Can your practice document? Yes Written standards for patient access and patient communication. Measures to document these standards. Use of paper or electronic-based charting tools to organize clinical information Use of data to identify important diagnoses and conditions in practice Adoption and implementation of evidence-based guidelines for 3 conditions Active support of patient self-management Tracking system to test and identify abnormal results Tracking referrals with paper-based or electronic system Measurement and reporting of clinical and/or service performance These are to be NCQA standards for certification. Many will be met by the use of HowsYourHealth. But what do you think you have now? No PRACTICE PROFILE KNOW YOUR PATIENTS % Birth-10 yrs % 11-18 yrs % 19-45 yrs % 46-64 yrs % 65-70 yrs % 80+ yrs Age Distribution Enter #s # pts seen/day # pts seen last wk INSTRUCTIONS: # new pts last mo Please complete this Practice # procedures last mo Profile information to the best of # referrals last mo your ability. # unique pts in practice PROFESSIONALS* (Enter FTE equivalents) *Under the "professionals" category, # MD please use decimals to indicate # NP/PAs "parts" of full time equivalents. For # RNs example, 1.5 physicians, etc. If # LPNs someone works less than a fulltime # LNA/Mas week in the office such as .6, # Secretaries indicate that as well. Other: Does the Practice Routinely Offer Yes No ** Established patient visit with Group Visits nurse. Practice Web Site Phone Follow-up Other questions are self- Disease Registry explanatory. Same-Day Appointments Private Waiting Room E-mail With Patients Nurse visits** Coordinated Hospital Care Protocols/Guidelines*** 24/7 Access Hours or % of Charity INFORMATION ABOUT OVERHEAD EXPENSES Monthly Cost Rent including utilities Malpractice insurance Personal/family insurance Business insurance Disability/Life insurance Auto insurance Other insurance Telecom (phone, fax, mobile, internet) Office supplies (Paper, toner, pens, etc.) Medical supplies - bandaids, table paper, etc. Billing service Accountant/legal fees Marketing (newspaper, yellow pages, etc.) Loan(s) - practice Loan(s) - school Dues/fees (AAFP, ACT, medical society) CME Employee expense Technical support/consulting Office software (e.g. EHR) Computer hardward Other (Describe): TOTAL: Since opening your IMP practice, are you more involved in community projects (voluntary or otherwise) outside your practice? No Yes If yes, what do you do? Very satisfied Satisfied Neurtal Unsatisfied Very dissatisfied How satisfied are you with your choice of medicine as a career? Check one. MORE PRACTICE MANAGEMENT INFORMATION What is your EMR? What billing program/clearinghouse do you use? What is your range of reimbursement for a 99214? Do you accept insurances? Do you take Medicare? How many square feet is your office? What is the tax structure of your practice (S-Corp, LLC, Solo proprieter, etc)? Do you have a business plan you would be willing to share? THANK YOU! Office Staff Survey # respond # respond # respond # respond # respond Questions Strong Agree Agree Diagree Strong Disagree #1. Opportunity to do best #2. Received recognition #3. Staff works like team Strong Agree Agree Unsure Disagree Strong Disagree #4. Recommend office Very Easy Easy Difficult Very Difficult #5. Easy to ask Strong Agree Agree Unsure Disagree Strong Disagree #6. Technology smooth Yes No #7. Full staff meetings INSTRUCTIONS: #8. Up-to-date display #9. Knows how confident Please ask all staff members to complete the Office #10. Regular meet patients Staff Survey questions and return to a designated person. (The survey is in the PDF format in the "Baseline Survey" on www.IdealMedicalPractrices.org.) Please tally responses and enter information in appropriate question line. (If you have 10 staff surverys and 5 people "strongly agree" and 3 agree and 1 disagrees to question #1, you enter those raw numbers in each of the columns. the one person wh did not answer does not get a number recorded). o complete the Office eturn to a designated e PDF format in the MedicalPractrices.org.) enter information in u have 10 staff surverys " and 3 agree and 1 nter those raw numbers ne person wh did not mber recorded). Office Staff Comments INSTRUCTIONS: 1 Please enter any verbatim office staff comments.
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