Good afternoon, everyone, and welcome to our presentation. We will begin in a little less than a minute. Just want to give everybody the opportunity to get yourself situated. Please turn off any background programs with the exception of this program. We do also have two handouts that you can download. One is a copy of the PowerPoint presentation, and the second is a sample scheduling guide that you can also download. As we begin, we're right at four o'clock. I want to make sure that we are on time. Hello, everybody, and welcome to the monthly HCCI Intelligence webinar and virtual office hours. Today's webinar is entitled Geographic Scheduling, the Impact on Home-Based Primary Care Productivity. My name is Danielle Feinberg, HCCI's Coordinator, Education and Research. I'll be your moderator for this event. We are joined today by Brianna Plentsner. She is Home Care, excuse me, Home Center Cared Institute's Manager of Practice Improvement. Brianna has deep knowledge and experience in house calls practice management, having focused her career in home care medicine and primary care. She's a certified coder and certified professional medical auditor. Prior to joining HCCI, Brianna served as the Practice Manager for Home Center Cared Physicians. In addition to her understanding of practice operations, Brianna excels at developing workflows and efficiencies for home-based primary care practices. Dr. Paul Chang is HCCI's Senior Medical and Practice Advisor and Medical Director for Home Care Physicians. Personally, Dr. Chang has made over 30,000 house calls to more than 2,800 patients. He's involved in both local and national efforts to advance quality home-based primary care through teaching, mentoring, and creating curriculum. Dr. Thomas Cornwell, the Chief Executive Officer at HCCI, founded Home Care Physicians, a practice focused on delivering care to medically complex patients in their homes in 1997. Home Care Physicians has provided more than 100,000 house calls to home-limited patients. He has mentored hundreds of medical students, residents, nurse practitioners, and physician's assistants. If you would like to submit a question, please do so in the questions box located on your screen. We will address all questions during the 30-minute virtual office hours following the webinar. A copy of our presentation is available in the handouts box and can be saved by clicking on the name of the presentation and downloading it. All participants today will receive a copy of the slide deck, questions and responses, and a recording of the presentation. At the conclusion of our virtual office hours, which immediately follows our formal presentation, we will send out a brief survey link via email. We appreciate your feedback, which gives us an opportunity to understand your needs and decide on meaningful future webinar topics. At HCCI, we are committed to advancing home-based primary care to ensure that medically complex patients have access to high-quality care in their home. We provide and support the following, education, consulting, research, and advocacy. Today, we will be sharing some websites that aid in the scheduling of house calls. These are not sites that we endorse, but sites that we can allow, that can allow for successful scheduling. Without further ado, I'd like to turn it over to Brianna Plentsner. Thank you, Danielle, and thank you everyone for joining us today. We're here to talk about geographic scheduling, and our objectives are to discuss the impact that geographic scheduling and route planning has on your practice. We're going to describe tools and resources that are available to you to assist with planning and routing, as well as we're going to identify ways that you can operationalize the process of geographic scheduling within your home-based primary care practice. So first, why is it important? Geographic scheduling is crucial to the success of any home-based primary care practice, and when you're able to minimize travel time for your providers so they can spend more face-to-face time with patients, that's going to result in what's needed in order for you to meet your productivity goals. It's also directly tied to provider satisfaction. When providers are not crossing paths or they're able to make more efficient days without having to spend more time in the car or in route than actually with their patients. And it really takes more of a thoughtful approach, and you want to maintain reasonable workflows and have a thought-out, documented process. So I would encourage you to involve your practice manager or office coordinator in really thinking through and looking at your areas, rather than relying on just kind of general knowledge of the area. You may be familiar with certain areas, but even patients that may reside in different towns could potentially be, you know, back-to-back neighbors, depending on scheduling. So really think through your process and involve the people that you have to help make the best workflow for your practice. When you have a well-thought-out process, it also enables you to identify what areas that you're serving that might be the most populated. Maybe you need to dedicate additional time and providers to a service area or a certain county because most patients are centrally located there, or decide more days of the week to have coverage for those days, or for those areas, excuse me. And Dr. Chang, before we move on, did you want to add anything about how much impact scheduling has on your daily days? Hey, thanks, Brianna. You know, for me, geographic scheduling is really important in two aspects. One is about medical service. I want to be able to get to as many patients as possible to take care of their clinical needs. And the other is about productivity. It's about, for our practice, we're currently still based on fee-for-service heavily and RVUs for our practice. So it allows us to maximize our productivity when we can travel in a geographically efficient manner. Thank you. So we're going to start with some overall geographic scheduling considerations. Assigning provider territories and zones within as close proximity as possible. So really making sure that each of your providers have their own zones. Again, they're not crossing paths and that that's well defined so that when you receive new referrals and you're determining which patients you can accept, they're assigned to providers appropriately. A scheduling guide, we're going to talk about that further in the presentation. We also have an example resource for you. But again, having that documented process that takes into consideration whether you're using technology or not, how many patients per day they can take, which areas they're going to be in on which days, and things like that to group future appointments together in, again, as much proximity as possible. You also need to think through who on your team is going to perform these tasks and have ownership of your geographic scheduling and your route planning. Those are two separate things. We're going to talk about both of them. But think about who on your team is going to have ownership from that. Many home-based primary care practices also will go to assisted living facilities, group homes, or potentially even skilled nursing. It's very helpful to maintain up-to-date patient lists from those facilities so that you can make sure when you know your provider is going to be at that location that all patients that are due for a visit or need care receive it when they're there so you don't have to go back two times in one week. And whether you ask the director of nursing or the DON to help you with that, they should be able to maintain patient lists for you and provide those to you, or maybe you use your EHR and maintain those patient lists internally. But I recommend doing that as a best practice as well. And also make sure that you solicit feedback from your team. Discuss any problems or breakdowns in the process, or maybe your provider comes back and shares with you that they had a difficult route. Make sure that you're, you know, looking into any issues and monitoring the effectiveness of your process. So as Danielle mentioned, we're going to review several different technology resources today. And we really wanted to make sure you have access and knowledge to the resources that we're aware of. We're not recommending one particular resource over the other. I am actually going to show you each at a high level. But again, these are geographic scheduling resources that Homebase Primary Care Practices are utilizing, and we wanted you to be aware of them. So the first is CareLink Mobile Practice Manager. The nice thing about CareLink, some high-level overviews, is it is HIPAA compliant. It uses map-based scheduling and driving optimization tools. It does have other functionality, whether you purchase the scheduling-only module or other services that will allow you to sign and send orders electronically, communicate with facilities. You can set visit frequencies for each patient, which would allow you to know when they're due for follow-up, or also have a reporting capability so you can avoid care gaps in which patients may be overdue and not have an appointment scheduled. It has additional scheduling enhancements, such as bulk scheduling, that will allow you to see on a map all nearby patients and schedule them accordingly. Also, if you have, for example, maybe a particular facility day, it will allow you to create reoccurring schedules. And the price for CareLink is $299 a month, and that's for up to two to five providers. The price does vary. That was for the scheduling-only functionality. I'm now going to exit our presentation for a moment and show you at a high level what CareLink looks like. So if you see on their website here, you actually can go in and do a demo for yourself. They have different demo links. I'm going to click on it quickly here, and it gives you the username and password. If I were to log into CareLink, I apologize for the slight delay there, but here you can see an example of how it's grouping patients and marking it. It does have various reporting capabilities, such as mileage and other functionality. It will assign timeframes and allow you to mark them as confirmed or not, and if I wanted to show you the bulk scheduling feature, here's an example of how it will show you up here all the nearby patients and allow you to group those accordingly. I'm going to go ahead and switch back to our PowerPoint. So the next resource that we're going to talk about is Road Warrior, and Road Warrior is a route optimization tool. If you are comfortable using your smartphone, it can be used for free for up to eight addresses. If you, again, just planning the route, so let's say you take one provider, you put all of their addresses in, you could select a start and end location, and it would optimize the most efficient driving route. It does also include route summaries and mileage for each route that you plan, and if you were going to look into a subscription, which has additional enhancements and other features, Road Warrior Pro would be $5 per month or $50 per year. And again, oops, I'm going to exit really quick so I can show you what that looks like. They do have a 57-second video, but you can see here how it displays on a smartphone with the locations. We're not going to watch the video, but it's going to tell you one, two, three, and four what the most efficient driving route is. So the next resource we wanted to make you aware of is called Maptiv, and it creates custom Google Maps using location-based data. You can also upload spreadsheet data, so if you're keeping track of your patients on a spreadsheet, it would allow you to draw a radius map. You can also use color markers by category, and again, it does have route optimization with directions features. You could purchase a 45-day pass for $250 for one user, or I'm sorry, for $250 would be the 45-day pass, or one user is $1,250 per year. And to show you what Maptiv may look like, you can check out their website for more information, but you can see here how it has the color-coordinated plots and how it's breaking up those areas by zip code and several other features that you can learn more about and look into if this was something that would benefit your practice when you're planning out your process, or maybe even looking at provider zones. Another resource that's available is called Multiplotter, and in this presentation, which is a handout, we've included links as well, so you can easily locate all of these, but it will create and save customized maps. Similar, it marks patients' locations numerically, grouping patients' zip codes using different colors, and also allows you to upload multiple addresses at a time. The cost for this particular resource would be $20 per month or $57 for every three months. And once again, I'm going to switch over so I can show you what that might look like. Since I'm in the test environment, I just inputted two addresses local to HCCI's office, and you might see how that could display on a map, and you could zoom in or zoom out from there and look at nearby streets and travel routes. So the next resource that's available would be Bing or Google Maps. Now let's say you had more of a manual scheduling process, but you wanted to use some technology to plan your provider's daily routes, again, thinking what their most efficient time is per day and in the order they should be seeing their patients. You could have some staff add and save addresses that would display on the map, and then that could be used to plan out their route. You would want to keep in mind start and end locations will have limits depending on how many addresses you can add, but these resources would be free online tools that your practice could use. And to show you what that would look like, so Bing Maps, similar, again, I'm just going to use a point of reference nearby, but let's say that I added this and I saved it on our map, and then I went in and I added another, hope I'm not making anyone hungry if you haven't eaten lunch already, but it will show you, let's say I had a whole route planned out where each location is, and that would enable you to plan your provider's route from there. So let's talk a little bit more about route planning, and again, all of these are kind of recommendations or considerations, whether you're using technology or not. So I mentioned it before, but what we mean by accounting for start and end locations is perhaps your providers are starting and ending their day from their home address, or maybe they have a certain office space that they need to, and that's going to impact which patient they travel to first and which patient they may end with. You also want to make sure that you have as much flexibility in your day as possible. So it's recommended to provide a window of time rather than telling a particular patient you'll be there at 1130. One option would be a two-hour time frame. Maybe you tell the patient you'll be there between 9 and 11 a.m., or some practices have used more wider just a.m. and p.m. time frames. All morning patients are given, you know, maybe 9 to noon, and all afternoon patients would be given 1 to 4 p.m. If you live in a, or reside and see patients in more of a rural area, or depending on even traffic, highly trafficked areas, you may need to consider building an additional travel time between visits. So that's something you're going to want to think through. Also, especially if you have other staff, such as a medical assistant that might be accompanying the providers to and from visits, you are going to want to build in time for a lunch break, or even those 15-minute breaks as needed. And for the providers, they're going to need to make sure that they have time to address messages throughout the day, or that your office has thought through a process on how to reach the provider in the field if they have an urgent patient concern or symptom that needs guidance. And Dr. Cheng, did you want to add anything here? Not a whole lot to add, Brianna. That was a great summary. Two things. It is important, and again, every practice is a little different. Our practice, we go out, the physician providers go out with a medical assistant so that we can be taking care of messages as we travel between visits. But it is really important to have that in-basket coverage or management, as I call it, to get the messages back to the patient in a timely fashion so that they don't end up going to the emergency room of the hospital, for example. So build in some time in your day to not only to get some rest, but also get to those messages so your staff can address them. The other is that understand not only your travel day, but where are your other providers? If you work with other providers, where are they today and during the week? So that, for example, myself and another nurse practitioner, we go to the same area, but on different days of the week. This way, we can provide coverage and address urgent need if there is a medical issue that comes up, and I was just there on Monday, for example, but I know that my nurse practitioner will be there on Thursday, and that's a way for me to kind of balance out covering those areas as much as we can during the week. So understand not only your geographic area, but also where are your other providers are during the week. So I think that's very important. Yeah, that's a great point. Thank you. So next, we're going to talk a little bit more in detail about scheduling guides. Again, whether you're using technology or not, or a manual process, depending on what works best for you, you can still have a really efficient geographic scheduling process when you plan out that workflow. So we talked about the importance of designating that staff and really having, you know, who's going to do it on what day and exactly what their role is. And whichever staff that may be, typically, it's going to be your clerical or front office administrative staff, if you also have someone that can look ahead for you. So prior to those confirmation calls that are being made, you know, look at schedules one to two weeks at a time, or even such as maybe a month at one time, so that if there's appointments that somehow maybe got scheduled on a day where it's really not making sense, those adjustments can be made. Also, we talked about the importance of flexibility, but try not to give patients an exact appointment date. So when your provider is finishing up their visit, and they're saying, I'll see you, rather than saying, I'll see you on, you know, September 20th, you say, I'll see you in two months, and my office staff will give you a call to confirm the date and time. And generally, especially when you're serving the elderly population, or maybe you're dealing with a, you know, very busy caregiver, or family member, you know, about waiting about one week to two days prior, not only make sure that they'll remember that you're going to show up and they're going to be ready for their appointment, but it also allows you to have that flexibility, so your scheduling staff can make adjustments to your schedule. So maybe you needed to accommodate a post-hospital visit, or an urgent visit came up, and you noticed that you have a patient that's on for a two-month follow-up, there isn't any urgent requests, you might be able to bump them to the following week in order to accommodate that acute and urgent visit. Also, you know, meeting with your provider staff, your operations team, your leadership team, I think communication is so key in many different ways, but even if it's at a monthly staff meeting, you just take the time to ask how scheduling is going, how your providers have been doing on their routes, if there's been any issues. Sometimes we get so busy that we forget to ask, and that causes, you know, maybe they don't have time to remember there was an issue, so they didn't bring it to your attention, and didn't have a chance to discuss it with you. So that can be really helpful, is just making the time. And then productivity standards, you know, it's not that, you know, again, when we talk about that communication, that you're doing it because you are just mandating that this is how many they need to see, and you're only caring about the visits per day, but it's really what your practice needs in order to be sustainable. So make sure you're communicating that message, and that you've gained their insight on how many patients they feel like they're able to see for the day, but also meets your budgetary and organizational standards, and to allow you to keep providing the care that you could do, and be able to go to the home and provide this much-needed service to your patients. There does need to be some goals set for each of the providers, and geographic scheduling can help make that a lot more obtainable. Another frustration that home-based primary care providers often face are no-shows. Now, not your typical, they didn't show up to the office patient, but let's say the patient forgot, or they were notified to in advance, and they weren't home because they, you know, had their once-a-month grocery delivery that someone came and picked them up for, or they're at a specialist appointment, or maybe the patient's just not physically able to get to the door to answer it, and the caregiver, you know, forgot about the appointment and wasn't around. So just having some sort of general policy, perhaps you have an office manager that's able to just call after the fact and address that, but if you see a reoccurring pattern, and it's happening, you know, three times in a row, are you going to charge a fee? Are you going to address with that patient? You know, your time is valuable, and that's time you could have been providing care to another patient. So really making sure that you're paying attention and have a policy for no-shows as well. Dr. Chang, anything to add here? I know your staff has a morning kind of routine to make sure they're communicating with each other if you wanted to speak on that. Thanks, Brianna. Communication and teamwork are very important. As Brianna already stated, at our office, we have a huddle board. Basically, it's a white-erase board telling, well, kind of summarizing for the front office staff where the providers are, who's maybe out of the office on vacation, where they're going, how many patients they're seeing, so that when they take that initial phone call, they have an understanding in their mind, as they kind of reflect back on a huddle board at the morning, that, oh, so-and-so is in this area, and her schedule is not that heavy today, so that perhaps that call can be routed to the provider and see if the provider can make a visit to address an urgent need. So, having a team understanding where your providers are, what their workloads are, can really improve efficiency and also care. Yeah, that's great. And so, the next slide. So, we mentioned a scheduling guide. I thought it would be helpful to give you a little bit more detailed overview on what that might look like. I also have a resource I'm going to pull up, but you can see here, starts with the provider. So, Dr. Smith, on Mondays and Wednesdays, there's two nearby areas that he's in. Maybe your practice does this by zip code or area. It's not going to be a perfect science, but then when your scheduling staff is grouping future appointments and scheduling those two-month follow-ups, four-week follow-ups, whatever it may be, they at least have a point of reference on what areas the provider is typically in on the day a week, and that makes grouping your future appointments much more easier. And, as well, if you do service-assisted living or group homes or even independent senior living, grouping those patients together accordingly, if you have the volume to do a designated facility day, that's really a win for productivity that allows you to maximize your time. This is a downloadable resource, but I'm going to pull up the scheduling guides for you here. So, this shows it in a little bit more detail. You'll notice some notes at the bottom of the page about allowing 15 to 20 minutes for travel time, if appropriate, again, knowing your geographic region, if that's something that you need to do or not. The other thing that you'll notice is it calls out, again, those productivity standards. You can see Dr. Smith scheduling 8 to 10 patients per day, can accommodate 2 to 3 new patients per day. So, visit type also plays into this. You know, new patients and post-discharge patients may take more time than maybe an established follow-up, as well as if this were a manual process, which areas that you serve should be scheduled together. Again, not relying on that intuitive nature. This really helps your scheduling staff or whoever's responsible to have some clear guidelines to plan their schedules accordingly, and you'll notice some difference with Jane Adams here. Her goal is scheduled for 5 patients per day, or if she does have an assistant, then bump up to 7. Partially, you'll notice she's on call for acute visits, obviously within logistical reason. So, maybe having that 5 to 7 makes that a little bit more manageable. Again, you know, giving how long she takes per patient, keeping in mind her home address if she starts from home, and which counties should be grouped together. So, this is just an example. You can build a little bit more detail to what works for your practice, but wanted to leave you some considerations on how you can really build out an efficient process, whether you're doing it manually or with technology. Dr. Cheng or Dr. Cornwell, did you have anything else to add? I'll just say by emphasizing again, this is literally, as we try to look at what we do, traveling and taking care of our patients and geographic scheduling, it is really a moving piece, right? We're trying to fit our workload, our schedule in a way that's appropriate and timely with our patients. It does take teamwork. It does take back and forth communication between the front office and the providers and say, you know, how can we help each other so that I can help you being efficient? And as a provider, I will not feel that distress like, you know, I can't get there to help this patient who's calling out for help. And Brianna, you might be able to comment on this because you used to do it for us, but we also sometimes, you know, sometimes there's patients with different names, like maybe a parent and a daughter that have different last names now, and the office doesn't necessarily know they live in the same home and you obviously want to see them the same day if they're both your patients. And we had a note system with our EMR, which is EPIC, where we would put, you know, little hint notes in there when there were situations like that. So you wouldn't accidentally go and see just one without seeing the other. Can you just comment on that? Yeah, that's a great point. Thank you for bringing that up. Different EMRs are gonna have different capabilities, but within Epic, like Dr. Cronall mentioned, the field that was utilized is actually called permanent comments. And when you bring up the schedule view that could be printed, those comments would show every appointment every time. So the front office staff in his practice, we would put notes in there too of if we needed to call ahead five minutes, so the dog could be put away and the door could be opened if there was an entrance around back, if they needed to be seen with another patient like that. Even if you maybe missed that when you were going to confirm that schedule, you would see that permanent comment and it would flag you. There's also different flags that you could put in there and play around with it within your EMR, but that's a great point. And another consideration too, you kind of made me think of, is verifying those addresses when you're calling with those confirmations. I know, especially if you're part of a health system, you may have a different visit address than you do for guarantor or for billing purposes. And sometimes that gets changed incorrectly during registration. And you wanna make sure that where you're sending your provider is where the patient is actually gonna be residing that particular day. So that would be one other important consideration to keep in mind, make sure that your scheduling staff is not only confirming the appointment and the timeframe, but that they're also confirming the address that your patient is gonna be at for the visit. Well, that's a great point. And I wasn't even thinking how there might be a note in there, caregiver doesn't arrive until 11 to open the door. You have to see the patient after 11, because obviously as you're planning the day with Road Warrior, Road Warrior might say you need to go this route, but if that patient needs to be seen after 11, you obviously need to take that into account. So thank you very much for that. Danielle, did you have any other comments before we transition into the virtual office hours and any questions that may have arisen? You're on mute Danielle. There we go. I apologize for that. My computer got updated, so I'm getting used to it. We actually had a couple of questions that came in ahead of time and then one that was posed today. And I wanna make sure that before we transition into our virtual office hours, we can address these. A question posed, are all map programs HIPAA compliant? Can you put names in with the Google addresses for future reference? I know Google is not HIPAA compliant. That's a great question. I can comment and then, Dr. Chang and Colonel if you have it. They're not all, like I said, I know out of the resources that we reviewed today, Care Link is a workaround that I know some practices have used is they'll put just the address or maybe an abbreviation to identify the patient. If you have analytic support, sometimes they can do some really impressive things with Google Maps. And then you keep track kind of like on a spreadsheet, almost the actual patient detail information. Yes, that's gonna be a little bit more cumbersome, but certainly something you need to keep into consideration with PHI if you're using something that's HIPAA compliant or not. Excellent. Another question that came in and this is a three-part question. And I know Brianna, you touched on this briefly. How do you account for traffic delays in highly populated areas? That's a great question too. And especially, you know, if you were in maybe a downtown area, that could be more challenging or just a rural area that takes time. You could look at what you're currently offering as far as timeframes for visits. If you're giving those patients timeframes, maybe you need to just consistently build in 15 minutes at the start and end to allow for that or a half hour. It's not gonna be a perfect science, you know, make sure your front office staff has scripting or if a patient or caregiver is upset about, you know, that your provider showed up, you know, a half hour late or if they're running late, communicate that with the patient. You know, providers and office staff should be communicating throughout the day. The patient generally is gonna be a lot more happier if they get a call and say, you know what? We really apologize. Dr. Smith is running late today. He got held up in traffic, but he'll be there within an hour or something along those lines. But you could also proactively build in travel time when you're planning your daily routes depending on the window of time that you're telling patients. Okay. So it sounds like planning and communication are definitely key elements. There was a second part to the question too. And it says, is driving the best option or should we be relying on sometimes the unreliable public transportation? I think that's going to vary very much so practice to practice. So what makes the most sense for you? Are your providers comfortable using their personal cars or do you have company cars? If you are able to drive, even if it is in a downtown area, you know, thinking about parking ahead of time. I know certain buildings that you might need a parking pass in. Sometimes you can grab an extra one for next time. So you have that already and don't have to run in twice or maybe you did have an assistant that could drop you off in front and then go park the car. It really depends practice to practice. Dr. Chang, Dr. Cornell, I don't know if you have anything else to add, but I would say you could try both options too. If you were considering public transportation, you'd probably need to build in a larger time window, but you also need to keep in mind the area that your providers are going to be traveling and the equipment that they have with them. Yeah, I agree, Brianna. We are a suburban metro practice. So we drive our vehicles from house to house and we generally park on a driveway or on the street. So parking is not a major concern for us. However, if you're urban practice, then the logistics will be very different, whether it's public transit or taking a taxi or one of the share rides, that might be your form of transportation because otherwise you may be wasting a lot of time looking for a parking space rather than taking care of your patients. So it is gonna be variable. And the final comment is, as you look at your schedule and whatnot and trying to beat traffic, perhaps you can try the map or route the day counter traffic meaning if the traffic's going eastbound in the morning, perhaps you should try to go westbound as a way not to be caught up in the traffic and increase your efficiency. Okay, and then the final part to this question is, how many visits are included in a full day schedule? And this particular question is gonna depend on various factors. You're gonna wanna keep in mind, like Dr. Chang mentioned, your geography, if you're suburban or rural, the typical miles per day that you have your providers traveling, if you have any organizational standards, also the setting of care, if it's in a private residence versus assisted living, that's gonna vastly change productivity. But I would say in our experience from the practices that we've worked with and collaborating with various home-based primary care practices across the nation, generally on average, if they do have an assistant, so for example, if a medical assistant was driving and traveling with them, around eight to 10 visits per day would be reasonable. And if your providers were traveling alone, I've seen averages closer to five to seven patients per day. But again, for practices that do all assisted living, maybe that could vastly change closer to 10 to 15 per day if it was just one place you had to travel. Dr. Chang, Dr. Cornwell, anything to add? Yeah, I was gonna say- I think those are good numbers. Yeah, those are good numbers, but also keep in mind the type of visits. If, as you understand and learn more about your patient, is it a new patient visit that might take longer? Or if it's a complicated post-hospital visit that might take longer, then perhaps more routine general checkup of their multiple chronic conditions that will consume less time. So keep that in mind as well as you plan out your day, as you think about your travel, and also who you are taking care of for that particular day so you can give an appropriate amount of time for the visit and also travel. Yeah, and I will just add one thing because I used to do house calls in a suburban area that was more densely populated. And now I'm at the fringes where I definitely drive in some cornfields. And generally, it's not as dense a population. I not uncommonly do 60 miles in a day, and that's not 60 miles an hour. And that is much different than what I used to do where it would be uncommon to see literally 10 patients and drive more than 15 miles. And so, that whole aspect comes into not only the number of patients that you see a day, but something we're not talking about today, the whole compensation model. How do you take that into account if you're on a productivity model, if you are in an area that is less densely populated that you have to travel more than maybe other providers in the same practice? Okay, perfect. Thank you very much. So, I would like to take a moment to thank Dr. Cornwell, Dr. Chang, and Brianna for sharing their knowledge today and their experiences with us. We are actually going to transition into our virtual office hours now where we'll not only answer the questions submitted during the presentation and previous to the presentation, but also any other questions related to home-based primary care, whether clinical or practice management. As a reminder, if you'd like to submit a question, please do so by clicking on the questions box located on your screen. If we're unable to get to all the questions today, we'll be sending out the Q&A to all participants as well as posting it on the HCCI website for reference and download. Another question that we received, and I think this is a great question, who on the team typically performs the scheduling and routing functionality? And that's going to depend, this is Brianna on your staffing model as well, but I would anticipate that that bearing the clerical or administrative front office staff are great people to fill that role. If you do have a smaller practice that maybe your care navigator or an MA is kind of wearing many hats, they could potentially do it as well. But typically administrative, I would just try and keep that burden off of your providers and enable everyone to make the most of their time and work to the highest level of their scope. And I haven't thought of this for a long time, but that's where I think technology really helps. We used to have our medical assistants several years ago do a lot of the mapping. One, they kind of knew where the patients were generally, they kind of knew the driving patterns of traffic and stuff. And the problem with that is we were finding that sometimes if the team got back late, it was hard for them to have the time then to map the next patient's days. And so we've actually switched to having the office staff do it and they've been doing a great job. And so I think it depends in part on just what your workflow is and who's available has the time to do this. And Dr. Cornwell, you were mentioning a little bit about workflow and this is something that leads nicely into our next question. Who confirms appointments and do providers ever call on their way to visits? Brianna, do you want to just start because- Sure, yeah. I just didn't know if you wanted to start. You did it. Yep, well, and then I'll chime in. Again, like Dr. Cornwell mentioned, the front office staff and the clerical staff took that over on both the routing and the confirmation calls. So two days prior to the provider seeing that administrative staff would make the confirmation calls. Appointments were always confirmed before the provider was actually sent out. So that role was filled by the clerical and then the administrative staff. And then as far as calling on the way, I think the day before with that timeframe is something that your administrative staff could do. I know some providers do sometimes call when they're on their way as well. So again, that's going to be dependent on who you have and your preferences. So Dr. Chang, do you want to start and then I'll chime in because we do it differently. Yeah, we do do it differently. So I have my office called regarding visit time and so on and so forth. I don't necessarily call each individual patient before my arrival. There are patients who specifically ask us to call them when we are on our way or if we're with the previous patient on the schedule. So we do make a notation or the front office makes a notation of that request on the schedule so that my medical assistant or myself will make that call before we move on to that particular patient. Yeah, and the reason why I chuckle a little bit is because both Paul and I really believe in standardization. We try to do things consistently for the sake of our staff so they don't always have to remember what does Dr. Cornwell like and what does Dr. Chang like, but this is one where we have differed and neither of us I think are willing, I'm not willing to change. And so for 25 years, I have called patients on the way for two reasons. One, I'm hoping that they're not going to be getting bathed, that they're not in the bathroom. If they're in an assisted living facility, if they're at lunch, they can finish up or if they're about to go to lunch that they might just wait until we're done with our visit. We also ask for them to have all their medications out in one place because we do do medication reconciliation on each visit. And the way our practice works is usually I am finishing up with a patient and my medical assistant goes out to the car to load the next patient's address into our GPS. And part of the routine with me is they will at that time, we do not make calls to other patients' homes while we're in another patient's home for HIPAA reasons, but they will make that call when they get out to the car to let my patients know. And so it is something that I have done for 25 years and I haven't been willing to give up. But I think I also asked my nurse practitioners as we're talking about standardizing this, if they called ahead and I don't think any of our three full-time nurse practitioners call ahead, which kind of surprised me. So I am actually the only one in our practice that does that and they do not find because of the two hour window that we give our patients, they told me they really don't find it a problem that the patient is in the middle of something where they have to wait 10, 15 minutes for them to finish up something. So there's my two cents, Brianna. Thank you, I think it was great. You guys kind of can share both of your experiences because there's gonna be no one size fits all. So it's nice to hear different perspectives. Yeah, Brianna, as you know, having worked with other practices and so on, each practice has got to look at what works for them. Some providers want the front office to do the scheduling and all that and so forth. The providers may want to be in charge of scheduling and who's gonna make those phone calls and so on. You're gonna have to look at your staffing and the personality of the providers and try to make it work within your practice so that communication is clear and that confusion will be minimized. So kind of going off of that, there's a question about what or how do you recommend saying no to a patient who's too far outside of your service area? Yeah, and I think this question, sometimes you just wanna help everyone and it can pull at your heartstrings, but realistically, you can't serve every patient. You can't travel to every service area. Depending on your organization, maybe you can only accept certain insurance plans. So I'll say my two cents and then Dr. Cheng and Dr. Cornwall, if you have anything to add, but I would say, you just have to explain that this is what you're able to do. You're only able to see patients in this area. However, if you are able to do your research on if there's other groups or other home traveling practices around your local area that have different service areas that you can at least give out and offer an additional option or put them in contact with the local area on aging or senior services that might have additional resources, at least you're offering them some sort of follow-up option if you're not able to see that patient, but you do need to know what your practice criteria is gonna be, what kind of patients are you serving, what's your service area, and then what insurance you can accept. Yeah, that's a really good question. It's tough for us. We love what we do. We wanna take care of as many patients as possible. We know their choices are limited, but on the flip side, there's something called the geographic creep, right? It's just another five minutes, okay? And then if you do that, what about the patient that's five minutes away from that patient? And you get the idea, and the creep just goes on and on, and all of a sudden your boundary is becoming rather blurred and your staff is getting confused. So there are times where we just say, hey, that's just outside of our territory. We're really sorry we can't do this to avoid this geographic creeping. Having said that, we do have friends of the health system or family members of the health system that we go out of the way as kind of a courtesy to them. So there's that tension definitely between taking care of those who are in need and then trying to manage our service area. And then there's also that relationship, that friendship that's there in terms of going that extra mile to take care of a colleague. So Dr. Cheng, you had touched on this question before. How do providers manage their in-basket during the day? Well, that's really gonna be different depending on your practice style. If you are traveling alone, make sure you built in some time. Talking with my providers, my nurse practitioners, I believe about every two hours or so, they have a period of time where they go into the basket and take care of basket messages. So again, getting the messages back to the appropriate staff so that responses can be made to the patients. For myself, when I'm out with a medical assistant in between patients, I am in the basket all the time taking care of as many messages in between visits as I can so that again, the messages can get out there and be addressed whether it's ordering an x-ray or lab work or ordering home health. Or yes, sometimes we tell them, it sounds like you need to go to the emergency room before things get worse. So again, the delay is minimized. So it really depends on the staffing, whether you travel alone, whether you travel with a medical assistant. I can't say that the two hour period is universal. Again, look at your practice, look at how many messages are coming in to your basket and also who's on the back office or front office. If you did route these messages to these individuals, how are they gonna be addressed? Any comments? Yeah, I completely agree with you. I think there's an efficiency to doing some of it during the day. You're gonna have to do it at some point anyways and we have wonderful nurses in our practice. And so if you wait too late and then the nurses are off, you end up having to maybe make some phone calls that they could have made if you had gotten them in in a more timely manner. And then also just in terms of utilizing your nurses while if all the providers, and so we have five providers, if all of them wait to the end of the day to suddenly empty their in basket, which often then routes things that need to get done to the nurses, the nurses are just overwhelmed at the end of the day and can't possibly get to all that. And so I completely agree that I think it really is good for both the provider as well as the patient and the practice to get to some of that during the day. The other two things is one of the things that our practice is also very good about is if it's something that really does need something urgent like possibly a chest x-ray, they'll oftentimes text us. So we know to look at that specific message if something needs to get done right away or if there's maybe an urgent phone call that we need to make. And also doing at a more timely manner prevents the same family or patient from calling back later in the day and now you have an extra phone call and so there is an efficiency to it. Excellent. And then our last question, kind of three that we can combine. How long do providers typically spend with new patients, established patients, and then what's the recommended timeframe to see a post-discharge patient? Dr. Connelly, Dr. Chang, do you want to start? Because I know this is the same for Paul and I. You know, 60 minutes for a new patient, 30 minutes for a follow-up. Our office actually sometimes schedules 45 minutes for a transitional care patient. One of the things that I have been doing virtually 100% on our new patients because we really are good about getting information ahead of time, we get a five-page history form that has all their ADLs, IADLs, how the caregiver is doing, information on advanced directives, obviously all their family history, social history, medical problems. And so we have that information from them, but also we usually have substantial information from Epic. And so I will usually spend at least 31 minutes. And the reason I say 31 minutes is if I spend 31 minutes ahead of time reviewing all this information and pre-loading the chart, I can bill a 99358, which gives me $115 for doing that work. That is in addition to the visit charge. And that allows me to get through virtually all their problems because you know how complicated these patients are within an hour on the new patients. And it also makes it a very good use of our MA time that they're not just sitting around with me trying to capture all this information. I get a lot of it ahead of time. Paul? Yeah, that's a difficult question. It sounds like, well, that should be able to easily answer. Again, it depends on staffing and what Tom just mentioned, you know, who's collecting the information and who's putting them into the chart. Are you able to get the information beforehand? Do you have access to hospital records? Especially if you're doing a post-hospital visit, if you are working with another health system, maybe you don't have access to those records, that can really delay the visit, make it much more protracted because you really are not quite sure what was done, what needs to be done and what follow-ups are necessary. So again, there are many different factors involved regarding setting exact time. And then Tom gave you some guidelines and that's exactly right. Those are guidelines that we work by. But again, looking at your patient and your clinic and your capabilities and your access to EHR, all of those things. And there are more factors that can impact dedicating a certain amount of time for each particular visit. And I'll just add in, I know the last part of that question was about post-discharge patients. And like you've heard them say, it's really gonna depend on your practice and what's feasible. There's no one size fits all. I know in our experience, you know, best practice is to see those transitional care patients within 48 hours of discharge, if at all possible. That might not be realistic with your provider schedule. Maybe they have home health and you're able to get a home health nurse out there sooner and have them call your office with an assessment. I think, and Dr. Cornell and Dr. Chang, within seven business days would be reasonable to see a post-discharge patient. Do you agree? Yes, data supports definitely within two weeks. A week is that risk time for readmission. And I think the final comment I'll make is that for our practice, we're actually tracking data regarding visit days post-discharge as part of our quality metrics. And that's something your practice may wanna consider doing as well. We have about three minutes and I want to first take a second to, again, express our gratitude to Dr. Cornwell, Dr. Chang and Brianna for answering all of the questions that came in during as well as prior to the start of our presentation. We also wanna thank all of you for joining us. To remind you, we will be sending out a follow-up email with a survey link. We definitely value your opinion. So any information, insights, future possible topics, please feel free to take that survey. It's very brief. We'll also be sending out a follow-up email within a few days, which will include a link to the archive recording, handouts and the questions and responses. We do have on our HCC website information for future webinars, e-learning modules, learning events, consulting services and other resources that we offer. As you can see here, we also have some educational opportunities for the October HCC Intelligence and Virtual Office Hours. You'll actually get to meet us in person at the American Academy of Home-Based Primary Care. I'm sorry, American Academy Pre-Conference, excuse me, where you'll get to have a live office hour with the experts. We also have our GAPNA Conference coming up on October 2nd in Las Vegas. And then our Advanced Applications Workshop in December on the 5th and 6th, right here in Schaumburg. And last but certainly not least, always feel free to reach out on the HCC Intelligence Resource Center. You have the hotline where you can reach out to us via phone or email and receive information from one of our subject matter experts, the webinars like you've attended today, as well as our virtual office hours. As we close everything out today, our upcoming webinar on Wednesday, November 20th, which will be back in our GoToWebinar series is with the National Nurse Entrepreneurial Network, Nurse Practitioner Entrepreneurial Network. And it is Entrepreneurship, I Want to Start a House Call Program. The objectives will be to describe the type of individual it takes to own your own practice, discuss the rewards and challenges faced in starting up a new practice and operating your own business, identify key elements in achieving success and sustainability, and define pitfalls and how to avoid them. And our presenters will be Sandra Berkowitz and Lynn Rapsilber. Okay, and we are right at the five o'clock hour. So thank you to everyone for joining us today. And again, thank you to Dr. Cornwell, Dr. Chang and Brianna. We wish you all a wonderful day. Thanks, Danielle. Thank you.

geographic scheduling

home-based primary care

minimize travel time

face-to-face time

improve productivity

CareLink

Road Warrior

Maptiv

Multiplotter

efficient schedules