EP 21: Quality Metrics You Can Win

Quality metrics don't have to be intimidating. In this episode of NP Launchpad, we break down HEDIS, MIPS/QPP, and other key quality measures while sharing practical strategies to close care gaps, improve documentation, and streamline workflows. Learn how data accuracy, team-based care, and pre-visit planning can help improve both patient outcomes and quality scores without adding unnecessary stress to your day. Tune in for actionable tips you can start using in your practice right away.

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Transcript

Christopher Gleason 0:01

Welcome to NP Launchpad, presented by Fitzgerald Health Education Associates, the podcast created for newly graduated nurse practitioners navigating the transition from school to clinical practice. Hosts Jason Gleason, Christopher Gleason, and Vanessa Pomerico De Nino deliver real talk, real experiences, and practical guidance to help you succeed from day one. So if you're ready, let's jump right in.

SPEAKER_02 0:35

Hello all and welcome to your next episode of NP Launchpad. So I'm here with my host, Jason and Vanessa. If you need to contact us, you can reach us at nplaunchpad at fhea.com. That is nplaunchpad at fhea.com. Quick disclaimer: this is for education only. Please verify your state, employer, and payer rules. All right, so what are we going to be looking at today? We're going to be looking at metrics. So when a clinic says we're being measured, what does that what does that actually mean? And how do NPs avoid drowning in alphabet soup like hiatus, MIPS, QPP, and UDS? What do you think, Vanessa?

Vanessa Pomarico 1:15

So things like HEDIS and MIPS, those are really like a cornerstone of everything that we do, especially now that almost everybody is on electronic health systems or health records. And basically it's it's looking at the quality metrics because what HEDIS does is it actually evaluates planned performance. And to be honest with you, what it what it really is all about is are we doing the appropriate things by our patients? Are they getting the routine screenings like their breast, their mammograms, their colon cancer screenings, their cervical and prostate screenings? Are they getting checked for diabetes if they're in a higher risk category? Um this looks at things like how chronic conditions are being managed and are they being managed appropriately? For example, are the patients coming back at regular intervals, or is the prescriber just giving a year's refill and saying, see a later in a year? Um and really, what are we doing to keep our patients healthy? Because we all know that health plans are really looking at their bottom line, and that's really cost containment. So the health plans really use the HEDA scores as a metric to help improve clinician performance, but also it helps to really with our patient outcomes. And they look at things like quality of care. They look at comparing performance with other plans, and then what they do is they send suggestions that identify areas for improvement. So those are things like you might get something in an email, or you might even get a snail mail that says, We notice your patient uh has hypertension, but we don't have a recent BUN and creatinine on them, or we notice that there is um inconsistency in the patient refilling their medications. And we see that the patient hasn't been in for 10 months, 12 months, however long it's been, for a blood pressure check. So really it's another avenue to really help keep our patients tightly controlled. Um, and then, you know, a lot of this really boils down to whether or not we're getting our patients to be compliant with this as well. Then the flip of that is from HEDIS, then we have MIPS. MIPS is um a merit-based incentive payment program, and that evaluates uh both the clinician as well as the patient performance. And it's just one of Medicare's primary value-based payment plans. Um, and then what it does is it links reimbursement to uh quality, uh, to cost, uh to practice improvement activities and that kind of thing.

Jason Gleason 3:50

Interesting. That's such a great overview. How did you remember all that? Yeah, that is a good question. You work with it all the time.

Vanessa Pomarico 3:57

Every day. I mean, every day. And and we're always, you know, they're always coming in and saying, you know, um, you know, sign this form. And they give you scorecards. So when you get your monthly scorecard and you're not meeting your metrics, you look at that and say, you know, and I'm, and again, you know, there is an incentive there. So a financial incentive to make sure, I mean, I don't really do it, yes, it's nice to have the money, but I really do it because we need to take care of our patients and we need to make sure that we give them the best outcomes. And it's something that I always say to students and and other nurse practitioners when whenever I'm even when I'm teaching review, I always say, don't give your patient carte blanc unlimited refills. If you know that your patient needs to come back, like with PPIs, for example. So PPIs are one of those things that we know that patients in primary care, patients shouldn't be put on a PPI long term unless they've been evaluated. And most insurances will require that the patient sees a GI. If they're on a PPI and they haven't improved after two months, they won't continue to refill it. So what happens is the patients then go, okay, well, I'll just get it over the counter. But that's one of the quality metrics because it's really meant as a balance and check for us to make sure that our patients are being followed appropriately and that we only give them enough refills to get through to their next visit with us.

Jason Gleason 5:17

Very interesting. Very interesting. You know, here's a stumper for you. This is something new that just came out. Have you guys heard of the PETA measures, P I T A measures? Yeah, it just came out. You know what it stands for? Pain in the ass measures, right? There's that too. There's that too. But seriously, I I agree with you. I agree with you, Vanessa. You know, it's so important. We make fun of these. They drive us bananas. It's like, oh, we're tracking all this stuff. Why are we doing this? And I think you hit the nail on the head. It it provides us the opportunity to measure the great care we're giving. And if we're not, to identify that and do something about it. It's all about the outcomes.

Vanessa Pomarico 5:50

But it's also really nice, you know, that after, you know, a once a quarter, you get an email that says, you know, uh, we're going to be depositing X number of dollars into your account this week because you're Hedis. And it's like, oh wow, I forgot about that.

Jason Gleason 6:04

That's right.

SPEAKER_02 6:05

Little bonus, right? Yeah, little bonuses that you don't think about. So I'm curious, Vanessa, what do you think? So there's people out there that say, you know, programs like the MIPS program make you focus more on metrics than it does patient care. What are your thoughts on that?

Vanessa Pomarico 6:21

You know, I think a lot of people just get a little cranky with the fact that we have electronic health systems and it does monitor what we're doing, but it it really keeps us on our toes as clinicians. Let's face it, a lot of these things fell through the crowd when we had paper charts and you had to go through a mountain of charts. I remember when I had to do my chart preps on Sunday nights, you know, for Monday and Tuesday. Do you, Jason, do you remember those things?

Jason Gleason 6:46

I don't know if you're Christopher, but I'm shaking my head, yes. Yeah.

Vanessa Pomarico 6:50

And or you'd come back from from, I remember coming back from vacation and I had a hundred charts on my desk. A hundred. And you had to go through every one of those um charts to make sure, you know, when was the patient's last colonoscopy? Did somebody not file it right? Did they not even get a copy of it? So when it comes to the metrics, it really is more of a reminder for us as clinicians that we have to stay on top of these things. So what I do is in my uh physical exams, in every one of my physical exam templates, whether it's at Medicare, whoever I'm doing it for, the annual exams, I actually have my checklist there. And what I do is I have a dot phrase. And what it does is so, you know, last colonoscopy, uh, last eye exam, last A1C, last PAP test, last mammogram, last PSA. And what it does is that it's a dot phrase so that when I open up that patient's chart, it automatically grabs that information and puts it into my note.

Jason Gleason 7:45

So that's great.

Vanessa Pomarico 7:46

You know, you have to utilize those kind of things so you're not spending a lot of time. It's one of those time saver techniques, but it really is is meant to help us. But, you know, some people say, you know, well, you know, I'm gonna do this because I'm gonna make more money. And you really shouldn't let the money be the driver behind what you're doing because we need to give good care to our patients. But again, if you make your life easier and put your dot phrases in there so it pulls that information, it makes your life a lot easier. And you're not prepping your charts the night before or spending a lot of time in the exam room with the patient saying, like, hey, I know your colonoscopy is in here somewhere.

Jason Gleason 8:24

So what I'm hearing from you is work smarter, not harder, right? With all this stuff. Would you suggest a new NP going into practice, even though it's a pain in the rear, maybe stay an hour a night for a few weeks or at least a week, you know, after work to kind of set up those dot phrases because it's gonna be time well spent and well invested.

Vanessa Pomarico 8:41

So I don't say uh after they start working, I tell them when you as soon as you get that laptop assigned to you, you start making your dot phrases, or if you have remote access. So I don't have a work laptop laptop. I I wanted to have a desktop because I work better on a desktop. Um, because I like to have a lot of different files open and that kind of thing. But I have remote access. And so when I was hired and I knew that I was starting on a Monday, as soon as I went through the training for my health system, my health electronic health records, I spent that whole weekend, several hours, just making my templates and my dot phrases so that when I started work on Monday morning, everything was right in there. And so for our new people, our new grads, you don't have to reinvent the wheel because there's people like Jason and Christopher and I that our templates are already out there. Yep. And you can just say, you know, is there somebody's template that I can use? And then you tweak it for your own. So I had developed mine. Our medical director happened to like my template and they adopted it and they said, can we use this as, you know, open access? I said, go for it. And, you know, sometimes I look at somebody else's note and go, Oh, they added that. I think I like that. And then I add that to my template. So a little bit of work on the on the the beginning of your work cycle is gonna pay off in the long run.

SPEAKER_02 9:58

Absolutely. Love it. Absolutely. So speaking of MIPS, it's important that we learn which programs apply to us, especially when you're looking at payer contracts or federal programs. And it really, it really is very dependent on the setting. Yep. So when you're in these situations, it's important to also to ask Free Dashboard what is measured, how often, and basically what is your baseline? That way you can go into it with a with a full knowledge base. Other important points, don't guess. Metrics are usually a data problem, not a motivation problem. So looking at this, uh Jason, how do you close care gaps without turning every clinic into a clip or tornado?

Jason Gleason 10:30

Well, you know, that's a great question. Before we get to that, you said don't guess. I would say be so careful with that because if you guess, even though it may not be intentional, there's a word called fraud, right? You never want to fraudulently, you know, work the numbers in your advantage so you get more money or anything like that. So but but they'll do audits, and if you're guessing through this stuff, they'll pick up on it. And even if you have the best intentions, if it's not correct data, it's gonna get you in the end. So be careful with that. But how do you close care gaps without turning every clinic day into a full-blown mess, a tornado of paperwork and tracking? You know what I love in our position at the VA is we have admin time. And not every clinic offers providers that, but I think it's so valuable to have that admin time built into your schedule. So, new NPs out there, when you're sitting for your job interview, I would say, I would say to the to the to who's gonna hire you, tell me about the admin time in my schedule. Is there any admin time built in? And usually it'll be about two to four hours of admin time because it does take that time to look at all these metrics and measurements, but not only that, to find the gaps. And then also, well, what are we gonna do about it? And to work with your team, because it takes a whole team, right? To work with your whole team to improve the outcomes and improve the measures. So that's what we do, Venice. So what do you do in your clinic?

Vanessa Pomarico 11:47

So similar, but you know, we also utilize a lot of team-based care. So, you know, I always say that the two of you are very fortunate that you have nurses on your team. Oh, you know, we don't have nurses in our office, um, but your medical assistants. So if you're doing team-based care, medical assistants can really look at the preventative care needs before the visit. So let's say the patient is due for some vaccines. Um, they'll actually get the vaccine ready. They'll say to the patient, you're due for X, Y, and Z, which one would you like today? And then they'll have the vaccines ready for me when I walk in the room. Um, for those of you that work with nurses, they can perform the screenings. They can also do the vaccinations. Um Connecticut has a law that uh medical assistants can now give vaccinations as well, but they have to do it after I've I've put the order in. So they don't just go ahead and do it. But nurses certainly can do that. And then if you're fortunate enough, like the two of you at the VA, if you have care coordinators, those are the ones that can actually schedule like follow-up testing and any specialty referrals. And then our front desk, you know, you you have to really look at the front desk as part of that team-based care that will help remind patients when they're overdue for certain things when the patients are calling for an appointment. So, for example, I had a patient last week uh that needed a pre-op and they said, You haven't seen Vanessa in three years for your routine physical. She can't clear you for surgery. So we had to scramble to get, and of course, the patient was like, Well, what do you mean? You know, just have her do the have her do it on the same day, because that's so simple in the real world that we can just throw a physical in, right? Yeah, I have to do that.

Jason Gleason 13:18

I have to tell you our pay our patients must communicate because I had the same kind of situation this week, right? Yeah, crazy. Have you ever had that happen, Chris? I know, right? Yes. I'm having surgery tomorrow. Can you clear me, please? Oh, we haven't seen you in three years.

unknown 13:31

Yeah. Yeah.

Jason Gleason 13:33

You have no lab work, you have no EKG that to be fair to patients, so they don't have any idea behind the scenes how much work it takes to get it clear it's like so true.

Vanessa Pomarico 13:41

They just think it's it's that. So we use a lot of team gaze care, but we also do um pre-visit planning. And that's, you know, really looking at the charts. You don't want to open up the patient encounter when you walk into the room because you're going to look like you're not confident, you're not competent, and it's not going to get put the patient in a very good situation. So I like to take a look when my medical assistant is rooming the patient. I've already gone in a little bit earlier. Um, and you know, again, when you get into your groove, it's not, it doesn't take that long. But like you said, having the admin time, if I go in a half hour early to do my pre-visit planning, that's part of my admin time. So that I'm able to look at the charts, what's overdue, what do they need, you know, what chronic disease monitoring do I need to take a look at and that kind of thing. And then the last thing that we use are standing orders and protocols. So um, and that's really when we have standing orders and protocols, that really is what help with that team-based care. So that we have the appropriate people give the vaccines, do the things like the PHQ nine and the depre and the anxiety screenings, they're they're able to take care of some of that.

Jason Gleason 14:46

Yeah. Yeah. And that's great. And you're all on the same page, you know. Yeah. And you again, we kind of look at metrics as a pain in the butt to measure, right? But you just mentioned the PHQ nine screening for depression. We screen for that all the time. But those times, and most patients actually, most patients, they'll be fine. They're not suicidal, but you'll have that occasional patient every now and then. It's like, holy cow, this screening saved their life. Yeah. So we're not just doing these things to jump through hoops. They really matter and they can be life-saving at times. Absolutely.

Vanessa Pomarico 15:17

Yeah. And they really do matter. Like things like blood pressure checks or looking at their A1C. You know, again, isn't that what our job is to keep our patients healthy? And if you're not, it's so we have to really move away from people focusing that it's just it's all about the metrics and how much money the organization can make. It has less to do with that and more to do with our job is to keep our patients healthy. And part of our work is to make sure it's our obligation is to make sure that we are closing those gaps on the patient visits.

SPEAKER_02 15:49

Absolutely. And the um that actually kind of leads into this uh next reminder, V talking about, you know, doing the metrics for A1C, colonoscopies, hypertension, things like that. And Jason touched on it a little bit earlier with regards to talking about documentation fraud. It's so important to document correctly because if it's not coded or recorded correctly, it may not count. And let's say you have you have a uh a patient that's had a colonoscopy recently. However, you never documented that they had the colonoscopy, then that metric is gonna remain in the negative until that is corrected. Same things with hypertension. If you have a hypertensive uh excuse me, hypertensive patient and you, you know, you give them the medications, you've done all you need all you need to do. However, you haven't documented the uh blood pressures correctly, then again, that's not gonna count and it's gonna flag. That's right. So it documentation is is huge and it's so, so important. The other thing to look at too, I mean, make it easy for patients. Schedule labs referrals and follow-ups before they leave. And V you you kind of you know touched on that too, as far as having your MAs go through, go through their charts so that that you know what's coming up and and uh the scheduling aspect of it. Like your patient they haven't seen for three years that want to want to pre-up for school. Holy cow.

Jason Gleason 16:58

You know, at the end of every visit, what I get used to doing is before they even leave the clinic, like as they're walking down the hallway, I'm entering that return to clinic order right away, the labs for the next visit. Do all that stuff ahead of time because it'll save you in the long run all that time that can be put to something else. Absolutely.

Vanessa Pomarico 17:14

So there's just a couple of things that I always like in the back of my mind, what I ask myself before I close the encounter. So you'll always want to look at did I provide the right care? Did I document that that care? Did I code it correctly? Because let's face it, the the billing and coding department is gonna, you know, come back and say this wasn't coded correctly. Did the system capture the care because now I've hit the metrics and now all of those um, those outstanding metrics have now been turned off because the patient came in for their AWV or that kind of thing? And does a particular metric or measure apply to that patient? And those are the things that you really need to look at so that you don't get that email back to say, this wasn't done. Did you address this or you might have addressed it in your review of systems, but there's nothing in the plan. So you have to make sure that you're closing all of those gaps in your documentation.

SPEAKER_02 18:08

Absolutely, absolutely. And um so kind of rebounding on that. When quality scores look wrong, what should clinicians check for before blaming the metric monster?

Jason Gleason 18:19

Jason, I'm gonna throw this one to you. I always blame the metric monster, right? Come on, come on. No, first of all, when the when the numbers just don't look right or you're you're not meeting the the mark that you need to meet, it starts with yourself, right? What can I do differently? What am I doing, not necessarily wrong, but what can I work on to improve? Um, and and there's challenges, but it begins with yourself. It's easy to blame everybody else or blame the computer or the tracking, but start with yourself and ask yourself, you know, are my problemless up to date? Is the is the flow of the clinic, you know, when I see patients the flow and how they are seen and work through the clinic experience, is that efficient enough? Those kind of things are important to look at, but it begins with yourself. So if the numbers are not looking right, start with yourself and then work out from there. Absolutely. Vanessa, what do you think about that?

Vanessa Pomarico 19:08

So I I agree completely with Jason, and I'll just give you an example. Just this, well, of course, it's only Wednesday, um, but just earlier this week, um, I had seen a patient last week and I did the talk about when you do the anxiety and depression screening, the patient answered positive to every single one of the PHQ9 questions. So I appropriately asked it, I documented it, and then I I clicked on um to charge for that because I spent so much time on it. And the the coder sent me an email, and I when I opened up my email on Monday, um, they said, uh, you we can't bill out because the pH, uh, the pH two q2 is the only thing that's documented here. And I was like, I know that I did this because I spent an inordinate amount of time. So sure enough, I opened up my chart or the patient's encounter, and there it is, the PHQ nine with every single one, because it was such a huge. And I and I I said to the the um coder, I said, it's in there. If you just look, you'll see she couldn't see it. I took a screenshot and I sent it to her and said, it's right here. Like you just have to click on it, but here it is, and you can see that I I have met every one of these because they make mistakes too. So you know that you've right. And if you know that you've done all the things that you just said, Jason, you know, then you have to be proactive on your end to say it is right here. Some of the other things that I always think about too are things like statin intolerance. So I get things from uh, let's say, the pharmacy or the insurance company, and it will say, you know, Mrs. Jones is a diabetic and uh she has high blood pressure, but she's not on a statin. Well, I have it right there in the diagnosis in the patient's, you know, um uh history. Patient is statin intolerant, and that's why they're on Zedia or they're on, you know, an alternative. But they sometimes don't look at that because they don't have that kind of access. So that's kind of frustrating that they're always sending us the little letters to say, you know, your patient's not on the statin. And it was like, okay, but they're statin intolerance. So you have to make sure that that is all also not just documented in your note, but documented in the problem list.

Jason Gleason 21:16

And spend some time when you get your new job out there, spend some time really working the EHR and talk to IT, talk to your colleagues, your mentors. At the VA, if I put in a note, I've done the PHQ nine and I have, and I document the score in my progress note, that's great. But if I didn't click the boxes and actually doing it in the EHR, administratively, when they look at all the data, it doesn't count because they're not gonna sit there and read our progress notes. A lot of providers assume that, like, oh, it's in my note, you're gonna see it right there. No, they're gonna look at a spreadsheet. I want all the PHQ nines for this clinic that was done in the last year, boom, there's your list, right? But if you don't go through the little reminders in your EHR, you're gonna miss all that stuff, and then you're gonna have to re enter it, you know, at some point.

SPEAKER_02 21:55

So, you know, speaking of metrics, we've talked a lot about what provides. Can do to kind of accurately document metrics, make sure we we uh we get through them. But I think it's important to also uh remember that some of the onus is on our patients as well. When we're doing metrics, when you're when you're checking uh blood pressures to make sure that they're you know within normal limits, when you're doing where you're when you're um ordering colonoscopies, things like that, the patients also have to be a part of the a part of the uh the solution and they have to be willing to do, you know, the steps that we've laid out to to get you know those chronic diseases in order.

Jason Gleason 22:27

They're the captain of the ship. And we all have all had patients where they say, you know what, I don't want all this health screening stuff. I'm good with it. Yeah. As long as you're informing them, at least my approach is this. I I want to inform my patients of the risks and the benefits and document that super well that you've gone over all that. But you'll have that occasional patient that says, I don't want anything. I have I have a female patient on my panel, actually. She's in her 60s, she doesn't want mammograms, no GYN screenings, no, no labs, nothing. She says, I'm healthy, I feel great, I don't want any tests done. And I educate her quite well on the risks and benefits and document that well. But you'll run into those patients that don't want anything. Don't want anything. Have you seen that, Vanessa, in your practice?

Vanessa Pomarico 23:07

And I have, and that's why I'm very grateful that we have the ability, let's face it, with computers, when we first started in our electronic health records, we didn't have the ability to put patient declines. But we and I said to IT, you've got to put this in here because every time the patient comes in, all of their vaccines here and patients are saying no to the vaccines, but I don't have a way to document that where it captures that data. So now we have to take a hit. Exactly. So now we have that. So next to where the mammogram is, um, even the um the PAP tests or you know, any of the other things that we need to do, we actually have a decline patient declined or patient refused button.

SPEAKER_02 23:47

Yeah, that's great. And I think it's really important when you're, especially when you're first meeting new patients, you're doing that new patient visit or what have you. It's important to let the patient know, hey, for me, um, this relationship is a partnership. Okay. I can do so much. I can order the tests, I can order your medications, I can order the imaging studies. However, if you're not willing to do your part and follow up and do and do, you know, X, Y, Z, then it's really a moot point for me to do what I need to do. I'm not going to get anything in the end.

Jason Gleason 24:13

So you know, here's a tip for our listeners out there regarding documentation, a document documentation tip that I would recommend I do it on every instance when this comes up, when a patient refuses a health screening. You educate them well, and then you document, you know, I've I've talked to the patient about this, reviewed the risks and the benefits, and then close it with this. And the patient verbalizes understanding and take take note of this, that declining the health screening could result in serious disability or death, and end it with that. And make sure you tell the patient that, right? You don't want to document something you didn't tell the patient. But the reason behind that is this. I know of one lawsuit that I've heard of in the past where the provider went over everything, even documented, could result in death if you if you don't pick up on some of these things, right? That's pretty obvious. So it could result in death on some of these certain things that are serious. But the patient had a huge health issue because they didn't do the screening, but they didn't die, but they were severely disabled. And the lawsuit was all about well, if I would have known, I knew I was gonna die possibly if I didn't, but if I would have known I was gonna be disabled, you know, in this way, I would have done the test. So in your documentation with could result in severe disabilities or death. Make sure that's documented for those instances where you need to. Absolutely.

Vanessa Pomarico 25:26

Right. And with the CARES Act, we know that patients are gonna read their notes anyway.

Jason Gleason 25:30

Oh, right.

Vanessa Pomarico 25:31

Yes, exactly. And they don't like that, you know, because I do something similar that to what you do, Jason. And they'll read it and they'll say, Well, don't you think that's a little harsh? Well, it's the truth. No, I'm not taking it out of the note. You declined it. I discussed with you that that not having your colonoscopy or not having your mammogram or your PAP test can lead to, you know, undiagnosed um diseases that can end up in death. And so you have to document it.

Jason Gleason 25:57

You feel like the grim reaper, but it's the reality, right?

SPEAKER_02 26:00

It is. It is, it is. Something that I've always included in my notes, especially um in the the initial documentation is you know, I say veteran, but veteran has expressed understanding of and was in agreement with treatment plan, you know. It and I think that is so important. I was actually taught that when I was doing family care, you know, when I first started as a nurse practitioner, how important that was. Yeah.

Vanessa Pomarico 26:22

Yeah.

SPEAKER_02 26:24

So more on metrics, obviously. Who owns quality metric success? And how do we keep it from becoming one more thing dumped on the NP? Vanessa, what's your take on that?

Vanessa Pomarico 26:33

So I always say it's like an onion. There's a lot of layers you have to peel. So when you think about metrics, really the health system or the health, you know, the hospital organizations, they own the infrastructure to our metric success, right? And then the practice or site leadership, they're the ones that have that day-to-day execution of whatever tasks are happening that day. But it's the care team that really does own that clinical decision making. And it's really up to the clinicians to make sure that that care is delivered and that it's documented properly. And that's how we then are able to measure our quality measurements. So again, your medical assistants can capture the vitals, they can do the screenings, um, they can um, you know, look for those um flags and gaps of care. Again, the nurses can run the protocols and then the templates actually, if you put your dot phrases to pull that information in, it will automatically capture that structured data that you need to meet the metrics. So it's not additional work for you to hunt for everything that you need.

SPEAKER_02 27:33

I love that. Which is amazing. Yeah. Do you some of your take on it?

Jason Gleason 27:36

Well, you know, I agree with everything Vanessa said, but here's the deal to bring all this together, I think those huddles are so important. Don't blow those off like, oh, we don't have time for this, but meet with your team and see who's going to do what. Otherwise, you're going to be stuck doing it all.

Vanessa Pomarico 27:49

Right.

SPEAKER_02 27:50

Absolutely. And, you know, speaking of that tenant team model, it's also important that we celebrate wins as a team. You know, small improvements in the in those metrics, they're important. You know, make sure, make sure your team's aware of them. Make sure that that they're aware of the the success and the and the great job that they're doing.

Jason Gleason 28:05

Yeah.

SPEAKER_02 28:06

All right. So next on our time, our list is some resources to share on air. So I'm not going to read these to you. They're actually in your show notes. So you can go to your show notes and um great resources. Great resources, and you can review them. Now is my favorite part of the show. It's time for fact or fiction.

Jason Gleason 28:23

Who's it gonna win? We should have prizes. Where are the prizes? I keep asking that. And it's still nothing. I want a mug or something.

Vanessa Pomarico 28:31

Yeah, I still don't have my mug like you guys have.

Jason Gleason 28:34

I know. What the heck? Look at this mug. See, very nice. I have this. Yeah. And Chris Christopher even has the clothing, you know, the jacket. And yeah.

SPEAKER_02 28:42

So, V, what I'm gonna do is I'm just gonna get somebody to make a copy of this mug. Yes. And I'll just send it to you.

Jason Gleason 28:47

Yes. That's right. That's right. And our listeners out there, you want prizes, right? Christopher will share something with you soon about a special discount, though, right, Chris? I absolutely.

SPEAKER_02 28:55

So stay tuned. All right. So quality measures can affect reimbursement and patient outcomes. V, fact or fiction.

Vanessa Pomarico 29:03

Fact.

SPEAKER_02 29:04

Absolutely. Absolutely. Fact. And we touched on that, you know, quite a bit throughout the podcast. So all right. So data accuracy, problemless coding. Can they change your quality scores, Jason?

Jason Gleason 29:14

I would say fact or fiction. Data accuracy can change your quality scores.

SPEAKER_02 29:18

Absolutely. Absolutely, 100%. All right. So, V, you can close gaps without a team if you work hard enough.

Vanessa Pomarico 29:25

I mean, that's a fact, but it's gonna be a lot of work.

SPEAKER_02 29:29

There come those PETA measures again. Yes, exactly, exactly. And we touched on that in the podcast, too, how important it is to come to approach this with a team, uh, a team approach. So, Jason, pre-visit planning can improve both care and metrics. Back to fiction.

Jason Gleason 29:43

How did you get all these questions that time? These are easy breezy ones, right? Pre-visit planning can improve both care and metrics. I would say yes.

SPEAKER_02 29:51

Absolutely, absolutely. And we touched on that in the in the earlier in the podcast as well. All right. So speaking about what Jason said earlier, so we appreciate all of our listeners and we'd like to share some special savings with you. Visit FHEA.com and use the code launchpad20 for 20% off all CE and memberships. It's just our way of thanking you for supporting the show. Again, that is FHEA.com. The code is launchpad20 for 20% off of all CE and memberships.

Jason Gleason 30:17

Who doesn't like to save money?

SPEAKER_02 30:19

Absolutely. All right. Next up is the audience mailbag. Let's see what we got going on. Let's see. All right. So which quality metric is your clinic clinic pushing hardest right now? BP, A1C screenings, vaccines, etc. V, what's your thoughts on that?

Vanessa Pomarico 30:35

So my office actually has a whiteboard, and every week we have all of those metrics and what our percentages are and what the goal is. So it's kind of hard to ignore it. Oh my gosh. Um, and it's all of the above. They're looking at everything the A1C, the screenings, the vaccines, all of it is on there.

Jason Gleason 30:54

I love that. Now, do you do you work in like a uh a clinic where you have different providers in the same room so you can see everybody can see the whiteboard and all the teams are on there?

Vanessa Pomarico 31:02

It's actually right in the hallway where our coffee machine is. So excellent. I love that. And it's right outside of the bathroom, but you can't miss it. And it's a good thing.

Jason Gleason 31:11

It kind of strikes up that competitive feel, right? Because we can pull that up digitally, but having a whiteboard, I mean, that really brings it brings it to the front front. So I love that idea.

SPEAKER_02 31:20

Exactly.

Jason Gleason 31:20

Yeah.

Vanessa Pomarico 31:21

Yeah.

SPEAKER_02 31:21

So what's one gap you wish you could close faster? And what's blocking it, Jason?

Jason Gleason 31:26

Uh, you know, technology, I would say, is is a hiccup sometimes. I know last year we were measuring um urine microalbumins for diabetes, but our numbers were way off. It's like, what is happening here? What is happening here? And it was an IT issue. Yeah. So it's so important. When you're seeing things that aren't off and you've looked at yourself and you've looked at your team, don't forget about IT because it might be a systems issue. And that could put everything at stake.

SPEAKER_02 31:49

Right. Absolutely. All right. So we're coming to a close. So let's look at our wrap-up landing checklist. We want you to pick three priority priority metrics, run a registry and call five patients and pick one gap A1C, blood pressure, vaccines, and close it with a tiny weekly registry habit. And a whiteboard. And a whiteboard, exactly.

Jason Gleason 32:08

Vanessa, I have a question. Do you ever find the eraser to the whiteboard?

Vanessa Pomarico 32:12

Can I share a secret with you? So we wanted to, a few years ago, we wanted to just kind of play around with our practice supervisor. And we took the eraser and we put all kinds of crazy numbers on there. And when she came in to look at it, she was like, Wait, what happened? Oh my gosh. That was our April Fool's joke. It what's I love that.

Jason Gleason 32:34

We're gonna write this stuff down. We've got to do that at our clinic. That would have to be pretty good. Thanks for the secret, Vanessa.

SPEAKER_02 32:39

Yeah, no kidding. All right, so what's your homework for the week? We want you to pull one metric, report a registry, and contact five of those patients to close one of those gaps, whether it be A1C, blood pressure, vaccines. You know, we've touched on a few of the gaps throughout the program. So that is it for this week. Thank you again for joining us. And I want to remind you guys before we close, it's important, please drop five stars because it pushes up our visibility and expands our community. Hit that follow button, tap subscribe. All of those things help to build our build our show. And most importantly, share. Please share this podcast with all of your friends and colleagues. So in closing, Vanessa, Jason, have a great week, and thanks for joining me. You too. Thanks, everyone. Bye. Bye, everyone.

Vanessa Pomarico 33:24

Bye.

Jason Gleason 33:24

Bye guys.

Christopher Gleason 33:28

You've been listening to NP Launchpad, presented by Fitzgerald Health Education Associates. Like, subscribe, and share. And for more tools to power your NP career, visit FHGA.com.