Travel Connections Performance Improvement Leadership Development Program Lynn E. Keplinger, MD,...
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Travel Connections Performance Improvement Leadership Development Program Lynn E. Keplinger, MD, FACP Deborah Kaplan, RN Keith Hampton, MSN, APRN, ACNS-BC February 19, 2010
Travel Connections Performance Improvement Leadership Development Program Lynn E. Keplinger, MD, FACP Deborah Kaplan, RN Keith Hampton, MSN, APRN, ACNS-BC
Travel Connections Performance Improvement Leadership
Development Program Lynn E. Keplinger, MD, FACP Deborah Kaplan, RN
Keith Hampton, MSN, APRN, ACNS-BC February 19, 2010
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Sponsor Les Hall, MD - Chief Medical Officer
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Advisors Robert Lancey, MD Anne Fitzsimmons, MD
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Mascot
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Aim Statement One year after transferring Travel Connections to
Fairview clinic we will have: Developed at least a budget neutral
business within General Internal Medicine Increased MU pharmacy
usage rate for Travel prescriptions from 12% to 50% Increased 0% MU
identified patients to 5% MU identified while gaining 25% of the
patient base into General Internal Medicine
Slide 7
What is Travel Connections? A full service approach to the
international traveler providing education, vaccines, prescriptions
and individualized attention to particular health needs.
Slide 8
Why Move Travel Connections? Timing was right Academic
involvement Research potential New product line for General
Internal Medicine Resident and fellow opportunities in both
Infectious Diseases and Internal Medicine
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SERVICE COMMUNITY
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INFLUENCING FACTORS
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Budget Neutral Business Fixed costs Salaries Taxation Variable
sources Visits Immunizations (no revenue sharing) Prescriptions
Downstream referrals
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Increased Pharmacy Usage Establish relationships Memorandum of
understanding drawing on Shoreland protocols Print prescriptions to
Fairview pharmacy without signature Adequate medication supplies
Codes developed for Fairview prescription tracking Develop
reporting capability for tracking Vaccine pricing for
competition
Slide 13
Documentation Move from handwritten notes to electronic record
Create PowerNote Encounter form creation Secondary provider noted
Validate vaccinations in EMR Travel history form placed on website
Receipt book
Slide 14
Travel Connections Patient Encounter Form VisitCPTCharge
___Travel education general99499$60.00 ___Vaccine
administration90471$12.00 _X_Facility fee754000000$0.00 Adult
Vaccinations Vaccine DoseCharge Code Charge ___Immune Globulin
**Travel < 3 months 0.02ml/kg IM x 165124952 $ 43.00 **Travel
> 3 months 0.06ml/kg IM x 165124952 $ 43.00 ___Hepatitis
A(Vaqta) 1ml IM, day 065115433 $ 75.00 1ml IM 6-18 mo.65115433 $
75.00 ___Hepatitis B(Recombivax) 1ml IM, day 065190746 $ 31.00 1ml
IM, 1 mo.65190746 $ 31.00 1 ml IM, 6 mo.65190746 $ 31.00
___Influenza 0.5ml IM65048329 $ 13.00 ___Meningovax(Menomune) 0.5ml
SC65801213 $ 147.00 ___Meningovax(Menactra) 0.5ml IM65121000 $
144.00 ___Japanese Encephalitis 0.5ml IM day 065124967 $ 319.00
(Ixiaro) 0.5ml IM day 2865124967 $ 319.00 ___MMR 0.5ml SC65804468 $
83.00 ___Polio(IPOL) 0.5ml SC65802597 $ 41.00 (Give dose 1&2
4-8weeks apart, dose 3 6-12 mo after dose 2) ___Td 0.5ml IM65803496
$ 34.00 ___Tdap 0.5ml IM65124509 $ 49.00 ___PPD 5TU 0.1 ml
ID65363526 $ 10.00 ___Rabies(Imovax) 1ml IM day 065804506 $ 259.00
1ml IM day 765804506 $ 259.00 1ml IM day 21/2865804506 $ 259.00
Other ___Typhoid(Typhim Vi) 0.5ml IM q 2 yrs65124898 $ 69.00
___Typhoid oral(Vivotif) 1 cap q48hrs x 4 $ 65.00 Boost q 5 yrs $
65.00 ___Yellow Fever 0.5ml SC q 10 yrs65802571 $ 113.00 Pediatric
Vaccinations VaccineAgesDoseCharge Code Charge ___Immune Globulin
**Travel < 3 months 0.02ml/kg IM x 165124952 $ 43.00 **Travel
> 3 months 0.06ml/kg IM x 165124952 $ 43.00 ___Hepatitis
A(Vaqta)1-18 yrs0.5ml IM, day 065115441 $ 38.00 1-18 yrs0.5ml IM
6-18 mo65115441 $ 38.00 ___Hepatitis B(Recombivax)Birth-19 yrs0.5ml
IM, day 065190746 $ 16.00 Birth-19 yrs0.5ml IM, 1 mo.65190746 $
16.00 Birth-19 yrs0.5ml IM, 6 mo.65190746 $ 16.00 Laboratory
Studies ___Influenza, injection 65124471 $ 13.00 (1=today/2=prior
to return/3=fasting) ___Meningovax(Menactra)> 2 yrs0.5ml
IM65121000 $ 144.00 ____BMP ___Polio(IPOL) primary series2 mo0.5ml
SC65802597 $ 41.00 ____CMP 4 mo0.5ml SC65802597 $ 41.00 ____CBC
6-18 mo0.5ml SC65802597 $ 41.00 ____CBC with diff 4-6 yrs0.5ml
SC65802597 $ 41.00 ____G6 PD ___Tdap11yrs and >0.5ml IM65124509
$ 49.00 ____Rabies IGG ___PPD 5TU 0.1 ml ID65363526 $ 10.00
Dx___________________________ ___Rabies (Imovax)Birth1ml IM day
065804506 $ 259.00 1ml IM day 765804506 $ 259.00 1ml IM day
21/2865804506 $ 259.00 Return to Clinic:______________
___Typhoid(Typhim Vi)> 2 yrs0.5ml IM q 2 yrs65124898 $ 69.00
Immunization only ___Typhoid(Vifotif)> 6 yrs1 cap q48hrs x 4 $
65.00 Boost q 5 yrs $ 65.00 ___Yellow Fever> 9 mo0.5ml SC q 10
yrs65802571 $ 113.00 Signature:___________________ __ Grand Total
$____________
Slide 15
Travel Clinic PowerNote
Slide 16
Facility Renovation at Fairview Transfer vaccine refrigerator
Transfer Travel Connections telephone number to Fairview Purchase a
safe Set up computers to allow prescription printing Signage
Slide 17
Stephens College Patient Flow
Slide 18
Travel Clinic Patient Flow
Slide 19
Road Blocks Negotiate with Dean of School of Health Professions
regarding timing of position transfer to General Internal Medicine
Construction in Fairview clinic Nurse position posting issues
Obtain and purchase protocols Pharmacy printer functional Completed
PowerNote
Slide 20
And then the Bomb.
Slide 21
A New Stakeholder Emerges Matt Levsen, Associate Chief
Financial Officer
Slide 22
Vaccine Costs/Charges Vaccinemark-up from costCPTCharge Code
FY08 Units FY09 Units FYTD10 (Oct) Units Yellow fever single dose
150% 9071765802571000 Hep A (Vaqta) 175% 9063265115433224325163 Hep
A peds (Vaqta) 175% 90633651154414,0283,4801,138 Typhim Vi 150%
9069165124898000 Adacel 175% 90715651245091,7973,2431,609 Td
(Decavac)175%90714658034962,0661,608175
IPOL150%90713658025972,2561,164126
Slide 23
Initial Projections Travel Connections 2008 Business Plan
Projections Updated Projections Number of visits17282,200 Office
visit revenue$31,773 $89,000$154,440 Vaccine
revenue$68,202$86,831More than $0 Number of
prescriptions1,7002,1642,600 Projected downstream
revenue-$497,200
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Next Steps Monthly Monitoring Marketing Patient Recruitment
into GIM Evaluate Patient Acquisition into MUHC Community
Activities
Slide 34
Patient Tracking Increased 0% MU identified patients to 5% MU
identified while gaining 25% of the patient base into General
Internal Medicine Medical Home development NCQA Guidelines for
Physician Recognition Programs 9 standards 7 th standard referral
tracking
Slide 35
More Collaborators! Scott Barger Debi Bell Diane Bernard Beth
Bernt Joe Cameron Gordon Christensen Janet Collins Adam Cullina
Kevin Dellsperger David Fleming Nancy Forrest Kim Grissum Paula
Heaviland Robert Hodge Tammy Kemp Matt Levson Liz Lukehart
Slide 36
Even More Collaborators ! Stephanie Lumley- Hemme Bill Martin
Del McMillan David Mountjoy Richard Oliver Penny Paisley David
Parker Sharon Rafferty Dick Schaefer Don Scharlott Neil Schmidt
John Schoemehl Mari Beth Schultz William Sparks Herb Stanley
William Steinmann Abby Tuttle Tim Waller Amy Watring