Transcript VANDERBILT UNIVERSITY MEDICAL STAFF & VANDERBILT MEDICAL GROUP ANNUAL MEETING

VANDERBILT UNIVERSITY MEDICAL STAFF
& VANDERBILT MEDICAL GROUP
ANNUAL MEETING
Thursday, June 28, 2012
4:30 – 6 pm
208 Light Hall
VANDERBILT UNIVERSITY MEDICAL STAFF
ANNUAL MEETING
AGENDA
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Welcome
C. Lee Parmley, MD
Chair, Medical Center Medical Board (MCMB)
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Proposed Amendments to Medical Staff Bylaws, Rules &
Regulations and Policies & Procedures
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MCMB Membership Elections
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Adjournment
PROPOSED AMENDMENTS TO MEDICAL STAFF
BYLAWS, RULES & REGULATIONS
AND POLICIES & PROCEDURES
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Goals of Proposed Revisions:
– To comply with evolving CMS, Joint Commission and
NCQA standards
– To streamline Medical Staff Bylaws, Rules &
Regulations, Policies & Procedures and VUMC policies
and to create internal consistency
– To address and codify evolution of VUMC staffing and
clinical practice
AMENDMENT REVIEW AND
APPROVAL PROCESS
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Administrative Affairs Committee
– identification of CMS, Joint Commission and NCQA
requirements, inconsistencies, and other needs for
additions/revisions/deletions
Executive Committee of MCMB & full MCMB
– review recommendations of Administrative Affairs
Committee, amend and endorse as appropriate
VUMC Medical Staff
– approval of amendments at Annual Meeting
Medical Center Affairs Committee (Board of Trust
Committee)
– final approval
AMENDMENTS TO MEDICAL STAFF BYLAWS
AND RULES & REGULATIONS
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Article XII – Corrective Action
– Proposal to add verbiage requiring providers to inform
their Chair of the initiation of any disciplinary action by
another hospital, licensing board, etc. and to keep
informed as to the progress and outcomes of such action
and proceedings
Article VII – Clinical Services
– Add Physical Medicine & Rehabilitation
Article VI – Privileged Professional Staff
– Change all references in Medical Staff Bylaws and Rules
& Regulations “Professional Staff with Privileges”
AMENDMENTS TO MEDICAL BYLAWS AND
RULES & REGULATIONS
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Article III – General Qualifications for Appointment
– Add verbiage that defines an “approved residency” as
one accredited by ACGME, American Osteopathic
Association, College of Family Physicians of Canada
CFPC and/or Royal College of Physicians and Surgeons
of Canada
– Add verbiage that refers all allegations of discrimination
in the credentialing decision-making process to EAD with
periodic audits of all denials to ensure that providers are
not discriminated against
Rules & Rags – History & Physical Section
– Change verbiage to include Anesthesiologists as
“attending” for the purpose of taking histories and
performing physical examinations
AMENDMENTS TO MEDICAL STAFF BYLAW
AND RULES & REGULATIONS
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Article III – Appointment and Reappointment
– Modify board certification requirements as indicated to
become compliant with Joint Commission standards and
current practice:
• When the applicant possesses comparable training, experience and
competence but (1) Board Certification was not applicable at the
time the applicant’s training was completed or (2) the applicant is
only certified in a non-U.S. or non-Canadian Board or 3) the board
certification is in a specialty other than the primary division
(department), the applicable Chief of Service may submit a written
request for a waiver of this requirement to the Credentials
Committee Chairman for action by the Credentials Committee with
subsequent approval by the MCMB and MCAC. However,
Physicians must maintain their Certification by board whatever recertification process is outlined by their applicable
ACTION POINT
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Approval of proposed amendments to Medical Staff Bylaws,
Rules & Regulations, and Policies & Procedures Required
MCMB MEMBERSHIP UPDATES & ELECTIONS
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At-Large Members (3) elected annually
Nominees:
– Andre Churchwell, MD
– A. Alex Jahangir, MD
– James “Pete” Powell, MD
ACTION POINTS
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At-Large Member Elections require a majority vote of the
voting members present
Adjournment of Medical Staff Meeting
VANDERBILT MEDICAL GROUP
ANNUAL MEETING
AGENDA
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VMGVMG Finance Committee – Roland Eavey, MD
VMG Credentialing – Steven Meranze, MD
VMG Billing Office –Meredith Marwill
Contracting Update – Beverly Coccia
VMG Quality Council – Racy Peters
Physician Council on Clinical Service Excellence – Gaye Smith
Hitch and Other Operational Initiatives – Margaret Head
Economic Repositioning – David Posch
VMG Finance Group
06/26/2012
Committee Members
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Dan Beauchamp
Marc Bennett
Brian Carlson
Sandy Cherry
Keith Churchwell
Titus Daniels
Marilyn Dubree
Roland Eavey
Phyllis Ekdall
Janice Fruci
Denis Gallagher
Sheri Haun
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Margaret Head
Stephan Heckers
Tommy Hollinden
Mack Howell
Mark Hubbard
Howard Jones
Mike Laposata
John Manning
Steve Meranze
Derek Miller
Colin Mothupi
Robin Mutz
Mike Neuss
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Jim Newman
Bill Obremskey
David Posch
Pete Powell
Margaret Rush
Warren Sandberg
Diane Seloff
Janice Smith
Robin Steaban
Cindy Sullivan
Paul Sternberg
Reid Thompson
Dell Yarbrough
Identity
Historically - an audit committee
Contemporary needs
• $400M budget re-engineering over upcoming
years
• Comfortable conversation to align our
values/missions with our economic forces
• Grow revenues plus reduce expenses
• Process > Product
Meeting 1:
Provider Compensation Model
• “Medicare cutting reimbursements”
Sensitive elephant
• “Officially” discussed compensation
modeling with reduced dollars (our values,
process examples, leadership)
November 30, 2011
• Bring up the sensitive topic
• Valued ingredients re compensation
• Time frame
Meeting 2: TOOLS
Cost Reduction = Quality Increase
• Lost/Cost Awareness Tools
– (SLA) Service Line Analytics (MD level
utilization)
– WebMD (local/national institutions)
– UHC (AMCs)
– Healthcare Quality Calculator (utility)
December 7, 2011
Meeting 3:
Strategic Growth Tools
• Investment information: THA, HSDA, UHC,
JAR, Thompson Reuters
• Finance: Where we are/Where we want to be
Medipac/Epic/TSI
SLA/Crimson/UHC
Tracking Team…..ROI view
January 12, 2012
Meeting 4: Cost Homework and
Parking
• Valve Data Analysis…Cost/LOS/Readmission
• Parking
January 31, 2012
Meeting 5:
Optimal Resource Management
• Teams (MD/RN/MBA)
• Departmental variance
• Inpatient/Outpatient
May 29, 2012
Meeting 6: Optimal Resource
Management
• Why haven’t we fixed Fridays?
Vanderbilt University Medical Staff
and Vanderbilt Medical Group Meeting
June 28, 2012
Credentials Committee Report
Steven Meranze, M.D.
Organizational Structure
• The Credentials Committee (Steven Meranze)
Participating sub-committees
• Children’s Hospital Credentials Committee
(Gregory Mencio)
• Joint Practice Committee (Clare Thomson-Smith)
• Provider Support Services Office (Danielle Midgett)
Credentials Committee
• Representation of the major clinical specialties, including behavioral
health, the hospital-based specialties and the Medical Staff at large
• Meets monthly
• Synopsis of duties (see Bylaws):
A. To evaluate the credentials and performance of all applicants for Medical Staff membership
and reappointment
B. To review recommendations from the Joint Practice Committee regarding the credentials,
performance, and supervisory arrangements of all Certified Nurse Practitioners, Certified
Nurse Midwives, Physician Assistants, Certified Registered Nurse Anesthetists and Allied
Health Practitioners who apply for privileges to practice at VUMC.
C. To report to the Medical Center Medical Board on each applicant for Medical Staff or other
professional staff recommendation to the Medical Center Affairs Committee (MCAC).
Reports and recommendations regarding Medical Staff and other professional staff
appointment and delineation of practice privileges shall include consideration of any
recommendations from the Service in which the candidate requests privileges;
D. To investigate any breach of ethics that is reported to it.
E. To review reports of Medical Staff or other professional staff member performance or
conduct issues that are referred to it, and to provide peer review in response to competence
or performance inquiries.
Medical Staff Actions
(1739 in FY 2012)
Reappointments
1075 (61%)
Initial
Appointments
325 (19%)
Expedited
3 (0%)
Resignations/
Terminations
187 ( 11%)
Additional
Privileges/
Change of
Status 164 (9%)
Timeliness of File Review and Approval
• Influenced by many factors
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Licensure and DEA
Verification (all education, hospital affiliations and work history)
Faculty appointment
Trust coverage/ Claims history
Competency documentation
Incomplete application
• Affects practice planning (personal and division)
• Enrollment considerations (NCQA)
• Increased need for expedited credentials committee
meetings
National Committee on Quality Assurance (NCQA)
certified Credentials Verification Organization (CVO)
• Develop delegated credentialing agreements with managed care
organizations (MCO)
• Delegate MCO credentialing activities to Vanderbilt. VMG
providers who are approved through the VUMC Credentials
Committee review process are “automatically” enrolled in ~43
managed care plans versus each provider completing and
submitting separate applications to each of these organizations
• Creates an additional layer of complexity and scrutiny to
credentialing activities
• Files >120 days are considered “expired” and require resubmission and re-verification
Files met within 90 Days
by Fiscal Year
350
319
300
243
250
200
185
150
100
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FY 2010
FY 2011
<90
>90
>120
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FY 2012
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Expedited Credentialing
• Expedited credentialing: Provider is reviewed
and approved for privileges by an agent
(subcommittee) of the governing body (MCAC)
• Defined exclusion criteria
• Legitimate action to answer immediate needs
(e.g. critical staffing issues)
• Large number may reflect system limitations
Expedited Files by Fiscal Year
140
120
113
116
100
80
67
60
40
20
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0
FY 2009
FY 2010
FY 2011
FY 2012
Future Initiatives
• Paperless credentialing
– E-file “secure transfer “(Accellion)
– Electronic signature - “Pronto System”
– Phased implementation
• Improved interface with the Faculty Information
System for Faculty Appointments
VMG Business Office Update
Presented by Meredith Marwill
Associate Director of Physician Billing Services
Faculty Practice Solutions Center Billing Office Survey
FY2010 Top 10 Performers
• VMG ranked 7th overall in benchmark performance indicators
reported by 56 academic institutions through University Healthcare
Consortium (UHC).
1.
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University of Pittsburgh Medical Center
UMass Memorial Medical Group
University of Minnesota Physicians
Massachusetts General Physician Organization
The Medical College of Wisconsin
University of Wisconsin Medical Foundation
7. Vanderbilt Medical Group
7. University of Texas Medical Branch (Galveston)
9. University of Virginia Physicians Group
10. Fletcher Allen Health Care/University of Vermont
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Gross Professional Charges
Charges have increased
10.9% from prior fiscal
year.
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Annual Cash Collections
Collections have
increased 7.9% from
prior fiscal year.
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Total RVU Volume
Total RVUs have
increased 8.7%
from prior fiscal
year.
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Collections Per RVU
Collections/RVU has
decreased 0.7%
from prior fiscal
year.
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Days in A/R / Charge Lag
UHC FY 2011 Survey
Days in A/R
25th percentile = 47.4 days
Median = 41.2 days
75th percentile = 36.9 days
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Cost to Collect
as percent of Net Collections
11.1%
10.8%
10.6%
Cost to Collect has
remained stable this
past fiscal year.
9.8%
8.8% 8.3%
7.9%
7.4% 7.0%
6.3%6.3%
2012
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*2012 FYTD through May
Projects and Opportunities for FY 2013
• Continue to improve patient collections
• Expand Point of Service collection program to address
increasing patient out of pocket requirements
• Develop vendor partnership to allow for combined
patient collection activities with VUMC
• Continue to redesign work flow processes and systems to
enhance the revenue cycle
• Migrate toward a paperless work environment in the
revenue cycle through further development of EPIC
workqueues and other technology enhancements
• Developing best practice documentation to move
towards more consistent work processes within all areas
of the revenue cycle
• ICD10 Training and Preparation
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Contracting 2012
Highlights
VMG Quality Reporting
2012 VMG Annual Faculty Meeting
June 28, 2012
6/28/2012
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The Mission of VMG is to improve
the health
of the people
in the communities we serve
through
evidence-based, personalized,
compassionate
care, research and education.
6/28/2012
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Hand Hygiene
FY 2012
FY 2012 Goal
1st
Hand Hygiene
Quarter
VMG Adult
VMG Peds
6/28/2012
93%
95%
FY 2012
2nd
Quarter
95%
94%
FY 2012
FY 2012 FY 2012
3rd
Threshold Target
Quarter
95%
95%
88%
88%
92%
92%
FY 2012
Reach
95%
95%
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Adult Anticoagulation Clinic
6/28/2012
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Adult Anticoagulation Clinic
6/28/2012
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New Patient Access
6/28/2012
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Publicly Reported Measures: OPPS
• Timing and appropriateness of antibiotic
prophylaxis in outpatient procedures
FY-2012
2nd Qtr Threshold Target Reach
OPS - Appropriate Care
90.0%
91%
94%
99%
OPS 6 - Timing of Antibiotic Prophylaxsis
97.0%
80%
85%
90%
OPS 7-Prophylactic Antibiotic Selection
91.5%
80%
85%
90%
6/28/2012
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Publicly Reported Measures: PQRS
• Voluntary quality reporting program
• Provides incentive payments of 1% of all
Medicare Part B billings for each eligible provider
(EP)
• Reporting Period: full calendar year 2011
• Data will not be publicly reported for 2011 or
2012
6/28/2012
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Publicly Reported Measures: PQRS
• Incentive timeline and amounts:
• 2012: 0.5 %
• 2013: 0.5 %
• 2014: 0.5 %
• Penalty timeline and amounts:
• 2015: 1.5 % (will be based on 2013 submission)
• 2016 and each subsequent year: 2.0 %
• Data will be publicly reported beginning 2013
or 2014 (exact year still TBD)
6/28/2012
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PQRS Measure #1: Hemoglobin A1c Poor Control in Diabetes
% of Pts Aged 18-75 with Diabetes Mellitus with Most Recent
Hemoglobin A1c >9.0%
6/28/2012
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Measure #2: Low Density Lipoprotein (LDL-C) Control in
Diabetes
% of Pts Aged 18-75 with Diabetes Mellitus who had Most Recent
LDL-C Level in Control (<100 mg/dl)
6/28/2012
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Measure #3: High Blood Pressure Control in Diabetes
% of Pts Aged 18 -75 with Diabetes Mellitus who had Most
Recent Blood Pressure In Control (<140/90 mmHg)
6/28/2012
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Measure # 5: Heart Failure: ACE Inhibitor or ARB Therapy for
LVSD
% of Pts Aged 18+ with Heart Failure and LVSD (LVEF < 40%) who
were Prescribed an ACE inhibitor or ARB Therapy
6/28/2012
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Measure #6: Oral Antiplatelet Therapy Prescribed for Patients
with CAD
% of Pts Aged 18+ with a Diagnosis of CAD who were Prescribed
Oral Antiplatelet Therapy
6/28/2012
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Measure #7: Beta-Blocker Therapy for CAD Patients with Prior
Myocardial Infarction (MI)
% of Pts Aged 18+ with a Diagnosis of CAD and prior MI who
were Prescribed Beta-Blocker Therapy
6/28/2012
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Measure #8: Beta-Blocker Therapy for Left Ventricular Systolic
Dysfunction (LVSD)
% of Pts Aged 18+ with a Diagnosis of Heart Failure who also have LVSD (LVEF
< 40%) and who were Prescribed Beta-Blocker Therapy
6/28/2012
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New VMG Medical Director for Quality:
Barron Patterson, MD
6/28/2012
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Physician Council for
Clinical Service Excellence
June, 2012
Patient Experience & Service
Council Structure
Physician Council for
Clinical Service Excellence
• Began meeting in March of 2011
• Meets monthly
• Membership represents 14 clinical departments plus Williamson
County
– 28 physician members
– Chair: Paul Sternberg, M.D.
– Co Chairs: Andre Churchwell, M.D. and Leah Harris, M.D.
– Facilitators: Lynn Webb, Ph.D.; Gaye Smith
Physician Council Members
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John (Jake) Block, Radiology
Nathaniel Clark, Psychiatry
Anthony Cmelak, Radiation Oncology
Marta Crispens, OB-GYN
Titus Daniels, Medicine
Jesse Ehrenfeld, Anesthesiology
James Felch, Ophthalmology
Brent Graham, Pediatrics
Rob Hood, Medicine
Alex Hughes, Anesthesiology
Ian Jones, Emergency Med
Eric Lambright, Surgical Sciences
Mike Laposata, Pathology
Tracy McGregor, Pediatrics
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Steven Meranze, Radiology
Paul Moore, Pediatrics
Melinda New, OB-GYN
David Parra, Pediatrics
John Peach, Medicine
Jan Price, Medicine
Russell Ries, Otolaryngology
Henry (Hank) Russell, W'mson Co - VMG
John Scott, W'mson Co - VMG
Carmen Solorzano, Surgical Sciences
David Uskavitch, Neurology
Douglas Weikert, Orthopaedics
Patty Wright, Medicine
Kelly Wright, Surgical Sciences
Key Topics Discussed
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Why a Physician Council?
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PRC Patient Satisfaction Surveys
– (use of % excellent vs. percentiles in Service Pillar goals)
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HITECH Meaningful Use implications for clinical practices and work flow
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Studer Physician Institute: “Practicing Excellence: Engaging Physicians to
Execute System Performance”
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Patient and Family “Always Promise”
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Use of a video on effective communication between physicians and patients
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Provided input for process improvement in patient complaint mgmt
– Renaming Patient Affairs “Advocates” to Patient Relations “Specialists”
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Ways to formally recognize Clinical Excellence
Operations Update
Margaret Head, RN, MSN, MBA
Chief Operating Officer/Chief Nursing
Officer
2012 Clinic Expansions and Acquisitions
• VEI acquisition of Lebanon Eye Associates
• VOI Clinic expansion to Mt. Juliet
• Williamson County School District contract for
athletic trainers
• Franklin Cardiology expansion
• Maternal Fetal Medicine rotation in Columbia
• DOT 10 floor completion
VMG Nursing Updates
• VMG Staff Turnover Rate 9.88%
• 32 RN’s and 9 LPN’s advanced in the nursing clinical
ladder program
• Significant work in developing nursing triage and RX
star renewal protocols
• Received special recognition during the Magnet Survey
Status of Meaningful Use Implementation
Cohort Training Timeline
8/1/2011 - 8/31/2011
Complete Pilot
of Star Tools
10/3/2011 - 12/30/2011
2nd Cohort Training
9/1/2011 10/1/2011 11/1/2011 12/1/2011
9/1/2011 - 10/14/2011
1st Cohort Training
8/1/2011
4/2/2012 - 6/29/2012
4th Cohort Training
1/1/2012
2/1/2012 3/1/2012
1/2/2012 - 3/30/2012
3rd Cohort Training
4/1/2012
5/1/2012
6/1/2012
7/1/2012
8/1/2012
9/1/2012
7/2/2012 - 9/30/2012
5th Cohort Training
9/30/2012
HITECH Faculty and Staff Trained
• Eligible Providers
– Eligible Provider trained
671
– Eligible Provider remaining to be trained
187
– Total Eligible Providers
858
• Providers Trained
963
• Staff Trained
1055
• Total Trained to date 2018
HITECH PHASE II/ICD-10
• HITECH Phase II
– Vanderbilt Outpatient Order Management (VOOM)
• Pilots under way in several clinics
• Staged roll out to begin in Oct 2012
• ICD-10
– Tools being developed to help with transition from
ICD-9 to ICD-10
– Pilots have begun on these tools with expected rollout
to being in Spring of 2013
Economic Repositioning
David Posch
June, 2012
Mitch Edgeworth
Chief Operating Officer
Vanderbilt University Hospital
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Coordinating Care
Redesign fundamental Care Processes to improve
efficiency and effectiveness
Clinic
Procedure
ICU
Inpatient Discharge Post Acute Home
Disease
Redesign the infrastructure to improve efficiency and effectiveness
across all care transitions
Self
Inpatient Care Coordination
Model
Risk
Stratification
Medication
Reconciliation
Huddle
Post Discharge
Phone Call
Care Plan 1.0
Post Discharge
Clinic Visit
Post Discharge
Intermediate
Care
Economic Repositioning
> 200 Ideas
submitted
~ 40 active
projects
Top 5 Projects
1)
2)
3)
4)
5)
MEOC Initiatives FY13
340B Contract Pharmacies
Specialty Pharmacy
Care Partner Redesign
Case Scripting
Top 5 represent ~$22MM of the
$30MM built into FY’13 Budget
FY’12
Forecast Savings
FY’13
Savings in Budget
FY’13
Anticipated Savings
$8 million
$30 million
$32 million
Manpower
FTEs
(Adult)
May ‘12
Actual
FY’12
Budget
FY’13
Budget
8,912.6
8,968.0
9,147.0
246 FTE reductions were made through
attrition and repurposing of positions