Volume 2 of 10:
Developing Standards of Care Guidelines
It is imperative that Primary Care practices no matter how big or small, develop office based Standard of Care Guidelines to ensure consistency amongst the provider group. Individual variance to these guidelines can often lead to missed care opportunities and by default, lost revenue potential for the organization. Too often individual practitioners will deviate from the standards, and patients that see multiple providers in a practice will get mixed signals. This is a recipe for poor patient satisfaction scores and decreased performance on quality metric measurement.
One of the best ways to start this process is to schedule regular meetings of the primary provider group to discuss establishing these guideline parameters so that all agree, and there are clear goals on what is to be accomplished by making these changes as a unified approach. Targeting office visit intervals for chronic disease patients is the first place to start. Medicare and commercial insurance companies are looking to see if patients are being seen frequently enough to prevent complications and hospitalizations. The standard is that all chronic disease patients are seen at least three times per calendar year. In the future, they will even cut payments under value based care if this standard is not met. Having conformity and allegiance between the providers is key to successful navigation of population health.
I suggest offices set up standard guidelines that all routine diabetic patients are seen every 91 days. If the patient falls inside of this time period, Medicare and some commercial insurers will not pay unless there has been a change of therapy or complication. Telling a patient to schedule a visit every 3 months may put them inside of the 91-day time period. These guidelines should be communicated to all office staff, from nurses to registration personnel, so that all understand the expectations and can communicate effectively with the patient. Other chronic disease patients should be seen every 4-6 months depending on the condition and standards set in your office. Consistency between providers is key.
Once office visit intervals are set, the next goal should be to standardize the type and frequency of ancillary testing to be ordered based on the disease state. There are numerous Standard of Care templates and even the USPTF (United States Preventative Task Force) to use as references. When was the COPD patients last Pulmonary Function Test? Are they properly staged following GOLD criteria? Have your hypertensive or hyperlipidemic patients had routine labs? Too often chronic disease patients fail to receive preventative testing because it is overlooked. EHRs have helped to some degree, but setting up office based guidelines facilitates closing this care gap.
It is understood that there may be unique circumstances when a provider may use their discretion, but this drift should be minimized as much as possible to achieve the best outcome. Having these guidelines shared with the nursing staff is critical to the success of population health initiatives. As I discussed in a previous article, having the nursing team work to the top of their license will ensure that these guidelines are front and center as part of the care plan. This helps providers stay on task to meet these guidelines, and often quality metrics by default. I am a big proponent of not chasing metrics, too often this puts undo pressure on providers. Establishing standard guidelines and having the whole care team vested in following them is the most efficient.
This simple strategy of setting up office based standard of care guidelines will have an immediate and measurable positive effect on achieving the Triple Aim Goals. Patients will be more invested in their care and satisfaction scores will improve.
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