JANUARY Missouri Baptist achieves top rankings from Healthgrades

13
JANUARY
Missouri Baptist was named one of America’s 100 Best Hospitals for General Surgery, GI Care, Stroke Care and Critical Care for 2013. Drs. Omar Guerra, Eric
Lederman, Dan Hafenrichter, Jeff Zuke, Mark Ludwig, Todd Howard, Larry Mendelow, Chris Pruett and Brent Allen are some of the hospital’s leading surgeons.
Missouri Baptist achieves top rankings from Healthgrades
New Healthgrades® study finds patients treated at hospitals receiving 5 stars have a 58% lower risk of dying
verses all other hospitals.
Missouri Baptist again received recognition for the quality of
its care from Healthgrades, the leading provider of information
to help consumers make an informed decision about a
physician or hospital. This recognition is part of new findings
in American Hospital Quality Outcomes 2013: Healthgrades
Report to the Nation, which evaluates the performance of
approximately 4,500 hospitals nationwide across nearly
30 procedures and conditions.
MoBap’s recognitions include:
One of America’s 100 Best Hospitals for:
★General
★
Surgery™
2 Years in a Row (2012-2013)
★Stroke
★
Care™ in 2013
★Gastrointestinal
★
Care™
2 Years in a Row (2012-2013)
★Critical
★
Care™ in 2013
Cardiac
• Five-Star Recipient for Treatment of Heart Attack
9 Years in a Row (2005-2013)
• Five-Star Recipient for Treatment of Heart Failure
2 Years in a Row (2012-2013)
continued on page 6
Physicians making medicine better
Coventry Health pilots COPD program
Small incision mitral valve surgery
The collaborative COPD program introduced in 2009 by Mitchell Botney, MD, to
reduce hospital readmissions recently began
a pilot with Coventry Health Plan’s BJC
Medical Group patients with COPD. Patients
are identified based on risk of readmission
to the hospital or ER. Those with moderate
Mitchell Botney, MD
and high risk are seen by BJC Home Care
nurses and pulmonologists who provide a
standard of care with the goal of improving health and reducing readmissions.
Dr. Botney also is working with local and regional nursing
homes and nursing services to put systems in place to allow
non-acute care facilities to more effectively treat patients with
COPD and avoid hospital readmissions.
Cardiothoracic surgeon Jim Scharff, MD,
successfully performed two small incision
mitral valve surgeries at Missouri Baptist.
The procedure is performed though a
small incision in the right chest versus a full
sternotomy. Dr. Scharff joined the cardiac
surgery team in August and brought experJim Scharff, MD
tise in small incision and off-pump cardiac
surgery.
The hospital received a $280,000 grant from the Missouri
Baptist HealthCare Foundation to fund redesign and technology needs involved in equipping one of our cardiac ORs to
perform minimally invasive and small incision cardiac surgeries.
Heart LifeLine AllianceSM
Missouri Baptist, along with Stuart
T. Higano, MD, and Gregory J. Beirne, DO,
hosted the Fourth Annual Heart LifeLine
Alliance Symposium this October. The
program was attended by more than 130
medical professionals from across Missouri
and Illinois, and focused on improving the Stuart T. Higano, MD
regional treatment of STEMI and other
cardiac emergent patients. The keynote
speaker was David Hildebrandt, RN, CFRN,
NREMTP, manager of CV Emergency
Program at the Minneapolis Heart Institute.
Since its inception in April of 2008,
Missouri Baptist’s Heart LifeLine Alliance
has treated more than 400 STEMI patients
Gregory J. Beirne, DO
from across the region. Average referring
hospital door to first balloon inflation at
Missouri Baptist is 108 minutes – 12 minutes below goal of
120 minutes.
TAVR and transapical approach
Missouri Baptist Medical Center is one of two sites in the
region (Barnes-Jewish Hospital being the other) to perform
Transcatheter Aortic Valve Replacement (TAVR) via a transapical approach. The procedure, along with expansion to high-risk
patients, was approved by the FDA in October 2012. The
transapical approach is performed through a small incision in
the chest wall. This procedure is performed by a team of collaborating cardiac surgeons Michael Mauney, MD, and Michael
Murphy, MD, and cardiologists John Hess, MD, and Robert
Kopitsky, MD.
2
Dr. Kouchoukos receives lifetime award
Nicholas Kouchoukos, MD, received
the 2012 Antoine Marfan Award from
the National Marfan Foundation (NMF).
Presented at the NMF’s 29th Annual
Conference in Chicago, the award was
bestowed upon Dr. Kouchoukos in
recognition of his global leadership in
Nicholas
cardiovascular surgery and his accomplishKouchoukos, MD
ment in pioneering surgical technique to
improve aortic and valve surgery for patients with Marfan
syndrome and related disorders.
Dr. Kouchoukos also is the lead investigator at Missouri
Baptist for a multi-center study evaluating the short and
long-term outcomes of aortic valve sparing and aortic valve
replacement procedures in Marfan patients.
Dr. Kouchoukos, along with Dr. Eugene Blackstone,
Cleveland Clinic; Dr. Frank Hanley, Stanford University; and Dr.
James Kirklin, University of Alabama at Birmingham, recently
wrote and published the fourth edition of “Cardiac Surgery.”
The previous edition sold more than 8,000 copies, and is
utilized worldwide by cardiac surgeons.
To learn more about these cardiac program
developments, please visit us at:
http://www.missouribaptist.org/heart
13
JANUARY
Systems. Awards. Surveys. Models.
2012 was quite a year! There has been so
much that we’ve both begun and accomplished thanks in great part to our Medical
Executive Committee, under the leadership
of Dr. John Niemeyer.
We start 2013 by celebrating our rollout
of Computerized Provider Order Entry. It was
two years in the making, and I want to thank
each member of the medical staff for this achievement as well
as extend my appreciation to the CPOE small group team.
Looking back to 2012, Missouri Baptist started the year with
an extremely successful Joint Commission survey and follow-up
survey focused on the OR. Additionally, CMS, the state of
Missouri, the Nuclear Regulatory Commission, FTA and FAA all
visited this facility. As you know, these organizations scrutinize
physicians and our processes. We passed with flying colors, and
I want to thank everyone for their participation.
We also began to position ourselves for the Accountable
Care world with the BJC ACO. During the past 18 months,
the system has focused on developing an ACO structure that
will achieve better patient-centered health outcomes and costs
savings by improving care coordination, disease management,
and expanding evidence-based care delivery models across BJC.
Through the leadership of Dr. Doug Pogue, we are moving
forward, so stay tuned.
Innovations this past year are many, and include minimally
invasive techniques that have greatly improved the treatment
of gastroesophageal reflux disease, opening of a Heart Valve
Center and Joint Center program. All hold promise to improve
patient flow, satisfaction and attract volume to our physicians.
There are literally hundreds of metrics now around quality
and patient safety monitored by Missouri Baptist, and these
measures are increasingly reported on an external basis. We’ve
developed composites in focused areas and are tracking certain
measures that we can standardize in our Best-in-Class scorecard.
A Best-in-Class score of 100% equates to the 75th percentile. Our current Best-in-Class score is 158% (note 150%
equates to the 90th percentile for a composite of 37 metrics).
This includes our initiatives around the timing of antibiotics and
surgery, antibiotics selection for pneumonia, MI treatment, and
STEMI interventions.
We will be challenged in 2013 with new and tougher
metrics. Information to come.
Thanks to your efforts, Missouri Baptist continues to receive
awards, such as the US News & World Report Best Regional
Hospital, 5-star rating for heart attack and heart failure nine
years running, and top 100 hospitals for general surgery, stroke
care and GI care by Healthgrades.
I wish the best to all of you in this New Year, and always
welcome your insights and contributions.
Timothy D. Ranney, MD, MBA
Chief Medical Officer
Best-In-Class Scorecard - October 2012
Color Key (corresponds to performance level achieved)
Maximum (Top 10%) Target Threshold (Top 25%) Minimum (Top 50%) Below Minimum (Top 50%)
Maximum
(Top 10%)
Target
Threshold
(Top 25%)
Minimum
(Top 50%)
YTD
(12/11 - 10/12)
Rolling 3
(08/12 - 10/12)
Points
Appropriate Care
97%
95%
91%
86%
96%
97%
1.5
25%
0.375
Efficiency
3%
6%
12%
17%
3%
3%
2
10%
0.200
Mortality
Better Than
Expected
0
No
Different
Than
Expected
0
No Different
Than
Expected
1
10%
0.100
Patient Safety
19
15
11
7
13
10
1
20%
0.200
Value-based Purchasing (VBP) Clinical
Process of Care
99%
97%
95%
90%
99%
99%
2
35%
0.700
Indicator
Weighted
Value
Weighted Total Score
Total Composites
Weighted
Points
1.58
5
3
In Brief
Grand Rounds moves to monthly
Interim Chairman, Hamsa Subramanian, MD, and the
CME Committee plan changes in the delivery of Grand
Rounds in 2013. The Grand Rounds now will be held monthly
on the second Wednesday of the month starting January 9.
Throughout the year, additional grand rounds on
pertinent topics may be provided as necessary.
For the most up-to-date Grand Rounds schedule, please go to missouribaptist.org/grandrounds.
MedNews Plus expands CME opportunities
Beginning in March, Missouri Baptist will offer a new, free
service called Med News Plus, that provides specialty specific
medical news from medical journals, conferences and leading
news and online CME credit.
Benefits
• Breaking Medical News and Conference Coverage by your
area of specialty or interests.
• Free, peer-reviewed, AMA PRA Category 1 CME with online
tracking.
• Hospital news that’s relevant to you.
Physicians can earn and track CME credits online — all
content is certified for the Category 1 credits. Physicians
assistants, nurse practitioners and nurses in your practice also
may participate. Please provide the Medical Staff Office your
preferred email for this service.
State license renewal: Jan. 31, 2013
As a reminder, MD and DO state medical licenses
expire January 31, 2013. Physicians can contact the
Missouri Board of Registration for the Healing
Arts if a renewal application form has not
been received. Call 573-751-0098 or visit
http://pr.mo.gov/healingarts.asp.
Verification of license renewal is completed
electronically; therefore, the medical staff office does not
require a copy.
Referral bonus program
Due to the importance of internal medicine and primary care
physicians, Missouri Baptist will be launching a primary care
physician employment referral bonus program in January. A
$10,000 referral bonus will be paid to physicians on the medical
staff who refer a qualifying general internal medicine or family
practice physician.
The candidate must elect to relocate their office to Missouri
Baptist’s main campus or the Missouri Baptist Outpatient Center
- Sunset Hills or be employed by BJC Medical Group and join
the Missouri Baptist medical staff. Further details about eligibility for this program will be sent to physicians in coming weeks.
CPOE one month in: 187,000 orders entered
Thanks to countless staff and physicians, CPOE is in place
at Missouri Baptist. The hospital joins the ranks of several BJC
hospitals who have achieved this success. In addition to being
the largest hospital to participate, we also have set a system
record — training 1,400 physicians prior to go-live.
Feedback was mostly positive. CPOE provides for safer,
more efficient care to our patients, by making patient care
more standardized and evidence-based.
While physician training sessions were underway, the
ECHOES team trained more than 250 staff members as super
users for the December 4 go-live. Five physicians, including
Drs. Mitch Botney, Don Morris, Ben Voss, Doug Pogue and
Jerry Sachar volunteered to receive additional training as physician super users.
For the go-live period, a centralized command center
was staffed 24/7 to assist in every aspect of CPOE. Ongoing
support is available to physicians with any issue by calling CIS
at 314-575-5189.
Data Shows Strong Adoption Rates
During the go-live, the BJC Clinical Workflow Initiative
(CWI) team provided daily adoption data, tracking the number
4
of orders entered by physicians each day, as well as the number
of telephone orders, verbal orders and written orders received.
An adoption rate of 70 percent or higher entered directly by
physicians is considered a success.
The Missouri Baptist physician go-live went well. Between go-live and
Dec. 31, physicians entered more than 187,000 orders directly into the
system. Direct order entry accounted for 72.8% of the total orders to-date.
Daily volume averages more than 5,000 orders.
Missouri Baptist seeks renewal of accreditation from the
Society of Cardiovascular Patient Care in 2013
By Robert Kopitsky, MD
Missouri Baptist continues to be a leader in
cardiac care, achieving percutaneous coronary
intervention (PCI) within minutes for all STEMI
cases over the last years.
Building on its reputation for excellence in
treating heart disease, the Cardiovascular
Robert Kopitsky, MD
Patient Care Team (formerly the chest pain
team) at Missouri Baptist, meets monthly
to review data and identify measures to improve patient
outcomes.
2011 STATS
Snapshot of our metrics:
AT A GLANCE
Cardiac surgery program:
3-stars (highest rating) for cardiovascular surgery
program from The Society of Thoracic Surgeons.
705 Open heart surgeries – 120% more than any other
hospital in West County
Cardiovascular program:
Patients receiving PCI within 90 minutes of
arrival (2010 through 2012):
100%
5826 procedures performed in the cardiac catheterization
labs.
Mean door-to-EKG time for patients
complaining of chest pain:
6 min.
AMI core measure quality indicators have been at target or
better for the majority of the past year.
Average door-to-balloon time for 2012:
56 min.
Field-Activation of our cath lab
EMS teams can now activate the Missouri Baptist Cath Labs
from the scene, further decreasing the scene-to-balloon time,
thanks to work done by the chest pain team during the initial
accreditation. This program included education courses for EMS
providers by Missouri Baptist. It has helped to greatly reduce
overall door-to-PCI time.
The reaccreditation involves a complete review of our
processes for taking care of patients with acute coronary
syndrome and myocardial infarctions, not only inside the walls
of the hospital, but also before and after hospitalization.
Door to Balloon Time Comparisons
(through December 3, 2012)
80
75
70
73.5
69.0
60.8
Minutes
60
56.4
60
55
CME programs
Missouri Baptist Medical Center continues to provide
CME programs for all physicians and their staff including
monthly grand rounds and two yearly physician conferences, the Heart LifeLine AllianceSM Symposium and the
Cardiology Review.
Patient education materials
In addition, Missouri Baptist makes patient educational
material on the signs and symptoms of heart disease
available for your staff and patients. Please call Physician
Services at 314-996-5544 for a supply.
Cardiovascular Patient Care Team
contact
74.1
71.5
65
CARDIAC CARE RESOURCES
50
52
56
56.1
45
For questions or more information, feel free to contact
Robert Kopitsky, MD, FACC, medical director for the
Cardiovascular Patient Care Team or Stuart Higano, MD,
FACC, chairman of the AMI Team and the Heart LifeLine
Alliance Program.
40
35
30
Year 2008
Year 2009
Year 2010
Mean
Year 2011
Year 2012
Median
5
Physicians don their finest toggery for the holiday party
Healthgrades Awards
(continued from page 1)
Neurosciences
• Top 5% in the Nation for Treatment of Stroke in 2013
• Five-Star Recipient for Treatment of Stroke
10 Years in a Row (2004-2013)
• Five-Star Recipient for Neurosciences in 2013
Pulmonary
• Pulmonary Care Excellence Award™
8 Years in a Row (2006-2013)
• Top 5% in the Nation for General Surgery
2 Years in a Row (2012-2013)
• #1 in MO for General Surgery
2 Years in a Row (2012-2013)
• Five-Star Recipient for General Surgery
2 Years in a Row (2012-2013)
Critical Care
• Top 10% in the Nation for Overall Pulmonary Services
8 Years in a Row (2006-2013)
• Top 5% in the Nation for Critical Care in 2013
• Five-Star Recipient for Overall Pulmonary Services
8 Years in a Row (2006-2013)
• Five-Star Recipient for Overall Critical Care in 2013
• Five-Star Recipient for Treatment of Pneumonia
11 Years in a Row (2003-2013)
Gastrointestinal
• Top 5% in the Nation for GI Medical Treatment
8 Years in a Row (2006-2013)
• #1 in MO for GI Services
2 Years in a Row (2012-2013)
• Five-Star Recipient for GI Procedures and Surgeries
2 Years in a Row (2012-2013)
• Five-Star Recipient for Treatment of GI Bleed
10 Years in a Row (2004-2013)
• Five-Star Recipient for Treatment of Bowel Obstruction
8 Years in a Row (2006-2013)
Emergency Medicine
• Top 5% in the Nation for Emergency Medicine in 2012
• Five-Star Recipient for Emergency Medicine in 2012
6
General Surgery
• #2 in MO for Critical Care in 2013
• Five-Star Recipient for Treatment of Sepsis
4 Years in a Row (2010-2013)
• Five-Star Recipient for Treatment of Pulmonary Embolism in
2013
• Five-Star Recipient for Treatment of Respiratory Failure
4 Years in a Row (2010-2013)
Women’s Health
• Women’s Health Excellence Award™
3 Years in a Row (2010/2011 & 2011-2012)
• Top 5% in the Nation for Women’s Health
3 Years in a Row (2010/2011 & 2011-2012)
• Five-Star Recipient for Women’s Health
3 Years in a Row (2010/2011 & 2011-2012)
Scan code with your smartphone for a link to
the The American Hospital Quality Outcomes
2013: Healthgrades Report to the Nation
Primum non nocere
Readmission: Resources for Physicians
Readmissions have emerged as a hot topic in the health
press. Hospitals are now being penalized for readmissions
within 30 days following discharge and it is anticipated that
in the near future, physicians also may be.
While the readmission rate at Missouri Baptist is about
average for St. Louis, it has become a top priority for us
to improve the continuum of care and prevent avoidable
readmission.
As we develop strategies, and focus on the early detection of high-risk patients, we have an opportunity to assist
physicians with resources for patients who may require
additional education or support.
Breaking the readmission cycle
Statistics show that 20 percent of Medicare hospitalizations are followed by readmission within 30 days, and that
only half of patients re-hospitalized within 30 days had a
physician visit before readmission. These statistics reveal an
opportunity for physician practices to further impact the care,
and
• Ensure the patient completely understands post-discharge
instructions and comprehends impact of non-adherence;
• Schedule a near-immediate visit with patient after hospital
discharge; no longer than seven days is recommended;
• Improve patient and caregiver awareness of risk factors
for readmission;
than 50% decrease in readmissions with the incident diagnosis of COPD. Orthopedic Joint Surgeons also have partnered
with Missouri Baptist to devise a new patient care path that
includes pre- and post-acute care to improve outcomes for
joint replacement patients.
Early engagement requires us to look at how we make
ourselves available to vulnerable populations, as well as
ongoing assessment of potential readmission risk factors.
This issue is happening now. It’s not about the penalties, it’s
about making medicine better for our patients.
A Dartmouth study, Care About Your Care, lists some of
the reasons a patient may be readmitted. Following are
the top five:
1. Patients may not fully understand what’s wrong
with them.
2. Patients may be confused over which medications to
take and when to take them.
3. Hospitals don’t provide patients or physicians with
important information or test results.
4. Patients do not schedule a follow-up appointment
with their doctor.
5. Family members lack proper knowledge to provide
adequate care.
Nancy Kimmel, Pharm.D.
• Help patients better understand their health with access
to specialists, if needed, and
Director Quality and Patient Safety
• Provide patients and families or patient support structure
with further education and support
Download Taking Care of Myself: A Guide
for When I Leave the Hospital, a helpful
guide to provide patients to increase
awareness about readmission, at
www.ahrq.gov/qual/goinghomeguide.pdf
Pulmonologists and orthopedists pilot programs
Pulmonologists, led by Dr. Mitch Botney, have begun a pilot
project with BJC Home Care that has resulted in a more
Physician resources
Care Coordination:
Carol Boehm, RN, ACM, IQCI, Director
314-996-5750
RN Care Coordinators:
Available on each acute unit
Monday-Friday 7 a.m.–4:30 p.m.
Social Workers
Monday-Friday
Saturday
Sunday
7 a.m.–4:30 p.m.
8 a.m.–4:30 p.m.
11 a.m.–4:30 p.m.,
on-call after hours
Palliative Care
Vicki Boehmer, RN, CHPN, BSN,
MAHCM
314-996-5173
Pharmacy
Tom Hall, Pharm.D., Director
314-996-5126
7
New to Missouri Baptist Medical Center campuses
We welcome the following physicians to our Main Campus, Missouri Baptist Outpatient Center-Sunset Hills and Rock Hill facilities.
Vincent Joe, MD
James Goldring, MD
Dr. Joe is board-certified in radiation oncology. He earned his medical degree from the
University of Rochester. He completed an
internship in internal medicine at Highland
Hospital and a residency training in radiation/
cellular oncology at the University of Rochester.
Dr. Goldring is board-certified in neurology. He
earned his medical degree from and completed
his residency in neurology at Washington
University School of Medicine.
Erin Gardner, MD
Lizette Alvarez, MD
Dr. Alvarez is board-certified in physical medicine and rehabilitation. She earned her medical
degree from Ponce School of Medicine. She
completed a combined internship/residency
and a fellowship in physical medicine and rehabilitation at the University of Virginia Hospitals.
Dr. Gardner is board-certified in dermatology. He earned his medical degree from
Vanderbilt University School of Medicine and
completed his residency in internal medicine
at Washington University School of Medicine.
He completed a residency in dermatology at
Duke University Medical Center and a fellowship in procedural
dermatology at Methodist Hospital in Houston.
Ryan Pitts, MD
Dr. Pitts is board-certified in orthopedic surgery.
He earned his medical degree from St. Louis
University School of Medicine. Dr. Pitts
completed a combined internship/residency
in orthopedic surgery at the Mayo Clinic and
a fellowship in sports medicine at Washington
University School of Medicine.
September - November 2012 new to staff
The following practitioners have joined the Missouri Baptist medical staff:
Helen M. Blake, MD
Pain Medicine
Brett W. Hronek, MD
Internal Medicine
Janice L. Reed, MD
Obstetrics/Gynecology
Kaylea M. Boutwell, MD
Pain Medicine
Christopher Hueser, DO
Hematology/Oncology
Ashley A. Ryan, MD
Obstetrics/Gynecology
Anthony Boyer, MD
Critical Care Medicine
Vincent Q. Joe, MD
Radiation Oncology
Donna N. Senciboy, DO
Obstetrics/Gynecology
Daniel Brown, MD
Critical Care Medicine
Brian C. Keller, MD, PhD
Critical Care Medicine
Aline T. Tanios, MD
Pediatrics/WU
Kelley S. Caddel, MD
Pediatrics
Jad A. Khoury, MD
Infectious Disease
Scott Wasserstrom, MD
Internal Medicine
Timothy J. Casper, MD
Pediatrics/WU
Christopher P. Lawrance, MD
Surgery/CVR Unit
Erin S. Gardner, MD
Dermatology
Maggie S. McCormick, MD
Pediatrics
A Commitment to Care
3015 North Ballas Road, St. Louis, MO 63131
Phone 314-996-5000
©2013 Missouri Baptist Medical Center.
MedStaff News submissions
If you have any suggestions or submissions, please call
Jo Anne Meives, 314-996-7573. You may FAX the
information to 314-996-5962, or email information to:
jam9937@bjc.org