This Month's Forum - Rochester General Health System

F
RGH MDS ELECTED
REPRESENTATIVES
Derek tenhoopen, md
President
Kevin Casey, MD
President-Elect
Cynthia Christy, MD
Secretary
Ronald Sham, MD
Treasurer
MAURICE VAUGHAN, MD
Past President
Elected Representatives:
Matthew Fleig, MD
John Hix, MD
Claudia Hriesik, MD
Kevin McGrody, MD
James Szalados, MD
Balazs Zsenits, MD
Editorial Staff:
Derek tenHoopen, MD, Editor
DIRECT ADMISSION NUMBER:
922-7333
CALL THE HOSPITALIST FOR YOUR PATIENT
922-7444
2014 Quarterly Staff Dates
• December 19
2015 Quarterly Staff Dates
• March 20
• September 18
• June 19
• December 18
Twig Conference Room
7:30 – 8:30 a.m. for all meetings
50% attendance recommended
for all attending Physicians
orum
December 2014
a newsletter by the medical & dental staff of Roch general hospital
more of your monthly updates can be found at
http://www.rochestergeneral.org/healthcare-professionals/medical-and-dental-staff-mds/
Message from RGH MDS President
Rochester Regional Health System:
Can we be a Disruptive Innovator?
Derek tenHoopen, MD, RGH MDS President
W
ith the arrival of the Rochester Regional
Health System’s new President and CEO,
Dr. Eric Bieber, a fresh perspective and
perhaps a new approach to RRHS’s focus and
mission may be in the offing. His hire, coupled
with the rapidity of health care change, made
me wonder: Is this an opportunity for Disruptive
Innovation?
Disruptive Innovation was a term first coined
Derek tenHoopen, md
by Harvard professor Clayton Christenson. The
RGH MDS President
theory explains the phenomenon by which an
innovation transforms an existing market or sector by introducing
simplicity, convenience, accessibility, and affordability where
complication and high cost are the status quo. It is crucial to remember
that disruption is a positive force. Disruptive innovations are not
breakthrough technologies, but rather ideas that make good products
better and services more accessible and affordable, thereby making
them more available to a much larger population.
Initially, a disruptive innovation is formed in a niche market that
may appear unattractive or inconsequential to industry incumbents, but
eventually the new product or idea completely redefines the industry.
Often cited examples are the personal computer, the Ford Model T and
most recently the smart phone.
When extrapolating to our industry, disruptive innovations in health
care are the development and implementation of ideas that have
the potential to decrease costs while improving both the quality and
accessibility of care.
Continued on page 2.
Disruptive Innovator, continued
What defines a high-performing health
system in 2014?
In the background that health care spending
in the USA was on an unsustainable trajectory, the
definition has shifted to Integrated Health Care
Delivery Systems. It is believed that this model can
successfully incorporate value and affordability
with better patient outcomes (the often cited Triple
Aim). However, complicating this picture is the
fact that while it is true that a handful of integrated
health systems are decisively outpacing their peers
across nearly all quality and cost measures (ie the
often cited Geisinger Health System), attempts to
expand or replicate them in new markets often fail.
Furthermore, even within the category of integrated
health systems, the range of performance varies
widely, with some lagging far behind despite
possessing what seemed to be the key ingredients
for success. There are a variety of explanations
published for why only some integrated systems
have risen to the top—many of them unsatisfying,
seemingly incomplete, or sometimes even
contradictory. A few explanations include culture,
leadership, the unique community it serves, or the
size of the organization itself.
Published reports support the following “
innovations” that often contribute to success:
1. Documenting best practices
2. Implementing Health IT across the entire system
3. Validating the importance of expanding the
scopes of practice of various clinical staff
4. Detailing the patient experience within the
integrated delivery system
5. Highlighting, assessing , and incorporating the
relative success of innovations already underway at
other integrated systems
Rochester Regional Health System, by all
definitions, seems to have the necessary ingredients
in place. As pay-for-performance, capitation and
bundled payments replace the fee-for-service model
that has been in place for decades, it will not be an
easy task. As we make the transition from Curve 1 to
Curve 2, the System needs to think outside the box
and innovate as never before.
Bibliography
• Vineeta Vijayaraghavan. “Disruptive Innovation in Integrated
Care Delivery Systems”. Innosight Institute. October 2011
• Clayton M. Christensen. “The Innovator’s Dilemma”. 1997
Care Connect Contact List
Who can you contact to discuss Care Connect improvements? If your dept or specialty is not identified –
give Dr. Robert Biernbaum a call.
Medical Informaticists
Specialty
Medical Informaticists
Specialty
Cafarell Robert
Anesthesia
Alcantara, Jose
Internal Medicine/Hospitalist
Butterer, Elizabeth
Cardiac Services
Zsenits, Balazs
McGrody, Kevin
Cardiac Services
Internal Medicine/
Hospitalist/Paliative Care
Biernabum, Robert
CMIO
Vargas, Roberto
Lab/Pathology
Sondhi, Damanpaul
Critical Care/Pulmonology
Cabral, Paul
OB/GYN
Keyes, Michael
Emergency Medcine
Kaplan, Cara
Orthopedics
Huynh, Thuc
Family Medicine
Mullin, Suzanne
Pediatrics
Casey, Kevin
Gastroenterology
Yamshchikov,
Alexandra
Infectious Disease
Salamone, Jane
Internal Medicine
Yawman, Daniel
Sinkin, Adam
Varland, Elizabeth
Tubolino, Melissa
Pediatrics
Radiology
SICU
Surgical Services
Alag, Karan
Internal Medicine/Hospitalist
2
Rochester General Hospital Medical and Dental Staff FORUM
REMINDER
New York State Care Connect Registration
for Electronic Prescribing of Controlled
Substances (EPCS)
Robert Biernbaum, D.O., Chief Medical Information Officer, Rochester Regional Health System
In early November, those of you who have registered
your DEA Certificate as part of your RGH/NWCH
MDS Membership were sent an EPCS packet with
the following information:
Effective March 27, 2013, amendments to
Title 10 NYCRR Part 80 Rules and Regulations on
Controlled Substances authorize practitioners in
New York State to issue electronic prescriptions
for controlled substances in Schedules II through
V. These regulations require practitioners to use
electronic prescribing applications consistent with
Federal requirements and to register their certified
electronic prescribing applications with the New
York State Department of Health, Bureau of Narcotic
Enforcement.
Please note that, as of March 27, 2015,
electronic prescribing of both controlled and noncontrolled substances will be mandatory for all NYS
practitioners (excluding veterinarians). We have
established the below process to assist you with
your Rochester Regional Health System Epic/Care
Connect registration. If you use additional electronic
prescribing applications in the community, and plan
to continue to do so beyond March 27, 2015, you will
need to follow a similar registration process for those
applications as well.
I wish to remind you that failure to complete this
registration process means you will not be able to
prescribe controlled substances via Care Connect
after March 27, 2015.
Electronic Registration:
All practitioners except Physician Assistants may
register electronically, using Registration for Official
Prescriptions and E-Prescribing Systems (ROPES).
ROPES instructions were included in your packet.
Once you have received confirmation of successful
registration, please notify the RGH Medical and
Dental Staff Office via email (EPCSRegistration@
rochestergeneral.org). This process must be
completed by 12/31/2014.
Registration via Mail:
If you are a Physician Assistant, or do not wish to
register electronically, you must complete the forms
included in your packet and return them to the RGH
Medical and Dental Staff Office in the envelope
provided. You may also return your forms via fax
(to Mary Lou McKeown, 585-922-4778) or email
(EPCSRegistration@rochestergeneral.org). These
materials must be returned by 12/31/2014. We
will submit your completed forms to the New York
State Department of Health, Bureau of Narcotic
Enforcement on your behalf.
If you do not prescribe controlled substances,
you will still be required to prescribe electronically
effective March 27, 2015; however, you do not need
to register. Conversely, if you prescribe controlled
substances and did not receive your packet,
please contact us via email (EPCSRegistration@
rochestergeneral.org) to request forms or ROPES
instructions.
After initial registration, NYS is also requiring
periodic attestations to coincide with software
updates. We will communicate with you when this
needs to occur.
Should you have any questions, or need
assistance with your Supervising Physician form,
please contact Mary Lou McKeown at 585-922-4259.
3
Interim RGH Chief
Nursing Officer
Announcement
Doug Stewart, Psy.D, President, Rochester General
and Unity Hospital
As we shared back in
June, Cheryl Sheridan,
B.S., R.N., M.P.A.,
N.E.A.-B.C., Chief
Nursing Officer for
Rochester General
Hospital (RGH) and
legacy Rochester
General Health System
(RGHS), will be retiring
at the end of this
year. In support of
Gloria Berent, R.N., B.S.N.,
this transition, I am
M.S., N.E.A.-B.C., RGH Interim
Chief Nursing Officer
pleased to announce
that effective January
1, 2015, Gloria Berent, R.N., B.S.N., M.S., N.E.A.B.C., Director of Nursing for RGH, will become
Interim Chief Nursing Officer for Rochester
General Hospital, reporting to me.
Gloria received her B.S. in Nursing and M.S.
in Health Administration from Roberts Wesleyan
College.
As the Director of Nursing, Gloria was most
recently responsible for Surgical Services, GI/
Endoscopy, Critical Care and Acute Care. She has
held several key clinical and leadership positions
in her 15 years at RGH. In her new role, Gloria will
be responsible for leading Patient Care services,
including inpatient and ambulatory Nursing, Social
Work, Care Management and Pastoral Care.
Once the new Rochester Regional Health
System CNO has been hired and fully acclimated,
we will conduct a full assessment, search and
selection process for the permanent RGH CNO
role later in 2015. This will enable our new System
CNO to play an active part in the evaluation and
selection process for this vital nursing leadership
position at Rochester Regional.
Details regarding coverage for Gloria’s
current role will be forthcoming. Please join me in
congratulating and wishing her all the best on this
upcoming new position!
4
Introducing
MedStaffConnect for
Rochester Regional
Health System
Rochester General Medical and Dental Staff and
Unity Medical Staff can now take advantage of a
mobile-friendly online portal designed to keep you
up-to-date on what’s happening within the Health
System.
This online portal gives you instant access
to:
• The latest news and updates on the clinical
integration process, new programs and more
• Announcements of new medical staff members
– see who’s recently joined our team
• Calendar of events
• Education and training opportunities, with
helpful links
• Referral assistance, including full-color PDFs for
various service lines
You can access the site at MedStaffConnect.com If
haven’t used MedStaffConnect yet, it’s easy to get
started:
1. Go to medstaffconnect.com on a computer or
mobile device.
2. Log in with your Rochester General Care Connect
ID or Unity network ID and password.
If you need help — or have forgotten your ID or
password — just call the:
• Rochester General Help Desk at (585) 922-HELP
(4357) or
• Unity Help Desk at (585) 368-3375
Be sure that you make the most of this valuable
new communication tool!
Follow us on Twitter @MedStaffConnect
Rochester General Hospital Medical and Dental Staff FORUM
CDIP CORNER
Continuity of Documentation
By Kim Miller, RHIT, CCDS
As during an inpatient admission there sometimes
is a change in the attending or mid-level coverage,
there also may be gaps in carrying through
documentation of a diagnosis that was addressed
by the prior covering attending and team. An
example would be a condition that was diagnosed
and treated in the ER, which does not require
further treatment during the remainder of the
admission. Also, these conditions may not be
referenced in the Discharge Summary.
Any gap in documentation may be targeted by
auditors and payers. For a more specific example:
a patient presents in early sepsis, just meets two of
four SIRS criteria, sepsis is included as a differential
diagnosis in the ER, antibiotics started, with a
quick and successful response to treatment. Sepsis
is documented once more in the H&P, then not
mentioned again, with the primary focus during the
rest of the admission on the underlying infection
causing the sepsis, and any comorbid conditions.
A payer may try to argue sepsis was not present,
possibly attributing the SIRS indicators to other
conditions present (tachycardia due to chronic
a-fib or dehydration; fever due to the underlying
infection only as examples.)
In this case, a follow-up statement of “sepsis,
treated and resolved” or “SIRS resolved,
continue antibiotic treatment for sepsis” provides
confirmation that sepsis was present and treated.
Remembering to include all evaluated, monitored
or treated diagnoses on the Active Problem List
(marking as resolved when appropriate) and
referencing all in the Discharge Summary provides
an accurate picture of the admission, allows for
efficient coding and billing, and protects the
account against a denial.
Another scenario includes inconsistent
statements: one note states acute renal failure,
another states renal insufficiency. Perhaps
a concurrent CDI was generated, with the
response clarifying acute renal failure; then later
documentation by another covering provider states
renal insufficiency. This type of inconsistency is
also scrutinized by auditors. Updating the Active
Problem list will allow a later covering provider
to quickly see the diagnosis confirmed earlier
in the admission, and adds to the continuity for
the appropriate diagnosis to be carried through
subsequent notes.
Accurate, consistent documentation of the
appropriate diagnoses provides for reflection of our
high quality of care as captured by the ICD code
assignment, and translation into both the provider’s
and the hospital’s public
profiles.
Congratulations to
Please contact your
Dr. Michael Gurell
CDI team at 922-3721,
who
was selected by
in person on the units, or
CDI as the November
via email at cdiquestions.
Documenter of the
rochestergeneral.org
Month!
for your documentation
questions.
2015
2015 quarterly staff meetings
March 20, June 19, September 18, December 18
7:30 – 9:00 am • Twig
5
GRIPA’s Website
If you haven’t been to the GRIPA.
org web site lately, it’s worth a look.
Users are provided a wealth of information that
they may not have access to anywhere else. The site is
valuable to all GRIPA stakeholders including physicians,
patients, employers, and interested community
members. Additionally, there is a section for Cognisight
as well as the RGHS ACO, our System’s Medicare
Shared Savings Plan Accountable Care Organization.
A brief tour of the GRIPA.org web site starts with
the home page. On this page, users can select from
the 6 clearly marked tabs across the top of the screen
that easily direct viewers to the site location that most
interests them. And, even before selecting a tab,
users can quickly understand what GRIPA is and learn
more about the Care for Health Accountable Care
Partnership. Additionally, on the Home page are links
to read more about GRIPA’s Advance Advisory Opinion
from the Federal Trade Commission addressing its
Clinical Integration Program as well as the 2013 Value
Report.
A deeper dive into GRIPA’s program is highly
encouraged and can be done by selecting one of the 6
tabs at the top of the page. The first tab, About GRIPA
includes information about GRIPA’s inception and
includes a variety of links to the different hospitals with
which GRIPA is affiliated. Also, on this page is a link to
GRIPA News which lists all the articles and presentation
from GRIPA and its experienced staff members as well
as article about GRIPA included in local and national
publications.
A wealth of additional information about GRIPA’s
clinical programs for patients and physicians can
be found on the Physicians and Patients tabs. The
Physicians page includes a discussion regarding
GRIPA’s Care Management Program with the focus
on the activities GRIPA undertakes. The Patients tab
offers a listing of the Care Managers with their pictures
and email address information. Interested patients also
have the ability to view many ‘success stories’ of other
patients who engaged with GRIPA’s Care Management
and as a result overcame clinical challenges. There are
also resources on over 35 separate topics including
various chronic conditions, diseases, wellness, and
others just to name a few.
Another tab on the Home page is dedicated
6
gripa.org
to Employers and
Brokers. GRIPA has a
robust service offering
to employers to help
better manage the
health of their respective
populations. GRIPA
currently works with
LiDestri Food and
Beverage, The Rochester
Regional Health
System, and Monroe
County. GRIPA representatives meet frequently with
the employer representatives to discuss the GRIPA
program and report on its effectiveness with these
populations. This web site page provides significantly
more information about the employer program and we
encourage you to read it.
The last 2 tabs on the GRIPA Home page for
Cognisight and Rochester General Accountable Care
Organization, Inc. (RGHS ACO) highlight the separate
organizations within GRIPA. Cognisight is a rapidly
growing risk adjustment vendor with clients in many
states. The RGHS ACO is one of 123 organizations
accepted in 2014 by CMS as an Accountable Care
Organization for the Medicare Shared Savings Program.
GRIPA is very pleased with both organizations and more
information can be found on the web site.
We hope you agree there is a lot to GRIPA and
we encourage you to learn more about this unique
organization by visiting the web site.