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Steve Sorensen, Founder and Chief Revenue Strategist at Enlighten360, LLC. Steve Sorensen
Steve Sorensen is the Founder and Chief Revenue Strategist
designed to improve workforce morale, company profits and
at Enlighten360, LLC. During his career history and now as
organizational longevity.
a business consultant, Steve has been instrumental within various organizations to achieve higher levels of revenue
He earned a Master of Science in Management degree from
growth and increased productivity.
Regis University with an emphasis in Leadership, writing his master’s thesis on the power of retained customers and
He has successfully led numerous national and regional
employees to maximize organizational profitability through
teams and business units. He has successfully launched and
high performance, client centric teams.
managed multimillion dollar national marketing and product initiatives within Fortune 500 clients.
Steve is adjunct faculty at the Healthcare Leadership Masters program, University College of the University of Denver. He
Steve’s experience includes three successful decades in the
writes for industry publications, and delivers speeches on
Fortune 500 as a Vice-President, a Manager of Corporate
the positive impact and strategic importance of leadership
Accounts and Western States/Western Canada Regional
development as well as customer and employee retention.
Manager. Steve also produces a live radio show every Monday morning Steve now directs this wealth of experience to help individuals
called “SoPE Box Radio” (Society of Physician Entrepreneurs).
and organizations accelerate to higher levels of performance
This radio show provides educational, informative and
and maximized profits.
conversational programs about topics of interest to medical professional entrepreneurs and stakeholders in the innovation
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Steve Sorensen Revenue Strategist
720.343.0033 steve@enlighten-360.com www.enlighten-360.com
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C on tents
COLORADO EDITION | JUNE/JULY 2012
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From the Medical Voyce President
B ronchoscopy Can Guide Effective Treatment for Refractory A sthma
WELCOME LETTER
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C OV E R F E AT U R E
C olorado Center for Robotic Surgery at Sky R idge Treats C ancer with Latest Technology, Skilled Teamwork
SPECIALTY UPDATE: ASTHMA
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LEGAL: CYBER SECURITY
Are You Ready to Lose Patient Information and Consequently Your Reputation?
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PHYSICIAN WELLNESS: STRESS MANAGEMENT
Have You Wondered About The Impact Stress And Burnout Might Be Having On You?
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SPECIAL FEATURE: NEW FACILITY PROFILE
Peak View Opens N ew Hospital
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PHYSICIAN PROFILE
H ealthSouth R ehabilitation H ospital, Dr . David Richman
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BUSINESS 101: FINANCE
Startup B asics: H ow To D o A Simple B reak -E ven A nalysis
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HEALTHTEAMWORKS: CPCI
H ealthTeamWorks Ready to A ssist C olorado Practices Participating in CPCI
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SPECIAL REPORT: COST ANALYSIS
Physician Recognition Program Linked Improved Health and Spending Savings
to
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EPCMS NEWS
Preparing the Community: Medical R eserve C orps in El Paso Cunty
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HEALTHCARE NEWS
H ealthcare Systems ’ Focus Should Be on Own Employees Before General Population
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Dear
Physician
Publisher’s Note: Staying Cool It looks as if Colorado is in for a record hot summer. Portions of our state are ablaze, smoke and dust are in the air, and an oppressive heat promise to make for a busy season in D i r k R. H o b b s , P r e s i d e n t Medical Voyce, Inc. the Emergency Department and other service lines for cases of dehydration, respiratory issues, sun burns, heat stroke and more. As much as you all are serving patients out there, don’t forget to do a little “self-care” as well. Keep the water consumption up and stay cool! Urology Focus James Fagelson, MD from Urology Associates, P.C. explains his use of the da Vinci S Surgical System on prostate cancer patients, and Ali Sarram, MD of Advanced Urology explains “Firefly” as a significant improvement for discerning kidney tumors from healthy tissue. Better visibility can make for earlier detection, shorter hospital stays, and quicker recovery times. Read more from our friends at the Colorado Center for Robotic Surgery at Sky Ridge Medical Center. Business 101 Do you know how to do a break-even analysis in your business? Experts suggest as many as 90% of physicians have omitted this important step in owning, managing a practice. Paul Moran, MBA explains some simple steps you can take today to get a better handle on your practice finances. Cyber Security If you’ve taken the path of least resistance in regards to protecting your patient information, you should have a look at Fox News Cyber Security contributor David Willson’s article. Your practice reputation could be one breech away from disaster. Next month, we’ll spotlight the orthopedics team at Centura’s Porter Adventist Hospital. Drink lots of water!
Dirk R. Hobbs President, Medical Voyce Sciences & Multimedia, Inc.
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Medical Voyce Magazine Colorado Edition Executive Publisher: Dirk R. Hobbs Medical Direction: Bhaktasharan C. Patel, MD Senior Medical Editor: Marty Banks Creative Director: Marta Podkul Printing Consultant: Marcum Group Media Contributing Writers: Dan Atkins, MD; Erwin Gelfand, MD; Thomas Warda; Jan Friedlander; David Naster; Mike Ware; and Robert Semro Medical Voyce Sciences & Multimedia, Inc. President: Dirk R. Hobbs EVP Operations: Scott W. Casey Chief Medical Officer: Buck C. Patel, MD Associate Medical Director: Sheldon Ravin, MD EVP Communications: Kim Ronkin EVP SEO Services: Greg Walthour Director of Web Services: Winn Jewitt DocVoyce VP Development: Abhay Natu DocVoyce Project Manager: Arun Raval Territory Managing Directors, NM: Michele Sequiera and Michael Westphal Medical Voyce Magazine is published by Medical Voyce Sciences & Multimedia, Inc. 212 Washington Street, Suite E Monument, Colorado 80132 PO Box 2942, Monument, CO 80132 Phone: 719.884.1184 | Fax: 719.884.1189 Email: info@medicalvoyce.com Web: http://www.medicalvoyce.com To advertise, reprint or submit sponsored content in Medical Voyce, contact us at info@medicalvoyce.com, 719.884.1184, ext 1 2012 Š Medical Voyce Multimedia, Inc. POSTMASTER: Use form 3579 to 212 Washington Street, Suite E Monument, Colorado 80132 PO Box 2942, Monument, CO 80132.
Every attempt is made to ensure accuracy of published materials. Medical Voyce cannot be held responsible for the opinions, facts, or ideas expressed by its authors or contributors. Medical Voyce Magazine – Colorado Edition is availabe in a digital edition at: www.medicalvoyce.com/medical-voyce-magazine
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Cover f e a t u r e
C olorado C enter for R obotic Surgery at S ky R idge T reats C ancer with L atest Technology, Skilled Teamwork S ummar y Improvements in imaging technology have made it easier for physicians to diagnose prostate and kidney cancer. Early detection allows treatment with less invasive measures that benefit appropriate patients. The Colorado Center for Robotic Surgery at Sky Ridge Medical Center is a leader in performing prostate and kidney cancer surgery using the daVinci S Surgical System, which promotes shorter hospital stays and quicker recovery times. The daVinci’s three-dimensional laparoscopic camera and three robotic arms with attached surgical instruments enable the surgeon to work deep within the pelvis to control cancer with greater precision than ever before. Sky Ridge Medical Center has developed an integrated, team approach to cancer care, from diagnosis to follow-up, to create a Robotic Center of Excellence at the Colorado Center
the urethra to the bladder. The daVinci system, with its enhanced viewing and ability to replicate the surgeon’s fine motor movements, gives the surgeon excellent control, says Dr. James Fagelson of Urology Associates, P.C., one of the surgeons who perform the procedure at Sky Ridge Medical Center. “Prostate surgery was tried using conventional laparoscopy, but it was always a challenge because you can’t judge depth,” Dr. Fagelson says. The daVinci system’s enhanced view, with 10-fold magnification, shows far greater detail than conventional laparoscopy. “We are able to see the demarcation between nerve bundles and the prostate, which allows better preservation of nerve tissue essential for erection”, Dr. Fagelson says. “Additionally, more precise dissection and preservation of the urethra allows for more complete urinary control than with traditional surgery.” Traditional surgery for prostate cancer requires an 8-12 week wait before the patient can resume light physical activity and 3-6 months before normal physical activity can be undertaken. Full urinary control can take up to a year.
“Many men have a choice between surgical and less invasive options. Some choose to have the prostate removed—that is the only way to get true pathological data so we can be sure to have the cancer contained.” Dr. James Fagelson
for Robotic Surgery. Preand post-operative nursing staff, as well as OR staff, are Dr. James Fagelson specially trained in robotic procedures and patient care to improve outcomes and patient experience.
Prostate Cancer Surgery
One of the challenges of prostate surgery is to preserve urethra length and perform difficult actions such as suturing
With robotic surgery, patients usually are able to ambulate the day of surgery and leave the hospital the next day. They require less pain medication than patients who have traditional surgery and are able to return more quickly to normal activity. Most patients are able to go back to work within 2-6 weeks and can resume normal physical activity after eight weeks. Urinary control usually returns within six months, and erectile function also returns more rapidly. Candidates for robotic prostate cancer surgery include men
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SKY RIDGE MEDICAL CENTER UROLOGY TEAM
with clinically localized cancer and good performance status. “Many men have a choice between surgical and less invasive options,” Dr. Fagelson says. “Some choose to have the prostate removed—that is the only way to get true pathological data so we can be sure to have the cancer contained.” Disqualifiers for robotic surgery include prior major intraabdominal surgery with scar tissue and adhesions, morbidly obese patients, prostate size above 80 g and poor surgical risk in general. “We tend to look toward less invasive radiation options for older patients,” Dr. Fagelson says. Robotic surgery for prostate cancer has been performed at Sky Ridge Medical Center since 2004. The facility performs more daVinci robotic prostatectomies than any other hospital in the Denver metro area.
Kidney Cancer Surgery
blood flow and the tumor as it abuts normal kidney tissue,” Dr. Sarram says. “With Firefly, we are able to circumdissect the tumor more accurately.” Better identification of branch vessels allows Dr. Sarram to selectively stop blood flow to the region of the tumor while preserving flow to the rest of the kidney. Sky Ridge Medical Center is among the first facilities to offer this brand-new technology. Patients usually present with a mass on the kidney, often discovered incidentally with a CT or MRI performed for other reasons, Dr. Sarram says. During partial nephrectomy, Dr. Sarram is able to use intraoperative ultrasound to evaluate the location of the tumor and determine if there is disease elsewhere in the kidney. The procedure takes about two hours, and most patients are able to go home within 24-48 hours.
Dr. Ali Sarram of Advanced Urology was one of the first urologists in Denver to perform a partial nephrectomy using the daVinci system. He has performed more than 100 partial nephrectomies since 2005.
“With this procedure, we can save kidneys that in the old days would be removed, and spare normal kidney tissue,” Dr. Sarram says. “We have evidence that people who lose a whole kidney run a higher risk of kidney failure.”
The daVinci system at Sky Ridge Medical Center incorporates the latest robotic improvements, called Firefly, enabling better visualization of kidney tumors vs. normal tissue.
Incisions are significantly smaller than with traditional surgery, which means less pain, blood loss and need for transfusions, reduced risk of infection, a better cosmetic outcome and faster return to work and physical activity. Patients with office or computer jobs usually can go back to work within 7-10 days.
“Firefly gives us an alternate view of the kidney that outlines
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“We can expand on our expertise and learn from each other to improve quality of care. We also realize that a lot of our patients’ experiences and outcomes depend not just on what happens in the OR, but also before and after.” Dr. Ali Sarram
Dr. Ali Sarram
State-of-the-art technology is important, Dr. Sarram says, but it must be used by staff and surgeons with specialized experience, expertise and training.
“Our idea was to bring our combined experience under one roof,” he says. “We can expand on our expertise and learn from each other to improve quality of care. We also realize that a lot of our patients’ experiences and outcomes depend not just on what happens in the OR, but also before and after. The hospital has dedicated a lot of resources to teaching and dedicating nurses who are part of the Center of Excellence, so patients get care above and beyond.”
His pathology showed renal cell cancer. He was very pleased that the procedure preserved an otherwise normal kidney. His prognosis is excellent.
Colorado Center for Robotic Surgery atSky Ridge Medical Center 10101 RidgeGate Parkway Lone Tree, CO 80124 (720) 225-1000 www.skyridgemedcenter.com
In addition to treating prostate and kidney cancer, the daVinci robotic system at Sky Ridge is also used to perform hysterectomies, certain colo-rectal procedures and more.
Case Study: Prostate Cancer
A 42-year-old male underwent regular screening for prostate cancer because of a strong family history. After he was diagnosed with early stage prostate cancer, treatment options including robotic surgery and radiation were discussed with him. He opted to undergo daVinci robotic surgery. The patient was up and moving the afternoon of the surgery and was discharged the following day. He was encouraged to do light activity such as walking and lifting very light weights for the first nine days after surgery. A more aggressive walking program was begun after removal of the urinary catheter, resulting in the patient losing about 20 pounds. By the fourth week post surgery, he was able to resume his normal work schedule, and by week six, he had returned to normal physical activity.
Case Study: Kidney Cancer
A 36-year-old male presented with abdominal pain. On workup, a CT showed the presence of a 2 cm right kidney mass, concerning for cancer. After the patient obtained several opinions from urologists who recommended a total kidney removal, he consulted Dr. Sarram for consideration of a robotic partial nephrectomy. The patient elected to have that procedure; after a successful robotic partial nephrectomy, he went home within 2 days and was back to work within 1 week.
Sky Ridge Medical Center offers the latest in medical technology in a soothing, healing environment. In addition to the Colorado Center for Robotic Surgery at Sky Ridge, this expansive campus includes a highly regarded Spine & Total Joint Center, a Cancer Program approved by the American College of Surgeons, as well as a Breast Center accredited by the National Accreditation Program for Breast Centers, a Sports Medicine/Rehabilitation Center an accredited Sleep Disorders Center, a Wound Care Center, the Rocky Mountain Hospital for Children at Sky Ridge and a Level III Trauma Center. Located in Lone Tree at I-25 and Lincoln, Sky Ridge also delivers more babies than any other hospital in South Metro Denver, has a comprehensive cardiac program including Chest Pain Certification and cardiac rehab and heart failure programs, advanced imaging services and a Joint Commission certified stroke program.
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S p e c i a l F e at u r e : n e w f a c i l i t y p r o f i l e
P eak V iew O pens N ew H ospital S ummar y
Dr. Julie Sanford, MD, Medical Director at Peak View Behavioral Health: Dr. Sanford brings with her more than 30 years of experience from a range of settings including acute inpatient,
Treating behavioral health can be a challenge. Peak View Behavioral Health is stepping in to help providers and their patients by opening a new 56,000 square foot psychiatric hospital in Colorado Springs. The treatment options will include acute inpatient, partial hospitalization, intensive outpatient programs and ECT. Medical Voyce talked with Dr. Julie Sanford, MD, Peak View’s Medical Director,
Q A
private practice outpatient, DR. JULIE SANFORD, MD college student health center, community mental health centers and geriatric psychiatry. Dr. Sanford graduated from the Rush University of Medicine and completed her Psychiatric Residency at the Rush-Presbyterian St. Luke’s Medical Center in Chicago.
: How do positive outcomes in your hospital affect other lines of health care?
: What we do is connected to the other health-related challenges a person may face. For example, if a person is not managing their diabetes—it may be because they are not managing their depression. Everything is interconnected and part of the treatment our patients receive is education on making healthy choices related to their life—both while in treatment and when they leave. We want to help the patient and reduce rehospitalizations.
Q A
Her career highlights include her leadership and team management in the merger of four independent Denver mental health centers into a single entity and functioning as the center’s first Medical/Clinical Director. She has served as the Associate Medical Director for Colorado Access’ Pikes Peak Region Medicaid Mental Health Contract and
: Describe your new hospital’s environment.
: It’s a therapeutic environment with lots of natural light, windows and open, safe courtyards. The color scheme is calming and the front entrance has a Colorado lodge feel to it. It’s a place where you would feel comfortable bringing a family member. I also like the design—essentially it’s a large one-level ranch, with a gym and separate units between the different populations.
Q A
founded, managed and practiced in Rocky Mountain Neuropsychiatric Associates. Dr. Sanford has previously served as the Medical Director of the Penrose-St. Francis Hospital’s Psychiatric Care Departments and currently serves as the Student Health Psychiatrist at Colorado College.
: Tell us about the ECT program. What types of patients are appropriate?
: ECT (electroconvulsive therapy) can be very effective. Patients who would benefit are not responsive or not good candidates for certain medication. They have tried other treatment options without improvement and pose a threat to themselves or others. These patients are usually depressed, suicidal or have bipolar disorder with depression/mania. The patient and their family will undergo pre and post-education
about the treatment and require two psychiatrists to recommend the service. ECT is administered under general anesthesia under the supervision of a psychiatrist inside our hospital.
Q
: What types of patients are appropriate to refer to Peak View?
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A
: We are an acute hospital so crisis psychiatric situations are what we specialize in on the inpatient side. People suffering from suicidal/homicidal ideation, hallucinations or dementiarelated behavioral disturbances can receive help here. Patients can enter our treatment program at any level and not all of them are crisis situations. Sometimes people think you have to be in our inpatient program to access the other programs, and that’s just not the case. People who struggle with symptoms of grief, loss, anxiety and isolation can also receive help.
Q A
: Which ages will you treat?
: We will treat patients ages 4 to 104. We will begin treating adults 18 years and older initially and add services for children and adolescents in the near future.
Q View?
: What is the process to make a referral to Peak
A
: Call the hospital. We see patients from all over the state now. You can fax us the patient information and the goal is to have an answer within one hour or sooner. We also do free assessments 24/7 at the hospital if a patient wishes to come directly to us. Open House, Wednesday, June 27; 10 a.m. to 8 p.m.; Ribbon Cutting at 10 a.m., 7353 Sisters Grove, Colorado Springs, Colorado 80923; www.peakviewbh.com, 719-444-8484
Robert Nathan, MD
Diplomat of the American Board of Allergy and Immunology Clinical Professor of Medicine Board of Directors, American Academy of Allergy, Asthma and Immunology President, Joint Council of Allergy, Asthma and Immunology
• • •
•
Daniel Soteres, MD, MPH
Board Certified Asthma, Allergy & Immunology Award-‐Winner, American Federation of Medical Research
• •
Staff Debra Walters, ANP-‐C Jamie A. Allen, PA-‐C
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Physician p r o f i l e
HealthSouth Rehabilitation Hospital, Dr. David Richman
Q A
: Tell us what the stroke program will do for your stroke patients.
: Having the stroke certification will provide a level of comfort to the community that we can deliver the highest level of care to stroke patients in this community. We are now recognized nationally as having the tools and services necessary to treat patients who have survived a stroke and get help them return to the highest level of function.
Q A
: Tell me about the process for acquiring the stroke certification.
: The stroke team was underway when I began my position as Medical Director at HealthSouth. I provided support to the team and reviewed the guidelines to ensure that we were following the
HealthSouth Rehabilitation Hospital DAVID RICHMAN, MD MEDICAL DIRECTOR
appropriate recommendations. I also made sure that the team had departmental, staff and leadership support in order to provide these services. Medical staff participation is critical and all of our Physicians have received special training related to the stroke program.
Q A
: What would your stroke patients say about the stroke program at HealthSouth?
: The patients recognize the effort put forth into working as a team to ensure the patients achieve their goal of returning home safely. We have a variety of components to include rehab, medical management, nursing and education.
Q
: Tell me about the services provide to stroke patients.
A
: Besides receiving physical, occupational and speech therapy that you typically see in other acute rehabilitation hospitals, we also provide educational programs for both the patient and family, we have 10 Certified Rehabilitation Registered Nurses, we have a Transitional Living Unit, and amazing technology.
receive a referral on these patients from a physician, home health company, etc, a nurse liaison is sent to their house to evaluate the patient. The patient is then admitted for a short stay at the hospital to improve their level of function and independence so that they can discharge safely back to their home.
Q A
Q A
: Tell me about the technology.
: One piece of technology that HealthSouth has is the AutoAmbulator. The AutoAmbulator is a body weight supported treadmill device with robotic legs designed to help patients safely relearn natural walking patterns. It is amazing to watch as our patients get out of the wheel chair the first time and take those first steps towards recovery. We also have the Bioness NESS H200, which incorporates Functional Electrical Stimulation (FES) to improve hand function and voluntary movement. The Bioness NES L300 is a small wireless device worn on a patient’s leg to help improve walking abilities. Through electrical stimulation, NESS L300 retrains lower leg muscles, increasing motion and blood circulation enabling the return to a more normal step. We also have VitalSim, which uses electrical stimulation to improve the swallowing ability of patients who suffer from dysphagia.
Q A
: What types of CVA patients do you see at HealthSouth?
: Not only do we treat patients who have recently suffered a stroke, we also see patients who have had a stroke in the past and their impairments have become progressively worse. When we
: Once discharged, what services are offered by HealthSouth?
: We are able to offer both Home Health and Outpatient services. We also offer a monthly stroke support group that we encourage both stroke patients and their family members to attend.
Q A
: Tell me about your philosophy on patient care.
: Rehabilitation is different than acute care. A true free-standing inpatient rehabilitation hospital requires a team of professionals that work together for a common goal – to improve the quality of life for each individual patient.
Q A
: Are patients satisfied with their care at HealthSouth?
: Our patient satisfaction has increased tremendously in the past few years. I believe a big contributing factor is the effort we’ve put into the team model and interdisciplinary management of the patient in order to improve all aspects of their physical, functional and emotional needs.
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B u s i n e s s 101: finance
Startup Basics: How To Do A Simple Break-Even Analysis BY MR. PAUL MORIN, MBA | COMPANYFOUNDER.COM
S ummar y It’s amazing how many startup entrepreneurs do not take the relatively simple, but very important step of doing a basic break-even analysis on their business. Here you will learn how to do a very basic break-even analysis for your venture.
F
irst, it will be important that you understand the meaning of a few terms:
Selling Price:
This is the price at which you will sell your product or service.
Fixed Costs:
These are costs that are the same regardless of how much you might sell. Typical examples would include facility rent, insurance (like property and general liability), utilities (may be variable in some businesses), etc. Just bear in mind that if it does not change regardless of how much you sell, it likely should be categorized as a fixed cost.
Variable Costs:
These are costs that vary depending on how much you sell. Some common examples include direct material costs (if manufacturing products), sales commissions, direct labor (for either manufacturing or providing services), cost to purchase products or services for resale, etc. Remember that if the cost varies in relation to the amount you sell, it is likely to be considered a variable cost.
Contribution Margin:
The difference between Selling Price and Variable Costs. So, if you are selling something for $100 and the Variable Costs of that sale are $60, then the Contribution Margin is $40. Now that we have the basic definitions out of the way, let’s talk about how to calculate your break-even point in terms of both dollars of sales and units. The formula to calculate the break-even point is very simple, as follows:
Break-even point = Fixed Costs / Contribution Margin Let’s look at a straightforward example. Let’s say that you are running a business that has fixed costs of $10,000 per month and you are selling a product or service that has a Contribution Margin of $40. The break-even point in this example would be: $10,000 / $40 = 250 units If the units sell for $100 each, then the break-even point in sales dollars would be 250 units x $100 per unit, or $25,000 per month of sales. As mentioned above, this is a very simple example. There can be many nuances in the break-even calculation, but this example gives you an idea of how the break-even point is
17
Understanding both the unit sales and dollar sales necessary to break-even gives you a good frame of reference for the results you need to achieve to begin to make your business successful. calculated. I encourage you to do such a basic calculation for the business you are considering starting, or for the business that you are already running. Understanding both the unit sales and dollar sales necessary to break-even gives you a good frame of reference for the results you need to achieve to begin to make your business successful. Remember, you must reach break-even, of course, before you can become profitable. If you have questions about this example or some of the nuances you are encountering as you try to do a similar calculation for your business, don’t hesitate to contact us.
sources To learn more about this from CompanyFounder.com, paul@CompanyFounder.com
topic and other articles contact Paul Morin at
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S p e c i a lt y U p d at e : a s t h m a
B ronchoscopy C an G uide E ffective T reatment for R efractory A sthma S ummar y Procedure helps personalize therapy .
distinguish
phenotypes,
U
sing a bronchoscope to visually examine the airways and collect fluid and tissue can help guide effective therapy for difficult-to-treat asthma patients, according to researchers at National Jewish Health. Reporting in the March 2012 issue of the journal Chest, the researchers identified five distinct phenotypes among the refractory asthma patients, and successfully treated four of them, often with reduced asthma medications. “While standard anti-inflammatory treatment with inhaled corticosteroids helps many asthma patients, there is a significant number of patients who need more personalized diagnosis and treatment,” said lead author James Good, MD, professor of medicine at National Jewish Health. “Bronchoscopy provides important clinical information that can help us better treat even the most difficult asthma patients.” Most tests for asthma involve evaluation of a person’s ability to inhale and exhale air under varying conditions. A bronchoscopy provides a more direct examination of the lungs. During a bronchoscopy, a physician inserts a small, flexible tube into the nose and threads it into the airways. The bronchoscope has a camera that allows visual inspection of the airways. Fluid can be collected from the airways, and a biopsy can retrieve small samples of lung tissue. The procedure is usually done with a patient under light sedation. The research team examined 58 patients with difficult-totreat asthma, which is generally characterized as needing oral corticosteroids for more than half the previous year or remaining symptomatic in spite of high doses of inhaled corticosteroids. Twenty of the patients received standard guidelines-based treatment for four months, followed by a bronchoscopy and personalized therapy. Thirty-eight of the patients received personalized therapy based on the bronchoscopy results.
The bronchoscopy included visual inspection of the upper and lower airway, bronchoalveolar lavage, endobronchial biopsy and brush. The researchers identified five mutually exclusive asthma phenotypes, those with; 1) gastroesophageal reflux; 2) subacute bacterial infection 3) tissue eosinophilia 4) a combination of two or three of these phenotypes; and 5) non-specific phenotype. Those with gastroesophageal reflux received intense medical therapy or surgery (Nissen fundoplication) for reflux in addition to their standard asthma therapy. Those with subacute bacterial infections received antibiotics, and those with high numbers of eosinophils received omalizumab,
“Bronchoscopy provides important clinical information that can help us better treat even the most difficult asthma patients.” also known as anti-IgE. Those with nonspecific phenotypes received no specifically-targeted therapy. After 24 weeks of targeted therapy, patients showed marked improvements in both lung function and in the Asthma Control Test, a five-question survey widely used to evaluate asthma control. Overall, FEV1 (maximum amount of air exhaled in one second) rose from 58.9 percent of predicted (very low) to 74.3 percent of predicted (mild reduction). ACT test scores rose from 11.6 (poorly controlled asthma) to 18.5 (minimally uncontrolled). The test has a maximum score of 25. The 20 patients who received standard, guidelines-based therapy (control period) followed by targeted, bronchoscope-guided treatment, improved only after beginning targeted therapy. “While our study will require additional studies to confirm the findings, it offers a promising step for doctors and patients who cannot get their asthma under control,” said Richard Martin, MD, senior author, professor and chair of the National Jewish Health Department of Medicine.
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S p e c i a lt y U p d at e : o n c o l o g y
Trial That Combines Biomarkers and Imaging S eeks to I mprove L ung -C ancer S creening S ummar y National Jewish Health is seeking to refine and improve lung-cancer screening by combining a blood test with CT imaging to detect disease earlier and more effectively.
T
he trial combines a CT chest scan and the EarlyCDTLung blood test to screen for cancer, and seeks to build on recent research demonstrating that CT screening alone can reduce lung-cancer mortality. “We have learned that CT screening of high-risk patients can reduce lung-cancer deaths. But we need to enhance screening to detect a greater number of early-stage lung cancers. That is the patient’s best chance of a cure,” said James Jett, MD, Professor of Medicine at National Jewish Health and principal investigator on the trial. “Combining CT screening with biomarker tests, such as the EarlyCDT-Lung, may help us detect more lung cancers at earlier stage while reducing the number of biopsies or operations performed for non-cancerous abnormalities.” EarlyCDT-Lung, developed by Oncimmune, Inc., detects antibodies that a person’s immune system produces in its attempt to fight cancer. It has been shown that some antibodies may be detectable as long as five years before symptoms develop. The National Lung Cancer Screening Trial recently demonstrated that screening patients with a high risk of developing cancer can reduce lung-cancer deaths by 20 percent. However, the CT screening also produces many false alarms, or false positives, which can lead to invasive follow-up testing, such as biopsy or surgery, that ends up finding only benign (non-cancerous) abnormalities. Researchers believe that the combination of the two tests, with their different detection strategies, may work together to make a screening method that is effective both medically and economically. Lung cancer is the number one cause of cancer deaths in
the United States, killing about 160,000 Americans every year, more than breast, colon and prostate cancer deaths combined. Early detection of lung cancer dramatically improves a patient’s curative treatment options. Five-year survival for patients with advanced, stage IV disease is only 1 percent, while those whose cancer is detected early at stage I have a 70 to 80 percent chance of surviving five years. Five year-survival of all lung cancer in the United States is only 16 percent, because the disease is usually detected at an advanced stage when it becomes symptomatic. “Early detection of cancer could dramatically improve survival and reduce the terrible toll it takes on people today,” said Debra Dyer, MD, radiologist at National Jewish Health and coprincipal investigator on the study. “We believe this study may demonstrate an effective method for doing just that.” The trial will screen 1,600 participants over four years. They will receive both the EarlyCDT-Lung blood test and a lowdose CT scan at no charge. Participants need to be 50-75 years of age, have a smoking history of at least 20 pack-years (equivalent to a pack a day for 20 years), and be a current or former smoker who quit fewer than 10 years ago. Those who have a history of cancer other than skin cancer, serious illness that limits their life expectancy to less than five years, or currently use oxygen to breathe are not eligible for the study. Those interested in participating can call 303.398.1911.
Who Can Participate * Ages 55-74 * 20 pack-year smoking history * Current or former smoker who quit fewer than 10 years ago Who Can’t Participate * History of cancer other than skin cancer * Serious illness that limits life expectancy to less than five years * Use oxygen to breathe
Ride for Heroes Presented by
Cycling for Heroes & Chicken
Chick-fil-A brings community together to cycle and celebrate local heroes with 3rd Annual Chick-fil-A Patriots’ Festival & Ride for Heroes by Torie Giffin Photos Courtesy of About the Shot Photography
It’s a beautiful summer Saturday morning in Colorado Springs. More than 60 cyclists are gathered in a Chick-fil-A parking lot before heading off on a two-hour adventure, which today includes a ride through Garden of the Gods, along the Pikes Peak Greenway and to a local lake. It culminates with a free catered breakfast on the beach.
There are a number of cycling clubs in the Springs and new ones are popping up all the time. The city was recently named one of the country’s top 20 places for cycling and the popularity of the sport is definitely growing in the Pikes Peak Region. This particular club has drawn together a very unique blend of cycling enthusiasts...mixing kids, seniors, families, fast-paced riders and yes, chicken connoisseurs. They all have something in common… they will ride for free chicken and they have a passion for Chick-fil-A. The riders leaving the parking lot of the Chick-fil-A at Garden of the Gods are quite a site to behold, with cow bells clanging and cows dangling from their handle bars. Many of them are dressed in red, white and blue, bearing the image of the Chick-fil-A Cow with a signboard that reads “Eat Mor Chikin” on their bike shirt or jersey. This is the 3rd year of the Chick-fil-A Cycling Club, a
group formed to prepare riders of all abilities for the Annual Chick-fil-A Ride for Heroes on September 8 at Glen Eyrie Castle and Conference Center in Colorado Springs.
“The people are exceptionally nice and they make you feel like you are part of their extended family. I look forward to our weekly rides.” Marion, Chick-fil-A Cycling Club Member
The Chick-fil-A Ride for Heroes has two treks: a 28-mile Heroes Challenge Ride with 2,200 feet of elevation gain through some of the area’s most scenic landmarks, and the 15-mile Patriots’ Ride, a family-friendly creek-side trail ride. More than 500 cyclists participated in the 2011 ride and this year that number is expected to grow with even more community partnerships and involvement. The Rides kick off the Chick-fil-A Patriots’ Festival, a free Community event to celebrate and honor local fire, emergency medical service, police and military heroes. It includes a heliopter landing, patrol and fire vehicles, kids play zone, a zip line and more. Funds raised from sponsorships, rider registrations, donations and sales at Chick-fil-A are donated to charities representing each of the hero groups: The Home Front Cares, the Peace Officers Memorial, the Firefighters Foundation and the National EMS
Memorial Service. Last year more than $10,000 was awarded to the charities. “Our goal is to build off of last year’s success and raise even more for the heroes who risk their lives to protect our community,” said Randy Watson, owner/ operator of Chick-fil-A at Garden of the Gods. “Each year, 9-11 reminds us of the importance of our fire, police and military personnel and the Patriots’ Festival & Ride for Heroes is a great way to show them our appreciation.”
Chick-Fil-A Patriots’ Festival & Ride For Heroes on Saturday September 8, 2012 Glen Eyrie Castle Colorado Springs
Life-changing Encounters in a Legendary Place www.gleneyrie.org
To connect with the Chick-fil-A Cycling Club or register for the Ride for Heroes www.PatriotsFestival.com Patriots’ Festival & Ride for Heroes is sponsored in part by Healthy Coloradan
“The Ride for Heroes is an amazing idea that received incredible support from our community. It hit a sweet spot among riders and residents in Colorado Springs. In a short amount of time it has become a do-notmiss event for the cycling community and for the entire community.” David Pico, editor Peak Region Cyclist Magazine
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Legal: c y b e r s e c u r i t y
A re Y ou R eady to L ose P atient I nformation and C onsequently Y our R eputation ? BY DAVID WILLSON
S ummar y Can you definitively claim patient data is secure and will not be lost or stolen? If yes, ignore this article. But, if you are not sure or even have the slightest doubt in your mind then read on.
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t the end of this article you will understand the steps you need to take to: a) lower your risk of losing patient information, whether lost or stolen, and b) significantly reduce if not eliminate any liability you could potentially suffer if patient data is lost or stolen. It’s simple: do a risk assessment identifying information collected, processed and stored, draft and implement the right policies reviewed by an attorney skilled in this area, ensure all with access to patient information receive cyber and physical security awareness training, and, ask vendors with access to patient data how they secure that data. Is this an IT thing? Well, yes and no. IT sets up your computers and network, keeps them running, and maybe installs some security. Some IT personnel are versed in security, but it is not their specialty. It is like asking the general practitioner to address your thyroid condition, or a dentist to deal with orthodontia. If you are serious about implementing good security, then ask a security expert. So, do you need to be concerned? Absolutely! The threat to information is greater than ever and only increasing as healthcare professionals move to EMR (electronic medical
records), more and more mobile devices are brought to work, and organizations look to save money by using services like the Cloud. Consider some recent headlines: State of Utah data breach exposes social security numbers of over 800,000 Medicaid recipients to hackers in Eastern Europe; massive health care breaches have been made public at Emory Healthcare in Atlanta and the South Carolina Department of Health and Human Services (SCDHHS). Do you believe that just because you are a small practice it won’t happen to you? Consider this: “Data breach experts are issuing a warning to small practices – don’t be the vulnerable target that data thieves assume you are. Small practices are more susceptible to security vulnerabilities because they are ‘the path of least resistance.’ 1 Many
Small practices are more susceptible to security vulnerabilities because they are ‘the path of least resistance’
rely on outdated technology. Basic security protections, such as proper use of encryption, often are overlooked as practices focus on meeting regulatory requirements, such as those related to meaningful use.” Compliance does not equal security. Let’s face it: identity theft is a big concern these days. One of the victims in the Utah breach commented that he will forever be looking over his shoulder since his social security number was stolen. Do you believe you won’t be audited or fined by the Department of Health and Human Services? That may be the least of your worries, but what should be foremost on your mind is the patient whose personal information is lost or stolen. Then you will have possible lawsuits, and worse, irreparable damage to your reputation. Simply saying you hired a company to install your network and implement security is not enough. You must be able to articulate what you have done to keep patient information secure. You are responsible, not the IT company.
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Physician Wellness: s t r e s s m a n a g e m e n t
Have You Wondered About The Impact Stress And Burnout Might Be Having On You? BY MICHELLE MUDGE-RILEY
M
ost physicians enter the medical field believing that hard work and dedication will lead to a happy, successful and satisfying career in the practice of medicine. The sacrifices made through the added years of education and training required to develop medical expertise seem to be well worth it in the journey that is supposed to culminate in a successful career with wealth, stability and a sense of personal accomplishment and altruistic satisfaction. A recent article in The Annals of Surgery reported that 40 percent of surgeons reported being burned out and 30 percent screened positive for symptoms of depression. Several other peer-reviewed articles suggest that many of these problems may actually begin during medical school and residency training. One study reported a 50 percent burnout rate in medical students with 10 percent
Physician burnout is more common than it should be. There are a number of steps you can take if you suspect stress and burnout may be affecting you.
experiencing suicidal thoughts. A survey conducted by the non-profit Physicians Foundation found that 78 percent of physicians think medicine is either “no longer rewarding” or “less rewarding” and 49 percent of primary care physicians say they will reduce the number of patients they see over the next three years. Physician burnout is more common than it should be. There are a number of steps you can take if you suspect stress and burnout may be affecting you.
Recognize The Symptoms
Many times, physicians don’t perceive that they’re working under any undue stress, and even if they do, they look at stress as being part of the job. You may recognize the more obvious physical symptoms of stress such as chest
“The Impact of Stress and Burnout on Physician Satisfaction and Behaviors”
MICHELLE MUDGE-RILEY
pain, palpitations, headaches, muscle pains, panic/ anxiety attacks, and gastrointestinal distress, but you may not recognize the more subtle symptoms such as anger, irritability, mood swings, apathy, loss of focus, sleep disturbance, isolation, and an overall sense of frustration and dissatisfaction with what you are doing. Understanding, acknowledging and accepting the fact that you are stressed and that the stress is affecting your moods and behaviors opens the door for the next steps.
Remind Yourself This Is Not A Character Weakness
Remind yourself that you are not invincible, that reacting to stress is not a character weakness, and you can take steps on your own to help adjust to the pressures of the surrounding environment. Introspection is often involved and includes re-visiting the question of why you became a doctor, what the you enjoy about the profession and what you could do to reenergize the passion in your medical career.
Reach Out To A Mentor Or Physician Coach
Taking advantage of a physician coach or mentor can help provide the needed expertise to move forward. An external “big picture view” from a knowledgeable person with experience working with other physicians can help you put things into perspective and create an action plan to move forward. This can culminate in a desire to change or offer a new perspective on the current situation. A
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Many times, physicians don’t perceive that they’re working under any undue stress, and even if they do, they look at stress as being part of the job.
recent study in the British Medical Journal concluded that physicians who are dissatisfied might greatly benefit from a peer coach or mentor to decrease the chance that the process of burnout will get out of hand.
Consider Diversifying Yourself And Your Career
You may want to take steps to innovate and diversify your current model of practice. You might try a new mode of practice such as academia, private practice, salaried employment or a community health center. You could explore opportunities in a field that is complementary to your current field and interests such as informational technology, public health, genomics, or long-term care. You could pursue more of an administrative role as a medical director. Some of the options for a physician who wants to use his or her medical knowledge and skills to do more than practice clinically include medical communications and writing,
consulting, teaching, starting a business, working in the medical device industry, wellness and health promotion industry, business development, finance, or grant writing. Any of these things can be done part time. There are also full time non-clinical roles. Bottom line is that it’s important to realize there are options and there is hope. Recognizing you are not a failure for feeling this way, then finding others and reaching out to those who have been there or who may be doing what you want to do can be an important and empowering first step.
sources From the following peer-reviewed article: Rosenstein, Alan and Mudge-Riley, Michelle. “The Impact of Stress and Burnout on Physician Satisfaction and Behaviors”. Physician Executive Journal Vol. 36 No.6, Nov-Dec 2010, p.16-23. Parts of this article appeared on FreelanceMD.com.
Testimonials from CPHP Participants:
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“You guys saved my career.” “I have felt that the docs and clinicians at CPHP really do care, and I thank you for this.” “I consider CPHP as having a hand in saving my life.” “Without an organization like CPHP I would not be working in medicine.”
Helping: Physicians Residents Medical Students Physician Assistants Physician Assistant Students
“Received excellent referrals, advice, documentation.”
Consultation Services to the Work Place The clinical Testimonials from team at CPHP will consult CPHP Mission Statement the workplace, as needed, to The mission of Colorado Physician CPHPwith Participants:
address a variety of issues. These include Health Program is to assist physicians, timely referrals and how residents, medical students, physician assistants and physician assistant to support CPHP clients at work. “I have felt that the docs and clinicians students who may have health at CPHPBack-to-work really do care, and I conferences, thank monitoring you for this.” problems which if left untreated, agreements, and work stress reduction could adversely affect their ability to “I consider CPHP as having techniques area hand alsoinoffered. practice medicine safely. “You guyshow saved to my career.” make
saving my life.”
CPHP can help you or someone you care about!
“Without an organization like CPHP I would not be working in medicine.” “Received excellent referrals, advice, documentation.”
Consultation Services to the Work Place The clinical team at CPHP will consult with the workplace, as needed, to address a variety of issues. These include how to make timely referrals and how to support CPHP clients at work. Back-to-work conferences, monitoring agreements, and work stress reduction techniques are also offered.
Colorado Physician Health Program 899 Logan Street, Suite 410 Denver, Colorado 80203 Phone: (303) 860-0122 Fax: (303) 860-7426
www.cphp.org
Colora 89 D P
CPHP Mission Statement The mission of Colorado Physician Health Program is to assist physicians, residents, medical students, physician assistants and physician assistant students who may have health problems which if left untreated, could adversely affect their ability to practice medicine safely.
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h e a lt h t e a m wo r k s :
cpci
H ealth T eam W orks R eady to A ssist C olorado P ractices P articipating in CPCI S ummar y As many of you have heard, Colorado has been selected for the Comprehensive Primary Care Initiative (CPCI).
T
HealthTeamWorks is mailing the revised guideline to more than 7,500 healthcare providers across Colorado. All HealthTeamWorks’ clinical guidelines and supplements are available for free download. If you have questions about the guidelines or would like laminated copies, contact HealthTeamWorks at
he Centers for Medicare & Medicaid Services (CMS) Innovation Center designed the CPCI to provide enhanced compensation to primary care practices. Extra funds will enable them to manage chronic conditions proactively and provide prevention services that include care management and care coordination for patients with complex healthcare needs.
303-446-7200 or e-mail egingerich@healthteamworks.org
The CPCI is made possible by the Affordable Care Act, Medicare and seven major commercial carriers. The project will engage 75 primary care practices throughout the state, helping small businesses, patients and taxpayers use their healthcare dollars more wisely.
and HealthTeamWorks convened eight payers and several large employers to designate Colorado in their application to CMS to provide enhanced compensation to primary care practices delivering patient-centered primary care. We believe that the combination of statewide progress in delivery system redesign by medical practices, and consensus among multiple payers — extending their engagement in the Colorado Multi-Payer PCMH Pilot — positioned Colorado as one of only seven regions in the country selected by CMS.
Colorado a Leader in Healthcare Transformation
The award of the CPCI speaks to the extensive healthcare transformation occurring in Colorado in delivery system redesign and compensation reform. To date, more than 2,500 physicians are on track to achieve Stage One “meaningful use” of electronic medical records (EHRs), and more than 700 physicians are practicing in nationally recognized* patient-centered medical homes (PCMHs).
What Does this Mean to Primary Care Practices?
CMS is meeting with the seven health plans participating in the CPCI — Anthem, Cigna, Colorado Access, Humana,
The project will engage 75 primary care practices throughout the state, helping small businesses, patients and taxpayers use their healthcare dollars more wisely. Organizations such as HealthTeamWorks, Colorado Community Health Networks and the Colorado Beacon Consortium have worked hard to establish a new model of healthcare delivery across the state, and the CPCI award validates those efforts. This spring, the Center for Improving Value in Health Care
Medicaid, Rocky Mountain Health Plans and United Healthcare — to finalize a memorandum of agreement. Once that is completed, CMS will release applications to medical practices wishing to join the program. Practices apply to CMS, which will select 75. Once the applications are released, practices will only have about 30 days to apply.
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Practices that have been working on PCMH and EHR meaningful use are well-positioned to apply for the CPCI. If your practice is interested, we suggest that you:
1 2
Review the criteria.
Determine whether your practice meets them, especially the requirement that it currently has 200+ traditional Medicare fee for service patients.
3 4
Contact your leadership group (e.g., CAFP, ACP, CMS, Beacon, your IPA) and notify them of your interest.
If you have participated in one of HealthTeamWorks’ PCMH programs, or if you want to enroll in the PCMH Foundations program, please e-mail Kari Loken. The CPCI will test the PCMH care delivery model and the payment model simultaneously. The PCMH focuses on comprehensive primary care, characterized as having: • • • • •
Risk-stratified care management; Access and continuity; Planned care for chronic conditions and preventive care; Patient and caregiver engagement; and Coordination of care across the “medical neighborhood.”
The payment model includes normal fee-for-service compensation, plus a monthly care management fee paid to selected primary care practices on behalf of their feefor-service Medicare beneficiaries. In years 2-4 of the initiative, these practices may share in any savings to the Medicare program. Practices will also receive compensation from other payers participating in the initiative, including commercial health plans and self-funded employers, which will allow them to integrate funding streams from multiple payers to strengthen their capacity to implement practicewide quality improvement, enhanced access and care management. “The PCMH model represents the new standard of healthcare and the next step for healthcare reform,” said Marjie Harbrecht, MD, HealthTeamWorks’ CEO. “We look forward to supporting medical practices in the new care delivery and payment models. Everyone — providers, payers and supporting organizations — needs to move in the same direction to maximize resources and realize the most value from this enterprise.” *Recognized by the National Committee for Quality Assurance and other authoritative accreditors
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Special Report: c o s t a n a ly s i s
Physician Recognition Program Linked to Improved Health and Spending Savings BY COLORADO BUSINESS GROUP ON HEALTH
I
n 2006, a number of Colorado health plans and employers joined together in a national program called Bridges to Excellence (BTE). Under the leadership of the Colorado Business Group on Health (CBGH), these groups agreed to recognize physicians who voluntarily applied to this national organization and who could demonstrate that most of their patients could meet rigorous standards for metrics on blood pressure, cholesterol, blood sugar, and other vital statistics. BTE recognizes and rewards physicians who deliver superior patient care. With a special emphasis on chronic conditions, the BTE collaboration among employers, health plans and physicians is designed to spur continuous improvements in the quality of health care.
the relevant costs that are for services that reflect poor outcomes for patients, such as emergency department visits, admission to the hospital, heart attacks and other complications of the disease. Studies have shown that patients whose diabetes is well-managed are more likely to be able to avoid or defer poor outcomes.
The BTE program is based on the theory that a patient whose health is carefully managed is more likely to avoid or delay illness or complications of illness. CBGH decided to look at raw data to answer the question: Do BTE recognized physicians have better outcomes for their patients? First, what is a better outcome? A better outcome for a patient with diabetes is that the control of the disease allows the patient to avoid trips to the emergency department, to avoid hospitalizations and to avoid bad complications such as heart attack or stroke. The same can be said for patients receiving cardiac care.
What Was Observed. For diabetes, it was found that BTE recognized physicians have:
How Can We Measure BTE Physician Performance?
CBGH compared the performance of BTE recognized physicians with physicians who were also primary care physicians, but who were not recognized. Both utilization and cost measures were used. A utilization measure is determined by traditional actuarial methods, for example how many patients per thousand went to the emergency department and how many days were spent in the hospital? For costs, more clinically-based measures defined by the proprietary PROMETHEUS Payment Model® were used. Most simply these are: • Relevant Costs. Costs that relate specifically and exclusively to a patient’s underlying condition and comorbid condition. For example, for diabetes, it would include routine doctor visits, medicines, lab tests, specialists and potentially avoidable conditions. • Potentially Avoidable Costs (PAC). That portion of
Using two years’ worth of medical claims for a national health care plan that covers Colorado, CBGH looked at performance measures for six chronic conditions: Asthma, Coronary Artery Disease (CAD), Chronic Obstructive Pulmonary Disease (COPD), Diabetes, Gastro-esophageal Reflux Disease (GERD), and Hypertension.
• Lower Costs. Diabetes recognized physicians had lower average relevant costs than non-recognized physicians. And, they also showed a strong trend of lower average potentially avoidable costs as well. • Better Utilization Rates. Recognized physicians fared better on a variety of utilization measures including: – Significantly lower number of emergency room visits (Figure 1) – Less total days spent in a hospital (Figure 2) – Lower frequency of hospital admissions (Figure 3) – Higher rates of getting routine care that leads to better diabetes control This means that the patients with diabetes who see BTE recognized doctors are less likely than other similar patients to have to visit the emergency room, or be admitted to the hospital in general. Patients of recognized physicians are also more likely to get all the routine care they need. Interestingly, for coronary artery disease, BTE recognized physicians demonstrated significantly lower average relevant costs as well. Other Observations. It is interesting to note that other than the cardiac and diabetes measures that are part of the BTE Recognition program, recognition as a whole did not translate into better care in terms of either costs and utilization for the other chronic diseases mentioned above.
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The BTE program is based on the theory that a patient whose health is carefully managed is more likely to avoid or delay illness or complications of illness.
Conclusions. No one should be surprised that in medicine, as in other fields, providers perform better for conditions on which they are measured. We applaud the efforts those physicians have made to attain cardiac and diabetes recognition, and patients can appreciate top quality management of their disease.
sources To find a physician who is recognized for diabetes or cardiac care, please visit www.coloradohealthonline.org and click on the Health Matters Quality Report: Physicians. If you have other questions, please call the Colorado Business Group on Health at 303-922-0939.
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Dr. Judith Reynolds has served as MRCEPC Associate Medical Director for the past two years, and became Medical Director of MRCEPC in January 2012. Dr. Reynolds was formerly the Medical Director at the El Paso County Public Health and Colorado College Treatment Center. For twenty years, she was the clinic physician for the Health Department's STD/HIV program and the McMaster Center. Colorado Springs has been home for Dr. Reynolds for thirty-one years, where she has served on many boards of non-profit organizations. She is Board Certified in Family Medicine and Addiction Medicine and has completed many hours of emergency preparedness training including several weeks at the National Emergency Training Center in Emmitsburg, Maryland.
Preparing the Community Medical Reserve Corps of El Paso County In October of 2011, a group of organi- Region VIII, and the City of Colorado zations in El Paso County pretended Springs Office of Emergency Managethere was an emergency situation. ment. This simulated emergency allowed MRCEPC is a grant funded organizaparticipating organizations to build on tion, administered and housed by the El partner relationships and break ground Paso County Medical Society, which and explore how they would better work organizes medical resources and voluntogether in providing care and services teers for disaster situations. In partnerto citizens during an actual disaster, ship with local, state, and regional orand is an example of the ongoing orga- ganizations. nizing and coordination that the Medical Reserve Corps of El Paso County (MRCEPC) and its volunteers contribute to the community. The situation picked for this exercise series was a large-scale fire causing a mass evacuation of Colorado Springs and resulting in the need for a mass care shelter; a situation eerily similar to the Lower North Fork Wildfire near Denver which ocRed Cross and MRCEPC volunteers provide care to curred some months evacuees during the “Up in Smoke” Exercise after these exercises. This exercise, and others like it such This exercise series emphasized the as the Colorado Statewide Functional coordinated role of city and county Exercise in April 2011, tested tools and emergency management, local public resources for mass care, public health, health, medical responders, fire rehealth care, and community partner re- sponders, police responders and other sponses that have not been used in the emergency preparedness partners such past during response drills with commu- as the Pikes Peak Chapter of the nity partners. American Red Cross, Medical Reserve The “Up in Smoke,” Exercise Series Corps of El Paso County and the El Paso County Animal Response Team. was sponsored by the Federal Emergency Management Agency (FEMA)
Medical Voyce is a print media sponsor of EPCMSnews and publishes this excerpt free of charge so that the Colorado medical community may receive relevant information and resources in one convenient publication. The El Paso County Medical Society is solely responsible for the subject matter included in its newsletter, and is not responsible for the content of articles found in other sections of Medical Voyce. Neither the EPCMSnews nor Medical Voyce is responsible for the opinions expressed or facts presented by the authors of articles.
El Paso County Medical Society 730 Citadel Drive East, #206 Colorado Springs, CO 80909 www.epcms.org 719.591.2424
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H e a lt h c a r e : n e w s
H ealthcare S ystems ’ F ocus S hould B e on O wn E mployees B efore G eneral P opulation BY MARGARET SABIN
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ith healthcare reform approaching and economic challenges all around us, the landscape as healthcare providers is changing rapidly. There’s a lot of “buzz” in the media today about clinical integration, population health management and physician alignment. Most of the coverage outlines the general business case for hospitals moving in this direction and the impact it would have on a traditional delivery system. But I believe many of us are missing a very real opportunity: What are our healthcare systems doing for our own employees. With nearly 2,700 associates at Penrose-St. Francis Health Services in Colorado Springs, we decided to approach our employee population as if it were population managed by an Accountable Care Organization (ACO) almost a year ago. We already had in place a well-recognized associate wellness program – one of the longest-standing programs in the country which is consistently accredited at the platinum level by the American Heart Association as a fit-friendly workplace – but we stepped it up to become a cornerstone program in the tool box of an ACO. As individuals, we know health status is a combination of lifestyle behaviors, genetics, the environment and medical care – many factors we can control and some we can’t. Yet, all too often, we feel disempowered and uncertain how to exert control and make smart choices. At Penrose-St. Francis, we empowered our associates to become an active partner in their health, and to cultivate a revitalized relationship with the primary care provider of their choosing. To help our associates in making positive lifestyle behaviors become an easy choice, we added wellness coaching, evidencebased programs (stress management, weight loss, smoking cessation and chronic condition self-management), and provided an outcome-based incentive program to drive engagement. Our health management program goal is to build employee accountability so they can be role models for our patients and community. We have engaged about 42 percent of our associates in our programs so far and have tracked successful outcomes, including improved Body Mass Index (BMI), blood pressure, and increased activity. And they’re choosing healthier food items, thanks in part to our Nutrition Services’ commitment to providing daily “Better Bites” offerings.
Sabin is President and CEO of Penrose-St. Francis Health Services in Colorado Springs, Colo., as well as President of Centura Health’s South State Operating Group, which includes hospitals in Pueblo, Colo., and Canon City, Colo.)
MARGARET SABIN
To align with our physicians, we partnered with a dedicated group of primary care physicians that committed to providing our associates with care coordination, managing outcomes and utilizing our wellness program services. These physicians have either reached National Committee on Quality Assurance (NCQA) Level 3 Patient Centered Medical Home (PCMH) accreditation or will acquire this level in the coming year. The PCPs are targeting areas that PSF, as an employer, identified as needs of our population, including: pediatric asthma, cardiovascular disease, diabetes and preventive screenings. The PCPs will report Patient Centered Medical Home metrics, as defined by NCQA, to us over the next couple of years. Penrose-St. Francis pays these PCPs a Per Member Per Month (PMPM) fee, funded in part by eliminating some of the care management and disease management functions we formally paid our third party administrator to perform. We realized the market rejection of the gatekeeper PCP referral model – and the subsequent move to an open access Preferred Provider Organization (PPO) – had the unintended consequence of disrupting primary care relationships, leaving our associates to navigate their way through the complex health care system. While meaning well, the medical management programs that grew up to fill this void model conflicted with, rather than complimented, the efforts of the physicians who were responsible for actually caring for their patients. We felt it was important to pay our PCPs for coordinating care, which lowers overall costs and improves quality of care. Over the next year, we hope to introduce pay for performance or shared savings models. While our associates had a choice in selecting their primary care
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H e a lt h c a r e : n e w s physicians, we built financial incentives in the plan design for choosing a partner PCP who had achieved PCMH accreditation. About 50 percent of our associates have chosen to obtain their care from one of these physicians. As a result of the patient’s ability to choose to participate, there has been little disruption to our associates, which has helped with our overall associate satisfaction of our pilot. We have begun to see some positive changes already. Our employees are becoming (measurably) healthier as proven by our annual health fair biometric screening results. Our absenteeism has decreased and several area employers are offering our wellness programs to their employees. And, not unexpectedly, our area employers and health plans are beginning to embrace the PCMH concept, and have begun discussions of their own with these PCPS. Most importantly, we believe we are on our way to a demonstrable, sustainable culture of health. We are transforming our own organization’s vision of our health care system from one of “sick care” to “health care” and we’ve aligned our benefits package with that vision. And it’s a highly efficient way to create the infrastructure for population health management.
Renee Ward, director of imaging at Penrose Hospital. “It’s designed by women for women.” The private environment, enhanced by calming earth tones, was created to provide women who need imaging tests with a more relaxing and enjoyable experience — an experience unmatched in the community. The vision was to provide an environment that did not feel sterile or create stress. Plus, Ward says, the center offers convenient hours. The first mammogram appointments begin weekdays at 7 a.m., and the last appointment is at 4:40 p.m. And if you need multiple tests, you can schedule them all for the same day.
Our experience served as a pilot program for Centura Health – our parent company and the largest hospital and health care network in Colorado – and it is now being adopted system-wide impacting nearly 14,500 associates at 13 hospitals.
“Our flexible scheduling can usually accommodate multiple exams,” Ward notes. “That way, women don’t have to return multiple times. We want to make this an easy, convenient, comfortable experience.”
The new Center for Women’s Imaging Offers Hospital Excellence in Spa Surroundings
Imaging Services
E
mbraced in the warmth of a plush robe, you settle into a comfortable chair. Quiet, soothing, instrumental music drifts softly above your head while you sample moisturizing hand products from the nearby boutique. A sip of lemon ice water refreshes your body and calms your nerves. No, this isn’t Saturday at the spa. This is the experience as you await your mammogram, ultrasound, or bone density test at The Center for Women’s Imaging at the Penrose Pavilion.
For Women, By Women When they envisioned a new imaging center, the women at Penrose-St. Francis Health Services saw an opportunity to change the way women experience imaging tests. “This center is built to be a relaxing, soothing environment,” says
The center is accredited by the American College of Radiology as a Breast Imaging Center of Excellence and was the first center in southern Colorado to achieve this distinction. It features state-of-the-art equipment for the following imaging tests: • • • • •
Digital mammography Stereotactic breast biopsy Ultrasound for women, including OB/GYN ultrasound Ultrasound-guided breast biopsy Bone densitometry
Results typically are returned within two to three business days, and they are sent to the woman’s physician. “We think women will feel respected and well cared for here — and maybe even a little pampered,” Ward adds. “We’re very proud of what we have built.” To schedule a test, call 719.776.8010.
Presents…
David Naster YOU JUST HAVE TO WHEN LIFE GETS TOUGH
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International Comedian & AwardNominated Documentary Film producer David Naster brings his world-famous program
to Healthy Coloradan!
No One Escapes Tough Times - How We Respond To It Makes A Difference!
Is There Laugh After Death? ~ Living with Serious Illness ~ Humor in Crisis ~ Humor After injury Humor in Grief ~ Tough & Thankless Jobs ~ Dangerous Jobs
Introducing the
Colorado Center for robotiC Surgery
at Sky Ridge
Our team of urologists have performed more than 1500 robotic prostatectomies and we have the largest, most advanced program in the metro area. State-of-the-art technology combined with a caring, compassionate team brings life-saving care to you‌close to home. For a free referral, please call our physician referral manager at 720-225-5DOC (5362) or visit us online at skyridgemedcenter.com.
I-25 and Lincoln