- Our St. Paul clinic opened this week to limited in-person appointments. While the numbers were purposefully kept low, the clinic was determined to be a success. We will continue to build on this patient volume in a safe and controlled manner.
- Providing in-person appointments for our non-English speaking patients remains a priority. A significant backlog exists due to our inability to serve this population through our telehealth program. To resolve this, we have authorized in-person interpreters to accompany our new patients. This will significantly improve our ability to complete the necessary paperwork in advance of their appointment.
- The list of postponed clinic patients, new patient referrals and interpreter patients is long. In the early stages of “re-booting” our clinics, we will prioritize the scheduling of our OP appointments as follows:
- Urgent in-person
- Interpreter in-person
- Virtual New Patients
- Virtual follow-up patients
- In-person new that will not or can’t be seen virtually
- As you may know, patients scheduled at Ridges and Maplewood surgical centers need a negative COVID test result prior to their surgery. Our early experience utilizing Valley Medical as our pre-surgical COVID testing center has been very positive. Patients are given a COVID test in a drive thru fashion and they receive their test result within 24 hours.
We continue to struggle in providing in-person appointments involving our non-English speaking patients. Utilizing the i-pad for interpreter communication has shown to be less than ideal. We will be discussing the merit of having our interpreter “in-person” to avoid this communication barrier. More to come.
We have identified a COVID testing center by the name of Valley Medical. They will be providing COVID tests for our patients who have been scheduled at Ridges and Maplewood surgical Centers. The workflow we have defined is as follows:
- Schedule family at ASC with enough lead time for testing
- PSA physician writes order for COVID testing and uses a DX code of Z20.828
- Surgery schedulers e-mail order to family with other surgery related information
- Patient IMMEDIATELY schedules COVID testing at drive thru testing center
- PSA faxes order to the center in advance
- If insurance does not cover the cost of the COVID test, PSA will write this portion off the patient balance.
The Nurse Practitioners recently met to discuss plans to provide in-person clinics as our Minnetonka and St. Paul offices begin to open. Following are some of their conclusions:
- Follow-up care can successfully be provided through our telehealth program – generally speaking
- New patients are best served through an in-person appointment
- The PNPs will be reviewing a list of clinical conditions that, if seen by the PNPS, would support our urologists and general surgeons over the upcoming months as they spend more time in the OR.
- Patients needing interpreter services will be offered in-person appointments at our St. Paul location beginning next week. Previously, Minnetonka was the only option for our patients. We will maintain our objective of making Minnetonka the primary clinic for these services.
- The guidelines related to the provision of in-person appointments are as follows:
- Circs and other appointments are to be 1 hour in length with a max of 3 patients in the am and 3 patients in the pm
- Telehealth appointments will be mixed into the schedule in an effort to decrease the likelihood of in-person appointments overlapping other in-person appointments
- Each clinic will be limited to one MD per day
- We will be designing a workflow to allow urgent visits to be seen within the clinics
- Judy Reitmeyer-Hunt, PNP, Kristen Collins, PNP and Erica Lundberg, PNP met with the COVID-19 workgroup to discuss their re-entry plan to in-person appointments. Generally speaking, there was agreement that new patients should be seen in-person whereas follow-up appointments could be seen via telehealth. The PNPs will be working with Molly to schedule their clinic blocks.
- The PNPs will also be reviewing their scope of services to identify how they can best support the urologists and surgeons in their clinic caseloads. More to follow.
- The workflow related to scheduling cases at Ridges, Maplewood and West Health has been difficult. Specifically, the COVID testing requirements have delayed getting cases scheduled at these locations. We continue to work with SCA leadership to lessen this bottleneck.
- PSA will gradually expand in-person appointments over the next few weeks. As a priority, patients/families requiring interpreter services will be offered appointments at our Minnetonka office since we have struggled to serve this population effectively through telehealth. Beginning, Monday, May 18th, we will expand our in-person appointments by opening our St. Paul office. Patient volume at both locations will be initially limited for the safety of our staff and families.
- Minneapolis and St. Paul Children’s has opened up outpatient OR blocks for our urologists and general surgeons beginning next week. Our physicians are in the process of prioritizing the patients to be seen.
- Similarly, Ridges, Maplewood and West Health ASCs have announced that they are opening their surgical centers next week. We will utilize our normal blocks at Maplewood and Ridges to start. These ASC’s have required a negative COVID test prior to the patients surgery. The ASC’s are opening a centralized COVID test center in Edina to perform 72 hour COVID tests. If patients are not able to get tested through their PCP, they may utilize this center for their testing. This center is supposed to be open next Wednesday (May 13th).
- Our pilot of a Saturday telehealth clinic has received a lukewarm reception by our families. Between Drs. Willihnganz and Linden, they are scheduled to see 6 patients this Saturday. Thank you physicians and clinic schedulers for giving this a shot.
- Trizetto, the automated e-cw based insurance eligibility verification system is now active within e-cw. Staff will receive training on this service over the next week or two.
- PSA’s new home-based phone systems are up and running for our scheduling team. This has considerably improved patient communication and our scheduling success. Thanks Jonathan!
- Our COVID group discussed the goal of slowly increasing our in-person clinics beginning Monday, May 18th. The tentative plan is to offer clinics through our St. Paul and Minnetonka office with very limited patient volume. Additionally, appointments are to be staffed by one provider per location. Additional details to follow.
- Special equipment and supplies are being ordered to protect our staff as we initiate in-clinic appointmetns. Examples include desk shields, face shields, surgical masks and gowns. Additionally, clinic workflow will be refined as we prepare for this patient volume.
- Lindsey Bolger, along with the surgery scheduling team, have prepared an excel spreadsheet detailing all postponed and recently recommended surgeries. This spreadsheet will be used to prioritize patients and surgical locations. Thanks Lindsey!
- Barb Klarenbeek recently distributed HIPAA and safety guidance for PSA physicians and staff working from home. Barb will be following up with us to document our receipt and agreement with these guidelines.
- Our surgery schedulers and prior authorization staff continue their planning efforts related to the scheduling of future cases. Expanding provider credentialing, training other PSA staff to assist in the workload and constructing an excel database to help prioritize cases are initiatives receiving their attention.
- An e-cw campaign is being designed to help promote our telehealth program. This campaign will be automatically sent to select patients/families through our e-cw database.
- We have struggled with the technology needed to offer a reliable and consistent telehealth service to our non-english speaking patients. Given this, we will utilize telephone and in-person visits to serve this important patient population.
- It’s payroll time! Staff, thank you in advance for your clean timecards and your timecard correction forms!
A few items since our last update……
- A new internet-based phone system has been purchased and installed at the clinic schedulers homes. Some minor “bugs” are being worked out before we can label this as successful. Surgery schedulers and prior-authorization departments to follow.
- A new work-flow is being piloted for telehealth patients requiring interpreter services. Once this process has been perfected, it will be used to whittle down the backlog of patients needing this service.
- Drs. Linden and Willihnganz will be offering a Saturday telehealth clinic on May 9th from 9:00am-11:00am. The success of this clinic will be evaluated and replicated if it is determined to be successful. Thank you Drs. Linden and Willihnganz for piloting this weekend service!
- Barb Klarenbeek is in the process of developing policies and procedures related to the safety of our work from home employees. These policies and procedures will be shared shortly.
- Paul Louiselle will be contacting our referral sources to remind them that PSA continues to see patients through its telehealth program. Appointment volume over the past 5 weeks has been 63, 137, 178, 133 and 119 (current week).
- The COVID workgroup discussed the need to design a framework for safely providing in-person appointments when it is deemed appropriate. Questions needing resolution include, but are not limited to, PSA clinic locations to be utilized, types of patients to be seen, volume of patients allowed and operational workflows that best protect our employees and families. More to come.
- Telehealth continues to be a valuable service for our patients. Since the COVID-19 stay-at-home order, PSA has provided 586 telehealth appointments. Way to go team! Recent improvements to our workflow involving interpreter services will increase our opportunity to provide this needed service to non-English speaking patients. (Thank you schedulers, COVID workgroup and of course our clinical team)
- In anticipation of the increased demand for OR space, we have worked to expand credentialing at the various hospital IP/OP and ASC locations. Recent additions to our OR locations include West Health and Maple Grove. (Thank you Molly).
- It’s late April. I know, for a fact, that we are closer to an end to this than we were a week ago. Hang in there.
- The clinic scheduling team has recently implemented a new (home-based) phone system. Their experience thus far has been largely positive. The next phase in the deployment is to the Surgery Scheduling team.
- Barb Klarenbeek has identified a “special project” for our employees who have extra time available. (Thank you to the employees who have volunteered thus far and to you Barb!)
- A reminder, our COVID-19 workgroup has reduced its meeting frequency from daily meetings to a Tuesday/Thursday meeting schedule. Thus, our nightly updates have also been reduced to a Tuesday/Thursday schedule.
- Clinic scheduling staff received their new phones late today. The new internet-based phone system will improve our communication with our families in two ways. First, it will show that “Pediatric Surgical Associates” is the caller, thus improving the family answer rate. Second, the new phone system will allow us to receive direct call backs from families. The feedback thus far has been very positive.
- The COVID-19 workgroup continues to struggle in identifying the best way to provide telehealth services to patients needing interpreters. A special workgroup has been assigned the task of developing the preferred workflow. More to come.
- The surgery schedulers dedicated some time working through the issues associated with scheduling the surgical backlog once the “green light” is given for elective procedures. This work will continue over the next few weeks.
- Wednesday, April 22nd (tomorrow) is Administrative Professional day. As we know, PSA’s administrative team is second to none. Thank you for serving our patients and for working together to make PSA the best medical practice! If you have not received it yet,
there is a “thank you” coming soon!
A reminder to all providers, the TelemedIQ application offers HIPAA compliant texting, two-way messaging and voice communication (you can make outbound calls shown as our 612-813-8000 number).
- PSA will be adopting a paperless paycheck stub system through our payroll processor, ADP. This system will allow our employees to securely view their paychecks and other important payroll information (W-2’s, etc.) using an internet browser.
- Heidi and Pam will (carefully) move our urolofow machine from our St. Paul office to our Minnetonka clinic location. This falls under “other duties as assigned” Thank you very much Heidi and Pam!
- While decreased, technical glitches still exist in the provision of our telehealth services. We are working to identify the source of the problem. We are also reaching out to other clinics utilizing this e-cw technology to compare notes on reliability.
- Over the last three weeks, our appointments for telehealth services have risen from 63 (week of 3/30), 137 (week of 4/6) to 169 (current week). Great work everyone!
- The transition to Outsource Receivables, our new billing and collections service, is prompting us to shift to TriZetto patient eligibility service. We are confident that this new eligibility service will lessen the time it takes to verify that our patients have coverage. We will be setting up a training session for the appropriate clinic staff soon.
- This short summary is once again loaded with notifications of how we are changing as an organization. Change has been the constant for the past several weeks and it will be the constant for weeks to come. Be patient with this change and above all be patient with each other. We will make it!
A short recap of today’s activities:
- Gotomeeting accounts have now been established for our providers. Utilizing Gotomeeting will allow greater flexibility in telehealth visits involving translation services and allow for more effective patient education. Andrew will follow up with providers concerning workflow recommendations.
- A new phone system will be tested by the clinic/surgery schedulers beginning next week. The new system will be programmed with “Pediatric Surgical Associates” as the caller. The new system will also allow families to return calls directly to the schedulers.
- Telehealth appointments will be reported on by urologists and surgeons in an effort to determine opportunities for service expansion.
- We will be scheduling an all staff meeting soon. Please e-mail Paul with suggested agenda items.
- PSA’s new intranet site is being populated with department specific resources/documents. It is anticipated that this new site will be unveiled within the next few days.
- PSA’s telephone message has been changed in an effort to clarify how families can best access our services.
- We will be moving our uroflow equipment from our St. Paul location to the Minnetonka clinic. This will help with the occasional patient needing this test/service.
- PSA’s COVID19 workgroup met with Jeff Dahlen today to discuss the potential problems meeting the surgical scheduling volume once restrictions have been lifted. Problems identified include 1) prioritizing patients recommended for surgery via telehealth appointments, 2) coordinating with Children’s in the rescheduling of postponed surgery patients, 3) handing surgery scheduling call volume, and 4) supporting Wendy in verification, pre-certification and prior authorization process. We will be following up on these issues over the next several days.
- Related to the surgery scheduling process outlined above, it was recommended that all physicians begin utilizing the paperless method for recommending/documenting surgery candidates. This system involves using e-cw’s “action” functionality. Training will be provided to those unfamiliar with the workflow. In particular, training will be provided to those using this process while on the ipad.
- PSA’s is expanding its credentialing at the various IP/OP and ASC locations to meet anticipated surgical demand. Molly and Jerry will coordinate with the facilities and payers to make sure these locations are covered by the various insurances.
- Telehealth appointments for this week will outperform the telehealth volume for last week. We had 137 visits last week we have 145 visits scheduled for this week. Well done schedulers, MA’s, RN’s, PNP’s and MDs!
A re-cap of the day/week…..
- Telehealth appointments hit 60% of our pre-covid average clinic volume this last week. The scheduling team will be working again this Saturday to add to the numbers. This is great work and clearly demonstrates what teamwork can accomplish.
- Andrew and Dr. Linden developed a workflow related to using GTM in our telehealth appointments. This technology would simplify our interaction with interpreters and provide an effective way of displaying images and patient education materials. Provider training will be coming soon!
- We discussed the issue of parents not competing paperwork in advance of their appointment. Improvements identified included 1) expanding “tech support” for our families, 2) improving team communication in the form of pre-clinic huddles, and 3) clarifying our instructions on the e-cw portal, e.g., “don’t forget to hit the submit button”.
- A 1st draft of a credentialing grid was developed. This grid will assist our surgery schedulers in identifying the various IP, OP and ASC options available. It will also assist us in identifying facilities where we should expand our credentialing efforts. Both of these issues will be key to our handling the upcoming demand for surgical services. Yes, it will be large.
- Related to the surgical scheduling challenges noted above, Wendy has started to think about ways she can meet the eventual increased demand for prior authorizations. Assistance in running eligibility, processing prior-authorizations well before a surgery is scheduled and lobbying the insurance companies to (temporarily) lift PA requirements are a few ideas identified.
I’m sure I have missed something important, however, that’s all I could think of at the moment. I hope you have a wonderful and restful Easter. Paul
- Surgery schedulers began brainstorming ideas to improve their ability to schedule surgeries once the “green light” has been given. Preliminary ideas include 1) partnering with the MD in triaging patient lists, 2) utilizing a variety of hospital and ASC locations, 3) training additional PSA staff in surgery scheduling, 4) being less accommodating with families when determining the time/place of the surgery and 5) realizing that prior authorizations may be a bottleneck to our scheduling process. Much planning to be done here.
- A security officer at our Minnetonka clinic location informed us that the silent alarm will engage if we attempt to access the clinic from the back door on Saturday or Sunday. He agreed to turn the security system off from 6:30am to 6:30pm Saturday and Sunday. If you need to access the Minnetonka clinic over the weekend, please do so during the time referenced. They will be installing a new card reader at the front door soon – which will resolve this problem.
- Jonathan has identified a solution for staff who continue to have problems printing from home. He is rolling out this solution for each of our staff.
- While telehealth appointments have grown significantly, some bottlenecks still exist in expanding the service. Improving the process of contacting families, efficiently entering medical/social history and reducing unnecessary records requests for selected services are a few examples. We will continue to refine our process.
- PSA’s intranet site is nearing completion. This site will enable physicians and staff the ability to review important practice information as well as share files in a HIPAA compliant way.
- We will be re-recording PSA’s phone message (8000 number) to improve the clarity of our temporary operational structure and internal processes, e.g., how to get ahold of our scheduling department.
- We will be testing GTM tomorrow as a tool for supporting telehealth appointments requiring interpreter services.
- We will reach 115 scheduled telehealth appointments this week. This is exactly half of our pre-covid average weekly clinic volume.
- We will be creating staffing “pods” to better support our providers during this challenging time. A pod will consist of an MA, a scheduler and a front office person. Each pod will be assigned to a specific set of providers. When a provider has questions concerning their schedule or a clinic issue, they can work with their pod in addressing issues/problems.
- The winner of yesterday’s Starbucks gift card giveaway was Diane Benson! Diane responded within 3 minutes of my summary. Probably a sign that she does NOT need any more coffee!
Tuesday’s gone with the wind…..,
Activities for today include:
- We continue to increase our bandwidth in scheduling and seeing televisit appointments. All eligible PSA providers have now been trained in providing e-cw televisit services, Angela has recently been trained in scheduling these appointments, providers will be relied upon a bit more in entering some of the social and medical history and we are now able to provide HIPAA compliant translator services via GTM.
- We still have trouble printing documents off the server from our homes. Jonathan has been working on this and will hopefully resolve this issue soon.
- Children’s West is no longer providing imaging services effective 5/7/20. Anyone on their books is being rescheduled to either Mpls or St. Paul. Also, nitrous sedation is no longer being offered due to supply shortages. If a provider feels sedation is necessary, they are offering Versed in place of the nitrous. Orders should now specify “Versed sedation.”
- When providing in-person appointments in Minnetonka, it is recommended that all staff (including front desk) wear an N95 mask. Julie has organized masks and printed instructions for wearing/maintaining masks in the Minnetonka nurse office.
- Staff who have struggled to keep busy with their “normal” job, have been asked to assist in special projects. One project underway is cleaning up our referral database in the e-cw system. Referring providers have missing credentials and have not always been linked to their associated clinic. Thank you staff for volunteering for this activity.
- PSA’s new billing and receivables management service, Outsource Receivables, have been maintaining our customer service and collection expectations. Barb has been successfully “managing” this new partnership. Well done.
- The first staff member who reads this last bullet and texts 612-802-8459 with “I read your summary” will win a $20 gift card to Starbucks.
A busy but good Monday…….
- The schedulers booked 36 televisit appointments this last Saturday. Well done! They worked very hard to get these appointments scheduled. We are evaluating an alternative strategy to our phone system that will allow the family to see “Pediatric Surgical Associates” as the caller (vs. 612-813-8000), thereby improving the % of people who respond to the call.
- We are reviewing “go to meeting” as an option for facilitating telemed translator services via Intelligere. Initial reviews suggest that this technology is HIPAA compliant and offers an acceptable translator strategy for telemed visits for non-English speaking patients.
- A tip to help our e-cw telehealth messaging…..When entering family phone numbers, please enter them as follows;
- Cell field should be the primary contact
- Home number should be the secondary contact
- Work field can be another number
This is important since all appointment reminders via e-cw will go to the cell #.
While we have accomplished a great deal in a short period of time, our goal of increasing telehealth appointments needs improvement. Three strategies were discussed to improve the outcome in this area:
Increase the number of PSA staff scheduling telehealth appointments
- Increase MD/PNP involvement in filling out various family history forms
- Improve our phone call response as previously noted in these minutes.
- Providers should be aware that the business office needs to routinely maintain payor credentialing privileges for all MDs/PNPs. Please respond to all requests for signatures and follow mailing instructions as indicated.
We finished the week strong.
- A reminder, we have established a consistent way to measure internet performance while working from home. Running this test will help isolate if a problem is based on your internet speed vs. other variables. Try it out! The speed test can be found at http://speedtest.mbdi.io/
- Optimal Download speed: Over 50 Mbps
- Optimal Ping speed: Under 50 ms
- We met again with the Concord group regarding the use of their optical character recognition (OCR) technology. We would like to utilize this technology to assist us in the management of our fax inbox. The application continues to look promising. The next step is to run some of our faxes through the software to see how it performs. Stay tuned…
- As stated previously, the schedulers are working Saturdays on a trial run basis. Thank you schedulers! A question was asked by the schedulers on how to handle the situation where a family says they would like to speak with one of our physicians or clinical staff regarding an immediate question they have. Schedulers should state that they will relay that request to the nursing staff (or appropriate clinical person) on Monday morning. They should also state that if they have life threatening issues or if it is an emergency, they should go to the ER.
- As an option and potential alternative to telehealth, we examined whether telephone appointments could be a useful way to provide care during this difficult time. In examining the difference in quality (telehealth vs. phone) and reimbursement (thank you Brenda Jonckowski for your help), it was determined that we will continue our effort to expand our telehealth services.
A few updates from today’s activities….
- As promised, we have established a consistent way to measure internet performance while working from home. Running this test will help isolate if a problem is based on your internet speed vs. other variables. The speed test can be found at http://speedtest.mbdi.io/
- Optimal Download speed: Over 50 Mbps
- Optimal Ping speed: Under 50 ms
- In an effort to increase the number of telehealth appointments being scheduled, clinic schedulers will begin working on Saturdays as available. We will routinely measure the impact of this weekend shift and make changes as needed.
- We have reminded staff not to schedule 15 minute telehealth appointments until we have developed a more reliable/predictable workflow.
- Fax performance has improved considerably since adding the two additional fax lines.
- Jonathan was working with a few remaining employees who have had printing issues while at home. This should now be resolved.
- E-cw continues to make improvements with its telehealth product. Specifically, e-cw has developed a new feature that will link patients directly with the telehealth visit. This would simplify the patient experience and reduce the time it takes to schedule the appointment. We are piloting this new feature and will adopt if found beneficial.