August 2017

News for Munson Healthcare Medical Staff

Right Things, Right Reasons Christine Nefcy, MD, FAAP, Chief Medical Officer at Munson Healthcare, shares thoughts about her first 12 months at the helm.

Defining the systemic direction Despite the complexities, Nefcy the house?’” “It helps keep things has taken time. Last year, Nefcy said that best practices at each in perspective”, she laughs. met with Munson Healthcare’s hospital have elevated the system’s Another piece of advice she chief medical officers to begin approach to care. always keeps in mind is to “do the that process, she said. “Our behavioral standards right things for the right reasons.” “The big things that came out document was created by the “We have a great opportunity here of that meeting were that they CMO in Charlevoix; Grayling’s to work together as a system and wanted to work on shared approach to high-risk OB learn from each other’s strengths governance, reducing variation, patients is a best practice,” she and our weaknesses. We really are clarification of roles, culture, said. “We will likely be adopting stronger together.” leadership development, some of Manistee’s quality removing silos, and optimizing measurement practices, and Dr. Christine Nefcy can be Christine Nefcy, MD, FAAP the EHR,” Nefcy said. “They Cadillac really led the way in their reached at 231-935-6556 and Chief Medical Officer wanted to make sure we were development of a massive blood [email protected]. aligned clinically, operationally, transfusion protocol.” and financially.” Just hours into her first day on the With an eye to year two, Nefcy job last year, Dr. Christine Nefcy From there the group met said she has three goals in said that communicating with monthly, inviting various mind: continuing leadership physician leaders was her biggest regional physician organizations, development, system peer review, In This Issue… priority. “I want to get a good recruiting, communication, and increased transparency understanding of their priorities and, each quarter, chiefs of staff to drive quality and safety 2 Welcome System and their concerns in terms of and leadership from physician improvements. Director of Quality being a part of a system,” she said organizations. See pg. 5 for what 2 Provider Satisfaction And even though there is so about her open-door philosophy. the CMO team has accomplished Survey much work to do, Nefcy says she “Physicians should feel very so far. 3 Cardiovascular Update keeps it all in perspective. welcome to come in and chat.” 4 Maternal Fetal With a year under her belt, Nefcy “When I talk to physicians going Medicine Update Twelve months on, Nefcy praises admits the role is “a big job.” into administrative roles, I remind 5 Meet Our CMOs the leadership, mission, and “This field is a complex one with them that even though there’s 9 Cerner Ambulatory vision that is now shaping the lots of moving parts, layered on really important stuff going on at Phase One system’s “true north, a patient- top of very different hospitals this level, nothing is really emer- 10 Health Care’s Lean centered community.” with cultures and histories – then gent,” she said. “I have a poster in Journey “We have some really awesome on top of that a federal change my office that says, “When there’s 11 HIPAA leaders here, physicians and and uncertainty with payment an emergency, no one shouts, ‘Is 11 MACRA otherwise, plus a great mission and the future,” she said. “There’s there a hospital administrator in 12 PAMA and vision,” she said. “But there’s a lot going on.” 12 CMS ABN Form still a lot of work to do.” munsonhealthcare.org/ForPhysicians Page 1 | thePulse Getting to Know

commitments to high quality all of these areas. I am also a very Tom Peterson, MD, FAAP and comprehensive safety are outcome-driven person. That is Munson Healthcare’s new VP of Quality and Safety started very apparent. Folks have been what truly makes the work fun. extremely inviting and friendly in June and we caught up with him for a quick Q&A during Can you tell us a little bit about as well. his first week: your personal life? What’s your game plan for I met my wonderful wife in 9th the first 90 days? My first grade, and we’ve been married What attracted you to this priority is to learn — about 35 years. We have three great role? I have worked in many the system, the history, the kids, with two of them working areas of health care the past personalities and the culture — in the medical field and one in 25+ years, so being part of an and understand the good things marketing at PepsiCo. My dad excellent high-quality, growing that are happening and where was also a physician, and with my system like Munson Healthcare we could improve. Leadership son in the field, it gives us three was a draw for me. Also, I engagement is a big deal in the generations of Dr. Tom Petersons. quality and safety world so I wanted to work for a system What’s the first tourist need to get to know the system that has a true commitment to attraction you plan to hit in leaders in these areas and safety and quality work. Not northern ? We have understand what we’re already every health care organization covered Leelanau and Old doing. I am a big proponent incorporates safety and quality Mission peninsulas already, of a shared learning approach, into their mission and values, or and just received a gift from my Tom Peterson, MD, FAAP especially in a new system. Vice President, Quality and Safety a framework like True North. children to kayak off of Sleeping Traverse City was another Why is it so important to Bear Dunes. We also want to hike have someone overseeing North Manitou Island. Nordhouse “My approach for quality and safety is that everyone both quality and safety? If you Dunes is also on our list, and we does it together. We can’t work in silos and it can’t are overseeing both, then you are looking forward to the many can really integrate all areas of festivals. just be a clinical approach.” these disciplines. My approach Is there anything else you’d like for quality and safety is that us to know? Traverse City is the Where were you working prior attraction. My family and I had everyone does it together. We smallest city we’ve ever lived in so to accepting this role? I came always talked about coming can’t work in silos and it can’t it is a new experience. However, from SCL Health in Denver, CO, to northern Michigan so we’re just be a clinical approach. The we’ve been very impressed with where I was Vice President and trading mountains for lakes. tools, methods, and resources Chief Safety Officer. This was everything it has to offer. We What are your first impressions need to work for everyone. a 9 hospital system in 3 states, feel very fortunate to be here. of our system? With Munson Is there anything else you’d approximately 15,000 employees. What is the best way to reach you? Healthcare being a relatively like physicians to know? I’m a Prior to that, I was Executive I can be reached at 231-935-6519 new system, I think there will pediatrician by profession and Director for Safety, Quality, and (office),616-717-0911 (cell), be opportunity to help build worked for many years in the Community Health at Helen and [email protected]. and shape a system culture, quality, safety, and the population DeVos Children’s Hospital. Please contact me at any time! which I find exciting. But the health worlds. I have a passion for

Provider Satisfaction Survey Results Helpful Creating an Excellent Place to provider satisfaction and engagement administration. This was a follow up senior leaders focus on the areas Practice for providers is something with your local hospital. The survey to the survey conducted in February that truly matter to providers. Munson Healthcare strives to ran March 20 – June 12. 2015 and will help us gauge progress We are currently analyzing the achieve. on the initiatives that resulted from The areas addressed in the survey survey results, but will be sharing that survey. Earlier this year, Munson were nursing, emergency services, these with our medical staff later Healthcare medical staff were radiology, pathology, anesthesiology, We had a 79 percent response rate, this year. asked to participate in a survey, laboratory services, surgical services, which was very much appreciated. Thank you to all providers who by web or phone, to determine medical records and information, and Your feedback will help physician and participated in the survey!

Page 2 | thePulse munsonhealthcare.org/ForPhysicians Cardiovascular Services

Cardiovascular Services cardiologists and additional more patient visits, consolidate and the body puts a layer of continues to expand as we look staff now offer extended hours heart and vascular testing cells over it within three for three new cardiologists to and expanding testing. The equipment, add Lab space, months, taking the risk of join the current 19-member clinic has the capacity for up and provide for a more rapid infection down to zero. Traverse Heart and Vascular to 2,000 patient visits and assessment of patients whose • Were among the first group (THV) physician team in FY18. 600 heart tests per year. primary care physicians, or of health systems in the Also, Cardiothoracic Surgeons the Emergency Department, A cardiologist and two APPs country to receive bioresor- of Grand Traverse added a sixth feel have an urgent need. now hold clinics weekly at bable scaffold stent-like cardiovascular surgeon in July. Paul Oliver Memorial Hospital On the technology front, devices to treat patients During FY17, there was a in Frankfort. THV also has cardiologists and cardiothoracic with coronary artery disease. lot of activity that included expanded clinic locations surgeons continue to stay The THV team was involved new technology, expanded to Indian River. Other current with new modalities in the clinical trial that led to community clinics, and clinic locations in include of care to benefit northern the stent being approved growth in the number of Cadillac, Charlevoix, Gaylord, Michigan residents. In FY17 we: in the U.S. patient visits across the Grayling, Kalkaska, Manistee, • Started implanting the Micra Munson Healthcare system. Prudenville, and Traverse City. Cardiovascular Services cared Transcatheter Pacing System, In Grayling, we expanded our for 332,098 patients from 76 In Traverse City, we look the smallest pacemaker capabilities through the opening different Michigan counties forward to the completion of available. Eligible patients of the Maxon Medical Building in Fiscal Year 2017. an expansion project of the benefit because the device is across from the hospital. Five THV office that will allow for completely within the heart

Save the Date Cardiovascular Update Conference - Saturday, Nov. 4 Hagerty Center | 715 E. Front St., Traverse City The fifth annual Cardiovascular Update Conference offers primary care, emergency medicine, and hospital medicine physicians, PAs/NPs, and nurses practical tools and resource including the most current developments in the diagnosis, treatment, and management of cardiovascular disease. Look for more information and registration details coming soon.

Culinary Medicine Think like a chef | Cook like a dietitian | Eat like a local farmer

September 22 - 24, 2017 Take your practice to the kitchen and learn about ways to: Great Lakes Culinary Institute • Chop, dice, and puree your way to better health outcomes Northwestern Michigan College, Traverse City for your patients. • Experience what it’s like to cook on a tight budget. This Farms, Food & Health training program offers northern Michigan • Engage in a partnership with local farmers to grow a health care providers an innovative continuing medical education healthier population. program that highlights local food, culinary, and nutrition trainings. • Write scripts for fruits and veggies. This program is a partnership with Groundwork, Grand Traverse • Explore cutting-edge nutrition interventions. Foodshed Alliance, Great Lakes Culinary Institute, Michigan Health • Endowment Fund, Rotary Charities, and Munson Healthcare. Motivate your patients on a very personal subject…their weight. This program has been approved forAMA PRA Category 1 Credit™. For details and to register by Sept. 15: groundworkcenter.org/ events/culinary-medicine-september-22-24/ munsonhealthcare.org/ForPhysicians Page 3 | thePulse Maternal Fetal Medicine Program to Launch in Fall Munson Healthcare looks to start a new Maternal Fetal Medicine program as early as this fall that will eventually encompass the owned facilities in the health care system.

Women and Children’s Services The perinatologist will fill a Executive Director Mary consultative role and will not Schubert said the health system perform deliveries. is on track to hire a perinatologist Plans call for the program to to begin working two days a week be implemented gradually with in the system, possibly starting the perinatologist working two in October. days a week with one or two OB “What is really exciting is that practices in the health system, our plans are to implement a allowing any issues to get worked full program,” she said. “And out of the program before it consistent with our True North expands to additional facilities. metrics, putting the patient in The goal is to have the program the center, the new perinatologist fully implemented in 2019. will be going out to the “We want to make sure that our individual organizations and program is really integrated and program, if a mom needs to “Our local obstetricians have done seeing the patient in their home something that all of our OB deliver at the medical center due a phenomenal job of caring for organization.” providers are comfortable with,” to a known condition, prenatal moms at the local level,” Schubert Seeing a patient at the OB Schubert said. “It’s really exciting visits could still take place in her said. “This will be an added level provider’s office close to home in that this is wrap-around care.” community. of support for the obstetrician Grayling or Charlevoix will save and for the patient. It is just really The role of the RN on the Of the 5,000 births that occur the patient travel time and also providing an extra layer of safety team will be to make sure that in northern Michigan annually, allow the perinatologist to build for the entire region.” information gets back to the nearly one-third are characterized relationships with local providers. care managers in the individual as “at-risk.” Some of the at-risk For more information on the Along with the perinatologist, practices so the care managers births will continue to need care MFM program, contact Schubert the program will include a nurse, can ensure that all the family’s from higher-level facilities in at 231-935-6560 or social worker, and an ultrasound needs are met. Under the Grand Rapids or Ann Arbor. [email protected]. technologist as part of the team.

Kiersten’s Ride Suicide Northern Michigan Prevention Conference HIV Summit

Sept. 26-28, 2017 Friday, Sept. 15 | 9 am - 3 pm | Kirkbride Hall, Ellison Place, 150 Dale Dr., Gaylord 700 Cottageview Dr., Ste. 200, Traverse City Cost for the 3-day conference is $35, which includes meals. Learn about and discuss the state of HIV care across our There is an extra $25 cost to attend either of the Day 3 region. Topics will include the impact of health care reform workshops: C.A.S.E. Experiential Training or Suicide to Hope. on the care of patients with HIV, strategies for reducing perinatal HIV transmissions in Michigan, and what it means Sponsored in part by Munson Healthcare Charlevoix Hospital, to age successfully with HIV. this program has been approved for AMA PRA Category 1 Credit™. There is no cost to attend, and lunch is included. This program has been approved for AMA PRA Category 1 Credit™. For more information and to register by Sept. 12: kierstensride.org For details and to register by Sept. 8 (registration required): munsonhealthcare.org/TJCC/HIV-summit

Page 4 | thePulse munsonhealthcare.org/ForPhysicians Chief Medical Officers – Getting to Know What we have accomplished so far Since they started meeting monthly last year, the results Joe Santangelo, MD from the Munson Healthcare CMO team include: Vice President of Medical Affairs, Cadillac Hospital

• Credentialing/Recruitment Biggest “a ha!” moment since becoming VPMA? • More standardization around credentialing and One of my first projects was a process privileging processes improvement to address OB hemorrhages. It was • Standardizing OPPE (Ongoing Professional Practice Evaluation) a multidisciplinary team that included anesthesia, and expectations for providers and physicians ER, lab, OB, and others. I was very impressed by • First steps to regional peer review the team’s willingness to work together quickly towards the goal of better care for our patients • Working towards using the same medical staff categories • Standardization of recruiting, highlighting places of Advice on building positive relationships? greatest need “Listen more.” More communication is always better! We often work from assumptions that aren’t true. Not all physicians and • Policies clinicians share the same perspective on an issue. Be prepared to listen! • Some standardization and broadening of policies applicable across the system Looking forward, what will be the most significant change for our health care community? • Quality/Patient Safety The Medicaid expansion has had a very positive impact on our • Standardizing clinical guidelines across the system for northern Michigan community by increasing the number of patients strokes, sepsis, and STEMIs with health insurance, which has increased preventive care for our • More integrated conversations about transfers patients and reduced bad debt for our hospitals. Our patients and • Finalized neonatal transport algorithm hospitals would be negatively impacted if the Medicaid expansion were to be rolled back or eliminated. • Shared serious safety events so that we can learn from each other What would people be surprised to learn about you? • Launched system-wide initiative for management of patients I may not look like it, but I am a long-distance runner. My favorite race is with concussions the Highlands Sky Trail Run, which I’ve completed 11 times. It covers 41 challenging miles over the beautiful mountains of West Virginia. • Technology • Multi-hospital approach to EMR implementation ongoing, Anything else you’d like providers to know? currently in Phase I Cadillac Hospital and our medical staff have a great relationship • Developed forum to assess and recommend system-wide because we work together to provide the right care in the right Cerner changes place. I think it helps that most of Cadillac’s providers belong to the Crawford/Wexford County PHO. This has been a very positive, helpful • Implemented system-wide IT governance decisions partnership for both providers and the hospital resulting in many process improvements for our patients. What We’re Working on Next: • Roll-out chest pain assessment protocol across system I am always willing to listen to what providers have to say. Your feedback • System-wide contract for radiology and pathology services is very important to guiding the delivery of care in our community. • Develop system peer review committee • Bring antimicrobial stewardship out to the system In Brief If you oversee or have a proposal for a system-wide initiative, or would like to become involved with any of the initiatives listed Hospital: Munson Healthcare Cadillac Hospital above, please contact Christine Nefcy, MD, FAAP, at 231-935-6556 Practices at: Mackinac Trail Pediatrics or [email protected]. VPMA Since: January 2016 Specialty: Pediatrics Education: Case Western Reserve University School of Medicine Residency: Cincinnati Children’s Hospital Medical Center Married to: Megan Santangelo, MD (19 years) Children: Ellah (13), twins Dino and Freddie (11) Favorite pastimes: Trail running, music, coaching my kids’ soccer teams, spending time outdoors Contact: 231-876-7152, [email protected].

munsonhealthcare.org/ForPhysicians Page 5 | thePulse Getting to Know Jim Jeakle, MD Marty Lougen, MD Chief Medical Officer, Charlevoix Hospital Chief Medical Officer, Grayling Hospital

Biggest “a ha!” moment since becoming CMO? Biggest “a ha!” moment since becoming CMO? No real “a ha” moments as I have practiced in My biggest “a ha!” moment was when I was our community for more than 20 years. Our listening to our daily safety briefing and first staff determines Charlevoix Hospital’s culture, learned of a process that was causing a serious which is why we recruit people who value safety concern at the time. I knew that if we continued process improvement on every front. shared how we fixed this issue with our other Sustaining that level of energy requires a very providers and clinics, we could partner with special and committed group of people. them to improve and prevent this problem from occurring in the first place. And because this safety issue wasn’t Advice on building positive relationships? isolated to Grayling, we needed to share our solution with all of the If someone knows you value their input and trusts you as a leader, Munson Healthcare hospitals and clinics so that we could all, together, there will exist a foundation for a positive relationship. This trust improve our processes and help protect patient safety. isn’t gained overnight and it’s earned more from actions than words. Advice on building positive Looking forward, what will be “Take a ‘time out’ to “Whenever possible, relationships? the most significant challenge ask a lot of questions There is no substitute for face-to- lead by example.” for our health care community? face time and actually spending time Governmental and private first to really try to listening and interacting with that insurers continue to reach new levels of intrusion into the doctor- understand the problem person. patient relationship in an effort to cut cost, increase quality, and improve outcomes based mostly on unproven methodologies. and situation before Looking forward, what will be the These changes have come in tidal wave fashion, greatly affecting identifying possible most significant challenge for our health care community? the day-to-day practice of medicine especially in the primary care solutions.” setting. The most significant challenge for providers will be finding There is a ton of uncertainty right a way to deal with the additional level of stress and frustration now concerning health care reform these changes will continue to bring. and so many of the future changes are impossible to predict. However, it’s safe to say that payers will continue to reward for higher quality What would people be surprised to learn about you? measures and outcomes and withhold for lower quality performance. During my high school summers I worked at Tiger Stadium where Thus our health care community must continue investing in improving I collected tons of autographed balls, and I gave away every one the quality of care for our patients. It’s good for the hospital system as I figured I had a never-ending supply. and it’s good for our patients. Anything else you’d like providers to know? What would people be surprised to learn about you? Our hospital’s leadership style is based on collaboration, trust, My wife and I go out on a date night every week. and putting the patient first. Anything else you’d like providers to know? All of our hospital leaders work hard and strive to uphold our hospital’s core values.

In Brief In Brief Hospital: Munson Healthcare Charlevoix Hospital (1995) Hospital: Munson Healthcare Grayling Hospital (2007) Practices at: Charlevoix Women’s Health; Boyne Area Health Center Practices at: Grayling’s Emergency Department as part of Emergency CMO Since: Sept. 2015 Physicians Medical Group Specialty: OB/GYN CMO Since: January 2017 Education: Michigan State University College of Human Medicine Specialty: Emergency Medicine Residency: St. Mary’s Health Services Family Medicine, Education: Wayne State University School of Medicine William Beaumont Hospital - OB/GYN Residency: Wayne State University/Detroit Medical Center Married to: Rebecca (26 years) Married to: Dr. Jennifer Leino (16 years) Children: Madeline (25), twins Molly and Will (22), Noah (20), Olivia (17) Children: Marty (13), Anastasia (9) Favorite pastime: Spending time with our kids, golfing, fishing, glass fusing Favorite pastime: boating, swimming, biking, hiking, downhill skiing Contact: 231-547-4477, [email protected]. Contact: 989-348-0313, [email protected]

Page 6 | thePulse munsonhealthcare.org/ForPhysicians Getting to Know Jeremy Holmes, DO Brian McComb, DO Chief Medical Officer, Kalkaska Memorial Health Center Chief Medical Officer, Manistee Hospital

You’ve been a CMO for a decade...what might Biggest “a ha!” moment since becoming CMO? others be surprised to learn about KMHC? I now have a better understanding of hospital We’re very unique in that our hospital is owned operations and logistics. It’s been eye opening to and funded by the Kalkaska County townships. see how administration actually works. I have a For a small community hospital, we offer a wide better sense of the whole picture – the hospital’s variety of services that meet many community perspective as well as the provider’s. My role is to needs such as the newer services of surgery and build bridges between area providers and hospital a dialysis center. administration. “Try to see a situation Advice on building positive Advice on building positive relationships? relationships? I am a big believer in being honest and building trust. It’s very from the other person’s Communicate. It takes time and important to follow through and do what you say you’ll do. effort, but open dialogue helps us all point of view.” Looking forward, what will be the work through challenges. “Be true to yourself but most significant challenge for our Looking forward, what will be the most significant challenge do it in the right way.” health care community? for our health care community? The government and insurances are Kalkaska County also has one of the highest percentage of patients putting a lot of restrictions on what tests providers can order and the on Medicaid or Medicare in Michigan – 68 percent. Plus another medications we can prescribe for our patients. I see where some of 13 percent of Kalkaska County residents under 65 are uninsured. these changes are necessary, but it’s all happening so quickly that it can The programs are working, as many of our patients are scheduling be challenging for providers to keep up with all of the new regulations. wellness visits after receiving a letter from Medicaid. There’s still a lot What would people be surprised to learn about you? of uncertainty right now over some of these programs because no one I’m an avid angler and used to compete in bass tournaments for knows the future of Medicaid expansion. both small and large mouth bass. A few years ago, I competed in the What would people be surprised to learn about you? northeast division B.A.S.S. tournament on Chesapeake Bay and placed My wife, Sarah, and I are starting a flower farm in Alden that 28th out of 190 competitors and was awarded $440. specializes in cut flowers for weddings or special events as well as Anything else you’d like providers to know? personal use and gifts. It’s been a lot of work getting the flower farm Please know that whatever the challenge, we’re here to help. off the ground, but we’re really having fun with it. Anything else you’d like providers to know? Our hospital’s leadership is very friendly, down to earth, and invested in our community. Our presidents attend town hall meetings to ask the community what it needs…and then use millage funding to meet those prioritized needs. Surgical services started this way.

In Brief In Brief Hospital: Kalkaska Memorial Health Center (2003) Hospital: Munson Healthcare Manistee Hospital (2003) Practices at: Kalkaska Medical Associates Practices at: Manistee Primary Care CMO Since: 2006 CMO Since: November 2016 Specialty: Family Practice Specialty: Family Medicine Education: Michigan State University College of Osteopathic Medicine Education: Michigan State University College of Osteopathic Medicine Residency: Munson Family Practice Residency Residency: Saginaw Cooperative Hospitals Inc. Married to: Sarah (24 years) Married to: Michelle (24 years) Children: Adelaide (19), Wilson (18), Jordan (17), Levi (13), Breanna (12), Children: Meghan (20), Jacob (18), Brendan (13) Megalyn (8), Lewis (8) Favorite pastime: Spending time outdoors, especially hiking with his Favorite pastime: Running, basketball, sports golden retriever, Cooper Contact: 231-258-7777, [email protected] Contact: 231-398-1143 (office), 231-398-1143 (cell), [email protected]

munsonhealthcare.org/ForPhysicians Page 7 | thePulse Getting to Know

George Ryckman, DO Chief Medical Officer, Paul Oliver Memorial Hospital

CMO is a new position at POMH…how do What would people be surprised to learn about you? you see your role? I was a pharmacist for 5 years before going to medical school. As a I’m really looking forward to my new position as third generation pharmacist, I worked in my family’s pharmacy. My Chief Medical Officer (CMO) for POMH, which time as a pharmacist was a great foundation to becoming a physician. just started this July. As we develop as a system, Anything else you’d like providers to know? the CMO role will be very essential, especially in At POMH, we’re a team. We may be small compared to other hospitals, the smaller hospitals. My role as CMO will be to but our commitment to providing quality care to our patients drives help champion and achieve True North strategies, us to accomplish large goals, which is why we have been recognized in particular our system-wide quality multiple times for excellence in delivering quality care to Benzie County. “Make time with your initiatives. For me, this is all very children when they’re necessary…and very rewarding work. young. But once they’re Advice on building positive In Brief relationships? Hospital: Paul Oliver Memorial Hospital (1988) grown, please make Honesty. If you’re not honest, then Practices at: Crystal Lake Health Center time to get involved game over. And it also helps to be CMO Since: July 2017 with your local hospital. concise in your communications and speak in a common language. Specialty: Family Practice We value and need Education: Kansas City University College of Osteopathic Medicine Looking forward, what will be the your expertise!” Residency: St. Joseph Hospital and Medical Center most significant challenge for our Married to: Carolyn (30 years) health care community? Children: Tucker (27), stepdaughter Stephanie (49) Reimbursement, especially for Medicaid and block grants. How can we Favorite pastime: Golfing, fishing, hiking at Sleeping Bear Dunes help our uninsured population receive necessary primary and preventive care? Health care in this country has just become too expensive for our National Lakeshore patients to afford. It’s important for us, as a health system, to do all that we Contact: 231-882-9661, [email protected] can to contain costs. OMH Exploring Closer Relationship with MHC Otsego Memorial Hospital (OMH) has decided to explore strengthening its relationship with Munson Healthcare. A non-binding agreement has been approved to develop an integration plan that would permit closer affiliation between the organizations.

and work together. Cadillac communities. Shared planning not be delivered based on Hospital, Charlevoix Hospital, and physician recruitment the size of a single hospital’s Grayling Hospital, and Manistee activities have also allowed us to individual community. Closer Hospital have all recently become reduce costs and enhance local collaboration could also help While many rural community fully integrated. With that, health care services. Being a fully recruit and retain the best hospitals across America are Munson Healthcare and Munson integrated member would enable talent. The two organizations struggling to survive, OMH is Medical Center have already seen OMH to have conversations are now in a due diligence in a strong position with high- the benefits of learning from each with other Munson Healthcare phase where leadership teams quality clinical services and other as we grow together. hospitals, including Munson will exchange pertinent Healthcare Grayling Hospital, information related to planning sound financial performance. Otsego Memorial Hospital on how to best serve patients for full integration and That makes this the ideal time first affiliated with Munson in their unique health care identify any opportunities or to explore closer integration Healthcare in 2006. During environment. Through regional challenges. with the Munson Healthcare the past 11 years, we have planning, OMH and Munson system. Northern Michigan is worked together to strengthen Once we are fully integrated, Healthcare can explore offering better served and health care is cardiology and oncology services we anticipate hiring a Chief services that otherwise could stronger when we collaborate in Gaylord and its surrounding Medical Officer for OMH.

Page 8 | thePulse munsonhealthcare.org/ForPhysicians techtalk

Cerner Ambulatory – Phase One Update

Phase One of the Cerner Munson Healthcare: Phase One Ambulatory implementation is • Christine Nefcy, MD, FAAP; 231-935-6556; [email protected] already well underway and is Kalkaska Memorial Health Center scheduled to be completed by Kalkaska Memorial Health Center: Forest Area Teen Health Clinic the end of the 2017 calendar • Nate Sailor, DO; 231-258-7777; [email protected] Kalkaska Medical Associates year. Phase One focuses on 182 • Christina Weasel Brege, PA-C; 231-369-3113; [email protected] Kalkaska Memorial Outpatient Clinic employed providers amongst Kalkaska Teen Health Corner 35 practices/specialties Munson Healthcare Cadillac Hospital: Munson Healthcare Cadillac (see side bar). • Sara Helm, DO; 231-876-6100; [email protected] Hospital • Sue Lanser, MD; 231-825-8101; [email protected] In June, we completed a series Cadillac Primary Care • of Roadshows where Phase I Jennifer Piwowarski, MD; 231-876-6200; [email protected] Cadillac OB/GYN providers, clinicians, and Munson Healthcare Grayling Hospital: McBain Primary Care practice managers were able to • Joanna Nigrelli, DO; 989-348-0550; [email protected] Munson Healthcare Grayling view the clinical functionality • Carl Schubert, MD; 989-348-0550; [email protected] Hospital of the generic Cerner AuSable Urology • Vince Schultz, MD; 989-348-0550; [email protected] Ambulatory EHR. Eldercare • Amanda Scott, FNP; 989-348-1212; [email protected] Currently, we are planning Grayling Community Health Center • Brian Stirling, DO; 989-348-6610; [email protected] for the Future State Validation • Pediatric Clinic event where Munson Healthcare • Timothy Thornton, MD; 989-275-1200; [email protected] • Primary Care • Obstetrics Clinic project champions evaluate Munson Medical Center: Cerner’s specialty-specific • Walk-in • Keith Anderson, NP; 231-935-2686; [email protected] approved workflows to ensure Grayling Surgical Services • Joe Cook, DO; 231-935-8013; [email protected] that they are supported and • General Surgery consistent with the design of our • Jan Drlik, MD; 231-935-6607; [email protected] • Orthopedic Surgery Clinic system EHR. • James Fox, MD, FACC; 231-935-5800; [email protected] Prudenville Community Health Center • Andy Luea, DO; 231-935-0322; [email protected] • Primary Care We are also actively recruiting • Orthopedic Clinic for a system Chief Medical • Satya Pillay, DO; 231-935-8000; [email protected] • Specialty Clinic • Bill Rawlin, DO; 231-935-8015; [email protected] Information Officer (CMIO) to Roscommon Community Health Center replace Dr. Pete Springsteen, and • Dino Recchia, MD, FACC; 231-935-5800; [email protected] • Primary Care are interviewing candidates now. • Kate Shaffer, MD; 231-935-8000; [email protected] Munson Medical Center • Nicklaus Slocum, MD, FACC, FSCAI; 231-935-5800; [email protected] We’re learning a lot through this Bay Area Urology process and always welcome General Surgery questions and feedback from For more Cerner Ambulatory information and updates: Munson Family Practice Center our medical staff. If you have munsonhealthcare.org/cerner-ambulatory Pre-Procedure Services Clinic questions on how the Cerner Traverse Heart & Vascular Ambulatory project will affect • Heart Failure Clinic you, please contact one of our • Structural Heart Clinic provider champions: • Traverse City • Outreach clinics in Cadillac, Charlevoix, Frankfort, Gaylord, Grayling, Indian River, Kalkaska, Manistee, and Prudenville

munsonhealthcare.org/ForPhysicians Page 9 | thePulse Health Care’s Lean Journey: Right Care at the Right Time in the Right Place

Recently Munson Healthcare “Lean offers physicians a means hosted its first system physician to remove non-value-added leadership retreat, and we were activities that unnecessarily extremely fortunate to have exhaust their time and energy, Dr. John Toussaint as our keynote and, thus, frees time for doctor- speaker. John Toussaint, MD; to-patient care.” CEO of Catalysis (formerly A key model of Lean, which “ThedaCare Center of Healthcare complements the scientific Value”), is one of the foremost method, is Plan-Do-Check- figures in the adoption of lean Adjust (PDCA). principles in health care. Physicians should be quite Here are highlights from the familiar with the PDCA process- white paper “Lean for Doctors” improvement cycle because it that Dr. Toussaint authored with compares closely to the “SOAP” John Billi, MD, and Mark Graban, model: MSME, MBA. • Understanding the Subjective “Lean thinking is about complaint • Looking at Objective facts providing the right and data resources to provide the • Developing an Assessment • Enacting and evaluating a right care, at the right Plan over time. time, in the right place, “With Lean, clinicians can apply From Lean Thinking problems, seek perfection, build with the right safety their aptitude and experience to Practitioners to Lean Health quality at its source, focus on flow and quality.” solving system problems related Systems and pull, and understand and to clinical quality and safety, Although the science of health manage variation. while simultaneously improving care management isn’t as well For those new to Lean, the core To successfully implement Lean the timeliness of care, cost, and defined as clinical medicine, idea is to maximize customer in your organization, physician throughput issues.” its successful practice can value – in our case, patients leaders must: significantly improve the lives of – while minimizing waste. An advantage to PDCA problem • be willing to change staff, patients, and their families. Although originally adapted from solving is that it’s done by those • be humble and admit that you the Toyota Production System actually doing the work. The Key principles of a rapidly don’t have all the answers and adopted by manufacturing, challenge is making the time for adaptable management system • be curious and observe the Lean principles can be applied process improvements. are: Align, Enable, and Improve. places where value is created to all businesses, including for patients “Improving the process to Align: Align organization’s goals healthcare. • persevere when the going eliminate workarounds will with True North metrics. At gets tough “Lean thinking is about providing free up more time, and begins Munson Healthcare those are: the right resources to provide the a virtuous cycle of continuous patient at the center of all we do, “This is a different way to manage right care, at the right time, in the improvement.” health care team, safety, quality, health care, but it’s a better way. right place, with the right safety and operational performance. Our physicians, staff, and leaders Start by identifying one problem and quality.” deserve it. More importantly, our to solve and then work towards Enable: Demonstrate respect, patients deserve it.” Lean as Familiar Thinking developing a culture of problem model continuous learning, and for Physicians solving so PDCA becomes a lead with humility. To request a full copy of For health care organizations to habit. Physicians, as leaders in Dr. Toussaint’s “Lean for Doctors”, Improve: Focus on process, successfully implement lean, it is your practice, can help start email [email protected] with “Lean use scientific method to solve critical to engage physicians in and guide your teams on a lean for Doctors” in the subject. the process. journey.

Page 10 | thePulse munsonhealthcare.org/ForPhysicians MACRA: HIPAA What You Need to Know

In 2015, Congress passed the Medicare Access and CHIP The Threat From Within Reauthorization Act (MACRA), which established a new way In health care, the hardest thing to secure is your own staff. macra for providers and hospitals to be paid and that will replace current Meaningful Use measurements. Starting in 2019, Although the large privacy providers will be paid…or penalized…based on the Merit- breaches listed below are from Based Incentive Payment System (MIPS) that rewards for quality around the country, there’s performance. Although MIPS adjustments don’t start until always the possibility that it 2019, they are based on 2017 performance measurements. could happen here at your own hospital or practice. It takes Below are five things you need to know about MACRA and MIPS. us working as a team to detect inappropriate access to patient 1. MACRA is Here to Stay information. You can help to Unlike the Affordable Care Act (ACA), MACRA prevent privacy breaches by legislation has bipartisan support. reporting suspicious behaviors or attitudes. 2. Pay for Performance MACRA is part of a broader national push towards Rochelle Steimel Employees at each of the Privacy Officer following hospitals accessed value and quality. hundreds, in some cases 3. Population Health Is Vital thousands, of patient medical records without a job-related need A greater portion of payments will be based on key to know: patient measures. • Beacon Health, Massachusetts - 1,200 4. You’re All In This Together • Berkeley Medical Center, West Virginia - 7,400 As most providers will report as a practice group, your overall • Chadron Community Hospital, Nebraska - 700 MIPS score will be determined by an average of ALL the • Covenant Healthcare, Michigan - 6,197 providers in your practice. Which means that high performers • Trios Health, Washington - 570 will help you…and low performers will hurt you. Which is why • An employee of a Californian plastic surgery clinic stole 15,000 it’s more important than ever that your practice work together medical records and then uploaded pictures and identification as a team to improve quality (see Lean article on pg. 10). information to social media, including several celebrities who Because of this, larger practices may fare better than small or were not amused. individual practices. All employees in the above cases were fired. Multiple accesses to 5. Transparency patient information due to curiosity or concern, or malicious intent Your practice’s quality scores will be available to the such as fraud or identity theft, is a flagrant disregard for policy that public on the Physician Compare website, can, and likely should, result in termination. medicare.gov/physiciancompare/. We anticipate that How You Can Help savvy consumers will use Physician Compare to choose • Report all suspicious EMR access. Munson Healthcare conducts their physicians based on reported quality metrics. audits on PowerChart and other hosted software, but a real-time witness can be very helpful. We’re currently developing a MACRA resource guide for • If you see protected patient information on social media, report providers and practices. Look for more information on MACRA it to your hospital’s HR or privacy officer. and the resource guide in the September/October Pulse. • If Munson Healthcare medical staff or employees violate patient privacy, the hospital’s privacy officer is responsible for If you have questions on MACRA/MIPS regulations, please investigating and notifying all patients involved. Credit contact Randi Terry at [email protected] or 231-935-5199. monitoring may be offered as well. It is important for all of us to work together to protect our workplace reputation and community trust. If you have any HIPAA questions, please contact your local hospital’s privacy officer.

munsonhealthcare.org/ForPhysicians Page 11 | thePulse Protecting Access to Medicare Act On January 1, 2019, CMS will implement a new regulation – section 218 of Protecting Access to Medicare Act (PAMA) – that will change the current prior authorization process for ordering certain advanced diagnostic imaging studies.

Section 218 of PAMA Highlights: • Establishes the use of Appropriate Use Criteria (AUC) for advanced Please look for continued PAMA Section 218 updates in future diagnostic imaging studies. AUC is defined as “criteria that are editions of Pulse. evidence-based (to the extent feasible) and assist professionals who order and furnish applicable imaging services to make the most “This regulation change will affect the way physicians have to appropriate treatment decisions for a specific clinical condition.” order advanced imaging tests both in and out of the hospital. • For hospitals and radiologists to be reimbursed, they must Please ask questions and make you opinions heard. The rules document that AUC was consulted, similar to the current process are the rules, but we can adjust the process somewhat.” for prior authorizations. • Covers all MR, CT, PET, and nuclear medicine tests for: – Kevin Omilusik, MD • Outpatients • Emergency Department patients Friday Medical Conferences: • Any patient in observation or outpatient status PAMA Section 218 • Excludes radiology testing for all inpatients. Speakers: Dr. Patrick Gartland, Grand Traverse Radiologists; To prepare for the mandate, Munson Healthcare (MHC) is working Dr. Kevin Omilusik, MMC Case Management; Jennifer Coleman, with the Nation Decision Support Company to connect these criteria to our current medical record. Although the go live is more than a year Grand Traverse Radiologists away, it is important that we start preparing for this regulation now • October 20, 12:30 - 1:30 pm as it will have a similar impact as ICD-10. We are currently in the process of assembling a team with representatives from all MHC Munson Medical Center Conference Center or via GoToWebinar system hospitals. To register: munsonhealthcare.org/cme

The Pulse is published six times a year. We welcome your feedback and topic suggestions: [email protected] Deb Kimball, Physician Relations, 231-935-3388; [email protected] | Dale Killingbeck, Corporate Communications, 231-935-3393; [email protected]

Munson Healthcare Contacts Updated CMS Advance Beneficiary Christine Nefcy, MD, FAAP, Chief Medical Officer Notice (ABN) Form Required 231-935-6556, [email protected]

Ed Ness, President and CEO CMS has updated the Advance Beneficiary Notice (ABN) form, 231-935-6910, [email protected] which is used when Medicare payment is expected to be denied. Al Pilong, Chief Operating Officer Old ABN forms will be invalid for all services performed after 231-935-6510, [email protected] 6/20/17 so please update your ABN forms if you haven’t already. New ABN form is available at: https://www.cms.gov/medicare/ Tim Binder, VP Physician Integration medicare-general-information/bni/abn.html. 231-935-6515, [email protected] Chris Podges, Chief Information Officer The ABN, Form CMS-R-131, and form instructions have been approved by the Office of Management and Budget (OMB) for 231-935-6501, [email protected] renewal. While there are no changes to the form itself, providers Thomas Peterson, MD, FAAP, VP Quality & Safety should note the newly incorporated expiration date on the form. 231-935-6519, [email protected] With the 2016 PRA submission, a non-substantive change has been made to the ABN. In accordance with Section 504 of the Andrea Ludka, Director, Physician Relations Rehabilitation Act of 1973 (Section 504), the form has been revised 231-935-3391, [email protected] to include language informing beneficiaries of their rights to CMS nondiscrimination practices and how to request the ABN in an alternative format if needed.

All valid ABNs will now have to have this form number and expiration on the bottom of the forms.

Page 12 | thePulse munsonhealthcare.org/ForPhysicians