Department of Anesthesia, Critical Care and Pain Medicine BID - PDF document

12/3/2018 Department of Anesthesia, Critical Care and Pain Medicine BID Plymouth Orientation December 3, 2018 Patient Engagement, Systems Science, and the Elimination of Preventable Harm Agenda • Introductions • Department Overview • Faculty Development • Quality, Safety, Innovation, and Information Technology • Compliance • Billing and Coding • Key Contacts • CME/PDA • What’s coming and Questions Our Mission • Improve the quality of our patients’ lives by providing compassionate, state-of-the-art care. • Advance the field of perioperative medicine by – Generating new knowledge – Educating the next generation of leaders in anesthesia – Driving expansion, improvement, innovation, and integration across the system of perioperative care delivery. • Support personal and professional development and fulfillment for Department members. 1

12/3/2018 Beth Israel Deaconess: Today Our System Today A premier, $2+ billion academic health system including  BIDMC and 3 community member hospitals  1,500 member faculty practice through Harvard Medical Faculty Physicians  6 additional affiliated hospitals  2,600 physicians in BIDCO  Affiliated Physician Group  Strategic partnerships with Atrius, Joslin & Hebrew SeniorLife Why BID + Lahey Health • Our missions are aligned • We share the same values • We complement one another • We will secure and strengthen our legacies • We can be transformative together Combined Scale: BID + Lahey + NEBH + MAH + AJH BI‐ Metric / Statistic Lahey Health Operating Revenue $2,263 M $2,091 M $254 M $449 M $156M $5,213 M Hospitals 4 6 1 1 1 13 Beds 1,035 960 118 192 140 2,445 Physician Network Adult PCPs 519 336 N/A 85 44 984 Specialists 1,875 1,092 92 400 137 3,596 Total 2,394 1,428 92 485 181 4,580 Notes and Sources: BIDMC includes BIDMC, BID‐M, BID‐N, BID‐P, and APG; BIDMC 2017 budget; Lahey 2017 budget. NEBH 2017 budget; MAH 2017 budget; NEBH staffed bed count from 2016 CareGroup filing; MAH staffed bed count from 2016 CareGroup bond filing. MAH physician count from MACIPA website and physician directory. AJH physician count from AJH website – includes BIDCO numbers previously represented in the BIDMC/BIDCO column. NewCo+ revenue does not include HMFP 2

12/3/2018 Our Department • BIDMC – 39 ORs – NORAs – 16 Labor and Delivery suites – 41 ICU beds • BID Needham- OR • BID Milton- OR and ICU • BID Plymouth- OR and ICU • Anna Jaques - OR • Pain: AWPC, Spine Center, BIDN, BIDM, BIDP, Chestnut Hill, Chelsea, Lexington Department Structure Chair Chair Chief Administrative Chief Administrative Executive VC Executive VC Officer Officer VC VC VC VC VC Operative VC Operative VC VC VC VC Divisions Divisions VC Research VC Research Quality Improvement Quality Improvement Anesthesia Anesthesia Education Education Perioperative Medicine Perioperative Medicine Faculty Affairs Faculty Affairs Innovation and IT Innovation and IT Residency Program Residency Program East Campus Director East Campus Director CARE CARE Director of PAT Director of PAT Director Director Director of Innovation Director of Innovation West Campus Director West Campus Director Director of Patient Director of Patient Fellowship Directors Fellowship Directors Safety Safety Chief Milton Chief Milton Medical Student Medical Student Director of Director of Education Education Informatics/IT Informatics/IT Chief Needham Chief Needham Internship Internship Chief Plymouth Chief Plymouth Chief AJH Chief AJH Department Staff 2010 2012 2014 2016 2018 Faculty 70 81 86 89 107 Research Faculty/Staff 21 23 17 24 37 CRNAs 10 15 21 37 38 Fellows 11 15 14 15 23 Residents 54 54 54 54 54 Interns 3 6 6 6 12 Nurse/PA/MA 15 17 17 24 32 Engineers/IT/Techs 18 19 19 28 29 Administrative 30 31 31 31 54 Totals 232 261 265 308 386 66% increase over 8 years 3

12/3/2018 Faculty Affairs Matthias Eikermann, MD Vice Chair, Faculty Affairs Faculty Affairs Taneshia D. Pina Susan Kilbride Nora Mc Carthy Matthias Eikermann, MD Letisha Phillips Project Administrator Administrative Coordinator Vice Chair, Faculty Affairs Administrative Director Project Administrator Credentialing, Privileging Faculty Affairs Professor of Anaesthesia Faculty Affairs Faculty Affairs and Enrollment and Recruitment and Recruitment Grand Rounds Lectures Opportunity Grand Round lecture series • Target audience: Attending physicians, residents, CRNA, research staff. • Focus on anesthesia and perioperative medicine. • Every Wednesday Morning 7-8 AM • CME credit • Streaming to BIDMC affiliated hospitals • Opportunities to present/ co-present • World class lectures / • Celebrate internal accomplishments 4

12/3/2018 Grand Rounds Agenda Topics Opportunity Grand Round lecture series • Division specific aspects: Cardiac, vascular, thoracic, vascular, obstetrics, pain, critical care. • Important topics across Divisions: Faculty development, research, QI, management, inter-professional relations. Develop Faculty Development program On‐ramp and off‐ramp options! Research (Bala, Simon, Robina, Phil, Rami) Clinical Administrative Excellence Excellence Bringing people together (Krish, Eswar, Sheila, (Pete, Dawn, Sugantha) Todd, Tom) Education (Stephanie, John) Deliverable Mateus: Open calendar for 1:1 meetings – request updated CV and some energy Faculty Affairs - Discussion • Professional growth • Mentorship • Lecture series - Case presentations - Guidelines - Clinical pathways 5

12/3/2018 Quality, Safety, Innovation and Information Technology Satya Krishna Ramachandran, MD Vice‐Chair, QSII Define & Measure Quality Structure Process Outcome How well do we perform How well do our How well does our the process of patient system allow us to patients fare during care? deliver high quality safe or after our care? care? Ext/Int standards Procedural Technical outcomes (e.g. TJC,CMS,DEA) Non-procedural Functional outcomes Compliance Outcomes that matter! Define & Measure Quality Outcome 6

12/3/2018 Challenge for Quality Systems Individual Structure Process Organization What Outcomes? Outcome Sample Workflow for Event Review QA Concern Review Closed Confidential Discussion: QA Committee & Secured Provider & Division Head Discussion Senior Review Subcommittee Professional Standards Organizational responsibility: 1. Defining measures of competence – FPPE/OPPE 2. Determining SOC/reasonable care standards for AE 3. Defining domains and concepts of excellence 4. Culture of respect – supporting individual quality journeys Individual responsibility: 1. Reporting AE and close calls 2. Participate in critical site and network training 3. Commit to respect, learning environments and organizational goals 4. Present AE to group at M&M/protected forums 7

12/3/2018 Tracking Relevant Outcomes Project Communication Project Communication 8

12/3/2018 Summary Structure, Process, Outcome • Renewed energy for aligning and enhanced focus on excellence • Support for framework from BIDMC QSII • Readiness for regulatory body visits Learning environment • Respect • Use technology and innovative methodology • Openness to change Compliance Phil Hess, MD Director of OB Anesthesia Program Director, Obstetrical Anesthesia Fellowship Compliance with: • Governmental organizations – CMS (Medicare & Medicaid) – FDA – OSHA – DPH • Non-governmental Organizations – The Joint Commission – USP – ACGME – Insurance companies 9

12/3/2018 Billing Compliance Patient care Office of the Inspector General Medical chart (OIG) Coding (ICD-10 & • Ensure CPT) compliance with Billing all Federal rules and regulations Denial & rebilling • 2016 Anesthesia billing compliance became a focus What’s covered? Perioperative care Not covered here • Pain Regional • APS OB • CPS GI • ICU Types of Billing Personally perform - continuously and personally present throughout the entire procedure Medical direction – coverage of 2 to 4 simultaneous cases (teaching rule exception for only 2 locations) Medical supervision – cannot meet demands of Medical direction  Each coverage is a modifier added to the submitted bill 10

12/3/2018 Medical Direction – 7 requirements • Performs a pre-anesthetic examination and evaluation; • Prescribes the anesthesia plan; • Personally participates in the most demanding procedures in the anesthesia plan, including, if applicable, induction and emergence; • Ensures that any procedures in the anesthesia plan that he or she does not perform are performed by a qualified anesthetist; • Monitors the course of the anesthesia administration at frequent intervals; • Remains physically present and available for immediate diagnosis and treatment of emergencies; • Provides indicated post-anesthesia care. Medical Direction – 7 requirements Personally participates in the most demanding procedures in the anesthesia plan, including, if applicable, induction and emergence • Induction and Emergence should be defined in policy Medical Direction – 7 requirements Induction – Occurs with GA and Regional anesthesia (e.g. spinal anesthesia, nerve block) – Does not occur as a discrete event with MAC / analgesia Emergence – Continuum of emergence from decision to PACU (GA only, ?MAC) 11