Wenonah (she/they)
In-House Trainers
Posts: 48
I work at a: Healthcare Facility
My job role is: Staff
I am interested in Centering because: ...it's about relationships and support being recognized as an essential component of health & Healthcare. The lasting connections created during the transformational year of pregnancy is an invaluable asset for new parents.
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Post by Wenonah (she/they) on Nov 6, 2020 15:21:45 GMT -5
We have been doing Virtual Centering on Zoom, the patient has an individual Health Check with the CNM, either in a breakout room or in a phone call. We have not been collecting vitals at the Telehealth (virtual visits) so it feels necessary to also have in person visits. The goal was to alternate in-person check ups between Centering group appointments. But that gets complicated because the centering visits are prescheduled. And the clinic staff schedules the patient for their next visit in the usual timeframe disregarding that their chart is labeled 'Enrolled in Centering'.
Often, the patient will have Centering and an in-person within a week of each other. At the group appointment it seems pointless to do the one on one time. The provider can't really bill for the visit if they are not doing an individual assessment.
It has gotten so messy as this contingency plan has been dragged out.Patients are ending up with 20 visits in a pregnancy! Has anyone else run into this problem combining telehealth and in person in order to do the Virtual Centering?
Anyone have any suggestions or thoughts? Every alternate plan we have tried doesn't feel like it is staying true to the model. Our staff is getting weary.
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Post by Tanya Munroe on Nov 9, 2020 14:04:46 GMT -5
Hi Wenonah, just a thought: could you schedule all of the prenatal appts (virtual group + in-person) for each patient in advance?
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Post by Katie Stephan on Nov 13, 2020 14:30:58 GMT -5
We were trialing virtual groups but recently had to suspend our efforts because our recruitment was down and we need to regroup and strategize. We created a schedule for Centering groups that consisted of 7 Centering sessions at 12, 16, 24, 30, 34, 37 & 39 wks and office visits in between at 20, 28, 32, 36, 38, 40 wks. We ended up blocking the providers schedule for the office visit dates but opened the unused slots to regular clinic patients once the centering patients had their appointments. Patients were given a schedule with all dates when they enrolled in Centering. It seemed to work out well.
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Post by dillon on Nov 13, 2020 14:50:51 GMT -5
Thank you so much for sharing your learnings and all the great work you are doing to keep your patients connected.
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Wenonah (she/they)
In-House Trainers
Posts: 48
I work at a: Healthcare Facility
My job role is: Staff
I am interested in Centering because: ...it's about relationships and support being recognized as an essential component of health & Healthcare. The lasting connections created during the transformational year of pregnancy is an invaluable asset for new parents.
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Post by Wenonah (she/they) on Nov 30, 2020 20:00:45 GMT -5
Katie - Thank you for the idea. That is looking like what we will be doing - something similar. I appreciate the input.
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Post by Ruth Guillaume on Dec 2, 2020 12:19:53 GMT -5
I agree you have to combine the session with one -to-one-breakout rooms that can cover triage of patients vitals, mental health, physical health, etc. The billable portion is triage so make that the the center of your scheduling virtual visits and education. Good luck
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rbaldwin
New Member
Posts: 15
I work at a: Healthcare Facility
My job role is: Healthcare Provider
I am interested in Centering because: it improves healthcare outcomes and patient satisfaction while building community.
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Post by rbaldwin on Dec 10, 2020 15:12:32 GMT -5
This is a helpful discussion, as we too are trying to implement virtual groups. For the traditional care model during COVID, we usually see women in person in the first trimester, and then do telehealth at 14-18 weeks. Per the Maternal Fetal Guidelines our practice uses, the 20 week sono counts as an in person visit, and we follow up with telehealth. We do telehealth at 24 weeks, in person at 28 weeks, telehealth at 30, in person at 32, telehealth at 34, in person at 36 weeks. Most of our moms can get BP cuffs, and we can do weekly telehealth up to 39 or 40 weeks. I especially like the idea of scheduling all the visits ahead of time, both group and individual. And the suggestion to have seven group sessions with office visits for the other visits is interesting. Katie, can you share how you adapted the content of the sessions when you went from 10 to 7 sessions?
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cmchugh
New Member
Posts: 6
I work at a: Healthcare Facility
My job role is: Healthcare Provider
I am interested in Centering because: Centering provides a framework that guides our patients to make deeper mind/body connections, instills a greater sense of community, and empowers them to be the best advocates for themselves and their families. I love being able to leave work re-energized and feeling like the work I do has reached someone on a a more personal level.
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Post by cmchugh on Dec 18, 2020 14:27:58 GMT -5
We are also running into this. Due to billing issues we must ask our Centering patients to have an in-clinic or virtual 1:1 visit with the provider on the day of a Centering session. We have had to reduce our group sessions to 1 hour due to the clinic time needed to have these 1:1 visits. We have also had to reduce our group numbers to 8 max, from 12, due to clinic time constraints for our midwives. Its becoming a lot to ask of patients and it is making the waters of what Centering really is about quite murky for all involved. Despite these challenges we have still been able to fill our groups. We just hope this will be sustainable until we are able to return to in-person Centering safely.
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Deleted
Deleted Member
Posts: 0
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Post by Deleted on Jan 5, 2021 17:51:25 GMT -5
This is such a helpful discussion between all of you! I'm wondering, Chelsea, if doing the clinical assessment during the group visit time, if 2 hours, with the provider using break out rooms to do the same quick assessent they would do in the corner in an in-person group would help with group schedules? Some sites are getting vitals equipment to the group participants, e.g. BP cuffs, wt scales, fundal height measuring tapes and dopplers, then training patients in clinic with the provider and MA. Patients take their vitals, minimum BP and weight, before the virtual group session, with someone navigating bringing patients in and out of the breakout room for the provider. The provider tries to keep the clinical assessment in the breakout room the same amount of time they would use as in-person group assessments. This way questions from patients can be referred to the group for facilitation, rather than the provider answering these questions if clinical assessments are done after the group session with telehealth or in person at the clinic the same day. Most sites doing these virtual groups work on what clinical assessment pieces need to be done in the breakout room to make it a billable visit. Then amended schedules bring patients into the clinics with 1:1 visits with their Centering group provider for those visits that require lab work, such as the 20 week sonogram or 28 wkg glucola draw, etc, as well as provider determined in-person visits, outside of the lab needs visits. There is a wide variety of amended schedules with virtual and in-person visits and some of the posts on this thread include this variation in what sites are doing. It does reduce the number of 1:1 clinic visits if you can have providers doing the clinical assessents in the virtual session breakout room. One site said their minimum to be able to bill was to have the patient take their BP and assess fetal movement, plus asking all the regular clinical questions that go with this assessment.
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Post by Lisa Goolsby on Jan 14, 2021 12:39:18 GMT -5
How are people utilizing the break out rooms? Are the patients scheduled for 2 hrs and given a time they will be broken out? How are the patients scheduled for the group and then broken out for the personal assessments?
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Post by Tanya Munroe on Jan 14, 2021 18:00:51 GMT -5
How are people utilizing the break out rooms? Are the patients scheduled for 2 hrs and given a time they will be broken out? How are the patients scheduled for the group and then broken out for the personal assessments? Hi Lisa - you will find some helpful info in the "Guidance" file under "Tools for Virtual Centering Groups" in the Resources section of the CHI website portal here: www.centeringhealthcare.org/store/virtual-group-resourcesI'm sure others will chime in but I wanted to highlight that for you as well. Patients are scheduled for the entire group session time and taken one-by-one into virtual breakout rooms, so the particular time for each patient is flexible during the group session.
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Deleted
Deleted Member
Posts: 0
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Post by Deleted on Jan 15, 2021 18:37:46 GMT -5
Hi Lisa, You can also watch the pre-recorded video titled "Guidance for Adapting Centering Groups to Virtual Format". Go to the Portal, Webinars, Pre-Recorded webinars and they are on page 5, three recordings of the same training. You can also register for the next live training in February under Upcoming Webinars and we go through how to do a virtual group from opening to closing, abbreviated of course. Let me know if you have any other questions about virtual Centering groups.
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jbwt77
OH - Ohio Centering Network
Posts: 37
I work at a: Healthcare Facility
I am interested in Centering because: I feel it is the best way to get pregnancy care! Especially seeing how teens are with the model!
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Post by jbwt77 on Jan 19, 2021 11:31:32 GMT -5
How are people utilizing the break out rooms? Are the patients scheduled for 2 hrs and given a time they will be broken out? How are the patients scheduled for the group and then broken out for the personal assessments? Hi Lisa - you will find some helpful info in the "Guidance" file under "Tools for Virtual Centering Groups" in the Resources section of the CHI website portal here: www.centeringhealthcare.org/store/virtual-group-resourcesI'm sure others will chime in but I wanted to highlight that for you as well. Patients are scheduled for the entire group session time and taken one-by-one into virtual breakout rooms, so the particular time for each patient is flexible during the group session. So I have only had 2 virtual group sessions so far (It took us awhile to get all of the equipment needed) - I set up the zoom session about a half hour before anyone signs in. At that time I have the powerpoint/videos etc all ready to go for the patients so they have the welcome screen to look at when they sign on. Also during that half hour I create multiple breakout rooms and name them. As the patients come in I move them to their assigned breakout room once the provider completes a previous patient. While the provider is in the breakout room, I'm making sure that each patient has their vitals information ready to go. At least for these first 2 sessions its worked well.
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