February 20, 2004

"Going live"with PACE: A practice's perspective

The support staff of MGH Women's Health Associates (WHA) recently had two guests at their daily staff meeting: Nicole Patenaude, Professional Billing Office (PBO) billing manager, and Melody Craff, MD, PhD, a project coordinator for the PACE (Patient Administrative Cycle Enhancements) project. Patenaude and Craff were there to review the previous day's activities with the support staff. It hadn't been an ordinary day for the busy practice, it was the first day that WHA "went live"with the PACE model, a system designed to streamline the administrative processes associated with outpatient visits.

"The go-live at WHA went very smoothly," says Craff. "Despite seeing more than 100 patients per day, the staff managed all the new PACE processes extremely well."

The seamless transition to the PACE model for WHA, which took place in December, was a result of a great deal of planning and hard work prior to implementation. A PACE project coordinator and a practice liaison — a role filled by either a PBO billing manager or a Practice Support Unit practice representative — work with the practice administrative director, the practice manager and support staff 12 weeks before the "go-live"date. They work with the staff to evaluate any practice-specific issues that may need to be resolved before going live with the PACE model. Practice staff attend PACE training one to four weeks prior to the go-live date to get a better understanding of the workflow and functional enhancements of the PACE model. The practice liaison and the project coordinator stay on site at the practice for three to five days after going live to help answer questions and work out any problems or issues.

The typical question that many practice staff members have is: "What actually happens during the go-live week?" One aspect of transitioning to the PACE model is the process of "flagging" certain patients to speak with a representative from the Registration and Referral Center (RRC), which is the PACE centralized call center. Practice staff will see a flag in the scheduling screen for patients who need to have their registration or eligibility information updated. Practice staff then can transfer flagged patient calls directly to the RRC using a specialized direct line button on their phones. An RRC representative asks the patient a series of questions to update the information — usually taking less than five minutes. Above, Kellie Burke, standing, and Judith Martin, during "go-live" week at WHA.

Patients also can update their information when they arrive for their appointments by using a dedicated express phone located in the practice, which connects them directly to the RRC. In addition, the RRC helps practice staff by processing referrals in advance of patient visits.

"The first day, we had more than 40 patient records flagged out of some 100 patients the practice saw, which is quite a lot. But the second day was much better," says Patenaude. "I did hear several compliments from patients that the RRC staff was very helpful."

Each day of the go-live process, Patenaude and Craff met with the WHA support staff to review reports about the previous day's activities, which included express phone usage, verification of patient data, transferred calls to the RRC and details about the check-in turnaround times for patients as they arrived for appointments. These reports remain available to practice staff after implementation, so they can track their performance with the PACE model.

Presently, each of the six PACE project coordinators are working with four to five different practices at different stages of the implementation process. All of the MGH
primary care practices have gone live with the PACE model, as have three of the MGH health centers.

According to Diane Hanscom, administrative director for the Practice Support Unit, most of the outpatient practices are already in the process of implementation. "Practices work hard to prepare during implementation and most do well with the go-live period," she says. "After the first week, practice staff members settle into the new routine."