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Physician Focus - Summer 2010 

In This Issue

Reducing Re-admissions and Palliative Care Program Updates
Privilege of Self-Governance Requires Your Vote
Physician Resource Center Construction to Begin
Epic Improvements are Continuous 
Clinical Improvement Leader Will Retire
Medical Cost Trend is Now Medical Value Program
New Online Safety Reporting System Unveiled
Class of 2013 Comes in as UW Family Medicine Marks 40 Years
Pharmacy Info: As Near as Your Computer
Physician Spotlight: Conrad Andringa, MD
Honors and Recognitions

Aug. 26, Sept. 23, Oct. 28 - Physician Breakfast
Aug. 27 - Steal Shamelessly Series
re: OR, 12:30 p.m.,
Bay 6
Sept. 2 - Grand Rounds, 7 a.m.,
St. Mary’s: "Treatment and Evaluation of
Atypical GERD"




Reducing Re-admissions and Palliative Care Program Updates 

The management of advanced chronic disease in our world of high technology and ever expanding interventions has become increasingly complicated. For the past several months, a very engaged interdisciplinary team, with participation from physicians, nurses, social workers, chaplains and administrators, has been studying the state of palliative care (or, perhaps more accurately, advanced chronic disease management) in our system and across our continuum of care.

The clearly stated and well understood wishes of our patients and their families should be fully incorporated into our compassionate, high-quality, exceptional care. Our team has learned that on two of our hospital units, whose focus is advanced chronic disease, only 50% of patients have advance directives. Despite the fact that more than 75% of the population with chronic illness expresses a wish to die at home, only 25% actually do. Caregivers describe frequent instances where they are concerned about the discordance between a patient’s wishes, the family’s expectations and the true value of medical interventions delivered. 

This interdisciplinary team has considered a multi-year process to improve the care that we provide in the hospital, in the clinics, in chronic-care facilities and in the homes of patients who have advanced chronic illnesses. We have defined palliative care as patient- and family-centered care, occurring throughout the continuum of their chronic illness that addresses their physical, intellectual, emotional, social and spiritual needs facilitating patient autonomy, access to information and choice. The team is working with system leadership to develop a first phase of a palliative care program that would include the following:

1.       A more effective, more understandable and more participative advanced care planning process so that the care we deliver has fully incorporated our patients’ wishes

2.       A multidisciplinary palliative care team at St. Mary’s available to:

a.       Provide a resource and consultation for patients and families to help articulate their desires for medical care

b.       Consultative assistance in developing a plan of care for patients with difficult symptom management issues

c.       An educational resource for medical staff, residents and clinical staff in the principles and delivery of effective palliative care

3.       Incorporate effective linking of hospital-based palliative care to the outpatient clinic setting.

The team is very interested in knowing your thoughts and hearing your input about this effort.  If you have comments or suggestions or wish to participate, please give me a call at 258-6178 or send me an email at john_butler@ssmhc.com.

John Butler, MD,
Vice President/Medical Affairs

    Privilege of Self-Governance Requires Your Vote
    Great changes are afoot in medical staff self-governance, and the Bylaws Committee wants to be sure you understand them and participate as a member of the medical staff.

    Dear Colleagues,

    We will be asking for your vote this fall on several changes to the Medical Staff Bylaws. As you know, these bylaws are your bylaws. One important tenant of the medical profession is the privilege and accountability of self-governance. The Board of Directors of St. Mary's Hospital (actually, of SSM Health Care of Wisconsin) delegates to the medical staff the accountability for its structure, professional performance, ethical conduct and delivery of the highest quality care achievable. Our bylaws are the mechanism by which we exercise this self-governance accountability.

    The bylaws must be reviewed and updated every two years in order to remain consistent with the expectations placed on our profession. The upcoming bylaws changes will 1) meet regulatory requirements, 2) provide updates that reflect changes in medical staff professional practice and 3) support our medical staff redesign. You recently received a letter outlining the changes, and several information sessions have been held on the topic. We on the Bylaws Committee remain available to discuss them as well. Please take the time to understand the changes and to exercise your obligation to vote for the appropriate changes to your bylaws.

    Medical Staff Bylaws Committee
    Al Musa, chair
    Brian Bachhuber, John Butler, Diana Choles, Kyle Martin, Brian Streeter, Jeff Welch, Paul Wertsch

    Physician Resource Center Construction to Begin
    A “one-stop shop” resource center for physicians is in the works, thanks to generous donor gifts to St. Mary's Foundation.

    A demolition event is slated this month for A South, the 8,000-square-foot wing that most recently housed Digestive Health and Project Beacon. A new Physician Resource Center, expected to be complete by January 2011, will include a physician lounge, dining and kitchen area, non-designated sleeping rooms, coat closet, locker and shower area, physician shared offices, hospitalist office and spaces for medical staff services, Continuing Medical Education (CME) and library services.

    Members of the design team include the following medical staff: Linda Siewert, Paul Huepenbecker, Santiago Hernandez, Al Musa, John Butler, and Lori Wendricks-House. The team gleaned input from a medical staff survey to determine the services and support for the space. Click here to view additional images.


      Epic Updates are Continuous 
      A number of changes to the functionality of St. Mary's electronic health record (EHR) have been made, and more are in the works.

      The Medical Staff EHR Leadership Committee continues its work on the electronic health record in order to optimize Epic to support exceptional patient outcomes, patient safety and clinician efficiency. This committee is co-led by Dr. John Phelan and Annette Fox of the WIITTS-Epic team. Some of the accomplishments over the past quarter include working through the diagnosis requirement in patient orders to ensure CMS compliance; working in collaboration with a St. Mary's interdisciplinary team to improve the compliance rate of a physician order of patient status on 100% of patients admitted to St. Mary's. The new configuration allows the patient status order to populate all admission, pre-operative and post-operative ordersets, but to hide this order once a patient status has been entered. This improvement has allowed physicians to meet their regulatory obligation while preventing unnecessary repetition of this order once it has been completed.

      The focus of the committee over the next quarter will be improving the usage and accuracy of the problem list activity, which will allow additional functionality to trigger alerts/orders associated with important performance metrics, patient safety interventions and greater efficiency for providers. Additionally a re-engineering of the discharge process will be undertaken in order to provide accurate and timely discharge medications/orders/treatments to patients and referring physicians. This process will accommodate the complexity of the growing multi-specialty, multi-disciplinary care provided to patients in the hospital.

      Clinical Improvement Leader Will Retire
      Dr. Andy Kosseff will retire Sept. 30 from his position as Corporate Medical Director of Clinical Improvement with SSM Health Care (SSMHC), parent organization of St. Mary’s Hospital. Concurrently, he held a similar position at St. Mary’s but retired from that last spring. His decade of leadership has contributed to quality and safety throughout SSM’s four-state reach.

      In 1999, Dr. Kosseff left his private practice as a Dean Clinic internist to join the SSMHC Quality Resource Center to design and implement clinical improvement initiatives across the system. He is credited with leading the charge to identify best safety and clinical practices and with helping to adapt and implement them in all SSM entities. As a Master TeamSTEPPS trainer, he has helped all SSM entities deploy teamwork training in at least one department. At St. Mary’s, Dr. Kossef was a leader in patient safety and instrumental in leading the Madison Patient Safety Collaborative. Since last spring's "retirement" from St. Mary's, he continues to lead the CME committee, participate in a growing Grand Rounds program and lead TeamSTEPPS training on a part-time basis. 

      Medical Cost Trend is Now Medical Value Program
      Medical Cost Trend is Now Medical Value Program The Medical Cost Trend (MCT) initiative was recently renamed to Medical Value Program, or MVP. This name change reflects the expanded scope of the program’s effort to focus not only on medical cost trend, but also quality of care and patient/member satisfaction. This also closely aligns with Dean’s value model to provide higher quality care at a lower cost.

      Summary of MVP Mission
      The goal of the MVP is to present an unbiased and clear explanation of where the System is spending money above industry norms and develop plans to improve performance, all the while maintaining or enhancing levels of quality and service.

      The MVP Committee will identify and evaluate these opportunities by utilizing both claims data from Dean Health Plan, as well as but not limited to, billing and clinical data from SSM Healthcare of Wisconsin and Dean Clinic. Whenever possible, cross-organizational data will be compared with industry costs and utilization benchmarks in order to identify new value opportunities and create solutions. Potential solutions will be analyzed and selected based on their ability to provide higher quality care at a lower cost as well as their net impact on the organization across all payers.

      For more information or questions about MVP, contact Medical Value Program Medical Director Bill Panek at Bill.Panek@deancare.com

      New Online Safety Reporting System Unveiled
      The Patient Occurrence Reporting System and Employee Incident Forms are being replaced this month by a new online system for reporting patient, visitor, employee and physician events, near misses and environmental hazards in the workplace. After 2 p.m. on Tuesday, Aug. 17, all reports must be entered online. Though the wording of the new system link will change, the location will be the same as the old system. A link will also be added in red on the left hand area on St. Mary’s Intranet.

      In addition to reporting patient, visitor, employee and physician events online in one central location, this new system offers a way for employees and physicians to report environmental hazards and unsafe practices or conditions – something the old Occurrence Report and Employee Incident forms did not offer. The system also allows anonymous reporting of everything except employee and physician injuries.

      A click on the link will take readers to a page of simple instructions and a link to the Event Reporting System. To begin a report, click on the magnifying glass icon and select one of the 5 descriptions of event types as shown below. Once you have made your selection, you will be given only those questions needed for that event type. Most events should take less than 5 minutes to report.

      Class of 2013 Comes in as UW Family Medicine Marks 40 Years 
       Class of 2013 Comes in as UW Family Medicine Marks 40 Years A new class of UW Family Medicine physicians has begun residency training at St. Mary’s. They represent the 40th group of Family Medicine residents since the discipline was established in 1970 in the UW School of Medicine and Public Health. In 1970, St. Mary’s provided much-needed space and enthusiastic medical staff to house the new program, and today the program remains headquartered in St. Mary’s Alumni Hall.

       Pictured are, from left, (back row) Tony Weston, Katie Ray, Elizabeth Schaefer, Will Schupp, Micah Puyear, Bryan Webster, LeRose Dhanoa, Eric Marty, Steve Almasi, Jonathan Meiman; (front) Benjamin Scherschligt, Elizabeth Kvach, Jensena Carlson, Adrienne Hampton, Kelita Fox, David Danielson.

      Pharmacy Info: As Near as Your Computer 
      Information about new medications available on formulary will be available in the “News From” link to Pharmacy in the upper left of each Physician Focus newsletter. A team including medical staff and nursing representatives is designing and implementing a process by which health care providers have access to information on medications.  Read more.


      Physician Spotlight: Conrad Andringa, MD
      Dr. Conrad “Connie” Andringa is a pediatrician with Dean Clinic, where he has practiced since 1968. In fact, he was the 22nd physician to be brought into the group that now numbers about 500. Still working full time at Dean West Clinic, his storied career includes more than 40 years of service to athletes in the Madison area, at the University of Wisconsin and at the 1976 Winter Olympics in Innsbruck, Austria. He recently was inducted into the Madison Sports Hall of Fame.

      Early Connections: As a medical student in 1961, I and Lou Bernhardt (now a retired cardiovascular surgeon), along with three others, were hired by St. Mary’s to do extern work conducting physicals and assisting with surgeries. Later, I was an intern at North Carolina Memorial Hospital in Chapel Hill and from 1964 to 1966 did my residency in pediatrics at UW Hospital, which included a rotation at St. Mary’s. I then entered the Air Force and, after completing my service, returned to Madison in 1968 to begin my practice.

      Other Interests: With my own sports background (Wisconsin Interscholastic Athletics Association state finalist and All-American swimmer at Waukesha High School) and my children active in sports, I became the team physician for Memorial High School in 1972 and still serve in that capacity. I became the WIAA tournament physician for football, baseball, individual and team wrestling, soccer, hockey, track, swimming and basketball. I have been chairman of the WIAA Sports Medical Advisory Committee for more than 30 years.

      Awards and Recognitions: Dr. Angringa has garnered many awards and honors related to his service as a physician and sports advocate. Here are just a few:

      • Inducted into the Madison Sports Hall of Fame
      • Received the Dave McClain Distinguished Service Award by the Wisconsin Football Coaches Association
      • Honored by Madison’s Memorial High School, which named its sports facility the Conrad Andringa Fieldhouse
      • Was team physician for the U.S. men’s Olympic hockey team in 1976
      One thing about St. Mary’s I’d change: I’d probably bring back the nuns to the floors. The image of their passion is still so strong for me. St. Mary’s was their life, their passion – their family. They were incredibly patient and care-oriented and they would stay with patients and families to see them through difficult experiences. All of us physicians would strive to keep up with the nuns because they exuded an incredibly high quality of care that we didn’t realize was possible. Even today, we have very compassionate and dedicated staff at St. Mary’s, but everyone has families and outside activities that make it difficult to commit in the same way.

      What makes me most proud: I have always been impressed with the total care provided to the patient and family by St. Mary’s. The staff are dedicated and compassionate and instill this with everyone. [President] Frank Byrne is doing the same thing today as we were doing back in the 1960s. He stresses total care for the patient in all he does and he keeps improving our facilities so we can keep getting better for our patients. I’m especially proud of the way that St. Mary’s and Dean Clinic lead innovations together.

      Special thanks go to the founding Dean Clinic pediatricians: Tom Geppert, Chuck Geppert, Bill Bartlett, Charlie Hopkins (Hoppy). They set the standards for the highest level of care. It was always my goal to keep up with them. That was the culture – patient care and service, community leadership—and it remains so today.

      New Faces on the Medical Staff - Click here.

       Honors and Recognitions
      Congratulations are in order for our colleagues who go above and beyond the duty of their day (or night) jobs. 

      Dr. Conrad Andringa (pediatrics) was inducted into the Madison Sports Hall of Fame for his service to Madison-area athletes and University of Wisconsin athletes. Among his accomplishments are service as team physician to the 1976 U.S. men’s Olympic hockey team and, years earlier, performance as an All-American swimmer at Waukesha High School.



      Dr. Charles Diggs (hematology/oncology) and his research team received the 2010 Clinical Trials Participation Award, which consists of a $500 reward from the American Society of Clinical Oncology.




      Dr. Garry Jean-Louis (infectious disease) received the 2010 Clinical Teaching Award from the residents in the UW Department of Family Medicine.




      Russ Jensen, director of Pharmacy at Dean Health/St. Mary's Hospital, is being awarded the Pharmacy Society of Wisconsin 2010 Distinguished Service Award. Russ has been in PSW's leadership for over 10 years and has helped lay the groundwork for the Wisconsin Pharmacy Quality Collaborative. His active involvement as a Wisconsin pharmacy leader spans three decades.



      Dr. Brooke Johnson is the first two-time physician recipient of the St. Mary’s Foundation Guardian Angel recognition. The program provides a way for grateful patients and families to recognize exceptional care and service with a financial gift that will then benefit other patients.



      Excellence in Dictation Awards were given to Dr. Clifford Anderson, Dr. Kay Barrett and Dr. Chad Yucus (pictured below) from St. Mary’s medical transcriptionists during National Transcription Week last spring. Their honored qualities include accuracy, brevity, clarity, organization and pleasing voice.


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