Module 20 Appendix C

Sample Policies and Procedures

Community Clinic

 

Policy Title: Panel Assessment and Maintenance

 

Manual: Clinical

Page 1 of 4
Approval Date:
Policy Created/Revised By:

Purpose

To link each primary care patient with a Primary Care Provider (PCP).

Goal

To increase patient and provider satisfaction, improve continuity of care, and improve delivery of care.

Procedural Steps:

1. PCP Assignment Roles and Responsibilities

Clinic Manager:

  • Reviews PCP assignments for team providers monthly.
  • Addresses discrepancies in PCP assignment and unassigned patients seen by team provider.
  • Tracks visits with PCP versus other providers (“Continuity Report”).
  • Determines whether panel is open/closed based on ideal panel size provided by the IT Panel Support.
  • Follows up on patient requests to change providers.

IT/Data Analyst:

  • Provides Clinic Managers an Ideal Panel Size report on a quarterly basis.
  • Provides Clinic Managers an Actual Panel Size report on a monthly basis.
  • Provides Clinic Managers with a monthly report of unassigned patients.
  • Provides a PCP Discrepancy report that tracks visits with PCP versus other providers (“Continuity Report”).
  • Informs the Call Center, AMD, DOO, Clinic/Nurse Managers, and CMO of closed panels.

Nurse Manager

  • Whenever a provider leaves, the NM will coordinate a Transition Team Meeting consisting of the following staff: Billing Manager, Clinic Manager, Data Analyst, AMD/CMO, and Call Center lead to: evaluate patient needs in collaboration with team; reassign patients to other clinic providers according to panel capacity; and notify affected patients.

2. Assigning Patients

New Patients

Call Center:

  • Schedules patient visit for next available/open provider panel.
  • Call all new IPA enrollees with a followup letter if there is no response to schedule initial assessment visit with their assigned PCP.

Front Desk Specialists:

Registration-related duties:

  • Assigns PCP in practice management system when new patient checks in during first appointment.
  • Registration/Discharge places PCP label on medical chart with Provider/Team name.
  • Provides the Patient Handbook to new patients.

Discharge-related duties:

  • Confirms assignment with patient. If patient requests different provider or if provider requests change, facilitates change of assignment only to an open panel. (Please refer to PCP Assignment Change.)

Unassigned Patients Previously Seen

Front Desk Specialists:

Registration-related duties:

  • Based on the four-cut method, determines who their PCP is and makes the assignment in the practice management system.
  • Assigns to PCP using the “four-cut” method unless patient requests different assignment.
  • Confirms PCP assignment at check-in.
  • If patient requests PCP change, staff will immediately contact the Clinic Manager.

Discharge-related duties

  • Reviews PCP assignment and confirms with patient and provider, and changes assignment as indicated.
  • If request is made to change to a Panel that is already full, immediately contact the Clinic Manager.
  • Confirms PCP assignment when making appointments.
  • Confirms PCP assignment with new patients.
  • Resolves discrepancies with provider assignment for established patients, contacts Clinic Manager.
  • Changes PCP assignment upon request by provider or management team.

3. PCP Assignment Change

Patient who wants to change PCP assignment within the same clinic:

  • Discharge and/or Registration staff: Facilitates the PCP change (in practice management system), unless the panel of the provider the patient is requesting is full. If the patient or provider does not agree with the request for change, defer to Clinic Manager and AMD as needed.
  • Inform the patient and providers of the change through email.
  • Clinic Manager: If patient has a provider preference regarding gender, then change can be made; otherwise, consults with current PCP. If transfer is approved, confirms acceptance by new PCP (should include PCP-PCP communication).

Patient requests transfer to PCP at different clinic:

  • Discharge: Will make change to an open PCP panel at patient’s desired location.
  • Clinic Manager: Consults with current PCP. Reviews patient’s history (# of PCP changes, no-shows, number of clinic transfers).
  • Provider: Notes request to change on the discharge form and will consult with the referring provider, if available or known.
  • Discharge staff: Informs patient of new PCP and ensures PCP reassignment in practice management system.

PCP requests transfer to a different clinic:

  • Discharge: Will make change to an open PCP panel at patient’s desired location.
  • Clinic Manager: Consults with current PCP. Reviews patient’s history (# of PCP changes, no-shows, number of clinic transfers).

4. Patient Notification of Provider Transfer or Termination

In the event of a provider transfer or termination, each clinic site will take responsibility for notifying patients.

CMO and AMD:

  • Notifies Clinic Manager, Nurse Manager, IT, Billing Manager, and Call Center Manager of the provider leaving within 2 weeks of receiving notice.

Information Technology Panel Support Staff:

  • Provides the Clinic Manager a list of patients assigned to the provider, patient letters, and optional mailing labels, if needed.
  • Upon request, provides PCP/team with panel list.

Call Center:

  • Eligibility will provide the IPA Disenrollment list to Clinic Managers on a monthly basis. (Note: The list produced will be from the month prior.)

Clinic Manager:

  • The manager will ensure that the computer is updated with the revised PCP information. Standard personalized letters will be sent from the provider to notify patients of the transfer or termination. Patients should be told that the clinic will notify them when their PCP has been replaced. Until reassignment occurs, patients will be seen by the appropriate provider as determined by the clinic manager in coordination with the other providers at the site.
  • Will inactivate account of disenrolled IPA patient in practice management system.

Billing Manager:

  • Assigns PCP a new provider number in practice management system when a new PCP is hired or when caseload needs to be reassigned to new provider. Clinics will be responsible for reassigning the patient to a new PCP within the clinic site.

Return to Module 20

Current as of May 2013
Internet Citation: Module 20 Appendix C: Sample Policies and Procedures. May 2013. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/prevention-chronic-care/improve/system/pfhandbook/mod20appendixc.html