Mercy Medical Center "Physician Update" Newsletter Writing

"Physician Update" newsletter is how Mercy Medical Center in Springfield, MA communicates with its medical staff. News, initiatives and other important information keep physicians "in the loop" and in step with MMCs messaging and branding. I interview key executives and physicians and write about medical, technical, reimbursement and other issues in the newsletter. Work done in collaboration with the MMC Marketing Department.

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Physician Update

(selected stories)

CEO’s Message

State of the Hospital: Good News in Uncertain Times

As we look at the state of the healthcare system, there are many uncertainties. The regulatory picture is unclear and we have concerns about the future of Medicare and Medicaid reimbursements. The recent federal debt-ceiling deal created a congressional “super-committee” whose coming deliberations could have an effect on the levels of those reimbursements. There are many other financial pressures as well, including HMOs pressing hospitals to reduce costs wherever possible.

At MMC, however, there is good news. On the fiscal front, after a difficult beginning to the year with the first few months over budget, things turned around somewhat. Internal efforts and the help of a one-time $2 million state infrastructure and capacity building payment have us confident about meeting our budget for the year, which is a break-even budget.  Our commitment to quality is ongoing and strong - the ED expansion, our private room project, and the continued work of implementing electronic records through CareLink are just a few examples. Additionally, we are confronting future challenges head-on with tireless work on our Strategic Repositioning Initiative (SRI).

Strategic Repositioning Initiative: Roadmap for Changing Landscape

The SRI has been the main focus of the senior management team. It serves as a road map that will guide MMC through the rapidly changing healthcare landscape. Despite the unsettled healthcare system, our work on the SRI has MMC well positioned to prosper and continue to be a high value provider of healthcare to the community. The SRI takes into account all phases of the system. Looking for growth in the following areas is key to our strategic goals:

Growing Specialty Services. We are particularly interested in looking at ways to grow and expand cardiology, vascular and oncology services.

Recruiting Primary Care Physicians. Primary care is a priority for all hospital systems. It is essential to bring PCPs to the area to boost practices that utilize MMC and other services in SPHS. We are working with physician groups and independent physicians on this initiative.

Licensure for Program for All-Inclusive Care for the Elderly (PACE). SPHS is planning to start the licensure process for PACE, a program to provide supportive services to elderly at risk for nursing home placement. PACE will help them remain independent for as long as possible. We are excited about moving PACE ahead and possibly locating it at the former Brightside campus.

Expansion of Accountable Care Organization (ACO). We are in the midst of completing a business plan for the ACO and communicating about it with physicians. Dr. Phil Gaziano, who has been instrumental in the small ACO already in place for some Medicare patients at MMC, is helping to lead this effort. Expanding the ACO concept by applying to be a federally designated ACO for Medicare patients is next. We are hoping to submit the application this fall and begin the program in early 2012. ACO expansion is a way to help managed care patients in a more comprehensive way and reward MMC for being a high value provider.

Seeking to make transitions more seamless.  MMC wants to enhance quality and patient care by improving processes to make accessing care and transitioning from one level of care to another easier and more efficient. An example is our new Direct Admit process.

Partnering with other organizations. We will investigate ways we can partner with other area provider organizations such as Kindred Healthcare, Bay State Medical Center and Noble Hospital. These mutually beneficial collaborations on specific kinds of services can enhance our quality and value.

MMC Is Awarded State Grant for $2 Million

In June Gov. Deval L. Patrick awarded grants to hospitals and community health centers across the state, MMC was awarded $2 million. We were thrilled that the Patrick administration recognized our work and needs. We thank the administration and our legislative delegation. The grant will be used to connect patients who frequently use the emergency room at MMC with primary care physicians. It will help finance an effort at the health system's Providence Behavioral Health Hospital in Holyoke to boost follow-up care for discharged patients and also to fund our ACO efforts. ACOs are an approach to payment and care that have been advocated by the Patrick administration.

We Are Positioned To Take On Challenges

I am optimistic despite all the uncertainties we face. MMC is positioned well and we are doing great things to keep moving in the right direction. As always, communication with our physicians is a vital piece in maintaining MMC’s role as a quality provider of healthcare and sustaining our healing mission. Please feel free to share your concerns and ideas, I am always ready to listen and value your input as we move ahead in challenging times.  Thank you for all that you do for our patients, our Hospital and our community.

The New Hospital Value-Based Purchasing Program: Quality Pays

On April 29, 2011 the new hospital value-based purchasing (VBP) program final regulation was released by the Centers for Medicare & Medicaid Services (CMS).  The final rule, which affects inpatient prospective payment system (PPS) hospitals, implements CMS’ first full-scale value-based purchasing program for inpatient hospitals, beginning with inpatient hospital discharges October 1, 2012.

Created by Congress as part of the Affordable Care Act, VBP aligns reimbursement for Medicare services with the quality of care that Medicare beneficiaries receive. With VBP, CMS is making a move to reward and pay for better value, outcomes and innovations instead of merely volume.

In anticipation of the final rule, MMC is beginning to ensure reporting processes are in order to accurately reflect the quality of care provided at MMC. The period of performance for the first year of the Program begins July 1, 2011, and extends to March 31, 2012

Tying Payments To Quality Care

The VBP program establishes goals to improve the quality and efficiency of health care services provided to Medicare beneficiaries by tying a portion of inpatient hospitals’ payments to steps taken by the hospital to keep patients safe and healthy while receiving care. The aim of these goals is to:

• Reduce injury and harm to Medicare beneficiaries-and by extension-all hospital patients
• Adopt clinical practices that are shown through the best available  medical evidence to be best and safest for patients
• Drive better coordination of care across caregivers and care settings
• Make patients more satisfied with the care they receive
• Ensure that patients receive care without unnecessarily high cost

“The emphasis CMS is placing on quality and patient experience through VBP and tying it to reimbursements, will mean MMC’s already extensive commitment to quality will need to be continually improved upon. The Quality Department is ready to provide support in that effort but it will require a team effort to be successful. ” said Scott A. Wolf, DO, MPH.

That team effort is reflected in the Quality Improvement Teams that work to promote positive clinical changes. “Our Quality Improvement Teams have at least one physician champion as a team member.  The physician champion provides the team with feedback from the physician ‘s perspective and promotes evidence based clinical changes with their physician colleagues. Staff physicians  provide feedback on the process to the physician champions as well as to the Quality Department,” said Theresa Trainor, LPN, BS, CPHQ, Clinical Quality Improvement Coordinator, Quality and Risk Management Department.

Thinking Differently About Payment:  Quality and Efficiency Gains

VBP is bringing the first real changes to the Medicare payment structure in years. Changes for Medicaid and private payers will soon follow. Preparing for the changes, MMC is partnering with physicians in anticipation of bundled payments, carefully projecting how any new pilot payment structures would impact finances.

In an effort to help providers adhere to quality measures, necessary changes are being planned including implementing checklists, practicing protocols and initiating other strategies. IT systems will have to be upgraded to reliably track the necessary (and yet to be determined) analytics that will document value – a key to negotiating with private payers.

Another key is aggressively marketing MMC’s value proposition of providing quality, cost-effective care. A prime example is MMC’s recognition by Cleverley + Associates as a Top 100 Community Value hospital for the second year in a row. 

VBP: Driving Excellent Care & Positive Patient Experiences

VBP is driving better integration of excellent clinical care and positive patient experiences.  The combination of these two elements provides quality health care that addresses the uniqueness of each patient. The Quality Department has an important part in the process. “The Quality Department's role is to facilitate process and systems changes and assist the direct care staff and departments with implementation. Achieving a high standard of care is challenging and requires staff engagement at all levels. It begins at the front door and continues with every interaction patients have with our staff. VBP’s role in helping us strive for that high standard is a concept that is very much in keeping with our mission as an institution,” concluded Trainor.

MMC ICU Sepsis Care: Better Outcomes at a Significantly Reduced Cost

The MMC ICU has received great news documenting superior results related to its battle against sepsis. According to a Sepsis Report from the Massachusetts Hospital Association (MHA) received in February 2011 for fiscal year 2009, MMC does better caring for sepsis cases than the average acute care hospital in Massachusetts in three key areas; our length of stay (LOS) is 4 days shorter, our mortality rate 16% better, and our cost per case is about $48,000 less than the average.  The bottom line is better outcomes at a significantly reduced cost.

Severe sepsis is one of the most common causes of death in ICUs. There have been major advances in understanding the pathophysiology of sepsis and septic shock, as well as numerous new approaches to treatment over the past two decades. Despite improved understanding of the pathophysiology of sepsis, novel therapies, and better ICU care all contributing to better survival rates, sepsis still remains one of the leading causes of death in the US. The incidence of severe sepsis and septic shock is difficult to determine accurately. There are an estimated 750,000 cases of severe sepsis leading to 215,000 deaths per year in the US alone.

Why the MMC ICU Has Better Outcomes

According to Kathleen Hutchins, Critical Care Clinical Nurse Specialist, the reasons why the MMC ICU is having better outcomes with sepsis care is teamwork and diligence: “In my opinion, the main reason why MMC is doing so well with treating sepsis is because we are delivering our ICU care based on the evidence based practices outlined in the Surviving Sepsis Campaign Guidelines.  We ensure that all disciplines are working together to implement early goal-directed therapy as well as the many other different interventions contained in the sepsis bundle.  We fully educate and re-educate all the staff on what the sepsis bundle is and the responsibilities of every staff member.  We have standardized our care in the ICU to the fullest so that every patient gets assessed, evaluated and treated according to these guidelines. Our ICU team has always felt that we provide outstanding care to all our patients and we are pleased to see that the MHA report backs up that assessment.” 

Daily ICU Goal Sheet Is Invaluable Tool

A daily ICU goal sheet outlining the Sepsis Bundle based on the “Surviving Sepsis Campaign Guidelines” is completed every day by the nurse and reviewed by the Intensivist. The Campaign was based on a partnership of the Society of Critical Care Medicine, the European Society of Intensive Care Medicine and the International Sepsis forum.  It teamed up with the Institute for Healthcare Improvement to "wage war on sepsis.”  The sepsis bundle, a detailed protocol covering a range of therapies and standards of care is an invaluable tool that has been adhered to in the MMC ICU since 2005 helping ensure nothing gets omitted or overlooked in the care of sepsis patients.  The hard work and diligence seem to be paying off with better outcomes for MMC sepsis patients and the ICU. “The ICU team at MMC is extremely proud and confident in the excellent care delivered to all our patients, including those with severe sepsis and septic shock.  This MHA report is just one example of how well we do our job.  As a team, our MMC ICU is the best,” said Hutchins.

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