variances and Risk Factors are also known as Exceptions. These

variances are barriers or risk factors that are affecting or may affect patient

outcomes during the OBP course of treatment.



1. Check the box for the Variances and Risk Factors

HPG expands this section and displays three (3) types of Variances and risk

Factors (Clinical, System, Patient/Caregiver)

2. Add a check mark next to the “Pain” and “Nutrition” items under the Clinical

section

HPG expands the items


Outcomes Reported by Reported Date Additional

Information

Pain Your name first name with Provider as your last name

Today’s Date “pain in surgical site”

Malnutrition Your name first name with Provider as your last name

Today’s Date “Poor eating habits”

Complete Activity Request

1. Activity Requests are intended to direct the performance of an activity by the

CCAC

2. CCAC will review the information and complete the activity i.e. arrange the

referral or report why it has not been completed

3. Complete the following Activity request

Activity Referred By Referral

Date

Additional Information

Specialist Physician under the CCAC column


Today’s Date At your discretion


These variances/risk factors are customized according to the three

Outcome-Based Service (OBS) types (Wound, Ortho, and Palliative)

Variances and Risk Factors:

Are submitted in an interval report by a SPO or CCAC (each partner

is notified when a variance report is submitted)

May be submitted independent of outcomes

Must be submitted when outcomes are reported as unmet




Expand each section of the Pathway Details page to see if there are any changes

Pathway Details

Sections



Yes/No

Reimbursement Status Has a core payment been

made? Yes/no

Interval Outcomes Has an Outcome Interval report been submitted?

Hint: Open the First interval to view details

Yes/No

Interval Reports Has a report been submitted?

Yes/No

What is the Status for the report?

Review Not Required/

Pending Review

What type of report was submitted (check under the Content column)?

6.3 Exercise 7 – Resubmit Interval Report for the Second Interval

To resubmit the 2nd Interval and a CCAC Activity Notifications/Requests

Report

1. Observe the Instructor resubmit the 2nd interval report and a CCAC Activity

Notifications/Requests report

2. In the Pathway Details page, select the „Submit Pathway Report button


3. Check the box for the 2nd interval report and Activity Notifications/Requests

4. Complete the fields:


Wound

Measurement

Value (2x2x2)

Numbers to

correspond to

50% healing


Today’s Date

Scenario:

The SPO is re-submitting the 2nd interval (wound healed > 50%)




6.4 Exercise 8 – Submit Last SPO Outcome & Discontinue SPO

Report

When the SPO has submitted all the outcomes and reports then the SPO should

send a „Discontinue SPO” request to indicate that the SPO is no longer responsible

for the patient care.

To Submit an SPO Interval Outcome and Discontinue Report

1. Observe the Instructor Submitting a SPO interval outcome report

2. In the Interval Report section of the Pathway Details page, select the „Submit

SPO Report” button

HPG expands the section to display the Submit Pathway Report page

3. Complete the fields for the reports:

A. Final SPO Interval Report


Wound

Measurement

Value: 0 x 0 x 0 Your name first name with Provider as your last name

Today’s Date

B. Discontinue Report

Field Information to be entered

Reason Treatment complete – goals met

Requested by Your name first name with Provider as your last name

Requested Date Today’s Date


Requested Action Discontinue SPO


Scenario:

The SPO is submitting last interval outcome report and as the wound is healed

submitting “SPO Discontinue” report (there is no further role for the SPO).




Expand each section of the Pathway Details page to see if there are any

changes

Pathway Details

Sections


Detail Section What is the ‘Partner

Status?’ SPO-Active/ SPO-

Discontinue Requested


Yes/No

Reimbursement Status Has a core payment been made?

Yes/No

Interval Outcomes Are all the intervals completed?

Expand to View Details

Yes/No

Interval Reports What is the Status for the report?

Click on date and time hyperlink to view report details

Review Not Required/

Pending Review

6.5 Print Pathway Report

1. Select Print Pathway report button at the top of the Details section for the

Pathway to view the Outcome-Based Pathway Summary Report.

6.6 Section 6 Quiz

1. True or False

Variances and Risk Factors are barriers or risk factors that are affecting or may

affect patient outcomes during the OBP course of treatment.

2. When a SPO submits an Activity Request for a CCAC to act on such as an

add-on for Adult Day Program:

a. A task is generated to remind the CCAC to review the report and take action

b. The Provider will never find out if their request is acted on

c. The CCAC action will be recorded as a pathway event

d. A and C



3. Core payments are sent from CHRIS to the SPO when Payment linked

outcomes are met, for the Surgical Wound Pathway, which interval

outcomes were PLOs:

a. Each interval outcome

b. First interval outcome

c. Second Interval outcome

d. Last Interval outcome

e. B and D

6.7 Demo 9 - Discontinue – Supervening Event

Supervening events are events which:

identifies conditions that determine that Patient is no longer eligible for the

pathway

occurs independently of (i.e. are not caused by) the pathway itself that affect

the quality of treatment

Note: For this demonstration the instructor will need to have a second patient set up

with an outcome based pathway in progress.

1. Observe the Instructor input a discontinue request for supervening event.

Scenario:

The SPO submits a Discontinue report as the client is moving to live with her

daughter in another city.

Field Information to be entered

Reason Transfer to other CCAC

Requested by Your name first name with Provider as your last name

Requested Date Today’s Date

Additional Info Your discretion

Requested Action Discontinue Pathway

2. CCAC is alerted to this request by a manual task in CHRIS. They will

Agree/disagree with the request and take the necessary next steps.

7. NOTIFICATIONS IN HPG

7.1 SPO Notifications

Outcome-Based Pathway notifications are system generated and sent to the SPO via

the HPG Inbox where the provider can open the notification.

Notifications are generated for the provider when certain events occur and are

grouped on a single notification when multiple actions have resulted in notification

being generated around same timeline.



There are ten types of Outcome-Based Pathway notifications:

1. Pathway Interval – Review Date Coming Due: One-time notification

generated for the pathway interval when an interval review date is approaching

2. Pathway Interval – Review Date Over Due: One-time notification generated

for the pathway interval when an interval due date has passed

3. Pathway Interval – Review Date Updated: One-time notification generated for

the pathway when the review date for an interval has been updated

4. Pathway Report – Added: One-time notification generated for the pathway

when a pathway report has been added by a user in CHRIS

5. Pathway Report – Deleted: One-time notification generated for the pathway

when a pathway report has been deleted

6. Pathway Shared Partner – Discontinued: One-time notification generated for

the pathway when the shared partner status (actor status) has been updated to

“Discontinued”

7. Pathway Shared Partner – Un-Discontinued: One-time notification generated

for the pathway when the shared partner status (actor status) has been updated

from “Discontinued” to “Active”

8. Pathway Final Payment – Authorized: One-time notification generated for the

pathway when the warranty payment status (final payment) has been updated

to “Authorized”

9. Pathway Final Payment – Reversed: One-time notification generated for the


to “Reversed”

10. Pathway Final Payment – Denied: One-time notification generated for the


to “Denied”



7.2 OBP/OBR Cross Word

DOWN ACROSS

2. _____ with patients and the health care

team is key to improving everyone‟s care

experience

3. _____ focus on achieving defined results

within a defined time period

4. _____ is an example of the type of category

of pathways available

5. What occurs for the providers when PLOs

are completed and goals met?

8. What is collaborative initiative between

CCACs and SPOs?

1. What is consistently measured?

6. What is shared with the health care

team?

7. What pathways are based on

9. What the health care team focuses on

10. What is required initially by the Care

Coordinator to determine which pathway

is most suitable?



7.3 OBP/OBR Word Search

ACCOUNTABILITY

ASSESSMENT

CARE

COLLABORATION

CONSISTENCY

CONTRACTS

EREFERRAL

EVIDENCE

EVOLUTION

FLEXIBILITY

HIPS

INNOVATION

JOURNEY

PATHWAYS

PILOTS

PUBLIC

QUALITY

REMIMBURSEMENT

SATISFACTION

SUCCESS

TEAM

WOUND



8. QUIZ ANSWERS

8.1 Section 3 Quiz

1. True or False

The Pathway Details page is called the „action‟ page as all communication and action

is generated from this page in both CHRIS and HPG

True

2. In CHP a SPO is able to:

a) Add a New Pathway

b) Submit a Pathway Report

c) View a Pathway Report Submitted by the CCAC

d) All of the above

All of the above

8.2 Section 6 Quiz

1. True or False

Variances and Risk Factors are barriers or risk factors that are affecting or may

affect patient outcomes during the OBP course of treatment.

True

2 When a SPO submits an Activity Request for a CCAC to act on such as

an add-on for Adult Day Program:

a) A task is generated to remind the CCAC to review the report and take action

b) The Provider will never find out if their request is acted on

c) The CCAC action will be recorded as a pathway event

d) A and C

A and C

3. Core payments are sent from CHRIS to the SPO when Payment linked

outcomes are met, which interval outcomes were PLOs:

a) Each interval outcome

b) First interval outcome

c) Second Interval outcome

d) Last Interval outcome

e) B and D

B and D



8.3 OBP/OBR Cross Word Answers

DOWN ACROSS

2. _____ with patients and the health care

team is key to improving everyone‟s care

experience

3. _____ focus on achieving defined results

within a defined time period

4. _____ is an example of the type of category

of pathways available

5. What occurs for the providers when PLOs

are completed and goals met?

8. What is collaborative initiative between

CCACs and SPOs?

1. What is consistently measured?

6. What is shared with the health care

team?

7. What pathways are based on

9. What the health care team focuses on

10. What is required initially by the Care

Coordinator to determine which pathway

is most suitable?



8.4 OBP/OBR Word Search Answers

ACCOUNTABILITY

ASSESSMENT

CARE

COLLABORATION

CONSISTENCY

CONTRACTS

EREFERRAL

EVIDENCE

EVOLUTION

FLEXIBILITY

HIPS

INNOVATION

JOURNEY

PATHWAYS

PILOTS

PUBLIC

QUALITY

REMIMBURSEMENT

SATISFACTION

SUCCESS

TEAM

WOUND

Documents

SPO Training Workbook for OBP/OBR in HPG