the observer

TEXAS MEDICAL AUDITORS ASSOCIATION
THE OBSERVER
Volume 125
November, 2012
President’s Message
Incoming TMAA President Planning for Future
TMAA is an impressive organization with more than two and a half decades of tenure. A statistic that
other organizations would find enviable is the fact that more than 50% of our members consistently attend the annual conference. Yes, we are a small group, but that makes the statistic that much more
amazing!
Would you believe that plans are already under way for the 2013 conference? Our Board of Directors
makes it look easy, but it takes a lot of collaboration and coordination to make it happen.
Some changes in the works to facilitate the planning process for the future include the following:
•
TMAA will be obtaining a teleconference line which will allow the Board to communicate more
frequently and at a very reasonable cost.
•
The dates for the next two conferences have been selected. We are in the process of finalizing a
hotel contract for next year. As soon as we get that one done, we will begin work on locking in a
place for 2014.

Program planning for next year will begin in November. Selecting topics and approaching speakers
with expertise in these areas will hopefully result in early commitments. This will in turn allow us to
begin work on the application to obtain continuing education credits. Spreading out the process of
putting together the application will make it a lot less taxing for our Education Committee.
By the way, assistance is still needed for this endeavor. If you’ve got a BSN or RN, love to collaborate with other professionals, and have a great time doing it, I would like to talk with you.
All-in-all, your 2013 Board has a good handle on what needs to be done to stage another
successful conference. If you have ideas for conference topics or speakers, please reach out
to me or your Program Committee – Hortense Gamez and Cathy Dunne.
Shonna Macaulay, RN, BSN, CCM
President
Our dear friend Maria J Petz recently passed away. The next issue of the Observer will be dedicated to this
very special lady. I am inviting everyone to send me a memory, a story, a special moment, photos, something you just want to share to be a tribute in her memory. She still lives in our hearts, and how wonderful it
will be to bring all of our wonderful memories together!
Please send your information to josefsen@ix.netcom.com
Maria J. Petz, RN, CMAS
Longtime Texas resident, Maria Petz, a nurse who loved to travel, died from her second
bout with cancer on Wednesday, October 31, 2012. She was 68. She was the widow of
retired DEA Special Agent David Petz. Maria was born in Germany in April 1945.
She came to the United States in 1949 on the US military transport ship, "General Blatchford." That was her first time on Ellis Island. Eventually with her parents she settled in
Chicago via Chazy, New York and Connecticut. After graduating high school she traveled west to El Paso where she received her diploma at Hotel Dieu School of Nursing.
There she fell under the spell of the West and never stayed away for long.
She made friends easily and those friendships lasted her lifetime. While in El Paso, Maria met her first husband,
Rich Baughman, who helped her grow her circle of friends. They had great moments together until Rich died from
heart disease.
Maria busied herself with running a business and nursing. She was an avid reader and a lover of animals. Her pets
were an important part of her family. She eventually met David Petz, who was a Special Agent with the Drug Enforcement Administration stationed with the El Paso Intelligence Center. Not long after they married David was
transferred to the DEA Dallas Division and they settled in Carrollton, Texas. Maria continued nursing, teaching
nursing and eventually found herself hospital bill auditing. She worked both on internal hospital bill auditing and
external for companies such as Equifax, National Healthcare Review and as an independent consultant. She was
qualified as an expert witness in Texas courts.
In 1989 Maria joined the Texas Medical Auditors Association and grew into the positions afforded her. She was a
Vice-President then President of the Metroplex Chapter TMAA. She was also on the Board of Directors for both
TMAA and the American Association of Medical Audit Specialists. Maria truly believed in the value and benefit
of these organizations and contributed to their success to the best of her abilities and available energy.
n 2004 Maria was diagnosed with colon cancer and fought it with months of chemotherapy which caused her
much pain and discomfort from the side effects. The treatment was somewhat successful and Maria had some respite for three years. In 2007 Maria underwent surgery for pancreatic tumors.
In January of 2009 Maria was widowed again when David died in the hospital of coronary disease. Then, in 2010
the cancer found a new home in her lungs. By this time Maria was physically and emotionally exhausted. She still
was able to put on a happy face. Everyone who knew her loved her dearly.
She is survived by her brother Joseph Petrauskas, his wife Yanira, her sister Barbara Ann Graupman with husband, Mark, aunt, uncle and cousins and her many friends who were like family each and every one.
Family members suggest that in lieu of flowers contributions be made to the:
Drug Enforcement Administration Survivors Benefit Fund:
DEA Survivors Benefit Fund
2020 Pennsylvania Avenue, NW Suite 659
Washington, D.C. 20006 https://www.deamemorial.org
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From the Past President
From the Event Coordinator
Well this is my last article to submit as the Event
Another conference is over, and as I am looking over Coordinator and I do have to say that it has been
the evaluation forms and comments it is obvious the a pleasure to work with you and the fellow board
conference was successful. We do value your members through the years.
evaluations and comments so we can continue to
build and provide the best possible conference to I have developed many friendships and learned a
meet the needs of our membership. I will be sharing great deal through this process. Planning an
your suggestions and comments with Shonna and the event is a little scary because you never know
Board members. Should any of you have suggestion what might happen. You could have every little
or education needs to improve your auditing skills or thing planned and documented with the hotel and
understanding new regulations, please contact then things still happen, for example, the audioShonna so her team can build on your requests for visual issues we had at this past confernext year.
ence. Even though the tables were a little
crowded, having everyone there was such a speI want to thank all of the board members and volun- cial treat!
teers for all their hard work during the conference. They did a wonderful job, and went way be- Our goal was that the overall conference package
yond their positions to make this the best conference was a positive experience and you felt you repossible. A thank you goes also to our wonderful ceived a cost effective and quality annual conferspeakers. Each brought a unique presentation to pro- ence. That is what the board members strive to
vide a well rounded conference.
provide to their members. So I pass the torch to
Three of our key board members—Genene Miller,
Joyce Allen, and Susan Guarrine are retiring after
many, many years of serving on the TMAA
board. We are so grateful for their guidance, mentoring, and for the many hours they have so graciously
given.
This an exciting time for the new board. I know under Shanna's direction, the Board will continue to
provide the best continue education conferences for
TMAA.
Nicole Cormier now and wish her the best of luck
in her future planning.
Take care and hope to see you next year!
Genene Miller, RHIT, CMAS
Event Coordinator
Thank all of you that attended, we appreciate you
coming and I for one can't wait until next fall for the
Mark your calendars now for the 2013 TMAA Conference
next conference to see all of you again.
Have a wonderful year!
Neta Morse, RN, BSN, MS, CMAS
Past President
Wishing everyone
A wonderful
holiday season
and a very
Happy New Year!
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that will be held in Dallas, TX! The dates are September
26-27.
There are so many talented members of the TMAA and it
would be wonderful to have presentations from you! Please
be thinking about what you would like to present-or would
like to have to be presented– and contact Shonna, Cathy, or
Hortense with your ideas.
If you have years of experience or are new to this world of
auditing, we want to hear your thoughts, ideas, questions,
recommendations and comments.
Your participation does make a difference!
It was great seeing everyone at the conference this year. For our members who could not make it, hope
to see you next year. This annual conference is a great way to keep up with friends, professional contacts, meet new people who share our interests and obtain needed credits for Nursing or CMAS certification. The Conference was still in progress and the new Board was already busy securing a hotel, and
discussing topics/potential speakers for 2013. It is very exciting to see so many new Board Members
who I am sure will bring new & refreshing talent & ideas with them to help continue the success of our
organization.
On behalf of the Board & general membership I would again like to express our gratitude to National
Audit>SCIO Health Analytics who for many years have generously supported TMAA.
We will continue our quest to obtain corporate support for our conferences and seek others who are willing to help TMAA provide the best programs possible for our members.
I am seeking input from our members to provide any companies, facilities or groups who may be willing
to support our conference. Please email your suggestions or contact information to nancyk1944@att.net
I wish each of you great Blessings for 2013.
Nancy Kaiserman, RN, CMAS
Vice President, Marketing Chairperson
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From the Secretary
Hello All,
TMAA Conference for 2012, The Trauma and Drama
of Medical Auditing” was a great meeting. It was a
joy seeing everyone there.
The speakers were awesome and the business meeting
went as planned. We dearly missed those who could
not be with us this year especially Maria Petz and Eileen Betzen. Please keep all our friends that are in
need in your prayers.
The Board is already planning for next year’s conference which will also be a great success with our new
presidency leading the way.
Don’t forget to get your articles turned in to Laura in a
timely manner a week before the newsletter goes out.
The TMAA Newsletter schedule for the rest of the
year is February 1st, May 1st, August 1st, and November 1st.
Have a wonderful
and safe
holiday!!!
Wanda Webb, RN
Secretary
From the Membership Chair
Let’s do a wrap up of 2012. We have a total of 93 members which
is slightly lower than the last few years. It seems we have several
members that are officially retiring and others not renewing due to
work reduction. We have 89 members information printed in the
directory and 4 more members information are enclosed in this
newsletter. Please remove that page and add it to your directory.
This will help keep us connected thru out the year.
By now everyone should have received your 2012 TMAA directory
and membership card. If you didn’t please contact me. Your membership will end December 31, 2012. Renewal letters will be sent
out in January 2013 for the new year. When you fill out your 2013
application please be sure and add all your credentials. This is very
helpful for the president and board when filling committee positions.
Membership this year did include members outside of Texas. We
had members join us from Alabama, California, Florida, Illinois,
New Mexico, and South Carolina. I would like to welcome all our
new members that joined TMAA this year:
Irene Bozzini of California
Mickey Brittingham of California
Jennifer Buchan of California
Marilyn Gerhardt of California
Margaret Giles of California
Jerry Lee Hubbard of Missouri City, Texas
Jing Kainer of Houston, Texas
Linda Kraft-Soniat of Houston, Texas
Angela Lenox of Houston, Texas
Bridgette McCullough of California
Diane Hope Nathan of California
Delia Rhoads of Houston, Texas
Jeanne Rozak of California
Jacqueline Schau of Magnolia, Texas
From the Nominations Chair
We hope you will continue your journey with us in TMAA in the
coming year.
The 2012 TMAA meeting was a chance for all of us
to appreciate what each has done both " in the field
" as they say and also those who are within the hallowed cubicles.
I would also like to acknowledge Barbara Thompson, a long
standing TMAA members who has truly retired from auditing and
no longer plans to attend TMAA functions. She was active members on the Board of TMAA for years and even held the office of
Presidency. We cannot thank her enough for all the years of service and leadership she gave over the years. We thank you and
wish you well.
My most sincere thanks to all who so graciously
have accepted to continue their present positions
(Nancy/Wanda) and of course, our newest Treasurer, Linda Hempfling.
We also have several members that are suffering with health issues,
having family problems and/or facing a reduction in jobs, so please
keep each of them in your thoughts and prayers. We are like family
to each other and wish only good fortune to each of you.
In the coming weeks I will be reviewing all who
have indicated an interest in serving on various
committees and also those who might want to take a
"mighty step" into a Board position.
Please consider where you feel you will be most
beneficial and benefited by this organization.
Deborah Hewitt
Nominations Chair
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Enjoy the rest of the year and have a great holiday season. I’ll be
back in January to remind you to renew your membership.
Take care everyone.
Debbie Bradddock
Membership Chairperson
NOTE: Website is under construction… check back for updates
Debbie Braddock—Website Coordinator
The Un-Comfort Zone
everybody has seen and thinking what nobody has
thought.”
- With Robert Wilson
What’s Holding You Back?
I noticed the training wheels on my son’s bike were
no longer touching the ground. He was riding without them. “Let’s take those off,” I said.
“No Daddy, I’m not ready.”
“Sure you are; let’s give it a try.”
After I removed them, he got on the bike, but couldn’t get enough momentum to stay up and fell right
over. “See Daddy, I can’t do it. Put them back on.”
“Let’s try it again, this time I’ll push.” I grabbed the
back of the seat and started pushing him. He was
pedaling and riding perfectly, and I was having to
run as fast as I could to continue holding the seat.
“You’re doing it!” I cried. “I’m going to let go
now.”
“No Daddy, don’t let go. I can’t do it.”
I let go, and he stopped pedaling. The bike rolled a
few more feet, began to wobble, then fell over.
“I can’t do it. Daddy, please put the training wheels
back on.”
He couldn’t see what I saw: that he was already riding without them. He was like a circus elephant tied
to a stake in the ground. That elephant is strong
enough to push over a tree, yet because she was tied
to a stake as a baby - when she wasn’t strong
enough to pull it up - she continues to believe it
can’t be done.
Greek Stoic philosopher, Epictetus, observed in the
first century: “Men are disturbed not by things, but
by the view which they take of them.” I’d like to
rephrase that, “We are held back by our perception
of things.”
When we encounter challenges in life, we attempt to
resolve them with what we know to be true. When
that doesn’t work we’re stumped. Today in business
we’re stumped by recession, international competition, high taxes and government regulation. We’re
boxed in.
We need to follow the advice of Albert Gyorgyi, the
Nobel Prize winning scientist, who discovered vitamin C, “Discovery consists of seeing what
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Easier said than done. The trick to “thinking what nobody has thought,” begins with changing our perception. Again, easier said than done. The trick to changing your perception can be accomplished by changing
your perspective... changing the view which you take
of things.
In the classic motion picture, The Dead Poet’s Society,
an English teacher has his students stand on their
desks to change their perspective. He says, “we must
constantly look at things in different ways.”
You can read a dozen books on how to think creatively, and each of the techniques you learn will be to
accomplish just one thing: changing the way you look
at the problem. By looking at it from a different perspective, you will begin to see different solutions.
With my son, I continued to push the bike and run as
fast as I could. After falling down a few more times,
he finally got it, and was able to ride on his own. I
would have given anything to spare him the pain and
the tears.
Someone else, much more creative than me, saw the
problem from a different perspective and came up with
a better solution. It is called the “balance bike.” Seeing
that children became dependent on training wheels,
this unknown person asked the question, “What if, I
didn’t have training wheels?”
The solution was to take the pedals off, and let children learn to balance on the bike first by walking it
along. As the children’s skills improve, they will
lengthen their strides until they can lift their feet off
the ground and coast. Once this is accomplished, the
pedals can be put back on the bike, and the problem of
becoming dependent on training wheels is eliminated.
It is human nature to constantly improve the way we
do things. If the traditional way of doing things isn’t
working for you, then change your perception. Ask
yourself what you would do if the current solution did
not exist. Now you’re looking at it from a different
perspective. You’ll be amazed with what you will
come up with!
Robert Evans Wilson, Jr. is an author, speaker and
humorist. He works with companies that want to be
more competitive and with people who want to think
like innovators. For more information on Robert,
please visit http://www.jumpstartyourmeeting.com
BOARD OF DIRECTORS
Newsletter Editor
PRESIDENT
Shonna Macaulay CMAS
shonnamac@me.com
210 386-7593
VICE PRESIDENT/MARKETING
Nancy Kaiserman, CMAS
nancyk1944@att.net
972 250-6636
SECRETARY
Wanda Webb
nwjw02@sleh.com
713 855-8085
TREASURER
Linda Hempfling
linda.hempfling@att.net
713 729-7303
PAST PRESIDENT
Neta Morse, CMAS
netamorse60@att.net
817 312-2629
BYLAWS & STANDARDS
Linda Hutchinson
biznurse@satx.it.rr.com
Mary Barrientos
barrientos@gmail.com
210 497-7627
EDUCATION
956 364-0440
EVENT COORDINATOR
Nicole Cormier
ancormier@yahoo.com
409-284-4827
HISTORIAN
Terri Harding
theresa_harding@equiclaim.com
Debbie Braddock
dlbraddoc@baptisthealth.com
972-965-7316
MEMBERSHIP/WEB
210-341-7900
NOMINATING
Debbie Hewitt
hewittd@sbcglobal.net
Cathy Dunne
cthydunne@yahoo.com
My nursing career has been wonderful because working in
all sizes/types of hospitals all over the country has given
me opportunities that I would not have had staying in one
place.
I never thought about being a nurse when I was growing
up. I took accounting my first two years of college. A
family physician needed a front office person one summer,
and talked me into working for him in his office. The rest,
as they say, is history. I have been an RN for over 40
years and have loved it every day. I am amazed that I got
paid for doing what I love to do!
In 1982 I was given another opportunity -I was asked by a
physician if I would like to start a hyperbaric unit with him
at the hospital we were at. I said “sure—and what is hyperbaric medicine?” From there, I was a founding member
of the Baromedical Nurses Association (1985), helped
determine standards of care for hyperbaric nursing, was
instrumental in the development and served as Chairman
of the BNA Certification Board. I wrote questions for
certification exam, and took very the first exam in 1995.
In 2010, my committee and I rewrote the test questions. I
am currently on the UHMS (Undersea and Hyperbaric
Medical Society) Board of Directors as Nurse Representative., as well as being a nurse surveyor for the UHMS Accreditation Team. This Accreditation process is Complimentary Arm of The Joint Commission. I am a published
author and an international speaker. I am co-editor of
Hyperbaric Nursing and Wound Care published in 2010
by Best Publishing Company .
Newsletter
281 685-8111
From the Newsletter Editor–
New Feature: Member Spotlight
This is the first of a regular series to spotlight members of the
TMAA! I would like to do a spotlight of a member(s) in
each edition of the newsletter. What a great way for us to get
to know each other! I encourage you to submit yourself or a
member to my email address at Josefsen@ix.netcom.com.
There is no particular format– submit whatever works!
The opinions expressed in The Observer are those of the authors or persons quoted. They do not necessarily reflect the
views of the TMAA Board of Directors
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My family and I have been in Texas since 1998. Prior to
that, I have moved every few years my whole life. I loved
the lifestyle of moving frequently! Now I love living in
Texas and we plan to stay here. Because we moved so
frequently, we get the urge to take everything out of the
closets and cupboards about every 3 years. My husband
even redesigns our yard every 3 years. It is so great– we
go through things and take out what hasn’t been used for
over a year. We do not accumulate things and it is so liberating. We are so blessed to have 2 daughters and 4
grandchildren—and they all live in Texas so we get to see
them often.
972 837-7772
lovettadkins@sbcglobal.net
josefsen@ix.netcom.com
I joined the TMAA at last years’ (2011) annual meeting,
and was so impressed with everyone that I said yes when
asked if I would be newsletter editor.
I started as a med/surgical staff nurse for about 2 years,
then went into ICU/ER nursing for many awesome years.
Do you know that I even set up an Open Heart Unit?
PARLIAMENTARIAN
Laura Josefsen
First member spotlight– Laura Josefsen, RN, ACHRN
713 202-5503
PROGRAM
Joyce Lovett-Adkins
(continued)
My nursing career involves years of management, very
active in quality improvement, documentation, education,
and developing processes for improvement.
I have had the title of nurse auditor for 16 months and am
so thankful for my mentors-Kathy Riehl, Wanda Webb,
Matt McKeon, Louise Allen, Wergena White, and
Debra Moore for their continued support and encouragement!
Texas Medical Auditors Association (TMAA)
Laura Josefsen, Newsletter Editor
23 Tudor Glen Place
Woodlands, Texas 77382
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From the Editor
Documentation: Does it reflect practice?
by Laura Josefsen, RN, ACHRN
Presentation at GCC Meeting
The goals of documentation are clinical assessment and communication. It is the tool to validate clinical practice. The right tool
will manage the information that guides decisions by optimizing
clinical practice, represents consensus of the multidisciplinary
team, and measures costs(1).
The goals for better documentation include decrease duplication in
charting, better utilization of clinician time, enhance patient outcomes through communication of all members of the team, evaluate and improve current documentation tools, and education processes for better documentation.
So why don’t we like to document? Documentation is a source of
frustration—it takes time away from patient care, has duplication,
and is not perceived as clinically valuable.
So.. What do we need to recognize? The chart is “no longer just a
place to write information”. We no longer have the luxury of saying “charting is taking away from the time I could be using for
patient care.”
What is different now than from a few years ago? Transparency.
It is multidisciplinary, patients are able to see report cards on-line,
as well as on-line health information.
What do we need to know? Remember that health care is a business and that payment is determined by third party payers upon
evaluation of the documentation.
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Clear documentation is essential—chart audits are performed by
clinical as well as nonclinical auditors. Documentation has to be
understood by everyone involved with that chart. Documentation
should be accurate, objective, timely, and use only approved abbreviations. Legibility is critical—if it cannot be read, it does not exist.
Chart reviews will not guess.
The order of the chart should be consistent, accessible and orderly.
Organized documentation leads to less duplication, saves time, is
more thorough, information is readily obtainable, increased reimbursement, and decreased costs due to efficiency. The perception is
that the quality of documentation equates to the quality of care.
The reason for audits: patient care is becoming increasingly multidisciplinary, communicate historic, current and accurate information,
and this information is the guide to the treatment of the patient.
Good documentation may decrease healthcare costs by better ability
to mange the information that guides the entire process of the interdisciplinary team, and is able to monitor quality of care and cost
issues.
Our goal is quality care. Documentation is evaluated by quality improvement measures. It is a continually changing process.
Peter Gladkin "Success means having the right tools to make decisions - healthcare enterprise network
technology". Health Management Technology.
Keenan, et al Documentation and the Nurse Care Planning Process, available at Patient Safety &
Quality: An Evidence based Handbook for Nurses AHRQ Publication No 08-0043 April 2008
Stetsona, P et al Preliminary Development of the Physician Documentation Quality Instrument Original
Investigation JAMIA 2008;15:534-541 doi:10.1197/jamia.M2404