Below are the October Medical Staff Updates. As a reminder, all providers must complete the attestation at the bottom of this page by October 31.
The summer that broke the record as the hottest summer in recorded history is sadly coming to an end.
Congratulations to the Kaleida Health team for a very successful DNV GL survey! A small army of 17 surveyors combed through Kaleida Health facilities for four days and left with only a handful of nonconformities. All previous nonconformities were closed out. Accreditation readiness teams led by Maralyn Militello, vice president and chief quality and patient safety officer, Kristen Bies, director of accreditation readiness, David Hughes, MD, MPH, executive vice president and chief medical officer, and Ken Snyder, MD, PhD, vice president of physician quality, as well as all Kaleida Health employees, worked very hard and did a phenomenal job preparing for the critical survey. In order to maintain a consistent state of readiness, the accreditation and rover teams will continue to make rounds.
September was a very busy month. The Press Ganey Engagement Survey for employees and providers took place during the first three weeks of September. The results are now being tabulated and analyzed by Press Ganey, and will be returned to management when completed. It is also budget season, and the management team is working diligently to meet the September 30 deadline.
Hospital Associated Conditions for the system are mostly on target. Under the joint leadership of Maralyn Militello and Dr. Ken Snyder, quality and patient safety teams are working hand-in-hand with all Kaleida Health employees and providers to keep Kaleida Health’s Harm Score down to the lowest levels seen in years.
This year’s Leading with CARE program is continuing full steam ahead. As previously noted, this year’s emphasis is on quality and patient safety, which is everyone’s responsibility.
David Hughes, MD, MPH
Chief Medical Officer
Kenneth Snyder, MD, PhD
Vice President, Physician Quality
Colin McMahon, MD
Chief Medical Officer
Buffalo General Medical Center
David Pierce, MD, FACEP
Chief Medical Officer
Millard Fillmore Suburban Hospital and DeGraff Memorial Hospital
Stephen Turkovich, MD
Chief Medical Officer
Women & Children’s Hospital of Buffalo
Kamil Alpsan, MD
Site Medical Director
DeGraff Memorial Hospital
A recent report by PwC (http://pwchealth.com/cgi-local/hregister.cgi/reg/pwc-hri-health-industry-changes.pdf) examined the enormous change in the U.S. health industry. They “identified five forces that are reshaping the industry. Three—the rise of the consumer, decentralization and technological advances—have already helped transform other industries. Two are unique to health—the drive, led by the federal government, to pay for value instead of volume, and a surging interest in wellness and health management.” They recommended that “organizations should consider re-evaluating their core capabilities, and invest in efforts to understand consumers who sit at the center of the emerging ecosystem,” and that they should “plan for the day that data inform and power the [health] ecosystem.”
According to PwC, the key barrier to coping with this change will be culture. Organizations, providers and employees will all have to adjust to new roles, scope of practice, use of protocols, data-driven care and new forms of access to care.
As we navigate this changing landscape, I believe we can use quality care as our “North Star.” We will all need to adjust and adapt, as difficult as that may be, but we should do so in the service of our patients.
At our Medical/Dental Staff Meeting on Wednesday, October 26, our guest speaker will be Jonathan Burroughs, MD, MBA. He will discuss population health management, which is one of the five forces identified in the PwC report. I hope that you will be able to join us for this event, and I look forward to seeing you there.
Peter Winkelstein, MD, MS, MBA, FAAP
Medical/Dental Staff President
All Kaleida Health physicians and advanced practice providers are invited to the Medical/Dental Staff Semiannual Meeting on Wednesday, October 26, 2016, at Templeton Landing in Buffalo.
The event will feature guest speaker Jonathan Burroughs, MD, MBA, FACHE, FACPE, president and CEO of The Burroughs Healthcare Consulting Network, who will discuss population health. Dr. Burroughs has over 35 years of healthcare experience as an emergency physician, manager and leader, healthcare consultant, and governing board member/leader. He works with healthcare organizations to craft customized policies/procedures and approaches that enable physicians and managers to work constructively together and to achieve mutually beneficial goals. CME credit will be available.
Providers will have the opportunity to vote on the revised Medical/Dental Staff bylaws. Flu shots will also be available at the meeting from the Visiting Nursing Association of Western New York.
Check your Kaleida Health email for an invitation to the dinner via Microsoft Outlook calendar. Please either “Accept” or “Decline” the invitation, and if you plan to attend, please visit the Survey Monkey link within the invitation to select your meal choice: https://www.surveymonkey.com/r/3CQVNGW.
RSVP by Friday, October 14, 2016. For questions, call the Medical Staff Office at 859-5501.
There are only a few days left to register the third annual Gates Vascular Institute Symposium: Updates in Cardiac, Vascular & Neuroendovascular Medicine.
This educational symposium will be held Friday, October 14, 2016 (full day) and Saturday, October 15, 2016 (half day) at Templeton Landing in Buffalo.
This year’s symposium will offer a wide range of speakers, topics and continuing education credits.
For more information, including registration details and the schedule of speakers and topics, visit www.kaleidahealth.org/gvi-symposium.
The Medicare Access and CHIP Re-Authorization Act (MACRA) was signed into law in April 2015. CMS’s MACRA proposed rule was released in late April 2016, and the final rule is set to be released by November 1, 2016. While clinician payment will not be impacted by MACRA until January 1, 2019, CMS proposed to use 2017 as the performance year for determining clinician payment adjustments in 2019. Therefore, clinicians and groups do not have much time to prepare for the new reporting requirements and/or get involved in the new Advanced Alternative Payment Models before the first performance year begins.
MACRA repeals the Sustainable Growth Rate (SGR) and mandates critical updates to Medicare clinician payment across the next few years by locking provider payment rates at near zero growth and requiring the development of two new payment tracks: the Merit-Based Incentive Payment System (MIPS) and the Advanced Alternative Payment Models (APM). Starting in 2019, clinician Medicare payment adjustments each year will depend on the track into which the clinician’s medical group falls.
CMS estimates that approximately 836,000 clinicians will be affected by MACRA changes in the first performance year in 2017. However, not all clinicians will be subject to these changes.
Included payments and clinicians:
Exempt payments and clinicians:
Under MIPS, Medicare will consolidate and expand upon all three of clinicians’ pay-for-performance programs – Meaningful Use, the Value-Based Payment Modifier and the Physician Quality Reporting System – into a single revenue-neutral program. Under this program, CMS will score clinicians and groups on their performance in four categories: Quality, Resource Use, Clinical Practice Improvement Activities (CPIA) and Advancing Care Information (ACI).
In 2019, physicians in this track will face a range of payment adjustments, starting with potential penalties of -4% and bonuses as high as 12% in 2019. These penalties and bonuses will grow to payment reductions as much as 9% and increases of up to 27% after the first few years of the program.
Alternatively, those that qualify for the APM payment track can earn favorable financial rewards. However, only clinicians or groups who are part of risk-based payment models will qualify, thus incentivizing a shift toward risk.
Clinicians or groups that participate in Advanced Alternative Payment Models, as defined by CMS, and are able to convert a large enough share of their Medicare and/or other payer reimbursement to risk-based payment models will earn a 5% annual payment bump from 2019-2024. They will also be exempt from the MIPS requirements.
It is time to prepare for the 2016-2017 influenza season. Kaleida Health will continue to follow the New York State Department of Health mandate titled, “Regulation and Prevention of Influenza Transmission by Healthcare and Residential Facility and Agency Personnel” to document the vaccination status of healthcare personnel.
Like last year, the vaccination status of all healthcare personnel must be documented and all unvaccinated personnel wear a surgical mask at all times while in areas where patients or residents are typically present during the entire influenza season as determined by the New York State Commissioner of Health.
Flu clinics will be held throughout the fall by both Employee Health and the Visiting Nursing Association of Western New York (VNA). Vaccines will also be available at each site Employee Health office during scheduled hours for those unable to attend a clinic. The clinic schedule is available on Employee Health’s website.
Providers must have their Kaleida Health ID badge to receive the vaccine. Providers will need both their Kaleida Health ID badge and their health insurance card if utilizing a VNA sponsored clinic.
At the time of vaccination, a Kaleida Health Employee Health nurse or VNA administering nurse will apply a new sticker on the right lower corner of the Kaleida Health ID badge to provide visual verification of vaccination. Please remove last year’s sticker prior to receiving this year’s vaccination.
Providers vaccinated by a facility or provider other than Kaleida Health or the VNA will need to bring official proof of vaccination to Employee Health in order to receive their sticker of verification.
Those who decline the influenza vaccine, must complete a “Declination of Influenza Vaccine” form. Anyone who declines the vaccine due to a medical condition will also need to complete the “DOH Medical Exemption Statement” form. Details for both forms are available on Employee Health’s website.
Please note that this year, Employee Health or a site designee will apply a red sticker on the right lower corner of the Kaleida Health ID badge of those who decline vaccination.
At the end of October 2016, Kaleida Health’s current Talent Management System will be replaced with a new system from an industry leader in talent management.
Detailed training and information on navigating the new Talent Management System will be available in the months to come.
Kaleida Health is transitioning from traditional hospital-based libraries to digital resource centers.
Like most hospitals across the country, the use of libraries in our organization continues to dramatically decrease as does the circulation of paper material, while there have been large increases in the use of online materials. In addition to this, Kaleida Health continues to see an increased demand for quiet space, computer stations and power outlets for smartphone and tablet use. Hospitals and hospital systems across the country continue to move in this direction, with less than one-third offering on-site library service. That compares to nearly 50% twenty years ago.
Kaleida Health will continue to give access to physicians, nurses and staff the respective database that they have traditionally been using (UpToDate, Guidelines for Perioperative Practice, Nursing Reference Center, Mosby’s Nursing Skills, Lexicomp Online are among the most utilized). A part-time employees will manage outstanding journals, books, and other materials as well as space and electronic subscriptions. There will also be demonstrations for accessing the electronic resources, including HUBNET and UpToDate.
The organization will utilize resources to provide a facelift to some of the current library space.
As a reminder, all providers must participate in a one-hour, instructor-led Leading with CARE class focused on creating a culture of safety using the concept "See, Say, Do."
Providers should enroll for one of the sessions as soon as possible via Talent Management at www.kaleidatms.com.
I have been working at Kaleida Health since 2013. I graduated from the University at Buffalo’s general surgery residency in 2011 and then did a two-year fellowship in burn surgery and surgical critical care at Massachusetts General Hospital. I was recruited back to Buffalo by Lucy Campbell, MD, to work as an intensivist in the surgical intensive care unit (SICU) at Buffalo General Medical Center (BGMC). I work 15 days a month in the SICU, and I also take unreferred general surgery call.
Since my start at Kaleida Health, we have added two additional surgical critical care intensivists, William Train, MD, and Elizabeth Bowdish, MD. For the first time, the SICU at BGMC is being staffed 100 percent by surgeons. This has been a well-received change at BGMC according to the many surgeons who admit post-operative patients to the unit.
We work as consultants, as the unit is not a formal “closed” unit. The patients are admitted under their operating surgeon, and our team assists with all critical care issues. In the future, we hope to merge our critical care group with the surgical intensivists at ECMC and start a SICU rotation for the general surgery residents.
Despite advances in breast cancer detection and treatment, 12.4% of women born in the U.S. will develop breast cancer. Most likely, everyone in this room will indirectly be affected at some time in their lives by breast cancer.
We believe that standardization of patient care is important to achieve consistency and the best possible outcomes for patients, surgeons and healthcare system. We will introduce the concept of the perioperative surgical home to the committee, and explore the challenges and advantages of adopting this system.
For patients, we would like to improve acute pain management. By implementing advances in regional anesthesia, there is a possibility of decreasing the risk of developing post mastectomy pain syndrome. Also, peripheral nerve blocks in combination with multimodal analgesia improve patient experience and may affect long term recovery. We are also intrigued by recent data that supports that the usage of local anesthetics may decrease the incidence of cancer recurrence and make cancer that does recur, less aggressive.
For surgeons and the healthcare system, there are advantages to implementing the use of local anesthetics. Better pain scores equal faster discharges from PACU which prevents Phase 1 backlog and improves patient flow.
Better pain management will hopefully lead to better HCAHPS scores. We acknowledge what other local hospitals are implementing and the need to stay relevant.
These strategies could be used for almost every service line that utilizes the Anesthesiology Department. We would like to be Kaleida Health’s strategic partner to ensure patients have the best experience possible.
Below are the revised policies that affect providers at Kaleida Health. Please take a moment to review this month's updates. The policy links below are accessible from a Kaleida Health computer only. For additional assistance, please contact Amy Palombo at firstname.lastname@example.org or 716-859-8447.
By submitting this attestation, I confirm that as a member of the medical staff I have read and understand the information included in this email from Kaleida Health in accordance with Kaleida Health policy MED.41 as approved by the Medical Executive Committee.
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