12/3/2018 department of anesthesia, critical care and pain ... · 12/3/2018 1 department of...

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Department of Anesthesia, Critical Care and Pain Medicine

BID Plymouth OrientationDecember 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 developmentand fulfillment for Department members.

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Beth Israel Deaconess: Today

Our System TodayA 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

Metric / StatisticBI‐

LaheyHealth

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

Combined Scale: BID + Lahey + NEBH + MAH + AJH

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

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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

ChairChair

VC Operative Anesthesia

VC Operative Anesthesia

East Campus DirectorEast Campus Director

West Campus Director West Campus Director

Chief Milton Chief Milton

Chief NeedhamChief Needham

Chief Plymouth Chief Plymouth

Chief AJHChief AJH

DivisionsDivisions VC ResearchVC Research

CARECARE

VC

Education

VC

Education

Residency Program Director

Residency Program Director

Fellowship DirectorsFellowship Directors

Medical Student Education

Medical Student Education

InternshipInternship

VC

Perioperative Medicine

VC

Perioperative Medicine

Director of PATDirector of PAT

VC

Quality Improvement Innovation and IT

VC

Quality Improvement Innovation and IT

Director of Innovation Director of Innovation

Director of Patient

Safety

Director of Patient

Safety

Director of Informatics/IT Director of

Informatics/IT

VC Faculty Affairs

VC Faculty Affairs

Chief Administrative Officer


Executive VCExecutive VC

Department Staff

66% increase over 8 years

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

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Faculty Affairs

Matthias Eikermann, MD

Vice Chair, Faculty Affairs

Matthias Eikermann, MDVice Chair, Faculty Affairs Professor of Anaesthesia

Faculty Affairs

Susan KilbrideAdministrative Director

Faculty Affairs

Nora Mc CarthyProject Administrator

Faculty Affairs and Recruitment

Letisha PhillipsProject Administrator Credentialing, Privileging and Enrollment

Taneshia D. PinaAdministrative Coordinator

Faculty Affairs 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

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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

Excellence

(Krish, Eswar, Sheila, Todd, Tom)

Education

(Stephanie, John)

Administrative Excellence

(Pete, Dawn, Sugantha)

Bringing people together

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

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Quality, Safety, Innovation and Information Technology

Satya Krishna Ramachandran, MD

Vice‐Chair, QSII

Structure

How well does our system allow us to

deliver high quality safe care?

Ext/Int standards (e.g. TJC,CMS,DEA)

Compliance

Process

How well do we perform the process of patient

care?

ProceduralNon-procedural

Outcome

How well do our

patients fare during

or after our care?

Technical outcomesFunctional outcomes

Outcomes that matter!

Define & Measure Quality

Define & Measure Quality

Outcome

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StructureProcess

Individual

Organization

OutcomeWhat Outcomes?

Challenge for Quality Systems

Sample Workflow for Event Review

Review Closed & Secured

QA Concern

Confidential Discussion:Provider & Division Head

QA Committee Discussion

Senior Review Subcommittee

Professional Standards

Organizational responsibility:1. Defining measures of competence – FPPE/OPPE2. Determining SOC/reasonable care standards for AE3. Defining domains and concepts of excellence 4. Culture of respect – supporting individual quality journeys

Individual responsibility:1. Reporting AE and close calls2. Participate in critical site and network training3. Commit to respect, learning environments and organizational goals4. Present AE to group at M&M/protected forums

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Tracking Relevant Outcomes

Project Communication

Project Communication

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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

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Billing Compliance

Patient care

Medical chart

Coding (ICD-10 & CPT)

Billing

Denial & rebilling

Office of the Inspector General (OIG)

• Ensure compliance with all Federal rules and regulations

• 2016 Anesthesia billing compliance became a focus

What’s covered?

Perioperative care

Regional

OB

GI

Not covered here

• Pain

• APS

• CPS

• 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

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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.


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


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)

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Monitors the course of the anesthesia administration at frequent intervals

• CMS makes no statement on the frequency, but…– Should be more often for higher acuity cases

– Should be more often for sicker patients


Remains physically present and available for immediate diagnosis and treatment of emergencies

• Physical proximity – Allows the anesthesiologist to return

– Reestablish direct contact with the patient

– Meet medical needs, urgent, or emergent clinical problems

Breaks

Short duration breaks are given for personal privileges and must be of brief duration

Long duration breaks include relief for other reasons

– Provider being given the break is not available

– Left the peri-anesthetic area

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Breaks

When the documentation of a break is ‘EASY’

“Like” breaking “like”– No problem!

Break during room turnover– No problem!

Name of break person with times of break placed in the record

Breaks

Not defined by time but by availability

The anesthesiologist who gives a Long duration break

– Is temporarily personally performing (for some time)

– Identify and communicate to an available staff anesthesiologist to cover their directed locations

– Group practice allows coverage by available staff

Backup

Backup anesthesiologist will be – Physically present and available for immediate

diagnosis and treatment of emergencies, and

– Responsible for the provision of anesthesia services

Name and coverage times must be in the chart

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The medical record

Things that can be done to ensure accurate and compliant medical records:

– When personally performing – ensure that the A-time and the D-time do not overlap with any other case. The D-time must be at least 1 minute earlier than the A-time of the next case

– If you receive a Long duration break, make sure the name of the clinician and time of coverage are recorded.

– Self-breaks when the turnover is prolonged are fully compliant.

The medical record

Things that can be done to ensure accurate and compliant medical records:

– When medically directing – ensure you are covering no more than four cases at once. Even one minute overlap is a problem.

– If you provide a Long duration break, identify which anesthesiologist is your backup for your other location(s).

– Provide breaks between cases, when appropriate.

Billing and Coding

Shannon C. Cameron, MBA, MHIIM, CPC

Executive Director, Anesthesia, Critical Care & Pain

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Anesthesia Financial Solutions

• Central Billing Office located in Needham, MA• Full Revenue Cycle Management (Chart acquisition, coding, billing,

backend AR): – Anesthesia – Pain – Critical Care

• Executive Director, (CPC Certified)– January 8, 2018

• Management (4) – (1) Coding Manager (CPC Certified)– (1)Revenue Cycle /Project Manager (CPC Certified)– (1) AR Manager– (1) Operations Manager (CPC Certified)

• Practice Management Billing Software– CONNECT -10/1/18 (former PM software PPM)

Coding Department

• Coding Staff – (1) Coding Manager – (7) Full time coders – (1) RCM Manager support– All Coding staff CPC certified- requirement*

• Ongoing Coder Training & Quality Assurance Assessments – Monthly QA per coder –scorecard + goals (QA &

Productivity)– Monthly Lunch & Learn Code Specific training – Continual feedback

Accounts Receivable

• AR Staff – 16 accounts receivable specialists

• Ongoing training – Ongoing training & feedback

– Scorecard & goals

– Certified Professional Biller Certification (CPB) – New • Via Lunch & Learn sessions

• Ongoing cross-training of staff – Maximization of productivity

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Provider Education

• Onboarding Orientation

• Monthly staff meetings & performance feedback

• Quick Reference Tools

• Monthly Anesthesia Department Newsletter – Current trends & industry news per coding & documentation

• Online MyPath Training (coming soon)

• Monthly utilization reports for E&M specific (New)– Pain & ICU

• How can we best help Anna Jaques providers?

Compensation and Call Structure

Pete Panzica, MD

Vice Chair, Clinical Operations

Compensation and Call Structure

• Compensation

• Call Theory and Compensation

• Bonus

• Scheduling and Anesthesia Record

• Questions

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Payroll

• Remains the same

• Paid on the 15th and 30th of each month

APHMFP Physician Compensation Model

• Total Compensation:• Base + Call Points + Bonus

• Base StructureRewards Tenure

• Year 1 $255,000

• Year 2 $265,000

• Year 3 $280,000

PhysicianCall/OT Pay Construct

• Call and OT are paid on a points basis

• 1 Point = $100

• Points are paid out quarterly

• MD OTAfter 5pm and callback

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PhysicianCall/OT Compensation

Call/OT Estimates

Points (1 Point = $100)

MD CRNA

Per Day Per Day

Daily Daily

SUN‐THU 7.50 SUN‐THU

FR 17.00 FR

SA 30.00 SA

HOL 7.50 HOL

HOL Eve Weekday 17.00

HOL Eve Sun 30.00

Beeper Beeper

M‐F 1.50 M‐F 1.25

SA 3.50 SA 2.50

Sun 3.50 Sun 2.50

HOL 3.50 HOL 2.50

OT (After 5pm) Per HourOT (After Shift or 40 hours and call back) Per Hour

M_F 1.50 Weekday 1.25

SA 1.50 SA 1.25

SU 1.50 SU 1.25

HOL 1.50 HOL 1.25

Post‐Call 2.00

APHMFP CRNA Compensation Model

• Total Compensation:• Base + Call Points + Bonus

• Base StructureRewards Tenure

• Year 0-2 $165,000

• Year 3+ $175,000

CRNACall/OT Pay Construct

• Call and OT are paid on a points basis

• 1 Point = $100

• Points are paid out quarterly

• CRNA OTAfter Shift and/or 40 Hours/Week and callback

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CRNACall/OT Compensation

Call/OT Estimates

Points (1 Point = $100)

MD CRNA

Per Day Per Day

Daily Daily

SUN‐THU 7.50 SUN‐THU

FR 17.00 FR

SA 30.00 SA

HOL 7.50 HOL

HOL Eve Weekday 17.00

HOL Eve Sun 30.00

Beeper Beeper

M‐F 1.50 M‐F 1.25

SA 3.50 SA 2.50

Sun 3.50 Sun 2.50

HOL 3.50 HOL 2.50

OT (After 5pm) Per HourOT (After Shift or 40 hours and call back) Per Hour

M_F 1.50 Weekday 1.25

SA 1.50 SA 1.25

SU 1.50 SU 1.25

HOL 1.50 HOL 1.25

Post‐Call 2.00

PhysicianPaid Time Off

PTO construct rewards tenureYear 0-2: 5 weeks PTO and 1 Week Meeting/Conference

Year 3: 6 Weeks PTO and 1 Week Meeting/Conference

Year 5: 7 Weeks PTO and 1 Week Meeting/Conference

• Scheduled 1 year in advance

• 5 days maximum carryover otherwise cash-out at base pay

• Eligible to convert points up to 2 weeks of additional vacation (points valued at 15 per day) and vice versa

• Paid Holidays Aligned with Individual Hospitals

CRNAPaid Time Off

PTO construct rewards tenureYear 0-2: 5 weeks PTO and 1 Week Meeting/Conference

Year 3+: 6 Weeks PTO and 1 Week Meeting/Conference

• Scheduled 1 year in advance

• 5 days maximum carryover otherwise cash-out at base pay

• Eligible to convert points up to 2 weeks of additional vacation and vice versa.

• 4 -10 hour days CRNAs: 12.5 points = 1 day of vacation

• 5-8 hour days CRNAs: 10.0 points = 1 day of vacation

• Paid Holidays Aligned with Individual Hospitals

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Bonus

Guaranteed in Year 1

Metrics Based** in Year 2 and beyond

** Metrics TBD

Points/Scheduling

Joanne Grzybinski

Scheduling Manager

Points and Scheduling

Points– Document via Anesthesia Intranet

Scheduling– Existing scheduling practice will remain during transition

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1. Log into the BIDMC Portal at https://portal.bidmc.org/Login

Type in your username/password

Directions to access the BIDMC Portal/Anesthesia Intranet


2. Following screen will pop up


3. Then click the word applications – see blue box drop down below. Go the bottom of the box and click more

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4. Once you click more – the screen will expand to the below image and then click “Anesthesia Intranet” (7th one down from the left hand column under clinical)


5. The Anesthesia Intranet Page looks like the below – you want to click on the Community Tab and hit BID Plymouth


• 6. The following Screen shows upHere you have access to the following

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7. Your points screen looks like this

Administrative Housekeeping

Dawn Ferrazza, MA


Administrative Housekeeping

• CME/PDA Process

• Key Contacts

• Anesthesia Record

• Questions

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PhysicianCME/PDA

• CME/PDA (pro-rated for partial year and FTE)• Physician: $4500

• Department Paid: ASA, MSA, BIDCO dues

• CME/PDA Paid: Staff Dues, Initial and Reappointment Fees, Fed DEA, MACS, Mass Medical

• Must use in current fiscal year (Oct 1-Sept 30)

• Paid out per HMFP Accountable Spending Plan

PhysicianCME/PDA Summary

Physician Community

Anesthesia ‐ CME/PDA $4,500

Dept Paid

ASA $750

MSA $400

BIDCO Dues $1,100

Total Dept $2,250

CME/PDA Paid

Staff Dues $$$

Initial Appt $$$

Reappointment $$$

Fed DEA $731

MACS $150

Mass Medical License $600

Total CME/PDA Varies

CRNA CME/PDA

CME/PDA (pro-rated for partial year and FTE)• CRNA: $2500

• Department Paid: AANA Dues

• CME/PDA Paid: Staff Dues, Initial and Reappointment Fees, NBCRNA, CRNA License

• Must use in current fiscal year (Oct 1-Sept 30)

• Paid out per HMFP Accountable Spending Plan

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CRNACME/PDA Summary

CRNA Community

Anesthesia ‐ CME/PDA $2,500

Dept Paid

Fed DEA ‐

MACS ‐

AANA Dues $645

Dept Paid Varies

CME/PDA

Staff Dues $$$

Initial Appt $$$

Reappointment $$$

NBCRNA $180

CRNA License $150

Total CME/PDA Varies

CME/PDA

• Primary Contact: Trish Stevens ([email protected])

• Community Intranet Features:

– Instructions

– Ability to check your balance

– Relevant Forms posted

• Important Reminders:

– Deadline for submitting is 60 days from date expense is paid or last day of your trip

– Finance team needs 7 days to process

– Need to submit within 53 days to get paid

CME/PDA – Submit to Cathy Grey

Patricia R. Stevens, MBA

Director of Finance

Phone: 617-667-3108

Email: [email protected]

Department of Anesthesia, Critical Care and Pain Medicine Beth Israel Deaconess Medical Center

330 Brookline Avenue, Boston, MA 02215

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Anesthesia Record

Anesthesia Record– Existing record maintained during transition

– Move to Shareable Forms in 2019 – exact date TBD

Questions

12/3/2018 department of anesthesia, critical care and pain ... · 12/3/2018 1 department of...

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