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VANDERBILT UNIVERSITY MEDICAL STAFF & VANDERBILT MEDICAL GROUP ANNUAL MEETING Thursday, June 28, :30 – 6 pm 208 Light Hall 1
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VANDERBILT UNIVERSITY MEDICAL STAFF ANNUAL MEETING AGENDA
Welcome C. Lee Parmley, MD Chair, Medical Center Medical Board (MCMB) Proposed Amendments to Medical Staff Bylaws, Rules & Regulations and Policies & Procedures MCMB Membership Elections Adjournment 2
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PROPOSED AMENDMENTS TO MEDICAL STAFF BYLAWS, RULES & REGULATIONS AND POLICIES & PROCEDURES
Goals of Proposed Revisions: To comply with evolving CMS, Joint Commission and NCQA standards To streamline Medical Staff Bylaws, Rules & Regulations, Policies & Procedures and VUMC policies and to create internal consistency To address and codify evolution of VUMC staffing and clinical practice 3
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AMENDMENT REVIEW AND APPROVAL PROCESS
Administrative Affairs Committee identification of CMS, Joint Commission and NCQA requirements, inconsistencies, and other needs for additions/revisions/deletions Executive Committee of MCMB & full MCMB review recommendations of Administrative Affairs Committee, amend and endorse as appropriate VUMC Medical Staff approval of amendments at Annual Meeting Medical Center Affairs Committee (Board of Trust Committee) final approval 4
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AMENDMENTS TO MEDICAL STAFF BYLAWS AND RULES & REGULATIONS
Article XII – Corrective Action Proposal to add verbiage requiring providers to inform their Chair of the initiation of any disciplinary action by another hospital, licensing board, etc. and to keep informed as to the progress and outcomes of such action and proceedings Article VII – Clinical Services Add Physical Medicine & Rehabilitation Article VI – Privileged Professional Staff Change all references in Medical Staff Bylaws and Rules & Regulations “Professional Staff with Privileges” 5
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AMENDMENTS TO MEDICAL BYLAWS AND RULES & REGULATIONS
Article III – General Qualifications for Appointment Add verbiage that defines an “approved residency” as one accredited by ACGME, American Osteopathic Association, College of Family Physicians of Canada CFPC and/or Royal College of Physicians and Surgeons of Canada Add verbiage that refers all allegations of discrimination in the credentialing decision-making process to EAD with periodic audits of all denials to ensure that providers are not discriminated against Rules & Rags – History & Physical Section Change verbiage to include Anesthesiologists as “attending” for the purpose of taking histories and performing physical examinations 6
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AMENDMENTS TO MEDICAL STAFF BYLAW AND RULES & REGULATIONS
Article III – Appointment and Reappointment Modify board certification requirements as indicated to become compliant with Joint Commission standards and current practice: When the applicant possesses comparable training, experience and competence but (1) Board Certification was not applicable at the time the applicant’s training was completed or (2) the applicant is only certified in a non-U.S. or non-Canadian Board or 3) the board certification is in a specialty other than the primary division (department), the applicable Chief of Service may submit a written request for a waiver of this requirement to the Credentials Committee Chairman for action by the Credentials Committee with subsequent approval by the MCMB and MCAC. However, Physicians must maintain their Certification by board whatever re-certification process is outlined by their applicable 7
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ACTION POINT Approval of proposed amendments to Medical Staff Bylaws, Rules & Regulations, and Policies & Procedures Required 8
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MCMB MEMBERSHIP UPDATES & ELECTIONS
At-Large Members (3) elected annually Nominees: Andre Churchwell, MD A. Alex Jahangir, MD James “Pete” Powell, MD ACTION POINTS At-Large Member Elections require a majority vote of the voting members present Adjournment of Medical Staff Meeting
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VANDERBILT MEDICAL GROUP ANNUAL MEETING AGENDA
VMGVMG Finance Committee – Roland Eavey, MD VMG Credentialing – Steven Meranze, MD VMG Billing Office –Meredith Marwill Contracting Update – Beverly Coccia VMG Quality Council – Racy Peters Physician Council on Clinical Service Excellence – Gaye Smith Hitch and Other Operational Initiatives – Margaret Head Economic Repositioning – David Posch
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VMG Finance Group 06/26/2012
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Committee Members Dan Beauchamp Marc Bennett Brian Carlson
Sandy Cherry Keith Churchwell Titus Daniels Marilyn Dubree Roland Eavey Phyllis Ekdall Janice Fruci Denis Gallagher Sheri Haun Margaret Head Stephan Heckers Tommy Hollinden Mack Howell Mark Hubbard Howard Jones Mike Laposata John Manning Steve Meranze Derek Miller Colin Mothupi Robin Mutz Mike Neuss Jim Newman Bill Obremskey David Posch Pete Powell Margaret Rush Warren Sandberg Diane Seloff Janice Smith Robin Steaban Cindy Sullivan Paul Sternberg Reid Thompson Dell Yarbrough
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Identity Historically - an audit committee Contemporary needs
$400M budget re-engineering over upcoming years Comfortable conversation to align our values/missions with our economic forces Grow revenues plus reduce expenses Process > Product
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Meeting 1: Provider Compensation Model
“Medicare cutting reimbursements” Sensitive elephant “Officially” discussed compensation modeling with reduced dollars (our values, process examples, leadership) November 30, 2011
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Bring up the sensitive topic
Valued ingredients re compensation Time frame
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Meeting 2: TOOLS Cost Reduction = Quality Increase
Lost/Cost Awareness Tools (SLA) Service Line Analytics (MD level utilization) WebMD (local/national institutions) UHC (AMCs) Healthcare Quality Calculator (utility) December 7, 2011
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Meeting 3: Strategic Growth Tools
Investment information: THA, HSDA, UHC, JAR, Thompson Reuters Finance: Where we are/Where we want to be Medipac/Epic/TSI SLA/Crimson/UHC Tracking Team…..ROI view January 12, 2012
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Meeting 4: Cost Homework and Parking
Valve Data Analysis…Cost/LOS/Readmission Parking January 31, 2012
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Meeting 5: Optimal Resource Management
Teams (MD/RN/MBA) Departmental variance Inpatient/Outpatient May 29, 2012
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Meeting 6: Optimal Resource Management
Why haven’t we fixed Fridays?
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Credentials Committee Report Steven Meranze, M.D.
Vanderbilt University Medical Staff and Vanderbilt Medical Group Meeting June 28, 2012 Credentials Committee Report Steven Meranze, M.D.
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Organizational Structure
The Credentials Committee (Steven Meranze) Participating sub-committees Children’s Hospital Credentials Committee (Gregory Mencio) Joint Practice Committee (Clare Thomson-Smith) Provider Support Services Office (Danielle Midgett) The credentials committee is “The” committee and Children’s and Joint Practice are the sub-committees. My last name does not end with an e and it should be “joint practice” with the s.
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Credentials Committee
Representation of the major clinical specialties, including behavioral health, the hospital-based specialties and the Medical Staff at large Meets monthly Synopsis of duties (see Bylaws): To evaluate the credentials and performance of all applicants for Medical Staff membership and reappointment To review recommendations from the Joint Practice Committee regarding the credentials, performance, and supervisory arrangements of all Certified Nurse Practitioners, Certified Nurse Midwives, Physician Assistants, Certified Registered Nurse Anesthetists and Allied Health Practitioners who apply for privileges to practice at VUMC. To report to the Medical Center Medical Board on each applicant for Medical Staff or other professional staff recommendation to the Medical Center Affairs Committee (MCAC). Reports and recommendations regarding Medical Staff and other professional staff appointment and delineation of practice privileges shall include consideration of any recommendations from the Service in which the candidate requests privileges; To investigate any breach of ethics that is reported to it. To review reports of Medical Staff or other professional staff member performance or conduct issues that are referred to it, and to provide peer review in response to competence or performance inquiries.
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Timeliness of File Review and Approval
Influenced by many factors Licensure and DEA Verification (all education, hospital affiliations and work history) Faculty appointment Trust coverage/ Claims history Competency documentation Incomplete application Affects practice planning (personal and division) Enrollment considerations (NCQA) Increased need for expedited credentials committee meetings Verification encompasses all education, hospital affiliations and work history. License and DEA are both problematic
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National Committee on Quality Assurance (NCQA) certified Credentials Verification Organization (CVO)
Develop delegated credentialing agreements with managed care organizations (MCO) Delegate MCO credentialing activities to Vanderbilt. VMG providers who are approved through the VUMC Credentials Committee review process are “automatically” enrolled in ~43 managed care plans versus each provider completing and submitting separate applications to each of these organizations Creates an additional layer of complexity and scrutiny to credentialing activities Files >120 days are considered “expired” and require re-submission and re-verification
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Number files met 90
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Expedited Credentialing
Expedited credentialing: Provider is reviewed and approved for privileges by an agent (subcommittee) of the governing body (MCAC) Defined exclusion criteria Legitimate action to answer immediate needs (e.g. critical staffing issues) Large number may reflect system limitations MCBEC-BOT is no longer the correct term for the Board. It should be MCAC.
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Future Initiatives Paperless credentialing
E-file “secure transfer “(Accellion) Electronic signature - “Pronto System” Phased implementation Improved interface with the Faculty Information System for Faculty Appointments Our credentialing documents have always been standardized…..now they are able to be disseminated and completed electronically. Submission of them with an electronic signature is the future state. E-file is too closely associated with activities we currently perform. I would re-word to “secure transfer” through Accellion or something similar. I would refer to Faculty Affairs initiative as interface with the Faculty Information System for Faculty Appointments.
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VMG Business Office Update
Presented by Meredith Marwill Associate Director of Physician Billing Services
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7. Vanderbilt Medical Group
Faculty Practice Solutions Center Billing Office Survey FY2010 Top 10 Performers VMG ranked 7th overall in benchmark performance indicators reported by 56 academic institutions through University Healthcare Consortium (UHC). 1. University of Pittsburgh Medical Center 2. UMass Memorial Medical Group 3. University of Minnesota Physicians 4. Massachusetts General Physician Organization 5. The Medical College of Wisconsin 6. University of Wisconsin Medical Foundation 7. Vanderbilt Medical Group 7. University of Texas Medical Branch (Galveston) 9. University of Virginia Physicians Group 10. Fletcher Allen Health Care/University of Vermont
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Gross Professional Charges
2012 Charges have increased 10.9%. 2011 Charges increased 6.7% 2010 Charges increased 17.2% 2009 Charges increased 11.0% 2008 Charges increased 8.1% 2008 – 2012 Charges increased 54.0% Charges in the last five-months of this fiscal year (Jan-May) are running 7.0% higher than in the first-six months (July-Dec) of the fiscal year – Anesthesiology, Medicine, Pediatrics, and VHI make up 62% of the increase. Charges have increased 10.9% from prior fiscal year. 34
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Annual Cash Collections
2012 Collections have increased 7.9%. 2011 Collections increased 9.6% 2010 Collections increased 16.5% 2009 Collections increased 11.4% 2008 Collections increased 11.3% 2008 – 2012 Collections increased 53.4% Collections have increased 7.9% from prior fiscal year. 35
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Total RVU Volume **Confirm all prior years are restated to new year**
2012 Total RVUs have increased 8.7% 2011 Total RVUs increased 6.1% 2010 Total RVUs increased 12.6% 2009 Total RVUs increased 6.1% 2008 Total RVUs increased 5.1% 2008 – 2012 Total RVUs increased 37.8% Prior year RVUs have been restated to 2012 RVUs. RVUs generated for FY12 are estimated at 11.3M compared to 10.4M last year. This represents a 8.7% increase in RVUs generated. Total RVUs have increased 8.7% from prior fiscal year. 36
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Collections Per RVU **Confirm all prior years are restated to new year** FY12 Collections per RVU has decreased to $48.13 From 2011 to 2012 the Collections/RVU for Medicare declined 4%. The Collections/RVU for TennCare declined 2%. Blue Shield increased 2% and Commercial increased 5% to help offset the decline from Medicare and TennCare. The Medicare Payor Mix has shifted from 26% in 2011 to 27% in 2012. Collections/RVU has decreased 0.7% from prior fiscal year. 37
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Days in A/R / Charge Lag UHC FY 2011 Survey
Days in AR are estimated to be at 31 days with Charge Lag at 5.0 days at the close of this fiscal year. UHC FY 2011 Survey Days in A/R 25th percentile = 47.4 days Median = 41.2 days 75th percentile = 36.9 days 38
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Cost to Collect as percent of Net Collections
11.1% 10.6% 10.8% Cost to Collect has remained stable this past fiscal year. 9.8% 8.8% 8.3% 7.9% 7.4% 7.0% 6.3% 6.3% The Cost to Collect remained the same at 6.3% for FY12 as of May 31, 2012. The Business Office, Physician Billing, Coding and Provider Support Services represent 4.4% of this percentage (FY11-4.6%). The FY12 budgeted expenses for these four areas is projected to be below 4.3%. The cost is the same despite the 8-10% growth in volume. The cost to collect over the past three years has remained unchanged even as charges have increased from 2009 – 2012 by 38.7%. 2012 *2012 FYTD through May 39
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Projects and Opportunities for FY 2013
Continue to improve patient collections Expand Point of Service collection program to address increasing patient out of pocket requirements Develop vendor partnership to allow for combined patient collection activities with VUMC Continue to redesign work flow processes and systems to enhance the revenue cycle Migrate toward a paperless work environment in the revenue cycle through further development of EPIC workqueues and other technology enhancements Developing best practice documentation to move towards more consistent work processes within all areas of the revenue cycle ICD10 Training and Preparation Add note on ICD 10 implementation date…..may want to add it to the slide for all to see
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Contracting 2012 Highlights
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2012 VMG Annual Faculty Meeting June 28, 2012
VMG Quality Reporting 2012 VMG Annual Faculty Meeting June 28, 2012 6/28/2012
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The Mission of VMG is to improve the health of the people
in the communities we serve through evidence-based, personalized, compassionate care, research and education. 6/28/2012
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Hand Hygiene 6/28/2012
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Adult Anticoagulation Clinic
6/28/2012
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Adult Anticoagulation Clinic
6/28/2012
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New Patient Access 6/28/2012
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Publicly Reported Measures: OPPS
Timing and appropriateness of antibiotic prophylaxis in outpatient procedures 6/28/2012
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Publicly Reported Measures: PQRS
Voluntary quality reporting program Provides incentive payments of 1% of all Medicare Part B billings for each eligible provider (EP) Reporting Period: full calendar year 2011 Data will not be publicly reported for 2011 or 2012 6/28/2012
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Publicly Reported Measures: PQRS
Incentive timeline and amounts: 2012: 0.5 % 2013: 0.5 % 2014: 0.5 % Penalty timeline and amounts: 2015: 1.5 % (will be based on 2013 submission) 2016 and each subsequent year: 2.0 % Data will be publicly reported beginning 2013 or 2014 (exact year still TBD) 6/28/2012
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PQRS Measure #1: Hemoglobin A1c Poor Control in Diabetes % of Pts Aged with Diabetes Mellitus with Most Recent Hemoglobin A1c >9.0% 6/28/2012
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Measure #2: Low Density Lipoprotein (LDL-C) Control in Diabetes % of Pts Aged with Diabetes Mellitus who had Most Recent LDL-C Level in Control (<100 mg/dl) 6/28/2012
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Measure #3: High Blood Pressure Control in Diabetes % of Pts Aged with Diabetes Mellitus who had Most Recent Blood Pressure In Control (<140/90 mmHg) 6/28/2012
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Measure # 5: Heart Failure: ACE Inhibitor or ARB Therapy for LVSD % of Pts Aged 18+ with Heart Failure and LVSD (LVEF < 40%) who were Prescribed an ACE inhibitor or ARB Therapy 6/28/2012
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Measure #6: Oral Antiplatelet Therapy Prescribed for Patients with CAD % of Pts Aged 18+ with a Diagnosis of CAD who were Prescribed Oral Antiplatelet Therapy 6/28/2012
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Measure #7: Beta-Blocker Therapy for CAD Patients with Prior Myocardial Infarction (MI) % of Pts Aged 18+ with a Diagnosis of CAD and prior MI who were Prescribed Beta-Blocker Therapy 6/28/2012
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Measure #8: Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD) % of Pts Aged 18+ with a Diagnosis of Heart Failure who also have LVSD (LVEF < 40%) and who were Prescribed Beta-Blocker Therapy 6/28/2012
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New VMG Medical Director for Quality: Barron Patterson, MD
6/28/2012
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Physician Council for Clinical Service Excellence
June, 2012
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Patient Experience & Service Council Structure
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Physician Council for Clinical Service Excellence
Began meeting in March of 2011 Meets monthly Membership represents 14 clinical departments plus Williamson County 28 physician members Chair: Paul Sternberg, M.D. Co Chairs: Andre Churchwell, M.D. and Leah Harris, M.D. Facilitators: Lynn Webb, Ph.D.; Gaye Smith
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Physician Council Members
John (Jake) Block, Radiology Nathaniel Clark, Psychiatry Anthony Cmelak, Radiation Oncology Marta Crispens, OB-GYN Titus Daniels, Medicine Jesse Ehrenfeld, Anesthesiology James Felch, Ophthalmology Brent Graham, Pediatrics Rob Hood, Medicine Alex Hughes, Anesthesiology Ian Jones, Emergency Med Eric Lambright, Surgical Sciences Mike Laposata, Pathology Tracy McGregor, Pediatrics Steven Meranze, Radiology Paul Moore, Pediatrics Melinda New, OB-GYN David Parra, Pediatrics John Peach, Medicine Jan Price, Medicine Russell Ries, Otolaryngology Henry (Hank) Russell, W'mson Co - VMG John Scott, W'mson Co - VMG Carmen Solorzano, Surgical Sciences David Uskavitch, Neurology Douglas Weikert, Orthopaedics Patty Wright, Medicine Kelly Wright, Surgical Sciences
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Key Topics Discussed Why a Physician Council?
PRC Patient Satisfaction Surveys (use of % excellent vs. percentiles in Service Pillar goals) HITECH Meaningful Use implications for clinical practices and work flow Studer Physician Institute: “Practicing Excellence: Engaging Physicians to Execute System Performance” Patient and Family “Always Promise” Use of a video on effective communication between physicians and patients Provided input for process improvement in patient complaint mgmt Renaming Patient Affairs “Advocates” to Patient Relations “Specialists” Ways to formally recognize Clinical Excellence
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Chief Operating Officer/Chief Nursing Officer
Operations Update Margaret Head, RN, MSN, MBA Chief Operating Officer/Chief Nursing Officer
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2012 Clinic Expansions and Acquisitions
VEI acquisition of Lebanon Eye Associates VOI Clinic expansion to Mt. Juliet Williamson County School District contract for athletic trainers Franklin Cardiology expansion Maternal Fetal Medicine rotation in Columbia DOT 10 floor completion
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VMG Nursing Updates VMG Staff Turnover Rate 9.88%
32 RN’s and 9 LPN’s advanced in the nursing clinical ladder program Significant work in developing nursing triage and RX star renewal protocols Received special recognition during the Magnet Survey
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Status of Meaningful Use Implementation
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Cohort Training Timeline
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HITECH Faculty and Staff Trained
Eligible Providers Eligible Provider trained Eligible Provider remaining to be trained 187 Total Eligible Providers Providers Trained Staff Trained Total Trained to date
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HITECH PHASE II/ICD-10 HITECH Phase II
Vanderbilt Outpatient Order Management (VOOM) Pilots under way in several clinics Staged roll out to begin in Oct 2012 ICD-10 Tools being developed to help with transition from ICD-9 to ICD-10 Pilots have begun on these tools with expected rollout to being in Spring of 2013
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Economic Repositioning David Posch
June, 2012
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Chief Operating Officer Vanderbilt University Hospital
Mitch Edgeworth Chief Operating Officer Vanderbilt University Hospital
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Coordinating Care Redesign fundamental Care Processes to improve efficiency and effectiveness Disease Clinic Procedure ICU Inpatient Discharge Post Acute Home Self Disjointed care coordination or lack thereof across the continuum Failure to reliably apply and execute known science every patient every time Extraordinary variability in quality and cost Failure to effectively engage patients and their extended care givers in their care process Estimates exist that solving these problems could remove 30% of health care cost Health care remains fragmented-MDs in single specialty private practice, disconnected from each other and hospitals, duplicative testing, poor sharing of patient data, no common IT infrastructure, not knowing problems, prior procedures, allergies , drugs-source of error While consolidation is occurring-look under the covers-is care coordination occurring or just bargaining strength? Redesign the infrastructure to improve efficiency and effectiveness across all care transitions
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Inpatient Care Coordination Model
Risk Stratification Medication Reconciliation Huddle Care Plan 1.0 Post Discharge Intermediate Care Post Discharge Phone Call Post Discharge Clinic Visit
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Economic Repositioning
Top 5 Projects MEOC Initiatives FY13 340B Contract Pharmacies Specialty Pharmacy Care Partner Redesign Case Scripting > 200 Ideas submitted ~ 40 active projects Top 5 represent ~$22MM of the $30MM built into FY’13 Budget Detail is on the next slide. FY’12 Forecast Savings FY’13 Savings in Budget Anticipated Savings $8 million $30 million $32 million
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Manpower May ‘12 Actual FY’12 Budget FY’13 Budget FTEs (Adult) 8,912.6
8,968.0 9,147.0 246 FTE reductions were made through attrition and repurposing of positions Detail is on the next slide.
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