What to Expect from Your First CPSO Peer Assessment Dr. Ian Cowan, - - PowerPoint PPT Presentation

What to Expect from Your First CPSO Peer Assessment

• Dr. Ian Cowan, MD, CCFP

DISCLOSURE

No conflict of interest declared

OBJECTIVES

• 1. Explain the selection and expectations of a College of

Physicians and Surgeons (CPSO) Peer Assessment;

• 2. Identify College requirements on clinical documentation of

specific assessed conditions as per the Peer Assessment Handbook;

• 3. The steps following a Peer Assessment – both good & bad!

INTRODUCTION

Like Death and Taxes, you will eventually have a CPSO Peer Assessment!

A Peer Assessment is done by a physician with a similar practice make-up to you The aim is education, not discipline

Types of Family Medicine Peer Assessment

• Random
• CPSO hopes to assess each physician every 5-10 years
• Special Circumstances
• Limited licence
• FMG
• Age > 70 years
• Reassessment
• by same or different physician
• New to Practice (< 2 years)

NOTIFICATION

• Letter from CPSO notifying of selection with

instructions and link to CPSO website for more detailed information;

• Name of Assessor;
• Usually 2-3 month notice;
• Assessor will contact you to confirm instructions

& negotiate a date for the assessment

SPECIFICS

• Review of 15-20 charts selected on single or two office days
• We select a date for the chart review 3-6 months prior to your

letter from CPSO notifying you of the peer assessment

• No hospital or LTC charts; will look at WIC charts
• Review of specific charts (5 each):
• Mental health
• Pre-natals
• Chronic Opiate Use
• Periodic Health Exams
• Well Baby/Child Visits
• Diabetes

HOW IT STARTS…

• Introduction and expectations
• Quick review of EMR system and any special or add-on

programmes

• Tour of your office looking at equipment, cleanliness,
• rganization, emergency equipment, drug samples & staff

introduction

• Assessment usually takes 4-5 hours
• 30 min initial meeting
• 4 hr chart review – you can see patients but should be available to

answer questions or clarify records

• 30 min wrap-up

ARE YOUR CHARTS UP TO STANDARD?

• Current & complete Cumulative Patient Profile
• Allergies listed
• Chronic conditions and surgical history
• Chronic & episodic medications listed
• Preventative Medicine interventions listed when completed or pending (colon

cancer screening, PAP, Mammogram, Bone Density +/- PSA)

• Immunizations – both child & adult
• SOAP Note format for most visits
• Look for logical flow of notes, appropriate history & exam including salient

negatives

• Commit to a diagnosis or differential diagnosis
• Make a plan including investigations, medications and note follow-up

WHERE MDs GO WRONG!

• Could a locum or colleague step in and understand your note,

decision making process and plan – look at your note when done & think of this!

• SOAP – not enough history to define the problem including salient

negatives

• SOAP – record you physical exam findings; more importantly do a

physical exam ! This is omitted more often than you think!

• SOAP – Commit to a diagnosis or DDx – many don’t
• SOAP – if you start a new medication, discuss/record S/E’s and risk

benefit especially if a new long-term medication; note follow-up

MEDICATION PITFALLS

• If you start an ACE-I or ARB – check lytes & renal function

within a few weeks

• Off label use of drug or excess dosages – write a comment in

chart

• When you prescribe DOAC’s – keep an eye on renal function.

Suggest a max 6 month prescription only then check renal function to confirm use & dose still appropriate

• Remember our nemesis “QT” – check QT when prescribing one
• r multiple meds that can influence QT
• Remember & try to use the Sick Day Meds Sheet

MENTAL HEALTH CHARTING

• Ask about & record presence/absence of suicidality/homicidality at

each mental health visit

• Consider use of objective scales for depression at each visit (PHQ 9,

HAMD, etc.) – not mandatory but recommended

• Close follow-up of depression patient. Bring them back quickly (ie: 2

weeks) and adjust doses, change or augment to get to remission ASAP

• Use and record the use of local mental health providers
• Record start & stop times for “K” code billings
• If you do psychotherapy, make sure you have the training and follow a

template

DIABETES CHARTING

• Flow sheets a must ! Should include serial HgbA1c, LDL, BP,

renal function, ACR, etc.

• Don’t forget to document eye exams & do periodic

monofilament testing of the feet

• Review the CDA guidelines – there are more choices than just

Metformin, suflonylureas & insulin; this is the sole armamentarium of many MD’s !

• We do look at overall diabetes control so you should too!

OPIATE PITFALLS

• Big concern these days so be careful & cautious
• Use Opioid Screening Tool before starting long-term opiates
• Use Opioid Agreement with copy on chart & with patient
• Use frequent, small volume prescribing
• Consider mandatory blister packs for opiates to aide compliance and

pill counts; do pill counts at visits periodically

• Random Drug Screens – do them & do them often!
• Use Brief Pain Inventory at each pain visit
• Read the new Opiate Guidelines and get your Opioid Practice

Assessment

PREVENTITIVE MEDICINE PITFALLS

• We do look for PAP’s, colon cancer screening, mammograms,

bone density. +/- PSA (or discussion)

• Adult Immunizations are under close scrutiny now.

Remember Flu shots, Pneumovax, Td & Varicella

• Don’t forget to mention/offer Gardasil 9, Prevnar 13, Bexsero &

travel vaccines when appropriate; record that you discussed them

GENERAL OFFICE MEDICINE PITALLS 1

• Have a system for your INR notifications & record instructions for

repeat testing

• If you or staff give telephone advice, record in a note on the patient’s

chart

• For significant lab or Xray abnormalities, make a chart note on the

action you are taking and follow-up required

• We are mandated to look at equipment, drug samples and safety

issues

• Emergency Equipment – if you do immunizations and/or allergy

shots, have the appropriate emergency drugs & equipment. We will check emergency drug expiration dates

GENERAL OFFICE MEDICINE PITALLS 2

Minor Surgery

• Consider use of single use vials (ie: Lidocaine)
• Consider disposable single use equipment (ie: suture kits)
• Thanks to Public Health Ontario (PHO) and new WHIMS regulations
• ur life in the office will get more difficult. They are recommending

against office autoclaving unless you have a horrendous number of checks & balances in place. These rules have not been enacted yet. For a good read – look at the 120 page document “Infection Control in the Physician’s Office” on the PHO website !!

ACTIONS AFTER PEER ASSESSMENT

• Assessor sends report to CPSO & reviewed by staff:
• No Concerns (70% of assessments) – letter sent to you with congrats and copy
• f report
• Urgent Safety Concerns (<1%) – immediate CPSO review and action
• Mild & Moderate (Non-safety issues) (30%) – review by CPSO Committee

with follow-up actions initiated. This could include:

• Interview with the committee; and/or
• Direction to correct deficiencies then re-assessment by same or different

assessor (your choice); usually in 1-2 yrs;

• If you fail two assessments and require third, CPSO will bill you for the cost of the

third assessment.

REFLECTIONS ON A PEER ASSESSMENT

• Assessor will help you improve your practice and documentation

skills

• Most of us have done dozens of assessments and can pass on

some good suggestions

• EMR’s do not guarantee good records – remember “junk in, junk
• ut”
• Complete your records so another physician could step in and take
• ver without any angst
• You want a Peer MD doing your assessment, not a non-

MD assessor appointed by the College or MOH !