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Leadership Pulse – January 2015

Preparing Statewide Launch

Honoring Choices Pacific Northwest’s vision is for everyone in Washington state to receive care that honors personal values and goals at the end of life. To accomplish this, Honoring Choices Pacific Northwest will launch a multi-year, statewide initiative providing training and resources to hospitals and doctors so they are prepared to discuss and honor their patients’ wishes.

First Choice Health is the first Platinum level sponsor to join the initiative, with a contribution of $300,000 over three years.  Premera Blue Cross is the first Gold level sponsor, with a contribution of $50,000. These contributions ignited the ability to take the next steps with preparation, including having a key note speaker from Gundersen Health present at the upcoming Partners in Quality: CEO and CMO Leadership Forum about the Respecting Choices® First Steps® program.

We continue to seek financial sponsorship, identify early adopters, develop supporting materials and create a leadership structure to ensure sustainability. For more information, please contact tanyac@wsha.org or jessica@wsma.org.

New Website Launched!

www.HonoringChoicesPNW.org
people at computer

Honoring Choices Pacific Northwest just released a comprehensive new website designed to help people create end-of-life care plans and guide them through sharing those plans with loved ones and health care providers. The resources and tools on the website are free and available to anyone.  Health care professionals can also find valuable resources on the site and participate in trainings to prepare them for conversations around end-of-life care, recording patient wishes and ultimately honoring those choices.

Please take a moment to review the web site, add it to your favorites and spread the word! Work has already begun for Phase II of the website, which will include a list of  advance care planning resources in each county. For more information or to get involved, please contact tanyac@wsha.org or jessica@wsma.org.

 


Washington state data point to widespread overuse and variation; Choosing Wisely Action Manual puts recommendations in practice

Choosing Wisely

A Washington state study measuring the use of medical tests and procedures included in recommendations from the national Choosing Wisely® campaign clearly shows overuse of some tests, as well variation in use between counties. The report, Less Waste, Less Harm: Choosing Wisely in Washington State, offers county-by-county results for nine different Choosing Wisely recommendations.

The results are based upon claims data representing 3.3 million individuals in Washington state and was issued this week by the Washington Health Alliance in conjunction with the Washington State Choosing Wisely Task Force, a group of more than 20 medical leaders from health care organizations in the state. The task force is co-sponsored by the Alliance, the WSMA and the WSHA.

Among the key findings of the report:

  • Overuse exists. Patients may be getting unnecessary care that costs money and could potentially put them at risk.
  • Variation exists. Often the rates between the lowest and highest performing counties vary by more than twofold.
  • Where you live and the type of insurance you have (commercial vs. Medicaid) may influence the type of treatment you receive.

The report provides a useful look at how some of the Choosing Wisely recommendations are being utilized by physicians and patients in Washington state. It encourages clinics and hospital systems to continue integrating Choosing Wisely within their organizations and for physicians and patients to consider the recommendations at the time of care.

To support physicians seeking to integrate Choosing Wisely recommendations into their practices, the task force has developed the Choosing Wisely Action Manual that outlines eight steps for leading change that include developing a change vision and generating short-term wins.

Looking ahead, the Washington State Choosing Wisely Task Force has set out to work on the following projects in 2015: operationalize “Change One Thing,” hold a Choosing Wisely Summit, continue to work on clinical and claims data, engage consumers, and develop communication skill-building training.

If you’d like more information about how to integrate Choosing Wisely into your organization, please email Jessica@wsma.org or TanyaC@wsha.org.

Washington State Choosing Wisely Task Force Reports:

Choosing Wisely Action Manual

Choosing Wisely Action Manual

Less waste. Less harm. Choosing Wisely in Washington state

Less waste. Less harm. Choosing Wisely in Washington state

Choosing Wisely Claims-Based Technical Specifications

Choosing Wisely Claims-Based Technical Specifications



Notable Reduction in Dose for Head CT at Participating LEAPT Hospitals

100K Kids Campaign logoRadiation in Children, Less is More

Studies indicate repeated exposure to computed tomography (CT) scans is increasing the incidence of cancer in adults and children. Reducing and/or removing the instances of unnecessary radiation, reduces future cancer risk from direct medical radiation exposure.   The Washington State Hospital Association (WSHA) as a participant of the Centers of Medicare & Medicaid Services Leading Edge Advanced Practice Topics (LEAPT) piloted reduction in radiation dose and reduction in unnecessary studies. The hospitals and health systems that participated in the LEAPT Reduction in Undue Radiation project implemented strategiesto reduce the dose per scan in head CTs and tools to guide decision making for CTs with pediatric head trauma and appendicitis. The LEAPT hospitals had an 8% reduction in the average dose per adult head CT and a 9% reduction in the average dose per child head CT.

WSHA will continue this work through Washington 100K Children Campaign to maximize the long-term health of our children by ensuring safe imaging in health care. Eliminating overuse of imaging procedures results in better care, better health, and lower health care costs. WSHA will lead Washington on a journey to reduce radiation exposure in children in collaboration with the national 100K Children Campaign and Dr. James Duncan of St. Louis Children’s Hospital Radiology and the Mallinckrodt Institute. We will be monitoring dose length produce for head CTs, the percentage of single phase head and chest studies, percentage of ultrasound for appendicitis, and percentage of observation ordered instead of head CT for minor head trauma in children. Please commit to safer imaging for children by joining our 100 Children Campaign.

Please visit our 100K Children Campaign website to see our Toolkit, Measures, and Resources.


Finalizing the Statewide Performance Measures Set

The Governor-appointed Performance Measures Coordinating Committee  approved a statewide core measure set on December 17, 2014. The measures address topic areas related to prevention, acute care, chronic care, health care cost and population health. These measures will ultimately inform statewide purchasing, cost benchmarking and quality improvement.

Read more about the progress…

The development of a statewide core set of measures was established under the state’s health care transformation effort as part of ESHB 2572 . WSHA staff represented hospitals on the Committee and on the three technical workgroups who reviewed and recommended measures. WSHA will continue to work with stakeholders on how to best implement these measures and update the core set priorities and evidence changes. For background information, refer to the July 11 WSHA Bulletin or contact Ian Corbridge at ianc@wsha.org.


WSMA Leadership Development

UW-WSMAedu_BANNER

UW/WSMA Leadership Course

In partnership with the University of Washington Graduate Programs in Health Administration, and UW Professional and Continuing Education, the WSMA is offering a 40+ hour hybrid-distance leadership skills-development course. The course combines face-to-face and online learning to enable course participants to begin developing and honing their leadership skills at their convenience. Click here for a detailed curriculum.

The spring 2015 course will be held March 6 – May 8. The in-person classes will be held Friday and Saturday, March 6 and 7 in Spokane. Course participants will then have eight weeks of online instruction and interaction, finishing with a third in-person session on Friday, May 8, also in Spokane.

Presentation of your capstone project on the final day is required as assessment for the online portion of the course.

The course is limited to 30 participants. Individuals or group/system teams are encouraged to apply. The tuition for the course is $2000 for WSMA members and $2550 for non-members. A 5 percent discount is offered for groups of five or more. This activity has been approved for AMA PRA Category 1 Credit™.

If you are interested in the course or have a physician(s) or physician assistant(s) in your organization you would like to nominate for the spring 2015 course, please submit a cover letter outlining the applicant’s interest in the course and goals they hope to accomplish, a CV and a letter of recommendation by Friday, Jan. 30 to Lynda Sue Welch at lyndasue@wsma.org or to the WSMA Seattle office: Attn: Lynda Sue Welch, 2001 6th Ave, Suite 2700, Seattle, WA 98121.

If you have any questions about the WSMA/UW Physician Leadership Course, please contact Lynda Sue Welch at (206) 956-3622 or lyndasue@wsma.org.

2015 Annual WSMA Leadership Development Conference

Leadership skills are essential for physicians regardless of practice setting—and were not necessarily taught in medical. This conference is one of our most popular meetings. Sessions are highly interactive and enable physicians to walk away with concrete ideas and skills that can be put to immediate use. The 2015 WSMA Annual Leadership Development Conference will be held May 15-16 at Campbell’s Resort at Lake Chelan. Visit: www.wsma.org/LDC for the latest information.

American College of Physician Executives

The WSMA, in collaboration with American College of Physician Executives, is offering members access to a variety of ACPE online leadership skills-development courses at a discounted rate. WSMA members receive access to these courses at the ACPE member rate—plus an exclusive 20 percent discount. These activities have been approved for AMA PRA Category 1 Credit™.

The self-study courses are taken and completed at your convenience. They do not require a scheduled date. Once purchased, you can access the course as often as you’d like until June 1, 2015.

For more information about the WSMA’s leadership development opportunities, please contact Jessica Martinson, WSMA’s director of clinical education and professional development, at jessica@wsma.org.


Your Quality is Showing

At the WSHA Annual meeting, and most recently at the Medical Officers Collaborative, we introduced the new look and function of the quality transparency web site www.WAHospitalQuality.org. This site takes the results on almost 90 measures for all of our state’s 99 hospitals, and makes them public—but not just public. Really accessible and understandable. Anyone can go to the website and:

  • Read all the quality scores from a single hospital;
  • Compare any three hospitals on all measures (with the help of easy-to-read gauges);
  • Compare all of the hospitals on a single category of measures;
  • Read patient tips related to the measure they’re interested in.

Watch the 4-minutes video about the new web site and how it works. 

WSHA has long been committed to transparency as a way forward; we are excited to be able to show the public what kind of information is available to them, and how they can use it to improve their own hospital experience. We anticipate this will elicit questions from patients to discuss with their doctors. Being prepared for those conversations about quality scores is something physicians will need to be ready to discuss.

Like any new technology, we’re looking forward to building the capacity and functionality of www.WAHospitalQuality.org. We encourage you to go explore it and tell us what you think. What works? What doesn’t?  We are just getting started…

 


Prepared for Ebola patients, but what about influenza?

The Centers for Disease Control (CDC) has been front and center with ensuring updates are presented on the latest guidelines for hospital and ambulatory readiness should a known or suspect Ebola patient arrive in the U.S. These updates are posted on the CDC web site and the WSHA Ebola web page.

Most recently, the CDC has provided guidance on for EMS providers and a flyer for Ambulatory assessment, including a Top Ten Things You Should Know about Ebola, public safety flyer.

There have been four confirmed cases in the U.S., with one death. No new cases have commenced in 2015. The Washington Department of Health has been effective in communicating and working with hospitals, clinicians and other state entities, such as Washington State Hospital Association and Washington State Nursing Association.

According to an article in the Washington Post, “Widespread influenza activity was reported by 43 states, an increase from 36 states during the previous week, the CDC announced. Hospitalizations are up, 12.6 per 100,000 people in the final week of December compared to 8.9 per 100,000 during the same period in the 2013-2014 season.”

Ensuring hand hygiene and flu precaution efforts continues to be a high priority for hospitals during this time of year. So, be knowledgeable about your hospital preparedness for a potential Ebola patient, but be ready for influenza.

Prescription Monitoring Program Activity Comes to You

The Washington State Department of Health is working to provide education and outreach on an important patient safety program and is looking for opportunities to spread the message.

Prescription drug abuse and misuse is a national and local problem. After an eight-fold increase in the prior decade, the prescription overdose rate in Washington state declined by 29 percent between 2008 and 2013. The decline in deaths due to a prescription-drug overdose seems to be leveling off — there were 381 of these deaths reported in 2013, only seven less than from 2012 (for more details you can view the Nov. 17 DOH press release). While the news is promising, there is still much to be done to further address this problem.

One way Washington state is working to address prescription drug abuse is through the Department of Health’s Prescription Monitoring Program. The PMP is designed to promote patient care and prevent prescription drug misuse by allowing providers to review the controlled substance history of patients they are treating. The data can be very valuable for preventing duplicative prescribing, identifying overdose risk or addiction, coordinating care and assisting in compliance with pain management agreements.

PMP is offering to provide information or presentations to your organization’s health care professionals with or without continuing medical education credit. PMP Director Chris Baumgartner reports, “The training will show you how to streamline controlled medication reports into your workflow and generate a thoughtful care plan, and will explain how your office staff can facilitate the process.” Training will be provided by either the PMP director or the DOH operations manager and may include insight from a medical provider who regularly uses the program.

Health care providers who have successfully used the system report,

“This has changed my practice as an ER physician. No single thing in the last 10 years has had such a positive impact on my practice and my patients as this program, so thank you!”

“A significant tool that all providers should have access to and use. An incredible patient safety tool to monitor patient prescriptions with.”

“I love the program! It gives me a real tool for real discussions with the patients. It is not just about weeding out abuses; but also, about preventing unwitting addiction. Great tool!”

The PMP system itself is free for providers to use and can be critical for patient care and safety and for protecting your practice.

If you would like to discuss hosting this presentation at your organization, please contact Chris Baumgartner, PMP director, at chris.baumgartner@doh.wa.gov or (360) 236-4806.

Upcoming Events

 February 2, 2015  Partners in Quality: CEO and CMO Leadership Forum 
 May 15-16, 2015  2015 Annual WSMA Leadership Development Conference
 May 29, 2015  Medical Officer Collaborative Safe Table
 October 30, 2015  Medical Officer Collaborative Safe Table

Leadership Pulse – July 31, 2014

Get the Conversation Started

As physician leaders, you know that talking about end of life decisions is not always comfortable and many times it’s a topic both patients and physicians simply avoid altogether. In response to the Medical Officer Collaborative’s Call to Action, WSHA and WSMA have taken significant steps towards a statewide community plan to promote advance care planning through Honoring Choices Pacific Northwest.

Implementation Plan: With the guidance of the Honoring Choices Work Group, WSHA and WSMA are working with Dr. Bud Hammes from Gunderson Health and Respecting Choices to develop an ambitious five-year, six-phased strategy to bring an adaptable resource to communities across the state. The First Steps® Design & Implementation strategy offers both advance care planning (ACP) curriculum and a customizable process for healthcare delivery systems, religious affiliations, consumer advocacy groups, and other community partners to promote ACP through conversation and stewardship of information. A critical aspect of the plan is to certify Faculty, Instructors and Facilitators in our state, which will ensure the sustainability of the program into the future.

Website: The Honoring Choices Pacific Northwest website is currently being developed, with a proposed go-live in late September. The website will provide resource-rich information on advance care planning for both the public and for healthcare professionals, including a periodic e-newsletter, social media outlets and an Invite Family & Friends section for sharing the importance of having the conversation.

For more information on the initiative, please contact Tanya Carroccio, WSHA’s director of quality and performance improvement, at TanyaC@wsha.org.


Washington State Choosing Wisely Task Force

Choosing Wisely25% of patients in Washington with an uncomplicated headache receive either an MRI or CT—contrary to the Choosing Wisely recommendation: “Don’t do imaging for uncomplicated headache.”

As a result of the Medical Officer Collaborative’s Call to Action, the Washington State Choosing Wisely Task Force was formed to develop a pragmatic system to implement Choosing Wisely across the state, with a focus on changing behaviors, driving results and creating measurable improvement.

The task force is comprised of 20 physician leaders from clinics and hospitals across the state who are leading efforts within their organization to implement the Choosing Wisely recommendations. The Washington State Medical Association, the Washington Health Alliance and the Washington State Hospital Association jointly support the statewide task force.

The task force recently published the document, Choosing Wisely Claims-Based Technical Specifications (pdf 768kb), which includes a set of measures that can be used to evaluate provider integration of Choosing Wisely recommendations. Several organizations across the state have already used these specifications to run reports on their own clinical data and are identifying and addressing opportunities for improvement.

The task force is launching an initiative to “Change One Thing.” By focusing efforts on a single Choosing Wisely recommendation, we can create a measurable difference and learn how to integrate Choosing Wisely recommendations, generally speaking, into practice. The Task Force selected the recommendation: “don’t do imaging for uncomplicated headache,” which came from the American College of Radiology’s “List of 5.”

Based on the Washington Health Alliance’s analysis of 2012 claims data, 25% of patients with an uncomplicated headache received either an MRI or CT. The goal isn’t 0%; however, the general sense of the task force is that 25% is too high. Because this particular recommendation impacts a broad range of specialties and providers, has a high “N”, and exposes patients to unnecessary radiation (in the case of CTs); this Choosing Wisely recommendation provides us with an opportunity to make a meaningful impact for patients in Washington state.

The task force is currently developing a toolkit that physicians can use to integrate Choosing Wisely into their organization’s practice.

If you’d like more information about how to integrate Choosing Wisely into your organization, please email Jessica Martinson, WSMA’s director of clinical education and professional development, at Jessica@wsma.org.


Dr. John Vassall’s Book Recommendation

Why is it so hard to make lasting changes in our organizations, in our communities, and in our own lives?

SwitchSwitch: How to Change Things When Change is Hard
I recommend this book for those trying to make organizational change. We have been told that physicians will change if they are just shown good data. It turns out that is not necessarily true.

The authors of Switch, using the analogy of a rider guiding an elephant down a pathway, explore three requirements for people to make a change: they must intellectually understand the change (Direct the Rider), they must accept and embrace the emotional aspects of the need for change (Motivate the Elephant) and they must know in specific terms how to get from present state to future changed state (Shape the Path).

The authors provide valuable tools to overcome challenges with large-scale change by factoring in the human decision-making experience. This book is not only engaging, it is applicable to many of the challenges we face in the ever-changing health care environment.


Join WSHA 100K Children Campaign!

100K Kids Campaign logoRadiation in Children, Less is More

Be a national leader and join the innovative work being accomplished by the Washington State Hospital Association 100K Children Campaign! This is a statewide effort to make diagnostic imaging safer for our children through dose optimization and imaging appropriateness.

The Campaign kick-off was celebrated at the WSHA Safe Imaging Safe Table Collaborative on July 8, 2014. WSHA is partnering in this work with the national 100K Children Campaign. National experts and LEAPT (Leading Edge Advanced Practice Topics) hospitals shared compelling data on the importance of understanding dose data and ensuring providers have the information needed to make the best choice for their patients. Hospitals will be collecting data related to observation versus CT for pediatric minor head trauma, ensuring dual phase studies are performed only when indicated, making a public commitment to the use of pediatric protocols, and having a process to collect dose information for pediatric head CT.

Learn more about this initiative at the 100K Children Campaign Safe Table Webcast on August 21st from 1-2 p.m. To join or for questions, please contact Becky DeMers at beckyd@wsha.org or 206-216-2509.


Washington State Health Care Innovation Plan (SHCIP)

The effort to transform Washington’s health care system is one of the largest efforts of its kind and guided by the principal that no one individual or organization alone can make it happen. Working together, we can achieve better health and better care at lower cost for Washington’s residents. ~Healthcare Authority

WSHA and WSMA members are reforming structures and processes to improve health care quality and reduce costs. We have seen incredible changes in the past few years; including a focus on population health and how we can work together at the community level to support better health and health care.

At the same time the state has been considering ways to support transformation. To help finance and spur change, Washington state submitted a grant application to the Center for Medicare and Medicaid Innovation (CMMI) for funding to support the plan for a healthier Washington. “The $92.4 million application proposes to invest deeply in connections and active collaboration with Washington’s communities and providers to produce better health and better care at lower cost. The funding is Washington’s opportunity to take the State Health Care Innovation Plan–completed in December 2013 with the participation of hundreds of individuals across the state–to the next level of implementation.”

The State Health Care Innovation Plan for a healthier Washington is guided by three core strategies and seven building blocks. Click here for details on the plan.

To incorporate some of our work into the plan, the Washington State Hospital Association and the Washington State Medical Association teamed up with the Washington State Association of Leaders of Public Health Organizations.  Building on our success with sharing best practices in a safe table format, we suggested we could use the same structure to exchange and share ideas on community health. Where are partnerships working well? What roles do the providers play, and what roles does the public health agency play?  What barriers are there to collaboration, and how can they be addressed?

All three organizations believe our members have a lot of experiences to share and learnings best come from one another. It is too soon to know if the state will take us up on our offer of support. It is not an idea, though, that we will let die even if the state is not interested.  Expect to hear more from us in the coming months about how we can provide information, tools, and a forum to exchange ideas.


WSMA Leadership Development

The need for strong physician leadership is more important than ever. To help build these essential skills, the WSMA offers the following valuable opportunities.

WSMA & UW Physician Leadership Course

The WSMA has partnered with the University of Washington Graduate Programs in Health Administration and UW Professional and Continuing Education to offer a 40-hour leadership course focusing on:

  • Leadership and conflict management
  • Strategic planning and management
  • Safety and quality management
  • Finance
  • Communication and advocacy

The 10-week course is a combination of face-to-face and online learning. Members receive a tuition discount. This course is offered twice per year. For full course syllabus and application information, contact Lynda Sue Welch at (206) 956-3622 or lyndasue@wsma.org. This activity has been approved for AMA PRA Category 1 Credit™.

Annual WSMA Leadership Development Conference

Leadership skills are essential for physicians regardless of practice setting—and were not necessarily taught in medical. This conference is one of our most popular meetings. Sessions are highly interactive and enable physicians to walk away with concrete ideas and sills that can be put to immediate use. The 2015 WSMA Annual Leadership Development Conference will be held May 15-16 at Campbell’s Resort at Lake Chelan.

Physician/Administrator Team Leadership Course

Teamwork is necessary to produce better outcomes. Having the whole team on the same page for the right reasons is crucial to drive real change. The WSMA is currently developing our Physician/Administrator Team Leadership Course, which will employ a custom-designed curriculum to develop the skills necessary to ensure a team’s success. The program will focus on four critical areas: communication, planning, patient safety and cost effectiveness. More details about the course will be made available later this summer.

American College of Physician Executives

The WSMA, in conjunction with the American College of Physician Executives, now offers members access to ACPE’s catalog of 10 specifically chosen online leadership courses. WSMA members get the ACPE member rate, plus an additional 20% off. These activities have been approved for AMA PRA Category 1 Credit™.

For more information about the WSMA’s leadership development opportunities, please contact Jessica Martinson, WSMA’s director of clinical education and professional development, at jessica@wsma.org.


Voluntary Survey

Wales

Dear Medical Officers,

As you know the changing landscape of healthcare in the United States provides Physician Health Programs with a number of challenges and opportunities. Changes in our healthcare system including implementation of the Affordable Care Act and the aging of both the physician and general populations, the need for physicians and their services has increased at a time when many physicians are leaving practice due to age, physical and mental health issues, dissatisfaction and/or burnout.

Changes in the structure of practice as well as changes in practice patterns including the rise of multi-disciplinary teams as well as increasing reliance on physician extenders has led to ongoing increases in stress. Physician Health Programs are uniquely positioned to assist hospitals, practices, and clinics in supporting the functioning of physicians.

To respond to the many changes facing the healthcare industry, we were interested in completing a needs analysis to determine what issues (substance use, aging physicians, burnout, disruptive behavior, etc) those in healthcare leadership role face in dealing with physicians providing services in their facilities. We were also interested in exploring their knowledge of resources as well as their perceived needs for additional services.

Please take a few moments to complete this survey. Thank you for your participation.

Regards,

Sandon K. Saffier, MD, MBA
Director of Consulting on Quality
Wales Behavioral Assessment


Upcoming Events

September 4 WSHA Safe Table Event – Safe Deliveries Roadmap
September 5 WSHA Safe Table Event – ADE Prevention and Antimicrobial Stewardship
September 19 WSMA Medical Staff Peer Review Workshop
September 19-21 WSMA Annual Meeting: Affordable Care Act – Challenges and Opportunities
September 23 WSHA Safe Table Event – Readmissions
SAVE THE DATE
October 30
WSHA & WSMA Medical Officer Collaborative Safe Table
Please note: the date has been changed from October 14 to October 30
October 15-16 2014 WSHA 82nd Annual Meeting: Embracing Disruptive Change in Health Care
 October 29 WSHA Safe Table Event – Infections

 

Leadership Pulse – April 15, 2014

New Release! Patient Safety: Transforming Culture Toolkit

Despite tremendous efforts to address preventable harm to patients in healthcare, we continue to see high rates of harm. Research confirms the key relationship between organizational culture and the ability to consistently deliver services which provide value and good outcomes.

A safe culture is an environment in which there is shared responsibility, role clarity and open and frequent communication related to safety. By the nature of your roles leading care in the community, at the bedside in clinical units, and in acute care operations; you as physician leaders are well-positioned to have a substantial influence in creating a safe culture.

Through the Partnership for Patients initiative, WSHA and WSMA developed a toolkit to support physician leaders in strengthening your organizations’ culture to achieve safe, timely, effective, efficient, equitable and patient-centered care. The focus of the toolkit is on high-impact approaches that are effective in a clinic or hospital’s journey toward a safe culture. Click here to access the toolkit.

If you would like more information about the initiative, please contact Jessica Martinson, WSMA’s director of clinical education and professional development at jessica@wsma.org.

 

Have you had the conversation?

April 16 is National Health Care Decision Day and the Honoring Patients’ Choices work group wants to know if the hospital and clinic Medical Officers have started the conversation about advance care planning in their own institutions…and at home.

Washington State Hospital Association and Washington State Medical Association, in alignment with the Medical Officer Call to Action and the Honoring Patients’ Choices work group have partnered with Institute of Healthcare Improvement (IHI) Conversation Ready to increase awareness and education on advance care planning for both the community and in the health care setting. The Conversation Project is promoting community awareness through mass communication surrounding the April 16 Health Care Decisions Day.  Recognizing the importance of respecting what patients want and the tremendous efforts regarding end of life and advance care planning, WSHA and WSMA aligned with Twin Cities Medical Society Honoring Choices® and have plans to affiliate the trademark to create Honoring Choices Pacific Northwest®, which will provide a resource rich website for both community and clinicians.  More exciting news to come as WSHA and WSMA work with leaders to continue to inspire, educate and empower the public and providers about the importance of advance care planning.

For more information on the initiative, please contact Tanya Carroccio, WSHA’s director of quality and performance improvement, at tanyac@wsha.org.

 

Washington State Choosing Wisely Task Force

The goal of the statewide Choosing Wisely task force is to develop a pragmatic system to implement Choosing Wisely across the state, with a focus on changing behaviors, driving results and creating measurable improvement. The task force is comprised of 20 physician leaders from clinics and hospitals across the state who are leading efforts within their organization to implement the Choosing Wisely recommendations. The Washington State Medical Association, the Washington Health Alliance and the Washington State Hospital Association jointly support the statewide task force.

Recent work has focused on developing technical specifications to analyze performance using claims-data at a county level on select Choosing Wisely recommendations with the goal of educating physicians across the state on opportunities for improvement. No current measurement specifications exist, so the task force’s “Choosing Wisely Claims-Based Technical Specifications” packet will be the first of its kind in the nation.

Going forward, the task force plans to identify one Choosing Wisely recommendation on which everyone will focus their efforts with the goal of creating measurable change. We will also develop education and communication strategies and ultimately a toolkit to support physicians’ efforts to integrate the Choosing Wisely recommendations into their practice.

If you would like to confirm who is representing your organization on the Choosing Wisely Task Force, please email Jessica Martinson, WSMA’s director of clinical education and professional development, at Jessica@wsma.org.

 

2014 WSMA and WSHA Joint Legislative Advocacy Priorities

The Washington State Medical Association and the Washington State Hospital Association work together on statewide advocacy efforts that are of paramount importance to physicians and hospitals. As partners in these efforts, these two associations worked together on policy and budgetary issues during the 2014 legislative session.

We wanted to take the opportunity to update you on the status of important issues we partnered on during the session:

 

  • Telemedicine – Advocated for legislation to guarantee that if an insurer covers a clinical service on a face-to-face basis, they will also cover the same service if it is provided using video technology; payment levels subject to negotiation.Status: Unsuccessful. This bill died in the Senate due to concerns about increasing access to “webcam abortions.” This was exceptionally frustrating as the bill would in fact increase women’s access to help to maintain high-risk pregnancies.  We urge WSMA and WSHA members to express their disappointment to members of the Senate Republican Caucus.
  • Crisis Standards of Care – Advocated for legislation to provide liability relief if providers follow state triage requirements in a government-declared major disaster or emergency when adequate health care personnel or supplies are not available, such as an earthquake or H1N1 outbreak, and allow for emergency credentialing.Status: While weakened, this bill did pass and allows for easier emergency credentialing. It grants health care providers immunity from civil liability arising out of credentialing or granting of practice privileges during an emergency.
  • Mental Health Funding – Advocated for legislation to correct an error in mental health funding tied to Medicaid expansion, secure additional funding for capital and operating costs for new evaluation and treatment centers, and create new pathways for the integration of behavioral and mental health care.Status: The legislature made major new investments totaling almost $18 million in mental health.  This includes $4.5 million to correct the previous error and will pay for mental health services that are not matched by Medicaid, including providing funding for Institutes for Mental Disease (free-standing psychiatric hospitals with more than 16 beds).  It also includes funding for three Evaluation and Treatment (E&T) facilities in King, Spokane, and Thurston-Mason counties, which if built, should help to reduce inpatient need; Program of Assertive Community Treatment teams in King, Pierce, and Spokane counties to serve people who are high risk for rehospitalizations; and recovery services in the Greater Columbia, Grays Harbor, and North Sound regions to serve people who have been committed and are transitioning back into the community.

    WSHA and WSMA also advocated for significant mental health funding in the capital budget to help create new inpatient psychiatric capacity, but the legislature reached an impasse on the capital budget and did not enact any capital funding for any projects this year. This is very disappointing. It is unclear if without capital funding, the new Evaluation and Treatment facilities can move forward.

  • Health Care Reform – Advocated to defer decision on whether to create a new state operated program (Federal Basic Health) to eliminate almost all premiums for those less than 200 percent of poverty until more information on enrollment is known. The decreased premiums are proposed to come in part through providers accepting Medicaid-like rates.Status: The decision was deferred. The legislation that took shape would have required the Health Care Authority (HCA) to perform econometric modelling and reporting regarding the establishment of the Federal Basic Health Care Program, but this was not passed.  The future of the program is unclear. The two associations will continue their strong work to enroll people in Medicaid and the Exchange and work for the success of those programs.
  • Transparency and All-Payer Claims Database – Supported the development of meaningful, accessible data that includes physician- and hospital-friendly policies when implementing a statewide All-Payer Claims Database.Status: The bill that passed includes provisions to create and implement a statewide all-payer claims database but includes only those claims from state and federal monies (i.e., Medicaid, etc.).  This is a first step, but its usefulness remains to be seen.
  • Access to Primary Care – Advocated to retain funding for primary care support through continuing the Medicare rates increase for Medicaid providers.Status: Unsuccessful. Given the slimness of the state budget, this budget request was a heavy lift at $24.8 million and was not adopted by the state legislature.

If you would like to learn more about the legislative priorities listed above and how to get involved next year, please contact Katie Kolan, WSMA’s director of legislative and regulatory affairs at kak@wsma.org or Cassie Sauer, WSHA’s senior vice president of advocacy and government affairs at cassies@wsha.org. Click here for WSMA’s 2014 Legislative Summary.

 

Upcoming Events

April 30 or May 1 WSHA Patient Safety CEO & Trustee Summit
May 16-17 WSMA Annual Leadership Development Conference
May 28 Washington Patient Safety Conference
July 1 Medical Officer Safe Table Learning Collaborative
September 20-21 WSMA Annual Meeting

Leadership Pulse – January 10, 2014

2014 WSMA and WSHA Joint Legislative Advocacy Priorities

The Washington State Medical Association and the Washington State Hospital Association work together on statewide advocacy efforts that are of paramount importance to physicians and hospitals. As partners in these efforts, these two associations work together on policy and budgetary issues. The issues below are examples of joint priorities for both associations going into 2014.

  • Telehealth – Advocate for legislation to guarantee that if an insurer covers a clinical service on a face-to-face basis, they will also cover the same service if it is provided using video technology; payment levels subject to negotiation.
  • Suspect and Inmate Care – Protect caregivers and other patients by requiring adequate guarding by law enforcement of patients who are suspected or convicted of a violent or sexual crime, unless directed otherwise by the patient’s attending physician.
  • Crisis Standards of Care – Provide liability relief if providers follow state triage requirements in a government-declared major disaster or emergency when adequate health care personnel or supplies are not available, such as an earthquake or H1N1 outbreak.
  • Mental Health Funding – Correct an error in mental health funding tied to Medicaid expansion, secure additional funding for capital and operating costs for new evaluation and treatment centers, and create new pathways for the integration of behavioral and mental health care.
  • Health Care Reform – Defer decision on whether to create a new state operated program (Federal Basic Health) to eliminate almost all premiums for those less than 200 percent of poverty until more information on enrollment is known. The decreased premiums are proposed to come in part through providers accepting Medicaid-like rates.
  • Transparency and All-Payer Claims Database – Support the development of meaningful, accessible data that includes physician- and hospital-friendly policies when implementing a statewide All-Payer Claims Database.
  • Access to Primary Care – Retain funding for primary care support through continuing the Medicare rates increase for Medicaid providers.

If you would like to get involved in supporting these legislative priorities, please contact Katie Kolan, WSMA’s director of legislative and regulatory affairs at kak@wsma.org or Cassie Sauer, Cassie Sauer, WSHA’s senior vice president of advocacy and government affairs at cassies@wsha.org.

 

WSHA Hospital Engagement Network Selected to Catapult Patient Safety Forward

We are excited to share with you news that the Centers for Medicaid & Medicare Services (CMS) identified the Washington State Hospital Association Hospital Engagement Network (WSHA) as a participant in the Leading Edge Advanced Practice Topics or LEAPT program. WSHA is one of just six Hospital Engagement Networks in the nation selected by CMS for the program.

LEAPT was created by CMS to expand and spread knowledge in several important areas of patient harm. The LEAPT program began September 26, 2013 and will continue until December 8, 2014. This year-long project will provide intensive focus on areas important to our clinicians and patients.

What is Different?

LEAPT builds on the Partnership for Patients initiative. Through this program WSHA will work with groups of five to fifteen hospitals to discover the leading edge practices in 12 focus areas. The strategies will then be shared with hospitals locally and nationally.

  • Severe Sepsis and Septic Shock
  • Clostridium difficile, Including Antibiotic Stewardship
  • CAUTI (house-wide – moving beyond ICU)
  • CLABSI (house-wide – moving beyond ICU)
  • Failure to Rescue
  • Airway Safety
  • Iatrogenic Delirium
  • Undue Exposure to Radiation
  • Obstetrical Safe Delivery Roadmap
  • All Cause Harm Report
  • Readmissions Bundle (Acute Myocardial Infarction, Heart Failure, Pneumonia)
  • Hospital Culture of Safety with Worker Safety

Interest in participation has been very strong. We are pleased to announce that 45 hospitals from across our state, including several multi-state health care systems will participate with us.

 

Choosing Wisely® Update

The Choosing Wisely Task Force was recently formed as a joint effort between the Washington Health Alliance, WSMA, and WSHA. The 14 Task Force members represent 11 delivery systems and 3 health plans. The group will meet every other month with the purpose of strategizing and promoting the implementation of Choosing Wisely recommendations across Washington State in a collaborative way that minimizes duplicated efforts.

The Task Force held their first meeting on November 25, at which they carefully reviewed and recommended 10 Choosing Wisely recommendation measurement specifications. Special thanks to Premera for providing the starting point for the measurement specifications. The recommendations cover a broad range of topics, including PAP smears; NSAIDS; spirometry; antiobiotics; imaging for back pain, headaches, and adnexal cysts; syncope; appendicitis; and DEXA screening. Watch for the results of this data analysis, which will be published at the county-level statewide in the first quarter of 2014.

If you’d like to confirm who is representing your organization on the Choosing Wisely Task Force, please email Jessica Martinson, WSMA’s director of clinical education and professional development, at Jessica@wsma.org.

 

New Developments in Health Care Price Transparency 

There is much interest in Washington State in providing more information, especially to purchasers, on cost and quality.  About a dozen other states have done so through the establishment of an All Payer Claims Database (APCD), which captures paid claims data from insurers.  This data allows reports and information to be disseminated based on the contracted price.   We anticipate legislation this session.

The Washington OIC was awarded a $3.4m grant to establish the framework for implementing an APCD for Washington State that builds upon the capabilities of the Washington Health Alliance (previously the Puget Sound Health Alliance). The vision is to develop a community resource of comprehensive health care claims data from multiple sources that informs improvements in the quality and cost of health care in Washington State.

At the end of the Health Care Price Transparency Project, Washington State will have:

  • Introduced legislation, regulatory changes, and/or purchasing leverage required to ensure submittal of medical claims data, including reimbursement amounts, from all payers in Washington State.
  • Qualified the Washington Health Alliance to receive Medicare data.
  • Established the infrastructure needed to receive all medical claims data for the state.
  • Developed some publicly-facing tools that provide consumers and other stakeholders with information on the cost and quality of health care services.
  • Developed a plan for ensuring the sustainability of the All Payer Claims Database in the future.

APCDs are designed to accumulate data from health insurance payers in order to inform users regarding cost containment and quality improvement efforts. Payers can include both private and public payers (e.g. Medicaid, state employee health benefit programs, prescription drug plans, dental insurers, self-insured employer plans).

The databases can contain claims and eligibility data (e.g. medical, pharmaceutical, dental). The data can consist of “service-level” information based on valid claims processed by health payers. Service-level information includes charges and payments, the provider(s) receiving payment, clinical diagnosis and procedure codes, and patient demographics. To mask the identity of patients and ensure privacy, states usually encrypt, aggregate and suppress patient and provider identifiers.

Generally, the data can be used to report cost, use and quality information. APCDs can also be used for various research and policy purposes and consumer and purchaser information.

 

AMA, WSMA and WSHA General Principles, Operations and Governance of an APCD

AMA model legislation can be used to guide Washington in building and governing its APCD in order to best benefit physicians and patients.

  • State Oversight: If data collection or reporting resides with a private agency, the work should be overseen directly by the state.
  • Governance: Such an agency should have a governing body with adequate representation of all party’s interests and all areas of the state, including physicians.
  • Standardization of data: Approaches to data-standardization is non-uniform in each state. We recognize the benefit of each state harmonizing data collection standards.
  • Accurateness and completeness of data: Health plans must submit all relevant data, regardless of whether the data resides on multiple data platforms, and a process to certify the accurateness of data must be in place.
  • Release of Data/Reporting: Any report at the aggregate level describing health care service variation and utilization and cost patterns must be complete, accurate, statistically valid, methodologically sound, and must be the product of a risk adjustment methodology. Any report must clearly disclose the time frame of the data upon which the report is based. If the data is available at the individual physician level, it’s very important that physicians be able to review their data if it is going to be reported at the individual physician level. Reports should also recognize the variability in treatments and cost driven by acuity of the patient, as well as other factors that may influence a provider’s cost structure or quality measures – such as total treatment patterns that recognize some providers may substitute for expensive treatments or procedures, provider location, patient mix, and amount of charity and government sponsored care.
  • Appealing data: The appeals process and what a physician can do if their data is incorrect must be addressed.
  • Use of data: Non-patient identifiable data should be made easily available to consumers, purchaser, payers, and providers. Data should not be used for the purposes of specifically informing reimbursement and contracting negotiations.

 

Our Position

WSMA and WSHA support transparency of provider cost and quality as a way to promote efficiency and evidence-based care. The development of transparency tools is an opportunity for quality improvement, cost containment, and better decision making on the part of consumers, payers, purchasers and providers. The development of these tools will benefit from valid data, public oversight and a sustainable payment model. For more information from WSMA, visit the WSMA legislative agenda page. For more information from WSHA, visit www.wsha.org/policyadvocacy.cfm.

 


Alliance Releases Report on Health Care Cost Variation

The Washington Health Alliance recently released a report that shows variation in aggregate professional and facility costs for 24 select high-volume hospitalizations for reasons such as deliveries, joint replacements, and spine surgery. The report found at least a 240 percent difference in individual case prices across delivery systems and as much as a 780 percent difference.  The data for the report was provided by six health plans and eight self-insured purchasers. To meet concerns about anticompetitive behavior, the Alliance has only made the full report available to purchasers and plans, however, a summary is available online.

 

Upcoming Events

January 15 WSHA 2014 Legislative Session Preview Webcast
January 18 ER/LA Opioid REMS: Achieving Safe Use While Improving Patient Care
February 10 2014 WSMA Legislative Summit
February 28
Health Care Data: Business Intelligence and Predictive Analytics for Physician Practices
March 7 to May 10
WSMA & UW Physician Leadership Course
March 31
CMO Safe Table Learning Collaborative (More details soon!)
May 16-17
Annual WSMA Leadership Development Conference
May 30 to April 1
WSHA Patient Safety CEO & Trustee Summit

Leadership Pulse – October 8, 2013

Welcome to Leadership Pulse!

Welcome to “Leadership Pulse,” our periodic newsletter for medical officers, where you will find valuable information, resources, and an opportunity to share information and insights on relevant topics. Included will be pertinent themes for leadership, quality, healthcare policy, hot issues and best practice.

We are also renewing our email communications in order to provide an open-forum platform for the medical officers to distribute comments or questions via email. Watch for an email next week.

Sincerely,

John Vassall, MD
Physician Advisor, WSHA
Chair, Medical Officer Advisory Group

 

Swap Ideas, Ask Questions on Medical Officer E-list

The Washington State Hospital Association and WSMA are pleased offer medical officers a new platform to connect. The new email list platform gives participants a forum to share ideas, discoveries, and information.

We hope the list will complement the Safe Tables and provide a venue for members to ask general questions or poll their colleagues about helpful policies, quality, safety, and leadership topics. Additionally, we hope it will foster increased unity, collaboration and cooperation among medical officers in Washington state.

To kick-off this peer-to-peer service, we’ve subscribed all medical officers to the email communication list. We don’t anticipate it to be a high-volume communication platform, however. Recognizing that your inboxes are already full, we’ve set some guidelines, which will be included in the roll-out email, to make this communication platform more effective. Most importantly, it won’t duplicate official announcements about news or events that would be conveyed through separate channels.

An email will be sent to you soon regarding your subscription. You will be able to unsubscribe at any time. If you have any comments about the e-list or to unsubscribe, please email Tanya Carroccio, director of quality & performance improvement, directly at tanyac@wsha.org.

 

Have Pharmacists Delayed Filling Prescriptions for Your Patients?

Walgreens, Costco and CVS pharmacies were the subject of DEA actions in Florida recently, as a result of requiring substantial details of prescribers before filling prescriptions for controlled substances. For example, in a May 10 memo, Walgreens advises its Passport Health Plan providers that a pharmacist may contact the prescriber to obtain “additional information” including the “diagnosis, ICD-9 code, expected length of therapy and previous medications/therapies tried and failed.” The WSMA finds such requirements are overly broad and not supported by current state or federal laws or regulations.

Under federal law, prescriptions must be written for a legitimate purpose. There is currently no requirement under law for including ICD-9 codes or other detailed information related to the patient’s condition on a prescription. In fact most will find that such information cannot be added on a prescription generated by today’s electronic health record systems.

The WSMA Executive Committee supports the position that all valid prescriptions should be filled without delay. These burdensome requirements have the potential of placing needless additional administrative burdens on busy physicians and other prescriber and could delay or even deny patients’ access to needed medications.

Recently the Medical Quality Assurance Commission has recommended as a best practice that physicians include a “notation of purpose” (e.g. “for headache”) [pdf]. Additionally the commission has pointed to language in the rules for management of chronic non-cancer pain which states that opioid prescriptions need to include “indications for use” or ICD code (WAC 246-919-859(3)). The MQAC believes that what a physician puts on a prescription for a controlled substance is up to the prescriber and their comfort level with the patient.

WSMA will continue to work with all parties to try to assure that patient care does not suffer because of the new practices of the large pharmacies. WSMA has received written confirmation from the Seattle Drug Enforcement Agency office that the “DEA has placed no additional requirements on Washington pharmacies ‘when verifying certain prescriptions for controlled substances’.” WSMA is pursuing this issue locally with the state attorney general’s office and nationally in consultation with the AMA.

While WSMA continues to pursue this matter, if you are faced with a specific, particularly egregious delay or denial of a prescribed controlled substance for a patient, you can file a complaint with the state Board of Pharmacy. Be sure that you are adhering to Washington state regulations on prescribing controlled substances. For questions, contact Bob Perna at rjp@wsma.org or Denny Maher, MD, JD at dpm@wsma.org.

 

Engaging Physicians in Enrollment: Health Care Coverage Expansions

Physicians offices, hospitals and health systems across the state are working to help their communities access health care insurance coverage available under the Affordable Care Act. Key audiences to engage include physicians and medical staff. Swedish created a focused effort to reach this group.

To help with changes associated with the ACA and new health coverage options offered through the state’s expanded Medicaid program and the new health benefit exchange, Swedish formed a Quality Improvement Project Team. The “Medicaid Expansion/Exchange” QIP Team represents content experts from across the organization who have come together to establish an action plan for Swedish.

A core element of the QIP Team action plan is centered on physician/medical staff outreach and education including:

  • Physician leadership meetings: Action plans and resources are being presented at a series of upcoming meetings targeting physicians and all staff across the Swedish system
  • Targeted newsletters/publications: Updates on the ACA and specifically Medicaid expansion and the health benefit exchange will be shared via Swedish Medical staff news and other internal newsletters/publications
  • Onsite enrollment: Swedish providers will receive a list of Swedish trained “In-person assistors” who can help enroll patients at Swedish hospitals
  • Partnerships: Swedish Medical Group is partnering with federally qualified health centers (FQHCs) and other community clinics to help manage the influx of new patients
  • Online resources: A toolkit of medical staff and patient materials will be available via Swedish intranet pages.

The Swedish team will continue to evolve this action plan, as needed, to best meet the needs of Swedish staff and patients. For more information contact tom.gibbon@swedish.org

 

Medical Officers from Hospitals and Clinics Invited to Safe Table October 24

Join WSHA and WSMA for a Safe Table meeting of physician leaders from hospitals and clinics across the state on Thursday, October 24, 2013 from 9 a.m. to 2:30 p.m. at the SeaTac Double Tree Hotel.

Historically, attendance at our Chief Medical Officer Safe Table events has been limited to physician leaders from hospitals.  Because health systems are becoming more integrated and physician groups are aligning with larger systems, we’ve decided to extend an invitation to physician leaders from clinics across the state.

The agenda was created by medical officers and will address specific topics of interest to chief medical officers and physician leaders. Objectives for this Safe Table meeting include:

  1. Learn about different physician practice models used in Washington. What is working well? What will need to adjust as the delivery of health care evolves?
  2. Discuss the latest on the Washington State Health Benefit Exchange.
  3. Review the latest on Washington State Health Care Innovation Plan including cost/quality transparency and payment reform.
  4. Action Strategies: Discuss plan for Advanced Illness Planning (AIM)/Life Planning.
  5. Discuss Choosing Wisely® Campaign progress and updates.
  6. Understand where Washington stands on quality compared to other states including update on Partnership for Patients and LEAPT.

 

Literature Review – Heath Care Transparency is Inevitable

Article reviewed: The Transparency Imperative
by Robert P. Kocher, MD & Ezekiel J. Emanuel, MD, PhD
Annals of Internal Medicine 28 May 2013

The article’s authors argue that transparency of price, utilization and quality data must be made available to the public to shift the basis of health care competition from structural market power to the delivery of better value and service. They call this the transparency imperative and argue that currently available data is insufficient to achieve the system changes needed for better quality and cost control.

Achieving the transparency imperative will require a fundamental shift including a change in attitude by numerous stakeholders, publicly available claims data, improvement on privacy protection and transparent pricing for comparison by patients before decision-making on care occurs. Read more in the article

 

Have a great idea for a topic we should touch on? Please email your thoughts to Tanya Carroccio, Director of Quality & Performance Improvement, at tanyac@wsha.org or Jessica Martinson, Director of Clinical and Professional Development, at jessica@wsma.org