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450 Stanyan St. San Francisco, CA 94117


450md St. Mary’s Medical Center Physician Newsletter


Chief of Staff Message Francis Charlton, MD It is a truism that each year passes by ever more quickly than the one before. As life’s experiences accumulate and our memory banks fill until overflowing, each successive year represents a smaller portion of the whole. The paradox lies in the ever-increasing demands on our time, attention, and energy in this apparently shrinking time frame. The reality is that each day lasts 24 hours regardless of what we accomplish or the events that transpire: each day is what we make of it.

CANCER REHAB: INTERVENE EARLY AND PREVENT DISABILITIES The Washington Post recently reported on findings from Walter Reed National Military Medical Center’s Cancer Rehab Model. Established in 1999, it includes early integration of rehabilitation professionals in patient care soon after diagnosis, and then at regular intervals through treatment. This “prospective surveillance” approach is reported to reduce costs of care and improve functional outcomes. Walter Reed is now moving towards making early rehabilitation intervention a standard for cancer care. Will this model of care eventually benefit civilians with cancer? Representatives from the American Cancer Society, the American Society of Clinical Oncology, the American Society of Radiation Oncology, and the American Physical Therapy Association, among others, convened in February 2011 to consider the evidence and widespread adoption. A full report, including recommendations, is expected in the New Year.

This past year has been one of near continual surveys and evaluations of our hospital, our staff, and the quality of health care we deliver to our patients. The Center for Medicare Services (CMS), The Joint Commission (TJC), and the California Department of Public Health (CDPH) have all found us to be in compliance with their dizzying array of Conditions of Participation (COP). Although reassuring, we know that the bar is constantly being reset higher, regulatory requirements continually increase, and this confusing alphabet soup of acronyms is here with us to stay.

St. Mary’s held its Annual Progressive Dinner for the Medical Staff on Thursday, November 17. The Progressive Dinner is a way for St. Mary’s to showcase This year’s dinner was sponsored by the Primary Care Council. It started in the main lobby, showcasing orthopedics and primary care services. Attendees then visited the Cardiology Cath Lab and the CHW Cancer Center. St. Mary’s would like to thank all of the physicians who attended this year’s event. Plans are

Call the St. Mary’s Outpatient Therapies Dept. at 415- 750-5900 to learn more.

Our future is bright if we are able to collaborate with our colleagues at Saint Francis Memorial Hospital to build stronger bonds between our two CHW institutions. Our shared traditions, values, and interests are vital to the health care needs of San Francisco. To preserve our joint missions SMMC and SFMH can look forward to closer cooperative efforts in the days and years ahead. Stay tuned.


the many medical specialties available to the physicians.

Your patients can benefit from the same! St. Mary’s Outpatient Therapy Services provides specialty Physical Therapy and Speech-Language Therapy to patients living with cancer and the side effects of treatment. In addition to the longest-running Lymphedema Therapy program in San Francisco, our growing Cancer Rehabilitation practice is expanding in order to meet the unique needs of patients with a host of cancer diagnoses.

Our challenge is to monitor and improve performance while assiduously documenting our efforts in a timely fashion. Oversight, at times overbearing, provides feedback that guides us along the path toward the optimal care to which we aspire for all of our patients. We must either embrace the new paradigm or be driven mad by it. Engagement in the development of specialty specific physician Ongoing Professional Practice Evaluation (OPPE) measures by key department members in addition to the Chairs will help us make the inevitable feedback useful rather than merely annoying. Your input is most welcome.

already underway for the 2012 Progressive Dinner so stay tuned for dates and invites.

Medquist Conversion Announcement

facilities in moving to a single preferred transcription vendor, MedQuist. This transition will provide the organization with substantial savings while maintaining quality, efficiency and physician satisfaction, not only to St. Mary’s but to all of CHW. Currently there is a an active project team facilitating the conversion with the target implementation in early 2012. St. Mary’s anticipates that we will finalize the transition date in the coming weeks. This information will be shared with you as soon as it is available. Every effort will be made to minimize changes for the physicians. As the go live date draws closer, there will be additional communication.

to Physicians

In a health care environment of lower reimbursement and regulatory scrutiny, CHW explores for opportunities to lower cost and improve service to providers and patients.

St. Mary’s sincerely appreciate your cooperation and patience with this initiative.

In one of these initiatives, St. Mary’s will join other CHW


➜ See more at

CLINICAL DOCUMENTATION IMPROVEMENT Several years ago CHW developed a Clinical Documentation Improvement (CDI) Program with the goal of improving the quality and specificity of documentation, advancing regulatory compliance and improving coding accuracy to assure accurate severity and length of stay. Most recently St. Mary’s has hired a new Clinical Documentation Specialist, Summer Smith, RN, MSN. Summer’s role is to conduct concurrent inpatient chart review for identification of unspecified, inconsistent, or unclear diagnostic documentation; with the goal of improving clinical documentation to accurately capture patient severity, acuity, and risk of mortality. She will be reaching out to physicians and team members to discuss opportunities and provide education and support to the team. Clinical Documentation Clarification forms will be placed in the progress notes section of the patient’s medical record. The forms should be reviewed, completed by the physician, and subsequently reflected in documentation for that patient. The clarification process does not question the physician’s medical decisions/diagnoses. Clarifications are simply a tool used for specificity of medical diagnoses. The CDI Program is a collaborative team that includes nursing, inpatient coding professionals, physicians, and executive leadership; all working together to improve coding quality and bridge the gap on clinical findings and treatment in physician documentation.

DISASTER PREPAREDNESS “BE PREPARED.” – Not only is this the motto for the Boy Scouts of America, but it is good advice for anyone who works in a hospital. Doctors should remember these steps in case of an earthquake or other natural disaster.


Prepare Yourself Prepare yourself for an emergency at work. Create an Office Emergency Kit with emergency supplies and personal care items and have a change of clothing available in case you must stay longer at work. Understand Your Role During an Emergency

Look for Summer’s “Clinical Documentation Tips” in 450 MD. Her updates will focus on areas of improvement and opportunity in documentation that are identified in chart reviews. The following are 3 frequent diagnoses (not in order of priority) that require specificity to accurately reflect the patients’ risk of mortality, severity of illness; and justify the length of stay.

WALTER REED NATIONAL MILITARY MEDICAL CENTER TESTS CANCER REHABILITATION MODEL By Judy Graham, Published: October 10, 2011 | Updated: Tuesday, October 11 From: The Washington Post Intervene early and prevent disabilities related to cancer from becoming serious. That’s the focus of a cancer rehabilitation model developed at the National Naval Medical Center in Bethesda — now part of the Walter Reed National Military Medical Center — along with a few other U.S. medical centers. This “prospective surveillance model” of cancer rehabilitation involves evaluating patients soon after diagnosis and then at regular intervals — typically every three months, for up to a year — once treatment is complete. If emerging problems are identified, they can be addressed promptly. The center began using this approach with breast cancer patients in 1999. Most fully recovered their range of motion and other functions 12 months after surgery, according to a 2010 study in the journal Breast Cancer Research and Treatment. Costs are also lower when problems such as lymphedema are identified and addressed early on in breast cancer patients, according to a study

published in January in the journal Physical Therapy. Researchers estimated that treatment for breast-cancer-related lymphedema cost $636.19 a year when the prospective survellance model was used vs. $3,125 for traditional treatment, which typically does not begin until lymphedema is advanced and patients are experiencing significant functional limitations. In February, officials from the American Cancer Society, the American Society of Clinical Oncology, the American Society of Radiation Oncology, the American Physical Therapy Association and other groups met to review evidence supporting the prospective surveillance model and to consider promoting its widespread adoption. Proceedings from that meeting will be published early next year, and this new model of cancer rehabilitation may eventually become part of patients’ post-treatment plans, said Nicole Stout of Walter Reed. She said the medical center is working toward making the prospective surveillance model a standard of care for all cancer survivors.

Please forward comments and ideas for future issues to:

– Judy Graham, Kaiser Health News


Documentation must specify acute vs. chronic and clinical indication for the diagnosis of anemia (e.g., aplastic anemia, acute blood loss anemia, drop in hematocrit, etc).

Your department should have a Disaster Callback list and they may call you in the event of an emergency to tell you to report to work or to wait until a later date or your next scheduled shift. Make sure that your department has your most recent contact information. In addition, a hotline messaging system has been developed for communication to staff during a disaster. Staff and physicians can call this number to

Congestive Heart Failure

get recorded information about their facility

and what they are to do.

Documentation must specify acute vs. chronic vs. acute on chronic; and must include systolic vs. diastolic dysfunction or both if appropriate.

The SMMC employee emergency hotline


number is 415-750-5911.

Carry Your SMMC

Documentation must specify the causal organism, and should directly correlate with the treatment modality documented in the patient’s medical record.

Please feel free to contact Summer with questions, concerns, suggestions, etc. Summer Smith, RN, MSN Clinical Documentation Specialist 415.750.4085 (office and pager extension)

Identification Badge In the case of an emergency, if you leave home, please wear your identification badge. Your I.D. will allow you access to the medical center if it has been secured; check in with the labor pool.

St. Mary's 450MD January 2012  

St. Mary's current edition of 450MD is now available for reading.

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