A peer-reviewed, evidence-based journal that promotes clinical development and metabolic insights in total bariatric patient care for the healthcare professional
Issue link: https://bariatrictimes.epubxp.com/i/245728
14 Bariatric Center Spotlight Bariatric Times • January 2014 Welcome to THE DAVIS CLINIC Houston, Texas by JAMIE CARR, BSN, RN, CBN The Davis Clinic Staff. Front row: Dr. John Primomo, Dr. Robert Davis, Dr. Garth Davis; Second row: Alma Palacios, Naomi Garza, Nancy Ramirez, Zintia Dominguez and Deborah Thibodeaux and Jamie Carr; Third row: Gabrielle Rodriguez, Amy Philavanh, Leslie Stevens and Debbie Carter; Back row: Casey Edmiston and Claudia Arroyos Bariatric Times. 2014;11(1):14–15. WELCOME TO THE DAVIS CLINIC The Davis Clinic is a multidisciplinary, state of the art, freestanding, 8,000-square-foot, private bariatric practice, that was built specifically for bariatric patients. We are located in Houston, Texas. We are an accredited center under the American Society for Metabolic and Bariatric Surgery (ASMBS)/American College of Surgeons (ACS) Metabolic and Bariatric Surgery Accreditation Quality Improvement Program (MBSAQIP). We perform over 1,200 bariatric procedures annually. The procedures performed are gastric bypass, sleeve gastrectomy, duodenal switch, and revisions for failed gastric banding procedures. OUR STAFF We are a multidisciplinary comprehensive program, with three COE bariatric surgeons, a certified bariatric nurse, three medical assistants, a registered dietitian, an onsite psychologist, and a lab technician. In addition, we have eight administrative personnel who manage the day-to-day operations of the program, including marketing, human resources, finance, billing and collections, insurance coordination, and scheduling. In total, we have 17 members on staff, all strong in their respective areas of expertise. OUR FACILITY Our office facility. From the moment you enter The Davis Clinic, you are greeted by a warm, welcoming environment. From the beautiful wood floors to the warm paint colors, The Davis Clinic was designed specifically to meet the needs of bariatric patients. The clinic was designed to ensure that our patients feel at ease, at home, and special. All furniture is ergonomically designed to accommodate bariatric patients. Our hallways and doorways are four-feet wide and our exam rooms are spacious, making them easily accessible to patients, regardless of their mobility limitations. We designed a retail store for patients so that we could meet their needs on all levels for preand post-operative nutrition. Our facility has two education rooms where we hold support group meetings, cooking classes, seminars, and exercise classes. The facility is located on the street level of the building so patients can enter and exit our office with ease and convenience. Our procedure room. We provide in-house fluoroscopy services for our patients. This service provides efficiency for the surgeon and ease for the patient. The patient no longer has to wait for hospital scheduling for testing. The surgeons perform band fills under fluoroscopy. This not only allows the surgeon to observe the functionality of the band but it also provides the patient with a visual education on where the band is placed and how it functions. We also perform upper GIs in our procedure room, making it easier and faster to diagnose patients with possible complications. ACHIEVING ACCREDITATION DESIGNATION We did not have difficulty meeting the requirements for initial certification or recertification with the ASMBS/ACS program. We find that most patients do not ask if we are a bariatric center of excellence; however, our certifications are posted in our waiting room and on our website, and we do let individuals know at their initial seminar that we are COE-certified and explain the importance of this designation. MANAGED CARE As a bariatric practice that believes we must care for the whole patient and provide aftercare for life, it can be difficult at times to continue to provide robust services when managed care continues to reimburse less and less. We do not believe we are alone in this regard, as practices all across the country regularly visit our clinic as a "best practice" site visit. This topic always comes up for discussion and we are happy to share our knowledge about what has or has not worked for us when dealing with managed care. We routinely review our managed care contracts and negotiate with providers on reimbursement based on our outcomes and volume data. We are in-network with almost all major carriers to include Medicare. In summary, even though reimbursement lessens daily, we have not allowed that to affect our quality of care and our excellent aftercare programs. PATIENT CARE The Davis Clinic has a robust aftercare program, including several live monthly support groups, public and private Facebook forums and message boards. We recently added a bariatric app for smartphones. The app allows our patients to directly access the clinic. They are able to request appointments, download recipes, and ask questions to our dietitian and nurse. They can also RSVP to support group, and join our "10,000 Steps a Day" program challenge. It is a wonderful addition to our practice. Our aftercare programs emphasis is on behavior modification because we know that surgery alone will not "cure" obesity. If patients do not change why they eat, what they eat, when they eat, and how they eat, they will not experience long-term success. In addition to our live classes, cooking classes, and support groups, patients have access to us via e-mail, phone, and in-person consultations. We have registered dietitians and nursing staff that are available to assist patients during office hours, and a surgeon is always on call for after-hour issues. We are a very "high-touch" practice and believe that leading our patients through the process to surgery and beyond is critical to the success of our patients and to our practice. Our reputation for outcomes is on the line; therefore, we have put programs into place to ensure excellent outcomes and high patient satisfaction, which ultimately leads to more patient and physician referrals. From the initial seminar and all postoperative visits, patients receive educational handouts and a personal review of the materials.Prior to surgery, patients undergo pre-surgery classes and are given a patient manual for review. The patient manual provides information and education in a step-bystep method, from pre-surgery to lifetime follow up. The manual is truly a complete package so that the patient can read and re-read when a refresher on certain information may be needed. The manual includes information on the patient's hospital stay, diet, exercise, nutrition, guidelines for success, emotional well-being, support group information, and more. We believe that patients should always learn something from us, so this is a priority at The Davis Clinic. We strive for every interaction, every time, to be exceptional. We believe that word of mouth is our greatest referral source, so we have put a tremendous emphasis on customer service with our staff. In fact, we have held customer service training courses and even implemented a customer service satisfaction survey to capture critical feedback from our patients. With time, we have made some staffing changes to make sure the right people—with the right philosophy of customer service— are in place. Our staff is incentivized on a monthly basis to meet a specific number of positive mentions on our customer service satisfaction surveys. At the end of each quarter, those monthly numbers are tallied and our staff is paid a customer service bonus for each month they meet their quota. We have found that our patient experiences have improved, and our customer service satisfaction results went from an initial 79-percent approval rating to consistently hitting 93-percent approval rating (our goal was to reach and maintain at least 90%). With respect to patient privacy, we have trained all of our staff on HIPAA guidelines and we follow them strictly. To ensure that no areas are overlooked, we have our liability insurance provider come for a site visit periodically and review all areas of the practice for compliance.