Intermountain Trustee AN EMAIL BRIEFING FOR INTERMOUNTAIN HEALTHCARE TRUSTEES

August 2017

INTERMOUNTAIN ISSUES AND INITIATIVES

Intermountain Leaders Address Utah’s Opioid Epidemic CEO Marc Harrison, MD, says it’s time for courage and leadership

“It’s time for courage and leadership on our part,” said Dr. Marc Harrison, Intermountain President and CEO, addressing Intermountain leaders and physicians about the nation’s—and Utah’s—opioid epidemic. “I’m here to ask you for your full cooperation and your courage in addressing this issue in a very proactive way. We cannot fail to act in view of all the people afflicted by this nationwide epidemic.”

In an unprecedented effort to address the rising number of opioid use disorders and opioid- related deaths in Utah, Dr. Harrison called together Intermountain leaders and physicians to discuss prescribing patterns and improvement goals. Intermountain is one of the first healthcare organizations in the nation to organize what he described as “an urgent call to action.”

In opening the meeting, Dr. Harrison said, “We know that 142 Americans die every day from drug overdoses. Over the course of the Vietnam War, we lost 53,000 Americans. Now we’re losing more than that every year to drug overdoses, including opioid-related deaths.”

In Intermountain’s first Opioid Summit, Clinical Program leaders, pain management specialists, and physician leaders met to learn about the work Intermountain is doing to address the issue—and to discuss ways to “right-size” opioid prescribing within our hospitals and clinics. Dr. Harrison hosted the meeting along with Mikelle Moore, Senior Vice President of Community Health, Kim Henrichsen, Chief Nursing Executive and Senior Vice President of Clinical Operations, and Brent Wallace, MD, Intermountain’s Chief Medical Officer.

What is Intermountain currently doing?

• The Opioid Community Collaborative—a consortium of community leaders sponsored and funded by Intermountain to help prevent opioid abuse—has been working on the following initiatives: • Medication disposal drop boxes. • Distribution of naloxone rescue kits. Naloxone is a medication that can reverse an opioid overdose. • Increased caregiver training. So far, more than 2,500 Intermountain caregivers have received training on preventing opioid misuse. • Supporting the adoption of medication-assisted treatment. • Intermountain has also been providing education to patients and providers about effective alternative pain management strategies through pain management classes, videos, and provider training.

Recent survey interviews with Intermountain surgery patients indicate most patients are using only half of the opioids they’re prescribed, and only a small fraction of patients surveyed are safely disposing of the leftover pills. Last year Intermountain clinicians prescribed 19 million opioid tablets.

“The issues around prescribing are complicated, and many different types of organizations and agencies are trying to address the problem from various perspectives,” said Dr. Harrison. “That said, Intermountain touches nearly half the population of Utah every year. By stepping up our efforts, we can make a major contribution in addressing this problem.”

What is Intermountain planning to do? By the end of 2018, Intermountain’s goal is to reduce the average number of opioid tablets we prescribe (per prescription for acute conditions) by 40 percent.

To achieve the 40 percent reduction, Intermountain plans to expand training to additional caregivers in Utah and . We’re also adding prompts and default order sets into our electronic health records to remind caregivers of the number of tablets prescribed. Intermountain also plans to expand other services, such as pain management clinics and treatment resources for opioid use disorders, to better help patients with chronic pain conditions and opioid use disorders. More educational services for patients will be offered, and complementary therapies will be available.

Intermountain Applies to Launch Medicare ACO Beginning in 2018 Creating a Medicare ACO helps patients, advances mission, and supports vision to be a model health system

Intermountain Healthcare has applied to the Centers for Medicare & Medicaid Services— Medicare—to create a Medicare Accountable Care Organization (ACO) called Intermountain Accountable Care, LLC, which will be a separately licensed entity. Medicare ACOs are groups of doctors, hospitals, and other healthcare clinicians who come together voluntarily to give coordinated high-quality care to their Medicare patients. If accepted, our ACO will start providing care beginning January 1, 2018.

“Creating a Medicare ACO is another step Intermountain is taking toward value-based care,” said Mark Briesacher, MD, Intermountain’s Senior Vice President, Chief Physician Executive, and President of Intermountain Medical Group. “The new ACO model created by Medicare encourages and supports hospitals, physicians, and clinical teams that work together to provide care that’s safe, high-quality, accessible, and affordable—all within a patient- and family-centered experience.”

“Intermountain’s Medicare ACO would be one of about 500 ACOs in the United States, including five others in Utah,” said Mikelle Moore, Intermountain’s Senior Vice President of Community Health and the new President of Intermountain Accountable Care, LLC. “Creating a Medicare ACO advances our mission and supports our vision to be a model health system.”

How do Medicare ACOs work?

• “The goal is to ensure patients get the right care at the right time, while helping to safeguard against medical errors and avoid unnecessary duplication of services,” said Moore. Medicare certifies ACOs to receive payments on behalf of participating clinicians—in this case Intermountain Accountable Care, LLC. Payments are made according to Medicare payment models designed to enhance patient care, meet quality standards, and slow rising costs. • Medicare ACOs are different than Medicare Advantage plans like the one offered by SelectHealth. Medicare Advantage plans are offered by private companies like SelectHealth and approved by Medicare. Patients choose coverage under these plans. • Only Medicare patients enrolled in traditional Medicare coverage participate in Medicare ACOs. These patients don’t opt in or intentionally enroll in an ACO. Medicare assigns patients to ACOs based on whether the primary care physician the patient usually visits is a member of an ACO.

Intermountain’s ACO will include mainly employed physicians and APCs in 2018, and will expand to affiliated physicians and APCs in 2019. Intermountain plans initially to include physicians and advanced practice clinicians employed by Intermountain Medical Group and hospitals in our ACO, as well as certain physicians and APCs contracted by Intermountain who bill under Intermountain’s tax identification number (TIN). Skilled Nursing Facilities that are part of Intermountain’s SNF Quality Initiative and that have contracted with Intermountain Accountable Care, LLC, will also be part of the ACO.

“In 2018, we’ll develop participation requirements for interested affiliated physicians and advanced practice clinicians to join the ACO in 2019, consistent with our open-staff model approach,” said Dr. Briesacher.

Medicare rewards ACOs for quality and efficiency. When an ACO succeeds in providing high- quality care more cost-effectively, Medicare shares back with the ACO part of the savings the ACO achieves for the Medicare program. So if Intermountain is able to provide high-quality care at a low cost, we’ll potentially be rewarded by Medicare.

“We’re developing our program now,” said Stephen Barlow, MD, Medical Director of Population Health. “In our current value-based model, clinician groups earn additional payments for goals related to quality, service, and total cost of care, or upside risk. Intermountain bears the downside risk. We expect the Medicare ACO payment model to be similar to this.” Intermountain CEO: How Insurance Markets Will Be Affected if the Federal Government Withholds ACA Reimbursement In absence of cost-sharing reductions, rate increases could be ‘astonishing’

In the wake of another healthcare reform setback in the U.S. Congress, President Donald Trump released a statement proposing the possibility of withholding vital government payments from insurance companies if Congress doesn’t replace the Affordable Care Act. Intermountain’s CEO Marc Harrison, MD, was invited by Washington, D.C.-based National Public Radio to share how the withholding of funds would affect SelectHealth and Intermountain Healthcare.

The resulting NPR article explains that the payments President Trump proposes to withhold are designed to reimburse insurance companies for discounts the Affordable Care Act requires them to give to low-income people who buy insurance through the insurance exchanges. The federal money that goes to insurers in these payments, known as cost-sharing reductions, offsets the money insurers lose by lowering the deductibles and co-payments they require of these low-income policyholders.

Dr. Harrison told NPR that if the government withholds these payments, insurers would be forced to raise insurance rates for policies sold on the exchanges. “In the absence of the cost-sharing reductions, the rate increases could be astonishing,” he said. “We’ll see [the number of] people who are uninsured, or functionally uninsured, go way, way up.”

The NPR article says if President Trump decides not to make those payments, insurance companies across the country are likely to raise rates about 19 percent next year, according to an analysis by the . Congress is encouraging the president to continue the cost-sharing reduction payments at least through September while they hold hearings designed to seek ways to stabilize the ACA marketplaces for 2018.

SelectHealth Commits to Stay in ACA Marketplace Next Year Molina Healthcare’s departure leaves just two plans in Utah exchange

Molina Healthcare has announced it will no longer offer insurance plans to Utahns on the Affordable Care Act federal exchange next year because of financial losses and uncertainty over government funding—which means the 70,500 Utahns who are insured by Molina will have to choose a different health insurance plan in 2018.

Molina’s withdrawal leaves SelectHealth and Health Plans as the only insurers offering plans on the exchange in Utah next year, and SelectHealth is the only insurer planning to offer plans in every county in Utah (pending federal approval). Intermountain and SelectHealth leaders say they’re committed to staying in the market, though they’re concerned about the messages we’re getting from Washington, D.C.

“Pending regulatory approval for 2018, we intend to continue to offer individual ACA plan options through selecthealth.org, the Utah Federally Facilitated Marketplace, and on the Your Health Idaho exchange,” said Pat Richards, SelectHealth’s CEO. “Despite the current uncertainty in the individual insurance market, SelectHealth remains committed to serving all market segments.”

“These are our patients. We’re not going anywhere. We’re going to keep trying to figure this out,” said Marc Harrison, MD, Intermountain’s CEO. “We’re making the best possible financial and clinical decisions we can, and we aren’t going to cut and run because we actually believe in population health and we believe in value.”

Richards added, “We’ll continue to work closely with the departments of insurance in both Utah and Idaho to make sure our individual plan product designs, provider networks, and premiums are appropriate. We’ll also continue to work with all stakeholders to encourage Congress to fund the cost-sharing reduction subsidies that support low-income individuals and families and urge Congress to take additional steps to assure the stability and sustainability of the individual market.”

CEO Continues to Add to National Discussion About Healthcare Reform Leader’s recommendation to policymakers discussing healthcare reform: visit clinics, see what it’s like to be a poor person who’s receiving care

Intermountain CEO Marc Harrison, MD, was featured in a live on-air interview during National Public Radio’s Morning Edition on August 11 to talk about how uncertainty around federal subsidies in the Affordable Care Act is impacting Intermountain and the healthcare industry. According to Dr. Harrison, without ACA subsidies, insurance premiums will go up—leaving many people functionally or absolutely uninsured. That will have an impact on SelectHealth, Intermountain, and our patients and members.

“We view these patients and communities as ours, regardless [of subsidies],” Dr. Harrison told NPR. “We’re going to continue to take care of the people. But it will probably mean people will start showing up in ERs again.” These are people who would have gotten more effective care if they were insured.

“People will likely go back to emergency and really episodic care and not take care of their chronic conditions,” said Dr. Harrison. “We’re committed to helping people regardless of their economic ability. But we won’t be able to offer the longitudinal, thoughtful preventive care that we know people need in order to stay well.”

Dr. Harrison also gave this recommendation to policymakers as they discuss healthcare reform: “What they really need to do before they make any decisions is go to some clinics and see what it’s like to be a poor person who’s receiving care. I think they’ll find these people are people, and they’ll have a lot more empathy for them.”

Here are a several of the responses to the interview Dr. Harrison received from people all over the country:

• An adjunct professor from Kent State University: “Marc, what a treat to hear the NPR piece this morning which featured you and Intermountain Healthcare! I especially liked the way you stressed the importance of having politicians simply heading to ERs so they can see for themselves what’s going on.”

• Senior researcher from the Link Group: “I loved your advice that policymakers actually see the people who receive care at Intermountain Healthcare in order to be reminded that these are actually people (i.e., worthy of concern and compassion).”

• Physician practice manager from Indianapolis: “I was on my way to work this morning when I heard your interview on NPR. Having grown up in Orem and working for Indiana University Health, I immediately tuned in to the things you had to say. I was inspired by your dedication to the patients who utilize Intermountain Healthcare. You seem to be a passionate leader with a vision of keeping things calm amidst the continual changes with healthcare. We share that same vision in our Pediatric Urology department at Riley Children’s Hospital. Thank you for sharing your inspiring thoughts. It was a nice way to start off my Friday morning.”

• J.K.: “I heard your interview on NPR in Chicago this morning. Everything you said was well- spoken and made complete sense. Thank you.”

• A.S.: “I just wanted to tell you that your interview today on NPR was very impressive and I appreciate your determination to continue to serve everyone. Your suggestion to spend time with the poor and needy who depend on government healthcare is just completely on point—I agree that one issue with Washington leadership today is a lack of empathy. I’m a soldier and I completely depend on and benefit from government healthcare through the military. I feel many parallels with civilians who depend on government healthcare because of this. I want to sincerely thank you for your insistence to continue to care for others and I’m thankful for your service, and to everyone who dedicates their life to medicine and healthcare—the employees of your company included.”

• A physician from Drexel University College of Medicine: “I heard Dr. Harrison speaking about the impact of ACA repeal on patients this morning. I just wanted to thank him for what he said: ‘politicians should come see how poor people live and see that they are people, with real problems.’ Thanks to him for giving voice to those who the politicians may see as freeloaders.”

Listen to the entire interview on npr.org.

Generous $1.2 Million Gift to Cancer Services Pays It Forward St. George donor’s longtime caretaker is among the beneficiaries

Cancer research at Dixie Regional Medical Center has received a generous planned gift of more than $1.2 million from the estate of Elvin “Andy” Anderson, who passed away from a stroke at age 104 in St. George. And while Anderson’s contribution will benefit many, thanks to a twist of fate, it’s also making a difference for one of those he cared for most.

In 1985, Anderson and his wife June formed the Elvin and June Anderson Trust. Following June’s death from breast cancer in 1992, Anderson amended the trust as a perpetual endowment for the Cancer Center at Dixie Regional Medical Center. The endowment will benefit Intermountain’s Cancer Genomics research, which holds tremendous promise for cancer patients throughout Utah and across the nation. “Andy loved June and wanted to do something to honor her,” said Kalynn Larson, who served for many years as the couple’s full-time caregiver and trustee of the estate. “We spent long hours talking about it. He wanted the money to go to fight cancer.”

Since they were nearly always together, Anderson and his caretaker Larson developed a deep mutual fondness and a comfortable routine. But during the final weeks of August 2016, two events converged that would change their lives forever: Anderson passed away, and Larson was diagnosed with cancer.

Larson said Anderson’s passing left a legacy that will benefit countless cancer patients—herself now included. “Andy’s gift makes me feel like he’s taking care of me, just like I took care of him,” she said. “Now I have my memories of Andy, and his inspiration helps me through my own ordeal with cancer.” Larson is currently undergoing treatment at Dixie Regional Medical Center.

Intermountain’s Medical Director for Community Health Discusses Summer Air Quality Dr. Elizabeth Joy’s op-ed featured in on July 31

In an op-ed published in The Salt Lake Tribune, Intermountain’s Elizabeth Joy, MD, MPH, Medical Director for Community Health and Food and Nutrition, stressed that air quality in the summer can be just as bad as air quality in the winter—it simply comes from different sources.

Even though we typically think of poor air quality in the Salt Lake area as a winter occurrence, residents from Ogden to Provo suffer from other forms of air pollution—predominantly smoke, dust, and ozone—during the summer, according to Dr. Joy.

“From a health perspective, smoke can be especially problematic for people with lung conditions such as asthma or chronic obstruction pulmonary disease (COPD) or emphysema, and for people with heart conditions like congestive heart failure and angina. Windblown dust can also cause unhealthy levels of airborne particulate matter. Blowing dust is often a consequence of high winds and ambient dry conditions,” said Dr. Joy in the Tribune’s op-ed.

Dr. Joy also highlighted particular times of day to enjoy outside activity or exercise. In conclusion, she said, “We can all reduce ozone pollution by decreasing motor vehicle travel (combining trips, car-pooling, and avoiding idling); as well as switching to an electric lawn mower, eliminating outdoor fires, and limiting outdoor grilling when ozone levels are high.”

You can read Dr. Joy’s complete op-ed, published in the July 31, 2017, issue of The Salt Lake Tribune. Intermountain Physician Restores Man’s Hearing a Decade After He Lost It McKay-Dee ENT doctor removes stapes bone, implants prosthetic device

Imagine being a teenager and losing your hearing and not even realizing it. That’s what happened to Ogden resident David Bingham when he was in junior high. His hearing loss was so gradual that initially he didn’t notice anything was wrong. At first his parents didn’t notice either and thought perhaps he was ignoring them sometimes. They attributed it to “being a teenager.”

By the time Bingham finally went to the doctor when he was in the eighth grade, he’d lost 50 percent of his hearing in his right ear and about 20 percent in his left. Something had to be done, but it wasn’t clear what had caused the hearing loss or how to fix it. Doctors tried a few things, but nothing seemed to help.

The only accident Bingham had been involved in was an ATV rollover when he was 12 years old. In that accident, he’d hit his head and broken his arm, but he otherwise seemed fine. No one thought anything about his ears or connected his hearing loss to that accident. That was until Bingham met with Michael Scheuller, MD, a McKay-Dee Hospital ear, nose, and throat (ENT) physician. By then Bingham, who’s now 25, had been wearing hearing aids for almost a decade—all through his teens and early 20s.

“I really didn’t think anything could fix it at this point,” said Bingham. He was used to all the inconveniences of hearing aids, including the need for repair and having to remove them while swimming or taking a shower.

But Dr. Scheuller came highly recommended by a relative who encouraged Bingham to meet with him. “Dr. Scheuller pretty much looked at my medical records, knew exactly what was wrong, and knew what we could do to fix it as soon as he walked into the room,” said Bingham.

The diagnosis: A disease called otosclerosis that causes the stapes bone in the ear—the tiniest bone in the body—to stop working properly. All the nerves in Bingham’s ear were healthy, but the stapes bone wasn’t able to vibrate and carry sound. Dr. Scheuller explained that if you hit your head, such as in the ATV crash, it can speed up the disease, which can be caused by genetics. Outpatient surgery, called a stapedectomy, was recommended, as Bingham was a good candidate for it. The procedure removes the stapes bone and implants a prosthetic device in its place that permits sound waves to pass through the ear.

“The results of the surgery were life-changing,” said Bingham, who explained he had to wait a week afterward to experience the results. “It was like putting on glasses for the first time. I could hear the wind going past my ears, a piano playing down the hall, the buzz of the refrigerator running.”

Bingham has since recovered all of his hearing thanks to this treatment, which included surgery on both ears. He’s currently in his junior year at Weber State University studying athletic therapy and eventually plans to work in healthcare and become a physician assistant (PA). Intermountain’s Greg Poulsen Discusses Future of Healthcare at World Economic Forum Conference Senior Vice President and Chief Strategy Officer leads discussion in China

How technology is redefining where and how we care for the ill and injured was one of the topics discussed at a World Economic Forum conference in Dalian, China, in July, and Greg Poulsen, Intermountain’s Senior Vice President and Chief Strategy Officer, led the discussion. The conference brought together more than 1,000 top healthcare and business leaders, international political leaders, economists, and journalists for three days to discuss some of the most pressing issues facing the world.

Two highlights from Poulsen’s presentation:

• The future of healthcare will focus much more on prevention and early intervention. Poulsen said emerging technologies—including genomics, imaging, and other testing—will play an ever-increasing role.

• Intermountain is increasingly capable in providing care close to home—often in the home. TeleHealth, which involves both patients and practitioners, is reducing the need for people to travel for many types of care. Intermountain’s TeleICU, TeleStroke, and remote behavioral health support are examples of this very broad push.

Poulsen, along with Intermountain’s CEO Marc Harrison, MD, participate in the forum’s global Value in Healthcare project—an initiative that brings global healthcare leaders together to find ways to deliver the best healthcare value at the lowest appropriate cost. Dr. Harrison represented Intermountain earlier this year at the World Economic Forum in Davos, Switzerland.

Intermountain Is First in the Nation to Adopt Needle-free Inpatient Blood Draws Velano Vascular develops Pivo using feedback from Intermountain caregivers

Intermountain Healthcare is implementing a needle-free technology to improve the blood draw experience for inpatients system-wide. We’ll be using a single-use blood draw device called Pivo that connects to an indwelling peripheral IV catheter—which allows clinicians to extract blood without using a needle. Intermountain is already rolling out the new device.

“Blood draws are critical, common elements in modern medicine, but they cause an unnecessary amount of anxiety, pain, and risk due to the use of century-old technology and practice,” said Kim Henrichsen, MSN, RN, Intermountain’s Senior Vice President and Chief Nursing Executive. “We’re thrilled to offer a new standard of care that, over time, will help us avoid the need for needles used for hospital blood collection. This commitment to standardizing draws will enhance quality for both patients and practitioners.”

Todd Dunn, Director of Innovation in Intermountain’s Transformation Lab, added, “It’s baffling that in an era of smartphones and space travel, caregivers still draw blood by penetrating a vein with a needle—often in the early morning hours. Through our Design for People program, we resolved to find a better way for our phlebotomists and nurses to humanely and consistently draw blood. Following 15,000 Pivo draws on adults and children with no adverse events, and overwhelmingly positive feedback from patients and caregivers alike, it’s clear we’re establishing a new standard of care.”

Pivo was developed by the San Francisco-based tech company Velano Vascular using feedback from Intermountain caregivers. Intermountain is the first health system in the country to offer needle-free blood draws.

You can watch a video about the Pivo device and how it improves patient care, featuring interviews with Intermountain caregivers and patients.

RESEARCH AT INTERMOUNTAIN

Death Risk Doubles for People with Heart Disease and Depression, Intermountain Study Finds Research highlights importance of screening for—and treating—depression

People who are diagnosed with coronary artery disease and then develop depression face a risk of death that’s twice as high as the risk for heart patients without depression, according to a major new study by researchers at Intermountain Healthcare.

The increased risk of death from any cause holds true whether a patient’s depression immediately follows the heart disease diagnosis or occurs even years later, according to Heidi May, PhD, a cardiovascular epidemiologist at Intermountain Medical Center Heart Institute and the study’s lead author. The findings point out the importance of screening for—and treating— depression even years after someone is diagnosed with heart disease.

The research, one of a number of studies to explore the connection between heart disease and development of depression by researchers at Intermountain Medical Center Heart Institute, was published in July in the European Heart Journal—Quality of Care & Clinical Outcomes, one of Europe’s most prestigious peer-reviewed cardiovascular disease journals. The study was also presented in March at the American College of Cardiology’s 66th annual Scientific Session.

Researchers found that post-coronary artery disease depression was the single biggest predictor of death and remained so even after researchers controlled for the other factors. “Patients with depression, no matter how long or how short the duration, were found to have twice the risk of dying compared to those who didn’t have a follow-up diagnosis of depression,” said Dr. May. “Depression was the strongest risk factor for dying, compared to any other risk factors we evaluated. That included age, heart failure, diabetes, high blood pressure, kidney failure, or having a heart attack or stroke.”

That association didn’t change for patients who were previously diagnosed with depression before their heart disease diagnosis or for patients whose angiograms were performed for various reasons, which included stable angina, unstable angina, or heart attack. “I hope the takeaway is this: It doesn’t matter how long it’s been since the patient was diagnosed with coronary artery disease—continued screening for depression needs to occur,” said Dr. May. “After one year, it doesn’t mean they’re out of the woods. It should be ongoing, just like we keep measuring things like LDL cholesterol.”

The research was funded by the Intermountain Research and Medical Foundation.

Studies Find Oral Antibiotics as Effective as IV Antibiotics for Children Discharged from Hospital Patient-Centered Outcomes Research Institute (PCORI) funds studies

For a parent, there is nothing scarier than having a sick child in the hospital. Even scarier may be caring for your child at home with a serious infection after discharge. Faced with the challenge of becoming their child’s caregiver, parents can now be assured that oral antibiotics, the simpler method to administer antibiotics, is as effective as the more complicated intravenous (IV) route.

Scientific evidence from three different studies funded by thePatient-Centered Outcomes Research Institute (PCORI) shows how oral antibiotics are as good as IV antibiotics delivered directly to the blood stream using a peripherally inserted central catheter (PICC line). Antibiotics delivered orally have advantages over the PICC method, which can sometimes entail complications that can prolong a child’s illness.

The study investigating acute osteomyelitis compared the effectiveness and adverse outcomes of children and adolescents being treated with antibiotics. Osteomyelitis is a rare but serious bacterial infection that first requires hospitalization, followed by four to six weeks of antibiotic treatments at home.

Chris Miller, MD, from Intermountain Primary Children’s Hospital and University of Utah Health Care, said, “These studies show it’s safe to send patients home on oral antibiotics in three common pediatric diagnoses: complicated pneumonia, ruptured appendicitis, and osteomyelitis. Before the studies, many patients were being discharged home with PICCs to complete their therapy.”

“One hospital cannot answer all the questions about treating disease, but as a group, we can find answers,” said co-leader Raj Srivastava, MD, MPH, Assistant Vice President of Research at Intermountain Healthcare.

“It is through collaborative research we can improve the care and safety of our patients.”

Find out more about Intermountain Healthcare Research and the advancement of medical knowledge in many clinical areas. Lymph Node Removal Isn’t Necessary for All Melanoma Patients, Study Says Results may change standard treatment for patients whose cancer has spread

Many patients with melanoma need a sentinel-lymph-node biopsy to determine if cancer cells have spread there, but a positive finding doesn’t mean all the lymph nodes in the area must be removed, according to a new international study conducted in part by Intermountain Healthcare researchers that may change standard treatment for melanoma patients whose cancer has spread.

The international study invoilved 63 centers, including Intermountain Medical Center and the Huntsman Cancer Institute, and more than 3,500 patients. The study suggests any survival advantage associated with removing all the lymph nodes in the area closest to the melanoma is too small to justify the complications patients may suffer from having them removed.

Findings were published in The New England Journal of Medicine. Approximately one-fourth of the patients in the randomized phase-three trial were being treated for melanoma at Intermountain Medical Center or the Huntsman Cancer Institute.

According to Tawnya Bowles, MD, one of the study authors and principal investigator at Intermountain Medical Center, Utah has one of the highest melanoma rates in the nation—a combination of fair skin types, high elevation, and over-exposure to the sun. Those are all risk factors for melanoma.

Melanoma is a comparatively rare but potentially deadly form of skin cancer. Roughly 87,000 new cases of invasive melanoma are diagnosed in the United States each year. Lymph nodes are small glands that carry fluids, nutrients, and waste between tissue and the bloodstream. The lymphatic system plays a key role in the body’s immune response to infection and disease.

Because melanoma can spread to the lymph nodes, a routine step in treatment often involves removing the closest draining lymph node, called the sentinel node, and checking it for melanoma cells. For melanoma on an arm, for example, that nearest lymph node would be in the armpit, while the nearest lymph node for melanoma on the foot would be in the groin.

When a biopsy detects melanoma in a sentinel node, standard treatment has been to remove all the nearby nodes, which sometimes triggers complications.

“It can be a very big deal for patients,” said Dr. Bowles. “They can have repeat hospitalizations for infections in their extremities. They can have life-limiting, painful swelling where they can’t do the activities they like to do or wear their usual clothing. It’s a significant, real problem for patients who are affected.” AWARDS AND RECOGNITION

Intermountain CEO Marc Harrison, MD, Named One of Nation’s Top 100 Most Influential People in Healthcare Leader ranked nationally at No. 26 among Modern Healthcare’s 2017 list

Intermountain Healthcare’s President and CEO Marc Harrison, MD, has been named to Modern Healthcare’s list of the 100 Most Influential People in Healthcare. Dr. Harrison is listed nationally at No. 26 in the 2017 rankings.

According to the magazine, “The 100 Most Influential People in Healthcare awards and recognition program honors individuals in healthcare who are deemed by their peers and the senior editors of Modern Healthcare to be the most influential individuals in the industry, in terms of leadership and impact. This program allows for readers to vote for their top choices and selected winners are published in Modern Healthcare’s annual ranking.”

This is the 16th annual publication of the 100 Most Influential People in Healthcare ranking. Nominations for the recognition program, totaling more than 6,800 this year, were accepted from March 27 to April 28.

The ranking began with nominations, which were narrowed to a final ballot of 150 physician executives who received the most nominations. The final 50 honorees were chosen by readers and the senior editors of Modern Healthcare and Modern Physician magazines for their leadership in the varied sectors of the industry, whether provider organizations, government agencies, associations, insurers, or supplier companies.

You can review the entire list of the 100 Most Influential People in Healthcare.

U.S. News Ranks Intermountain Medical Center as One of ‘America’s Best Hospitals’ For the first time in its 10-year history, facility is included in annual rankings

For the first time in its 10-year history, Intermountain Medical Center is ranked by U.S. News as one of America’s Best Hospitals in the publication’s annual rankings of the nation’s top healthcare facilities, which were released in early August.

The Pulmonology Program at Intermountain Medical Center was ranked as the 48th top pulmonary program in the nation for outstanding pulmonary and respiratory care. Intermountain Medical Center was also ranked for providing high-performing services in diabetes and endocrinology care, nephrology care, and urology care.

“This is great recognition for our team of physicians and caregivers in the Pulmonary Program and throughout the Intermountain Medical Center campus,” said administrator Joe Mott. “This is further recognition of our commitment to providing the very best care possible to our patients.”

What makes Intermountain Medical Center’s Pulmonology service so effective? The pulmonology program is known for its singular focus on excellent patient care—it treats some of the most complex pulmonary patients, who often have other complications—combined with a research program that focuses on clinical outcomes.

The service’s clinical expertise is bolstered by a robust research focus, a patient-centered culture, and collaboration with Intermountain Medical Center’s other high-acuity services, including cardiology, thrombosis, thoracic surgery, oncology, and radiology.

As a result, the hospital’s high-acuity patients are evaluated thoroughly and quickly by multi- disciplinary teams who focus on the overall care of each patient, not just on a singular disease.

“Often, our patients have had a long road of symptoms and diagnoses before they see us, and our teamwork with our multidisciplinary colleagues ensures we treat each patient with the best current evidence, and more importantly, with the most empathy,” said Denitza Blagev, MD, Director of the Schmidt Chest Clinic and a pulmonologist at Intermountain Medical Center.

Logan Regional Hospital’s Dialysis Center Receives 5-Star Rating CMS rating is based on patient health outcomes, patient survey data

Intermountain ’s Dialysis Center has received a 5-star rating from the Centers for Medicare & Medicaid Services. The rating is based on patient health outcomes, along with patient survey data, and scores facilities on a 1-star to 5-star scale.

“This rating reflects that we’re giving good care,” said Denise Ames, Intermountain North Region Dialysis Services Manager. “Our infection rates are very low, and our patients are satisfied.”

Along with carefully managing patients’ vaccinations and managing anemia concerns, the center last year added peritoneal dialysis services. Logan Regional Dialysis Center treats some 600 patients every month. The hospital’s Dialysis Center achieved a 4-star rating last year.

Intermountain Named One of HealthCare’s Most Wired Organization recognized 18 of 19 years survey has been conducted

Intermountain Healthcare has been named one of HealthCare’s Most Wired organizations in 2017, based on a collaborative study conducted by Hospitals & Health Networks, the American Hospital Association, and the College of Healthcare Information Management Executives. Intermountain has made the list of the nation’s most technologically savvy hospital systems in 18 of the 19 years the survey has been conducted.

“Being one of HealthCare’s Most Wired is more than just complying with the rules of a survey,” said Marc Probst, Intermountain’s Vice President and Chief Information Officer. “It’s about fostering relationships between people and technology, processes and people, and supporting tools that make those relationships thrive. When technology unites caregivers and patients, we know we’re successful. We do that at Intermountain every day.”

The Most Wired survey of hospitals and health systems nationwide is based on four categories: infrastructure, business and administrative management, clinical quality and safety, and clinical integration. Although an organization may have many advanced capabilities, in order to be on the list they must meet specific requirements of analytics, structure, and clinical integration.

Because of the increasing number of clinicians who use technology in the care setting, this year’s survey emphasized clinical integration. For example, Intermountain’s Information Systems and Informatics teams work collaboratively to provide our caregivers with tools that facilitate their work and workflows — such as secure messaging, e-prescribing, and a robust patient portal. These initiatives demonstrate our efforts to maintain true clinical integration of health IT in our hospitals and clinics.

This year’s survey also looked at patient-portal adoption and what tools help patients self- manage chronic conditions like diabetes. Intermountain’s Health Hub app, Connect Care, and MyHealth portal are prime examples of our efforts to engage patients in their health through technology. And the numbers indicate we’re doing so successfully—only about 60 percent of organizations offer these types of tools.

Hospitals & Health Networks published the results.

What the World Is Saying About Us Recent news stories about Intermountain in the national and international media

CNBC, July 15: The Unicorn Test Was Always a Stupid Way to Judge a Start-Up — It’s Even Stupider With Health Tech. Many Silicon Valley leaders believe digital health is over-hyped and under-performing due to the lack of “unicorns,” meaning start-ups valued at more than $1 billion. But Tom Cassels, executive director at The Advisory Board Company, says there are a handful of health-technology unicorns that are likely to be successful. “Among his favorite companies are Empiric Health, a start-up spun out of the health system giant Intermountain Healthcare geared to evidence-based medicine …”

The Wall Street Journal, July 17: When Children Can Benefit From Playing Videogames. “Intermountain Healthcare joined a national study using specially designed videogames to for children with conditions such as attention deficit hyperactivity disorder (ADHD) and anxiety The videogames rack a child’s heart rate, and if the game becomes increasingly difficult as the rate increases. To resume playing without extra obstacles the child has to calm themselves down and reduce their heart rate.

“Kyle Smith, MD, a Child and Adolescent Psychiatrist at Primary Children’s Hospital in , said last year he began using the videogames as part of the therapy used in an outpatient program for children with anxiety…He incorporates the videogames but the feedback is variable he said. “Certain kids really seem to take to it quite well and it’s motivating for them,” he said. “And there are other kids who have a harder time. If they have motor coordination difficulty or sensory problems it can be a little tougher.”

CNN, July 20: Depression in Heart Attack Survivors Is Common, Often Untreated. “Heart disease patients who become depressed are twice as likely to die within the following decade as other patients, according to an unpublished study presented in March at the American College of Cardiology’s annual meeting. Depression increased the risk of death more than any other risk factor in the study—even smoking, said lead author Heidi May, a cardiovascular epidemiologist at the Intermountain Medical Center Heart Institute in Salt Lake City.”

The Advisory Board, July 25: Three Ways Intermountain Improved Its OR Efficiency. “In response to cost pressure, Intermountain Healthcare looked at cumulative tardiness in their operating room schedule and noticed three contributing factors: first case on-time starts, case duration, and turnover time. As a result, the organization developed a three-pronged approach to increase efficiency and improve access for both surgeons and patients.”

UK Daily Mail, July 28: How Depression Damages Your Heart. “Heart disease patients are twice as likely to suffer an early death if they suffer depression, new figures reveal. The research, by epidemiologists at the Intermountain Medical Center Heart Institute in Utah, was released today in the European Heart Journal, one of Europe’s most prestigious peer-reviewed publications.”

HealthLeaders, July 31: Metrics Supporting Mission. “Marc Harrison, MD, President and CEO of Intermountain Healthcare, focuses on metrics associated with customer service. ‘I’m more interested in access than just about anything because we can’t make people better if they can’t get in to see us,’ he says.”

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