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  Medical Staff Updates

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)

 

Improving Emergency Department Wait Times: A Team Approach

by Medical Staff Office on September 20, 2016

AAMC is among hospitals nationwide working diligently to improve the ED patient experience. We are taking action to improve processes in order to move patients as quickly as possible through the ED. Many nurses, doctors and other employees from several departments and units have come together and are doing excellent work to achieve this goal.

What we know is that ED wait times are not solely dependent on processes within the ED. Our ability to get patients admitted to units quickly is a big factor as well. So as part of our improvement work, we are making several changes to other clinical units in the hospital. The Observation Unit on the first floor of Hospital Pavilion North recently expanded from 12 patient beds to 17 patient beds. Here are other changes that are happening soon:

SUNDAY, OCTOBER 2:

  • The Special Care Unit on the third floor of Hospital Pavilion North will become the Intermediate Care Unit (IMU). Intensivists will manage these patients. The Special Care Unit on the sixth floor of Hospital Pavilion North will become part of the Acute Care for the Elderly (ACE) Unit. These changes will help us provide patients with the appropriate level of care.  (Special kudos to these clinical teams who have been working hard to prepare for these changes.)
  • The Critical Care Unit is changing its name to Intensive Care Unit (ICU) to better reflect the patient population.
  • The Heart and Vascular Unit (HVU) will move from the fourth floor of Hospital Pavilion North to the third floor of Hospital Pavilion South. The new location puts the Heart and Vascular Unit closer to the Intensive Care Unit, allowing us to better serve these patients and their families.

THURSDAY, OCTOBER 6:

  • A second Medical/Surgical Unit (MSU) will open on the fourth floor of Hospital Pavilion North. We will refer to this unit as MSU-4 to differentiate from the other MSU on the sixth floor of Hospital Pavilion North.

We appreciate everyone’s hard work as we strive to improve the patient experience. If you have questions about these changes, please talk to your leader.

AAMC Collaborative Care Network: Join 250 Members (and Growing)

by Medical Staff Office on August 9, 2016

The Medicare Access and CHIP Reauthorization Act (MACRA), Merit-Based Incentive Payment System (MIPS) and Advanced Alternative Payment Models…change is coming and the timeline for making big decisions is short. Please be aware of how federal and state changes will impact you, your practice, and your colleagues. Our talented and diverse medical community has long enjoyed success in a fee-for-service environment. But soon, the payment model will change, and our incomes will be tied to patient outcomes.

Do you have the internal systems in place to handle the mandated requirements starting next year?  Are you prepared to take on risk? In order to thrive in 2017 and beyond, we must recognize that our individual success is interdependent on the performance of our fellow colleagues and disciplines. That is why many clinicians across the country are joining clinically integrated networks that will allow them to weather future challenges while maintaining autonomy.

The Collaborative Care Network (CCN), chaired by Robert Hanley, MD, of Anne Arundel Urology, was established in August 2015 to support our medical community’s successful navigation of care redesign and payment transformation. The CCN is our local, physician-led platform that allows the health system to join forces with independent and employed physicians to share data, resources and opportunities to improve care, create efficiencies, and demonstrate the value that an integrated, cohesive medical community can deliver.

The CCN provides the necessary infrastructure and support to help you prepare for coming changes. It gives you the power to partner with your colleagues to improve health outcomes for the population we serve, while sustaining your autonomy and professional satisfaction.

We will all be responsible for health outcomes. We will all have to take on risk. We are interdependent upon one another to succeed. We will succeed and be rewarded as a high-performing, integrated medical community.

For more information on the CCN, or to request a presentation for your practice, please contact Heather Matheu at hmatheu@AAHS.org or 443-481-6617.

 

 

Zika Virus Update

by Medical Staff Office on June 23, 2016

An update from Mary Clance, MD, hospital epidemiologist: It has now been six months since the epidemic of Zika virus in South America came to the attention of U.S. public health authorities. During that time, the transmission zone has expanded northward from Brazil and now includes more than 25 countries in the Caribbean, South and Central America and Mexico. Local transmission is dependent upon two mosquito species, Aedes aegypti and albopictus, which have been established in the U.S. following importation from overseas. Both are now present in Maryland.

As of June 1, 2016, a total of 21 cases of Zika virus infection have been reported in Maryland. All were acquired in an area of known transmission outside of the U.S.

The West Nile Virus, a related Flavivirus, was imported (by humans) into the U.S. in 1999, and has since become established even though the vector mosquito (Culex) primarily feeds on birds and is less aggressive compared to the Aedes mosquitos, which are aggressive biters that prefer humans.

Considering the magnitude of international travel in this hemisphere, urban crowding, the presence of the vector mosquito adapted to both urban and suburban environments, the fact that most human infections are asymptomatic and therefore undetected, and entry into the summer mosquito season in the northern hemisphere, it is very probable that the Zika virus will become established in the U.S.

Old-fashioned public health measures regarding control of the vector are needed. This includes the removal of stagnant water sources that are mosquito breeding sites and the selective use of pesticides for both larvae and adults. Individual vigilance and tactics to avoid exposure to and bites by mosquitos are especially important this summer.

Resources:

https://www.cdc.gov/zika/

http://mda.maryland.gov/plants-pests/Pages/Zika.aspx

http://phpa.dhmh.maryland.gov/pages/zika.aspx

http://www.cdc.gov/chikungunya/pdfs/fs_mosquito_bite_prevention_travelers.pdf

AAMC Hosts First-Ever Virtual Grand Rounds

by Medical Staff Office on June 23, 2016

The James and Sylvia Earl Simulation to Advance Innovation and Learning (SAIL) Center recently hosted a first-of-its-kind virtual grand rounds based on simulation and surgical education and research. Adrian Park, MD, chair of the Department of Surgery, kicked off this new series of grand rounds sponsored by the American College of Surgeons and their Accredited Education Institutes.

Ivan George, director of the Earl SAIL Center, led the concept, development and implementation of the event. He conceptualized a novel and low-cost interactive video platform bringing together surgeons, researchers and medical experts from 30 facilities and 17 time zones at once to discuss the latest in surgical and simulation methodologies. Leaders participated from organizations such as Mayo Clinic, Cleveland Clinic, Cedar Sinai, and Tripler Army Medical Center, along with institutes in Greece, France, and many others.

Inaugural speaker Dr. Park provided an overview of his 11 years of experience in clinical video conference-based grand rounds, sharing wisdom learned over the years. Guest speaker Mark Pinsky, a dentist, international airline captain, and aviation expert, discussed how aviation methodologies can be applied to surgical processes. He presented a concept of adapting the use of aviation checklists as an organizational tool to empower each member of the surgical team to organize thoughts, identify errors, and increase situational awareness. Combining such systematic solutions with simulation practice could have a positive impact on improving quality and outcomes. The presentation fostered a lively discussion among practitioners and experts across many centers about translating the aviation principles into practice.

This groundbreaking event — for both simulation and surgical grand rounds — provided a unique opportunity for AAMC as discussion leaders. The Earl SAIL Center plans to continue its involvement in this new series of grand rounds in the future. If you would like more information, contact Ivan George at 443-481-6053. Read more about how airline industry strategies are being adapted for medicine.

Outpatient Home Therapy

by Medical Staff Office on April 29, 2016

The Joint Center at AAMC is piloting a program for joint replacement patients where an in-home evaluation is provided by an outpatient physical therapist to review the patient’s function prior to surgery. The therapist assesses the patient’s home and provides recommendations for set up changes to make before surgery to improve patient safety. Once they return home, the patient will receive one or two additional in-home therapy sessions before their transition to outpatient rehab. This program provides opportunity for a quicker discharge and a shorter length of stay, while maintaining quality care. The pilot program is rolling out doctor by doctor until all joint patients are included. The long-term goal is to expand this program beyond The Joint Center patients to other surgical programs at the hospital. For more information on in-home PT, contact Amanda Adkins at 443-481-1418 or aadkins@osmc.net.

Medical Staff In The News: March/April 2016

by Medical Staff Office on April 29, 2016

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