Burnout, Sepsis, Mandatory Care Models, and more ...

MHA, MMS, & Reliant Publish EHR Steps to Combat Clinician Burnout

The Massachusetts Medical Society – Massachusetts Health & Hospital Association Joint Task Force on Physician Burnout has published a paper in partnership with the Reliant Medical Group to show how electronic health records (EHRs) can lessen – not worsen – administrative burdens for physicians and other clinicians.
Changing the EHR from a Liability to an Asset to Reduce Physician Burnout includes more than a dozen practical EHR optimization techniques an organization can take to improve the usability of the EHR and its associated workflows to reduce the administrative burden.
A report published in January 2019 by the MMS-MHA Joint Task Force, Harvard School of Public Health, and Harvard Global Health Institute identified inefficient EHRs as one of several leading causes of burnout among healthcare providers. A 2016 Press Gainey survey of EHR users showed Reliant Medical Group’s EHR scoring in the 97th percentile nationally for usability.
The new white paper’s optimization strategies include cross-affiliated-facility information sharing for all patient EHRs; inbox management; staff placement of EHR-suggested draft orders prior to patient appointments; provider-specific guidelines for triage staff to handle patient phone calls; and direct EHR interfacing with patients to reduce clinician and staff clerical work.
The paper’s authors are Steven Defossez, M.D., MHA’s V.P., Clinical Integration; Larry Garber, M.D., medical director for informatics, Reliant Medical Group; and MMS President Alain Chaoui, M.D.

Task Force Issues 17-Step Guidance to Reduce Sepsis in EDs

The Massachusetts Sepsis Consortium, led by the Betsy Lehman Center for Patient Safety, has released a report -- Advancing Sepsis Care in Emergency Medicine -- containing 17 recommendations that hospitals and emergency departments can undertake to reduce incidences of sepsis.
Sepsis – the body’s extreme response to an infection that can lead to rapid tissue damage, organ failure and death if not treated quickly – is among the top causes of 30-day hospital readmissions in Massachusetts and is the third leading cause of the state’s hospital inpatient deaths.
Combatting sepsis is difficult. The symptoms of it are vague and easily confused with other conditions. There’s no definitive blood test to determine if a patient has sepsis. And there is no definite guidance from specialty societies on how to treat or report it. For example, most hospitals follow CMS’s “SEP-1” guidelines, which require extensive reporting. But many large insurance companies are now requiring international Sepsis-3 guidelines that mandate an entirely different form of reporting.
The Consortium’s report notes, “Despite these challenges, there are best practices on which most experts agree and for which there is well-established peer reviewed evidence.” The Sepsis Consortium, of which MHA is a founding member, decided that since most patients with sepsis enter the health system through the hospital ED, it would launch a special task force to develop ED protocols. That task force was chaired by Thomas Amoroso, M.D., medical director for utilization management at Commonwealth Care Alliance, and John J. Walsh, M.D., an emergency medicine physician at South Shore Hospital and the task force’s Mass. Medical Society representative. Every hospital in the state sat for interviews to help inform the task force’s work.
The task force recommendations focus on seven areas: adult screening and treatment; pediatric screening and treatment, patient management, appropriate antibiotic use, staff education and feedback, and patient education.
The Coalition says the focus on sepsis in the ED is “only one piece of the larger puzzle” and that in coming reports it would address sepsis in other care settings.

Calling All Leaders

Enrollment is open for the 2019-2020 class of the Massachusetts Health Leadership College, an MHA initiative that has proven to be of high value to its membership. 
With almost 100 graduates – many of whom have advanced to CEO positions or have achieved new levels of performance excellence – the Massachusetts Health Leadership College is a proven resource for executive leadership development. To keep this valuable program fresh and relevant for members, MHA has again partnered with the globally renowned Center for Creative Leadership faculty and Phillips, DiPisa & Associates, a leading executive recruitment firm. The deadline for enrollment is July 15, and enrollment is limited. Please contact Kirsten Singleton at ksingleton@mhalink.org for more information and application materials.

CMS Announces New Models to Support Primary Care

Last week, CMS announced the Primary Cares Initiative, which consists of five new voluntary payment models under two paths: 1) Primary Care First (PCF), intended for smaller primary care practices; and 2) Direct Contracting (DC), intended for larger entities, such as Medicare accountable care organizations, Medicaid managed care organizations, and Medicare Advantage plans.
The models are intended to increase opportunities for primary care providers and other organizations to participate in alternative payment models and to take on risk. CMS estimates that the models could include 25% of the Medicare beneficiary population and hopes to eventually expand them to Medicaid and private insurers. Specific details will likely be released through a Request for Applications later this spring. These models are anticipated to start in January 2020.
CMS Administrator Seema Verma said last Thursday that future payment models would have to be mandatory to ensure participation and to get broadly representative data from participants.
More information on the Primary Care First initiative, including webinars, is here. Information on the Direct Contracting model is here.

Offering Peer Support to Clinicians/Staff Involved in Adverse Events

Fifteen Massachusetts hospitals and outpatient practices have joined a pilot program aimed at helping clinicians and staff members who have been involved in an event that harmed a patient. The Betsy Lehman Center program provides the resources necessary for each institution to build its own peer support network.
Last December, MHA put out a call seeking five hospital volunteers for the pilot. Fifteen groups eventually signed up. They are: Atrius Health, Baystate Health, Boston Medical Center, Cooley Dickinson Health Care, Dana-Farber Cancer Institute, Emerson Hospital, Lowell General Hospital/Circle Health, Massachusetts General Hospital, MelroseWakefield Healthcare, MetroWest Medical Center, Newton-Wellesley Hospital, North Shore Medical Center, South Shore Hospital, St. Luke’s Hospital/Southcoast Health, and Tufts Medical Center.
Medical errors and other unexpected patient outcomes are obviously traumatizing for patients and families, but clinicians and staff also may suffer emotional or physical distress, believing they have failed their patients as they second guess their own clinical competence. Some even decide to leave their positions or professions. Caregivers are often reluctant to reach out for help following an incident for fear of being stigmatized or of compromising collegial relationships.
The Betsy Lehman Center’s peer support work also extends to patients and family members affected by adverse medical outcomes. In the coming weeks, the Center will begin its outreach efforts to connect with individuals in the state who have experienced medical harm and are interested in serving as a network of support for others.

South Shore’s Green on ED Use Steering Committee

The Massachusetts Employer Health Coalition – which is working to reduce emergency department utilization by 20% through 2020 – has announced creation of a 19-member steering committee to help it fulfill its goals. The steering group will look into such topics as care redesign, educating consumers, and providing incentives to convince them to seek alternative care site options. The hospital representative on the group is Dr. Gene Green, president and CEO, South Shore Health.

Last Day to Register: Communication, Apology, Resolution Forum

The Massachusetts Alliance for Communication and Resolution following Medical Injury (MACRMI) – of which MHA is a member – is holding its seventh annual CARe forum on Tuesday, May 7, from 9:30 a.m. to 1 p.m. at the Massachusetts Medical Society in Waltham. The last day for registration is Wednesday, May 1.
The Communication, Apology, and Resolution (CARe) process helps everyone involved after an adverse event in a hospital. At the May forum, MACRMI members and trained actors will present two case simulations of the CARe process after an adverse event, along with implementation background and guidance. Attendees are encouraged to participate in moderated discussion panels following each simulation. The event is free and lunch will be served. Register here.

An Overview of Healthcare Financial Management

Healthcare delivery methods and payment systems are changing rapidly. Alternative provider models; convenient, quick clinics in easy-to-reach retail locations; smartphone-based doctor visits; and Internet consults between ED physicians and nursing homes are changing the face of healthcare. Amazon, Berkshire Hathaway and JPMorgan Chase have joined forces to reduce healthcare costs. Because of this, carefully managing the financial health of the organization is more important than ever. 
This program will review the importance of budgeting and show participants how to read and better understand performance reports and dashboards. We will introduce a proven method of determining the real underlying causes of budget deviations, explore an objective way to examine departmental performance that highlights both high-performing departments and those in need of some assistance, and examine three ways to look for improvement in routine work processes.  The program takes place on Wednesday, May 8, from 8:30 a.m. - 3 p.m. at MHA Conference Center, Burlington, Mass. 
The course is taught by William J. Ward, MBA, Associate Professor of Health Finance and Management, Johns Hopkins Bloomberg School of Public Health. Learn more or register by clicking here.

John LoDico, Editor