ISSUE 17 AUGUST/SEPTEMBER 2012
450
MD
St. Mary’s Medical Center Physician Newsletter
stmarysmedicalcenter.org
Chief of Staff Message Francis Charlton, MD
One of my favorite movie moments is when the Road Boss regains his composure after brutally blackjack beating Cool Hand Luke, explaining to the Chain Gang, “What we have here is failure to communicate.” With that in mind, we will try to enhance medical staff communication by introducing a regular newsletter informing you of what’s going on around here: Meeting schedules, CME opportunities, policy changes, regulatory updates, social events, educational information such as disaster preparedness, and more. We would prefer to disseminate the newsletter via e-mail. Please let us know your preferred current address by
contacting june.rose@dignityhealth.org. Copies will also be made available in the Doctors’ Dining Room and the Medical Staff Office. The active medical staff recently voted resoundingly in favor of a measure that requires future members to acquire and maintain board certification to retain hospital privileges. This only applies to practitioners joining our staff from this point in time forward. During this past year, we have made great strides forward on a wide array of reportable quality measures such as sepsis mortality and re-admission rates, as well as standing up to the ongoing parade of regulatory surveys without significant findings or deficiencies. We should all be proud of the outstanding progress that we have achieved to forge St. Mary’s into a top-flight, safe place for us to work and for our patients to heal. Congratulations and thank you.
Dignity Health Announces Acquisition of U.S. HealthWorks From the Office of Dignity Health President/CEO, Lloyd H. Dean Dignity Health President and CEO Lloyd Dean announced in July that the organization had signed an agreement to acquire U.S. HealthWorks, the nation’s largest independent operator of occupational medicine and urgent care centers. The transaction was expected to be completed in August. According to Dean, the acquisition continues Dignity Health’s goal of becoming a national, integrated health care delivery system. “We are extending our mission of care into new settings because it will help us deliver quality care more efficiently and improve the overall health status of the communities we serve,” said Dean.
U.S. HealthWorks operates 172 clinics nationwide and has a network of more than 2,700 employees, including approximately 800 medical providers that deliver quality care to more than 12,000 patients each day. They primarily work with employers like Coca-Cola, Trader Joe’s, Walgreens, Target and The Home Depot to manage and reduce the cost of work-related injuries. “This is an investment in our future,” Dean said. “As I have said many times, we cannot shrink our way out of our current economic situation. We must grow, innovate, and improve quality care. “This opens an exciting new chapter for all of us at Dignity Health. In welcoming U.S. HealthWorks into our family we will extend our health care ministry into 16 states, and we will begin to partner with nearly 80,000 employers to help deliver excellent care more efficiently.” U.S. HealthWorks will operate as a for-profit subsidiary of Dignity Health, and like all members of our organization it will operate according to our Statement of Common Values.
St. Mary’s to Launch New Men’s Health Web Site By St. Mary’s Marketing and Communications St. Mary’s is getting prepared to launch a new web site
activity are the cornerstones to help men lead fulfilling
designed to educate men about health risks and issues
lives, and to reduce health risks.
that primarily affect them. It is geared to men as the “reluctant consumer in health care.”
The site contains information on health risks such as colorectal cancer, prostate health and liver disease.
The purpose of the St. Mary’s Men’s Health Site is to
And it also touches upon other information topics for
assist men with accessing all relevant information
men, such as how to treat hair loss, treatment of sports
on health risks, and to emphasize the need to take an
injuries, getting a vasectomy and key tips for health risk
active role in their own health care. At St. Mary’s, we
By St. Mary’s Marketing and Communications St. Mary’s Medical Center has started a new
Dr. Morelli is the Chief of the Chest Pain Evaluation
Arrhythmia Clinic that will provide evaluation and
Unit and the Peripheral Intervention Program at St.
medical management to patients experiencing cardiac
Mary’s Medical Center; Dr. Randall Lee is a Professor
arrhythmias. The clinic is just one of the expanding
of Medicine at UCSF; and Dr. Gerstenfeld is the Chief
services being offered by St. Mary’s Cardiology
of the Cardiac Electrophysiology and Arrhythmia
Division.
Service at UCSF.
The Arrhythmia Clinic will offer all four
Dr. Morelli and Dr. Lee were the developers of the left-
electrophysiology procedures, which include: left atrial
atrial appendage ligation, a procedure they have taught
appendage ligations, epicardial ablations, pulmonary
to other doctors around the nation.
vein isolation ablations and endocardial ablations. St. Mary’s is the only hospital in San Francisco that offers
The Arrhythmia Clinic is a key component of the St.
all four EP procedures in one setting.
Mary’s Cardiology Services Division, which offers highly renowned physicians and a comprehensive
Three highly reputable doctors are participating in the
array of cardiology services, all conveniently housed
Arrhythmia Clinic – Dr. Remo Morelli, Dr. Randall Lee
in one location. The Cardiology Services Division also
and Dr. Edward Gerstenfeld.
utilizes the very latest in technology and provides an integrative support program delivered with a caring,
Surgical Services Now Provided on Saturdays
compassionate touch.
By St. Mary’s Marketing and Communications St. Mary’s Medical Center has extended for another
According to Anthony Mistretta, St. Mary’s senior
three months its trial run of providing surgical services
director of cardiovascular, critical care, emergency and
on Saturdays.
perioperative services, offering surgical services on Saturdays opens up the schedule and provides flexibility
The hospital started its first three-month trial of
to both patients and physicians. And because St. Mary’s
prevention.
Saturday surgeries in May. After a slow start, cases
staffs an additional surgical team for the Saturday
began to pick up significantly over the last month of the
procedures, the cases do not delay any services.
The St. Mary’s Men’s Health Site may be found at
trial. The increased volume motivated the extension
emphasize that it’s never too late to begin taking better care of yourself. A healthy diet and regular physical
St. Mary’s Opens New Arrhythmia Clinic
www.MensHealthSanFrancisco.com
through October.
Cases are scheduled on a first-come, first-served basis.
Summer’s Corner By Summer Smith, Clinical Documentation Specialist
Why is accuracy in physician documentation necessary
documentation did not capture the actual higher severity of
when the patient’s medical record contains all the details
illness. Thus, if the CMI is low, based on the documentation
of the patient’s hospitalization?
in the chart, and the patient dies, then the observed mortality will look much higher than expected. As more and more data is
Coding is totally dependent on physician documentation and
publically reported, both insurers and patients will be making
results in assigning the diagnostic description/codes (DRG
decisions about your quality profile.
and ICD9 codes); as well as severity of disease, and CMI (case mix index). Your documentation or lack of specific description
Once the patient is discharged the medical record is sent
can lead to unintended results that could impact your financial
for review by coders. It is crucial for specificity of physician
payments. Additionally, your quality profile will be impacted.
documentation because there are parts of the medical record
For example, the observed mortality rate of your cases may
that coders are not able to assign ICD-9CM diagnosis codes.
appear to be very high to the expected rate if the physicians’
Some examples are listed in the following tables:
Table 1. Contents of Medical Record UNABLE TO CODE FROM
ABLE TO ASSIGN CODE FROM
Nursing Notes ED Physician Notes Pathology Reports History and Physical Laboratory Reports Physician Progress Notes Radiology Reports Physician Consultations Physical Therapy Notes/Assessments
Physician Orders
Wound Care Notes (the only exception is nursing assessment on Pressure Ulcer staging)
Discharge Summary Operative/Procedure/Anesthesia Notes
New Transformational Care Project Unveiled
Golf in the Shadow of the Great Ones
By Barbara Brownell, Director of Case Management
By Margine Sako, St. Mary’s Foundation
In August, St. Mary’s Medical Center rolled out a new process for medical necessity review on patients admitted
St. Mary’s Medical Center Foundation sponsored its 33rd annual golf tournament at the Olympic Club on Aug. 27. Foundation chairman Dr. Robert Murray and his golf committee worked miracles with this year’s event, utilizing one course instead of the usual two. The tournament raised more than $220,000, with the net proceeds funding needy patient care at the Sister Mary Philippa Clinic.
through the ED. This means an RN is collaborating with the ED team to review the clinical record for medical necessity. Why is this important? Currently, St. Mary’s is experiencing a significant amount of rework and loss of revenue related to preventable denials, both concurrent and retrospective (RAC). The loss has doubled over the last year, currently running at $3-4 million per month for the entire Dignity Health system. The lack of medical necessity review has been identified as an important contributing factor in these denials. Timely review ensures that the patient meets minimum criteria for either admission or observation status and qualifies us for payment. If this review is not performed prior to the physician writing the order to admit, the payment can be reduced or denied and creates multiple system challenges and rework at many levels. The bottom line is: Let’s get it right the first time. From a patient’s perspective, this correct status determination can affect their Medicare coverage and out-of-pocket expenses related to their stay, reduce the confusion to patients and their families, as well as help them understand the plan for their care.
Bank of the West and Maurice Kanbar were the top sponsors, and Maurice’s Blue Angel Vodka provided morning and afternoon spirits. Lloyd Dean, Dignity Health CEO/President, Tom Hennessey of Saint Francis Memorial Hospital and Steve Graham of the Dignity Health Treasury represented the system dignitaries, and Drs. Peter Curran, Robert Deitz and Richard Gerber were the lead physician sponsors. More than 40 volunteers from St. Mary’s, grateful patients and even a bagpipe player helped make a memorable day. One person who was almost a winner was Dr. Kevin Man, who came within 10 inches of winning the hole-in-one Jaguar car. Last year, Don Endo and British Motors of San Francisco gave the lucky winner a 2011 Range Rover. Better luck next year Kevin!
Correction By St. Mary’s Marketing and Communications In the May 2012 edition of 450MD, a story on the After Hours Clinic indicated an incorrect address and telephone number.
Table 2. Examples of Non-Specific vs. Specific Documentation Non-Specific Specific Urosepsis UTI with or without Sepsis E. Coli Bacteremia with hypotension E. Coli Sepsis with or without septic shock (Please refer to clinical documentation tip week 3 on Sepsis) Leukocytosis with significant bandemia in a setting with acute febrile process
Admission: altered mental status, rule out sepsis. Day 5: Klebsiella bacteremia resolving, may transfer out of the ICU
Prior to requesting a clarification, the CDS will need identify clinical indicators to support an infectious process that may or may not be associated with sepsis. Klebsiella bacteremia with or without Sepsis; additionally, altered mental status with or without encephalopathy (specify type/cause).
The accurate information is listed below:
AFTER HOURS CLINIC Phone: (415) 876-5762 Address: 1 Shrader Street, Suite 578 (Corner of Hayes and Shrader) Staffed by the Pacific Family Practice Medical Group, the clinic provides after-hours medical care at reduced cost for both patients and insurers. The clinic operates from 5 p.m. to 9 p.m. on weekdays and from 10 a.m. to 4 p.m. on Saturdays.
San Francisco Medical Society Perspective
By St. Mary’s Marketing and Communications
San Francisco Medical Society laces up for the AHA Heart Walk By Peter Curran, M.D. President, San Francisco Medical Society
sponsor and energetic fundraiser for the annual three-mile heart walk at Justin Herman Plaza and Golden Gate Park in September. Each year several survivors of
The Comprehensive Lung Center at St. Mary’s offers advanced technologies and minimally invasive techniques for diagnosing and treating lung disorders. Among the diagnostic techniques offered by the Comprehensive Lung Center are: Endobronchial ultrasound-guided biopsy (EBUS) – A bronchoscope inserted through the mouth provides highquality images that enable the physician to biopsy lesions and lymph nodes surrounding the airway. Video-assisted thoracic surgery (VATS) – This new procedure allows the doctor to insert a small camera and surgical tools through 1- to 2- cm openings in the chest to complete a wedge biopsy for the diagnosis of lung cancer and other lung diseases. Mediastinoscopy – This minimally invasive diagnostic technique, a thin scope is inserted through a small incision in the neck to biopsy lesions and lymph nodes in the space between the lungs. Lung Cancer Screening – Low-dose radiation CT screening helps identify abnormalities in the lung, including: pulmonary nodules and lung cancer, in patients who have been heavy smokers or are at high risk for cancer. The affordable, low-dose lung cancer screenings are particularly valuable in light of a new study conducted by the National Cancer Institute, which has shown that early detection through low-dose CT scans significantly reducing cancer mortality.
Dr. Jamie Bigelow Pulmonologist
Dr. Pierre Theodore Thoracic Surgery
Dr. Jamie Bigelow and Dr. Pierre Theodore have played key roles in making the Comprehensive Lung Center become a reality. Bigelow is a pulmonologist who helped develop the center, while Theodore leads the Thoracic Surgery Program and the Lung Center. The Comprehensive Lung Center is a vital part of St. Mary’s state of the art Cancer Center, which has been accredited by the American College of Surgeon’s Commission on Cancer and offers cancer navigation, the latest in chemotherapy treatments, radiation oncology technology and clinical research trials.
St. Mary’s Medical Center, under the guidance of Marcy Amonette and the Cardiac Rehabilitation Program, has long been a proud
heart disease walk with a smile and matching St. Mary’s t-shirts. This year, your San Francisco Medical Society, representing over 1,000 physicians in the Bay Area, has joined the party and has raised funds to sponsor a booth at the Golden Gate Walk on Saturday, Sept. 15. Realizing that community involvement is critical for promoting good health and wellness, St. Mary’s and SFMS
promise to be a formidable team in the fight against heart disease. Heart disease is recognized as the number one killer of men and women in the United States. Although significant gains in survival have been achieved over the last few decades, much work remains in promoting simple lifestyle changes, such as including moderate exercise in our daily life. Simply walking 30-60 minutes per day has been shown to promote overall good health and lesson the risks for most chronic illnesses.
450 Stanyan St. San Francisco, CA 94117
Save the Date – 2012 Progressive Dinner St. Mary’s Medical Center’s annual Progressive Dinner will take place: Thursday, Nov. 15, from 5 to 7:30 p.m. The event will begin at St. Mary’s new Women’s Health Center Imaging Services, located at One Shrader Street (fourth floor). From there, the evening continues in the hospital’s main lobby area and then onto Cardiovascular Services on Level C, where St. Mary’s new Arrhythmia Clinic will be featured. The Progressive Dinner concludes in the lobby of Cardiovascular Services with a showcase of St. Mary’s Advanced Wound Healing and Amputation Prevention Clinic and the new Comprehensive Lung Center. A formal invitation will be sent at a later date. For now, please use the information below to save the date for this year’s Progressive Dinner: Save the Date – 2012 Progressive Dinner Date Thursday, Nov. 15 Time 5-7:30 p.m. Location Starts at One Shrader Street, 4th Floor (corner of Shrader St. and Fulton St.)