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  Medical Staff 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 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.

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 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 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 for more information regarding this technology.

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


E. coli and Shigella



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:


  • 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.


  • 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 or 443-481-6617.



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