VANDERBILT UNIVERSITY MEDICAL STAFF ANNUAL MEETING AGENDA
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Transcript of VANDERBILT UNIVERSITY MEDICAL STAFF ANNUAL MEETING AGENDA
VANDERBILT UNIVERSITY MEDICAL STAFF & VANDERBILT MEDICAL GROUP
ANNUAL MEETINGThursday, June 28, 2012
4:30 – 6 pm208 Light Hall
VANDERBILT UNIVERSITY MEDICAL STAFF ANNUAL MEETING
AGENDA• Welcome
C. Lee Parmley, MDChair, Medical Center Medical Board (MCMB)
• Proposed Amendments to Medical Staff Bylaws, Rules & Regulations and Policies & Procedures
• MCMB Membership Elections
• Adjournment
PROPOSED AMENDMENTS TO MEDICAL STAFF BYLAWS, RULES & REGULATIONS
AND POLICIES & PROCEDURES
• 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
• 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
• 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 ANDRULES & REGULATIONS
• 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
• 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 re-certification process is outlined by their applicable
ACTION POINT
• Approval of proposed amendments to Medical Staff Bylaws, Rules & Regulations, and Policies & Procedures Required
MCMB MEMBERSHIP UPDATES & ELECTIONS
• At-Large Members (3) elected annually
Nominees:
– Andre Churchwell, MD
– A. Alex Jahangir, MD
– James “Pete” Powell, MD
ACTION POINTS
• At-Large Member Elections require a majority vote of the voting members present
• Adjournment of Medical Staff Meeting
VANDERBILT MEDICAL GROUPANNUAL MEETING
AGENDA
• VMGVMG Finance Committee – Roland Eavey, MD
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• VMG Credentialing – Steven Meranze, MD
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• VMG Billing Office –Meredith Marwill
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• Contracting Update – Beverly Coccia
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• VMG Quality Council – Racy Peters
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• Physician Council on Clinical Service Excellence – Gaye Smith
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• Hitch and Other Operational Initiatives – Margaret Head
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• Economic Repositioning – David Posch
VMG Finance Group
06/26/2012
Committee Members
• Dan Beauchamp• Marc Bennett• Brian Carlson• Sandy Cherry• Keith Churchwell• Titus Daniels• Marilyn Dubree• Roland Eavey• Phyllis Ekdall• Janice Fruci• Denis Gallagher• Sheri Haun
• 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
• 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: TOOLSCost 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
• Valve Data Analysis…Cost/LOS/Readmission• Parking
January 31, 2012
Meeting 4: Cost Homework and Parking
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 Staffand Vanderbilt Medical Group MeetingJune 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.
Timeliness of File Review and Approval
• Influenced by many factors– 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 re-submission and re-verification
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
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 UpdatePresented by Meredith Marwill
Associate Director of Physician Billing Services
Faculty Practice Solutions Center Billing Office SurveyFY2010 Top 10 Performers
1. University of Pittsburgh Medical Center2. UMass Memorial Medical Group3. University of Minnesota Physicians4. Massachusetts General Physician Organization5. The Medical College of Wisconsin6. University of Wisconsin Medical Foundation7. Vanderbilt Medical Group7. University of Texas Medical Branch (Galveston)9. University of Virginia Physicians Group10. Fletcher Allen Health Care/University of Vermont
• VMG ranked 7th overall in benchmark performance indicators reported by 56 academic institutions through University Healthcare Consortium (UHC).
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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 Collectas percent of Net Collections
10.6%11.1%
10.8%9.8%
8.8% 8.3%7.9%
*2012 FYTD through May
7.4% 7.0% 6.3%
Cost to Collect has remained stable this past fiscal year.
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6.3%
2012
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 40
Contracting 2012Highlights
VMG Quality Reporting
2012 VMG Annual Faculty MeetingJune 28, 2012
426/28/2012
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.
436/28/2012
Hand Hygiene
FY 2012 Goal Hand Hygiene
FY 2012 1st
Quarter
FY 2012 2nd
Quarter
FY 2012 3rd
Quarter
FY 2012 Threshold
FY 2012 Target
FY 2012 Reach
VMG Adult 93% 95% 95% 88% 92% 95%
VMG Peds 95% 94% 95% 88% 92% 95%
446/28/2012
Adult Anticoagulation Clinic
456/28/2012
Adult Anticoagulation Clinic
466/28/2012
New Patient Access
476/28/2012
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%
486/28/2012
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
496/28/2012
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)
506/28/2012
PQRS Measure #1: Hemoglobin A1c Poor Control in Diabetes % of Pts Aged 18-75 with Diabetes Mellitus with Most Recent
Hemoglobin A1c >9.0%
516/28/2012
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)
526/28/2012
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)
536/28/2012
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
546/28/2012
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
556/28/2012
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
566/28/2012
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
576/28/2012
New VMG Medical Director for Quality: Barron Patterson, MD
6/28/2012 58
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
• 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
• 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
• Why a Physician Council?
• PRC Patient Satisfaction Surveys – (use of % excellent vs. percentiles in Service Pillar goals)
• HITECH Meaningful Use implications for clinical practices and work flow
• Studer Physician Institute: “Practicing Excellence: Engaging Physicians to Execute System Performance”
• Patient and Family “Always Promise”
• Use of a video on effective communication between physicians and patients
• Provided input for process improvement in patient complaint mgmt– Renaming Patient Affairs “Advocates” to Patient Relations
“Specialists”
• 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 9/30/2012
9/1/2011 10/1/2011 11/1/2011 12/1/2011 1/1/2012 2/1/2012 3/1/2012 4/1/2012 5/1/2012 6/1/2012 7/1/2012 8/1/2012 9/1/2012
8/1/2011 - 8/31/2011Complete Pilot
of Star Tools
9/1/2011 - 10/14/20111st Cohort Training
10/3/2011 - 12/30/20112nd Cohort Training
1/2/2012 - 3/30/20123rd Cohort Training
4/2/2012 - 6/29/20124th Cohort Training
7/2/2012 - 9/30/20125th Cohort Training
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 RepositioningDavid Posch
June, 2012
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Mitch EdgeworthChief Operating Officer
Vanderbilt University Hospital
Coordinating Care
Disease
Clinic Procedure ICU Inpatient Discharge Post Acute Home Self
Redesign fundamental Care Processes to improve efficiency and effectiveness
Redesign the infrastructure to improve efficiency and effectiveness across all care transitions
Inpatient Care CoordinationModel
Huddle Care Plan 1.0
Post Discharge Phone Call
Post Discharge Clinic Visit
Post Discharge Intermediate
Care
MedicationReconciliation
Risk Stratification
Economic Repositioning
Top 5 represent ~$22MM of the
$30MM built into FY’13 Budget
Top 5 Projects1) MEOC Initiatives FY132) 340B Contract Pharmacies3) Specialty Pharmacy4) Care Partner Redesign5) Case Scripting
FY’12Forecast Savings
FY’13 Savings in Budget
FY’13 Anticipated Savings
$8 million $30 million $32 million
> 200 Ideas submitted
~ 40 active projects
Manpower
May ‘12 Actual
FY’12 Budget
FY’13 Budget
FTEs (Adult)
8,912.6 8,968.0 9,147.0
246 FTE reductions were made through attrition and repurposing of positions