Metropolitan Chicago Healthcare Council (MCHC)

Transcription

1 Emerging Trends All APNs Should TITLE Know OF to PRESENTATION Practice at Their License LORUM Ceiling IPSUM DOLOR October 10, 2014 Molly Harper, MHA Program Manager, Clinical Services Metropolitan Chicago Healthcare Council (MCHC) 08/23/13 Metropolitan Chicago Healthcare Council (MCHC) Membership and services association 170 healthcare organizations in Chicago and 8 county metro region; includes all 92 acute care hospitals Will celebrate 80th Anniversary in 2015 Our Vision: High quality, accessible healthcare for all communities 2 MCHC Services: Metropolitan Chicago Healthcare Council (MCHC) MetroChicago Health Information Exchange (MCHIE) Land of Lincoln Health (LLH) Illinois Poison Center (IPC) 3

2 November First survey completed History Patients Entering Health System 4 Introducing CAP2 Assess: Utilization of APRN/PAs Manage: Infrastructure to support APRN/PA practice Optimize: All APRN/PA activities at medical level of care Standardize: Best practices for APRN/PAs 5 5 Data represents: One of a kind interactive website 130 organizations (hospitals, healthcare systems, academic medical centers) Over 19,000 APRNs and PAs 25 different states 50 different specialty areas And growing CAP2 Database 6 6

3 CAP2 Resources Organizational Assessments Benchmarking reports Organization, system, state, national, and defined compare groups Multiple resources and toolkits National workgroups National listserv updates Coming January 2015: Ambulatory assessment and benchmarking reports Business case for hiring APRNs and PAs 2014, CAP2, UHC and MCHC. All rights reserved. 7 CAP2 Available Resources Billing and Reimbursement Credentialing and Privileging Competency Assessment The Role of the ARPN and PA Human Resources Competency Assessment FAQs Credentialing Checklist Sample The Role APRN of the Job APRN Description and PA: Billing and Reimbursement Checklist Competency Assessment Report Human Resources A Primer Presentation Core Sample PAReimbursement JobList Description BillingPrivilege and FAQs Direct Observation Review Form for Focused Review Specialty Lists Position-Specific Requirements APRN andprivilege PA Certification ListsChecklist Documentation Review Form for Discharge Notes Process for Adding New Privileges Job Posting Locations Documentation Review Form for Annotated Bibliography of Credentialing and Privileging H&P, Admission, and Progress Notes Process to Expand Specialty Privileges Recruitment APRN and PA Process Articles Recommendations General Peer Review Form Orientation Checklist APRN andassessment PA FAQ Websites Competency Flowchart FPPE for Possible Competency Assessment Competency or Performance Issue Hiring Process Checklist Competency Assessment Flowchart FPPE Process Interview Process Recommendations Competency Assessment Flowchart OPPE Process Billing and Reimbursement Competency Assessment Process Summary 2014, CAP2, UHC and MCHC. All rights reserved. 8 CAP2 DEMONSTRATION 2014, CAP2, UHC and MCHC. All rights reserved. 9

4 CORE AND SPECIALTY PRIVILEGE DATABASE 10 CAP2 Database Core Privileges APRNs % of total hospitals # of hospitals privileging privileging (out of N=95) Write admission orders % Write discharge orders % Write transfer orders % Obtain history and physical % Order and interpret diagnostic testing and therapeutic modalities % Order and perform referrals and consults % Order blood and blood products % Order inpatient non-schedule medications % Order inpatient schedule (II-V) medications % Order and manage conscious sedation % Order topical anesthesia % Prescribes outpatient non-schedule medications % Prescribes outpatient schedule (II-V) medications % Incision and drainage with or without packing % 11 Highest Volume Specialties APRNs 1. Anesthesia 2. Hematology/Oncology 3. Internal Medicine 4. Cardiovascular Surgery 5. Neonatal 12

5 Established Areas of Practice CAP2 Database Number of Hospitals Privileging in these Specialty Areas Number of Advanced Practitioners in this Specialty Area APRNs APRNs Allergy/Immunology Anesthesiology Bariatric Surgery Breast Health Burns Cardiovascular Surgery Cardiology/Telemetry Colon/Rectal Surgery Dermatology Education Electrophysiology Emergency Medicine Endocrinology Family Medicine Gastroenterology/ Endoscopy/Hepatology Genetics, Birth Defects and Metabolism Geriatrics Hematology/Oncology/Bone Marrow Infectious Disease Inflammatory Bowel Disease Intensive 2014, Care CAP2, (includes UHC and CCU, MCHC. ICU, All rights PICU, reserved. etc.) Internal Medicine CAP2 Database Established Areas of Practice Number of Hospitals Privileging in these Specialty Areas Number of Advanced Practitioners in this Specialty Area APRNs APRNs Neonatal Neurology Neurosurgery Nurse Midwives Obstetrics and Gynecology/Women's Health Occupational Health Ophthalmology 7 8 Orthopedics Otolaryngology Pain management, Acute or Chronic Palliative Care Pediatrics-General Physical Medicine and Rehabilitation Plastic & Reconstructive Surgery Prostate Psychiatry Pulmonary Radiology-General, nuclear, interventional Renal/Nephrology Rheumatology Surgery -General Transplant Surgery Transport 8 8 Urogynecology Urology Vascular Surgery Wound/Ostomy Specialty Database Uses Identify: Specialties where PA should be used Where the number of PAs could be increased Best practices Areas for placing student PAs 15

6 CAP2 Database Privilege List by Specialty Orthopedics APRNs % of total hospitals # of hospitals privileging privileging (out of=69) Digital block, regional anesthesia and isolated peripheral nerve anesthesia evaluation and management % Fractures and dislocations closed reductions % Injections of joints, tendons and bursa % Joint and bursa aspirations % Minor outpatient surgical procedures (i.e. tendon repair, needle biopsy, percutaneous pinning of fractures, k-wire removal, hardware removal) % Order, prescribe and dispense braces and other orthopedic devices % OR First Assist Traction adjustment Wound closure/suturing Wound packing % % % % 16 CAP2 Database Privilege List by Specialty APRNs Emergency Medicine % of total hospitals # of hospitals privileging privileging (out of=88) Anterior nasal cautery % Anterior nasal pack epistaxis % Arterial line insertion and removal % Arterial puncture % Athrocentesis % Central line insertion and removal % Digital block % Foreign object removal-eyelid % G tubes, j tubes, small bowel tubes and cecostomy tubes insertion and removal % Gynecological exams, including Pap smears % Immobilization/splinting/reduction of simple fractures % Intraosseous needle insertion % Joint Aspitation % Knee taps % Local anesthesia infiltration % Lumbar puncture % Moderate/procedural sedation % Nasal and endotracheal intubation % Needle decompression of the chest % Non-complex burn care % Ocular tonometry % Paracentesis % Regional block % Slit lamp examination % Stain eye for abrasion % Subungal hematoma % Superficial foreign bodies removal % Privilege Report Uses Identify variation Identify best practices Identify opportunities for expanding scope Use as evidence for credentialing committees 18

7 Remember Laws and regulations can be changed at the national and state level, but privileges are granted at the organizational level. CAP2 data illuminates variation (barriers) and can drive optimization (top of license). 19 EMERGING TRENDS IN THE APRN WORLD 20 Advanced Practice Committee EMERGING TREND! 42% of participants have a committee Of those who do, 50% are involved in APRN/PA credentialing 21

8 APRN/PA on Medical Staff Credentialing Committee EMERGING TREND! Nationally 16% of participants have a APRN/PA on the Credentialing Committee Provide expertise in questions about federal and state laws and regulations and also has understanding of academic programs, training and certifications Conduct initial and ongoing review of APRN/PA applicants, privileges requests, and competency review Work closely with medical staff office to streamline and increase efficiency of APRN/PA privileging process Follow up on medical staff concerns, regulatory interpretations, etc. Individual must be well respected by medical staff and also possess ability to discuss, negotiate and provide feedback to medical staff 22 APRN/PA Competency Review - Approaches EMERGING TREND! 23 APRN/PA Competency Review Process 63% of participants report having the same competency review process for APRN/PAs and physicians this is a Joint Commission requirement 24

9 APRN/PA Competency Review - Frequency 25 APRN/PA Competency Review Additional Approaches 26 APRN/PA Competency Review - Effectiveness 27

10 APRN/PA Orientation Only 43% of organizations have a formal orientation or transition into practice program. 28 APRN/PA Orientation -Components 29 APRN/PA Orientation - Effectiveness 30

11 New Graduate Time to Full Case Load 3 months or less 4-6 months 7-12 months PA 25% 37% 17% NP 28% 45% 15% CNS 29% 26% 6% CRNA 36% 35% 6% CNM 16% 28% 10% 31 Inpatient Productivity Tracking Only 1/5 of hospitals have the ability to track inpatient productivity 32 Outpatient Productivity Tracking Productivity tracking is more common in outpatient settings, yet varies from organization to organization 33

12 APRN/PA Compensation EMERGING TREND! APRN/PA compensation is beginning to be tied to productivity and/or outcomes 34 APRN/PA Leadership EMERGING TREND! 30% report having an identified leader who coordinates APRN/PA practice. 35 New Models of Care EMERGING TREND! 36

13 CAP2 CASE STUDIES 37 CAP2 Case Study Challenge: Organization could not hire enough intensivists to provide 24/7 coverage for new closed ICU model 38 CAP2 Solution I was intrigued by the breadth and the success of APRN/PA activities garnered from the database. It was a crucial factor in moving our hospital system toward a new closed ICU model of care that integrates APRN/PA s and Intensivists for 24/7 face to face care. - Dr. Zbigniew Lorenc, Vice President, Medical Affairs, Centegra Health System 39

14 CAP2 Case Study Challenge: Receive panic call that organization received a finding during Joint Commission survey regarding effectiveness of their OPPE/FPPE for APRNs and PAs and must develop a written action plan within 45 days. Joint Commission suggested they call us. 2014, CAP2, UHC and MCHC. All rights reserved. 40 CAP2 Solution 2014, CAP2, UHC and MCHC. All rights reserved. 41 CAP2 Case Study Challenge: In February 2014, two bills proposed in Illinois legislature one to limit administration of conscious sedation to only physicians, and the other to limit the use of fluoroscopy to only physicians. Illinois Hospital Association asked for data and stories of how this would impact APRN and PA practice. 2014, CAP2, UHC and MCHC. All rights reserved. 42

15 CAP2 Solution Specialty-Radiology Illinois CAP2 Database Privilege Practitioner # Hospitals % of Total # Hospitals % of Total Abscess drains and nephrostomy tubes removal APRN % % Arterial line insertion and removal APRN % % Central line insertion and removal APRN % % Lumbar puncture APRN % % Paracentesis APRN % % Thoracentesis APRN % % Thoracotomy APRN % % Tunnel line removal APRN % % Ultrasound guided biopsy APRN % % Wound closure/suturing APRN % % Abscess drains and nephrostomy tubes removal PA % % Arterial line insertion & removal PA % % Central line insertion & removal PA % % Lumbar puncture PA % % Paracentesis PA % % Thoracentesis PA % % Thoracotomy PA % % Tunnel line removal PA % % Ultrasound guided biopsy PA % % Wound closure/suturing PA % % The bill never moved out of committee 43 CAP2 Case Study Challenge: Service line director questioned whether a PA or APRN can bill for inpatient services 44 Reimbursement for APRN Services CAP2 Solution CMS guidelines were ed immediately to organization Health Management Associates 45

16 Another CAP2 Solution One organization captured over $200,000 in revenue by auditing current practices. 46 CAP2 Case Study Challenge: Organization hiring first mid-level into newly acquired primary care practice and needed assistance in developing orientation. 47 CAP2 Solution CAP2 Orientation checklist sent over immediately. 48

17 CAP2 Case Study Challenge: System focusing on having all team members practicing to the top of their license. 49 CAP2 Solution CAP2 team sent this report. Medical staff office professionals used list to clean up and streamline the RN Activities APRN privilege forms throughout the system. CAP2 Database General Hospital Healthcare Northwest General Hospital Suburban General Hospital Urban City Hospital Western County General RN Activities # Hospitals % of Total # Hospitals % of Total Privilege Privilege Privilege Privilege Application & % % N Y N N removal of casts, braces, or splints Clinical breast exam % % N Y Y N Compression wrap for venous disease % % Y N N N Conduct nursing research and participate in interdisciplinary research % % N Y N Y Conduct preventative screening procedures % % N Y Y Y Develop and implement a client education plan % % Y Y N Y Drain management % % N N N N Initial care of newborn and assessment % % N N N N Initiate ACLS to include defibrillation/cardioversion % % N Y N N Initiate BLS (CPR) % % N Y N N Initiate Neonatal ACLS % % Y Y N N Performs waived tests (rapid strep, urine dip, blood glucose, etc.) % % N Y N N Placement of synthetic or biological dressings % % N N N N Removal of casts % % N Y N N Removal of pleural chest tube % % N Y N N Removal of venous access % % Y Y Y N 50 Update & record changes in health status % % N Y N Y CAP2 Case Study Challenge: Organization considering adding Advanced Practitioner to Medical Staff Credentialing Committee needed prevalence and role description. 51

18 CAP2 Solution MCHC creates strength in numbers through the data they collect. They've given me a resource to work with our Chief Nurse Executives, Medical Staff Office, Allied Health Professionals, Credentials Committee and the Governing Council of Advocate Medical Group. - Lise Hauser, APN-PA Governing Council Representative Advocate Medical Group My organization is changing its medical staff bylaws...due to what we learned from the MCHC Database. - Michele Rubin, APN Executive Council Chair University of Chicago Medical Center 52 AARP/RWJF Collaboration IOM Recommendations: 1.Remove scope-of-practice barriers. Advanced practice registered nurses should be able to practice to the full extent of their education and training 2.Expand opportunities for nurses to lead and diffuse collaborative improvement efforts 3.Implement nurse residency programs 4.Increase the proportion of nurses with a baccalaureate degree to 80 percent by Double the number of nurses with a doctorate by Ensure that nurses engage in lifelong learning 7.Prepare and enable nurse to lead change to advance health 8.Build an infrastructure for the collective and analysis of interprofessional health care workforce data 53 State Action Coalitions The driving force of the Campaign for Action at the local and state levels, forming a strong, connected grassroots network of diverse stakeholders working to transform health care through nursing. Center for Advancing Provider Practices (CAP2) One of a kind resource to drive change at the organization level to support APRN practice to the full extent of their education and license. 54

19 Closing Thoughts Goal: Top of license for all care team members. Strategic Action Plan 1.Assess: Utilization of APRN/PAs 2.Manage: Infrastructure to support APRN/PA practice 3.Optimize: All APRN/PA activities at medical level of care 4.Standardize: Best practices for APRN/PAs Result: High quality, cost-effective care for all patient populations. 55 How can you optimize the role of the APN? QUESTIONS? 56