Docstoc

Scheduler Patient Insurance Information

Document Sample
Scheduler Patient Insurance Information Powered By Docstoc
					           THROUGH
PRACTICAL INITIATIVES
Introduction
 Goal One:
 Build a team of health care professionals who
 understand their contribution to effective care giving

 Goal Two:
 Empower all clinical-based staff to help improve care
 through practical actions
Patient Outcomes
 This is a way of measuring the how well a patient
  responded to the treatment provided
 It is usually compared to averages compiled by
  organizations
 Meeting or exceeding those averages is considered a
  way of gauging proper care
 Why improve patient outcomes?
Why improve patient outcomes?
 Governments, health departments or insurance
 companies may
   Measure your abilities on outcomes achieved
   Base their reimbursements on outcomes
   Decide on accreditation for facilities
 But more importantly, improving patient outcomes
 means improving people’s lives
Health Disparities
 Are differences in the quality of health and health care
 Usually noticed among groups of people:
    Minorities,
    Rural populations
    Non-citizens
Health Disparities
 Reducing health disparities means finding out
    who in a patient population is receiving substandard
     care
    And why they are receiving substandard care
Health Disparities
 Substandard care may be caused by:
    Communication Problems
    Discrimination
    Lack of insurance coverage
    Poor transportation
    Shortage of care givers
    Health literacy (patients have problems understanding
     health information)
Team Building
 A health care team includes:
    Doctors
    Nurses
    Schedulers
    Billers
    Receptionists
    Security guards
    Anyone who works in the clinical facility
Team Building
 Each member of the team can affect patient care
  through their actions,
 So they must understand how they can maximize
  positive contributions to patient care
 When all of the team members are attuned to the
  mission of improving care,
 Positive health outcomes will follow
Empowering Staff
 Staff can be oriented about how their work affects
  patient care,
 Through clarity of their job description
   to understanding the mission of the
    organization
   to practical skill building
Empowering Staff
 Staff members can understand how their
 contributions matter when it comes to providing
 excellent care
Successful Teams
 Understand that everyone has a role to play in helping
  patients get quality care
 Know that quality care improves the lives of those
  people they serve
Successful Teams
 Understand that unnecessary visits are reduced
  because care is more effective
 Know that the experience better for everyone involved
 Recognize quality care is what we would expect for
  ourselves, so providing it to others is the Golden Rule
What are common challenges
 Medication non-adherence
 Lost to follow-up
 Patients with low health literacy
What are common challenges
 Patients saying “yes” when
  they mean “no”
 Difficult patients, e.g.
Common challenges, cont.
 Difficult patients:
   Substance users: alcohol, drugs
   Angry patients
   Drug seeking patients
   Violent patients
   Mentally challenged
   Adolescents
   Et cetera
Forging Solutions
 Solving these and other problems is not a
 one person job:
   Everyone in a health care setting
    contributes to the solution;
    From the receptionist,
    To the schedulers,
    To the accountants,
    To the nurses,
    To the doctors…
Forging Solutions
 At its heart, health care is based on service
 It is also a professional environment where:
   Everyone understands their role within a
    team
   Knows what they contribute to the team,
Forging Solutions
  And how it can affect care giving,
  For the better,
  And for the worse…




                (African sickness mask)
Forging Solutions
 Each person can affect patient outcomes:
   The unfriendly intake person can drive up
    lost to follow-ups,
   The unhappy scheduler can
    discourage patients,
   The resentful clinician
    can too
Forging Solutions
 Patients need to feel comfortable at each
 step of their visit, encountering
 professionals committed to their care:
Forging Solutions
  Employees will not intuitively know their
  specific responsibility to help patients
  understand their path through care,
Forging Solutions
  They must learn the importance
  And responsibilities of their role,
  And how much it is valued by the
  management and those they serve
Forging Solutions
 The Hippocratic Oath can apply to all in the
 health care setting:
Hippocratic Oath
 …Our responsibility includes not only the
 presenting illness, but also how the illness
 affects the person's family and economic
 stability.
Forging Solutions: Professionalism
 Staff orientation upon hire and annually
 thereafter can ensure that people
 understand their professional
 responsibilities
Forging Solutions: Professionalism
 Understanding the organization’s mission
 and how a staff member’s work contributes to
  the mission
 helps diffuse frustration among patients and
  staff alike
Forging Solutions: Professionalism
 To understand how one’s work contributes
 to the overall attainment of the
 organization’s mission
Forging Solutions: Professionalism
 Ground’s a person in the importance of their
  work
 Clarifies a person’s understanding of how
  they contribute to improving people’s lives
Forging Solutions: Professionalism
 Job descriptions can be a tool to clarify staff
  members’ role in care-giving
 They reduce ambiguity by clarifying expectations
Forging Solutions: Professionalism
 Annual performance reviews based on job
 descriptions can provide valuable guidance
 about successes and opportunities for
 improvement
Forging Solutions: Professionalism
 Performance reviews
   Can actually reassure employees
       If done with the intent of helping someone
        find solutions to challenges they face
          And providing skill building methods to
           help
       And praising the successes they have
        demonstrated since the last review
Forging Solutions: Professionalism
 In short, every employee needs to
  understand that each patien--regardless of
  who they are--deserves respect and
  professional care
 At the core, we must remember…
Forging Solutions
 The Golden Rule:
 "Do unto others
   as you would have them
   do unto you."
Forging Solutions
 The Golden Rule is the cornerstone of
 human rights. Essentially, regardless of:
   Their circumstances
   Their station in life
   Their appearance
   The choices they have made
   The time of day, the day of the week…
Forging Solutions
 Each patient deserves equal and just
  treatment.
 As caregivers, our role is
   Not to judge people,
   Not to impose our resentments on patients,
   Not let our political views color our care
Forging Solutions
 It is to set aside any ill will we may have
  before we encounter a patient
 And treating all patients with the
  consideration and respect that your faith
  and/or professional code expects of you
Forging Solutions
 Active incorporation of the Golden Rule into our
  professional lives can:
   Reduce culturally-based differences
   Reduce health disparities
   Resolve underlying issues chronically and
    adversely affecting health outcomes
Approximately how many different cultures
are there in the Asia/Pacific region?

1. Nine
2. 23
3. Unknown
   What does culture include:
1. Language
2. Traditions
3. Behavior
4. Beliefs
5. All of the above
6. None of the above
What is your culture?
1. I’m a health professional
2. I’m a Christian                            12%   12%   12%   12%   12%        12%        12%   12%




3. I’m masculine
4. I’m feminine
5. I’m heterosexual
6. I’m gay
7. I’m wealthy
8. I’m educated
                                                                    ...


                                                                     e




                                                                                y
                                         ..




                                                                                                  y


                                                                                                 ed
                                                                   ...
                                                                    e
                                                                 lin




                                                                                          lth
                                                                             ga
                                      p.




                                                                 in
                                                                tia




                                                               xu




                                                                                               at
                                                              in
                                                             cu
                                      th




                                                                                        ea
                                                                          I’ m
                                                            ris




                                                            se




                                                                                             uc
                                                            m
                                    al




                                                           as




                                                                                    w
                                                          ro
                                                         Ch




                                                                                           ed
                                                         fe
                                  he




                                                        m




                                                                                 I’ m
                                                       te
                                                    I’ m
                                           a




                                                                                           I’ m
                                                   I’ m
                               a




                                                    he
                                       I’ m
                           I’ m




                                              I’ m
     Cultural Competency is the ability to:
                                                  25% 25% 25% 25%
1. Interact effectively with people
   of different cultures
2. Appreciate differences and
   adapt for effectiveness
3. Implement system-wide
   practices to optimize care
4. All of the Above




                                                                                       .
                                                   .




                                                                     .




                                                                                                      ..
                                                                                   t..
                                               c. .




                                                                 f ..




                                                                                                    o.
                                                                                ys
                                                               di
                                           ffe




                                                                                                  Ab
                                                                              ts
                                                             te
                                         e




                                                                                              he
                                                                            en
                                                        c ia
                                      ct




                                                                                              t
                                      ra




                                                                           m
                                                         e




                                                                                           of
                                   te




                                                      pr




                                                                            e
                                                                         pl




                                                                                          l
                                 In




                                                   Ap




                                                                                       Al
                                                                    Im
Which of the following ways can improve your
cultural fluency?
                                             20% 20% 20% 20% 20%

1. Ask and really listen
2. Minimize your assumptions
3. Empathize with your clients
4. All of the above
5. None of the above



                                                       .. .



                                                                     .. .
                                           ...




                                                                                     ..



                                                                                                  ..
                                                                                                b.
                                                                                   o.
                                                                    ith
                                       lly



                                                     ur




                                                                                 ab



                                                                                               ea
                                       a


                                                   yo



                                                                w
                                    re




                                                                                           th
                                                                             he
                                                               ze
                                                 ize
                                   d




                                                                             t


                                                                                          of
                                                               i
                                 an




                                                            th
                                           im




                                                                          of


                                                                                      ne
                                                          pa
                                k


                                         in




                                                                         l
                                                                      Al
                             As




                                                                                   No
                                                       Em
                                        M
Which of the following is True:
I am a Deaf/Mute
                                            33%               33%              33%
1. Don’t worry, I can’t hear a
   thing
2. Ignore me because I can’t
   speak
3. I want to be treated with
   respect and dignity




                                                              ...
                                          ...




                                                                                  .
                                                                               t..
                                                              ca
                                          ,I




                                                                           be
                                       ry




                                                            be
                                     or




                                                                           o
                                                        e




                                                                      tt
                                     tw




                                                        m




                                                                      an
                                                   re
                                   n’




                                                                    Iw
                                                    o
                                 Do




                                                Ign
A family member is an effective interpreter for
patients seeking medical care
                                33%     33%   33%

 1. True
 2. False
 3. Other




                                        se




                                                er
                               ue




                                         l




                                                 h
                             Tr




                                      Fa




                                              Ot
Which of the following is NOT true of a
culturally competent organization: 25%                                25% 25% 25%


1. Provides professional interpreters
2. Information is in the languages of
   its patients
3. Staff reflects the cultural mix of its
   of its clients.
4. Staff does not need to be
   reminded to treat all patients with
   respect.




                                                                    ..



                                                                                          ..



                                                                                                      ..
                                                        .
                                                     e..




                                                                                      ts .
                                                                  is.




                                                                                                    ot.
                                                 rof




                                                                                  c
                                                                 on




                                                                                                  sn
                                                                               fle
                                               sp



                                                               ti




                                                                                                oe
                                                                                  e
                                                            ma



                                                                             ff r
                                              id e




                                                                                               ff d
                                                            or


                                                                         Sta
                                               v




                                                                                           Sta
                                            Pro



                                                        Inf
Case One
Ramone
• 45 Filipino male who works on a fishing boat.
• Married to a local woman with 3 young children
• He is very religious.
• Has sex with other men but does not consider
  himself homosexual.
• Very upset with positive HIV test and accuses you of
  malpractice
How would you address his concerns?
Case Two
Rich
 35-year old local male seeing you off and on for 5-years.
 HIV+ and doesn’t work.
 He is an alcoholic, angry, and wants pain medications
  immediately
 Non-adherent to HAART because of the diarrhea and
  nausea
How should the receptionist be taught to deal with this
  patient?
How can the physician help this patient?
Forging Solutions
 While this is all well and good, the question
 ultimately becomes how do we handle
 situations that challenge our attempts to live
 by the Golden Rule?
Reducing Lost to Follow-up
What can we do?
   Standardize information gathering
 Document, Document, Document…
 Confirm contact information at every visit.
 Ask patients for the best way to reach them
 Ask if patient expects to move within the
 next six months.
Reducing Lost to Follow-up, cont.
 Obtain/Confirm emergency contact
  information for the patient at each visit.
 Obtain employer information
 Reminder calls
 Smiles and friendliness go a long way
Reducing Lost to Follow-up, cont.
 When suggesting follow-up
 appointments, you might ask:
   How will you get here?
   Will you have transportation?
   Would 4:30 be better for you?
Reducing Lost to Follow-up, cont.
   Could you call us if you can’t come so
    we can schedule other patients?
   Make it clear that “No” is OK.
    “It’s okay if that time doesn’t work for
    you. Tell me what
    time is better.”
Improving patient satisfaction
 Active listening to improve outcomes
  People often are not listening attentively
   to one another.
  They may be distracted, thinking about
   other things, or thinking about what they
   are going to say next
Improving patient satisfaction
 You can help by:
    Tuning in, ignoring distractions
    Acknowledging key points, and confirm
     w/patient,
    Expressing yourself clearly and
     succinctly
Enhanced Listening
 Active listening structures listening
 and responding to others.
Enhanced Listening
 It focuses attention on the speaker.
 Suspending judgments
 is important in order
 to fully attend to
 the speaker.
Enhanced Listening
 Modifying listening skills:
   Summarize the patient's chief concerns.
   Interrupt less.
Enhanced Listening
 Modifying listening skills:
   Offer regular, brief summaries of what you
    are hearing from the patient.
   Reconcile conflicting views of the
    conversation.
Enhanced Listening
 To improve understanding between
 patient and care-giver, you could ask:
  "What I hear from you is ….Did I get
   that right?“
  This affirms the patient’s perspective,
  And reduces misunderstandings
Enhanced Listening
 To illustrate empathy; ensure
 understanding of patient's emotional
 responses to condition and care:
   "You seem quite upset. Could you help
   me understand what you are going
   through right now?"
Enhanced Listening
 To improve adherence:
    "What's your understanding of what I am
     recommending?“
    “How does this treatment fit with your
     ideas about how to cure your illness?“
Enhanced Listening
 These questions can confirm your
 instructions and reveal challenges to
 treatment the plan
Universal Skill: Clear Communication
Don’t…...
 Use medical jargon
 Prescribe w/o explanation
 Provide too many recommendations
 Assume the patient understands
 Expect patients to recall your medical
 advice
Universal Skill: Clear Communication
Do…...
 Use simple explanations
 Be specific
 Prioritize, and focus on a few critical
 recommendations
Universal Skill: Clear Communication
Do…...
 Ask the patient to describe the treatment
  plan
 Give your patient written, simple
  instructions
Universal Skill Building
Don’t…...
 Assume knowledge/skill
 Teach too much at one time
 Assume one-session learning
 Assume skills will remain accurate over time
Universal Skill Building
Do...
 Observe behavior
 Prioritize, teach one skill at a time
 Repeat instructions
 Make skill assessment and instruction part
  of standard care
Foundations for Success
Don’t...
 Be judgmental
 Criticize and threaten
 Expect too much
 Ignore good behavior
Foundations for Success
Do…
 Accept less than perfect behavior
 Do problem solve
 Set realistic goals
 Praise even small positive behavior change
Difficult Patients: Types
  Substance users: alcohol, drugs
  Angry patients
  Drug seeking patients
  Emotionally Needy
  Violent patient
  Mentally challenged
Difficult Patients: Types, cont.
  Adolescents
  Demanding/Complaining
  Emotionally Needy
  Re-scheduler
  Seductive
  Non-paying
  Others?
Difficult Patients
May have difficulty understanding
 common social boundaries
 The patient/care-giver encounter is like any
  interpersonal relationship
 Boundaries must be established and
  maintained to encourage positive outcomes
  and maintain professional standards
Difficult Patients: The How’s
 A “demanding patient” may be a person
 who challenges the customary
 professional or personal boundaries
 between the patient and the care-
 giver.
Difficult Patients: The How’s
 They may challenge boundaries
 because:
  They don’t understand/recognize them
  Psychological impairments
    Neediness
    Et cetera
Difficult Patients: The How’s
 It is the care-giver’s responsibility to
 maintain professional and personal
 boundaries.
Difficult Patients: Boundaries
Basic boundaries
 Adhering to the law.
 Maintaining standards.
 Keeping appropriate emotional distance.
 Precluding inappropriate physical
 contact.
Difficult Patients: Boundaries
 Maintaining standards (rules).
   Rules are relative to a social setting.
   Rules promote efficiency because
    everyone abides by them.
   If rules are bent, then systems can be
    compromised (Change the rules if they
    are failing to meet needs)
Difficult Patients
 Challenging boundaries can;
   Engender feelings of frustration,
   Ambiguity,
   Anger
   And create a feeling of being
    manipulated
Difficult Patients: The Whys
 They may feel mistreated, cheated or
  ignored
 Have personality problems
 Be experiencing social/financial problems
 Lack trust, information or have
  communication difficulties
 Cultural differences
Difficult Patients: The How’s
 Set limits
 Restate common goals
 Schedule regular visits…
Difficult Patients: The How’s
 Keep visits short and focused
   Prioritize the patient’s needs
   Deal with the most pressing issue
   first
Difficult Patients: The How’s
 Schedule follow-up w/understanding
  given to the patient that her/his concerns
  are valid;
 They will be addressed fully in future
  visits;
 But it is important to focus on one issue
  at a time to ensure thorough care
Strategies : Complaining Patient
 Evaluate the physiologic basis for each
  symptom
 Conduct a thorough medical
  evaluation
 Refer for consultation with a mental
  health professional if needed
Strategies : Complaining Patient
 Some patients who complain no matter
 how well they are doing;
  Need to be evaluated for a physiologic
   basis for each symptom;
Strategies : Complaining Patient
 Care-givers need to understand a
  patient’s emotional patterns without
  labeling the symptoms as real or
  psychosomatic;
 Diagnosis of symptoms should be
  based on objective clinical and lab
  findings.
Strategies : Complaining Patient
 If a care-giver exhausts tests and
  cannot find the cause, the patient
  should be assured that there were no
  serious findings.
 And consider referring the patient to
  another physician for a second
  opinion.
Strategies : Complaining Patient
 In either case, it is imperative to
  document complaints in the medical
  chart.
 Documentation may preclude future
  misunderstandings
Re-Scheduler/
Non-Compliant Patient
 Provide patient with written
  notification of the potential
  consequences of failing to follow
  medical advice
 Inform the patient, in writing, of the
  need for ongoing care
Strategies: Re-Scheduler
 Care-givers are responsible for maintaining
  regular follow-up on patients who are
  prescribed medication on a regular basis
  since medical conditions change, progress,
  and get complicated over time.
 If changes are unidentified, Care-givers may
  miss something important.
Strategies: Re-Scheduler
 Patient education is necessary to reinforce
  the value of regular follow-ups.
 Rules should exist so that all patients are
  seen at set intervals of time.
 Missed appointments should generate a
  letter or conversation explaining the need
  for regular patient care.
Strategies: Re-Scheduler
 Repeated missed appointments may have an
  adverse outcome on the patient’s long term
  health.
 This information needs to be communicated
  to the patient, with documentation made in
  the patient’s medical record.
Strategies: Angry Patient
 Politely isolate patient into private
 space
   Assure him/her that privacy will aide
    your complete attention
   Leave the door slightly ajar to facilitate
    your escape, if necessary;
Strategies: Angry Patient
 Maintain your composure
   As the professional, your task is to
    control the situation through careful
    attention to your emotions
   Anger, fear, visible displeasure are
    unhelpful at this time,
Strategies: Angry Patient
 Visible concern and empathy can help
  to de-escalate a situation
 If you feel unsafe, excuse yourself
  politely and seek assistance
 Otherwise…
Strategies: Angry Patient
 Listen to the patient
   Don’t escalate the discussion by;
    Raising your voice;

    Vehemently contradicting   the
     patient;
    Vigorously denying the patient;
Strategies: Angry Patient
 Confirm what the patient is saying by
  succinctly restating the problem in a calm
  manner at natural break points in the
  conversation;
 e.g., “I understand you’re upset that we did
  not provide your test results as promised;
  that must have been very frustrating to not
  know your prognosis.”
Strategies: Angry Patient
 If feasible, offer a solution or solutions to
  the patient within your capabilities;
 If accepted, re-state your understanding
  of the frustration the patient experienced;
Strategies: Angry Patient
 Confirm your plan to resolve the matter,
  and
 Obtain a clear sign that the patient
  accepts and is satisfied with the solution.
Strategies: Violent Patients
 Maintain a calm demeanor as a means of
  being a neutral factor in the exchange
 Suggest the conversation be moved
  outside
Strategies: Violent Patients
  Never let the patient get between you
   and the door,
  If the door is closed, get it ajar in a non-
   threatening manner;
  Keep your back to the door at all times
Strategies: Violent Patients
 When in doubt, politely excuse yourself,
  and get help;
 If there appears to be no means of de-
  escalating the situation, recommend an
  opportunity to collect more facts, and
  promise a follow-up phone call or
  meeting
Concluding thoughts
 All of us in the health care field
 contribute to the well-being of our
 patients
Concluding thoughts
 We each can make a positive difference
 in someone’s life through our actions
Concluding thoughts
 By treating all patients with the
 consideration and respect that your
 faith and/or professional code expects
 of you
Questions?

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:1
posted:8/11/2011
language:English
pages:108
Description: Scheduler Patient Insurance Information document sample