Projects in a Box: Or how to do a PI-CME project

Amy K Mosman, PA-C SLU Division of Nephrology American Academy of Nephrology PAs Disclosure: None

Kidneys in a Box

Bugs in a Box

Outside the Box

Objectives1) Understand the new NCCPA requirements for

self-assessment (SA) and performance improvement (PI) CME

2) Recognize and discuss criteria that place diabetics at risk for development of chronic kidney disease (CKD), discuss health disparities commonly found in practices and risk factors for infectious disease

3) Identify opportunities within your practice to adjust for modifiable risk factors for CKD, infectious disease or decrease incidence of health disparities

Passed PANCE/PANRE

Passed PANCE/PANRE

CME 1 and CME 2 Year 1-2 Year 3-4 Year 5-6 Year 7-8 Year

9-10

CME 1 50 credits

50 credits

50 credits

50 credits

50 credits

CME 2 50 credits

50 credits

50 credits

50 credits

50 credits

How to Maximize

Credit

SA = 1.5X

PI = 2X

SA = 1.5X

PI = 2X

SA = 1.5X

PI = 2X

SA = 1.5X

PI = 2X

SA = 1.5X

PI = 2X

SA - CME• Q&A type questions • Can be done in a weekend • Offered at 1.5X normal CME 1 credits • Readily available: –PA conference (AAPA, state meetings,etc) –Online (AAPA Learning Central) –For-profit programs

PI - CME• Can be more costly or difficult to find

• Can take anywhere from 4 weeks to 6 months to complete…dependent on PI program

• True ‘butt in chair time’ is 5 hours*

• Offered at 2X normal CME 1 credits

• Worth 40 CME 1 credits for the first project in a 2 year cycle

• Worth 20 CME 1 credits for the 2nd project in a 2 year cycle

* As calculated by NCCPA

Incredible, inexpensive options!

Why pick CKD?

26 million Americans have

CKD: Most don’t know it

10 people die every day

waiting for a kidney

transplant

Early detection and TREATMENT

can slow or prevent CKD progression

More than 100,000 people are waiting for a

kidney transplant

Every 5 minutes

someone’s kidneys fail

Why pick Health Disparities?

CMS wants 90% of Medicare

payments as fee-for-value by 2019

Martin Luther King Jr: 'Of all the forms

of inequality, injustice in health

care is the most shocking and

inhumane

Health disparities increase health

insurance premiums for

everyone

More deaths

occurred 1990-2001 due to health

disparities than were saved by medical

advances

Many populations who

experience health disparities are

invisible

Why pick Bugs?

Unvaccinated adults cost the

US >$26 BILLION in

2013

Although the CDC mandated universal

HIV screening in 2013, 51% of

practitioners did not do it

Kidney Disease, Diabetes

Osteomyelitis, Pregnancy

And more….

Oral health has been shown to

have a link with: Alzheimer's, Heart Disease

Handwashing decreases infections by 20-30% yet health care providers only wash their hands ½

the time

Tell me more about Kidneys

Pick 1 of the proven 6 modifiable risk factors: CKD staging

UACR A1C

Smoking Statins

OTC medications

Tell me more about Outside

Pick 1 of the 5 modifiable risk factors: Race/Ethnicity

Gender Identity/Sexual orientation Socio-Economic

Disabilities Literacy/Numeracy

Tell me more about Bugs

Pick 1 of the proven 5 modifiable risk factors: HIV testing Oral Health

Travel Vaccines

Handwashing

How do I pick which one to do?

Outside The Box • You need to finish in 30 days • You do pediatrics • You want to evaluate yourself

for any ‘unknown’ biases • You do not see diabetics in

your practice

Kidneys in the Box• You have 90 days • You want to compare yourself

against national guidelines • You see diabetics • You are interested in learning

more about kidney disease

Bugs in a Box

•You have 60 days to finish •You are trying to decrease infections in your practice •You need to do a MIPS Medicare project •You see all types of patients

Example: Outside

• Project = practitioner reviews race per patient choice

• You put an asterisk (*) next to your SOAP note to mean that you, personally, confirmed race

• Now when you order screening or calculate GFR, you are using the correct race!

After logging into the computerized pre-test, you find you are weak in 4 out of the 5 modifiable factors You realize that your office staff inputs race into the EHR…

Example: Kidneys

• Project = When you look at daily labs, you code AKI (N17.9  for ICD-10) if SCr changes

• By adding N17.9, the discharge summary includes AKI

• The hospital summary goes home with the patient and to the primary who double-checks the SCr after discharge

After filling out the pre/post test, you find you are weak in 4 out of the 6 modifiable factors

You are a hospitalist and have no control over A1C or urine so you decide to code AKI

Example: Bugs

• Project = your staff adds dentist name/addresses to the practitioners who receive your SOAP notes

• The patient asks why you want to know their dentist

• Your reply that the healing fracture can become infected from oral bacteria

• The patient actually follows up with their dentist for a teeth cleaning!

After the pre/post test, you find out you are weak in 2 out of the 5 modifiable factors

You decide to concentrate on oral health

Pick 1 of the folders and let’s go!!

Be sure you write your name And

Which project you are doing!

Questions?