I. Access
Telephone system
An efficient telephone system will be maintained within each division with the following features:
· Sufficient staffing and/or phone tree capability to ensure calls are answered within 6 rings.
· A SINGLE phone number for scheduling all patient appointments will be
established, with routing to the proper individual to schedule the appointment requested. Appointment scheduling will be available during regular business hours.
Greetings
Incoming telephone calls, will be answered promptly and in a courteous fashion, with the following minimal standard content:
· Standard Children’s greeting – “Good morning/ afternoon, Children’s Memorial Hospital”
· Identification of division or clinical area – “Allergy division”
· First name of individual answering the call – “This is Mary”
· Salutation - “How may I help you?”
Answer mode/ Use of voice mail
Incoming calls will be answered in person during regular business hours, without the use of voice mail, unless all lines are busy. If calls go to voice mail due to volume, messages will be retrieved at least hourly by the staff and calls returned on the same day.
After-hours calls
After hours, callers are directed via an appropriate voice mail message, to an answering service or covering physician, or callers are provided with emergency procedures.
II. Appointments & Scheduling
Services will be provided within an “appropriate time frame”, which may differ by division, specialty, individual medical needs and referring physician expectation. However, minimal goals will be targeted, as outlined below.
Primary care
Urgent visit
Within 24 hours of request. If requested attending is not available, patient will be offered an appointment with another physician in the division.
“Same day” availability (Attending of the day/night)
At least one physician from each division will be available at all times for urgent evaluations which cannot be accommodated by a clinic appointment. This schedule will be published.
Non-urgent visit
Symptomatic non-urgent visit
Within 3 weeks.
Asymptomatic/routine follow-up visit
Within 6 weeks (i.e. well child, health maintenance, etc.).
Triage availability
A triage system will be in place (i.e. triage nurse) to provide telephone consultation and assist in prioritizing urgency of appointments when in question.
Specialty care
Urgent visit
Within 24 hours of request. If requested Attending is not available, patient will be offered an appointment with another physician in the division.
“Same day” availability (Attending of the day/night)
At least one physician from each division will be available at all times for urgent evaluations which cannot be accommodated by a clinic appointment. This schedule will be published.
Non-urgent visit
Symptomatic non-urgent visit
Within 3 weeks.
Asymptomatic/routine follow-up visit
Within 6 weeks.
Non-traditional appointment availability
Each division is encouraged, if feasible, to provide nontraditional clinic hours, defined as those hours other than Monday through Friday 8 am - 5 pm, in order to extend appointment availability and increase patient satisfaction.
Advance scheduling lead-time
Appointments will be available at least 3 months, and preferably 6 months, in advance. This requires every faculty member to design his or her monthly schedule templates at least 3 to 6 months in advance.
Clinic cancellations
At least 6 weeks notice will be given for expected provider clinic cancellations. Exceptions are only to be made in cases of emergency.
Scheduling templates
It is understood that individual specialties and physicians will have differing needs with regard to schedule templates. Design of clinic templates will be left up to the individual physician, but must meet the following criteria:
· The template accommodates both new and return patients.
· The template allows for urgent overbooks as feasible per individual physician/specialty.
· The template results in a timely clinic that meets “wait times” criteria and a clinic that concludes at a time appropriate to meet staffing guidelines. Scheduling templates are to be amended/updated as needed to meet these criteria.
Appointment confirmation
All new and return patients will receive an appointment confirmation in the mail (such as used by KIDSDOC) after scheduling the appointment. This confirmation will contain the following information:
· Clinic name, date/time of appointment, physician, location
· Division phone number in case of need to cancel appointment
· Reminder to arrive 15 minutes before scheduled appointment time
If possible, phone call reminders (personal or automated) will be made one day in advance of the scheduled visit.
Accessibility to individual divisions
Each division will maintain a patient telephone line available for the following patient needs:
· Changing or canceling appointments.
· Prescription refills, test results and telephone advice; each division will have a system in place for recording these patient calls and referral of them, along with the appropriate patient chart, to the appropriate physician or other qualified individual (i.e. nurse) in a timely fashion.
III. Registration
The following options for registration will be available:
· Completed or verified at the time of appointment scheduling, or prior to appointment date, by the central registration department, in cooperation with CMMC with a goal rate of 90% registration of patient visits.
· Completed on the day of the appointment, prior to the scheduled appointment time, at an on-site location, in cooperation with CMMC.
· Patients will be encouraged to arrive 30 minutes early if on-site registration is to be completed.
Pre-registration
As noted above, pre-registration is encouraged with a goal rate of 90% of all patient visits. This registration will be completed (or updated) at the time of appointment scheduling, by the central registration department.
Registration on-site
As noted above, if necessary, registration will be completed on the day of the appointment, prior to the scheduled appointment time, at an on-site location in coordination with CMMC; patients will be required to arrive 30 minutes early if on-site registration is to be completed.
Insurance verification
Insurance plan and referral/authorization requirements will be reviewed at the time of appointment scheduling and registration, and again at the time of patient check-in.
Availability of multilingual staff
· Spanish-speaking staff will be available in the central registration area during all hours of operation.
· Spanish-speaking staff will be encouraged in individual divisions, with language bank access readily available if needed.
· Language bank access will be readily available for telephone assistance, for other non-English languages as needed, during regular business hours.
· At the time of appointment scheduling, special language needs will be assessed and interpreter services requested in advance for the appointment date and time.
IV. Physical Access
Directions to clinic
Standardized patient maps/guides to the hospital, individualized with clinic directions for the specific division, will be available and supplied to patients at the time of appointment scheduling/registration.
Parking/valet services
Parking validation and valet services will be offered to all patients and visitors, in coordination with CMMC, and will be described on above noted maps/guides.
Internal directions to appropriate clinic/signage
Clear directions to the appropriate clinical areas will be outlined by adequate signs throughout the hospital and clinical areas, in coordination with CMMC. Personnel at the front desk of the main hospital will be sufficiently trained and supplied with clinic location information, in coordination with CMMC, to accurately direct patients to their appointments.
V. Clinic experience
Staff arrival times
Nursing and front desk staff will be present at least 15 minutes prior to the scheduled outpatient session to ensure timely check-in and rooming of the patients. Physicians are expected to be present promptly at the clinic start time to ensure timely commencement of the clinic.
Staff dress/attire
All physicians, nursing staff and Point of Service staff will wear clearly visible name tags at all times. All staff will maintain a professional appearance, be well-groomed, and meet established dress code standards, (including lab coat of appropriate color).
Point of Service desk
The reception desk area will be clean and clearly indicate the specialty and physician(s) holding clinic at the time. Patients will be greeted in a friendly and professional manner as they arrive, and the procedure for signing in will be clearly delineated. Patients will be informed of anticipated delays in their appointment. The following guidelines will be followed at all times at the reception desk and in patient care areas:
· No loud talking
· No profanity
· No food in reception or patient care areas
· No personal calls or business
· No discussion of patients by name
· Vigorous observation of patient confidentiality at all times
Medical and nursing staff
All physician and nursing staff will introduce themselves by name. Patients and parents will be treated respectfully and courteously. Medical problems, diagnostic examinations and therapies will be explained fully with time allotted for questions if needed.
Wait times
The standard goal will always be for immediate rooming of patients and evaluation as soon as possible after being placed in the room. Maximum wait times will be as listed below:
· “Appointment to room” time
Patients will be taken to a room within 15 minutes of their scheduled appointment time. If there will be a delay of more than 15 minutes, patients will be informed of the delay and the reason, and given an estimate of how long it will be before they are roomed.
· “Room to evaluation” time
Patients will be evaluated within 10 minutes of being roomed. If there will be a delay of longer than 10 minutes, patients will be informed of the delay and the reason, and given an estimate of how long it will be before they are evaluated.
Rooming
All patients will be identified in a professional, polite and discreet manner when called for rooming. The staff member rooming the patient, will introduce himself or herself, be friendly, and make every attempt to set the patient and parent(s) at ease. At the time of rooming, patients will be given information regarding what to expect next.
Patient education
It is expected that every effort will be made to thoroughly educate patients and parents, including but not limited to the following:
· Information on diseases, conditions, medications, etc. will be available to patients as pertinent for each practice.
· The appropriate provider will provide didactic instruction to patients and parents as necessary, so that the meaning of the diagnosis and its implications are clear for the family (and child, where appropriate).
· Additional patient education resources are made available at the patient’s request
· General information regarding PFF services, and CMH/NUMS educational services and events, will be posted as appropriate in clinical areas.
· Documentation of patient education is clearly evident in the medical record.
V. Facility quality
Waiting areas
All waiting areas will meet the following criteria:
· Clean, comfortable and safe.
· Adequate seating available for patients and families, taking into account all divisions or patient care services that may hold clinics at the same time.
· Reading materials and age-appropriate play items available.
· Bright, colorful, child-oriented decor
· Appropriate maintenance and housekeeping support
· Public telephone access
· Coat racks
· Patient comment box
Examination rooms
All examination rooms will meet the following criteria:
· Clean, comfortable and safe
· Adequate seating for parents/families
· Adequate lighting
· Appropriate maintenance and housekeeping support
· Cleaned (and restocked as needed) in between each patient
· Sufficient space for conducting the physical examination and any procedures safely and without compromise on the part of the patient or physician.
Interpreter availability
· An adequate supply of Spanish interpreters will be available (and accessible within 15 minutes) in-house during regular business hours, with this number modified intermittently as needed based on demand.
· If a Spanish interpreter is not available, Spanish interpretation will be immediately accessible via telephone from a language bank.
· Interpreter services for all other languages will be available via telephone from a language bank on demand, and in person when available.
· Every attempt will be made not to utilize family members who are children for interpretation.
VI. Check-in and check-out process
Check-in
Staff will greet patients in a professional and friendly manner at the time of arrival. Methods for signing in will be clearly delineated, explained politely and confidentiality will be maintained at all times. The check-in process will include the following:
· Completion or review of all patient demographic data
· Verification of insurance and patient financial data
· Information provided to patients regarding financial responsibilities
· Patients will be informed if a delay is expected and offered the option of rescheduling the appointment if desired.
· Consent for evaluation form will be signed and a patient encounter form prepared with patient labels affixed.
Walk-in patient policy
When patients arrive to a clinic without an appointment, clinic staff will immediately notify the attending physician or triage nurse, who will make the decision regarding disposition of the patient. Physicians will strive for a balance between providing the appropriate level of patient care and avoiding positive reinforcement for service misutilization.
Non-scheduled patients with non-urgent issues who are “add-ons” will be incorporated into the schedule in a fashion that will not interfere with scheduled patients’ appointment times (i.e. at the end of the clinic). Patients will be notified of this policy at the time they are accepted into the clinic.
Late patient policy
Patients who arrive late for scheduled appointments will be informed of the PFF policy in a friendly manner. The late patient policy will be as follows:
· Patients will be given until 30 minutes after their appointment time without having the appointment canceled.
· For patients arriving more than 30 minutes after their appointment time, the attending physician or triage nurse will be notified and make the decision regarding whether to accommodate the patient in the daily schedule.
· Physicians will strive for a balance between providing the appropriate level of patient care and avoiding positive reinforcement for service misutilization.
· Late patients who are to be seen will be incorporated into the schedule in a fashion that will not interfere with on-time patients’ appointment times (i.e. at the end of the clinic). Patients will be notified of this policy at the time they check into the clinic.
· If late patients desire, they will be given the option of rescheduling for another available appointment time.
POS collections
Co-payments (or payment-in-full where appropriate) will be collected at the time of the visit in at least 95% of cases. Every clinical area will have appropriate signage reminding patients that co-payments are expected at the time of the visit.
Check-out
Staff will greet patients in a professional and friendly manner at the time of check-out. Methods for check out will be clearly delineated and explained politely when necessary. The check-out process will include the following:
· Collection of co-payments or bills-in-full where necessary.
· Generation and issuance of payment receipt for the patient.
· Each practice will have credit card capability and the appropriate monies for providing change to patients.
· When possible, follow-up appointments are made at the time of check out and an appointment card issued to the patient.
No-show policy
A no-show policy will be adopted and enforced across all practices. Divisions may adapt this policy to their individualized specifications, within reason.
No-show chart review
The record of any patient who fails to show for a scheduled follow up appointment will be reviewed at the conclusion of the clinic session, and a determination made regarding the need for telephone follow up. This responsibility ultimately lies with the attending physician, although he or she may delegate this responsibility to other personnel.
VII. Customer satisfaction
Intermittent surveys
Patient satisfaction surveys will be conducted regularly, both scheduled and in random fashion. Surveys will specifically elicit patient feedback in the following areas:
· Medical care
· Nursing care
· Front desk staff
Surveys will be simple, timely and specific. Administration of surveys will be coordinated in conjunction with Information Services. Systems will be maintained such that results can be reported and acted upon in a timely fashion, and will be overseen by the Ambulatory Clinical Board in conjunction with the Department Chairman and President of PFF.
Complaints/suggestions
Each practice will maintain a consistent and effective process for handling patient inquiries, complaints and suggestions. Each practice will designate one member (i.e. Clinical Practice Director) who will be responsible for handling such inquiries in a timely fashion with a goal response time of within 48 hours.
Incentive program
Incentive program goals, as set forth by the Chairman of PFF, will include compliance with service standards and patient satisfaction.
VIII. Physician communication & outside physician referrals
Respect for the referring physician’s relationship with the patient and responsibility for the continuing medical care of the patient will be stressed at all times and clearly relayed in all physician communications.
Referral process
An efficient referral system will be maintained with the following features:
· SINGLE phone number.
· Sufficient staffing/set-up to ensure calls are answered within 6 rings.
· Appointment scheduling capability or appropriate referral to contact person within each division.
· Each clinical division will have one physician designated daily (i.e. attending of the day/night) who will be readily available for contact by referring physicians when necessary to discuss urgent patient issues or needed evaluations.
· A standardized “referral information form” will be distributed to referring physicians and will be completed and forwarded to the clinical area being consulted prior to the patient visit; each clinical area will have a system in place to ensure that this information is readily available at the time of the appointment.
Subspecialist referrals
Subspecialist to subspecialist referrals will be made with the notification and involvement of the patient’s primary care physician. For HMO patients, subspecialist to subspecialist recommendations can be made, but the PCP will coordinate all referrals.
Physician-to-physician communication
Respect for the referring physician, their relationship with the patient, and their responsibility for the continuing care of the patient will be maintained and clearly reflected in all communications with the referring physician.
Written communication
It is expected that dictations to referring physicians will be performed on all patients and will be completed within 48 hours (and preferably on the same day) of service. Written communications will be reviewed, signed and mailed to the referring physician within 24 hours of receipt from the transcription service. Copies of written communication will be sent to the appropriate referring physician, primary care physician (when different than referring physician), and other specialists involved in the patient’s care.
Telephone communication
In addition to written communication, telephone communication with the referring physician will be completed under the following circumstances:
· Specifically requested by referring physician
· Urgent clinical situation/emergency room visits
· Patient requires hospitalization
· Further evaluation, treatment or follow-up requires referring MD involvement
· Unexpected or life-threatening complications
Reports of invasive diagnostic or therapeutic services
If not included in the written communication as outlined above, or if specifically requested, a telephone call or fax to the referring physician will be made on the day of the procedure.
IX. Documentation
Medical record documentation
Documentation will be complete, and all written, dictated or computer-generated records of patient encounters will follow regulatory guidelines of CMS. In-service educational sessions on compliance, documentation and coding will be required of all new faculty, and ongoing continuing medical education efforts will be offered and attendance encouraged.
Telephone message forms
A standardized telephone message form will be utilized to record all patient telephone calls, communication, and actions taken. A copy of this form will become part of the patient medical record.
E-mail communication
Electronic mail communication with patients or parents will be appropriately recorded in the patient record (i.e. printed and placed into chart), and will comply with HIPPA regulations.
X. Billing and collections
Completion of billing documents
Completion of billing forms, including appropriate CPT and ICD9 coding, will be performed at the conclusion of each patient visit or, at the minimum, by the end of each workday, in preparation for immediate submission to PFF.
Appropriate coding
Appropriate ICD9 diagnoses will be documented for every patient visit, and documentation will be appropriate for the CPT code used. Each faculty member is ultimately responsible for determining the level of complexity for services billed in his or her name, and for ensuring that documentation in the medical record supports the bill being submitted.
POS collections
Co-payments (or payment-in-full where appropriate) will be collected at the time of the visit in at least 95% of cases. Every clinical area will have appropriate signage reminding patients that co-payments are expected at the time of the visit.
Authorizations
Appropriate referrals/authorizations for services/procedures will be confirmed prior to any patient evaluation, with the exception being the provision of emergency services or procedures. Insurance plan pre-certification and referral/authorization requirements will be reviewed at the time of appointment scheduling and registration, and again at the time of patient check-in.
Superbill submissions
Billed services will be submitted by PFF to the billing service within 48 hours of completion of superbill forms for outpatient services.
Access
Each clinical service will have at least one physician available at all times by telephone or pager for contact regarding patient-related issues or from whom to request consultation. This schedule will be published.
Attending coverage
Each clinical service will have physician availability for consultative services 24 hours a day, 7 days a week. If residents or fellows are utilized in this capacity, attending coverage back-up will be available at all times.
Timeliness/delivery of services
Services will be provided within an “appropriate time frame”, which may differ by division, specialty, individual medical needs and referring physician expectation. However, minimal goals will be targeted, as outlined below.
Urgent consultations
Within 6 hours of request. If appropriate (i.e. ambulatory patients, non-infectious conditions, etc.), patients requiring consultation may be added on to ambulatory clinic schedule for the same day, as suggested/approved by the consulting physician or service.
Non-urgent consultations
Within 24 hours of request. If appropriate (i.e. ambulatory patients, non-infectious conditions, etc.), patients requiring consultation may be added on to ambulatory clinic schedule for the same or following day, as suggested/approved by the consulting physician or service.
Emergency department consultations
If the patient is stable and ambulatory, and the specialty clinic is in session, it will be acceptable to have the patient come to the clinic for evaluation, as suggested/approved by the consulting physician or service. In cases in which the patient must be evaluated in the emergency department, every attempt will be made for a representative of the requested service to begin the consultation within one hour of the request.
Consult experience
Medical care
All physician staff will introduce themselves by name. Patients and parents will be treated respectfully and courteously.
Patient education
Medical problems, diagnostic examinations and therapies will be explained fully with time allotted for questions if needed. Documentation of patient education is clearly evident in the medical record.
Physician communications
Respect for the referring physician’s/team’s relationship with the patient and responsibility for the continuing medical care of the patient will be stressed at all times and clearly relayed in all physician communications.
Documentation
Documentation will be complete, and all written, dictated or computer-generated records of patient encounters will follow regulatory guidelines of CMS.
Written communication
It is expected that the attending physician will record medical record documentation immediately following patient consultation.
Telephone communication
In addition to written communication, telephone communication with the referring physician or team will be completed under the following circumstances:
Billing
Appropriate coding
Appropriate ICD9 diagnoses will be documented for every patient visit, and documentation will be appropriate for the CPT code used. Each faculty member is ultimately responsible for determining the level of complexity for consultative services billed in his or her name, and for ensuring that documentation in the medical record supports the bill being submitted.
Billing forms for consultative services will be immediately submitted to PFF after the consultative service has rendered the requested services and signed off the case. Billed consultative services will be submitted by PFF to the billing service within 48 hours of receipt of completed superbill forms from the division.
Patient confidentiality
Patient confidentiality will be maintained at all times, and staff will be sensitive to patient privacy issues. Patient information will be discussed only with the patient (or parents for minors), and other medical personnel as indicated (i.e. referral physicians or ancillary care providers), unless otherwise requested by the patient or parents. Specific medical information (i.e. test results) will not be recorded on answering machines. Patient discussions will not take place in public areas of the hospital, i.e. elevators, cafeteria, etc.
Space utilization
All faculty physicians will maintain practices that maximize efficient use of physical space and clinical resources. Room utilization standards will be maintained at least 90% of the time, with intermittent assessment and reallocation as needed.
“Equal opportunity providers”
It is expected that all faculty will provide services equally to all patients in need of those services, regardless of ethnic background, socioeconomic background or payor status.