450MDSt. Mary’S Medical center

PhySician newSletter

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.

ISSUE 17

aUGUSt/SePteMBer 2012

stmarysmedicalcenter.org

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.

dignity health announces acquisition of U.S. healthworks

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 is getting prepared to launch a new web site designed to educate men about health risks and issues that primarily affect them. It is geared to men as the “reluctant consumer in health care.”

The purpose of the St. Mary’s Men’s Health Site is to assist men with accessing all relevant information on health risks, and to emphasize the need to take an active role in their own health care. At St. Mary’s, we emphasize that it’s never too late to begin taking better care of yourself. A healthy diet and regular physical

activity are the cornerstones to help men lead fulfilling lives, and to reduce health risks.

The site contains information on health risks such as colorectal cancer, prostate health and liver disease. And it also touches upon other information topics for men, such as how to treat hair loss, treatment of sports injuries, getting a vasectomy and key tips for health risk prevention.

The St. Mary’s Men’s Health Site may be found at www.MensHealthSanFrancisco.com

St. Mary’s to launch new Men’s health web SiteBy St. Mary’s Marketing and Communications

St. Mary’s Opens new arrhythmia clinicBy St. Mary’s Marketing and Communications

St. Mary’s Medical Center has started a new Arrhythmia Clinic that will provide evaluation and medical management to patients experiencing cardiac arrhythmias. The clinic is just one of the expanding services being offered by St. Mary’s Cardiology Division.

The Arrhythmia Clinic will offer all four electrophysiology procedures, which include: left atrial appendage ligations, epicardial ablations, pulmonary vein isolation ablations and endocardial ablations. St. Mary’s is the only hospital in San Francisco that offers all four EP procedures in one setting.

Three highly reputable doctors are participating in the Arrhythmia Clinic – Dr. Remo Morelli, Dr. Randall Lee and Dr. Edward Gerstenfeld.

Dr. Morelli is the Chief of the Chest Pain Evaluation Unit and the Peripheral Intervention Program at St. Mary’s Medical Center; Dr. Randall Lee is a Professor of Medicine at UCSF; and Dr. Gerstenfeld is the Chief of the Cardiac Electrophysiology and Arrhythmia Service at UCSF.

Dr. Morelli and Dr. Lee were the developers of the left-atrial appendage ligation, a procedure they have taught to other doctors around the nation.

The Arrhythmia Clinic is a key component of the St. Mary’s Cardiology Services Division, which offers highly renowned physicians and a comprehensive array of cardiology services, all conveniently housed in one location. The Cardiology Services Division also utilizes the very latest in technology and provides an integrative support program delivered with a caring, compassionate touch.

Surgical Services now Provided on SaturdaysBy St. Mary’s Marketing and Communications

St. Mary’s Medical Center has extended for another three months its trial run of providing surgical services on Saturdays.

The hospital started its first three-month trial of Saturday surgeries in May. After a slow start, cases began to pick up significantly over the last month of the trial. The increased volume motivated the extension through October.

According to Anthony Mistretta, St. Mary’s senior director of cardiovascular, critical care, emergency and perioperative services, offering surgical services on Saturdays opens up the schedule and provides flexibility to both patients and physicians. And because St. Mary’s staffs an additional surgical team for the Saturday procedures, the cases do not delay any services.

Cases are scheduled on a first-come, first-served basis.

cOrrectiOnBy 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. The accurate information is listed below:

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.

Summer’s corner By Summer Smith, Clinical Documentation Specialist

Why is accuracy in physician documentation necessary when the patient’s medical record contains all the details of the patient’s hospitalization?

Coding is totally dependent on physician documentation and results in assigning the diagnostic description/codes (DRG and ICD9 codes); as well as severity of disease, and CMI (case mix index). Your documentation or lack of specific description can lead to unintended results that could impact your financial payments. Additionally, your quality profile will be impacted. For example, the observed mortality rate of your cases may appear to be very high to the expected rate if the physicians’

documentation did not capture the actual higher severity of illness. Thus, if the CMI is low, based on the documentation in the chart, and the patient dies, then the observed mortality will look much higher than expected. As more and more data is publically reported, both insurers and patients will be making decisions about your quality profile.

Once the patient is discharged the medical record is sent for review by coders. It is crucial for specificity of physician documentation because there are parts of the medical record that coders are not able to assign ICD-9CM diagnosis codes. 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 Discharge Summarynursing assessment on Pressure Ulcer staging) Operative/Procedure/Anesthesia Notes

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

Table 2. examples of non-Specific vs. Specific documentation

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).

By Barbara Brownell, Director of Case Management

In August, St. Mary’s Medical Center rolled out a new process for medical necessity review on patients admitted 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.

new transformational care Project Unveiled

Golf in the Shadow of the Great Ones By Margine Sako, St. Mary’s Foundation

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.

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!

aFter hOUrS clinic Phone: (415) 876-5762address: 1 Shrader Street, Suite 578 (Corner of Hayes and Shrader)

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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 high-quality 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.

By St. Mary’s Marketing and Communications

San Francisco Medical Society Perspective

San Francisco Medical Society laces up for the AHA Heart WalkBy Peter Curran, M.D. President, San Francisco Medical Society

St. Mary’s Medical Center, under the guidance of Marcy Amonette and the Cardiac Rehabilitation Program, has long been a proud

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 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.

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.

dr. Pierre theodore

Thoracic Surgerydr. Jamie BigelowPulmonologist

450 Stanyan St.San Francisco, CA 94117

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

SaVe the date – 2012 ProgrESSIvE DINNErdate Thursday, Nov. 15time 5-7:30 p.m.location Starts at one Shrader Street, 4th Floor (corner of Shrader St. and Fulton St.)