Wednesday, January 16, 2019

Becoming the Practice of the Future Today: 10 Steps to Transform Your Practice and Provide Individualized Care

By Susan Corneliuson, MHS, FACHE and Mary Witt, MSW

Reproduced with Permission
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Current business and care delivery models, even if combined with innovative or sustainable technologies, will not lead to future success. Practices must create new care delivery and business models while incorporating technological advances to effectively compete today and in the future. New payment models, disruptive technology, and care delivery vehicles (e.g., e-visits, home monitoring, retail clinics), along with changing consumer demands for immediate access and transparency, require medical practice transformation. Here are the top 10 steps you should be taking now to transform your medical practice in order to succeed now and in the future.


1. Create a profile of your current and potential patients. Who are they (e.g., age, sex, payer mix)? What is their health status? What are their priorities for their healthcare (e.g., convenience, access, relationship, continuity of care)? How do they want their care delivered? Perhaps through e-visits, urgent care, face-to-face visits, telemedicine, or e-mail? How do they want to communicate (e.g., e-mail, texting, phone, patient portal, face-to-face encounters)? Identifying who your patients are will allow you to tailor your practice to meet their needs.

2. Assess your market. What are the demographics (e.g., ages, sex, income, health status) of your service area, and how fast is it growing? What do consumers want from their physicians? What do employers want from providers? Where are payers going with their payment models? What are your competitors doing to position themselves for the future? Who else might come into your market? Market knowledge should inform your practice redesign efforts as you move to meet the needs of patients and payers.

3. Examine your practice from your patients’ perspective. Assess your practice from top to bottom as if you were a patient. Use patient shoppers and patient focus groups to understand their perspective and expectations. Scrutinize your patient satisfaction surveys for useful data on patient needs and wants. Identify the amount of value-added time (the amount of visit time spent in actual interaction about the patient’s care) versus non-value added time, and perform cycle time studies to identify reasons for long wait times. Target patient cycle time at 30 to 40 minutes for a routine visit, and value added time at 75 to 80 percent of the visit total. By examining your practice from the patient’s perspective, you will be able to identify the gaps and develop a roadmap to transform your practice.

4. Create process excellence to drive patient, provider, and staff satisfaction. Document and analyze your work flows for all key operational areas, including patient scheduling, check-in, vitaling, exam, check-out, and patient follow-up. Identify waste, duplication, and barriers in each operational function and develop revised workflows that reduce process variability. Focus on process excellence, ensuring that every step in the process is meaningful and leads to better care. This not only will improve patient satisfaction but motivates providers and staff because it eliminates unnecessary steps and increases direct patient care time.

5. Develop patient-directed, convenient access points to your practice. Based on your patient profile, develop the access points your practice requires to meet the needs of your patient population. Be able to offer same day patients appointments so they do not go elsewhere. Implement a robust patient portal with interactive email and scheduling capabilities. Offer e-visits, text messaging, expanded hours, and/or develop relationships with urgent cares. Create an environment that allows the patient to choose the method in which they will access care with convenience and ease.

6. Change your care delivery model to facilitate population health management.
With the move to fee-for-value reimbursement and the new demands of patients in this technological age, providers need to use teams more effectively to meet patient needs. Based on your patient’s needs, determine what type of team will be most successful in managing your population of patients. Consider the use of medical assistants, care managers, social workers, and health coaches to create the support network required. For example, if your practice has a high volume of chronic care patients, consider a high-touch, high-contact delivery model with the use of care managers and health coaches to continuously engage patients in their care. For panels with high commercial, healthy populations, increase the use of advanced practice clinicians, offer e-visits, and expand hours to provide easy, convenient access. Ensure that all team members are working to the top of their license and skill sets to maximize efficiency and physician support.

7. Assess your current business model based on what is necessary to succeed in a fee-for-value world.
Assess your capabilities to provide high quality, effective, affordable care not only today, but three to five years from now. Analyze your practice’s cost structure, and identify the profit formula that will allow you to compete. Based on the needs of your patients and resources required to manage your population, identify the profit margins, reimbursement, and volumes required to meet your business goals. Analyze your payer contracts and explore fee-for-value payment model options with your payers that build on your strengths as a practice. Understand the total cost of care for your patients so you can be part of the solution in bringing them the care they deserve in a cost-efficient manner. Ensure that your compensation models effectively align with practice goals and critical success factors.

8. Optimize your use of data to enhance care, ensure accountability, and achieve your goals.
Create your practice’s value proposition for the future, and use it to guide your practice metrics and dashboard reports. Apply integrated technology and automated dashboards to track and report on practice performance, including quality measures to maximize pay for performance dollars. Use the electronic medical records (“EMR”) to proactively prompt you about a patient’s care needs. Utilize real time prompts to remind physicians of needed preventive and chronic care during the patient visit so needs can be immediately addressed. Implement a patient registry to manage patients with chronic diseases and consider the integration of home monitoring and diagnostic equipment in your care model. Gather data on your use of ancillaries, and assess if you are following best practices and only performing tests and procedures when necessary.

9. Implement strategies to foster patient “stickiness” to your practice. Focus on creating patient loyalty. Use texting, email, and social media to maintain contact outside of the face-to-face visit. Provide your patients with the information they need to stay healthy on a regular basis through texting, email, and phone calls. Develop your patient portal as the “go-to” site when they have questions by making patient education materials readily available on the portal, including the provision of links to reputable internet sites. Explore the creation of a phone application that can provide patients with a ready source to answer their immediate health concerns so they don’t have to go outside the practice’s sphere of influence. For example, the application could be linked to a branded call center which could provide an immediate response to health questions and concerns.

10. Optimize the use of technology. Utilize technology purposefully to allow providers more touch time with patients and make sure your technology works for you, not against you. Assess EMR efficiency by counting the number of clicks, screens, and typing required per task; observe physician and staff as they use the EMR and record extra steps. Work with your EMR vendor to decrease extra steps and streamline the data entry process. Note variations in the use of the system and train providers and staff in the most effective and efficient processes. Implement other technology such as automated appointment reminders and easy payment tools through the use of text, email, and phone. Use your patient portal to decrease call volume by activating patient scheduling, referral management, prescription refills, lab notifications, and pre-registration and check-in features. Consider the cost benefit of each technological feature and ensure that, once the feature is enabled, it is optimized to work for the practice.

Start now: make transformation a priority to ensure you successfully achieve your practice’s value proposition. Do not wait until your payers change how they pay, retail clinics proliferate in your community, your practice is losing patients or physicians, or you are losing money. Practice transformation does not occur over night. It takes time and hard work. To succeed in the future, you need to lay the foundation now.

For information on how The Camden Group can help in your journey to transform your practice, please contact Susan Corneliuson, MHS, FACHE at scorneliuson@thecamdengroup.com or Mary Witt, MSW at mwitt@thecamdengroup.com. They can be reached at 310-320-3990.

Call For Nominations: 2015 RCMA Annual Outstanding Contribution Awards

The RCMA is soliciting nominations to recognize and honor deserving individuals for the 2015 Annual Outstanding Contribution Awards.

Nominations will be screened by the Awards Committee, with final selection determined by the Board of Councilors. The awards will be presented at the RCMA Installation of Officers Dinner on Friday, January 29, 2016.

NOMINATION DEADLINE: FRIDAY, OCTOBER 16th

AWARD CATEGORIES


  • Outstanding Contribution to Organized Medicine - Presented to a member who through his/her constant support and perpetual service has advanced and achieved the goals of organized medicine.
  • Outstanding Contribution to Medicine - Presented to a member who has displayed dedication to the advancement and improvement of the medical profession through his/her tireless efforts, innovative ideas, and commitment to excellence.
  • Outstanding Contribution to the Medical Association and Its Goals - Presented to a member who has exhibited long-standing dedication and service to the RCMA over and above that expected by the membership-at-large.
  • Outstanding Contribution to the Community - Presented to a physician or lay person who has exhibited sustained interest and participation in one or more medicine-related activities which has benefited the members of his/her community.
If you would like to nominate someone for an award please use the link below to download the Nomination Form or email Bianca Scarborough at bscarborough@rcmanet.org

RCMA/CMA Works with CMS to Mitigate Medicare ICD-10 Disruptions

With implementation of the ICD-10 code set just around the corner, many physicians have been understandably wary about the transition and the potential for payment disruptions and claims processing errors that could interfere with patient care. Fortunately, the RCMA/CMA – working closely with the American Medical Association (AMA) and other medical associations – has secured provisions that will ease this transition, particularly for physicians in practices with limited resources.

Thanks to RCMA/CMA advocacy, the Centers for Medicare & Medicaid Services (CMS) recently announced that it will provide a one-year grace period during which it will allow for flexibility in the Medicare claims payment, auditing and quality reporting processes as the medical community gains experience using the new ICD-10 code set. The ICD-10 implementation date of October 1, 2015, has not changed.

The changes announced include: Claim denials: Medicare review contractors will not deny claims based solely on the specificity of the ICD-10 diagnosis code as long as a valid code from the right family of codes is used. Moreover, physicians will not be subject to audits as a result of ICD-10 coding mistakes during the grace period.

Quality reporting: Physicians also will not be penalized under the quality reporting programs for errors related to the additional specificity of the ICD-10 diagnosis code, again as long as a code from the correct family of codes is used.

Advance payments: If Medicare contractors are unable to process claims within established time limits because of administrative problems, such as contractor system malfunction or implementation problems, advance payment may be available to keep resources flowing to physician practices.

ICD-10 communication center: CMS will set up a communication center to monitor the implementation of ICD-10 in an effort to quickly identify and resolve issues related to the transition. As part of the center, CMS will have an ICD-10 ombudsman to help receive and triage physician and provider issues.

California State Budget Update

Today, the Governor and legislative leaders announced an agreement on the 2015-16 State Budget Act and have settled the major issues and spending priority differences between the administration and the Legislative branch. A few key points and dollar amounts for the budget year include:

  •   $40 million to expand Medi-Cal to cover all low-income undocumented children effective May 1, 2016 ($132 million when fully implemented)
  • $265 million to fund 7,000 additional preschool slots and 6,800 child care slots, plus a rate increase for all providers.
  • $97 million over the January budget for the California State University to expand enrollment and focus on increased success.
  • $226 million on a one-time basis to restore the 7 percent reduction in service hours for In-Home Supportive Services.
The budget bills that will be voted on over the next several days will not contain an increase to Medi-Cal Provider Reimbursement rates. In a typical year, the conclusion of budget negotiations would mean the end of our hopes of improving access for over 12 million Californians who rely on the Medi-Cal program for the next 12 months.

However, the Governor made an additional important announcement this afternoon – he is calling a Special Session of the Legislature to address “Health Care Financing,” i.e. the Medi-Cal program. He specifically called for the need to address the budget hole created by the failure to pass a new managed care organization (MCO) tax and called on the Legislature to enact a permanent and sustainable funding source to fund “additional rate increases for providers of Medi-Cal and developmental disability services.” If you recall, since 2005, the state has had some form of a tax on managed care plans used to fund payments to Medi-Cal providers and reduce the state’s general fund exposure while drawing down federal matching funds. However, recently the federal government found California’s MCO tax structure fails to comply with new federal requirements that such a tax be broad-based and not limited narrowly to Medicaid plans. In his January budget, the Governor proposed a new MCO tax that conforms with the new federal requirements, however the Legislature did not adopt the proposal largely due to objections from health plans. In response, the Governor is proposing that the Legislature enact permanent and sustainable funding to provide at least $1.1 billion annually to the Medi-Cal program. His announcement states the funding could come from an MCO tax and/or alternative sources in the special session, such as a tax on tobacco products.

While the failure to address provider rates in the state budget is regrettable, the special session of the Legislature provides a new opportunity for RCMA/CMA and other stakeholders to push through a permanent and significant funding increase dedicated almost exclusively to providers of health care services and ensure the health care infrastructure exists to care for the Medi-Cal population. The Governor’s special session announcement was made on the same day, perhaps coincidentally, that the State Auditor released a report finding Medi-Cal managed care provider networks are severely lacking integrity and are resulting in barriers to accessing care. The State Auditor found that not only were managed care plans providing the state with inaccurate data on availability and participation of in-network physicians, it found the state was not verifying whether the data from the plans was accurate, and thus could not reliably determine whether the Medi-Cal networks meet California’s stringent network adequacy standards. A summary of the audit’s findings can be found at this link here.

The announcement of the special session allows the Governor and legislative leaders to bypass the traditional legislative and budgetary calendar. RCMA/CMA continues to work with its legislative allies and coalitions to push this issue over the finish line.

Medicare Eligible Professionals: Take Action by July 1 to Avoid 2016 Medicare Payment Adjustment

Payment adjustments for eligible professionals that did not successfully participate in the Medicare EHR Incentive Program in 2014 will begin on January 1, 2016. Medicare eligible professionals can avoid the 2016 payment adjustment by taking action by July 1 and applying for a 2016 hardship exception.

The hardship exception applications and instructions for an individual and for multiple Medicare eligible professionals are available on the EHR Incentive Programs website, and outline the specific types of circumstances that CMS considers to be barriers to achieving meaningful use, and how to apply.

To file a hardship exception, you must:

  • Show proof of a circumstance beyond your control.
  • Explicitly outline how the circumstance significantly impaired your ability to meet meaningful use.

Supporting documentation must also be provided for certain hardship exception categories. CMS will review applications to determine whether or not a hardship exception should be granted.

You do not need to submit a hardship application if you:

  • are a newly practicing eligible professional
  • are hospital-based: a provider is considered hospital-based if he or she provides more than 90% of their covered professional services in either an inpatient (Place of Service 21) or emergency department (Place of Service 23), and certain observation services using Place of Service 22; or
  • Eligible professionals with certain PECOS specialties (05-Anesthesiology, 22-Pathology, 30-Diagnostic Radiology, 36-Nuclear Medicine, 94-Interventional Radiology)

CMS will use Medicare data to determine your eligibility to be automatically granted a hardship exception.

Apply by July 1
As a reminder, the application must be submitted electronically or postmarked no later than 11:59 p.m. ET on July 1, 2015 to be considered.

If approved, the exception is valid for the 2016 payment adjustment only. If you intend to claim a hardship exception for a subsequent payment adjustment year, a new application must be submitted for the appropriate year.

In addition, providers who are not considered eligible professionals under the Medicare program are not subject to payment adjustments and do not need to submit an application. Those types of providers include:

  • Medicaid only
  • No claims to Medicare
  • Hospital-based
Want more information about the EHR Incentive Programs?
Visit the EHR Incentive Programs website for the latest news and updates on the programs.

Practice Check-Up: How scheduling strategies can reduce disruptions and long patient wait times

This is the second in a series of articles aimed at highlighting key areas practices should examine in an effort to improve practice performance. This month we focus on how effectively managing the appointment schedule can have a positive impact on both patient and practice satisfaction.

It’s rare that an appointment schedule in a medical office survives a day without any changes. No-shows, cancellations and last-minute emergencies will always crop up and cause shifts and changes. But these changes don’t have to disrupt the flow of the office. Here are a few things to consider:

To double book or not to double book
Many practices experience no-shows and/or a high demand for appointments when the schedule is full. To address these situations, many practices will book multiple patients into a single slot. However, double booking will likely guarantee some bad patient experiences. If you have a double booking system in place right now, the California Medical Association (CMA) recommends you review that process.

One thing to consider before double booking is the patient’s “show” record. Double booking two patients with perfect “show” records in the same slot is likely to guarantee a long wait for one of them. But, it may be a reasonable strategy to consider double booking if your scheduling system can provide information on the patient’s track record of showing up on time. If you have information on the probability of the patient keeping the appointment, consider double booking a patient with a perfect “show” record with another that has a poor “show” record. Double booking without this kind of information will almost certainly create a traffic jam at the practice and at least one unhappy patient.

Taking charge of your appointment schedule
Oftentimes, there is no rhyme or reason to how patient appointments are scheduled. In an effort to meet patient demand, sometimes patients are simply crammed into an already busy schedule without considering the appointment type and/or the amount of time needed for the appointment. For example, new patient visits generally require about twice as much time as an established patient visit, while follow-up appointments are typically the shortest.

If your practice doesn’t have a schedule template, create one by identifying the amount of time required for each different type of appointment. Working with the physician(s), determine the average amount of time the physician needs for new patient visits, established patient visits, follow-up visits, well care visits, etc. Build that information into your scheduling system so when you are creating an appointment, the amount of time is automatically calculated based on the type/need.

More in-depth triage
Beyond the schedule template, it can also be helpful for schedulers to do a more in-depth triage with patients to identify whether additional time will be needed. For example, an established patient visit to address multiple complaints will likely require more time than the average established patient visit. Training your office staff who are responsible for scheduling to ask specific questions such as, “Do you have any other issues to discuss with the doctor?” as well as encouraging patients to be on time (or even early) in order to prepare them to see the doctor will help to keep your practice running on schedule.

Pad the appointment time
Practices often make the mistake of advising patients to arrive at the time of their scheduled appointment. However, if the patient’s appointment is at 8 a.m. and he or she arrives at 8 a.m., after check-in at the front desk, completion of any necessary paperwork and rooming of the patient, it would be impossible for the physician to actually see the patient at 8 a.m. and therefore immediately puts the physician behind schedule. Imagine how far behind the physician will be if that patient is late to their 8 a.m. appointment!

While some practices report they advise patients to arrive 10-15 minutes early, let’s face it, most patients don’t comply. They remember their appointment time and rarely arrive any earlier.

One way to address this is to pad the appointment time by 10 minutes or so. For example, if the patient’s appointment is at 8 a.m., the practice may wish to advise the patient that the appointment is at 7:50 a.m. This allows time for check-in, paperwork and rooming so the patient is ready to see the physician at his or her scheduled appointment time of 8 a.m., which maximizes valuable physician time.

Following some simple, but well thought-out scheduling strategies can maximize the number of visits in a day, prevent a chaotic work environment and improve patient satisfaction.

It's Finally Over! The Medicare SGR is Dead!

LAST NIGHT THE SENATE APPROVED H.R. 2: THE MEDICARE SGR REFORM AND THE CHILDREN’S HEALTH INSURANCE REAUTHORIZATION ACT WHICH REPEALS MEDICARE’S SUSTAINABLE GROWTH RATE FORMULA, HOURS BEFORE DOUBLE-DIGIT PAYMENT CUTS TO PHYSICIANS WERE SET TO TAKE EFFECT. THE BILL HAS BEEN SENT TO THE WHITE HOUSE WHERE PRESIDENT OBAMA IS EXPECTED TO SIGN IT INTO LAW.

After a decade of battling, the U.S. Senate, in a whopping vote of 92-8, passed H.R. 2, the monumental, bipartisan Medicare SGR Payment Reform and Children’s Health Insurance Program (CHIP) Reauthorization Act. Both California Senators Feinstein and Boxer voted in the affirmative. Two weeks earlier, the U.S. House of Representatives adopted the legislation in a landslide vote of 392-37. This was a rare, bipartisan achievement in a deeply divided Congress. RCMA, CMA, AMA and more than 780 state and national physician organizations supported the bill. In 2013, the policy was jointly developed on a bipartisan basis by the three House and Senate health committees. This year, U.S. House of Representatives Speaker John Boehner (R-OH) and Minority Leader Nancy Pelosi (D-CA) are credited with negotiating the final budget offsets to fund the SGR bill.

RCMA/CMA extends a sincere thank you to all physicians for the extraordinary campaign this last decade to end the SGR. We have kept up the fight these last two years to hold Congress’ feet to the fire to develop a comprehensive bill to reform Medicare physician payments. The unity within organized medicine finally put this over the finish line. Moreover, 52 out of 54 Members of the California Congressional delegation voted to support physicians. This is an incredible achievement in one of the most dysfunctional Congresses in history.

PLEASE BE SURE TO CONTACT YOUR REPRESENTATIVE AND
THE CALIFORNIA SENATORS TO THANK THEM FOR THEIR SUPPORT!

While H.R. 2 is far from perfect, it represents a significant improvement over the current Medicare program which mandates penalties up to 13% in the coming years with no opportunities for payment updates or bonuses. This bill consolidates the burdensome reporting programs and reinstates significant bonus payments. By repealing the SGR and providing annual updates, it provides stability to physician practices that allows for longer term planning. Significantly, it allows physicians to design new payment systems that work for physicians and patients instead of government bureaucrats. And it mandates physician involvement in defining and developing quality measures. Moreover, once the costly SGR is repealed, it will be much easier for physicians to work with Congress to make improvements to the payment system (such as increasing the annual update) at a lesser cost. The enormous cost of the SGR has been a barrier to making any improvements.

Note that Medicare should begin processing claims today for services provided in April at the rates that were effective before the 21 percent cut was scheduled to take effect. Under the provisions of H.R. 2, the fee schedule conversion factor will be increased by 0.5 percent on July 1, 2015, and by another 0.5 percent on January 1, 2016.

House Landslide Vote to Pass SGR

Today, RCMA/CMA congratulates the U.S. House of Representatives for passing monumental Medicare reform and the Children’s Health Insurance Program (CHIP) extension, and urgently asks their colleagues in the Senate to do the same before spring recess. The 392-37 vote clearly shows that now is the time to make Medicare reform a reality.

The legislation, H.R. 2, known as the “The Medicare and CHIP Reauthorization Act,” will reform the broken Medicare sustainable growth rate (SGR) physician payment system and extend the expiring Children’s Health Insurance Program. Both of these important reforms will help to improve access to doctors in California for five million seniors on Medicare, one million military families on TriCare and the nearly one million uninsured children currently covered by CHIP.

“It is imperative that the House AND the Senate act before the 21 percent SGR Medicare payment cut takes effect on March 31,” said Luther Cobb, M.D., CMA president. “A drastic cut to physician payments will result in decreased access to care for some of our country’s most vulnerable patients. It’s crucial to the success of our health care delivery system that the bill passes before Congress goes home.”

The SGR legislation is nearly identical to the bipartisan, bicameral Medicare physician payment reform package that three Congressional committees unanimously approved in the last Congress and more than 750 state and national physician organizations, including CMA, supported.

There are more than 1,000 new Medicare enrollees every day in California, yet many physicians are no longer accepting new Medicare patients.

“California desperately needs payment reform to improve access to physicians because Medicare influences all public and private health insurance,” added Dr. Cobb. “Patients are experiencing access to care problems all across the state and H.R. 2 will help alleviate some of that.”

With the new bipartisan agreement between House Speaker John Boehner (R-OH) and Minority Leader Nancy Pelosi (D-CA) on how to fund the SGR fix, CMA is calling on Congress to immediately pass this monumental, fiscally responsible legislative achievement that will lead to meaningful improvements in our health care system.


Remembering Paul Green

RCMA’s Executive Director Dolores Green lost her husband Paul on March 9th after a brave and valiant fight with Multiple Myeloma. Paul Green was a gentle man and kind soul to all who knew him. A Celebration of Paul's Life will be held on Saturday, March 21st at 3:00pm at the Home of Alonso and Debbie Ojeda, 6910 Sandtrack, Riverside.

Download Announcement

Paul was born at March Air Force Base on February 29, 1952. He graduated from Moreno Valley High School in 1970 and after 30 years working in the manufacturing field, he pursued his passion and became an interior designer where he spent the last 15 years of his life helping others bring beauty to their homes.

Paul leaves his loving memories to be cherished by his wife of 29 years, Dolores; sons Christopher Green and Craig Spinnato; and the sparkle of his eye, Granddaughter, London Raine Green. Paul also leaves behind his daughters, Rochelle, Sara and Allison and son, Ariel; as well as his beloved brother David Green, in-laws Gary and Dorothy Cummings and numerous brothers-in laws, sisters in-laws, nieces and nephews. Paul was preceded in death by his father and mother, Paul and Hoyt (Bea) Green.

Memorial contributions may be made to the Muscular Dystrophy Association at www.mda.org.


Measles Health Advisory

2/17/2015 Free CME On Demand Webinar Measles Update: A Primer for Health Care Providers

Situation Update

Measles activity continues to increase in California. As of January 30, 2015, 79 cases of measles in patients from 11 different jurisdictions have been reported to the California Department of Public Health. Fifty-two California cases and 14 out-of-state cases are epidemiologically linked to Disneyland Park in Orange County. Five confirmed and two probable cases are Riverside County residents. Students without documentation of two MMR vaccinations have been excluded from two high schools pending the end of the 21 day surveillance period.

Measles Alert

Prompt identification and implementation of infection control measures can make a difference in preventing the spread of measles in our community. Health care facilities should routinely ensure that healthcare workers are immune to measles, as well as other vaccine preventable diseases. Non-immune health care workers may need to be excluded from work and quarantined from day seven through day 21 post exposure.

If You Suspect Measles:
  • Isolate the patient immediately using airborne and standard precautions. The risk of measles transmission to others can be reduced if control measures are implemented.
  • Place patient in a surgical mask, if it can be tolerated.
  •  Do not use the examination room for at least two hours after the measles case (or suspect) leaves.
  • Restrict care of patients with suspect or confirmed measles to immune healthcare workers.
  • Collect specimens for measles testing:
       o Draw 2-5 cc blood in a red-top tube; spin down and remove serum if possible.
          NOTE: Capillary blood (approximately 3 capillary tubes to yield 100 µl of serum)
                       may be collected in situations where venipuncture may be difficult,
    such as for children less than one year of age.
       o Obtain a throat or nasopharyngeal swab using a Dacron swab to dislodge
           epithelial cells; use a viral culturette and place it into a 2-3 ml viral transport media.
       o Collect up to 50-100 ml of urine from the first part of the urine stream
           in a sterile 50 ml centrifuge tube or urine specimen container.
  • For questions on submission of specimens to the County of Riverside Public Health Laboratory, please call Megan Crumpler, Assistant Laboratory Director at (951) 358-5070.
Management of Exposed Individuals

  • IG may be given to exposed susceptible individuals of any age, if given within six days of exposure.
  • MMR vaccine may be given within 72 hours of exposure to individuals six months of age and older with one or no documented doses of MMR, if not contraindicated (two MMRs given after one year of age are still indicated).

Reporting

Notify Disease Control immediately of any suspect measles patients by calling (951) 358-5107 during regular business hours or (951) 782-2974 after-hours (request to speak with the Public Health second call Duty Officer).

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