Welcome to The Davis Clinic

| January 22, 2014

Houston, Texas

by Jamie Carr, BSN, RN, CBN

Jamie Carr is the Executive Director , The Davis Clinic, Houston, Texas.

FUNDING: No funding was provided.

DISCLOSURES: The author reports no conflicts of interest relevant to the content of this article.

Bariatric Times. 2014;11(1):14–15.

Welcome to the Davis Clinic
The Davis Clinic is a multidisciplinary, state of the art, free-standing, 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.

The Davis Clinic Staff

Additional pictures from The Davis Clinic

Our Staff
We are a multidisciplinary comprehensive program, with three COE bariatric surgeons, a certified bariatric nurse, three medical assistants, a registered dietitian, an on-site 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 pre- and 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-by-step 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.

Patient Adherence and Long-term Follow Up
Our patients adhere to a specific postoperative follow-up schedule. We set that expectation up front and call to remind patients of their appointments one day prior. In addition, we schedule the patient’s next appointment at the time of check-out. As we are following these patients for life, there will always be another appointment to be scheduled, even if it is their next annual appointment. For patients who miss appointments, we call and reschedule them. In addition, we are currently in the process of contacting each and every patient that has not been seen within the last year via a letter from our surgeons. We are requesting that they schedule their next follow-up appointment within 90 days of receipt of the letter. So far, we have had a good response to these letters.

We find that when patients begin to feel that they are doing well on their own, they tend to slack off on their follow-up appointments. Ultimately, this can lead to weight regain in the long term and then patients are hesitant to come in and see us, perhaps feeling as if they have “failed.” We feel strongly that if patients are committed to keeping each and every appointment, and staying plugged into the support groups and our online message boards, they are much less likely to stray from the guidelines for success. We stress to each patient that even when feeling great, he or she should still continue to be monitored. This is a life-long commitment and we recognize that patients will need our support for life.

Our Equipment and New Technologies
The latest technology we have implemented is a bariatric app for smartphones. The BariApp® is an innovative way for our patients to “stay in touch” with the practice. We provide the app for no fee to our patients. The app is HIPPA compliant and is patient focused. Patients have direct access to support group calendars, can request appointments, monitor their daily progress, join our fit challenge, download recipes, and ask questions to our dietitian and nurse. Patients rave about it and it is a great way to market our program.

After much research, we chose to implement a bariatric specific EMR. This system is a “plug and play” EMR specific to bariatric medicine.

The program is internet based, so we are able to access it from anywhere. We have found the program to be intuitive and easy to use. For example, a workflow can be changed or adjusted simply. No programming skills are required by the end-user, and it is easy to customize to our needs. This EMR also provides reporting that clearly shows you where there may be bottlenecks in your pipeline and where your referrals are coming from (or where they are not coming from), so that marketing dollar decisions can be applied without guesswork.

We also provide testing for measuring patients’ metabolic rate so that they gain understanding and knowledge of the amount of calories needed to stay within their daily caloric budget. The test is painless and quick. The patient breathes into a specially designed and calibrated breath machine. This test allows us to accurately provide a patient’s daily calorie intake to encourage weight loss or to maintain current weight.
Our retail store is stocked with bariatric specific products to ensure our patients have access to the highest quality vitamin and mineral supplementation and meal replacement options. We have a long-standing relationship with Bariatric Advantage® (Aliso Viejo, California) as we believe their products are excellent, in that they truly maintain proper micro-nutrient levels in our patients. We like Bariatric Advantage because they offer a complete line of products and meet the needs of our patients on all nutritional levels.

Cost and Efficiency
We continually monitor and create new opportunities to increase revenue and decrease overhead. We have partnered with cardiology, lab, and psychology companies to bring these services in-house. This increases patient satisfaction as they can get everything done under our roof, and it also helps with increasing revenue. Some of the most simple costs reducers can easily be overlooked. We encourage staff to turn off lights in exam rooms and office when not in use. Before ordering supplies, we ask staff to empty their drawers of paper clips and pens for reuse. Reducing overhead is not that difficult, you just need to be creative and think simple.

Patient Assessment
We have created a complete pathway to determine patient appropriateness for surgery that begins with our call center. Patients are lightly screened during this call to ensure body mass index meets criteria. We perform this initial screening so that patients whose BMI does not meet criteria can be redirected to our medical program. We are sensitive to making sure patients get the right service so that we are not wasting their time.

Once patients view the webinar, patients are seen in consult with the surgeon. Both the patient and the medical staff complete an assessment intake. This assessment covers everything from weight history, previous surgical procedures, psychological history, medications, and typical daily food intake lists. This history is reviewed with the patient by the surgeon, and candidacy is then determined for the appropriate surgical procedure.

Patient and Staff Safety
The Davis Clinic was designed and built for our bariatric patients. Our exam tables and chairs are made specifically for bariatric patients and the exam rooms are large enough for any mobility issues/devices that patients use. All of our staff members undergo annual education on proper body mechanics and patient sensitivity. We also have protocols and policies to follow in the event of a patient fall.

Staff Training
All employees are required to attend a patient webinar and a support group and read the patient manual upon hire no matter what their role within the office. We even offer the opportunity for the employee to view a surgical case if he or she wishes. All employees must view our sensitivity training presentation as well. No matter what the role, all new hires shadow a person in each department so they have an overall understanding of the roles in the office and how important each and every one is for the success of the patient and the success of The Davis Clinic. We have dedicated staff members to answer telephones but all staff members are trained and expected to assist with answering phones to ensure patients that call our office are taken care of in a efficient and timely manner. Our medical assistants shadow and are trained by our certified bariatric nurse and are given a test yearly to ensure patient safety and quality patient outcomes. Employees are also given a extensive overview of the required vitamin and mineral supplements of the patients so they can assist the patient in purchasing products from our retail store if necessary. In summary, we are a team and our goal is to make the patient process safe, precise, clear and easy for the patient.

A Unique Facility
What makes The Davis Clinic unique is our approach to customer care and satisfaction and the full service we provide as a private multidisciplinary practice. Our philosophy is to provide the highest quality care for the patient under one roof.  Every aspect of our clinic designed with our patients in mind. When we designed the space, it was important that patients could easily access our office. Our office is on the ground floor so that patients can literally drive right up to the front door. We offer all services, including an on-site laboratory , cooking classes, support groups, back on track classes, behavior modification classes, medical weight management, fitness training, a retail store, an onsite psychologist, and a licensed dietitian. We believe in holding our patients hands through the entire process of improving their health. Whether they choose surgery or medical weight management, all patients matter and deserve and get our complete commitment. Our knowledge, our empathetic and attentive staff, and our multidisciplinary approach to the patient makes us a leader in our field We are very proud of what we have built and continue to build at The Davis Clinic.

Category: Bariatric Center Spotlight, Past Articles

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