Projects In A Box: Or How To Do A PI-CME Project

Projects in a Box:Or how to do a PI-CME projectAmy K Mosman, PA-CSLU Division of NephrologyAmerican Academy of Nephrology PAsDisclosure: NoneOutside the BoxKidneys in a BoxBugs ina BoxObjectives1) Understand the new NCCPA requirements forself-assessment (SA) and performanceimprovement (PI) CME2) Recognize and discuss criteria that placediabetics at risk for development of chronickidney disease (CKD), discuss healthdisparities commonly found in practices andrisk factors for infectious disease3) Identify opportunities within your practice toadjust for modifiable risk factors for CKD,infectious disease or decrease incidence ofhealth disparities

Passed PANCE/PANREPassed PANCE/PANRECME 1 and CME 2Year 1-2 Year 3-4 Year 5-6 Year 7-8Year9-10CME 150credits50credits50credits50credits50creditsCME 250credits50credits50credits50credits50creditsHow toMaximizeCreditSA 1.5XPI 2XSA 1.5XPI 2XSA 1.5XPI 2XSA 1.5XPI 2XSA 1.5XPI 2X

SA - CME Q&A type questionsCan be done in a weekendOffered at 1.5X normal CME 1 creditsReadily available:– PA conference (AAPA, state meetings,etc)– Online (AAPA Learning Central)– For-profit programsPI - CME Can be more costly or difficult to find Can take anywhere from 4 weeks to 6 monthsto complete dependent on PI program True ‘butt in chair time’ is 5 hours* Offered at 2X normal CME 1 credits Worth 40 CME 1 credits for the first projectin a 2 year cycle Worth 20 CME 1 credits for the 2nd project in a2 year cycle* As calculated by NCCPAIncredible, inexpensive options!

26 millionAmericans haveCKD: Mostdon’t know it10 people dieevery daywaiting for akidneytransplantEvery 5minutessomeone’skidneys failWhy pick CKD?More than100,000 peopleare waiting for akidneytransplantEarly detectionand TREATMENTcan slow orprevent CKDprogressionCMS wants 90% ofMedicarepayments as feefor-value by 2019Many populationswhoexperience healthdisparities areinvisibleHealth disparitiesincrease healthinsurancepremiums foreveryoneWhy pick Health Disparities?More deathsoccurred 1990-2001due to healthdisparities than weresaved by medicaladvancesMartin Luther KingJr: 'Of all the formsof inequality,injustice in healthcare is the mostshocking andinhumaneUnvaccinatedadults cost theUS 26BILLION in2013Handwashingdecreases infectionsby 20-30% yet healthcare providers onlywash their hands ½the timeAlthough the CDCmandated universalHIV screening in2013, 51% ofpractitioners did notdo itWhy pick Bugs?Oral health hasbeen shown tohave a link with:Alzheimer's,Heart DiseaseKidney Disease,DiabetesOsteomyelitis,PregnancyAnd more .

Tell me more about KidneysPick 1 of the proven 6 modifiable risk factors:CKD stagingUACRA1CSmokingStatinsOTC medicationsTell me more about OutsidePick 1 of the 5 modifiable risk factors:Race/EthnicityGender Identity/Sexual racyTell me more about BugsPick 1 of the proven 5 modifiable risk factors:HIV testingOral HealthTravelVaccinesHandwashing

How do I pick which one to do?Outside The BoxKidneys in the Box You need to finish in 30 days You do pediatrics You want to evaluate yourselffor any ‘unknown’ biases You do not see diabetics inyour practice You have 90 days You want to compare yourselfagainst national guidelines You see diabetics You are interested in learningmore about kidney diseaseBugs in a Box You You You Youhave 60 days to finishare trying to decrease infections in your practiceneed to do a MIPS Medicare projectsee all types of patientsExample: OutsideAfter logging into thecomputerized pretest, you find you areweak in 4 out of the 5modifiable factorsYou realize that youroffice staff inputsrace into the EHR Project practitioner reviewsrace per patient choice You put an asterisk (*) next toyour SOAP note to mean thatyou, personally, confirmedrace Now when you order screeningor calculate GFR, you are usingthe correct race!Example: KidneysAfter filling out thepre/post test, you findyou are weak in 4 outof the 6 modifiablefactorsYou are a hospitalistand have no controlover A1C or urine soyou decide to code AKI Project When you look at dailylabs, you code AKI (N17.9 forICD-10) if SCr changes By adding N17.9, the dischargesummary includes AKI The hospital summary goes homewith the patient and to theprimary who double-checks theSCr after discharge

Example: BugsAfter the pre/posttest, you find out youare weak in 2 out ofthe 5 modifiablefactorsYou decide toconcentrate on oralhealth Project your staff adds dentistname/addresses to thepractitioners who receive yourSOAP notes The patient asks why you want toknow their dentist Your reply that the healingfracture can become infectedfrom oral bacteria The patient actually follows upwith their dentist for a teethcleaning!Pick 1 of the folders and let’s go!!Be sure you write your nameAndWhich project you are doing!Questions?

Passed PANCE/PANRE Passed PANCE/PANRE CME 1 and CME 2 Year 1-2 Year 3-4 Year 5-6 Year 7-8 Year 9-10 CME 1 50 credits 50 credits 50 credits 50 credits 50 credits CME 2 50 credits 50 credits 50 credits 50 credits 50 credits How to Maximize Credit SA 1.5X PI 2X SA 1.5X PI 2X SA 1.5X PI 2X SA 1.5X PI 2X SA 1.5X PI 2X