FOCUS TOPICS BEHAVIORAL HEALTH/PSYCHIATRY • PRACTICE MANAGEMENT
November 2018 >> $5
Who’s Getting Healthcare Right?
Healthgrades Releases 2019 Hospital Quality Rankings 2 0 19
By CINDy SANDERS
For 20 years, Healthgrades has reviewed hospital quality and released an annual analysis of performance across a number of common conditions and procedures, assigning a rating of one to five stars for each. Last month, the online healthcare information resource released its 2019 Report to the Nation.
Why Ratings Matter
As the nation continues the move to value-based care, consumers have become more engaged in their health and healthcare. With higher deductibles and co-pays, more consumers have begun to think of healthcare in a similar fashion to other major purchases, looking online for information on cost and quality. When it comes to healthcare, however, the stakes are considerably higher than selecting a new car or refrigerator. In looking at the variation in clinical quality and outcomes across the nation, the 2019 Healthgrades analysis found patients treated at a hospital with a five-star rating, as compared to a hospital with a one-star rating, in a specific condition or procedure have a significantly lower risk of death and of experiencing complications during the inpatient stay. To create the latest report, Healthgrades analysts looked at Medicare Provider Analysis and Review (MedPAR) data from 2015 through 2017, which provides information on Medicare beneficiaries who access inpatient services. From the data dive, the report found:
Being There in Difﬁcult Times At the Jackson Clinic, Psychiatrist David Helm helps patients cope As a psychiatrist, David Helm, MD, often deals with people at some of the most difﬁcult periods in their life. Being able to help them through these tough times is one of the more rewarding aspects of his job at the Jackson Clinic, PA. The son of parents who demonstrated service to others through their jobs, Helm knew early on he would in some way pursue a path of service to others. Growing up in Bowling Green, Kentucky, Helm saw his father, a Vietnam veteran, serving and protecting the community in his role as a police ofﬁcer. His mother was a career nurse whose career ultimately led her to mental health nursing at a psychiatric facility.
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West Tennessee Healthcare’s Newest Addition Dr. Bob Pryor brings wealth of knowledge and experience to new role as Chief Physician Executive By SUZANNE BOyD
Read the story on page 3.
ONLINE: WESTTN MEDICAL NEWS.COM
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Take a look at the resume of Robert Pryor, MD, and it would be hard to not be impressed. The story it tells is one of a man who is as accomplished as a physician as he is an administrator. Today, Pryor has shifted from a
consulting role with West Tennessee Healthcare to a permanent one as Chief Physician Executive where he has been charged with engaging the medical staff in robust clinical quality integration and improvement initiatives, patient safety standardization and physician leadership (CONTINUED ON PAGE 6)
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Being There in Difficult Times At the Jackson Clinic, Psychiatrist David Helm helps patients cope By SUZANNE BOYD
As a psychiatrist, David Helm, MD, often deals with people at some of the most difficult periods in their life. Being able to help them through these tough times is one of the more rewarding aspects of his job at the Jackson Clinic, PA. The son of parents who demonstrated service to others through their jobs, Helm knew early on he would in some way pursue a path of service to others. Growing up in Bowling Green, Kentucky, Helm saw his father, a Vietnam veteran, serving and protecting the community in his role as a police officer. His mother was a career nurse whose career ultimately led her to mental health nursing at a psychiatric facility. Helm chose to pursue an undergraduate and master’s degree in biology at Western Kentucky University in Bowling Green, with the intent of going to medical school. During his time at Western Kentucky, he worked at the same psychiatric facility as his mother as a psychiatric tech where he helped patients with daily care and other needs. It was this experience that led him to consider psychiatry as a profession. “My mother was the influence that led me to the world of healthcare, but it was my primary care physician, Dr. Leslie Lovett, who had a significant impact on why I wanted to go into medicine specifically,” said Helm. “Dr. Lovett, who was also a graduate of my medical school, the University of Louisville School of Medicine, came to my home town in the 1970’s to practice medicine at a time when medicine, in some ways, was still archaic. As a new breed practicing cutting edge medicine, he was instrumental in elevating the status of emergency medicine at my local hospital and as a result saved lives. He was my primary care physician up until just a few years ago when he retired. Not having him anymore as a physician felt more like losing a family member. To me this type of lasting influence is what practicing medicine is all about.” After completing his residency in psychiatry and behavioral medicine at the Brody School of Medicine at East Carolina University in Greenville, North Carolina, Helm joined the staff of West Tennessee Healthcare’s Pathways as a general psychiatrist. While at Pathways, Helm gained experience by treating basically the gamut of mental health disorders. After five years there, he joined the Jackson Clinic, PA in February 2016 as westtnmedicalnews
the only psychiatrist on staff at the multispecialty clinic. His practice, located at the clinic’s North campus in Jackson, treats patients 18 years of age and older. “Being the only psychiatrist at a clinic that has a large referral base, means I am busy,” said Helm. “With only a few
psychiatrists in the area, we are facing the same issue that much of the rest of the country faces, a dire shortage of psychiatrists with a growing need for services.” One other large barrier to care is insurance reimbursement said Helm. “It is a vicious cycle, insurance seems to have a tough time reimbursing for psychiatric services, so it is hard for patients to seek care and it makes it harder for a psychiatrist to be able to see patients if their insurance does not cover these services,” he said. “Compounding the problem is that often times people with severe mental illnesses are unable to work and thereby may not have access to insurance to help them get services. The stigma of mental health can still be a very difficult hurdle to overcome.” Anxiety and depression tend to lead the list of disorders Helm sees in his practice. “By nature, it is the most prevalent disorder you would see anywhere,” he said. “I think most everyone will have to deal with anxiety or depression at some point in their life. But really they are no different than someone who has hypertension or any illness, it has to be treated. While the causes can range from a ge-
netic chemical imbalance to a life crisis such as divorce or death, most disorders are life-long, therefore much like in family medicine, some patients I will see long-term.” Treatment can include a combination of psychotropic medication management and therapy. “Most importantly is being there for them in difficult times,” said Helm. “Medications don’t fix everything. Adding therapy can give the patient the best chance to get better. Having that time to talk to a patient can help to develop trust and a relationship that can be important to identify and deal with the issues.” As with other areas of medicine, psychiatry is looking at genetic testing and advancements in medications to improve treatment of patients. “While many are still in experimental phases, we are seeing great promise in new medications for depression and mood stabilizers for bipolar disorder,” said Helm. “Knowledge of medications is growing exponentially and advances in genetic testing will help to determine which medications may be more effective for a patient.” Being able to provide psychiatric services in a rural health setting is very important to Helm and was one of the big reasons he was attracted to Jackson. “I have dedicated my life to medicine,” he said. “And my main objective is to help as many people as I can.”
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Whoâ€™s Getting Healthcare Right? continued from page 1 â€œFrom 2015 through 2017, if all hospitals as a group performed similarly to hospitals receiving 5-stars as a group, on average 222,210 lives could potentially have been saved and 157,210 complications could potentially have been avoided.â€? Healthgrades Chief Medical Officer Brad Bowman, MD, noted, â€œConsumers have many choices for healthcare, but most important is understanding that there is a significant variation in care from hospital to hospital and doctor to doctor. In fact, hospitals within close proximity to each other can have significant differences in complication and mortality rates for the same condition or procedure. The analysis of hospital qual-
ity is intended to spotlight the importance of doing your homework before selecting your care. It could be a matter of life or death.â€?
National Health Index
At the same time Healthgrades released the 2019 Report to the Nation, the organization also released its second annual National Health Index. Archelle Georgiou, MD, a senior advisor to Healthgrades, said the index looks at â€œwho is getting healthcare right.â€? A former CMO of UnitedHealthcare and author of the book â€œHealthcare Choices,â€? Dr. Georgiou noted, â€œWe recognize that healthcare is broader than just the quality of the hospitals.â€? She contin-
ued, â€œHealth and healthcare is comprised of many different factors. To understand whether a city is getting healthcare right is complex, which is why Healthgrades compiled numerous industry data sets to help paint a more complete picture of healthcare at the local level in cities across the country.â€? Archelle Georgiou, MD Healthgrades analysts turned to four key sources to evaluate health and healthcare in 130 metropolitan areas across the country. Data was pulled
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from the Behavioral Risk Factor Surveillance System (BRFSS) 2016 survey at the MSA level, provider specialty information and patient experience survey scores from Healthgrades.com, 2017 population estimates from the U.S. Census Bureau, and the 2019 hospital quality rankings from Healthgrades. Dr. Georgiou said the team looked at 14 factors spread across four major categories. The big categories, she said, were: â€œDo people have access to care? Is the population healthy? Do they have high quality hospitals? And do they have high quality specialists?â€? She said in addition to having some form of insurance coverage, analysts also considered the percentage of population that didnâ€™t feel restricted from seeking care due to cost, including high deductibles and co-pays. The group also looked at preventive and behavioral measures including the percentage of people ages 50-75 who had a colonoscopy in the past 10 years, percentage of women 40 and older who had a mammogram within the last two years, percentage who had visited a dentist in the past 12 months, had a normal body mass index (BMI), reported physical activity within the past month, and the percentage of residents who reported having at least one person they identified as their personal healthcare provider. Hospital quality measures came from the latest Healthgrades rankings; and the team looked at the number of specialists per capita across multiple disciplines, as well as patient satisfaction with those specialists. â€œIn order to have a healthy community, itâ€™s all these different factors,â€? Dr. Georgiou said of the ingredients required to enable healthiness. Rochester, Minnesota, Burlington, Vermont, and Charleston, South Carolina, led the way this year. San Francisco, which came in at 17th on the list, was identified as having the healthiest residents. Worchester, Massachusetts, with an overall rank of 55, had the highest access to healthcare. Berlin, New Hampshire, which ranked last at 130, struggles with population health and availability of high quality hospitals and specialists. Yet, Dr. Georgiou noted, the area does have a high percentage of the population insured and an above average rate of those who can access care affordably. She pointed out every metropolitan area has different strengths and challenges to address. Some cities might need to focus on community programming or public works to create more opportunities for physical activity. Others might have to look at creative ways to entice more specialists to the area. The index, she noted, provides a starting point for those discussions and a snapshot for patients making decisions about their care. â€œI think the index is a step forward in our whole mentality around being consumer-focused. It looks at the full continuum from access and insurance all the way through to your personal behaviors,â€? Dr. Georgiou concluded. â€œThe National Health Index is designed to help consumers understand the health of their community, to empower them to navigate their care journey with confidence and to help them access the right care in their market.â€? westtnmedicalnews
Responding to Payer Audits By Kathy Doelling Health care payer audits are pervasive. We receive requests on a continual basis for assistance in addressing these and in assessing potential risks and liabilities associated with an audit. Audits can be time consuming and stressful, especially for the small group practice. There are several things for a Kathy Doelling healthcare provider Senior Compliance and Coding Advisor to consider when (901) 680-7215 responding to an kathy.doelling@ audit request from butlersnow.com Medicare, Medicaid or a commercial carrier. How an organization responds to an audit can have long lasting financial and/ or personal penalties for the entity and its personnel, therefore payer audits should be taken very seriously. We have put together the following steps that should be considered when responding to a payerâ€™s request for medical records or medical record audit. This list is not exhaustive, but does represent a sampling of items that we routinely discuss with providers facing an audit.
care, (v) equipment list, (vi) exercise and modality records, (vii) therapy evaluation, (viii) legend of abbreviations, (ix) name and credentials of all individuals rendering care to patients, (x) signature log, and (xi) proof of delivery forms. Note that this list is not a comprehensive list of documentation that an auditor could request. Also note that this information should be readily available and should be assembled by an individual familiar with the medical record system and the types of information the auditor is requesting.
8. Send the audit package to the payer via certified mail or return receipt requested. Keep a copy of the proof of delivery form. When appealing an audit, we recommend getting a signature from the appellate organization receiving your appeal and documentation to ensure evidence of timely submission. 9. In order to preserve your appeal rights, ensure your response is sent within the stated timeline. Commercial payer auditors are usually flexible to extend deadlines if you get that approved in writing, in advance. Note that Medicare will not extend a deadline, so filings must be timley.
SOME TAKE CREDIT. WE TAKE INITIATIVE. 3. Engage a certified coder to review all records prior to submission confirming (i) documentation supports the service billed, (ii) documentation was appropriately authenticated by the author, (iii) documentation was dated appropriately, (iv) all information reported on the claim is accurate. Although this is an up-front added expense, an independent review by a certified coder may raise concerns in a proactive sense and help the organization strategize in its response with the auditor to appropriately address identified issues.
10. Include a cover letter in response to all issues identified in the audit. 11. Consider contacting a health care attorney to assist you in responding to an audit if you have concerns that the audit may raise issues based on regulatory or policy interpretations.
The items listed above should be viewed as a starting point in responding to an audit not a comprehensive list of instructions. As a best practice and to avoid audit penalties, it is a good idea to affirmatively review payer 4. Do not alter medical records bulletins, manuals, program memoranda, 1. Ensure all payer correspondence is without appropriate and transparent medlearn articles, local coverage received by someone in the organization amendments, attestations, etc. determinations, local coverage articles, local who knows how to recognize and medical review policies, national coverage 5. Ensure that each page of the record is address an audit request. Make at least determinations, and society coding guidance copied completely and text is legible. one copy of the correspondence and on a regular basis to ensure that your save it electronically for reference in a 6. Number each individual page of the organization is in compliance with payer secure file. documents you are sending to the payer billing and record keeping policies. Finally, in consecutive order. If the auditor loses having an effective compliance program in 2. Carefully read the audit request letter Some legal teams are more concerned with pages, the numbering system will help a highly regulated industry like healthcare and provide all information requested, retain integrity of the submission. This Snow, is essential. The compliance program taking credit than initiative. At Butler but no more. A few examples of will also help both the provider and must include internal billing auditing and information payers may request are our teamwork approach allows with us to anticipate the auditor discuss concerns clear monitoring. This is a smart business practice (i) complete medical record for date reference to the medical record. and demonstrates that your organization GLEPPIRKIWERHXSÄŒRHGVIEXMZIWSPYXMSRW of service requested, (ii) results of is committed to act in accordance with diagnostic imaging tests orders, (iii) Keep copy of all documents you send After7. all, wea measure our success by yours.healthcare rules and regulations. treatment flow sheets, (iv) plan of to the payer.
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GrandRounds Rhodes Builds Impressive Med School Acceptance Record
Rhodes College has one of the top medical school acceptance rates in the nation. Eighty-six percent of Rhodes graduates with a GPA greater than 3.4 and an MCAT score greater than 57 percent have been accepted to medical school over the last five years. Harvard, Vanderbilt, and Emory were among the medical schools where Rhodes graduates were admitted in 2018. Two graduates were awarded spots in the National Institutes for Health Medical Scientist Training Program, which provides a fully funded path to a PhD and MD. J. Carey Thompson, vice president of enrollment and communications, said, “Our pre-health advising program has a top-notch reputation, as proven by this year’s list of acceptances.” Rhodes offers pre-health advising to all students pursuing medical school or a career in the health professions. Mentorship begins as soon as students are admitted to the college and continues beyond graduation.
Tennessee Skilled Nursing Communities Launch Program Improving Residents’ Quality of Life
JACKSON – Tennessee Health Management (THM) that operates 29 skilled nursing communities, announced an expansion of an interactive program for patients and residents that combines online activities with restorative therapies to improve their quality of life. With the addition of nine facilities in the Jackson region, approximately 1,646 skilled nursing patients in 19 THM facilities throughout West and Northwest Tennessee can now participate in the Activities, Restorative and Therapy in Sync (ARTS) program. The ARTS program was funded by the Tennessee Department of Health and the Centers for Medicare & Medicaid (CMS) Services Region IV with $964,766.16 from the Civil Monetary Penalty funds. The grant supports the use of the It’s Never 2 Late (iN2L) computer-based system to engage residents in fun and meaningful activities. The iN2L touch-based technologies
encourage users, even those unfamiliar with computers, to “touch their way” through programs to connect with loved ones via Skype, create “My Story” digital biographies, do simulated physical activities, and play brain games. Activities therapy, restorative care and rehabilitative therapies have historically been separate departments in a residential nursing facility. As a requirement of the grant program, the team will measure and report on the program’s results over the next 36 months. So far, THM therapists are enthusiastic about the results they are seeing. At Applingwood Healthcare Center in Cordova, Tenn., the staff has incorporated the program into most patients’ therapy sessions and reports that patients are enjoying the new online activities. At Covington Care Nursing and Rehabilitation Center in Covington, Tenn., the therapists have found that patients who use the system are more active and tolerate longer treatment times prior to rest. The 19 THM skilled nursing facilities
that have implemented the ARTS program include: Applingwood Healthcare Center of Cordova; Bright Glade Health and Rehabilitation Center and Harbor View Nursing and Rehabilitation Center in Memphis; Covington Care Nursing and Rehabilitation Center; Crestview Health Care and Rehabilitation Center of Brownsville; Decatur County Health Care and Rehabilitation of Parsons; Dyersburg Nursing and Rehabilitation; Forest Cove Nursing and Rehab Center of Jackson; Humboldt Healthcare and Rehab Center; Lewis County Nursing and Rehabilitation Center of Hohenwald; Lexington Health Care and Rehabilitation; McKenzie Healthcare and Rehabilitation Center; McNairy County Health Care Center; Northbrooke Healthcare and Rehab Center of Jackson; Paris Health Care Nursing and Rehabilitation Center; Savannah Health Care and Rehabilitation Center; Union City Nursing and Rehabilitation Center; VanAyer Healthcare and Rehab Center located in Martin; and Westwood Health and Rehabilitation Center of Decaturville, Tenn.
West Tennessee Healthcare’s Newest Addition, continued from page 1 development and engagement. Healthcare became a part of Pryor’s life early on. He hails from Temple, Texas the home of Scott and White Healthcare, which in 2013 combined with Baylor Health Care System to become Baylor Scott & White Health, the largest not-forprofithealthcare system in Texas and one of the largest in the United States. While in high school, Pryor helped clean the hospital at night and thanks to a pathologist who took an interest in him, his interest in medicine began. Pryor attended medical school at the University of Texas and completed his post graduate training, focusing on pediatrics, at the University of Oklahoma and Baylor College of Medicine. His medical career includes the distinction of being among the first group of board certified pediatric intensivists in the country. After 20 years in practice and earning an MBA, Pryor began his shift to administration when he became chief medical officer for a hospital in Phoenix. He was then recruited to Scott & White Healthcare which eventually merged with Baylor Healthcare where he served as president and chief medical officer for the not-forprofit healthcare system that included 53 hospitals and more than 900 access points. “There were more than 70,000 employees in the Baylor system,” said Pryor, “and all called me Bob.” When retirement approached, Pryor realized he was not ready to stop working, so he began a part-time job with Kauffman Hall Associates, a healthcare consulting company. The part-time turned into the full-time position of senior vice president which led to him working with West Tennessee Healthcare. “While I was in practice in the 1990’s, I helped put together the Children’s Hospital of North Texas. During that process, 6
I became interested in the fact that physicians and administrators say the same thing but argue because they don’t realize it,” said Pryor. “Healthcare is a team sport, and we all have to work together bringing our own expertise into the mix for the best patient care.” As a consultant to West Tennessee Healthcare, Pryor was to assess how the hospital and physicians could better work together. Upon arrival, Pryor said he was immediately impressed with what he found in not only the team, but especially its leader. “The key to all this was the brilliance and capabilities of J.R. Ross,” he said. “He is one of the best leaders for healthcare in the country and I have seen a lot of them and been one of them – he is what makes it work around here.” Through conversations with Ross, it became apparent that someone was needed full-time at West Tennessee Healthcare. “J.R. asked me to come work with them and a few months later I came on board,” said Pryor. “One of the biggest reasons I wanted to come was to have the opportunity to work with J.R. and to get to know him better.” Since his arrival two months ago, Pryor is doing much of the same thing he did as a consultant; bringing combined accountability and capabilities to the healthcare team under the direction of Ross. “It is all about the mission here and the only interest, is the interest of the patient,” said Pryor. “The medical staff and administration have a common culture here. It is just a matter of understanding the root of a problem then developing an action plan to solve it, as well as any underlying issues. The goal is to get to the best possible decision at the earliest possible time.” Many organizations are beginning to use medical administrators. This model
works well when the physicians and administrators each bring their own unique skills to make better decisions for patient care, said Pryor. “The Cleveland Clinic has done this all along,” he said. “Physicians and administrators work closely together and have co-accountability for the total care of the patient.” Adding a degree of difficulty to things is that healthcare changes rapidly, almost on a daily basis. “We are seeing changes in regulations, payment structure and expectations. The model of caring for the sick is shifting to keeping people well,” said Pryor. “What worked in the past, will not work in the future so it is going to take new solutions to these ever-changing problems.” Pryor found that WTH was doing better on the issue than the national average. “It is just JR’s vision to take this to the next level, and I am proud to be a part of that,” he said. “I have been in lots of places around the country and can add some unique perspective to things. But ultimately, healthcare is local, so our solutions will be uniquely West Tennessee solutions.” Right now, Pryor says he is doing a lot of listening to get some perspective on where people are coming from. “I have found that it is always best to listen first in order to bring people together to identify where we can make improvements. I have no preconceived idea of what it is, but people do here so once we get problems listed, we will bring a team together to identify solutions and get to work,” he said. “Everyone is curious about why I am here. I am here to help. I have already been CEO and have no desire to do that again. All I want to do is be here to help and get things done in the best way I can.”
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West TN Medical News November 2018