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  News and Updates

The Collaborative Care Network: Preparing for Participation in Advanced Alternative Payment Models

by Medical Staff Office on January 31, 2017

Looking for an Advanced Alternative Payment Model (AAPM)? The CCN’s primary focus is to offer a portfolio of AAPMs to as many CCN-member clinicians as possible. Being in an AAPM provides several benefits: 1) automatic five percent Medicare bonus 2) significant relief from reporting burdens 3) opportunities to achieve greater incentive payments 4) a larger Medicare rate increase in 2026 and beyond and 5) resources to improve patient outcomes.

AAMC has recently submitted a Letter of Intent to participate in the state’s Hospital Care Improvement Program (HCIP) in 2018. HCIP is expected to be approved by Medicare as an AAPM for hospital-based clinicians, meaning it will offer the benefits listed above. Clinicians interested in participating in AAMC’s HCIP will need to be members of the Collaborative Care Network. The HCIP applies to inpatient care and has the following objectives:

  • To enhance the quality of patient care by adoption of evidence- based and other standardized practices
  • To improve physician and organizational efficiencies in providing patient care
  • To reduce the cost of care and eliminate medically unnecessary services

Providers participating in HCIP will benefit through:

  • Participation in programs designed to meet Medicare Access and CHIP Reauthorization Act (MACRA) requirements
  • Potential financial incentives from the hospital for performing activities that will improve care, reduce potentially avoidable utilization (PAU) and reduce the total cost of care (TCOC)
  • Access to detailed reports to allow physicians to improve their individual performance, and achieve greater incentive payments and improved patient outcomes over time

There are more Care Redesign Programs currently in development at the state levels that will include outpatient care. The CCN will support local practices in these programs as well. We are building the infrastructure to be successful together in the era of payment reform and care transformation.

For more information on the CCN, or to learn how your practice can join, please contact Renee Kilroy at rkilroy@aahs.org or 443-481-6619.

Essentials for a Culture of Safety

by Medical Staff Office on January 31, 2017

The Institute of Medicine’s groundbreaking report, “To Err Is Human,” highlights the importance of patient safety in health care organizations. This report, along with emphasis from many health care improvement entities such as the Joint Commission, triggered a renewed effort among health care organizations nationwide to eliminate medical errors and improve patient safety.

“One of the first steps in creating a safer health care organization is establishing a culture of safety. High reliability organizations emphasize safety as a fundamental priority that we continually strive to improve upon. A safety culture flourishes when…”

  • We learn about patient safety from the successes and positive events that occur in health care every day to build strong patient safety programs.
  • We examine our approaches and, therefore, increase safety and actively prevent harm.
  • We report events and, ultimately, seek understanding and value through other experiences that lead to safer care and practices.
  • We think and act in the manner necessary to develop successful solutions, find answers, overcome obstacles, and deliver results to ensure safety.
  • We provide a learning environment that is constantly improving and focused on patient safety.

AAMC has been pursuing a culture of safety, in which front-line operators and others are not punished for actions, omissions or decisions that commensurate with their experience and training where gross negligence, willful violations and destructive acts are not tolerated. A culture of safety safety is created through the collective attitudes and values of a group of people. To achieve a safety culture, each one of us in the organization must embrace a safety mindset and support each other in our safety efforts.

Patient safety affects everyone at AAMC. Building a safer culture depends on our ability to listen and learn from all members of the health care team.

Beginning Feb. 6 through Feb. 20, we are once again participating in the Agency for Healthcare Research and Quality AHRQ Safety Culture Survey. This survey will enable AAMC to assess how staff and medical staff perceive various aspects of our patient safety culture, and will also:

  • Raise staff awareness about patient safety.
  • Diagnose and assess the current status of our patient safety culture.
  • Identify strengths and areas for patient safety culture improvement.
  • Examine trends in patient safety culture change over time.
  • Evaluate the cultural impact of patient safety initiatives and interventions.

Our goal is to get a response rate of at least 80 percent of all employees. The survey is very easy to complete. We encourage all staff to participate in this essential initiative, so that quality and patient safety remain high priorities here at AAMC.

2017 Medical Staff Photography

by Medical Staff Office on January 9, 2017

To support the marketing and promotion of our practices and programs, we like to have a professional photography of each member of our medical staff.  For 2017, we have arranged for a photographer to be onsite from 4-6 pm for each of the quarterly Medical Staff Meetings to take photographs of our new providers, as well as any existing provider who would like a new photograph for marketing or Find-A-Doc on our website.

Dates

  • January 11th
  • April 12th
  • July 12th
  • October 11th

Location

Belcher, 7th Floor

Time

4-6 pm

Wardrobe

  • Men: Suit in a solid color of dark blue, black or dark gray with a solid colored shirt and conservative tie. Please bring a freshly pressed lab coat— either embroidered with your current practice, or no embroidery.
  • Women: Solid color dress or suit. Please bring a freshly pressed lab coat— either embroidered with your current practice, or no embroidery.

Questions

Contact Carrie O’Meara, marketing strategist comeara@aahs.org or 410-961-3041.

Pathology Update: New PCR Testing Available for Routine Antepartum Screening Available Jan. 9; New Group B Streptococcus LIM Broth-Enriched Molecular Test

by Medical Staff Office on January 9, 2017

From Sanford Robbins III, MD, Chief Pathologist, and Jacqui Kozireski, Microbiology Lab Manager

We are pleased to announce that the Cepheid Xpert GBS LB (Group B Strep LIM broth enriched) is a qualitative real-time PCR test used to detect GBS DNA from LIM broth culture of vaginal/rectal swabs after 18 to 24 hours of incubation. This test is for antepartum testing (35-37 weeks).

Conventional methods of culturing are less sensitive and can take up to 72 hours from collection to reporting. The combination of LIM broth enrichment and PCR provides reduced turnaround time with an extremely sensitive and specific method to detect GBS colonization in antepartum women, which fulfills the CDC (November, 2010) recommendations for testing.  Results will be reported in 20 to 24 hours as compared to the three-day turnaround of current culture methods.

Routine susceptibility testing will only be performed on those patients who are penicillin-allergic at the request of the physician, and can be requested up to three days post collection or indicated when the test is ordered. Susceptibility testing will require an additional two to three days when requested.

Specimen collection: Use Remel BactiSwab (double swab) provided by the lab as long as testing is sent to us. PAR levels will be monitored periodically. We will no longer accept gel swabs as this is incompatible with PCR testing.

Store specimens refrigerated and transport to the lab within 24 hours of collection. Patients who have used systemic or topical (vaginal antibiotics in the week prior or patients with placenta previa should not be tested.)

On written/printed orders, please specify:

  • Group B Strep, Lim Broth PCR (Antepartum Only)
  • Group B Strep Lim Broth, PCR w/Sens (Antepartum Only) for Penicillin Allergy

 

Contact the Microbiology Laboratory at 443-481-4232 with questions or if further testing is needed.

What Is Clinical Integration and Why Is It Important?

by Medical Staff Office on January 9, 2017

In the days of “no questions asked,” fee-for-service payment, our medical community thrived as a cottage industry, each of us humming along independently, minding our own business. But now with state and national initiatives tying our payment to outcomes, our local “cottages” of care need to recognize one another and benefit from our interdependencies. No individual clinician or practice can alone shoulder the burden of cost and quality improvement for patients. Imagine being accountable for a patient’s outcomes and not knowing where, how or from whom he/she is getting care, or whether his/her other clinicians have the same goals and incentives as you. The missing ingredient is clinical integration, which requires aligning goals and incentives across settings of care, and sharing data and resources to ensure mutual success in promoting better health outcomes. Clinical integration is more than just infrastructure: it creates the culture that recognizes medical professionals’ roles and expertise in delivering appropriate care efficiently.

Why is clinical integration important? Maryland is accelerating the move to linking practice-based care to hospital-based care by “MACRA-tizing” our state’s unique all-payer model through the provision of a growing number of advanced alternative payment models (AAPMs) for physicians to choose from. Maryland AAPMs currently in development provide opportunities for specialists, primary care physicians and hospital-based clinicians to collaborate locally with each other and their hospitals. Physicians are attracted to AAPMs because their participation in an AAPM relieves physicians from the significant reporting burdens of MIPS (merit-based incentive payment system) and provides five percent annual bonus in Medicare payment, in addition to potential further financial rewards from the AAPM itself.

Achieving success in AAPMs depends upon recognizing interdependencies and aligning goals among providers of care. The AAMC Collaborative Care Network (CCN) is your local, physician-led platform that enables our own medical community to share data, resources and AAPM opportunities. The CCN is your clinically integrated network, formed for our own medical community and the patients we serve together.

Currently, the CCN has more than 400 clinician members. Our objectives are:

  • AAMC (private and employed) clinicians together taking responsibility for the cost and quality of care for populations;
  • Shared responsibility between AAMC clinicians (both private and employed) for the cost and quality of care for populations;
  • Better coordination of care across settings and clinicians;
  • More effective management of chronic disease by both clinicians and patients;
  • Measurable improvement in health outcomes;
  • Successful performance in pay-for-value programs;
  • Enhanced role satisfaction of clinicians;
  • Building a community of practice recognized and preferred by patients.

For more information on the CCN, or to learn how your practice can join, please contact Renee Kilroy at rkilroy@AAHS.org or 443-481-6619.

The Collaborative Care Network: Promoting the Success of Our Members through Payment Transformation and Care Redesign

by Medical Staff Office on November 25, 2016

In recent months, the Collaborative Care Network (CCN) has sponsored two events to provide updates to our medical community on MACRA, MIPS and Advanced Alternative Payment Models, and how these programs affect Maryland providers. We learned that we can expect an ever-changing landscape as a variety of innovative reimbursement models and programs are released at the federal and state levels. These programs are moving from volume-based models to value-based models that reward quality and outcomes, while enhancing provider experience.

The amount of information to digest is enormous. Many of us don’t have time to read the volumes of material released continuously, to understand these programs, or to focus on the infrastructure needs that will be required in our practices to meet their expectations and reporting requirements. Many of us need a single, trusted resource to help us accomplish all of this.

The Collaborative Care Network is here to help you. Our team focuses on these emerging opportunities and will continue to provide you with up-to-date information and guidance on how to be successful as we all navigate payment reform and care redesign. Our goal is to help remove some of the administrative burden so you can get back to what you do best: practicing medicine and taking care of our community.

In 2017, essentially all providers in the State of Maryland will report through MIPS. The CCN will assist our members with interpreting the quality payment program requirements and can provide guidance on the MIPS reporting process. We are exploring how federally funded quality improvement organizations can help support MIPS reporting by local practices.

The CCN’s primary focus is 2018, the year we will be able to offer a portfolio of Advanced Alternative Payment Programs (AAPMs) to as many clinicians as possible. Being in an AAPM provides two benefits: 1) an automatic 5 percent Medicare bonus, and 2) significant relief from reporting burdens. In Maryland, we anticipate having multiple opportunities to participate as a network in programs like:

  • Maryland Comprehensive Primary Care Model
  • Hospital Care Improvement Program (HCIP)
  • Medicare Shared Savings Program Track One Plus (ACO)

 

The CCN will be the organization that will support local practices in these programs. We are building the infrastructure to be successful as we, together, prepare for success in the era of payment reform and care transformation.

For more information on the CCN, or to learn how your practice can join, please contact Renee Kilroy at rkilroy@AAHS.org or 443-481-6619.

Pathology Update: New Gastrointestinal Pathogen Panel (Multiplex PCR testing)

by Medical Staff Office on November 25, 2016

From Sanford H. Robbins, MD, chief pathologist; Jacqui Kozireski, microbiology lab manager; and Mary Clance, MD, hospital epidemiologist

The era of molecular microbiology is here. We are pleased to announce that Multiplex PCR testing will be available for the detection of stool pathogens starting November 15, 2016. The FilmArray Gastointestinal Panel from BioFire diagnostics is FDA- cleared and provides overall sensitivity and specificity of 98.5% and 99.3% respectively.  Rapid and highly sensitive detection of gastrointestinal pathogens is vitally important to provide appropriate therapy when indicated and to reduce transmission of disease.

Conventional identification techniques, such as culture, microscopy, and antigen detection, typically test for a limited number of pathogens, and are much less sensitive than PCR testing. Since the presentation for many GI pathogens is clinically indistinguishable, multiplex testing offers an expanded panel for the testing of multiple pathogens. Clinical studies have shown that co-infections can occur and are being under-detected due to our current methods of testing.

Multiplex testing offers a rapid turnaround time and the ability to detect multiple pathogens, including bacterial, viral and parasitic infections. The new GI Pathogen PCR Panel is intended to replace the now-archaic stool culture methodology. Traditional culture will only be available for patients in whom no other pathogen has been detected by multiplex testing.

We will no longer offer antigen testing for Rotavirus or Giardia- Cryptosporidium and C. difficile.  C. difficile will continue to be offered as a separate PCR test. Diarrheal stool specimens should be submitted following our current practice and only one sample should be sent within a 7 day period. Outpatient samples should be submitted in Cary-Blair media. Formed stool will be rejected.   Contact the Microbiology Laboratory at X4232 with questions or if further testing is needed.   See www.filmarray.com for more information regarding this technology.

Pathogens detected by a single test in less than 2 hours include: GI PANEL MENU

Bacteria

E. coli and Shigella

Parasites

Viruses

Campylobacter (jejuni, coli and upsaliensis)Plesiomonas shigelloidesSalmonella

Yersinia enterocolitica

Vibrio (parahaemolyticus, vulnificus and cholera)

Vibrio cholerae

 Enteroaggregative E.coli (EAEC)Enteropathogenic  E. coli (EPEC)Enterotoxigenic E. coli (ETEC)lt/st

Shiga-like toxin-producing E. coli (STEC) stx1/stx2

E.coli O157

Shigella/Enteroinvasive E. coli (EIEC)

CryptosporidiumCyclospora cayetanesnsisEntamoeba histolytica

Giardia lamblia

Adenovirus F40/41AstrovirusNorovirus

Rotavirus A

Sapovirus (I,II,IV and V)

 

Mindfulness Meditation-Based Intervention is Feasible, Acceptable, and Safe for Chronic Low Back Pain Requiring Long-Term Daily Opioid Therapy

by jmiller on November 3, 2016

“Findings of this study indicate that the targeted mindful meditation-based intervention is feasible and safe in patients with opioid-treated chronic low back pain.  Mindful meditation-based interventions are particularly attractive for the treatment of chronic disabling conditions because they promote an acceptance-based, self-reflective process, which can encourage a patient-empowering and personalized approach addressing the whole patient.  This approach extends beyond the traditional, disease-focused treatment model of chronic pain and passive nature of pharmacotherapy, offering a valuable therapeutic option for those with refractory chronic low back pain requiring daily opioid therapy.”  (Journal of Alternative and Complementary Medicine, August)  Click here to read full-text.

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