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November 6, 2015

Articles:

1. Joint Commission on Health Care Recommendations on Graduate Medical Education Improvement 2. VHHA in the News 3. 2015 Legislative Election Recap 4. VHHA’s October-November FOCUS Examines Rural Hospitals and Communities They Serve 5. All Payer Claims Database Update 6. Plans Underway to Create Pro-Hospital Virginia License Plate 7. Research Corner: Scrutinizing Patients with Hip or Knee Replacements 8. March of Dimes Gives Virginia High Marks for Premature Birth Improvement 9. McNamee Joins VHHA as Vice President, Chief Financial Officer 10. Last Chance to Register for Virginia Nurses Association Interprofessional Conference in November 11. VHHA Members Offered Discount for Orlando (FL) Studer Conference 12. VHREF Upcoming Programs and Webinars

1. Joint Commission on Health Care Recommendations on Graduate Medical Education Improvement

The Joint Commission on Health Care at its Nov. 4 meeting took action on eight staff recommendations to strengthen Graduate Medical Education (GME) in Virginia. The entire list of recommendations can be found at the JCHC Decision Matrix. The Commission adopted recommendations two through eight. As detailed in the JCHC Decision Matrix, the Commission staff has identified three policy options to address the needs of rural and underserved communities:  Start-up funding for new residency programs;  Start-up funding for programs that follow the Teaching Health Center GME Program model; and  Ongoing funding for sole community hospital residency programs. Other policy options considered include updating Virginia’s Medicaid GME payment system, increasing Medicaid GME funding for needed specialties, increasing state appropriations for the Loan Repayment Program, workforce and GME data collection, and establishing a GME governance structure. Members of the Commission agree that Virginia’s current GME system is not sustainable and needs improvement. To that end, legislation and budget amendments will be introduced by JCHC members during the 2016 General Assembly session reflecting staff recommendations. VHHA formally responded to the recommendations presented by the JCHC staff; Association comments can be found in the JCHC Decision Matrix. Meanwhile, the Virginia Health Workforce Development Authority will survey hospitals and health systems to determine interest in developing a new GME program. – Jennifer Wicker Back

2. VHHA in the News

VHHA is an active participant in conversations about public policy outcomes to protect and enhance the public’s access to high quality health care. That public engagement includes working to attract news coverage focusing on the issues affecting Virginia hospitals and health systems to help better educate the public and elected officials. In the past week, VHHA has been featured by multiple news organizations. Fresh news coverage of VHHA’s Virginia Hospitals: Our Lifeline campaign appeared in the Health Journal Magazine, which published a story about the local economic impacts of fiscal stress on hospitals. A story that appeared on WTVR, Richmond’s CBS affiliate, featured VHHA on the subject of health care policy and coverage access. VHHA was also included in two Virginia Business Magazine articles – one on the All Payer Claims Database and another on Virginia’s economic outlook. In addition to traditional media engagement, VHHA actively promotes hospital and health system good news stories through its Facebook and Twitter pages. We invite you to engage with VHHA on those platforms. – Julian Walker Back

3. Virginia 2015 Legislative Election Recap

Virginia held its off-off-off year legislative elections Tuesday. After months of intense campaign politics, the overall numeric results were nearly identical to what they had been prior to the election. Republicans retained their narrow majority in the Senate, winning the same number of seats (21) they had entering Tuesday. Likewise, Democrats ended the campaign with control of the same 19 seats party representatives presently occupy. No Senate incumbent seeking re-election this year lost their seat and no seat held by one party was captured by the other. Republicans also maintained a firm grip on power in the House of Delegates. Democrats made a net gain of one seat, reducing the GOP majority in the 100-member House from 67 to 66 seats. Both chambers will have some new faces due to incumbent retirements and the outcome of a few nomination contests back in June. Significant focus in these elections centered on the Virginia Senate because control of that chamber was at stake. As a result, political parties, donors, and outside groups poured substantial sums of money (it is estimated the total eclipsed $40 million) into various Senate contests. While both sides invested significantly to influence the outcome, not every race was contested. According to the Virginia Public Access Project, 17 of 40 Senate seats were uncontested, and 62 of 100 House seats were uncontested. In the Senate, there are five new Republicans and two new Democrats. A headliner of the new Senate Republican class is , a Richmond School Board member who won a Chesterfield County-centric district contest to replace retiring Sen. John Watkins, a Republican who advocated for the Marketplace Virginia plan to enhance health insurance coverage in Virginia. Sturtevant’s victory over Democrat Dan Gecker in a seat Democrats targeted as a potential steal scuttled the party’s hope of regaining control of the divided Senate. In the end, status quo won the day. Other Senate Republican newcomers include Dr. Siobhan Stolle Dunnavant (the sister of Virginia Beach Republican Del. Chris Stolle – he is also a physician), who replaces retiring GOP Sen. Walter Stosch, another Marketplace Virginia champion, in a Henrico County- based district; replaces departing GOP Sen. Steve Martin in a Chesterfield area seat; Del. Bill DeSteph handily won his bid to succeed retiring Sen. Jeff McWaters (R) in a Virginia Beach area district; and former Legislative Aide succeeds his boss, Sen. Ralph Smith, in district near Roanoke. Among Democrats, Del. of Fairfax County matriculated from the House to the Senate by succeeding retiring Democratic Sen. Linda “Toddy” Puller; and Jeremy McPike outlasted Manassas Mayor Hal Parrish, the Republican nominee, in a multi-million dollar race to replace long- serving Sen. Chuck Colgan (D) as the representative of a Prince William County-based district. The new members-elect in the House of Delegates include seven Democrats and four Republicans. Democratic newcomers include Lashrecse Aird (Petersburg), Steve Heretick (Portsmouth), Paul Krizek (Fairfax County), Mark Levine (Fairfax County), and Marcia S. “Cia” Price (Newport News). Republican newcomers include Chris Collins (Winchester area), Nicholas “Nick” Freitas (Culpeper County), and Jason Miyares (Virginia Beach). (Republican Mark Dudenhefer is a past delegate returning to the legislature to represent a district encompassing portions of Stafford and Prince William counties.) Overall, the GOP claimed one House seat currently held by Democrats, while Democrats won two swing seats being vacated by Republicans. In each of those cases, the incumbent did not seek re-election to that seat this year. Both parties retained other open seats for which the party incumbent was not the nominee. – Julian Walker Back

4. VHHA’s October-November FOCUS Examines Rural Hospitals and Communities They Serve

The October-November edition of VHHA’s FOCUS publication takes a closer look at the challenging economic plight of Virginia’s rural hospitals and the communities they serve. Rural hospitals are vitally important to their local communities as economic engines, major employers, and public health providers. Unfortunately, they face serious financial stress due to government decisions, funding cuts, and community demographics. Policy solutions that protect rural hospitals are necessary to preserve the stability of health care providers in communities outside Virginia’s population centers where a strong health care network is a key asset. We encourage you to read the current edition and share it among your networks. We also encourage you to visit www.ISupportVirginiaHospitals.com to learn more about the Virginia Hospitals: Our Lifeline public awareness campaign, and to sign up in support of Virginia’s local hospitals. – Julian Walker Back

5. All Payer Claims Database Update

Virginia Health Information (VHI) now offers a new tool from Milliman called Query Express (QE) for use with data in Virginia’s All Payer Claims Database (APCD) on the MedInsight platform (see image below). MedInsight QE gives APCD subscribers robust capabilities to conduct database queries. Each user may create customized de-identified data sets* and then generate detailed queries using the created data sets. Additionally, set operations are provided in QE to allow users to join sets to create detailed unions or subsets. QE, in essence, allows the user to generate sophisticated queries, without coding expertise, through an intuitive drag-and-drop interface. Six health systems have joined: Carilion Clinic, HCA Virginia, Inova Health System, Mary Washington Healthcare, Sentara Healthcare, and Virginia Hospital Center. VHI will provide resources on QE in the coming weeks, including a video training session. – Barbara Brown

*All claims information available from the Virginia APCD utilizes a Standardized Proxy Reimbursement amount. The Standardized Proxy Amount prevents the potential for reverse engineering actual reimbursement amounts on aggregate or individual claims data.

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6. Plans Underway to Create Pro-Hospital Virginia License Plate

As part of its efforts to promote Virginia’s local hospitals and health systems, VHHA is working with members of the Virginia General Assembly to create a pro-hospital license plate that, if passed into law, would be available to Virginia drivers through the Department of Motor Vehicles. Achieving this requires passage of legislation and, as a pre-condition of General Assembly authorization, prepaid applications from 450 Virginia motorists who want to order the specialty plates for their vehicle. The fee is $10 for non-personalized plates, or $20 for personalized plates. VHHA staff will provide applications and be accepting prepaid signs-ups at the upcoming annual meeting Nov. 11-13 at The Homestead. A mockup of the plate design is pictured above. Working to create a pro-hospital Virginia license plate is another way to communicate with lawmakers, the media, and the public about the value and importance of health care providers. – Julian Walker

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7. Research Corner: Scrutinizing Patients with Hip or Knee Replacements

Starting this year, the Centers for Medicare and Medicaid Services (CMS) is tracking hip and knee replacement readmissions as part of its Value Based Purchasing initiative. The choice of these procedures is interesting for several reasons. As shown in Figure 1, patients most likely to have a hip or knee replaced are those 40-64 years old.1 People in that age bracket are not typical Medicare beneficiaries. Figure 1. THR/TKR Readmissions by Age Category

Figure 2. THR/TKR 30-Day Readmissions by Age Category

Overall, knee replacements are nearly twice as frequent as hip replacements. Hospital readmission trends following hip replacement track age trends. More readmissions occur in the 40-64 age group than in older or younger patients. However, as Figure 2 shows, that is not the case for readmissions of patients with knee replacements. With knee surgery, patients ages 65 -74 have a greater number of readmissions. Their readmission rate is 28 percent, whereas the younger age group has a readmission rate closer to 8 percent. Hip and knee replacement procedures are costly. The average median hospital charge for a hip replacement in the Richmond area is $75,000. It is $83,0002 for knee replacement. Cost, frequency, and the rate of readmissions are good reasons for CMS scrutiny.—Barbara Brown Footnotes 1 VHHA Hip and Knee Readmission Database (2015, First Quarter) 2 VHHA PricePoint website Back

8. March of Dimes Gives Virginia High Marks for Premature Birth Improvement

The March of Dimes released the 2015 Premature Birth Report Cards this week at a news conference in the General Assembly Building at the State Capitol. Virginia received high marks in two areas. The 2014 preterm birth rate for Virginia was 9.2 percent, a “B” score on the Prematurity Report Card (the national average is 9.6 percent with a score of C). On the racial and ethnic disparity index, which provides a measure of differences in preterm birth rates across racial and ethnic groups within a geographic area, was 16, ranking Virginia sixth in the nation. Also at the Nov. 5 event, Keith Middleton, Board Chairmain with the March of Dimes Virginia, presented state Health Commissioner Dr. Marissa Levine with the Virginia APGAR Award. The Virginia APGAR Award recognizes states and territories that accepted and met the challenge from the March of Dimes and the Association of State and Territorial Health Officials to lower their preterm birth rate by 8 percent between 2009-2014. The award is named for Virginia Apgar, MD, who developed the 5-point APGAR score to evaluate an infant’s health at birth. Dr. Levine accepted the award on behalf of all Virginians who work tirelessly to promote thriving infants and families in Virginia. The March of Dimes also thanks Virginia hospitals and VHHA for their collaboration on reducing preterm births, including the work to reduce early elective deliveries. – Joan Williamson Back

9. McNamee Joins VHHA as Vice President, Chief Financial Officer

Certified Public Accountant and Human Resources specialist Elizabeth McNamee recently joined VHHA as a Vice President and Chief Financial Officer. Beth has more than 25 years of professional experience in accounting, organizational finance, and human resources management. She also brings to VHHA past experience with a membership association, having most recently served as Director of Human and Financial Resources for the Virginia Education Association which represents teachers in the Commonwealth. Beth is a married mother to three children – ages 26, 23, and 15 – and a dog named Cooper. Back

10. Last Chance to Register for Virginia Nurses Association Interprofessional Conference in November

Join the Virginia Nurses Association Nov. 20-21 for an exploration of interprofessional collaboration at the Virginia Nurses Association’s Patient- & Family-Centered Care: An Interprofessional Approach fall conference. Presented in partnership with the Medical Society of Virginia, VHHA, and the Virginia Pharmacists Association, the conference will feature best practices for interprofessional collaboration and engaging speakers including Sally Okun, Marilyn Tavenner, Nick Dawson, Julie Haizlip, and Peter Boling. Attendees will have the opportunity to hear from experts, and learn about practical, easily implemented strategies for interprofessional collaboration with fellow nurses, physicians, pharmacists, administrators, and educators. The conference will also feature more than 140 poster presentations. Visit this link for more information and conference registration. Back

11. VHHA Members Offered Discount for Orlando (FL) Studer Conference

Studer Conferences is offering VHHA members a $200 discount to attend its upcoming Orlando conference (Feb. 22-24, 2016). The conference offers core tracks and more than 40 breakout sessions and keynote presentations from innovative health care leaders. Track options include: Evidence-Based Leadership, HCAHPS Quality of Care, Physician Partnership, Medical Group Transformation, and Emergency Department Excellence. Visit www.studerconferences.com to learn more, and use the code SC16 to receive the member discount. Contact Sara Harris at (850) 439-5933 or [email protected] for more information. – Erin Ehrlich Back

12. VHREF Upcoming Programs and Webinars

The Virginia Hospital Research and Education Foundation regularly hosts informative programs and webinars that can help educate health care professionals and providers. Click here to learn more and register online for VHREF programs. All webinars are $200 per connection (one audio and one internet) unless otherwise noted. Back

Webinar Invite: Physician Leaders’ Role in Becoming a High Performing Health System

Truven Health Analytics invites those interested to participate in a free webinar (Nov. 13, 2015, 2:30 p.m. EST) with the theme “What does it take to become a high performing health system?” Participants will hear from Truven Health Analytics’ Associate Chief Medical Officer, Byron Scott, MD, MBA; and Senior Vice President for Performance Improvement, Jean Chenoweth. They will discuss the key characteristics of high performing health systems. Click here to register. Webinar participants will:  Learn key factors in the development and success of physician leaders in health systems.  Learn key characteristics of high performing health systems.  Learn how two health system physician leaders drive performance and consistency across multiple hospitals.