Streamlined Prescription Mgmt: Save an Hour per Day

Thomas Sinsky, MD Christine Sinsky, MD csinsky1@mahealthcare.com Medical Associates Clinic and Health Plans Du u!ue, "o#a

Agenda

"ntroduction Streamlined Prescription Mana$ement

%ne o& ' strate$ies in the Core Team model

(ive ) * A

How do you write scripts?

How do you write scripts?

Prescriptions are killing usmy

nurse is spending so much time on refills that

we cant seem to get anything else done.
Minnesota Family Physician

Observation

PCP practices+ 1,-+ . MDs Survey+ ma/ority calls &or scripts Systems+ all scripts 1 yr at annual 0&&iciency+ 1 phone calls y 234

Synchronized, !enewals

undled

All scripts rene#ed, resynchroni5ed annual visit

6i.e. Medicare Annual 7ellness 8isit9

:3 d ; < re&ills 612 mo9

"o Prescriptions as Hoo#

Planned care appts tri$$er disease monitorin$

-e=t appt scheduled at conclusion o& appt Pre>visit la ,eminder phone call

Separate monitorin$ &rom rene#in$ Avoid loadin$ interval visits #ith unnecessary, redundant #ork

"o Prescriptions as Hoo#

Sta&& time saved

?e&ore+ si= calls or &a=es@year A&ter+ 5ero

Ma$$ieAs o servation+ only B24 time spent in previous practice

Study: -urses #ith Stop#atches

(ean+ %ne #eek o& data 61< practices9

,eceivin$ &a=es Talkin$ to patients or pharmacies ,evie#in$ chart Addressin$ concerns #@ physicians ,eturnin$ &a=es Documentin$ prescription in 0H, 6narcotics, en5odia5epines e=cluded9

Synchroni5ed B34 o& ,andom

$he usiness %ase: -ursin$ Time (ost

Primary care providers+ -ursin$ time (ost

BC D133,333@yr

BC primary nurses = < d@#k = E hr@d = <. #k@yr = DFF@hr 1 on>call nurse B hr@ d = 2 d@#k = 2B #k@yr = DFF@hr

Physician Productivity (ost DB<3,333@yr

<. #eeks@year T#o &e#er ::B1< visits@#eek D:C = B = BC= <. G

Total

DF<3,333@yr

$he usiness %ase: -ursin$ Ho Satis&action

Arch Intern Med. 2011;171(9):814-822. (Refill Con olid!tion")

etter Medication Adherence

Iam Prac M$mAt -ov@Dec B31B

%ore $eam Model

Planned Care Appt 8isit Planner 0mpo#ered Team Pt. )uestionnaire Annual 0=am Prescription Mgm&t ,apid Access "ntentional ?ehaviors

,elationship uildin$ Sel&>m$mAt support

%ase: DM, HT-, (ipid, Depression

Met&ormin HCTJ 0nalapril Atorvastatin Citalopram

Synchronized, undled !enewal

)ec P( 1 !2

4A Sept Met&ormin (isinopril *+, Atorvastatin Iluticasone Citalopram 3 !2+ yr Mar

*+, A-c ./0

- !2

'un

*+,

!e5ills until "e2t 6isit

)ec P( 1 !2

!2 Sept Met&ormin (isinopril *+, 1 !2 Atorvastatin Iluticasone Citalopram 01 !2+ 07 yr !2 'un !2 *+, 1 !2 *+, 1 !2 Mar

!andom !enewals
)ec P( - !2 1 !2 - !2

Sept Met&ormin (isinopril *+, Atorvastatin Iluticasone Citalopram 01 !2+ yr *+,

Mar

1 !2 - !2 *+,

'un

- !2 - !2

Multiply over Panel

)ec P( 1 !2 - !2 - !2

Sept -777 pt 8 meds+pt *+, 1 !2 98:; call+yr <-7,777 calls+5a2 -:0 min ;877 hr+yr *+,

Mar

1 !2

'un

- !2 - !2

- !2

*+, 1 !2

Annual Prescription !enewals

Physician time

3.2 hour@day

-ursin$ time

1 hour@day per physician

'3 million PC visits@year

817,777 P%Ps 2 007d+yr 2- visit+d

Medical care must be provided with utmost efficiency. To do less is a disservice to those we treat, and an injustice to those we might have treated. Sir William Osler, !"#

23

)iscussion

!e5erences

Sinsky TA, Sinsky CA. A streamlined approach to prescription mana$ement. #!$ %r!ct M!n!& -ov@Dec B31B 11>12. Sinsky CA. Practice Pearls+ Streamline processes #hen usin$ an 0H,. #!$ %r!ct M!n!&. B311 Sep>%ctK1'629+<C. Sinsky CA et al. Core Teams+ -urse>Physician Partnerships Provide Patient Centered Care at an "o#a Practice. Health A&&airs B313KB:629+:..>' Lravit5 ,(. "mprovement Happens+ An "ntervie# #ith Christine Sinsky, MD. H Men "ntern Med. B313 MayKB2629+<C<>C. Sinsky CA. "mprovin$ o&&ice practiceN#orkin$ harder, not smarter. Iamily Practice Mana$ement. -ov@Dec B33.K1F+B'>F<