Through thousands of personal stories posted online, President Obama is setting out to humanize the healthcare debate and push Congress to pass serious reform. In search of momentum, the president and his supporters are preparing for a prime-time broadcast and a weekend of grass-roots projects from canvasses to blood drives.
CoxHealth, a three-hospital system in Springfield, MO, is currently awaiting its latest triennial survey at any moment. Fortunately, with a series of survey preparation tools and practices in place, the system's accreditation coordinator was confident in the system's ability to handle the pending survey.
Preparation and education for staff has become an evolving concept for hospitals, says Ruth Anne Moore, accreditation program manager at CoxHealth.
"There are more scoring opportunities than ever before. Eventually this will all be helpful but for now" it means putting the newest and most accurate information in the hands of the people who need it, says Moore. This means multiple presentations to leadership, department heads, and other managers.
The organization has also devised survey tips and preparation processes that occur at steady but not overwhelming intervals—weekly, biweekly, and monthly—to help keep all staff and departments prepared for the next survey.
The J-Blitz is a survey prep tool doctored to meet the specific needs of the system.
"Blitz was a quick, 'offensive' rather than defensive term to prepare for a survey," says Moore. "A cheat sheet of sorts."
The tool, a weekly checklist of preparatory tasks, had been in-house for some time, but had really become something the system relied on over the past year.
"We had it out there, but we really weren't using it until this past year, knowing that we were scheduled for a full triennial survey," says Moore.
Specific staff members use the J-Blitz—in essence a last-minute check list to prepare for surveyor arrival—every Sunday night to catch last minute details.
"We asked managers to designate someone to do this every Sunday evening—we're scheduled for a five-day survey, so surveyors are probably going to show up on a Monday morning," says Moore.
Knowing that these necessary tasks are checked off prior to every Monday morning works to alleviate fears by managers—and keep compliance with Joint Commission requirements steady.
"It gives managers a sense of comfort," says Moore. "It gives them something they can look at when they hear the welcoming page for The Joint Commission surveyors."
The tool was originally created with a list of 25 last-minute items to check on before surveyors arrive, but CoxHealth had tailored the list to suit its facilities and increased the list to 30 items.
"We've adapted it, changed things," says Moore.
Also included on the tool: Tips for talking with surveyors and added reminders on restraints standards.
"With all the recent CMS changes on restraints, and now with The Joint Commission's integration with CMS, we felt like this was a focus area," says Moore.
Departmental checklists
The J-Blitz is not the only tool CoxHealth uses to track its survey readiness. More in-depth department checklists have been created to go over questions that might arise on hot-button issues like medication management and National Patient Safety Goals.
"The Blitz is the down and dirty checklist. The department checklist is more in-depth and is divided into areas, including environmental services, security, infection control, safety, medication management, and more," says Moore. These surveys are conducted on a monthly basis.
FridayFacts
In addition to weekly and monthly checklists, CoxHealth also makes use of bi-weekly "FridayFacts," an internal newsletter-style set of tips for survey. Created by Moore's predecessor, the FridayFacts arrive in a Q-and-A format and are crafted to help staff know how to talk to surveyors. The answers are worded in a way to provide an outline for the right way to address questions from surveyors to cut down on nervousness or confusion.
The patient access team at Skagit Valley Hospital has many goals as it works through this economic recession: Sustain morale, maintain trust, minimize criticism, and acknowledge success.
Michele Hill, CHAM, patient access manager at the Mount Vernon, WA, facility, knows it's not easy considering what the hospital faces:
Federal and state budget cuts
Change in payer mix
Increased charity care requests
RAC audits
"Our facility, like many others, is facing significant challenges during this time of economic downturn," Hill says.
To cope, leaders at Skagit Valley asked managers like Hill to provide a 5% and 10% reduction plan. Originally, it was a "what-if" scenario. Economic woes, however, made it a reality, and Hill and other managers were forced to trim 5%.
So she went to work in several key areas:
Reduced monthly staff meetings to quarterly and implemented a newsletter to keep staff up-to-date
Identified a less expensive, yet more user-friendly patient armband that has reduced the use of the expensive armband/label sheets; this resulted in a $10,000 annual savings
Eliminated printing duplication in ED that results in significant paper and toner expenses
Deployed staff to the shifts that have greater volumes, while saving on shift differentials and increasing productivity
Eliminated all travel for 2009
Centralized patient access services throughout the organization to provide a highly trained and efficient team that can be deployed to any area for support
"Other processes have been evaluated," Hill says, "and utilizing lean methods, we have found many ways to reduce waste that while not in the hundreds of thousands of dollar savings, are adding up to make a significant difference."
Then came the difficult part. Skagit Valley could only do so much internal restructuring and cost-cutting before it took a hard look at labor expenses.
It implemented a wage freeze. Each full-timer must give up 64 hours of work/pay between May 1 and December 31.
"Working with my teams, we have come up with creative ways to make this happen," Hill says. "We are on a no-lunch agreement, and during down times, staff take an hour for lunch. We may have someone leave an hour early, and the rest of us chip in to back up. These must be hours that are not covered by someone else. This is the most difficult as my team have never been on a low-census expectation."
Skagit also eliminated a number of FTEs, the majority through not filling vacancies; however, a small number of staff members did lose their jobs.
"This has been an emotional time," Hill says. "And at this point, I am spending as much time being even more upfront and center with my teams to show my personal support, leadership support, and to be aware of any issues as soon as possible so as to be able to provide assistance, or referral for more than I am able to address. … By involving the team in the decision making processes, on those things that we have power over, I have buy-in, and greater success, because they own it."
Editor's note: This is the fourth in a series of stories on HealthLeaders Media talking to revenue cycle managers about coping in a tough economy. The previous installments were:
The Joint Commission International and the Korean Hospital Association have announced a strategic collaboration designed to improve healthcare quality and safety in South Korea.
Karen H. Timmons, president and CEO of the Joint Commission International, said the collaboration made sense for both sides, as the JCI and KHA both seek to improve quality and safety at their respective member hospitals.
"Working in many different countries it's very useful and beneficial to have credible, reputable partners who can also be local 'feet on the ground' to understand the culture, the healthcare delivery system, etc.," Timmons said. "They are assisting and partnering with us since we have such collaborative goals.
Through the partnership, the KHA and JCI will establish programs that seek to further quality and safety in Korean hospitals. As part of this "Memorandum of Understanding," the JCI and the KHA will:
Establish an ongoing series of educational programs for KHA member hospitals
Establish a help desk for KHA members to answer their questions about JCI standards, accreditation, and services
Distribute information on JCI standards for all accreditation programs via the KHA information network
Develop and promote the use of patient safety solutions for the benefit of Korean patients and health professionals
Promote KHA recommendations on healthcare quality and safety through the South Korea representative that is a member of JCI's Asia-Pacific Regional Advisory Council
One major goal of the collaboration is to help Korean hospitals achieve a level of quality that is recognized worldwide.
"Working with JCI will help the Korean Hospital Association raise the profile of health care in South Korea, and bring international recognition to the quality of care in Korean hospitals," said KHA President Hoon Sang Chi, MD, in a statement. "Improving the quality of healthcare and patient safety in South Korea is a strategic initiative of the KHA."
Currently, one hospital in South Korea has achieved JCI accreditation, but several other facilities have expressed interest in doing so, JCI says.
By working together, the two organizations should be able to exert some influence and leadership with respect to helping organizations meet their needs and goals regarding quality and safety, Timmons says.
"I would hope that the partnership would have an impact—a very positive impact—raising the awareness in respect to patient safety and providing concrete education on ways to enhance quality and safety," she says.
Timmons says that she hopes the work achieved through the collaboration with the KHA will ultimately benefit patients not only in Korea, but other areas of the world as well. If the partnership with Korea and other countries proves successful, the JCI could potentially reach out to other nations seeking to improve quality and safety in their hospitals, Timmons says.
"In China, we have a memorandum of understanding with the Chinese Ministry of Health to carry our educational programs," Timmons says. "We also have a partnership agreement with the Peking University to conduct education and research. There are absolutely opportunities in other areas."
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The initial reaction to the HIT Policy Committee's recommendations for the definition of "meaningful use" of electronic health records was shock and concern. I overheard phrases like:
"It's more of a stimulus stick."
"You have to walk before crawling."
"It sets the bar so high; it forces us to game the system."
"It doesn't show how the functionality required furthers quality goals."
Chief information officers were overwhelmed by the list of objectives for EHRs by 2011, which include
Using computerized physician order entry systems for all order types including prescriptions in both outpatient and inpatient settings.
Incorporating lab-test results into EHRs in both outpatient and inpatient settings.
Generating lists of patients by specific condition to use for quality improvement initiatives, reducing disparities, and outreach in outpatient settings.
Providing patients with an electronic copy of- or electronic access to- clinical information (including lab results, problem list, medication lists, allergies) in both outpatient and inpatient settings i.e. through a personal health record.
Providing clinical summaries for patients for each encounter in outpatient and inpatient settings.
Exchanging key clinical information with other care providers, such as problems, medications, allergies, test results in both outpatient and inpatient settings.
Submitting immunization and laboratory data to public health agencies.
Complying with HIPAA Privacy and Security Rules and state laws.
These objectives were centered around five desired health outcomes: Improving quality, safety, efficiency, and reducing health disparities; engaging patients and families; improving care coordination; improving population and public health; and ensuring privacy and security for personal health information.
Even though the policy committee was more aggressive in its first draft of recommendations than many healthcare executives expected—perhaps the committee was hoping to generate a lot of public comment—many healthcare leaders still applauded the goals of the committee.
"The healthcare industry is far behind other industries in this country. Therefore, the bar needs to be set very high in order to drive the industry to catch-up and get where we need to be," says Norm Mitry, CEO of Heritage Valley Health Systems, an integrated delivery network in southwestern Pennsylvania.
Peter Basch, MD, the medical director for ambulatory clinical systems at MedStar Health, an eight-hospital system based in Columbia, MD, agrees. "The HIT policy committee has to take a road where an incentive is an incentive," he says, explaining that it should put the goals within reach of early adopters or just outside of reach of average physicians and hospitals adopting HIT. "We don’t what to set the bar too low that the results of this massive investment by American tax payers in healthcare infrastructure goes to naught."
Still there is a real concern that the bar may be out of reach for many providers. "Hospitals will need significant clinical systems already in place to meet the proposed timeframes," says Catherine Bruno, vice president and chief information officer at Eastern Maine Healthcare Systems in Brewer, ME. "Even though these are health information technology objectives, they are really changing clinical practice," she says.
CPOE in 2011—really?
Not surprisingly, the two areas that seemed to cause the most consternation were the CPOE requirement and emphasis on PHRs listed in the 2011. Some hospital executives said that CPOE and medication administration using barcoding, which was listed under the 2013 objectives, should be flipped.
For his part, Basch says that implementing CPOE in the outpatient setting in the 2011 timeframe is a doable goal. The inpatient setting is a different story, however. "For those of us in medical field, we are a little gun shy of pushing CPOE too quickly when we haven't gotten other pieces of the loop complete—medication administration and barcoding—and done sufficient workflow analysis first to make sure there will not be unintended consequences," he says.
MedStar Health, which has been working on an accelerated timeline to have all of their physicians in the outpatient setting up on EHRs, is on target to achieve meaningful use under the proposed recommendations and timeline, Basch says. The organization decided to move on the outpatient setting first because it is "easier, far less expensive to do, and the technology was more shovel ready," says Basch. In the inpatient arena, however, MedStar had barcoding and CPOE flipped in its schedule of adoption. If CPOE stays in the 2011 timeframe, the organization may have to alter its strategy. "We will have to reconsider the impact and size of federal incentives on our existing roadmap and make a decision at the leadership level as to whether we keep to the roadmap or adjust it," says Basch.
Bruno is concerned about implementing this amount of change at all six of EMHS' hospitals under the current timeline. She says their tertiary referral hospital, Eastern Maine Medical Center, will likely be able to meet the 2011 and 2013 objectives because 93% of orders are created using CPOE and they already have most of the other functionality planned. However, the same cannot be said for their smaller hospitals, which do not have CPOE yet. The organization plans to implement CPOE at the other facilities over the next three years. But with the 2013 requirement for barcode medication administration, it will be taxing, Bruno says, because pharmacy expertise is needed for both projects.
"A significant part of CPOE is medication ordering, dose range alerts, allergy alerts, and drug interaction alerts. The barcode medication administration also requires pharmacy expertise," she says. "It will be difficult for all six of our eligible hospitals to meet the 2013 objectives."
PHR surprise
Many healthcare executives were shocked to see the emphasis on personal health records in the 2011 objectives. But Mitry was not one of them. "We are a believer that everyone should have the opportunity to access their personal health record online at anytime of the day or night," he says.
Glen Tullman, CEO of software vendor Allscripts, is also supportive of PHRs being included in the 2011 objectives. "We cannot create an electronic healthcare highway and not have onramp for patients," he says. "Right now PHRs aren’t connected and nobody wants to use it, but who wanted to be the first fax users?"
Basch, however, is not convinced that forcing providers to adopt PHR technology at this point is the right approach given the limited adoption rates. "I’m not saying that having a dimension of meaningful use that includes engaging patients and families is a mistake. I think that is correct," he says. The language should be altered to include "patient portals, PHRs, or some other means of sharing data securely with patient and families," he says.
Do you think the HIT Policy is being too aggressive including CPOE and PHRs in the 2011 goals? Do you think the timeline for other functions and objectives should be altered? These recommendations are just a first draft and you still have time weigh in. Comments are due by June 26, 2009, and should be no more than 2,000 words in length.
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The Cardinal Health Foundation has awarded $1 million in grants to hospitals for projects designed to leverage health information technology and other measures to improve patient safety. Cardinal plans to award grants of up to $35,000 per institution for projects that employ creative and replicable strategies to improve patient care.
Bar code medication administration is one tool being adopted by hospitals to help reduce medication errors. BCMA technology involves labeling individual medicine doses with unique bar codes at their point of entry into the pharmacy (if not already done so by the manufacturer), and then tracking these medications as they move throughout the hospital.
The Memphis, TN, area is one of a growing number of regions or states with a health information exchange, which enables electronic patient data to be shared among hospitals and physicians. Nearly all of the hospitals and public clinics in the Memphis region participate, which allows their emergency department doctors and other authorized personnel to call up patients' blood tests, imaging scan reports, and hospital discharge summaries. The three-year-old exchange is helping doctors make better decisions and avoid wasting money on duplicative tests, say those involved.
Florida Gov. Charlie Crist has signed legislation aimed at curbing the growing black market of illegal prescription drugs flowing from South Florida pain clinics across the eastern United States. The new law, passed nearly unanimously in the Legislature, will require doctors and pharmacists to record patient prescriptions for most drugs in a state-controlled database.
Three Cleveland-based community health centers—Care Alliance, Neighborhood Family Practice and the Northeast Ohio Neighborhood Health Services—will receive about $2.7 million combined in stimulus funding to switch over to electronic medical records systems and undertake other capital projects. The change will allow the organizations to share patient data efficiently with local hospitals already using electronic medical records.
