Below are the September Medical Staff Updates. As a reminder, all providers must complete the attestation at the bottom of this page by September 30.
Medical Leadership Message
Congratulations on our collective achievement of Best Regional Hospital in U.S. News & World Report rankings placing us 15th in New York. It is important that all Kaleida Health physicians join Doximity and maintain a presence for our departments since this serves as an important factor in hospital and departmental reputation. Please reach out to Mike Hughes, senior vice president of public affairs and marketing, at mhughes@kaleidahealth.org, Kevin Wild, associate planner, at kwild@kaleidahealth.org, or Kenneth Snyder, MD, PhD, vice president of physician quality, at ksnyder3@kaleidahealth.org if you have any questions.
Thank you to the clinicians who are currently participating in our system-wide Hospital Acquired Condition (HAC) teams. Your energy, effort and ideas have led to a dramatic reduction in our system "Harm Score." If anyone else is interested in participating, including residents or fellows, please email Maralyn Militello, vice president and chief quality officer, at mmilitello@kaleidahealth.org or Dr. Kenneth Snyder.
Although everyone has been doing a great deal of work to prepare for the DNV GL site visit this year, this work needs to be incorporated into daily improvements for patient quality and safety. This paradigm shift has led to daily quality huddles and internal auditing rounds engaging with unit managers to look for opportunities for improvements. Physicians, please communicate with your unit managers to make sure your needs are being addressed as well, and feel free to participate on these rounding teams. Do not hesitate to email the site chief medical officers, site quality directors or Dr. Kenneth Snyder with any quality improvement projects.
David Hughes, MD, MPH
Chief Medical Officer
Kaleida Health
Kenneth Snyder, MD, PhD
Vice President, Physician Quality
Kaleida Health
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
Message from the President of the Medical/Dental Staff
Last May, the Medical Executive Committee (MEC) had Andrew Curtis, MD, MBA, from the Greeley Company provide an orientation for the MEC. Among the many excellent points he made, one in particular has continued to draw my attention: our goal must be to achieve the triad of good patient care, hospital success and provider success. Each one of those elements is critical; no one thrives if any one element is missing. The board of directors, medical staff and management must be aligned around this shared vision.
One of challenges to achieving this triad is that providers and hospitals sometimes face different pressures. As Greeley points out in their Physician-Hospital Integration seminar, hospitals may be most concerned with issues such as reducing waste without compromising quality, whereas providers may be concerned with maintaining clinical autonomy. One the other hand, both are facing the need to plan for the transition from volume-based reimbursement to outcome-based reimbursement. Navigating these sorts of issues in such a way as to find “win-win” solutions is going to be critical to our future.
There is no question in my mind that successfully achieving the triad requires strong physician leadership. We are going to have the need for well-trained, engaged physician leaders at all levels. The Kaleida Health Physician Leadership Academy (more about this in a future newsletter) is one example of how we are beginning to address this need. We are also fortunate to have a strong, dedicated Medical/Dental Staff leadership in place: the members and officers of the MEC, the Credentials Committee and the Peer Review Committee. Thank you for your efforts; you exemplify the leadership that will make us successful.
Peter Winkelstein, MD, MS, MBA, FAAP
Medical/Dental Staff President
Kaleida Health
Register Now for an Upcoming Leading with CARE Class
This year's Leading with CARE classes are now underway, and all employees, providers and volunteers must participate in a one-hour, instructor-led class focused on creating a culture of safety using the concept "See, Say, Do."
Each session will be led by a variety of specially-trained facilitators from across Kaleida Health and will offer much more opportunity for group discussion and interaction. Providers should enroll for one of the sessions as soon as possible via Talent Management at www.kaleidatms.com.
CAUTI Prevention
Part 2 – Do We Need to Order a Urine Culture?
As we continue our efforts to reduce our catheter-associated urinary tract infection (CAUTI) rates, a group of physician and laboratory experts met to develop an algorithm to guide provider decision-making when ordering urine cultures. The intent is to minimize the number of extraneous urine culture orders and unnecessary antibiotic treatment for positive urine cultures. The algorithm is a guide to reevaluate the necessity of the urine culture order and you will see the following:
Gates Vascular Institute Symposium Next Month — Register Now
Register now for 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.
2016 Press Ganey Engagement Survey Begins September 1
We’re listening, so take the 2016 Press Ganey Engagement Survey, which will be conducted from September 1-22, 2016.
Invited physicians and residents in program year 2 or higher will receive an email from Press Ganey with a survey link on Thursday, September 1, 2016. Physicians will receive the first email to their kaleidahealth.org email address. If there is no response, a reminder email will go to their kaleidahealth.org email address. Two additional reminder emails will then go to the alternate email, if available. Residents will receive the initial and reminder emails to their buffalo.edu email address. Since we cannot control "spam" to non-Kaleida Health email addresses, recipients should check their spam folders for the link. The sender will be David Hughes, MD. The online survey will take less than 10 minutes to complete and is completely confidential. Kaleida Health's goal is for all invited physicians and residents to take the survey.
The results will be available by the end of 2016, and action will be taken in response to the findings starting in early 2017.
Mandated Change That Affects Doctors and Hospitals
Healthcare providers, hospitals and others who receive federal financial assistance are now subject to new non-discrimination rules and notice requirements under Section 1557 of the Affordable Care Act.
The new regulation broadly prohibits discrimination in health care on the basis of sex, including pregnancy, gender identity and sex stereotyping. It also sets forth the obligation to provide language assistance services free of charge to persons with limited English proficiency and appropriate auxiliary aids and services, where necessary for effective communication with individuals with disabilities.
All healthcare providers that receive reimbursement from federal sources such as Medicare (“covered entities”) — including physician practices, hospitals, nursing homes, clinics and individual physicians — must comply.
- Beginning on October 17, 2016, covered entities will be required to post a notice of individual’s rights providing a statement of nondiscrimination and information about language assistance, among other information.
- Beginning on October 17, 2016, covered entities will also be required to post taglines translated into 15 languages of New York State that alert individuals with limited English proficiency to the availability of free language assistance services.
- Covered entities with 15 or more employees must have a grievance procedure and designate one employee to coordinate efforts to comply with and carry out the responsibilities under Section 1557.
The Department of Health and Human Services’ Office for Civil Rights (OCR) has added a number of resources to its website to assist covered entities in their efforts to remain compliant.
Restraint Update
In the near future, you will notice a change to the power form when ordering restraints.
The order for restraints must now be co-signed by an attending physician when completed by any other provider, including residents, nurse practitioners (NPs) and physician assistants (PAs). Interns remain unauthorized to write restraint orders. The power form will now have a mandatory area to choose the attending physician, and the order will then fire to that attending for co-signature. The attending physician will be responsible to co-sign these orders from their message box as soon as possible (within 24 hours).
The provider writing the initial order will still complete the reason for restraints (interfering with medical devices remains the only reason to restrain a non-violent patient; harm to self or others remains the only reason to restrain a violent patient), and the behavior warranting the restraint (agitation, confusion, etc.).
You will also continue to be responsible to assess the patient within one hour of the restraint application, whether non-violent or violent, and then to write a brief note regarding the circumstances and assessment immediately after.As always, non-violent restraints must be reassessed, and if necessary, renewed every 24 hours. Violent restraints must be reassessed and if necessary, renewed every four hours.
The goal of the restraint is to keep the patient safe only until proper medical treatment is administered and effective.
If you have any questions, please feel free to call Barb Kuppel at 859-7658 or Heidi Lowitzer at 859-3758.
Medical/Dental Staff Semiannual Meeting
Please be aware that the date of the October Medical/Dental Staff Semiannual Meeting has changed, and providers will receive a separate communication with details about the upcoming dinner.
Medical Executive Committee - Department Presentations
- Great Lakes Medical Imaging – Presented by David Cipolla, MD, and Ken Pearsen, MD
In a collaborative effort in 2012, Great Lakes Medical Imaging (GLMI), Western New York Urology Associates (WNYUA), and Cancer Care of WNY developed a prostate MRI program. We established protocols for patient preparation, imaging, structured reporting, and MRI/US fusion biopsy for positive exams. In a busy private practice setting, MRI/US fusion biopsy has been added to standard transrectal ultrasound biopsy with minimal disruption to procedural workflow.
We jointly created an anatomic localization scheme and scoring system based on current literature and daily practice. Standardized and structured reporting has been implemented with specialized radiologist interpretations to ensure consistency and accuracy. Extensive internal review of our cases has demonstrated improved detection of prostate cancer and particularly higher grade disease by utilizing prostate MRI.
Since 2009, GLMI and WNYUA have partnered to offer exceptional care to our patients coordinating same day imaging/urology appointments with nearly instantaneous final reads. Common GLMI PACS/radiologists facilitates consults, quality assurance feedback, and efficient comparison of outpatient and inpatient studies. GLMI attendings regularly attend WNYUA conferences and give conference to urology residents. Future radiology residents will benefit from interdisciplinary exposure as well.
Some future initiatives include further expansion of services, global implementation of standardized reporting, increased enrollment in our lung cancer screening program, and unified PACS across all GLMI sites improving efficiency and subspecialization. GLMI and WNYUA are currently investigating noncontrast prostate MRI with promising internal research. We are collaborating to offer lung cancer screening to appropriate WNYUA patients in addition to those at Kaleida Health hospitals and throughout the community. - Children’s Psychiatry Clinic – Presented by Sourav Sengupta, MD, MPH
Nationwide, only one in five children needing mental health treatment access the care they need. The Western New York region has struggled to help children and adolescents with mental health needs access appropriate mental health treatment. A collaboration between the UB Jacobs School of Medicine Department of Psychiatry, Kaleida Health, HealthNow (BlueCross BlueShield of WNY), and several area primary care practices, the Integrated Care for Kids (InCK) program was developed to improve access to quality mental health care through integration into primary care. In these pilot primary care practices covering approximately 80,000 lives, our team of therapists, an integrated care coordinator, and a psychiatrist provides training and education to primary care clinicians, informal "curbside" consultation, brief psychotherapy and psychiatric consultation directly with patients, and facilitates referrals and linkages for children and families needing higher levels of care.
InCK has worked with over 3,000 families over the past three years to ensure access to the care they need. The majority had never previously accessed mental health treatment. Most patients are seen within two to three weeks of the initial referral, although the InCK team often helps with urgent clinical issues as they arise. Most patients are seen briefly, for fewer than eight sessions. Preliminary data indicates significant clinical improvement for patients engaged in brief treatment. Pediatric residents as well as child and adolescent psychiatry fellows rotate through to gain a broader experience in collaborative care. We hope to be able to expand the program more directly into Kaleida Health’s primary care clinics in the future.
Policy Updates for Providers
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 apalombo@kaleidahealth.org or 716-859-8447.
Revised Policies:
- LE.11 – Autopsy Consent and Process – Including Medical Examiner Cases – Revisions highlighted throughout including adding active TB to exclusion list and adding extenuating circumstances being included on consent
- MED.27 (was HR.212) Relocation Benefits for Employed Physicians of Kaleida Health – Revisions to compensation highlighted and added reference to IRS publication
- MED.33 – Physician Requirements – Employed Physician and Independent Contractor –Changes highlighted regarding timely documentation, prescribing narcotics, updated discrimination language, and employee health physical
- PT.12 – Advance Directives – Health Care Proxy, Living Will, MOLST – Revisions highlighted throughout regarding eMOLST
Medical Staff Attestation - September 2016
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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