Public Health SolutionsHIV Care Services (HIVCS)

Subcontractor Site Visits 2011February 8, 2011

Bettina Carroll Director for Programs and Contract Management

HIVCS’ “Charge”

HIVCS Contract Monitoring

Service Verification - Site Visits

Types of Site VisitsVisit Type Contract Reimbursement Methodology

Cost Performance Deliverables

Initial X X X

Routine X X X

Fiscal X X* X*

(Performance-based) Reimbursement Documentation

X

(Expenditure) Support Documentation

X

Single Payer Verification (SPV)

X

RW Payer of Last Resort (POLR)

X X

RW PCSMs X X X

Technical Assistance X X X

Event/Occurrence X X X

Arranging a Site Visit

What should you expect at a site visit?

Who needs to attend the site visit?Visit Type Program Staff

Program Director Fiscal Director

Initial X X

Routine X X

Fiscal X* X

(Performance-based) Reimbursement Documentation

X X

(Expenditure) Support Documentation

X* X

Single Payer Verification (SPV)

X X

RW Payer of Last Resort (POLR)

X X

RW PCSMs X

Technical Assistance X* X*

Senior Administrator is usually only present for the Entrance and Exit Conferences

Billing Department staff may be needed for POLR and SPV visits

*Shared responsibility specific to PB contracts and/or dependent on nature of TA

After the entrance conference, staff are not required to be present while HIVCS reviews are conducted

Improved Coordination of Site Visits

DOHMH

AIDS Institute Quality ProgramSite Visits/Performance Reviews

Dan Belanger, Director, New York State Quality ProgramTracy Hatton, Director, Part A Quality Management Program

February 8, 2011

Quality Management Program

NYSDOH AIDS Institute Quality Program experience:

– Clearly defined HIV quality of care clinical indicators for adults and adolescents

– Clinical Advisory Committee of New York State experts refine clinical indicator definitions to reflect current standards

– Annual quality indicator reviews (ehivqual) at 200 HIV ambulatory care facilities throughout New York State, including New York City

– Organizational Assessments conducted at HIV clinics throughout NYS

ORGANIZATIONAL ASSESSMENTS

Assess the program’s capacity to effectively manage and improve the quality of care and evaluate the element necessary for an effective quality improvement program:

Organizational leadership Program infrastructure Staff participation and buy-in Resources allotted to QI

Organizational Assessment Tool

Organizational Assessment (OA)

AIDS Institute staff and quality consultants conduct an assessment of these elements and then work with programs /organizations to develop a capacity-building plan to address any elements that need strengthening.– Offer recommendations to inform:

• Areas for Improvement• Annual Goals• Capacity building

Elements of the OA

Quality Structure Quality Planning Quality Performance Measurement Quality Improvement Activities Staff Involvement Consumer Involvement Evaluation of Quality Program Clinical information Systems

Organizational Assessment Process Contact in advance of scheduling to outline the purpose and

goals of assessment; On site interview conducted by AI quality staff with key

representatives from programs (medical director, program director, QI staff person, administrator, program staff, consumer)

Assessment should include brief listing of recommendations for program

Collect any examples of best practices, QI projects, quality plans

Written feedback sent to participants after completion of OA

Part A Performance Measurement Program

Currently reviewed programs:

Mental Health Care Coordination Supportive Counseling Tri-County Medical Case Management Harm Reduction Food and Nutrition Early Intervention Services

Chart reviews conducted by IPRO/NYCHSRO

Performance Review Process

Indicators Developed

Review planned with providers

Data collection strategy developed

Case List requested from each program

Sampling plan derived from facility case size

Performance Reviews-On Site Activity

Review date scheduled (generally 2-4 days)

List of records to be reviewed requested (review sample)

Entrance interview conducted at program site

Charts/records reviewed by professional analysts on site

Exit interview conducted when reviews complete

Data scored according to indicators

Performance measurement reports prepared—both aggregate and facility specific results

Using Performance Measurement

Prioritizing areas for improvement Identification of common issues through

performance data Measuring progress Benchmarking and goal setting to improve the

care for PLWHA in NY EMA-not about measurement, about improvement!

Comments

What suggestions do you have?

Contact Us

Daniel R. Belanger, LMSWNew York State HIV Quality Program Directordrb08@health.state.ny.us

Tracy HattonPart A Quality Management Programteh04@health.state.ny.us