News Working Committee of Interns and Residents Smarter, SEIUHealthcare® November 2010 Safer and More Efficiently CIR Physicians Must Pave the Way

HHC Patient Safety Conference: page 4

SEIU NON-PROFIT ORG. for the full story. U.S. POSTAGE NEWS PAID Committee of Interns and Residents NEW YORK, N.Y. Innovative CIR 520 Eighth Avenue, Suite 1200 Permit No. 9621 New York, NY 10018 contract at Maimonides Address Service Requested Medical Center establishes quality improvement incentive program and fellowship. Visit www.cirseiu.org

Get the CIR News and more on CIR’s Website www.cirseiu.org 2 • November 2010 COMMITTEE OF INTERNS & RESIDENTS

PRESIDENT’S REPORT News FARBOD RAISZADEH, MD, PHD Committee of Interns and Residents of SEIUHealthcare® National Headquarters Why Our Hospitals Need Us to Play a 520 Eighth Avenue, Suite 1200 New York, NY 10018 (212) 356-8100 Role in Quality Improvement Projects (800) CIR-8877 E-mail: [email protected] ver the last two years it has become increasingly http://www.cirseiu.org obvious that the practice of medicine in the United States is undergoing a deep and rapid transforma- 1 Boston Medical Center Place O Boston, MA 02118 tion. Passage of the Affordable Care Act (the centerpiece of (617) 414-5301 health care reform), the increasing focus on cost control, and the transformative power of new technologies in med- 1400 NW 10th Ave., Suite 1509 Miami, FL 33136 icine and IT mean that the physician of tomorrow will (305) 325-8922 function in a world that looks very different from today’s. As resident physicians, how do we respond to these P.O. Box 40734 changes? This has been a big topic of conversation at CIR Albuquerque, NM 87196-0744 (505) 508-3306 meetings — most recently at the Northeast Regional Meeting in New York and the Western Regional Meeting 1300 Clay Street in Los Angeles. There is a growing shared understanding Suite 600, Room 21 among CIR leaders at different hospitals that these Oakland, CA 94612 (415) 861-5235 changes are coming and we, the frontline providers of care in different fields, can make a real difference in how the Box 512075 new initiatives are translated into actions in our hospitals. Los Angeles, CA 90051 As an example, let’s look at the issue of prevention of (310) 329-0111 hospital-acquired infections. On October 7, CIR co-spon- Washington, DC Office sored a meeting on this topic in collaboration with New Residents, by virtue of our role as the frontline (202) 872-5838 York City’s Health and Hospitals Corporation, the largest providers of care and the staff with the most patient con- municipal healthcare organization in the country. tact — both in quantity and quality — have an intimate EXECUTIVE COMMITTEE In attendance were attending physicians, residents, and unmatchable knowledge of the operations of the hos- 2010-2011 interns, nurses, ancillary staff, and administrators and pital and of the needs of patients. We have to find ways to Farbod Raiszadeh, MD, PhD managers of different units at all 11 HHC hospitals. As share this information with change-makers and adminis- President was evident in many of the conversations and presenta- trators in our hospitals. tions, teamwork is the key word in efforts to optimize the If you have experience in this area or ideas about qual- Hillary Tompkins, MD function of large hospital systems, and residents are key ity improvement in your institution, please email me at Executive Vice President focal players that will make or break such attempts at [email protected]. I look forward to continuing this John Ingle, MD quality improvement. conversation. Secretary-Treasurer

REGIONAL VICE PRESIDENTS Innovators in Quality Improvement: Case Studies Michael Core, MD Southern California Health care delivery reform includes important cost con- to achieving excellence in patient care. UCSF budgets over Nick Nelson, MD trols that will soon begin to reimburse hospitals based on the $1 million for the housestaff incentive program and sees a Northern California quality of care they deliver rather than the quantity of care. substantial return on its investment, such as reduced Kelly Liker, MD This will have major implications for residents and the clinic waits, improvements in operating room start times, Florida hospitals that employ them. CIR is anticipating the chal- and reduced hospital-acquired infections. lenges and opportunities that these will bring. At a one-day Payment is based on achievement of three goals, at a rate Jay Bhatt, DO, MPH Massachusetts Northeast Regional CIR meeting held in New York City on of $400 each for a maximum incentive payment of $1,200. For September 11, residents learned about several examples of more information on departmental and hospital-wide goals, Tony R. Tarchichi, MD programs where housestaff and hospital management are visit medschool.ucsf.edu/gme/residents/incentives.html. New Jersey working together to improve patient outcomes. At Boston Medical Center, residents identified prob- Bijay Acharya, MD At UCSF, Dr. Arpana Vidyarthi, Director of Patient lems with the implementation of a text-paging program New York Safety and Quality Innovations (and a CIR leader from and participated in a multi-disciplinary focus group to Alisha Parada, MD Cambridge Hospital), started the Housestaff Incentive find solutions. The focus group resulted in some new prac- New Mexico Program to involve residents much more integrally in hos- tices and increased the number of text pages instead of Gregory Dodell, MD pital quality improvement efforts. The program provides numeric pages overall. The next step is a move to have New York direct financial “bonuses” to clinical housestaff based on staff capture the appropriate pager number in the achieving quality and operational goals which are linked patient’s electronic medical record. Thaddeus K. Lynn, MD At Cambridge Health Alliance, patient satisfaction New York scores on two Med-Surg floors at Cambridge Health Sepideh Sedgh, DO Alliance were very low, according to most indicators sur- New York veyed. Staff satisfaction scores were similar. Staff Ian Wittman, MD described a significant number of core processes of care as New York “totally broken.” Staff formed two Improvement Teams to • work on “micro” care delivery system problems. Participants included residents, attendings, nurses, case Eric Scherzer

PHOTO CREDIT: ERIN MALONE/CIR PHOTO CREDIT: management, social work, physician assistants, informa- Executive Director tion technology, houseskeeping, and pharmacy. One team Heather Appel focused on improving the experience of patients being Editor admitted, and the second sought to improve multidiscipli- Erin Malone nary communication with patients and families in the Timothy Foley discharge process. Contributing Writers Residents at numerous CIR hospitals are Cover photography: involved in quality improvement and patient Erin Malone/CIR safety projects. Visit http://cir.seiu.org/policy to find a resource guide for residents and to share Woodhull Medical Center Staff at the 2010 CIR-HHC Conference on Patient Safety. Residents at the Northeast Regional Meeting identified the sources of their your experience with quality improvement initia- most frequent interruptions. tives at your hospital. of SEIU Healthcare November 2010 • 3

IN BRIEF Residents Make Contract Gains; Prepare for Changes At a time when most health care systems are facing major financial challenges, CIR residents across the country persevered in difficult negotia- tions and came away with significant gains. Cambridge Health Alliance Cambridge residents negotiated a 2.5% salary increase (effective January 2011), up to $650 towards the cost of licensing exams, a 403(b) retirement plan with employer contributions, APPEL/CIR HEATHER PHOTO CREDIT: emergency child care services and guaranteed on- site parking for all housestaff. The administration also agreed to establish a work hours committee to examine ways to redesign training. Hoboken Medical Center CIR members at Hoboken University Medical Center successfully negotiated a new contract directly with the hospital after UMDNJ ceased to be the sponsoring institution. The one-year agree- From left: Drs. Ian Wittman, Bijay Acharya, Farbod Raiszadeh, State Senator-elect Gustavo Rivera, Drs. Greg Dodell and Sepideh Sedgh ment preserves the gains from the previous UMDNJ contract and adds moonlighting language CIR Members Hit the Streets for Victorious NY State Senate Candidate and the CIR benefits plan at no cost to the resi- dents. This is the first hospital in NJ to participate After a long and careful process, CIR’s New York delegates decided to endorse Gustavo Rivera in in the plan. his primary race against incumbent Pedro Espada for the 33rd State Senate seat in the Bronx. The 33rd Senatorial District includes St. Barnabas Hospital, where residents have been fighting to join CIR for two years, and Bronx-Lebanon Hospital Center, a strong CIR chapter entering con- New Contracts Ratified at tract negotiations this fall. CIR members stood next to Mr. Rivera as he announced his “Health Care For All” platform and California Hospitals pledged to improve community health care and preventative services in the Bronx. Residents volun- Residents at Kern Medical Center (KMC) in teered to phonebank and doorknock in the district to reach out to voters. Mr. Rivera won the Bakersfield, CA will now have funding for national Democratic primary on September 14 with 62 percent of the vote. conferences and will be reimbursed for per diem expenses, mileage, and housing for non-elective outside rotations, thanks to a new contract. The two-year agreement, ratified overwhelm- three years, increases of $200 to the relocation reforms would mean to physicians and their ingly on July 30, 2010, also preserves salary and bonus and $300 to the education allowance, savings patients. Dr. Link focused on a new provision that health benefits and ensures access to free scrubs, on health insurance, and an increase in the chief children may no longer be denied insurance cover- yearly security walk-throughs, and job security in stipend. They were also able to preserve the “sick hit age because of pre-existing conditions. the case of KMC or program closure. The contract fund,” which will cover the $40 an hour residents victory comes after Kern residents decided to are paid when they’re called in to cover for an Residents Learn Campaign organize as a CIR chapter in the fall of 2009. unscheduled absence. Residents at Children’s Hospital & Research Strategy at LA Training Center Oakland (CHRCO) overwhelming ratified On September 25, 60 CIR residents from their second CIR contract for a new three-year New Mexico CIR Leader Northern and Southern California, New Mexico, agreement. Highlights of the contract include Addresses Children’s and resident physician guests from the University PALS re-certification at no cost to the resident of Washington attended the seventh annual CIR physician, increases to the meal allowance each Health Insurance Western Regional Meeting. year of the agreement, and salary increases of On the day before the six-month anniversary of Residents participated in a dynamic program to 3.5% in 2010, and 2.75% in 2011 and 2012. the enactment of the Patient Protection and help understand the economic climate within At Sutter Medical Center of Santa Rosa, resi- Affordable Care Act, UNM pediatrics resident Dr. which CIR operates and to gain new leadership dents ratified on July 29 a new three-year contract Nate Link joined policymakers, patients, and and negotiating skills. They heard from Barb guaranteeing them salary increases over the next advocates at a press event to explain what the Maynard, an expert researcher and advisor to the Los Angeles County Coalition of Unions, who spoke about the economic climate and forecast in Work Smart Tool Kit Helps Residency Programs the region, and Jim Araby, organizer for the California Teachers Association, who gave a train- Adapt to New ACGME Rules ing on strategizing for campaigns. Teaching hospitals and residency programs across the Connie Leyva, President of the California Labor country will soon be scrambling to implement the new Federation and the United Food and Commercial ACGME work hour rules that will go into effect July 1, 2011. Workers Union, presented an award to Kern To help provide residents the tools to participate in discus- Medical Center residents who just ratified their sions at their hospitals, CIR created a tool kit that draws on first union contract and formally joined CIR in best practices from programs that have redesigned their September 2010. schedules in innovative ways. After hearing the speakers, residents partici- The Work Smart Tool Kit includes: pated in a workshop to gain skills in contract • A checklist to help ensure successful work re-design enforcement and running efficient labor-manage- implementation ment meetings. CIR leaders, along with staff, • 20 best practices from residency programs across the role-played key hospital decision-makers, as resi- country, with specific details and residency program contact dents learned to implement their strategy training information from earlier in the day by meeting with said deci- • A list of additional resources to get started sion-makers in order to get hospital issues resolved. Then, residents and leaders participated Visit http://cir.seiu.org/policy to find an electronic version of the tool kit. in true-to-life, but often very funny, mock labor- management meetings. 4 • November 2010 COMMITTEE OF INTERNS & RESIDENTS Six Months After Health Care Reform: What’s in Place and What’s to Come t’s hard to believe, but it’s been six • No child can be denied coverage or • Launch of a new website — Medicare and Medicaid, with months since Congress passed and care because of a pre-existing con- www.healthcare.gov — for those $250 million in additional funding IPresident Obama signed the dition without insurance to find all pub- • A new Prevention and Public Affordable Care Act. Although the • Insurance companies cannot lic and private plans available Health Investment Fund increases full extent of health reform will take rescind coverage for any reason based on their specific circum- national investment in smoking years to implement, much has other than fraud stances cessation, anti-obesity, breast can- already been put in place. • No insurance plan can have a life- cer screening and other under- Consider this a handy reference time benefit limit New benefits for health funded public health priorities for when your patients have • Department of Health and care workforce • Increased funding for Health IT questions — or when you do! For Human Services establishes • Expanded funding available for and comparative effectiveness more information on how the annual review of unreasonable scholarships and loan repayments research American health system is changing, premium increases to primary care physicians go to http://cir.seiu.org/healthreform. • No prior approval required for through the National Health Coming on January 1, 2011 If patients are unclear as to whether Service Corps they qualify for any of these new Emergency Room or OB/GYN care • Major change forcing health programs, you can suggest they go to • Physicians may deduct loan pay- insurance plans to spend more on www.healthcare.gov. New programs for ments made to state-issued patient care: all employer spon- employers and patients student loans from their personal sored insurance required to have income tax a medical loss ratio (MLR) of 85% Changes to insurance • Small businesses with fewer or higher; all individual and small regulations than 25 employees are eligible to • Many additional low-interest stu- business plans required to have apply for a tax subsidy to pay for dent loans and scholarships are Applies to all NEW insurance available through the an MLR of 80% or higher plans sold on or after September 23, up to 35% of health insurance premiums Department of HHS for primary • Medicare patients who reach the 2010: care and general surgery health- Medicare Part D prescription • Medicare patients who reach the • Young adults must be allowed to care workers drug “donut hole” receive a 50% Medicare Part D prescription remain a dependent on their par- rebate on their prescription drugs drug “donut hole” automatically • Unused residency slots are redis- ents’ plan until the age of 26 (value of rebate will increase each receive a rebate for $250 tributed to hospitals in need, with • Greatly restricts the ability of first preference going to primary year) • Eliminates cost-sharing (co-pays) insurance plans to have annual care • Every Medicare patient will be for preventative services under benefit limits (limits are phased entitled to an annual wellness Medicare • Department of HHS establishes out entirely in 2014) an independent National Health visit with no co-pay • New government-sponsored Pre- • Insurance plans must cover rec- Care Workforce Commission • 10% bonus payment in Medicare Existing Condition Insurance ommended preventative care and for all primary care physicians Plan will be available in every • Expanded funding for community immunizations with no cost-shar- health centers nationwide and general surgeons ing (co-pays, deductibles, etc.) state for those who have been • New screening measures to weed practicing in a health resource Applies to all health insurance denied coverage in the past six out waste, fraud, and abuse in shortage area plans as of September 23, 2010: months

“This conference allowed us to see how we could all really work together — really take on a project and watch as we improve it and increase patient safety.” — Dr. Kathir Palanisamy, Internal Medicine Chief Resident, Bellevue Hospital Center Patient Safety Conference Stresses Teamwork in Fight to Stop Hospital-Acquired Infections YC Health and Hospitals This year HHC and CIR were close to 250 health care workers and patient safety officer. Corporation and CIR collabo- joined by union leaders representing administrators from HHC’s 11 Participants were welcomed by Nrated in 2008 and 2009 to host support staff and PAs (DC 37, acute care hospitals. The conference HHC President and CEO Alan Aviles highly successful one-day confer- AFSCME), attendings (Doctors —“Improving Patient Safety and and CIR President Dr. Farbod ences to improve teamwork and Council), Environmental Services Reducing Infections through Effective Raiszadeh. Dr. Edmund Giegerich, communication skills. But 2010’s staff (DC 37), and LPNs (1199SEIU). Teamwork and Communication” — Medical Director at Coney Island effort topped the charts. The conference attracted a crowd of took place on October 7 at Bellevue Hospital, reviewed the devastating Hospital Center. effects to patients of hospital-acquired The theme was inspired by infections, and Caroline Jacobs, Senior keynote speaker Dr. Richard Vice President for Patient Safety, dis- Shannon, Chair of Medicine at the cussed HHC’s ongoing efforts to University of Pennsylvania Health reduce infections. System and a nationally recognized Pediatric resident Elaine Carrasco leader in patient safety. Dr. Shannon and Associate Director of Nursing stresses that all members of the Evelyn Montecer from Lincoln health care team, from nurses and Hospital then led the group in a

PHOTO CREDIT: ERIN MALONE/CIR PHOTO CREDIT: physicians to ward clerks and house- review of important skills to empower keepers, need to be involved in all health care providers to speak up improving patient safety because all when patient safety is at stake. have valuable contributions to make Dr. Shannon’s keynote galvanized to that effort. In keeping with that the crowd and kicked off an after- belief, conference organizers invited noon breakout session, organized by representative members of an inpa- hospital, in which the inpatient tient unit (medical or surgical) from teams determined what project they each HHC hospital to attend, along wanted to tackle upon their return to with those hospitals’ administrative work and what they hoped to accom- staff, e.g. the chief operating officer, plish in the next three, six and Lincoln Hospital residents and colleagues with Mei Kong, RN, MSN, Senior Director for Patient Safety medical and nursing directors, and 12-month intervals.