Tools for Application of SAIL and the Mental Health ... Conference Presentations/Da… · Deep Dive Tools FY15 Facility Score 10th-50th-90th ptile Location Numerator Score Std. ScoreNumerator

Tools for Application of SAIL and the Mental Health Management System

Lisa K. Kearney, PhD, ABPP Office of Mental Health OperationsCliff Smith, PhD, ABPP Iron Mountain VA Medical CenterJodie Trafton, PhD Office of Mental Health Operations

VETERANS HEALTH ADMINISTRATION

Objectives

1) Participants will identify specific MH and non-MH metrics to be utilized to monitor mental health program improvement.

2) Participants will learn what to do and not do with data management tools for local process improvement.

2


Tools, Tools, and more Tools


Overall Common Tips for SAIL MH Improvements

Use resources on the Mental Health Business

Operations SharePoint for coding, labor mapping, productivity monitoring

and accessing prior presentations.

Assign champions for process improvements for

areas covered in SAILAttend 2nd Friday at 2pm

EST Bus Ops calls

Review labor mapping of each provider

Ensure all residential and inpatient mental health providers are capturing

individual encounters per VHA Directive 1082.


Overall Common Tips for SAIL MH Improvements

• Review all clinics for each provider ensuring their clinics match their schedules and that the stop codes for each clinic are accurate. Stop code accuracy is critical for SAIL metrics, while clinic set up is critical for reviews on clinic efficiency metrics. Cross reference the metric definitions to the clinics

• Review your data on the Clinic Practice Manager (CPM) dashboard to review utilization, supply, and demand for scheduling/clinic grids

• To address high no-show rates, VERC presented on the national MH business operations call this past year sharing some best practices in improving no show rates in MH. Miami presented on a national call their method of tracking follow up on no-shows. The presentation and supporting materials are available on line.

• Utilize the deep dive tool to focus efforts Missed Opportunity Daily Call List


GPM Tools

• Office of Productivity, Efficiency, & Staffing (OPES)

• Specialty Productivity - Access Report and Quadrant (SPARQ)

• Physician Capacity Summary Report

• Access Glide Path

• Clinic Practice Management Dashboard

• Healthcare Operations Dashboard

• Clinic Access Index (CAI)

• Clinic Capacity Report


Specialty Productivity – Access Report and Quadrant (SPARQ)


Clinic Practice Management Dashboard

If you click on summary by clinic, you can get a detailed breakdown by each provider for each of their clinics for the measures on the left including wait time, no show, clinic utilization, etc.


Healthcare Operations Dashboard

Note: this tool is used daily by CO leadership to assess

concerns.


Clinic Capacity Report

• 502 Clinic Slots in March

• Congress: “Why do we have an access problem with only 50% utilized?”

All Facility V01 V02 V03 V04 V05 V06 V07 V08 V09Past Clinic Capacity Appt Slots 1,192,726 101,314 31,197 42,837 58,866 26,890 49,207 83,187 86,422 52,830Past Number of Open Appt Slots 590,421 63,371 16,235 26,698 25,729 15,361 19,592 32,996 32,092 22,971Past Percentage Appts Scheduled 63.24% 36.72% 54.81% 54.67% 74.23% 58.10% 85.07% 76.42% 80.87% 75.02%Past Percentage Appts Utilized 50.50% 37.45% 47.96% 37.68% 56.29% 42.87% 60.18% 60.34% 62.87% 56.52%Past Scheduled Appointments 754,242 37,202 17,099 23,417 43,699 15,624 41,862 63,570 69,892 39,633


Clinic Access Index (CAI)

• 502 Clinic Slots


Access Glide Path


MH Tools

• Performance Evaluation Center (PEC) Portal

• Mental Health Management System

• Mental Health Outcomes Oriented Quality Metrics (MHOOQM)

• Specialty Programs (e.g., PCMHI, BHIP, EBP Tracker)

• Prescribing Safety

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Population Coverage Composite FY2015 Qtr4 FY2016 Qtr1Measure Description Measure

NameMeasure Weight

Preferred Direction

Deep Dive Tools

FY15 Facility Score10th-50th-90th ptile Location Numerator Score Std. Score Numerator Score Std. Score

MH Population Coverage PCov2 -- -0.6: 0.0: 0.5 Iron Mountain, MI -- -0.45 -0.95 -- -0.17 -0.35% psychosis‐dxed patients receiving MHICM services

HIAS21 1 -- 2.7: 3.7: 6.9Iron Mountain, MI -- NA NA -- NA NA

% patients w/ targeted MH indication served by PRRC

HIAS72 1 -- 0.6: 1.4: 3.9Iron Mountain, MI -- NA NA -- NA NA

% VHA pts using MH services MPT1 1 -- 13.8: 19.6: 23.6 Iron Mountain, MI 1,791 16.01% -0.78 2,138 18.99% -0.02% primary care patients with PC‐MHI engagement

PACT15 1 -- 3.7: 6.8: 10.6Iron Mountain, MI 596 9.31% 0.83 529 8.88% 0.68

% pts w/ MH dx who have a MH E&M encounter

PMED1 1 -- 33.7: 45.8: 58.2Iron Mountain, MI 1,448 28.45% -1.81 1,484 30.29% -1.61

% local MH service‐connected Vets receiving VA MH services

Pop6 1 -- 43.6: 52.0: 59.0Iron Mountain, MI 1,766 48.24% -0.54 1,765 47.84% -0.60

% depression‐dxed pts w/ psychotherapy visit for depression

Psy32 1 Link 27.6: 34.9: 43.2Iron Mountain, MI 980 32.50% -0.44 994 34.59% -0.10

% SMI‐dxed patients w/ psychosocial tx for SMI


% SUD‐dxed patients w/ psychosocial tx for SUD


% PTSD‐dxed patients w/ psychotherapy visit for PTSD

Psy38 1 Link 45.3: 54.4: 67.3Iron Mountain, MI 699 61.64% 0.78 728 62.76% 0.91

% PTSD‐dxed patients receiving specialty PTSD outpt care

PTSD56 1 -- 6.5: 16.4: 29.8Iron Mountain, MI -- 11.17% -0.64 291 20.12% 0.40

% pts w/ targeted MH dx using transitional work services

SMIE2 1 -- 0.4: 1.2: 2.9Iron Mountain, MI -- 1.20% -0.22 59 1.28% -0.17

% psychosis‐dxed pts using supported employment services

SMIE1 1 -- 0.2: 1.8: 3.9Iron Mountain, MI -- 1.88% -0.09 15 2.38% 0.22

% pts w/ opioid use dx receiving opioid agonist/antagonist

SUD16 1 Link 12.9: 33.2: 49.8Iron Mountain, MI 34 36.17% 0.32 36 36.36% 0.33

% SUD‐dxed patients with intensive SUD treatment

SUD4 1 Link 1.8: 6.1: 15.4Iron Mountain, MI 13 1.07% -0.99 5 0.43% -1.08

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Continuity of Care Composite FY2015 Qtr4 FY2016 Qtr1

Measure Description Measure Name

Measure Weight

Preferred Direction

Deep Dive Tools

FY15 Facility Score10th-50th-90th ptile Location Numerator Score Std. Score Numerator Score Std. Score

Continuity of MH Care Cont2 -- -0.6: 0.0: 0.6Iron Mountain, MI -- 0.08 0.17 -- 0.20 0.41

% MH residential discharge w/ MH follow up within 1 week

FURR1 1 Link 47.9: 60.8: 77.1Iron Mountain, MI 12 66.67% 0.38 1 NA NA

% pts on new antidepressant med w/ 84 days continuous trtmt

MDD43h 0.5 Link 58.5: 73.3: 84.5

Iron Mountain, MI 91 58.70% -1.37 77 58.33% -1.41

% pts on new antidepressant med w/ 180 days continuous trtmt

MDD47h 0.5 Link 43.8: 56.5: 68.3

Iron Mountain, MI 67 43.22% -1.41 55 41.67% -1.58

% loss to VHA care for pts with schizophrenia or bipolar dx

mhoo8 -1 Link 4.2: 3.0: 2.0Iron Mountain, MI 9 1.81% 1.33 13 2.66% 0.45

% MH inpatient discharge w/ MH follow up within 1 week

MHT12 1 Link 75.0: 82.0: 88.3Iron Mountain, MI 41 82.00% 0.01 8 88.89% 1.29

% depression‐trtd pts w/ 3 psychotherapy visits in 6 weeks

Psy33 0.25 Link 20.1: 27.3: 37.6Iron Mountain, MI 330 33.67% 0.72 408 41.05% 1.70

% SMI‐trtd pts w/ 3 psychosocial tx visits in 6 weeks


% SUD‐trtd pts w/ 3 psychosocial tx visits in 6 weeks

Psy37 0.25 Link 38.2: 50.1: 62.9Iron Mountain, MI 85 30.04% -1.88 110 33.43% -1.56

% PTSD‐trtd pts w/ 3 psychotherapy visits in 6 weeks



Experience of Care

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Experience of Care Composite FY2015 Qtr4 FY2016 Qtr1

Measure Description Measure Name

Measure Weight

Preferred Direction

Deep Dive Tools

FY15 Facility Score

10th-50th-90th ptile

Location Numerator Score Std.

ScoreNumerator Score Std.

Score

Experiences of MH Care ExpC1 -- -0.9: 0.0: 0.9Iron Mountain, MI -- -0.23 -0.30 -- 0.05 0.05

MH Provider Survey‐‐Collaborative MH Care

MHPC3 0.25 Link 3.3: 3.6: 3.9

Iron Mountain, MI -- 3.22 -1.30 -- 3.24 -1.24

MH Provider Survey‐‐Job Satisfaction

MHPS4 0.25 Link 3.3: 3.6: 3.9Iron Mountain, MI -- 3.26 -1.36 -- 3.59 -0.04

MH Provider Survey‐‐Quality of MH Care

MHPQ2 0.25 Link 3.3: 3.7: 4.1Iron Mountain, MI -- 3.73 0.11 -- 3.79 0.27

MH Provider Survey‐‐Timely Access MH Care

MHPA1 0.25 Link 2.4: 2.7: 3.1

Iron Mountain, MI -- 2.48 -0.99 -- 2.93 0.79

Veteran Satisfaction Survey‐‐MH Appointment Access

VSAA1 1 -- 3.7: 3.9: 4.2

Iron Mountain, MI -- 3.87 -0.33 -- 3.87 -0.33

Veteran Satisfaction Survey‐‐Patient‐Centered MH Care

VSPC2 1 -- 3.8: 4.0: 4.2

Iron Mountain, MI -- 4.08 0.53 -- 4.08 0.53


MHMS Facility Strengths & Areas of Growth

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Process Improvement:Utilizing MH tools for Clinical and

Administrative Program Development


Process Improvement Takes Time

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Common Tips for Follow Up Treatment on SAIL

MHT12 - % MH inpatient discharge w/ MH follow up within

1 week

• Assign a champion responsible for the oversight of ensuring follow-up occurs.

• Review policy requirements VHA Memo (issued 7-17-13), Guidance on Post-Discharge Follow-Up for Mental Health (MH) Patients. Ensure that your tracking system meets all required elements outlined in this memo. Utilize the drill down link to help track discharge follow-up.

FURR 1 - % MH residential discharge w/ MH follow up within

1 week

• Assign champion for oversight• Implement new tool is available

on the PEC portal. Review the technical manual to insure that the appropriate level of follow-up is provided.


Example Information from Report Treating

orHome Station

CategoryDischarge

or AdmitFacility

AdmitDate

Discharge Date

ContactBeforeDate

Follow‐upCompleted?

FirstFollow‐up

Site

FirstFollow‐upProvider

Treating Discharge 5/16/16 5/19/16 5/26/16 YesTreating Discharge 5/18/16 5/19/16 5/26/16 NoTreating Discharge 5/18/16 5/19/16 5/26/16 NoTreating Discharge 5/12/16 5/20/16 5/27/16 NoTreating Discharge 5/14/16 5/20/16 5/27/16 NoTreating Discharge 5/18/16 5/20/16 5/27/16 YesTreating Discharge 5/18/16 5/20/16 5/27/16 NoTreating Discharge 5/18/16 5/20/16 5/27/16 NoTreating Discharge 5/19/16 5/20/16 5/27/16 NoTreating Discharge 5/19/16 5/20/16 5/27/16 No


Common Tips for SMI SAIL MH Improvements

Group Treatment: • Enhance SMI groups in your general

MH clinic to target Veterans who might not desire more specialized programs.

• Explore enhancing SMI groups in your general MH clinic for those not in PRRC services

Engage Veterans Lost to Care • SMI Cohort Loss-to-Follow-up

Dashboard• Report provides patient names with

assigned providers and recent or upcoming appointments. Combine with LRC’s work with the SMI Re-Engage team. (MHOO8)

Enhance TSES Services• Here is the Therapeutic and Supported

Employment Program share point.• Resources on this site will assist with

enhancement of programming in this area.

• (SMIE1 & 2)

Expand PRRC• Develop strong marketing strategy for

your local PRRC.• Enhance Bridge Groups on inpatient.• Meet with BHIP teams and other

specialty teams, and incorporate your Peers into this endeavor.

• (HIAS 72)

VETERANS HEALTH ADMINISTRATION 23


Psy34 vs Psy35

Psy34 % SMI-dxed Vets w/ psychosocial tx for SMI• Population Coverage• Numerator: Veterans with SMI

diagnoses and at least one psychotherapy or psychosocial treatment visit for SMI (CPT codes: 90791, 90832, 90834, 90837, 90839, 90847, 90849, 90853, 99078, 99509, 99510, H0004, H0031, H0036, H2011, H2017, H2027, S9445, S9446

• Denominator: Number of Veterans with SMI diagnoses in last 4 quarters

• FY16Q1 = 512 of 1,994 (-1.5)

Psy35 % SMI-dxed & trtd Vets w/ 3 psychosocial tx visits in 6 weeks• Continuity of Care• Numerator: Number of Veterans with SMI

diagnoses and a psychotherapy or psychosocial treatment visit for SMI who received at least 3 psychotherapy or psychosocial treatments for SMI in a 6 week period

• Denominator: Number of Veterans with SMI diagnoses and a psychotherapy or psychosocial treatment visit for SMI in last 4 quarters

• at least one psychotherapy or psychosocial treatment visit for SMI (CPT codes: 90791, 90832, 90834, 90837, 90839, 90847, 90849, 90853, 99078, 99509, 99510, H0004, H0031, H0036, H2011, H2017, H2027, S9445, S9446)

• FY16Q1 = 271 of 512 (.85)


Link between SMI Re-Engage &SAIL Loss-to-Care (mhoo8) Measure

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Last VA Visit 123 6 9

12 Months since last VA Visit

Veteran “at risk” of becoming lost-to-careVeteran identifiable on “SMI Loss-to-

Follow-up Report” dashboard to preventVeteran from becoming lost to care*

*Accessible via SAIL Deep Dive Tools:

https://spsites.dev.cdw.va.gov/sites/OMHO_PEC/Pages/MH-Domain-Composites-HomePage.aspx

**Waves sent to LRCs directly from SMITREC

Veteran now lost-to-careVeteran in the loss-to-care

measure on SAIL (mh008) and will be on an SMI Re-Engage

wave**

15 18 21 24


Common Tips for PCMHI SAIL Improvement

• Use MDD43h and MDD47h drill down tool to offer engagement in CM for those newly prescribed an antidepressant

Enhance Care Management

• Link on Center for Integrated Health Care contains sample Service Agreements between MH and Primary Care.

• Here is a presentation about how to develop a strong one.

Review PC-MH Service Agreement.

• Review stop codes for all 534 clinics to ensure that this is reflecting actual PC-MHI care. Review Stop Codes

• To track your progress and effectiveness, a new dashboard has been developed: Click here for the PCMHI Same Day Access Dashboard.

Increase Same Day Warm Handoff


Sample MDD 43h/47h Report

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Common Tips for PTSD and Psychotherapy on SAIL

EBP Implementation and Tracking: EBP tracking: review allotted time for EBP, local tracking system of offering EBP and tracking EBP over time, use of EBP Dashboards for local individualized tracking

Routine offering of psychotherapy options to Veterans for PTSD, Depression, SMI, and SUD

Coding: review the tech manual to ascertain what CPT codes and clinic stop codes provide credit and ensure providers are utilizing appropriate codes in the right clinics (For Psy32, Psy34, Psy36, Psy38)


EBP Dashboard – Monthly Summary Example

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EBP Dashboard – Individual Monthly Summary Example

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Tip: Drs. Kristine Day and Claire Collie are great consultants to help with questions on tracking EBP implementation.


Common Tips for Satisfaction in SAIL

MH Provider Survey

• Informal meetings with subgroups to discuss and identify concerns.

• Obtain feedback from all providers in the action steps to take to address these concerns as part of your formal action

• Consider methods of empowering front line staff in methods for quality improvement.

Veteran Satisfaction

• Review FY15 Veteran Satisfaction summary power point here and review your most recent data sent in October.

• Work with the LRC Coordinator to engage involvement of the Veterans Mental Health Council (VMHC) and obtain their feedback on their concerns/satisfaction.

• Dr. Peggy Henderson ([email protected]) is a great resource nationally to discuss how to assist in building engagement with VMHCs.


Common Tips for SUDSAIL MH Improvements

Implement STORM Dashboard on a regular basis to identify Veterans who might appropriately be offered opiate substitution treatment. (SUD16)

Expand extended hours to provide more intensive services at times when Veterans might be better able to attend. Use the dashboard to track how robust your extended hours are.

Coding: SUD4, Psy36, and Psy37 -review the tech manual to ascertain what CPT codes provide credit for this and ensure providers are utilizing appropriate codes on SAIL MH

Reach: SUD4, SUD16, Psy36 and Psy37 - Review dashboard to assess if population reach for SUD treatments is more difficult in particular locations.


Data is just Data without little Self-Reflection

• Does SAIL reflect the quality of our program?• Is the challenge administrative (e.g., coding or documentation errors)?• Is there a true population gap?• Is there an engagement gap?• Where are the opportunities to improve our clinical outreach?

Process Improvement: Putting it all together


Implement Daily, Weekly, Monthly, Quarterly, Annual Routine

DAILYTask Description Date Column1Encounter Action Required Report (EARR) Encounter Action Required

Encounter Closeout Workload CloseoutSame Day Screening Evaluation

Review all Consults for completion of 5 elements

Inpatient/Residential Follow upMHT12 and FURR1 - 7 day post-discharge follow up Acute Daily Discharges

WEEKLYTask Description Date Column1Run the Incomplete Encounter Management Module (IEMM) Report in VISTA (^Incomplete, Select #4)

Review the rejected workload transmissions from Austin to determine error trends and opportunities to maximize workload capture. Any rejected transmission from Austin will not be credited for workload


Review Daily Dash, Current Focus, Access to Care in the Healthcare Operations Dashboard




MONTHLY Date last completed

Task Description Date Column1

Non-vested patients

Pull the ARC Vesting Codes by Non-vesting Provider report. Review for documentation errors, to include incorrect designation of the primary provider (encounter must designate highest level provider as primary). Audit encounters with CPT codes 99203, 99204, 99205, 99213, 99214, or 99215 to see a vesting-provider was not listed as the primary on the encounter form. Review of encounter via VISTA, PCE Encounter Viewer option, Display Detail (DD) or via CPRS (edit encounter). ARC SSN Details (Report #7)

Review Labor Mapping

Coordinate meeting with MCA staff to review local labor mapping and update changes needed.

National module in development; Utilize local MCA reports

Access Clinic Practice Management DashboardClinic Practice Management Dashboard

Access Clinic Capacity Report Clinic Capacity Report

Access

Clinic Access Index (v2) - review Stop Code and provider- level clinic utilization, access, and missed opportunity rate.

Clinic Access Index (v2)

AccessAccess Glidepath - review service level access and scheduling issues Access Glide Path



QUARTERLY Date last completed


Review of CMI Patient Class

Cross-reference the ARC Workload Data SSNs by CMI patient class with the service line list of MHICM/RANGE patients. Verify that any patient with >41 552 Stop Visits is placed into the CMI class ARC SSN Specific Cubes

Review Provider Productivity Review wRVU and Encounter data from previous Quarterhttp://vhaaacweb3.vha.med.va.gov/MHOB/

Review of provider person class codes

Obtain a list of Licensed Independent Practioners (to include MDs, NPs, PAs, and CNSs) at your station from the Office of the Chief of Staff. Cross-reference the VERA approved list of vesting provider person class codes on the ARC website with your station's person class codes by provider type. Refer to your Station Memorandum on New Person File Maintenance for the point of contact on any corrective actions. Recommendation to complete in August and February. Person Class Assignments

Review count vs. non-count clinics

Review clinic profile management to maximize workload capture. Refer to VHA Directive 2010-027, VHA Outpatient Scheduling Processes and Procedures for policy information on designation of count or non-count.

Review Clinic Grids and Utilization

Tools include CUSS Report and CAI(v2) which will drill to individual provider level

http://vssc.med.va.gov/webrm/cussrpt.aspx

Review Past Clinic Utilization CUSS Report

MHIS ReviewMental Health Information System - Covers UMHSH required areas. MHIS Dashboard

Clinic Provider Report Clinic Default Provider Report Clinic Provider Report



SEMI-ANNUAL Date last completed


Review Provider Performance Plan

MCA Cost Per Clinic Stop Code by Service MCA CDW Innovations Reports

Outpatient Stop Code by Service

Chronic Mental Illness Retention Audit (to be completed 3rd and 4th quarter)

Pull the ARC VERA report Workload Utilization for Complex patient classes. Identify patients who are below a price group of 9, the number of visits they had, and the number of visits required. Qualifying CMI visit stop codes are 156-157, 121, 502-525, 529, 532-535, 538-540, and 547-554.

ARC SSN Specific Cubes

Outpatient Stop Code Average Cost ALL

Displays the cost of each stop code by facility compared to the Medical Center Group, VISN and National averages. Standard deviations are included to highlight areas that may need to be further reviewed.

Outpatient Stop Code Average Cost

Time Study - Clinic Review Evaluate Daily Scheduling Practice

Encounters - PHI Cube; OPES Pyramid

Complete OPPEs

C:\Users\vhairosmithc\Desktop\BO


Implementation Checklist: Labor Mapping

Validate labor mapping for each provider. Managerial Cost Accounting (MCA) labor mapping must accurately reflect the percentage of each employee’s time spent providing direct clinical care and where that care was provided.

See Directive 1161 for description of mental health clinical, administrative, research, and education mapping.

WHY? If not, productivity monitors will be off. Ensure that all required mental health positions are mapped according to

national guidelines. Does each position have the required amount of time assigned to administration, education, and research required by VA Policy?

Local Recovery Coordinator – 75% AdministrativeEvidence Based Psychotherapy Coordinator – 30% AdministrativeMilitary Sexual Trauma – recommended at least 10% administrativeSuicide Prevention Coordinator – 100% Administrative


Review all Labor Mapping for accuracy

• Labor Mapping should be reviewed on a monthly basis to ensure accuracy

• Establish monthly meeting with local MCA staff to review labor mapping

• Labor Mapping Resources: Labor Mapping Tools

If the Labor Mapping of Clinical time is NOT correct, productivity will be incorrectly reported (potential for

extremely high or low numbers)


Practical Implementation Checklist: Labor Mapping

Does time mapped to clinical versus administrative, education, or research accurately reflect providers' dedicated time and duties (i.e., match weekly grid established below)? Under-mapping a provider’s time to clinical care may make him or her appear over-productive. Over-mapping a provider’s time to clinical care may make him or her appear under-productive.

Does the labor mapping match the functional statement for each listed provider? (NOTE: If more time is mapped to clinical care than is actually being spent providing clinical services, the provider’s productivity will be reduced).

Does the labor mapping of each provider meet the guidance for providers outlined in the Mental Health Productivity Directive and the Physician Mapping Directive for clinical, administrative, education and research duties? These are available at: http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2891 and http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2384


Practical Implementation Checklist: Labor Mapping

Are individuals participating in non-clinical meetings taking more than one hour of time each week mapped for non-clinical time (e.g., disruptive behavior committee, etc). See the MH Productivity Directive for guidance.

Is the supervision of residents, interns, and students assigned to a provider’s Clinical time?

Is driving time for community services assigned to a provider’s Clinical time? Is time set aside for clinical administration (e.g., progress note completion, chart

review, etc) assigned to Clinical time?


Person Class

• Run a report listing the person class for each of your providers and check for accuracy of this report. A listing of all person classes for identifying provider type is available at: Person Class Taxonomy and Directive 2012-003 Person Class File Taxonomy)

• Active Person Class Assignments

• Make any necessary changes to person class.

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Stop Code/CHAR 4 Verification

• Collect the names of all clinics providers currently utilize for scheduling patients.

• Identify the stop codes for each of these clinics. – Clinic Practice Management Dashboard

• Ensure the stop codes accurately reflect the type of work provided in each of these clinics: MCA Stop Codes

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StaffDisplayName ClName PrimStopSecStop Unique Patients for Timeframe Slot Supply (Total Slots) Total Slot Demand

ALDERMAN,DAVID R (585) IM BH ALDERMAN GMH NP 502 185 14 28 25IM BH EXT HRS TH PTSD NP 562 185IM BH EXT HRS TH SUD NP 513 185IM BH TMH ALDERMAN 502 692

ANDRESKI,SARAH R (585) IM BH ANDRESKI GMH 502 510 7 25 15IM BH ANDRESKI PTSD 562 510 10 13 17IM BH ANDRESKI SUD 513 510 1 11 16IM BH WED ANG GRP 550 510

BEAUCHAMP,GAIL S (585) IM BH BEAUCHAMP GMH 502 125 2 11 11IM BH BEAUCHAMP PTSD 562 125 6 19 8

IM BH PTSD FRI GRP BEAUCH 516 125 4 2 1IM BH PTSD TUE GRP BEAUCH 516 125 5 2 0IM BH TMH BEAUCHAMP‐X 502 692 15


Individual Clinic Verification• Build an Excel Document file containing the current representation of all clinic

grids for each provider by tab. If a provider has multiple clinics, ensure that all clinics are represented on each tab of the Excel document.

• Review with each provider if their current grid availability truly reflects actual availability. For example, if a clinic grid states the provider is open all day for 60 minute appointments on Wednesday, but in reality she has a clinic meeting from 8-9am on Wednesdays, the grid must be updated.

• Review the length of clinic grid slots to ensure they reflect the service need for that area (e.g., 30, 60, 90 minute appointments)

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8:00 AM

9:00 AM

10:00 AM

11:00 AM 11:15 AM

11:30 AM 12:30 1:00 PM2:00 PM

3:00 PM 3:15 PM4:15 PM

Monday access Clinic Clinic Clinic Clinic Clinic

Tuesday access Clinic ClinicPTSD Grp

adminClinic Clinic

Wednesday Dept meetings Clinic Clinic access Clinic accessThursday admin Clinic Clinic Clinic Clinic access Clinic

FridayClinic Clinic Clinic PTSD Grp admin Clinic Access


Individual Clinic Verification• Determine the number of bookable hours each provider is to have. Make sure to

account for mandatory breaks and time for non scheduled clinical work (e.g., consultation, phone call returns, eConsults, etc) and regular mandatory meetings(e.g., clinic meetings, discipline meetings, etc)

• Update all clinic grids in the Excel document to reflect availability, appropriate time length, and appropriate stop code.

• Work with your administrative staff to ensure all clinic grids are updated in VistA

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Bookable TimeHours (minus Lunch)

% Clinical Labor Mapping 75% 80% 85%

37.5 100% Available Clinical Hours 37.5 37.5 37.5Bookable Weekly

Hours 27 29 31Work Weeks 46

Total Clinical Hours (yearly) 1251 1334 1421


Proper CPT Coding• Providers must follow the precepts of the Centers for

Medicare and Medicaid Services (CMS) Correct Coding Initiative.

• For further guidance, please see VHA Handbook 1907.03, Health Information Management Clinical Coding Program Procedures and the specific mental health coding guides for multiple areas of mental health available on the OMHO MH Business Operations SharePoint:

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Individualized Productivity Monitoring

• VHA Directive 1161: Facility leaders must establish productivity targets for mental health providers.

• Use the Mental Health Onboard Clinical (MHOC) data or the Excel-based tool available on the Mental Health Business Operations SharePoint

– Includes wRVUs for VA services not credited in standard CMS assignments – May be used for individualized productivity monitoring.

• These tools are helpful in monitoring productivity for providers not included in the Physician Productivity Cube.

• Links to these tools are available on the PEC Portal Staffing and Productivity page.

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Questions?

Documents

Tools for Application of SAIL and the Mental Health ... Conference Presentations/Da… · Deep Dive Tools FY15 Facility Score 10th-50th-90th ptile Location Numerator Score Std. ScoreNumerator