Keeping Up - What's New
Save the Dates
Quarterly Medical Staff Meetings
Danbury/New Milford Hospitals – Creasy Auditorium
September 17, 5:30 pm
November 12, 5:30 pm
Norwalk Hospital – Perkin Auditorium
September 17, 5:30 pm Special meeting to discuss and approve Bylaws
October 28, 5:30 pm
Information Technology Update
Working Strategy: Integrated Electronic Health Record
One of the major complaints we hear from the Medical Staff is the lack of interoperability and the excessive number of different clinical systems used for managing patient care. WCHN has signed an agreement with Cerner Corporation to implement a single, fully integrated platform for all patient financial and clinical systems. Danbury/New Milford Hospital, Norwalk Hospital and Western Connecticut Medical Group will work together on a single design using Cerner’s best practice model system as a starting point. This strategy will enable WCHN to provide collaborative, patient-centered care, support for value-based care business models and population health, improved advanced analytics, and both operational efficiencies and expense savings.
This extremely large project is expected to start in January 2016 and take approximately two years to complete. Over 100 full time employees (FTEs) will be assigned to the core project team. Approximately half will be staffed from IT and the remaining will include part-time assistance from physicians, nursing, all clinical ancillary departments, revenue cycle, compliance, and many other support departments. Stay tuned for more on this.
Ongoing Initiatives
IT is continuing to work on a number of initiatives targeted at improving clinicians’ ability to access our systems both internally and remotely. Some improvements are already being deployed, while others have a longer delivery time.
For WCMG, we distributed a simple device for direct access from home into the secure WCHN network. This solution will soon be available for the remainder of the Medical Staff. In addition, we’ve streamlined the configuration of laptops used by WCMG to speed up and optimize response time. This has already been provided to three practices, with plans to deploy to the remaining WCMG practices.
On the Norwalk campus, a new solution to support secure HIPAA-compliant text messaging is being implemented. This will allow the combined Medical Staffs throughout WCHN to communicate patient and other confidential information safely, securely and efficiently. In September, PowerChart (Cerner EHR) will be updated with new functionality to optimize physician workflow and provide dynamic clinical documentation.
Long-Term Projects
We continue to work on two additional projects designed to streamline physician access into clinical applications. Included is upgrading and enhancing our single sign-on application and developing a more robust and easily accessible portal.
Marketing Update
Joe Carofano
Vice President, Marketing and Communications
Western Connecticut Health Network
New Branding, Advertising, DOC-Line and More
Later this year, we will celebrate the unveiling of the Network’s new branding and advertising campaign. After numerous discussions, the decision was made to emphasize our local Hospitals and Affiliates while keeping the WCHN name. Many thanks to everyone who participated in the process.
We’re excited about changing the dialogue and differentiating ourselves with our consumer-centric approach which focuses on personalized care. A random selection of physicians and employees have been invited to participate in our online market research survey – the final step in finessing our advertising campaign. This feedback will allow us to better focus our story and differentiate ourselves in today’s crowded marketplace.
Launch plans call for extensive external advertising and promotion in 2016, as well as for new websites for all three Hospitals and the Network. The websites are designed to work on all devices (mobile, tablet, desktop) and will feature an enhanced “Find a Doc” tool to make it easy to find primary and specialty care physicians, and save them to your contacts.
Internally, several initiatives are underway to help keep the Medical Staff aware of important Network and industry news. To supplement face-to-face meetings (Medical Staff meetings, department/section meetings and committee meetings) we have been publishing DOC-Line more frequently with short articles on topics we feel are important to share (organizational strategy, population health, clinical integration, quality achievements, state budget impact and more). We will also be redesigning DOC-Line allowing it to be accessed and utilized effectively on a mobile device.
We recognize the importance of communications and welcome your feedback and suggestions as to how we can continually improve. Please email me at joe.carofano@norwalkhealth.org
Population Health and Accountable Care: What Physicians Need to Know
Rowena Bergmans, Vice President Clinical Integration and Population Health
- The Fundamentals and WCHN Status
Our healthcare system is being transformed. We are changing from a fee for service system where hospitals and providers are compensated individually based on volume of services provided to a system in which providers will be collectively reimbursed based not on volume, but on performance outcomes and value.
The Center for Medicare and Medicaid Services (CMS) recently released a declaration that by 2018, 50% of all CMS payments will be tied directly to value based arrangements and that only 10% of payments will be based solely on fee for service (FFS). As we providers move towards value based reimbursement we are expected to take on more risk while being responsible for delivering care for defined populations on established cost and quality targets.
To prepare for these changes Western Connecticut Health Network (WCHN) has been forming a clinically integrated network to build the competencies needed to meet these new demands and to meet the tenants of the ‘Triple Aim’
- Improving the health of a population
- Improving the patient experience
- Lowering overall medical costs
WCHN has now entered into several value-based arrangements with Centers for Medicare and Medicaid Services (CMS)
Medicare Shared Savings Program (MSSP)
In January, WCHN was designated as a Medicare Shared Savings Program (MSSP) Accountable Care Organization by CMS. Under the MSSP, the Network is responsible for the overall cost and care delivered to a defined set of Medicare beneficiaries regardless of where the beneficiaries seek their care. Over time, if the Network continues to deliver high-quality care across the entire continuum and lowers overall costs, then WCHN and its partners will have an opportunity to share in generated savings. These savings can then be reinvested into services and programs that benefit our community.
Bundled Payments for Care Improvement (BPCI)
On July 1, WCHN began participating in the Medicare Bundled Payments for Care Improvement (BPCI) program. Under the BPCI, WCHN entered into payment arrangements with CMS that includes financial and performance accountability for defined episodes of care that span the Hospital, ambulatory and post-acute care settings. WCHN has selected certain case types, or “bundles,” that include both medical and surgical diagnoses. The goal is to achieve improved patient outcomes through better coordination of care throughout a 90-day period post-discharge. We are closely collaborating with our care teams, physician partners and external subject matter experts on this effort. We anticipate this program will lead to positive financial outcomes down the road, but the main objective of this program is to learn how to manage conditions across the continuum with our physician and community partners.
Extent of Accountable Care at WCHN
WCHN is currently accountable for managing 80,489 lives through our value based contracts. By 2020, we expect that number to grow to 500,000 lives. The MSSP and BPCI programs are our first introduction into delivering value-based care models that have been proven to improve care and reduce cost. Successful performance under these programs, along with other WCHN population health and accountable care efforts (behavioral health integration, practice transformation and post-acute care initiatives), can lead to better patient experience, lower rates of morbidity and decreased cost – which translates to healthier lives and healthier communities.
- Accountable Care and the Physician Practice
So how do these changes impact the day to day life of the physician who has historically been rewarded for discreet visits and procedures? Under value based arrangements physicians will be rewarded for care delivered more efficiently, and for meeting quality and preventative services goals but these changes require different tools, competencies and relationships.
Practices will need help
Individual physicians or even a group of physicians cannot be responsible for all of the acute, chronic and preventative care services required for defined populations. Providers will need additional practice support in the form of IT and analytics and will need other care team members to lighten the burden that these new challenges present.
The WCHN Physician Hospital Organization Accountable Care Organization does offer some support to address the new requirements. You can find contact names at the end of this article.
IT and Analytics
IT investments in the form of EMR or other data analytic applications will be required as part of this transition. Over the past several years CMS has rewarded early adopters of EMR and those provider organizations that report on quality measures but like all things CMS they start with the carrot and then end with a stick. Penalties are now coming for those provider organizations that are not using EMR or reporting on quality. The new reality requires these tools even if the provider practice chooses to stay with fee for service models.
Payment and Support for Added Services
Payers are now willing to fund a monthly care management fee to help cover those services that are non-reimbursable but are needed to optimize care. In addition CMS just began reimbursing for certain non-face-to-face care management services provided to Medicare beneficiaries. Those services can be provided by a nurse care manager or a social worker. The movement toward Patient Centered Medical Homes (PCMH) can also identify opportunities to deploy practice office and clinical staff more efficiently.
The Fourth AIM, Provider Satisfaction
It’s hard to imagine that with all the changes we are experiencing that there is an opportunity to also increase provider satisfaction but organizations that are further down this journey have done just that. The transitions are difficult. Physician leadership and governance must drive how we respond to these new challenges. That is the only way the transition from volume to value will be successful.
Network Leadership Team
Network leaders for population health programs and strategies include:
ICD-10 – It’s Finally Here - October 1st
New coding requirements
The transition from ICD-9-CM to ICD-10-CM is effective on October 1, 2015.
ICD-10-CM will affect diagnosis coding in all provider settings: physician practices, hospitals, home health. ICD-10 requires greater specificity and detail for documentation and coding. Diagnosis codes are used as a consistent standard for billing and reimbursement, and for determining and supporting the medical necessity of services or treatment provided, the level of care and severity of illness.
Referring Physician’s Reason for the Order:
Ordering and referring physicians and advanced practice practitioners are responsible to provide appropriate ICD-10-CM code(s) and relevant detailed clinical indications supporting the medical necessity of the tests or services ordered.
To Prevent Delays for Services:
Providing the ICD-10 code at time of the order will prevent delays in scheduling or performing a service, and minimize calls to the ordering physician’s practice for additional information. Providers and their office staff should keep in mind that any order for either diagnostic or therapeutic services that will be scheduled and/or performed after October 1st, will require an ICD-10 code rather than ICD-9 code. Radiology services that involve laterality must have the appropriate diagnosis code indicating right, left or bilateral.
ALLscripts
WCMG physicians and advanced practice practitioners who use Allscripts will have an advantage in that orders generated by Allscripts will automatically contain the relevant ICD-10 diagnosis codes. This is made possible by Allscripts system functionality. Unfortunately there is no corresponding functionality in Cerner PowerWorks.
EMRs
EMRs used by outside referring physicians may have a similar capability. Check with your EMR vendor to determine whether this ordering functionality exists.
Everyone’s support is essential in preparing for ICD-10. A smooth transition is critical to our success because ICD codes are the basis for reimbursement, quality measures, public health research, clinical and outcomes research, and administrative performance measurement. WCHN is testing its systems to allow for electronic receipt of ICD-10- CM codes prior to October 1.
For further information contact ICD-10@wchn.org.
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