University of Houston Student Health Center
External Review - Two year update
▪ Jamie Shutter – Director of UHC within SHS @ University of Texas at Austin
▪ Jake Baggott – AVP, Health and Wellness @ The University of Alabama at Birmingham, previous ACHA President FY16
▪ Glynda Moorer – Executive Director of SHC @ Michigan State University
Executive Summary of Visit
1. The Health Center should… investigate ways to expand services in general medicine, women’s health and psychiatry to better meet the needs of UH students.
2. Should work to find efficiencies within their current operation to improve service to UH students.
3. Should convert current collaborations into strategic partnerships to improve the health status and quality of life for UH students by mobilizing the community.
4. Should look for ways to improve internal and external communications.
5. Should provide more opportunities for continuing education and professional development for key HC staff.
6. Should look for ways to better coordinate mental health care with CAPS to improve access and care for UH students.
Accreditation Association for Ambulatory Health Care
▪ Reaccredited by AAAHC in June 2018.
▪ Accreditation is an external, independent review of a health care delivery organization against nationally-accepted standards and its own policies, procedures, processes and outcomes.
▪ Our organization is delivering safe, high-quality patient care in the way that it says it will.
▪ Major team effort
▪ Designation of members to various committees
1.
Expansion of Services
TO MEET NEEDS OF STUDENTS
The Past
New Location
The Present
The Present
General Medicine Clinic
a. Executive Director = Administrative lead + Chief Physician + Staff Physician + Nurse practitioner supervisor
b. Onboarding and retention of full-time GM providers:
Jose Montalvo, M.D., Emergency Medicine
Terah Tower, D.O., Family Practice
Kimberly Hardy Sampson, Family Nurse Practitioner (FNP)
c. Hiring of Chief Nurse in May 2017 (with extra credentials/training):
Nicole Robinson, MSN, FNP-C, allows her to see patients as a provider and not just as supervising nurse
d. Coordination of part-time coverage by Family Practice physicians affiliated with the UH COM:
Steve Spann, M.D., M.B.A., Founding Dean of UH COM (Tuesday and Thursday afternoons)
Brian Reed, M.D., Chair of Clinical Sciences (Tuesday mornings starting this Fall)
General Medicine Clinic - continued
a. There are General Medicine, Physicals, Women’s and Men’s health visits available. These can be scheduled online via Healthy Coog.
b. Same Day visits are scheduled by patient services representative or nurse
c. Nurse visits include: Immunization clinic, Triage visits and Labappointments
d. Student Health Insurance Coordinator: Insurance related consultations
Specialty Clinics
Women’s Clinic:
a. Expansion with added FNP coverage on Fridays
b. OB/GYN, once a month, to perform procedures
** LARC (IUDs and Nexplanon)
c. Men’s and women’s health with pre-counseling and
discounted STI panel for self-pay students made available
Student Health Pharmacy
AKA Campus Pharmacy
▪ Efficient and friendly service
▪ Acceptance of most insurance programs since early 2017
▪ Accepts electronic prescriptions and credit card payments
▪ National Drug Take Back / RX Take Back Program
Utilization of clinics
Clinics Visits Visits
FY17 FY18
GeneralMedicine 8396 9055
Women’s 2578 2773
Psychiatry 1856 1945
Ortho 155 174
Nursing 2405 2625
2. Efficiencies to improve services
▪ ERC RECOMMENDATIONS:
▪ Another office should handle insurance waivers for students as tremendous amount of HC resources funneled to managing this process.
▪ Discontinue offering appts to faculty and staff as those visits take away from students who pay the fee.
▪ Efficiencies in clinic flow:
▪ We have several point of care tests to get fairly immediate results on glucose, mono, strep, flu, urine infection and pregnancy status.
▪ Use an efficient lab, CPL. Quick to deliver results within 24 to 48 hours as its software interfaces with our PNC.
“SHC would greatly benefit from adding more administrative staff as well”
▪ IT
▪ EMR (PNC) support
▪ Public information
▪ Marketing/social media
▪ HR
▪ QI
▪ Risk management
▪ Infection control
▪ Accounting/finance
▪ Purchasing
▪ Credentialing & privileging
▪ Strategic planning
▪ Assessment
▪ Annual Reports
▪ Surveys
▪ Analytics
3. Collaborations versus Strategic Partnerships
▪ Stabilization of organization with staff = availability = more presence over time
▪ Health and Wellness efforts: Healthy Coop, City of Houston (flu, TB tracking), Health and Human Performance, School of Nursing, CAPS, Sleep and Anxiety Center, School of Optometry and Pharmacy, City of Houston (TB and flu tracking, public health concerns).
▪ Committee involvement: EOM committee, HC Advisory Board, Emerging Health Issues Advisory Board, Wellness Planning Committee, Assessment Committee, Learning and Travel Abroad, ISSSO Advisory Board, CART, Student Affairs Committee for COM.
▪ Supportive role: Let’s Talk location, Athletics, Assisting UHPD with development of naloxone program on campus, ordering of flu shots for researcher (grant related study).
4. Improve Internal/External Communications
▪ Change agent with ultimate goal to unify and always deliver quality care and customer service
All Staff Meetings
Annual Staff Retreat – first in 2015
Provider meetings (nurse and physician teams meet separately) – brief, biweekly
1:1 with direct reports
▪ Marketing
▪ Administrative Staff
5. Continuing Education and Professional Development
Professional Conferences: American College Health Association annual meeting, Board specialty related conferences
Ongoing required continuing education: CME for physicians, CEU’s for nurses, certification of medical assistants, CE for pharmacists, CAP for administrative assistant
Board recertification for own specialties and renewal of Texas and DEA licenses
Basic Life Support/biannual CPR renewal
Related courses offered on campus: staff encouraged to attend
In-services to present and discuss common medical topics
Review HIPAA, FERPA, Diversity, Ethics education
Attendance to other conferences: WGRC, Gender Infinity, Sports Medicine-Eating Disorder Symposium
Journals and online articles: NEJM Knowledge, Journal Watch, Medscape
6.
Coordination of Mental Health Care
Challenges
▪ Psychiatry Clinic: Two vacancies currently
▪ Utilizing temp coverage to offer services
▪ Need for “face of mental health” representing the student health center
The Future
▪ Initiation of third party billing to accommodate more of our student population.
▪ We want to offer access to a part-time specialists such as registered dietitian, dermatologist, physical therapist (if HHP provides) and eventually radiology for plain radiographs (increase convenience for students).
▪ Opportunities for further collaboration with the medical school related and community health related entities.
*Alignment of all efforts with our and institution’s strategic plans. Always end goal is to benefit the UH student/s.
The Future
THANK YOU
Health Center External Review Committee February 2016
Jamie Shutter – Director of University Health Center in University Health Services at UT Austin
Jake Baggott – Assistant Vice President, Student Development, Health and Wellness at the University of Alabama, Birmingham. Previously Executive Director, Student Health and Wellness and ACHA President for FY15-16
Dr. Glynda Moorer – Executive Director, Michigan State University Student Health Center
Recommendation # 1
The Health Center should investigate ways to expand services in general medicine, women’s health and psychiatry to better meet the needs of UH students.
Program: Evaluate Appointment Timing and Increase Availability
Electronic Health Records (EHR): Point and Click Solutions. Templates easily adjusted according to needs. Can change schedules, administrative time. Check in kiosks has helped reduce wait time < 10 minutes.
Same day appointments: 15-22 openings available in GM clinic on daily basis. Able to create more depending on needs.
Triage: Registered nurses assess acute needs and help prioritize patients needing to be seen.
Visits: Routine allotted 20 minutes. Procedures or General P.E. 30-40 minutes. Appointments in Men’s Clinic were reduced.
GM clinic: 2.5 full time physicians and added a full-time family nurse practitioner
Women’s clinic: expanded women’s clinic appointments to Friday with addition of academic nurse practitioner (NP)
Psychiatry clinic: hired second psychiatrist to help with mental health needs on campus
Student Access to CareAssess Who Has Access to
Care
Point and Click Healthy Coog Portal allows for online scheduling of appointments within General Medicine, Men’s and Women’s Clinic.
Completed interfacing of EHR with CPL and HMI
Medical providers are able to provide results (laboratory or radiologic) and both patient and medical provider can message via this secure web portal
New Student Health Insurance Program (SHIP) negotiated and utilized by all students (domestic, international and Language & Cultural Center students)
Pharmacy has contracted with many insurance carriers and is able to process claims for many
All UH main and UHSL students are eligible to have access to our services
Recommendation # 2
The Health Center should work to find efficiencies within their current operation to improve service to UH students.
Program and Organization:Look at strategies for hiring/retaining staff and determine if
new staff models could address needs
Hired Emergency Medicine M.D., Family Practice D.O., Family Practice N.P., Child and Adolescent Psychiatrist, full-time phlebotomist (M.A.), part-time M.A. and pharmacy tech II
Hired a dedicated professional Administrative Assistant, Certified with International Association of Administrative Professionals, to assist Chief Physician/Executive Director (CP/ED)
Hired new Associate Director with compliance and practice management experience
Hired an accomplished and knowledgeable Chief Nurse who is also a FNP
Pay grades/salaries: Challenging to allure and retain highly qualified candidates in a rather competitive medical field surrounding market
Route health center resources better
Chief pharmacist able to delegate duties after administrative responsibilities augmented in past year and able to add another tech position
Closed Attendant Care Services
New student health insurance program adopted in Fall 2016. Academic HealthPlans helped reduce administrative burden
The Health Center initiated the process of having a UH System Policy for International Students Insurance Requirements. This policy will eliminate the majority of burdens placed on the HC staff.
Leadership and Human Resource
Recommended to add more administrative staff
Following responsibilities are spread out among staff who already have a full time primary role: IT, EHR (PNC) support, public information, marketing/social media, HR, QI, risk management, infection control, accounting/finance, purchasing, credentialing, privileging, strategic planning and basic administrative support.
Associate Director should focus on strategic planning, assessment, annual reports, surveys, and analytics.
Balance daily administrative and medical responsibilities for CP/ED
Please Note:* = Non-Benefits Eligible Part-Time Employees4 part time employees27 full time employees11,789=Health Center Sq. Footage
DR. DAVID STERN Psychiatrist
7/16
DR. TERAH TOWERPrimary Care Physician
9/16
DR. JOSE MONTALVOPrimary Care Physician
10/15
DR. KEN ARFAPsychiatrist
8/01
VIRGINIA MILLERNurse Practitioner – Women’s Health
2/98
KIMBERLY HARDY SAMPSONNurse Practitioner – General Medicine
06/17
*DR. MIKE MONMOUTHOrthopedist
03/91
DR. VANESSA TILNEYChief Physician
Staff Physician since 3/12
JEANETTE GARCIAMedical Assistant
6/14
T’JUANA DERBIGNEY-HAMPTONRegistered Nurse
5/09
KATHY WALLERRegistered Nurse
6/12
LECITA LACEY Registered Nurse
4/14
*CAROLINA TAMAYOMedical Assistant
9/15
KENYA WILLIAMSMedical Assistant
6/11
MARTHA GARCIAMedical Assistant
9/09
SHEILA DE LA ROSAMedial Assistant
2/03
AUGUSTINE SUTTONPhlebotomist
9/15
NICOLE ROBINSONChief Nurse
5/17
SAMANTHA GUILLORYPharmacy Tech I
4/17
DR. JIMMY COOPERPharmacist
5/08
ADRIANA GOMEZCPhT – Pharmacy Tech II
11/14
*DR. ROKSANA DARAB Pharmacist
10/14
*DR. MARY WILLIAMSPharmacist
3/12
DR. VERONICA SIMMONSChief Pharmacist
10/11
MARY GIBSON Administrative Assistant
11/16
Dr. Vanessa TilneyCHIEF PHYSICIAN/EXECUTIVE DIRECTOR
8/15
JENNIFER GRAHAMPatient Services Manager
4/09
JOE PIERCEPatient Services Specialist
6/01
SHERRY ROSSPatient Service Specialist
5/13
PAT RICHARDPatient Services Specialist
12/15
NAOMI ODOMStudent Health Insurance Coordinator
8/16
RODRICK JORDAN Associate Director
12/16
Consistent/regular communications with staff on happenings in the health center (HC) and on campus and structured all-
staff meetings
First all day staff retreat: focus on professional development and team building
Mandatory monthly meetings for all staff to update and inform all employees about new developments or changes.
Monthly one on one meetings with direct reports for all supervisors with their respective team members
New administrative staff members so changed to weekly senior staff meetings to plan and organize
Recommendation # 3
The Health Center should convert current collaborations into strategic partnerships to improve the health status and quality of life for UH students by mobilizing the community.
Marketing and visibility of the center and the staff
Collaboration with UH Wellness, Women’s Resource Center, Central Care, City of Houston, Rec center: World AIDS Day, Sexual Violence Prevention and Education Programming, free HIV testing, TB testing, O2 provision for Aquatics Safety Program
Involvement in: Healthy Coop, UH Health Collaboration Work Group, Wellness Planning Committee, International Students Advisory Committee, Emerging Health Issues Advisory Board, Emergency Planning Committee
Health center advisory board. Work with Student Government Association to find more student allies
Health center staff rotate NSO/ART attendance, ISSSO orientation attendance, associate director to visit with Resident Life Coordinators (RLC). Academic Health Plans (SHIP representatives) and pharmacy present at orientation and tabling events as well.
Branding, ordering of swag for better marketing
Recommendation # 4
The Health Center should look for ways to improve internal and external communications.
HC should engage in a collaborative process with their staff to develop a stronger, more robust mission statement
Our mission is to provide cost-effective, comprehensive, compassionate and quality primary medical care to all UH students so they can learn best health practices and maintain their focus on successful academic outcomes.
Recommendation # 5
The Health Center should provide more opportunities for continuing education and professional development for key HC staff.
Response
Onboarding of new talent and delegation of responsibilities (response to concern for ED workload).
ED, AD and CP have attended the American College Health Association conference for continuing education, collaboration on best practices and networking.
Following information on SHS listserv
Engaging in regular conversations with PNC to maximize use of EHR. Time permitting join in on user group conversations.
License re-certifications and continuing medical education for ongoing professional development are required for all medical health professionals.
Each provider assigned a date to present current medical topics in an in-service to doctors and nurses
Recommendation # 6
The Health Center should look for ways to better coordinate mental health care with CAPS to improve access and care for UH students.
Mental health in the primary care setting needs to be collaborative (ways to look at shared medical records or better
communication)
Modified psychiatrists’ schedules to accommodate more students
Hire part-time established psychiatrist, during periods of long wait times, to help decompress
Elevate comfort level for general medicine practitioners to initiate treatment of milder cases of anxiety and depression via in-services, primers given by psychiatrists to the team.
Plan regular meetings with CAPS throughout the year to review coordination of care
What lies ahead: Facilities and Equipment
Invest in new student health center.
Relocating to HBSB2 in October 2017.
Increase in exam rooms
New collaborations in future building:
Health & Human Performances
Nursing School faculty
Sleep lab, educational psychology
Federally Qualified Health Care entity with any resources
Future Location
Second floor plan: Student Health Center
First Floor Plan: Pharmacy
Summary Staff frustration with lack of communication addressed via multi-level
meetings and consistency
No show charges implemented. Track no show rates/utilization.
Patient Satisfaction Survey. Weekly review and with more robust responses to students with concerns.
Have hired physician extenders (nurse practitioners) to increase availability for reasonable investment
Budget concerns addressed via reduction in force, review of expenditures
Focus on strategic planning and analysis of the data, more readily retrievable via our PNC EHR.
Utilize technology effectively to reach students, increase accessibility. Meet students’ needs and expectations.
What lies ahead Set up for growing population and evolve with campus’ needs. Hire more
providers to increase appointment availability as utilization grows (whether part or full time)
Third party billing in the clinic is in its developmental stage
Translation services for our large population of international students to be explored
Case manager/social worker, dedicated on site IT staffer
SAM policy re: mandatory health insurance and to whom that will apply
Web/social media: monthly or weekly tips. Build catalog of information. Providers should contribute.
Non user survey pending - Table at student center for survey and SHIP
Consider granting R.N.s more autonomy to run basic STI, URI, UTI clinic
Working together to prepare for next Accreditation Association for Ambulatory Health Care (AAAHC) visit in 2018 for another 3 year re-accreditation
Q&A
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GO COOGS!
Stay Healthy!
Thank you
Table of Contents
Mission
Program (appointment availability, student access to care, clinical salaries, increase contraceptive options, reduce length of men’s appointments, hire physician extenders, address mental health needs in the primary care setting)
Organization and Leadership (turnover, support, professional development, roles, internal communication, staff morale, meetings)
Human resources (short staffed, admin support, mgt of insurance waivers)
Ethics (all HC staff members abide by UH P&P concerning confidentiality, guidelines re: conduct via recert and license renewals)
Table of Contents Law, Policy and Governance (HC staff members must participate in numerous
trainings, licensing requirements, performance assessments, adhere to established standards evident by AAAHC review, mitigate institutional risk via ensuring necessary competencies)
Diversity, Equity and Access (maintain welcoming environment, accessible and inclusive to all; must provide diversity education for staff)
Institutional and External Relations (collaboration with campus partners, especially UH Wellness, increase awareness of HC, signage, marketing, HC advisory committee underutilized)
Financial Resources (student funding inadequate especially for institution of this size, better communicate value of on-campus, university-run health center esp tying work to success, build relationships, develop allies, DC ACS program, implement no-show charge)
Table of Contents
Technology, Insurance and Ancillary Services (EHR no small task; need dedicated on-site IT staffer who is also a PNC specialist to strategically invest in understanding, implementing and supporting the full functionality of EHR –would pay dividends in increased efficiency and provide essential data for informing the provision of services and deployment of resources, web and social media presence, third party health insurance requires contracts and needs a great deal of work behind the scenes to make operate successfully, communication with students on how it works, need to hire additional staff to support transition and track claims submissions, monitor accounts receivable, troubleshoot denied claims, in house lab and radiology * look at xray machine at new location)
Facilities and Equipment (invest in new student health center facility as current one is absolutely inadequate in terms of size, safety, functionality to provide health services to campus of enrollment > 42K; hopefully new appearance will influence perception of quality of care, recommended dental service be relocated as well to allow for addition of primary care services)
Table of Contents
Assessment and Evaluation (goal to increase utilization to enhance health and success and share with student leaders and upper administration, patient satisfaction survey, feedback solicitation, non user survey)
