Improving the Quality and Efficiency of the Prenatal Care Coordination Program


Impact Statement: 
Wisconsin’s Prenatal Care Coordination (PNCC) program has been shown to decrease low-birth weight among single women, increase family support and involvement of the father, decrease preeclampsia, and decrease smoking among pregnant women. Clark County health department used QI to achieve 100% compliance with PNCC program guidelines, streamline the billing process and increase revenue from the program.

PLAN: Identify an Opportunity and Plan for Improvement

1. Getting Started

Problem: Prenatal Care Coordination (PNCC) services have been provided in Clark County for many years. However, the health department recognized that the program has not been evaluated or updated since 2007. The policy and procedure were outdated and did not adhere to the requirements in the Wisconsin (WI) Medicaid PNCC Services Handbook, program forms were outdated, no flowsheet/checklist was in place to ensure consistency and chart compliance, and staff were not properly oriented to the program. Additionally, no clear billing guidelines were in place.

2. Assemble the Team

The health department committed the time of the lead public health nurse (PHN) as the project coordinator, as well as staff PHNs and the health officer to assist with the project.

• Brittany Mews, RN BSN-Lead PHN
• Cortney Olejniczak, RN BSN-PHN
• Sabrina Meddaugh, RN BSN-PHN
• Susan Backaus, RN BSN-PHN
• Robert Leischow, MPH-Health Officer

3. Examine the Current Approach

After a chart review process, the department found none (0%) of the PNCC charts were in compliance nor did they reflect the WI Medicaid PNCC Services Handbook. The department also tracked its PNCC Medicaid reimbursement from 2007 through 2011 and discovered it was being reimbursed only about 30% of the maximum allowable reimbursement per client.

Aim Statement: By November 30, 2012, after Clark County Health Department’s PNCC policy and procedure has been updated reflecting the WI Medicaid PNCC Services Handbook, program forms have been updated, a PNCC flowsheet/checklist developed, staff training conducted on the PNCC revisions, and 100% of the PNCC client charts will be in compliance after a chart review process.

Sub-Aim Statement: Billing guidelines will be established. These guidelines will result in an increase in Medicaid reimbursement for the PNCC program from an average of $270.00 per client in 2011 to an average of $540.00 or more per client in 2012, a 200% projected increase in revenue. (Total maximum Medicaid reimbursement is $887.46 per client.)

4. Identify Potential Solutions
• Update the PNCC policy and procedure.
• Update all program forms.
• Develop a chart audit flowsheet/checklist.
• Train staff on the new revisions.
• Establish billing guidelines.

5. Develop an Improvement Theory

Updating the PNCC policy and procedure and program forms, developing a chart audit flowsheet/checklist, training staff, and establishing billing guidelines will result in 100% of charts being in compliance and a 200% increase in Medicaid revenue.

DO: Test the Theory for Improvement

6. Test the Theory

The project coordinator reviewed the WI Medicaid PNCC Services Handbook protocols, updated the PNCC policy and procedure to reflect the Medicaid guidelines, updated all program forms, developed a chart audit flowsheet/checklist as well as a billing guideline cheat sheet, and trained staff on the new revisions.

A trial process began on August 15, 2012. Staff followed the newly developed policy and procedure and used the new forms, including the billing cheat sheet. Average Medicaid reimbursement was tracked per client.

STUDY: Use Data to Study Results of the Test

7. Study the Results

In October 2012, two PNCC chart audits were conducted. Both of these charts were 100% in compliance, using the newly developed chart audit flowsheet/checklist. The preliminary results of 100% chart compliance compared to the baseline data of 0% chart compliance indicate the test has been successful.

In October 2012, four clients' Medicaid reimbursement totals were analyzed. These four clients were a part of the new program revisions, and the nurses used the new billing guidelines established. The average reimbursement the department received between these four clients was $671.61 per client, a 250% increase (+$406.91) from the 2011 average reimbursement of $270.00. In addition to the Medicaid increase, it was discovered the Medicaid denials also decreased. These data signified that the billing guideline cheat sheet helped increase the revenue and streamlined the billing process.

ACT: Standardize the Improvement and Establish Future Plans

8. Standardize the Improvement

On November 1, 2012, the health department adopted and standardized the process. The health department's director formally approved the new PNCC policy and procedure and program forms, including the billing guideline cheat sheet.

9. Establish Future Plans

Additional PNCC chart audits will be performed each quarter to ensure compliance. The department plans to sustain the momentum of the project by reviewing and updating the program policy and procedure at least annually, updating program forms as needed, and tracking Medicaid reimbursement revenue.

Organization that conducted the QI initiative: 
Clark County Health Department

Mews, B. Public Health Quality Improvement Exchange. Improving the Quality and Efficiency of the Prenatal Care Coordination Program . Mon, 02/13/2017 - 12:20. Available at Accessed May 20, 2024.

Submission Status: 
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