2012 Orlando Conference Presentation - PCP

Primary Care Protocols and Services : 

Primary Care Protocols and Services

Objectives: 

Objectives Review aspects of a Primary Care practice Benefits of being a Primary Care practice Primary Care protocols Primary Care services

Primary Care Provider (PCP): 

Primary Care Provider (PCP) A provider responsible for supervising, coordinating, and providing initial and primary care to patients; for referrals for specialist care; and for maintaining the continuity of patient care. Primary Care credentials offer less burdens by not having patients required to have referral and often times a base of patients are assigned to you upon enrollment. Primary Care may also offer additional revenue streams.

PCP Evaluation : 

PCP Evaluation Collection of Subjective and Objective information including history, exam, etc. to assist in forming a working assessment/diagnosis of the presenting problem

PCP Treatment : 

PCP Treatment Order appropriate laboratory tests and diagnostic procedures, including but not limited to health screening tests as necessary to understand the disease process, treatment effectiveness and health status. Initiate in clinic care to address disease process and/or health status including but not limited to skin care, medication, counseling support, and consultation with specialty services. Initiate medication administration and education to manage the presenting signs and symptoms and/or the associated disease process, in accordance with the drug management and scheduled controlled substances policies. Referral to relevant services, including but not limited to physical therapy, occupational therapy, speech therapy, nutrition, mental health services, and other therapies when deemed appropriate to address presenting medical condition. Initiate referral process consistent with internal policies and referral protocol guidelines.

PCP Education : 

PCP Education Provide patient with health and wellness education, as indicated by the signs and symptoms and disease process. Provide patient with information pertaining to the plan of care. Provider patient medication information pertaining to side effects, toxic effects, and compliance with drug schedule. Provide patient information about lifestyle counseling and health maintenance. Discuss follow-up plan with patient and/or patient agent.

PCP Supervision/Specialist Referral : 

PCP Supervision/Specialist Referral Initiate oversight physician consultation or outside specialist referral that may include but not limited to: Any condition that is not listed in the policy under the agreed disorder/medical conditions. Three or more chronic conditions. Signs and symptoms that are not consistent with expected medical condition. Medical condition that deviates negatively from expected course of illness over time. Psychiatric illness or conditions. Any condition related to a pregnant patient. Any condition related to a patient under age 18 . Questions or concerns about clinical pathway including but not limited to diagnostic and treatment decisions.

PCP Condition Guide : 

PCP Condition Guide Musculoskeletal Acute sprains, muscle strain, back pain, joint pain, contusion, arthritis enT Otitis media/externa, sinusitis, conjunctivitis, tonsillitis CARDIAC Controlled essential and secondary hypertension , hyperlipidemia Genitourinary Urinary tract infection RESPIRATORY Asthma , pharyngitis, bronchitis, influenza , pneumonia, smoking cessation Gastrointestinal Diarrhea , constipation, gastroenteritis Neurological Migraines , tension headache, cluster headache Endocrine Controlled diabetes mellitus , Controlled hypo/hyperthyroidism METABOLOIC Obesity and weight loss Dermatological Contact dermatitis, scabies, insect bites, psoriasis , eczema, general Physical/Wellness examination, sports physicals

PCP Condition Guide - Urgent : 

PCP Condition Guide - Urgent Acute and severe chest pain Acute and severe abdominal pain Acute psychiatric episode with suicidal and/or homicidal ideation. Joint infections Exposure to hazards material Acute respiratory distress Acute altered level of consciousness or neurologic status Lacerations or open fractures Acute eye injuries

PCP Supervision - Urgent : 

PCP Supervision - Urgent Evaluation and intervention as deemed appropriate and necessary for purposes of stabilization in addition to attempting to contact and inform oversight physician about patient status. Initiate medication administration to manage the presenting signs and symptoms and/or the associated disease process, in accordance with the drug management and scheduled controlled substances , if indicated. Initiating relevant services including but not limited to cardiopulmonary and other therapies when deemed appropriate to address acute medical conditions. Initiate EMS if indicated. Consult with oversight physician prior to initiating care, if appropriate and clinical situation permits.

Primary Care Services : 

Primary Care Services Evaluation and Management Services Annual Wellness/Physical Exams (all payers required to cover) Smoking Cessation 99406/G0436 > 3min = $9.87 99407/G0437 > 10min = $19.24 Obesity Counseling (NEW) G0447 15 min = $18.26 Alcohol Counseling (NEW) G0443 15 min = $18.26

Primary Care Services : 

Primary Care Services Screening and Diagnostic Labs (all CLIA waived) Blood Sugar/Hemoglobin A1C Cholesterol Urinalysis Occult Blood Strep Test Mono Test Flu Tests Pregnancy Test

Primary Care Services : 

Primary Care Services Other Screening and Diagnostic Tests EKG 93000 = $13.82 Spirometry = $26.50 Chest X-ray = $22.45 Bone Density = $41.20

Questions? Please email: : 

Questions? Please email: