MEDICAL CONNECTION O c t o b e r
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Value-Based Purchasing
Contact information:
New Faces of GHS a,b
Medical Connection is published monthly except for July and December for GHS physicians and clinical staff.
Nursing Home Selection
• Dr. William Kanto—Senior Vice President for
Ordering Home Health
Medical Affairs and Chief Medical Officer, Georgia Health Sciences Health System (kanto@georgiahealth.edu)
• Carole Poe—Medical Connection Liaison (cpoe@georgiahealth.edu)
• Publications Director—Christine Hurley
Deriso (cderiso@georgiahealth.edu)
• Editor/Designer—Patricia Johnson
(pjohnson1@georgiahealth.edu)
• Photographers—Patricia Johnson, Phil Jones and Stock X-Chng
Links: www.georgiahealth.org
Value-Based Purchasing Value-Based Purchasing, QHIP, Pay for Performance: What it All Means Dr. William Kanto Senior Vice President for Medical Affairs and Chief Medical Officer
Patricia Johnson
Over the next several months, we will use
the Medical Connection to better familiarize the medical staff with the Affordable Care Act. Our baseline period for reporting our measures in the VBP was July 1, 2009 to March 31, 2010. The performance period for the first year is July 2011-March 31, 2012. Hence, the data are already in for this first period, but the principles are the same for subsequent years. All hospitals in the country participate in this program and our $420,000 is put into a pot with at-risk dollars from other hospitals to give a total pool of approximately $970 million. We are in competition with all other hospitals for these dollars. Our performance on
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11 process measures and eight HCAHPS measures of patient satisfaction will be compared to all other participating hospitals to determine how many “at risk” dollars we receive. The dollars are awarded based on a calculation in which process measures are worth 70 percent of a hospital’s total score and 30 percent is based on patient satisfaction scores. Our previous performance during the baseline period is only an estimate of how we will fare. We can get the same amount, more or less, depending on our performance. HCAHPS is the measure that CMS uses to quantify patient satisfaction and is primarily based on patient questionnaire responses. These questionnaires are mailed to patients following discharge or completion of service. Bernard Roberson, MSM, BA, HSC, Patient Family Center Care, is leading the effort to optimally prepare us for this measure. It is an imperfect system, but we are being judged by the same standards as other hospitals, and rather than complain or criticize, we need to get to work to make our care more acceptable to patients. It is important to understand that scoring applies not only to attendings, but to residents and in some cases, students.
GHS Hospital Medical Reimbursment
$420,000
2013
2014
2015
$420,000 c 1.25 percent $420,000 c 1.5 percent $420,000 c 2 percent
Value-Based Purchasing
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Value-Based Purchasing, QHIP, Pay for Performance: What it All Means
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We need to be prepared for the changes and will prosper in the coming environment which, to some extent, is already here. Bottom line:
Phil Jones
E l e v e n
H e l p f u l
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M e a s u r e s
Heart attack patients receiving PCI within 90 minutes of arrival Heart failure patients given discharge instructions that are specific and documented in the medical record Pneumonia patients getting a blood culture before receiving a first dose of antibiotics Pneumonia patients receiving the most appropriate initial antibiotic Surgical patients receiving the appropriate preventive antibiotic within one hour before surgery Surgery patients receiving the appropriate preventive antibiotic for surgery Surgery patients having preventive antibiotics stopped within 24 hours after surgery Heart surgery patients maintaining good blood sugar control Surgical patients receiving certain surgical procedures and treatments to prevent blood clots Surgical patients receiving treatment to prevent blood clots within 24 hours before or after selected surgeries Surgical patients staying on their beta blockers before and after surgery
New Faces of GHS Medical School: St. Bartholomew's Royal London School of Medicine and Dentistry, 1999 Residency: St Joseph Mercy Hospital, 2007 Fellowship: Northwestern University, 2012
Ranjan K. Avasthi, M.D., Psychiatry
Medical School: American University of Caribbean School of Medicine,2004 Internship: Memorial Medical Center, 2007 Residency: Morehouse School of Medicine, 2010 Fellowship:Georgia Health Sciences University, 2012
Pankaj H. Chhatbar, M.D., Anesthesiology
Medical School: M P Shah Medical College, 2001 Internship: Jersey Shore Medical Center, 2008 Residency: M P Shah Medical College, 2004 Medical College of Wisconsin, 2011 Fellowship:Medical College of Wisconsin, 2012
Andrew J. Hamilton, D.M.D., Dentistry
Dental School: MCG Medical Center, 2000 Residency: MCG Medical Center, 2001
Kelly C. Homlar, M.D., Orthopedics
Medical School: Georgia Health Sciences University, 2006 Internship: Vanderbilt University, 2007 Residency: Vanderbilt University, 2011 Fellowship: Vanderbilt University, 2012
Sarah E. Mowry, M.D., Otolaryngology
Medical School: Tulane University, 2003 Internship: UCLA Medical Center, 2005 Residency: UCLA Medical Center, 2009 Fellowship: University of Iowa, 2012
Olivier Rixe, M.D., Hematology-Oncology
Medical School: Pierre Et Marie Curie University, 1987 Residency: Saint-Louis Hospital, 1993
We l c o m e
Adil M. Abuzeid, M.D., General Surgery
New Faces of GHS
Jason A. Rolls, M.D., Transplant Surgery
Medical School: Columbia University, 1996 Internship: Northwestern University, 1997 Residency: Northwestern University, 1999 Allegheny General Hospital, 2000 Weill Cornell University, 2007 Fellowship: Weill Cornell University, 2003 Columbia University, 2009
Kuldeep S. Talwar, M.D., Cardiology
Medical School: The University of Texas Health Science Center, 1997 Residency: The University of Texas Med Branch, 2000 Tulane University, 2003 Fellowship: University of Florida - Jacksonville, 2012
Lok H. Wong, M.D., Psychiatry
Medical School: Georgia Health Sciences University, 2007 Residency: Georgia Health Sciences University, 2012 Maine Medical Center, 2012
We l c o m e
Shawn M. Roberson, B.S.N., N.P., Hematology-Oncology
Nursing Home Selection What Should I Do When My Loved One Needs A Nursing Home ? Judy Tyler, Manager Social Work Services
Where? Facilities within 100 miles of the
family’s home are assessed. The patient’s medical information is faxed to multiple nursing homes and the wait begins. Once the nursing home is found, the patient and family are notified of acceptance and asked to tour the facility and sign paperwork.
Stock X-chng
One of the most difficult duties of a social worker is to sit down with a family member to discuss nursing home placement for a loved one who has said in the past, “I never want to be placed in a nursing home.” The first step is to reassure the family that nursing home placement is in the patient’s best interest.
Why do patients go to a nursing home? they are too weak to stay alone; the patient might not have anywhere to live and needs further care; the family works outside the home, can’t care for the patient and lacks the funds to hire someone; safety issues due to factors including Alzheimer’s progression, dementia or non-compliance with medicine.
What is the process for this difficult decision? After the physician has examined the
patient, checked results and consulted physical, occupational and/or speech therapy, the team’s findings are discussed with the patient and family. A decision is made that a nursing home is needed – and a multidisciplinary team is assembled. The social worker collaborates with the family to decide on a nursing home that fits the patient’s needs
Final steps: Once the paperwork is signed, the social worker notifies the staff and determines a contemplated discharge date. This is an important date for all. For the patient, it is the beginning of a new journey. For the family, it is the day they begin to worry and hope that their family member will be treated with the respect, dignity and quality care associated with Georgia Health Sciences Medical Center. The staff that treated the patient says goodbye and prepares for the next patient. The social worker—who worked so diligently to arrange the proper placement, comfort the nervous family and encourage the staff—completes documentation and arranges transport for a patient he may never see again but whose destiny will be changed forever.
Nursing HOME
Ordering Home Health Services Dena Jupin, RN, MSN Director of Case Management supervision of a nurse, the service is not considered a skilled nursing service although a nurse actually provides the service. Similarly, the unavailability of a competent person to provide a nonskilled service, notwithstanding the importance of the service to the patient, does not make it a skilled service when a nurse provides the service.
H o m e
Phil Jones
Q u a l i f i c a t i o n s If you or your Case Manager feel a patient would benefit from home health services, the patient must meet the following conditions to qualify for Medicare home health: � � � � �
Be confined to the home Be under the care of a physician Receive services under a plan of care established and periodically reviewed by a physician Need intermittent skilled nursing care, physical therapy or speech therapy Need ongoing occupational therapy
Intermittent means skilled nursing care that is provided or needed fewer than seven days each week or less than eight hours a day. Intermittent skilled nursing is not considered a skilled service merely because it is performed or supervised by a nurse. If a service can be safely and effectively performed (or self-administered) by a nonmedical person, without the direct
C o n f i n e m e n t
Home confinement means the patient is unable to leave the home without a considerable and taxing effort. Determining when this care is needed: � Attendance at adult day centers to receive medical care � Ongoing receipt of outpatient kidney dialysis � The receipt of outpatient chemotherapy or radiation.
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A patient is considered homebound if a medical condition restricts the ability to leave home without supportive devices such as crutches, wheelchairs or special transportation; or if leaving home is medically contraindicated.
For more information about arranging home health for your patients, please speak with your Case Manager or call the Case Management office at 706-721-8150.
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Georgia Health Sciences Physicians and Clinical Staff