ANTIMICROBIAL STEWARDSHIP PROGRAM The Antimicrobial Stewardship Program is a collaborative initiative between physician members, who represent the Baptist Physician Alliance, and interdisciplinary representatives of the Baptist Health System. Antimicrobial agent development was shortly followed by the development of antimicrobial resistance in clinically important pathogens including bacteria, fungi, and viruses. In recent years, the emergence of multidrug-resistant bacteria, in particular, has led to concern that antibiotic development has fallen far behind the ability demonstrated by pathogens to successfully evade therapy. While these infections were rare in the past, occurring only in a handful of medical centers in very ill patients, they are now commonplace throughout the United States and increasingly encountered by clinicians in all settings, where they increase the risk of poor outcomes for our patients and add significant costs to care. In the absence of new drugs and therapies to combat these infections, the best approach to limit the development of drug-resistant bacteria is the more judicious use of the antimicrobials we currently have available. Antimicrobial overprescribing contributes to the selection of increasingly drug-resistant pathogens, as well as exposing the patient to the risks of drug toxicity, and increases infection with Clostridium difficile. Developing a program to monitor and guide the use of antimicrobials has been proven to be an effective tool to improve the care of patients. Antimicrobial Stewardship Programs may also have a long term favorable impact by reducing the pressure on pathogens to become more drug resistant. The Antimicrobial Stewardship Program will use an evidence-based approach to improve clinical outcomes while reducing the emergence of antimicrobial resistance, preserve the utility of current and future antimicrobials, and reduce toxicity related to antimicrobials. In addition, the interventions and activities of the Antimicrobial Stewardship Program will also address cost reduction related to antimicrobials without compromising high quality medical care.
Arache Milka Martinez, MD Citizens
Curtis Coley, MD Princeton
Leland Allen, MD Shelby
Anthony Tesoriero, MD Walker
Chris Davis, MD CMIO/CIO
Bruce Tucker, MD Princeton
Michael Crain, MD Princeton
Amanda Denham, MD Shelby
Mukesh Patel, MD Medical Education
*Non-Physician BHS Members from Citizens, Shelby, Princeton, and Walker will represent Pharmacy, Infection Control, Microbiology, and Laboratory
NEW MEMBERS
2.
3.
4.
5.
Membership Update: October 2014
6.
7.
8.
9.
10.
1. Rishi Agarwal, MD
4. Talia Gates, MD
7. Matthew Purcell, MD
10. Charles Shipman, MD
2. Jack Aland, MD
5. Michael Hovater, MD
8. Lee Roberson, MD
11. Barton Wood, MD
3. Charles Dasher, MD
6. Wayne Pressgrove, MD
9. Yahya Sabri, MD
Gastroenterology PRN Otolaryngology WLK Gastroenterology PRN
IN THIS ISSUE:
OB/GYN WLK
Urology PRN
Nephrology PRN
CPQC and Contracts Update Page 3
Upcoming Meetings Page 4
Gastroenterology SHB
Michael Brasfield, MD Tim Christopher, MD Elizabeth Ennis, MD Stan Jett, MD Jim Lasker, MD John McBrayer, MD Rian Montgomery, MD Mark Prevost, MD Tommy Tomlinson, MD Tom Watson, MD Jim Weems, MD George Zaharias, MD Keith Parrott Scott Fenn
Gynecology PRN
Dr. Bearden gathered physicians and other healthcare professionals involved in the care of patients with diabetic foot infections and began collaborating to create a scientific literature library of best practices for the treatment of GREG BEARDEN, MD patients with diabetic foot infections. The Task Force then translated those guidelines into EPIC smart phrases and order sets which can be used for the initial history and physical examination and evidence-guided treatment of these patients. To help aid in the bedside evaluation of patients, the team developed the “Lower Extremity Assessment Pack (L.E.A.P Box)” which contains the tools needed to objectively assess these patients. Lastly, the committee identified meaningful outcome markers and developed a method to compare our results over time. As the chairman, Dr. Bearden has indicated that he is very pleased with the level of participation and commitment to excellence exhibited by all the members of the committee and reports that the Task Force is ready to move this project from the development phase to the system implementation phase. These resources are now available for all BHS physicians: H&P Template Smart Phrase: 1. When creating a new EPIC note, search “diabetic foot” in the “insert smart text” box and the note template will pop up. 2. Part of the H&P template will prompt one for an accurate description of the ulcer and a basic vascular evaluation (LEAP assessment).
11.
General Surgery SHB
SUMMER/FALL 2014
In the Fall of 2013, as part of its ongoing commitment to improving patient care, BPA launched a Diabetic Foot Task Force, under the direction of Greg Bearden, M.D., general surgeon at Princeton BMC. Dr. Bearden came to the BPA CPQC with an idea to develop a best practice initiative for caring for patients with diabetic foot infections. His interest developed from his clinical observations and was fostered by review of the medical literature which has repeatedly shown that the standardization of care of these complicated patients, in a multidisciplinary team setting, will lower amputation rates and improve healing. Additionally, he recognized that the evidence guided utilization of resources could result in lower health care costs while elevating the care these patients receive.
New Members Page 4
Internal Medicine WLK
Cardiothoracic Surgery PRN
PHYSICIANLED PHYSICIANDRIVEN PHYSICIANGOVERNED
DIABETIC FOOT INFECTION EVIDENCEBASED CARE MODEL IS LAUNCHED
HEP Program Page 2
BPA BOARD MEMBERS
PHYSICIAN MEMBERS:
1.
BPA
BAPTIST PHYSICIAN ALLIANCE
Diabetic Foot Infection Comprehensive Order Set: 1. Search “Diabetic Foot Wound” in the Order Set portion of the Orders Tab. 2. Just click the boxes to initiate current evidence-based care. The order set focuses on the evidence-based recommendations for antibiotics, the recommended laboratory and imaging assessments and also includes ancillary consultation options. LEAP Box Locations: All boxes contain the following: Doppler, BP Cuff, monofilament, curettes, culturettes, flashlight, measuring tape and 4X4s.
Upcoming Meetings
10.15.14 10.16.14
BPA
5:30pm
PQC Chair/Vice Chair Meeting
5:30pm CPQC - Surgery
BAPTIST PHYSICIAN ALLIANCE
CONTACT US
CLINICAL INTEGRATION DIRECTOR 205.715.5703
CLINICAL PROGRAM & QUALITY COMMITTEES 205.715.5464
Princeton:
Boxes on all floors – stored in Pyxis or Nurse Manager’s office Unit Nurses will obtain for physicians
Shelby:
Boxes in House Supervisor’s Office
Call HS directly at 620-8886 or direct unit secretary to obtain box.
Walker:
Boxes in House Supervisor’s Office
Call HS directly at -6208 or ask charge nurse to obtain box.
Citizens:
Boxes in Med/Surg (3rd floor) Nurse Manager’s Office
Unit Nurse Managers can obtain box.
The members of the Diabetic Foot Task Force hope that instituting these measures will make caring for these patients easier.
HOSPITAL EFFICIENCY PROGRAM 205.715.4808
PROVIDER RELATIONS/ MEMBERSHIP 205.715.5763
PHYSICIANLED PHYSICIANDRIVEN PHYSICIANGOVERNED
HOSPITAL EFFICIENCY HOTLINE 855.BPA.EZ4U OR DIAL EXT. 5757
VISIT US AT BPA.BHSALA.COM
SUMMER/FALL 2014
The Diabetic Foot Task Force anticipates that as antibiotic use is standardized, appropriate ancillary testing is encouraged, and transition from inpatient to outpatient management is facilitated, our patients will benefit and our physicians and facilities will develop an enhanced reputation for providing evidence based quality care. Most importantly, the broad implementation of best practice guidelines should improve the health and extend the lives of our patients.
BPA
BAPTIST PHYSICIAN ALLIANCE
PHYSICIANLED PHYSICIANDRIVEN PHYSICIANGOVERNED
SUMMER/FALL 2014
HOSPITAL EFFICIENCY PROGRAM UPDATE As you know, there has been a great leadership demonstrated by the BPA CPQC committee members through their review and subsequent approval of the 2014 Hospital Efficiency Program initiatives. BPA physicians, in aggregate, have been strong supporters of the identified initiatives. As a result of these efforts, BPA has reached the “Distinguished” level of achievement through August 2014 on both supply cost per adjusted discharge and pharmacy cost per adjusted discharge.
over the annual benchmark. Also, the year to date performance (through August) on pharmacy supply cost per adjusted discharge is at $266.16 per adjusted discharge. This represents an 8.2% decrease over the annual benchmark. This decrease has resulted from successful initiatives that have targeted stents and ballons, neuro spinal implants, cardiac rhythm management devices, ortho joints, and surgical/cath lab reprocessing.
The year to date performance (through August) on supply cost is at $1,238.23 per adjusted discharge. This represents an 8.3% decrease
We need continued diligence to have a strong finish in 2014.
Although CMS has delayed the date after which all claims must be submitted using ICD-10 codes until October 1, 2015, Baptist Health System has already implemented these codes in EPIC to provide physicians and coders additional time to get used to the new nomenclature before it is required for filing. The 2014 upgrade of Epic has given us a new ICD-10 calculator that will suggest additional specificity of diagnoses, when necessary. Utilizing this functionality will give us time to become more fluent in the new ICD-10 coding language as well as an opportunity to improve our clinical documentation to better capture the intensity and severity of our patients’ illnesses. We have partnered with Precyse and HealthStream to provide you with online ICD-10 training. Courses have already been assigned to you based on your specialty. CME is provided after you complete a post test for phases 2 and 3.
10
ICD-
While we have designed the curriculum into three distinct phases to be spread out over several months, they can be taken at once and reviewed again at any time. Courses for mid-level providers will be assigned at a future date.
COMPLETION OF ALL ASSIGNED ICD-10 TRAINING IS THE BPA HEP TRIGGER FOR 2014.
If you have not done so, please complete your ICD-10 training, per the schedule below, and encourage your BPA colleagues to do the same. For those who want to complete all sections at once, the system is configured such that all three phases can be completed, in sequence, at the same time. To avoid unforeseen technical issues, please complete your assigned courses as soon as possible. Phase 1 - Introduction “What is ICD-10?” - Approximately 20 minutes - Should have been completed by 8/31/14
- CME is not provided for this brief introductory course.
Phase 2 - Basic documenting in ICD-10 CM (all physicians) and ICD-10 PCS (for surgeons and proceduralists) - Approximately 30 minutes for each course - Should complete by 10/31/14 Phase 3 - Specialty specific courses - Approximately 30 minutes for each course
- Must complete by 12/31/14
You will need to use the link below to access The HealthStream site. Both your username and password are the username you use to log into the Baptist Portal and/or Epic (ex: ELK435).The letters must be in ALL CAPS. Access to your ICD-10 Training Site: https://www.healthstream.com/hlc/baptist Student Login User ID:
EPIC Login – ex: ELK435
For questions please contact Chris Davis at (205) 715-5462 or at
[email protected].
Password: EPIC Login – ex: ELK435
CHECK OUT THE NEW BaptistHealthAlabama.org What can we help you find? As a physician, the information you need is now easier to find on our new public-facing website baptisthealthalabama.org. The modern appearance, mobile version and responsive design of our site considers all of our potential website customers’ needs: For Consumers – a responsive design site (which provides optimal viewing and navigation across mobile devices and desktops), an up-to-date “Find a Doctor” search, plus ready-access to bill pay options For Physicians – easy access to the Physician Portal, BPA portal, Continuing education and more What we know - Our current website analytics reveal the primary reason consumers visit the BHS website is to find two things: a doctor or a career. With that in mind, we’ve made sure our new design brings those two items to the forefront. Find a Doctor - This new database has been updated with search capabilities for common procedures, specialties and medical conditions, along with the existing credentialing information for our physician network. By providing a single-source of physician listings, our Call Center, physicians, employees and consumers can easily access the information they need.
Your physician profile. Visitors to the site can search for a physician based on provider name, specialty, common procedure name, diseases and conditions as well as by zip code/location. Our web team conducted extensive research to connect Baptist’s medical staff with all of the relevant search terms that apply to each provider. To ensure that we are directing potential patients and referring physicians accurately, a list of almost 450 services, procedures and specialties was assembled with credentialing and privilege reports. The resulting list means searching cardiology procedures and services will lead to cardiologists, and so on. Once a provider is selected, a profile, generated by MD Staff credentialing, will be visible. This profile includes a brief biography containing a photo, age, specialty, credentials, education experience, other treatments and services, office contact information, and a map for directions. Have changes to your profile? Medical Recruitment Coordinators (Leigh Leak, Margaret Ann Webb, Darlene Bond and Juanita Williams) – This team will assist with all recommended changes and relay suggestions to members of the credentialing staff. Small changes like a new phone number, address, photo, website, etc. will begin appearing on the profile within 24 hours of entering into the system. You may also submit recommended changes directly to our feedback address for faster response time. All feedback, changes, and comments are asked to be submitted to
[email protected].
BAPTIST HEALTH SYSTEM AND BPA PLAN FOR 3 NEW SHARED SAVING CONTRACTS FOR FY2015 As BHS and BPA continue to learn and improve through our experience with the VIVA ME product, we are also looking ahead to new shared savings opportunities. New agreements with Secure Horizons, Blue Cross Advantage, and Humana are all on track for implementation on January 1, 2015.
management. Their model will be attribution based initially; members are not required to designate a PCP. Blue Advantage attributes a member to a PCP based on medical utilization and through clinically based assumptions. Blue Advantage estimates that there are approximately 5,500 current Blue Advantage members associated with BPA primary care physicians.
- The Secure Horizons shared savings model consists of quality and efficiency measures that lead to bonus opportunities. Their model requires that members select a designated PCP. Currently, Secure Horizons has approximately 5,000 members who have BPA Primary Care physicians and are therefore assigned to BPA. The new shared savings agreement will be triggered by our attaining a Medical Loss Ratio (MLR) that contemplated our current performance.
- Humana has also actively approached BPA to move their Humana BPA– based members over to a shared savings agreement. The new agreement will also enhance and expand the quality measure bonuses currently being paid to individual physician who have direct agreements with Humana. Humana estimates that there are 900-1,000 lives currently associated with BPA; that is, prior to the October enrollment period.
- Shared savings contracts are a new concept for Blue Advantage but they have committed to working with BPA as a pilot initiative in FY2015. The Blue Advantage commitment to shared savings with BPA is a testimony to the progress we have made in clinical integration and overall population
Shared savings and potential risk based models are the basis of future quality and financial successes for BPA and BHS. CMS is moving very quickly to quality based reimbursement and the BPA/BHS Clinical Integration model will be leading the way with these new payer contracts.
CPQC UPDATE There are now seven CPQC committees within BPA. At the August BPA CPQC Chair and Vice-Chair meeting the committee heard the recommendation from the Women’s and Children’s Committee that the committee “sunset” and that the pediatricians and OB/GYN physician members should be included in the Primary Care and Surgery committees, respectively. They felt that this new structure would provide for more alignment opportunities for these physicians. Collegial discussion ensued and the CPQC Chair and Vice-Chair Committee made a motion to support this change to the BPA Board. Dr. Jim Weems and Dr. Kara Conti were recognized and thanked for their leadership on the committee. At the August 27, 2014 BPA Board of Directors meeting, this change was approved. Our most recent BPA CPQC Chair and Vice-Chair Meeting was held on October 15, 2014. At that meeting, the committee members reviewed recent CPQC meeting activities including core content (All committees reviewed ICD-10 progress, Patient Safety, Membership, Conflict of Interest survey completion, Hospital Efficiency Program performance; clinical committees also reviewed the Clinical Quality Improvement projects and Viva Me contracting/performance updates) as well as committee specific agenda items. Dr. Mike Wilensky (Vice-Chair, Heart & Vascular) reported that the H&V committee continues to explore evidence-based, trial demonstrated HEP opportunities as well as clinical improvements to work flow which are patient satisfiers such as same-day discharge after PCI, in appropriate patients. At Shelby, there has been excellent success, over the last month, with a pharmaceutical change from bivalirudin to unfractionated heparin in appropriate interventional patients. To date, they have seen excellent clinical outcomes with this change. Data obtained from the conclusion of The HEAT Trial was important in beginning this discussion within the committee. Dr. Agata Przekwas (Chair, Medicine CPQC) reported the initiation of a multidisciplinary task force to examine and develop the BHS implementation of currently recommended clinical practice guidelines for the management of Pain, Agitation and Delirium in adult patients in the ICU, otherwise known as the PAD guidelines. Additionally, the ABCDE bundle (Awakening and Breathing Coordination Delirium Early Exercise and Mobility) for standardization of ventilator weaning will also be addressed by the task force. Dr. Frank Thomas (Vice-Chair, Neurosciences) reported that Neurosciences has initiated the review of acute stroke and TIA order sets to maintain their compliance with recommended therapies. This is critically important for our stroke center designations at those facilities so designated. They also reviewed additional HEP opportunities and compliance.
Dr. Clem Cotter (Chair, Surgery CPQC) provided the committee with an update on the HEP activities that surgery is pursuing and relayed the excellent multidisciplinary work (Surgery & Pharmacy) that led to the removal of IV acetaminophen from our facilities. A thorough and critical review of the refereed literature coupled with collegial discussion led to this important change. Dr. Mike Brasfield (Vice-Chair, Primary Care) provided an excellent thorough report of the recent series of called primary care meetings wherein the year to date VIVA Me performance has been reviewed. Additionally, the CPQC members have received information about opportunities from Merck pharmaceuticals which has patient education information that is available for patients, centering on diabetes education and management. This educational material is available for any BPA physician. If interested in additional information about these programs, please contact Patty Poe, RN (BPA Lead Clinical Nurse) for more information at 205.715.5238. Dr. Chris Davis (Chair, Clinical Infrastructure) reviewed the Epic order set review plan and approval process and the correct way to copy and paste notes in Epic, along with updates on connectivity for quality reporting and the ICD-10 progress to date. Dr. Elizabeth Ennis (Chair, CPQC) presented the Hospital Clinical Services (HCS) report on behalf of Drs. Kim Parker and Brett Lindsey (Chairman and Vice-Chair of HCS respectively). After completing the successful voice recognition transcription pilot at Citizens BMC, the HCS committee has extended that use to Princeton and Walker. Developing normal templates for normal examinations, which standardizes our reporting format, has been critical in the deployment of this technology. The committee hopes to extend this to the Shelby campus in the near future, which was strongly supported by the Chair and Vice-Chair committee. Additionally, the HCS committee has seen great adoption of our change in clinical lab services. At present, ~85% of all clinical laboratory studies are being performed at Quest Diagnostics, our BPA preferred clinical laboratory. In addition to the individual CPQC reports, the Chair and Vice-Chair committee members had a presentation by Greg Smith (Executive Director, Managed Care - BPA/BHS) wherein he presented BPA contracting opportunities for 2015. Additional comments by Scott Fenn complimented the discussion. We are currently positioned to have a strong and successful 2015 BPA contracting year. Please see the upcoming meetings section for dates of other upcoming scheduled meetings.
