To Be Determined
It seems fitting that I am writing this article at SSM's conference titled "The SSM Experience, Imagine the New Reality” because this month marks a historic time for both SSM, Dean Clinic and Dean Health Plan. When at the crossroads of their decision this month, 97% of the Dean Clinic physicians voted to merge with SSM as their partner for the future. Assuming governmental approval, this union vaults the triumvirate onto the short list as one of the largest fully integrated health care systems in the country.
This includes more than 1,300 physicians under the SSM banner and another 6,000 physicians with close affiliation, a health plan that understands value-based care for its 300,000+ members and is perched to expand across the SSM geography, a pharmacy plan to help manage a system-wide formulary, award-winning acute care as well as skilled nursing care facilities. Additionally, St. Mary's Hospital in Madison and Dean Health Systems are in rarified company with both attaining HIMMS level 7 electronic integration, placing both among the top 3% in the country.
Our advantages are clear: an aligned incentive during a time of change in health care that strengthens the whole system, the ability to manage health across the continuum of health care from wellness to acute care to convalescence to end-of-life care, a highly integrated electronic medical record that can be used to standardize evidence-based care and improve our population's health, and the advantages of leveraging the strengths of each arm of the conglomerate to create a stronger entity than each of its parts. Many of the details are yet to be determined. Clearly, efficiencies will be gained and best practices will be determined and disseminated. We will continue to bend our cost curve via our aligned incentives while still driving higher levels of quality.
Make no mistake that there is a lot of work ahead. We will need to address external forces from regulatory agencies, shrinking reimbursements, limited resources and a shifting model for delivering care and wellness.
One key component in shaping the future of this powerhouse in health care is physician influence and leadership. Physician engagement is key for the successful health care team. SSM recognizes the value of physician leadership in shaping the future of its health care delivery. High-level physician leadership in SSM has more than doubled in the past six years. This growth is just the beginning as SSM's CEO, Bill Thompson, sees the strategic value of intimate physician involvement in SSM. He envisions a dyad model of leadership with physicians engaged at every level of decision-making.
Physicians have the ability to model the health care we provide. Renowned management consultant Peter Drucker stated that "the best way to predict the future is to create it." Though the precise details of our model are yet to be determined, as I see it, our future is very bright, so bring your sunglasses.
- Dr. Greg Burnett, Vice President for Medical Affairs
St. Mary’s Hospital Medical Staff Directors
(front row) Greg Burnett, Kay Barrett, Lee Carter, Timothy Crummy, Jeff Welch
(back row) Tim Crummy, James Goodsett, Anne-Marie Lozeau, Kyle Martin
SSM Is Growing
In addition to the anticipated merger with Dean Health Systems’ network of specialty physicians and clinics, SSM Health Care now counts 18 acute-care hospitals among its holdings in four states, thanks to the recent acquisition of the 88-bed Audrain Medical Center in Mexico, Missouri, and its nine MedChoice Clinics. The growth is part of an overall strategic plan for SSMHC to be “an indispensable, top-performing Mission-based integrated health care delivery system,” according to SSMHC President and CEO Bill Thompson.
We’re National Leaders in EHR Use
St. Mary’s Hospital and Dean Clinic received Stage 7 Awards from the Healthcare Information and Management Systems Society, recognizing them as the first combined clinic/hospital organization in the country to have complete implementation of the electronic health record for improving patient care and safety. Read more.
In addition, individual honors went to Dean Clinic, St. Mary’s Hospital and Stoughton Hospital , recognizing the highest level possible for use of the electronic health record. Just 1.9 percent of hospitals in the nation can claim this honor. All other SSM Health Care of Wisconsin wholly owned and affiliate hospitals are at an impressive Level 6 – an honor only 9.1 percent of hospitals in the nation can claim. Stage 7 means that all records are electronic and all systems are in place for reducing the number of preventable errors that can be made using traditional manual systems. In addition, Stage 7 providers are able to share patient information with other health care providers as needed, further improving patient care and safety.
Be Proud of (and Thank You for!) Our Safety and Quality
St. Mary’s was the only Madison hospital to earn an “A” grade this spring for hospital safety from the national Leapfrog Group, a nonprofit founded by businesses to improve the safety and quality of health care. In addition, St. Mary’s is among a small number of organizations nationwide named as top performers in multiple quality areas determined by Premier Healthcare Alliance. For three years in a row, St. Mary’s met the criteria to reduce mortality; reduce the average cost of care; reliably deliver evidence-based care measures to patients in the areas of heart attack, heart failure, pneumonia and surgical care; improve the hospital experience; reduce preventable harm events; and reduce readmissions.
C. Difficile: It’s Facile to Access Resources
The Clostridium difficile order set was finalized in Epic last December. This order set was the end-product of the C. Difficile Pathway Development Team efforts. To leverage the electronic health record, clinical links are imbedded into certain order sets. The highlights of this order set are the availability and identification of: (1) clinical resource and radiographic / lab / drug ordering information; (2) treatment chart according to severity and recurrence; (3) infection control measures; and, (4) nursing educational information for patients and family.
||How to Access / Where Available|
|C. difficile order set
||- Enter “C diff” (or, Clostridium Difficile Colitis Orders) into order set entry in Epic|
- Sections: nursing orders; IV fluids; consults; labs; imaging; medications according to severity or recurrence
|“C. Difficile Pathway” process
||- Upper left hand corner of order set, just below the order set title. |
- Describes overall components of Access, Diagnosis, Treatment, and Transition / Discharge.
|Drug Treatment Algorithm
||- Upper left hand corner of order set, below the order set title|
- Applies the IDSA (Infectious Disease Society of America) definition of severity of infection to treatment choice. Outlines treatment to: mild / moderate, severe or complicated; first or second recurrence.
- Describes micro lab diagnostic testing using PCR
||- Pre-checked on C Diff order set under “nursing orders”|
- Components: contact isolation, sign on alcohol dispenser “do not use”; contact isolation sign on door; personal protective equipment at bedside; education of patient, family and visitors. Soap and water preferred method of hand hygiene.
|Patient and Family Education Materials
||- “C Diff: Keeping You and Your Family Safe at Home”. On intranet → patient education → look under C → C Diff Home Care. Designed by Ellen Smith, Infection Control. Tips on cleaning and bleaching the home environment |
- “FAQs (frequently asked questions) about Clostridium Difficile”. Order from Patient Education, PEC #1408
- “Help Stop the Spread of Infections: Isolation Precautions”. On intranet → patient education → look under D through M → iso info for patients
COMING UP: An Antibiotic Stewardship website will be available in the next few months that will be a comprehensive resource of St. Mary’s stewardship program featuring disease state algorithms and infectious disease links.
If you have any questions or would like a copy of the patient education materials, contact Geri Naymick, PharmD: email@example.com or 444-5739 (cell).
For the 2013 APIC “Guide to Preventing Clostridium difficile Infections,” visit www.apic.org/implementationguides
Pharmacy Gains Interim Director and New Web-Based Newsletter
Dr. James Rybacki, a pharmacist of national renown, joins St. Mary’s Hospital as interim director of Pharmacy, and the P&T Committee has launched its inaugural newsletter, available through the Medical Connections website. Read more.
Lab Director Named
Mike Baron, interim lab director since March, has assumed the role of administrative director of laboratory on a permanent basis. Mike had joined St. Mary’s in 2012 as operations manager- core laboratory. Prior to that, he was laboratory manager of support services at the University of Wisconsin Hospital; operations manager- pharmaceutical analysis for Covance Laboratories; laboratory services manager/project manager for American Red Cross Biomedical Services; and field operations supervisor for SmithKline Beecham Clinical Laboratory, which is now Quest Diagnostics.
Malnutrition May Impede Treatment
A 2012 St. Mary’s Hospital study regarding malnutrition in patients demonstrates a significant practice gap in the identification and accurate diagnosis of malnutrition. A strong partnership between physicians and registered dietitians can close this gap and result in better outcomes for our patients with malnutrition.
Malnutrition was first described as the skeleton in the hospital closet in 1974. Unfortunately, nearly 40 years later, malnutrition in the hospital setting remains a serious concern. Reports of malnutrition vary widely from 13% to 60% of hospitalized patients. Malnourished patients are two times more likely to develop pressure ulcers and three times more likely to develop infections. These patients also have extended lengths of stay and increased readmission rates.
At St. Mary’s, a nutritional study followed patients admitted from January to May 2012. Registered dietitians identified 120 patients who fit criteria for malnutrition using nutrition focused physical assessment. Malnourished patients met two or more of the following criteria: low BMI 18.5, poor intake over seven days, unintentional weight loss, and physical findings of muscle or fat loss. These criteria have been established jointly by the American Society of Parenteral and Enteral Nutrition and the Academy of Nutrition and Dietetics. Of those 120 malnourished patients, only 11 were actually diagnosed and coded for malnutrition.
Many clinicians are still tempted to look at a serum albumin level as the sole nutritional status marker. Since albumin and prealbumin decrease in response to inflammation and physiologic stress, they are not accurate indicators of nutritional risk in the acute care setting. Registered dietitians look beyond albumin levels to assess nutritional status.
Nutrition focused physical assessment as well as nutritional intake patterns, weight history and functional capacity all provide a more accurate picture of a patient’s nutritional risk. Consulting a registered dietitian will result in faster assessment and treatment of malnutrition.
--Cheryl Kleve, RD
BACK TO TOP
ICD-10: One Year And Counting!
Less than one year from now, SSM Health Care will begin using new codes to report medical diagnoses and inpatient procedures. These are the codes that are entered into a patient’s electronic medical record. The change is part of “ICD-10,” the classification system used to collect data to improve health care services. SSM will begin using the new codes in April 2014, and the entire health care industry will be required use the new codes starting Oct. 1, 2014.
What is ICD-10? In the United States, a medical classification system is used to collect information regarding diseases and injuries. The system is called the International Classification of Diseases (ICD), and ICD-10 refers to the 10th revision. The transition to ICD-10 is required for everyone covered by the Health Insurance Portability Accountability Act (HIPAA). It has been more than 30 years since the last revision.
How does it work?
Health care staff uses the ICD to translate the words used by physicians and other health care providers to describe a patient's condition into alphanumeric codes.
What is different?
As part of ICD-10, more codes will be used (about five times more), as well as increased code specificity. For example, under the previous guidelines, one code would be assigned to a procedure, such as a vascular graft, while under ICD-10 multiple codes would be assigned for the same procedure to account for complications that can occur.
Why the change?
The more specific data will provide better information for identifying diagnosis trends and public health needs. The more precise codes also have the potential benefit for fewer rejected claims and improved quality of care management.
How can you prepare? SSM will provide online and in-person training beginning late summer 2013. Be sure to stay tuned to the SSM ICD-10 internet resource site for more details coming soon.
CME-CPD Website Refresher
Physician Spotlight: Greg Matzke
As a three-time recipient of St. Mary’s Guardian Angel recognition, Dr. Greg Matzke (general surgery) most certainly has most certainly has earned his wings —through compassion, professional achievement and service to community.
Dr. Matzke joined Dean Clinic’s general surgery department in 2005 and today also serves as St. Mary’s trauma director. He has worked with other surgeons to perform multiple major surgeries simultaneously that are easier on the patient versus having separate surgeries. He recently began working with the neurology department to laparoscopically place a diaphragmatic pacer system in appropriately selected individuals to benefit patient's with spinal cord diseases. In fact, he became the first Wisconsin physician to implant a diaphragm pacer in a patient. (See story in St. Mary’s Community Connection newsletter.)
The procedure salvages patients’ independence by improving respiratory function for activities of daily living. Long-term data are encouraging and with the other medical treatments and scientific advancements, the hope is for patients to live a longer, more independent life.
“Surgical success is a team sport. It cannot be done alone,” he says, sharing credit with his general surgery department colleagues, physician assistants and clinical nurses. “I’m proud of the ability to care for my patients in a multidisciplinary fashion in a tertiary care setting. It is very rewarding to see patients get well through our collaboration.”
Dr. Matzke is originally from Green Bay. He attended UW-Madison for an undergraduate degree (molecular biology) as well as his doctor of medicine degree, comes to St. Mary’s after having completed his residency in general surgery at Mayo Clinic. He is a big advocate for preventive care. “It improves quality of life, increases productivity and benefits physical and mental health throughout a patient's lifespan.”
Community is important to Dr. Matzke in personal ways, too. He is a coach for his children's basketball, soccer, baseball and softball teams, enjoying the game as much as the mentorship. He loves quiet moments in the great outdoors too. “If I'm not at work or coaching, odds are that you'll find me on one of the nearby lakes boating, fishing or skiing.”
The website for continuing professional development (formerly known as CME – continuing medical education) was first organized in 2012, based on a variety of requests made to the Medical Staff Services Department. Accessed through the Medical Connections website, the CME-CPD site is a valuable professional tool that allows the following interactions:
- Access CME transcripts
- Keep track of external credits
- View Grand Rounds videos
- Request CME credit for an activity you would like to hold
For more specific instruction about using this website, click here
. Library Staff Offer Flexible, Valuable Resource
2013 Nursing Scholarship Recipients
Honors and Recognitions
Congratulations are in order for institutional successes and for our colleagues who go above and beyond the duty of their day (or night) jobs.
A total of $30,000 was awarded to eight St. Mary’s nurses completing advanced degrees. The hospital and Foundation proudly support the continuing education of staff. Many thanks to St. Mary’s Auxiliary, Nursing School Alumni and other generous community members who made gifts to this fund.
|Stacey Hamre, NICU
Jessica Krier, Surgical Suite
Stephanie Lehmann, ER Services
Susan Luginbuhl, Float Pool
Beth Rozak, Surgery & Procedure Ctr
Kara Sedlmeyer, Surgical Suite
Patricia Webster, NICU
|Sr. Mary Jean Ryan, FSM Nursing|
Anne Bormett Dardis Scholarship
Madison Emergency Physicians Scholarship
Auxiliary Nursing Scholarship
Leona Grubb Nursing Scholarship
Dr. William and Alice Kopp Scholarship
Nurses Shaping the Future Scholarship
Dr. Janet Droessler (Family Medicine is the first Wisconsin physician with certification from the American Board of Obesity Medicine.
President Frank Byrne has been recognized as a Champion of Women’s Health by the Wisconsin Women’s Health Foundation for, among other things, his work to bring Wisconsin’s first hospital-based Ronald McDonald Family Room to St. Mary’s.
Dr. Ernie Pellegrino, retired Dean orthopedic surgeon, received the Rotary Senior Service Award for his volunteer teaching and surgery in Tanzania and development of the BSP (Benevolent Specialist Project) Free Clinic, which provides specialty care for the uninsured and medically underserved in our community.
Guardian Angels: Ten physicians have been honored as Guardian Angels February 1 to May 31 for their exceptional care. Patients and families have made a gift to St. Mary’s Foundation to honor the following physicians:
Dr. James Couser
Dr. Scott Gibson
Dr. Vijay Kantamneni
Dr. Jeffrey Kao
Dr. Ibuki Kimura
Dr. Greg Matzke
Dr. Joseph Mnuk
Dr. John Phelan
Dr. Marcus Santana
Dr. John Snider