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September 2013 

Inpatient and Observation Status
New Help Behind the Scenes: Clinical Documentation Specialists
Heads Up on Changes in Epic
Physician Spotlight: Ibuki Kimura
ACO Medical Director Named
New SSM Takes Shape
Know Your Testing Options for C. Difficile
A Finishing Touch to Birth Suites Renovation
Pharmacy Newsletter Features Q&A
Librarians Remain Available
Cardiology Symposium Made Possible by Foundation
New Faces on the Medical Staff
Honors and Recognitions

Physician Breakfast:
7 a.m.

Sept. 26, Oct. 24, Nov. 21, Dec. 19

CME Grand Rounds:
7-8 a.m., St. Mary's, Bay 1
Sept. 5
Palliative Care in Advanced Complex Illness - Lu Marchand, MD & Panelists
Oct. 3
Renal Disease - Chris Eggert, MD Nephrology
Nov. 7
New Anticoagulation Therapies – Shannon O’Mahar, MD

Upcoming Conferences:
SCOPE OF PAIN: Safe Opioid Prescribing
Sponsored by Safe Communities of Madison-Dane County, St. Mary’s, Meriter & UW Friday, Nov. 1, 8 a.m. - 1:30 p.m. Monona Terrace

Nov. 2: Annual Pediatric Obesity Symposium
Sponsored by St. Mary’s, Dean Pediatrics &, UW Pediatrics
Saturday, Nov. 2, 8 a.m. - 12 noon (Optional ABP-MOC II activity in PM) UW HSLC

From the Medical Staff Directors:
Inpatient vs. Observation: What Does It Matter?

Many of us have questions regarding inpatient vs. observation status:

  • Should a particular patient be admitted with inpatient status or observation status?
  • How do I know which is correct?
  • What difference does it make anyway?
It is important for all of us to make sure that we are admitting patients to the appropriate level of care based on medical necessity in a patient-focused way.

The level of care that is designated upon patient admission—inpatient or observation status—affects the patient’s insurance benefits that cover the hospital stay and potential follow-up care. In addition, an incorrect status can have a serious impact on reimbursement for the physicians and the hospital.

Review: Here at St. Mary's, our Care Management team reviews all admissions within 24 hours of the patient being admitted, using a licensed product for level-of-care reviews called InterQual® by McKesson. This tool is an evidence-based clinical decision-support tool to help us get the right care in the right setting. As clinicians, we owe it to our patients to partner with Care Management in designating admission status based on the appropriate needs of the patient.

Revise: When the evaluation by InterQual® recommends a different level of care than what was ordered upon admission, Care Management will call the admitting physician to discuss the details. These calls will come from a clinician (RN case manager) who offers professional support to identify the appropriate level of care based on the patient’s medical necessity. The discussion will center on the patient’s diagnoses and our clinical documentation. Sincere and professional collaboration will allow us to serve our patients in the best way possible.

Reach Out: If you are admitting a patient and have questions regarding the status a patient should be admitted under, you can contact the Care Management team any time. You can find the Care Management team by seeking them out in the hospital on any floor or by calling 258-6561. After hours, you can use the switch board and ask for the Care Management RN.

St. Mary’s Hospital Medical Staff Directors

(front row) Greg Burnett, Kay Barrett, Lee Carter, Jeff Welch
(back row) Tim Crummy, James Goodsett, Anne-Marie Lozeau, Kyle Martin

New Help Behind the Scenes: Clinical Documentation Specialists
A new team of experienced nurses have begun work behind the scenes to improve patient care and the quality of each patient’s medical record.

What is a Clinical Documentation Specialist?
This new team is made up of experienced nurses who help clarify the medical record during a patient’s hospital stay so clinicians and physicians receive real-time feedback and the record is complete and accurate before the patient is discharged.

Why is This Role Important?
Accurate and comprehensive documentation will help in diagnosis, handing off care to another clinician and, eventually, in coding the record. Such data will help achieve goals in public reporting, care quality and reimbursement. Furthermore, such specific documentation will help transition to the new revision of the HIPAA-required International Classification of Diseases (ICD-10) in 2014.

Who’s on the Team?
The team is led by Bonnie Ball (back left), who transitioned from her role as a MICU nurse and Coordinating Council chair. Other members (from back left) are Corinne Beck, Betty Buckmaster, Christy Schwartz, Kellie Schmidt (seated, left) and Emily Kangogo.

Heads Up on Changes in Epic
September and October will bring new capabilities to the electronic health record, and the ever-useful yellow sticky note is calling for your attention.

Cardiovascular PACS is going live Sept. 17.
  • Which modules will go live? Echo, stress test and nuclear medicine.
  • What does this mean to you? Reports will be immediately available for viewing within Epic. No need to wait for transcription to occur. The actual images will also be viewable as well, if desired.
Don’t forget to read the yellow sticky note!
The Clinician-to-Physician Communication yellow sticky note is one way that nursing staff can communicate with the providers for non-urgent issues, but it frequently gets overlooked. Reviewing and acting upon queries in this section just got a lot easier with this one-time setup:
  • Select your patient list, then click on PROPERTIES.
  • On the left column, scroll down to NOTE TO MD and then click ADD.
  • Move it up or down on your SELECTED COLUMNS list, then click ACCEPT.
  • You will now see a small icon in that column if the patient has a yellow sticky note. If you hover over the icon, you can read the contents of the message. Double click then erase when addressing the issue.
  • You will now see a small icon in that column if the patient has a yellow sticky note. If you hover over the icon, you can read the contents of the message. After acting on the query, delete the message by double clicking the icon to open the notification page. On the far right, click the ADD/EDIT COMMENTS link, delete the comments, and click ACCEPT.
ICD-10 set to roll out in phases:
  • Phase 1 of the ICD-10 upgrade will occur on Oct. 1. Changes will be minimal with the only impact being that you must search for diagnoses by name instead of number.
  • April 1 will be the Phase 2 clinical go-live. Training and education will begin a few months prior.
  • Oct. 1, 2014 will be the Phase 3 go-live when the official changes take place that affect payers. Ideally, there should be minimal clinical impact.

Physician Spotlight: Ibuki Kimura

Ibuki Kimura may have two jobs – as a hospitalist and as medical informatics director for Dean & St. Mary’s – but she has just one goal: improving patient care. In fact, both of her jobs work in perfect harmony and provide the springboard to make an even bigger impact for patients everywhere – not just her own.

My Current Work
I always strive for improving the care we can give patients on any level. This may be by trying to help with communication among our physicians and staff or trying to figure out better workflows that will improve care, satisfaction, cost and safety. That is largely why I took the position as a medical informatics director. Epic and all of the other medical technologies that we have at Dean & St. Mary’s are excellent tools that allow us to improve the care we provide, but those tools need to be optimized and customized for our specific needs.

Our Work Environment
I’m most proud of working at St. Mary’s because of the team mentality regarding patient care. We each have a role that is just as important as any of the others. We work together to help our patients. My wish is that the issues regarding cost of care could go away and that we could just do what is in the best interest of the patient.

All of the hospitalists play a special role in the quality of my work, but especially Dr. Eichhorn who tirelessly leads the hospitalist department in the ever-changing needs or our group and always has in mind what is best for the patient.

Previous Positions
I worked as a hospitalist at Meriter for 5 years prior to coming to Dean & St. Mary’s in 2004.

I graduated from Harvard University in 1992 with bachelor’s and master’s degrees and received my medical degree from the University of Chicago in 1996. Now board-certified in internal medicine, I did my residency at UW-Madison from 1996 to 1999.

Personal Life
My husband (NOT Dr. Ray Kimura at Meriter!), my two children (ages 11 and 7) and two dogs (Bernese Mountain Dog and Golden Retriever) are most important to me. I also enjoy camping, hiking, canoeing and fishing. My husband shares similar professional interests as a venture capitalist largely focusing on health care technologies.

ACO Medical Director Named
The Dean Clinic & St. Mary’s Hospital Accountable Care Organization, which was legally formed last summer, now has a medical director: Paul Reber, DO. Paul is a longtime endocrinologist at Dean Clinic and previously has served as a medical director for Dean Health Plan as well as the vice president for clinical excellence at Dean Clinic. In this new role, Paul will work closely with the ACO leadership team and front-line clinical staff to accomplish the ACO’s goals to deliver better care at a lower cost to our ACO Medicare patients.

New SSM Takes Shape
Though official regulatory approval is pending for the merger of Dean Health Systems with SSM Health Care, plans for the new and improved SSM Health Care are taking shape, all on the heels of a state quality award for the Wisconsin region of the four-state system.

SSM Health Care, based in St. Louis, is led by CEO Bill Thompson, who has devised a new structure with three executive vice presidents overseeing hospital operations (Chris Howard), physician and ambulatory services (Dr. Shane Peng, on interim basis), and health care delivery, finance and integration (Dr. Gaurov Dayal, who also serves as interim president/CEO of SSM Health Care of Wisconsin). The merger with Dean is expected to be approved by September, when a new series of communications will begin on the implication for staff, physicians and patients.*

SSM Health Care operates in Illinois, Missouri, Oklahoma and Wisconsin. SSM Health Care of Wisconsin—which includes three wholly owned hospitals and two nursing homes--earned the state’s highest recognition of quality business practices: the Excellence Level of the Wisconsin Forward Award. The award indicates a high level of readiness for further streamlining of Dean and SSM. WFA leadership says this level showcases organizations with mature, fully integrated performance management systems and recognizes “industry leaders and role models for others.” The award, which remains in effect for five years, emphasizes quality practices, business results and continuing efforts to learn and improve.

SSM Health Care of Wisconsin had applied for the Wisconsin Forward Award as a system once before, earning the Mastery Level in 2011. Prior to that, each entity applied on its own.

* A Q&A about the plans that are unfolding can be found on St. Mary’s Intranet by clicking on MyNews, where additional links will be at the top of the page. Or you may click here for direct access. If you have a question that has not yet been addressed, you can submit questions and comments on that site, by phone to (314) 881-TEAM or by email to SSMDeanQuestions@ssmhc.com. As answers become available, they will be posted on the site.

Know Your Testing Options for C. Difficile
The laboratories at St. Mary’s Hospital and Dean Clinic use different tests to detect C. Difficile, and each has implications on test interpretation, repeat testing, and the impact of drug therapy prior to testing. St. Mary’s Antibiotic Stewardship program outlines the nuances to help provide better care. Read more.

A Finishing Touch to Birth Suites Renovation

St. Mary’s Birth Suites – the last of three areas of the Family Birth Center to be renovated – features a memorial to one of its longtime obstetricians: Dr. Karl Rudat (pictured right). He delivered more than 5,000 babies at St. Mary’s over 34 years before he passed away in 2011. Physicians were among contributors to the memorial bench and artwork in the Birth Suites family lounge on 2 West. Among those attending the July dedication ceremony with Marilyn Rudat (center), widow of Dr. Rudat, were Dr. Lori Wendricks House and Dr. Joseph Fok.


Pharmacy Newsletter Features Q&A
Step into the shoes of a pharmacist with a Q&A to understand different real-life scenarios. That’s one of many features of the latest Pharmacy Newsletter.

Librarians Remain Available
Because most physician requests for librarian help come by phone or email, the medical librarians will no longer hold office hours in the Physician Resource Center. Read more.

Cardiology Symposium Made Possible by Foundation
St. Mary’s Foundation recently approved funding to support the Dean & St. Mary’s Cardiology Symposium with the Experts. The symposium, slated for Saturday, Oct. 19, will feature Dr. Rick Nishimura and Dr. Carol Warnes from Mayo Clinic Cardiology and Dr. Mario Goessl from Dean Clinic. Cardiologists and their teams from south-central Wisconsin will be invited to attend. Watch for further details.

New Faces on the Medical Staff
A new class of Family Medicine residents joined our medical staff this summer and many other practicing physicians have been granted admitting privileges to St. Mary’s (click here for list). Photographed are, from left, Drs. Sean Duffy, Josh Schulist, Maria Din, Jasmine Hudnall, Lisa Netkowicz, Julia McMillen, Kira Labby, Rachel Lee, Julia Lubsen, Vinny Minichiello, Chris Danford, Jessie O'Brien, Caitlin Hill, Walker Shapiro, Ali Brock and Anna Veach.

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. 

Russ Jensen,recently retired director of pharmacy services for both St. Mary’s Hospital and Dean Clinic, received the Bowl of Hygeia award from the Pharmacy Society of Wisconsin. He is recognized for his leadership in the profession and service to community, including his role as a founder of the MedDrop program in Dane County.

Guardian Angels: Eight 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. L. Douglas Cowgill
(cardiovascular surgery)

Dr. David DeAngeles
(general surgery)

Dr. Todd Eckelberg
(internal medicine)

Dr. Jennifer Edgoose
(family medicine)

Dr. Gregory Matzke
(general surgery)

Dr. John Phelan

Dr. John Snider
(cardiovascular surgery)

Dr. Gary Waters




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