Where is it that health care is trying to go? The answer would not be clear without a reminder of where it has been. The face of health care in the 1990s was the Health Maintenance Organizations. HMOs were seen as the savior and future of health care, controlling cost and improving quality. Physicians were scared, and many were told that unless you join you will be left behind. Ironically, twenty years later, the percentage of patients belonging to an HMO has dropped from 27% in the 1990s to almost 18% in 2008.

Today’s efforts at integration, the new face of health care, are “déjà vu all over again,” says Paul M. Wiles, Chief Executive of Novant Health, a 13-hospital system based in Winston, Salem N.C. Many of these attempts

have been tried before and did not improve quality and did not reduce cost. Certain hospitals lost money on their doctor-practice acquisitions because of overly high prices and doctors’ tendency to ease up work after selling out. Furthermore, HMOs triggered a backlash from consumers who feared they were being denied access to needed care.

The success or failure of efforts to change health care will largely hinge on doctors. Doctors in general often react sharply to efforts to control their practices. A recent survey of medical administrators found doctors’ cooperation to be the most frequently cited “serious obstacle” to creating accountable-care organizations. Doctors are not the problem, and they have not been consulted for the

solution. It is being imposed upon them.

Of course, some integrated models have been successful: Kaiser Permanente in California, Pennsylvania’s Geisinger Health System, and Inter-Mountain Health Care in Utah. Proponents of integration point out to such systems, today’s new technology (EMR), and again, preach on quality to cut costs. They believe things are different this time around. Only time will tell.

Nobody disputes that there is tremendous waste in health care and ample room for improvement, but there is no one model or system that fits all. Change is needed; however, what kind of a change remains to be seen.

FROM THE CHIEF OF STAFF

Zahi Nassoura, M.D.

A PUBLICATION FROM THE PROVIDENCETARZANA MEDICAL STAFF OFFICE

Winter 2o12

The New Face of Health Care INTEGRATION

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Robert Oblath, M.D.Chief of Surgery

Richard Shapiro, M.D.Vice Chief of Surgery

George Fischmann, M.D.Chief of Medicine

As a result of the rapidly changing healthcare environment, coupled with the nation’s economic challenges, the outlook for our country’s hospitals is not bright. California is particularly hard hit, with 52% of all hospitals in the state losing money, and those numbers continue to increase at a rapid pace.

The overall economic downturn has hurt virtually all sectors of healthcare. The changes in reimbursement coupled with dramatic declines in census in all hospitals across the country result in less payment. Both hospitals and physicians will see consistent declines in Medicare and private insurance reimbursement in 2012, requiring each of us to make necessary adjustments in operations to stabilize the bottom line.

Anticipating this trend, Providence Tarzana improved operational efficiencies and developed growth initiatives resulting in a 10% increase in admissions over 2010, placing ourselves in a more stable financial position. However, we are constantly making adjustments as patients are delaying elective surgeries; more people are uninsured or underinsured; and some are not paying their deductibles, all adding to an already challenging environment in which to operate.

As hospitals in our area make adjustments in order to maintain good financial health, it is unfortunate that some had to take more extreme measures. In the past couple months, we learned of significant layoffs that occurred at major hospitals throughout Southern California. Providence Health & Services, Southern California offered a voluntary separation program for employee consideration which provides an option for our employees should they elect to leave the organization. Although this news is unsettling because of the impact it has on people’s lives, it made me pause and reflect upon the successful efforts we have undertaken in the last year to improve our financial position.

With more changes on the horizon, we will continue to communicate with you new 2012 strategies that revolve around improved customer service and quality scores that are linked to value-based purchasing, another government-based initiative that will impact hospital finances. We look forward to working together towards a common goal, while continuing to provide options for our physicians that address their personal and practice needs.

Thank you for your continued support and commitment to Providence Tarzana Medical Center. All of us in the hospital and the people you serve in our community value and appreciate the care you provide.

A MESSAGE FROM

Dale SurowitzChief Executive, Providence Tarzana Medical Center

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Alina Lopo, M.D.Vice Chief of Staff

Marc Ehrich, M.D.Chairman, Division of Cardiology

Marie-Therese Medawar, M.D.Vice Chief of Pediatrics

Kathy Fazendin, a 43-year-old mother of one, was at the end of her battle with ovarian cancer. She had been discharged to the home of her parents who chose Providence TrinityCare Hospice for their family’s end-of-life care needs.

The love of Kathy’s life was her 17-year-old son Christopher, and Kathy was hanging on, wanting to see her son graduate from high school. As part of the hospice admissions process, the Care Team works with the patient to identify their goals, and in this case it was the graduation and to make sure her son would be okay, and not left behind.

The Care Team went into action and within two weeks a full-fledged ceremony, complete with cap and gown and school officials took place in the family’s back yard. Kathy sat in the front row at this event that will forever remain in the memories of her family and friends.

“The person who loved and enjoyed the ceremony the most was my mom,” said Christopher. “For the longest time, my mom had one goal in mind that she told just about everyone, including doctors, friends and family. She wanted to see me graduate. I extend my appreciation to TrinityCare Hospice for putting this ceremony together because my mom wouldn’t

have made it to my actual graduation.” The hospice continues to tend to Christopher, now a freshman at University of Colorado.

As you can see from the story above, being a dedicated member of the TrinityCare Hospice Care Team can be one of the most emotional jobs one can have, but it is important and speaks to our core values of compassion and respect during one of life’s most difficult moments. These trained teams of doctors, nurses, social workers, chaplains, home health aides and volunteers work with patients and their loved ones to ensure that end-of-life is met with compassion and respect.

TrinityCare provides its services in supervised settings or in-home. “A diagnosis can be really grim and overwhelming for the patient’s loved ones, so we work hard to make a connection and walk the journey with the family,” says Terri Warren, director of TrinityCare. “No two families are alike so we find what is important to the patient and those who love them and use that as our guide to provide really good care.”

Some of the special things that are done with families include a “family tree,” where very colorful paints are used to create a tree out of handprints and footprints. Pictures are drawn around the tree and many families frame this and put it in their home as a remembrance of their loved one who has

passed. For neonates the footprint of the baby is used to create a heart. “Everything is customized based on the patient and family need,” says Warren.

When parents lose their child the loss is unbearable. Hospice makes Teddy Bears using fabric from the child’s favorite blanket or article of clothing. In some cases the child’s clothing is used to dress the bear. This is cherished by the parents. And when parents die, the children and grandchildren become the focus. One grandfather wanted to share his immigration story through Ellis Island with his grandchildren, so hospice workers videotaped him telling his

(Continued on page 4)

TrinityCare Hospice Honoring the very special needs of our dying patients

PTMC recently upgraded and expanded the Rapid Medical Evaluation area to better serve the needs of the community. The RME is designed to quickly treat those with minor injuries and illness, reducing wait times and improving flow throughout the ED. The following is the direct mail campaign sent to households in the San Fernando Valley.

There are times when minor injuries or illnesses result in a trip to the Emergency Department.

Providence Tarzana Medical Center introduces the Rapid Medical Evaluation (RME) area specifically designed to efficiently treat less serious health issues. Our RME is unique because:

• Unlike an urgent care, our RME is staffed with board-certified emergency physicians and nationally certified nurses• We have efficient service treating less serious health issues such as the flu, sprains or minor injuries• Our goal is for the patient to get in, get out and get well• The patient will be seconds away from the main ED in the event your condition suddenly worsens and requires a

different level of care• Specialists are available should the need arise

Our physicians, nurses and staff are dedicated to providing the highest quality treatment, right when it’s needed. Whether your patient’s emergency is big or little, Providence Tarzana Emergency Department is the best choice. If it is little, our new RME was designed with that in mind, because here, the little things matter.

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James Danielzadeh, M.D.Chief of OB/GYN

Brian TzyYoung Lin, M.D.Chief of Pathology

G. Scott Brewster, M.D.Director of Emergency Medicine

18321 Clark StreetTarzana, CA 91356

1-888-HEALING (432-5464)www.providence.org/tarzana

at Providence Saint Joseph Medical Center

Get In. Get Out.

Get Well.Introducing the

New EMERGENCY DEPARTMENT RAPID MEDICAL EVALUATION PROGRAM at Providence Tarzana Medical Center

story, a gift that was given for the 2- and 3-year-olds to watch when they were older. The care doesn’t end upon the patient’s death. “We continue the care for 13 months with group therapy, in-home counseling, phone connections and mailings,” says Warren. A good bereavement plan is important for the healing of the loved ones.

There are so many stories about the important impacts TrinityCare Hospice has had on people. As Terri Warren says, “It is all about the connections we make, because at the end of the day that is what makes our employees and volunteers feel good about doing their job. It is profoundly sad and also a very intimate time in the life of a family. It is an incredible gift to be given – to be in touch with people at core of who they are.”

Recently, a Facebook campaign launched by Toyota asked people to rate their favorite non-profit organization. TrinityKids Care, a program for pediatric patients, was the winner and recipient of a van that will be used to provide transportation for hospice patients and families who don’t have vehicles.

TrinityCare Hospice can be reached at 800-535-8446.

TrinityCare(Continued from page 3)

Zahi Nassoura, M.D.Chief of Staff

Gail Goldstein, M.D.Chief of Anesthesiology

Jeff Work, M.D.Secretary/Treasurer

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Many upgrades and fixes to the CAMIS program will occur as a result of the recent installation of Meditech Priority Packs 8, 9, 10, and 11. The following list is a summary of some of the major improvements addressed in the upgrades. The four Priority Packs include over 3,600 software patches which will address many individual performance issues and minor bugs. The major items with importance to physicians include:

• Reflex orders will now be supported. A reflex order allows one physician order to automatically trigger a related order. For example, a gentamicin order could automatically launch a laboratory order for gentamicin levels.

• The computerized physician order entry (CPOE) user interface changes from a horizontal format to a vertical format. ED physicians will begin to enter their own orders in April 2012, and this change will allow physicians to scroll down through the various pages of an order set and avoid the need to manually click from screen to screen. This will also be an enhancement for when we move forward with inpatient CPOE in fall 2012.

• A variety of fixes in the Report Designer tool (e.g., allowing for page breaks to be coded in reports) will address several critical reporting needs which includes the improved formatting of the medication lists in the Medication Reconciliation Report.

• The CPOE process will now support multiple orders for the same medication in a single order set (e.g., Tylenol for pain in one section of the order set and Tylenol for fever in another section).

• A fix in CPOE for issues related to medication changes in the pharmacy that caused a corruption of physician order sets and favorites.

• Support for e-sign on mobile devices such as tablet computers and smart phones.• Improved support for the Apple iPad and iPad2.

There are many more improvements, but these are the major points being addressed by the upgrade. No significant training will be required for the upgrade. We anticipate the next significant upgrade process will occur in late 2012.

A MESSAGE FROM THE CHIEF MEDICAL OFFICER

Glenn Irani, M.D.

Capital Expense Allocation

Scope - Flexible GIAnesthesia Machines-2Glidescope - ORFluoro Table - VascularGE Muse-Heartlab PACSGE Muse-Heartlab PACS-BalancePortable X-ray Unit

L&D ShuttleFluoro Table – VascularSpyglassGI ScopesMayfieldMotorized Cart - GISurgical Tables

Anesthesia MachinesBronch ScopeC02 ModuleLaryngoscopesC-arm SurgicalFluid Containment System (Ortho) ACT machine

The following equipment was approved by the physician capital committee and purchased in 2011:

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ELIMINATION OF SHORT FORM HISTORY AND PHYSICAL FOR CATH LAB PROCEDURESPerformance of a Cath Lab procedure will now require a full dictated History and Physical.

JOINT COMMISSION SURVEY RESULTSWe had a very successful Joint Commission Survey. The Hospital ultimately ended up with three direct and three indirect findings.Direct Findings:(1) PC.01.03.01-Care is planned based on an assessment: This resulted

from a lack of documentation issues based on the assessment.(2) PC.03.01.03 - No airway assessment before moderate sedation for

a 10 year old in the MRI.(3) PC.03.05.07 – Every 15 minutes observations were not

documented on patients in restraints for violent behavior in the Emergency Department.

Indirect Findings:(1) PC.03.05.05 – Physician order for a restraint was not completed

on the top portion of the form, however, it was signed, dated and timed.

(2) RC.01.01.01 – Untimed entries for admission orders and pre and post anesthesia assessments.

(3) TS.03.01.01 – Tissue stored in wound care center did not have the required documentation. Monitoring of these issues will be ongoing. Physicians are encouraged to assure that all chart entries are consistently signed, dated, and timed.

CREDENTIALING• Any physician requesting cesarean section assisting privileges must

document malpractice coverage for the procedure.• Addition was made to the Podiatry Delineation of Privileges – C02

Laser - (documentation required, certificate of laser training and current competence in performance of the procedure)

E-SIGNING AND GREEN ORDER SHEETSRecommendation has been made to eliminate the Green Order Sheets in order to avoid duplication of signatures. This change is currently in process.

In an effort to be good stewards of our resources, we have decided to send MD Connect to you electronically and post it on our website for easy access. This will be the last hard copy issue. To view on the Providence Health and Services website, simply log onto your computer and type www.providence.org/tarzana into your web browser and you will arrive at our home page (see image). Then click on the physician tab in the top right corner and it will take you right to the tables for the following content: Medical Staff Services ContactsMedical Staff BylawsMedical Staff Rules/Regulations RosterMD Connect NewsletterMedical Staff CalendarCME CalendarPharmacy News

Changes to Medical Staff Bylaws/Rules and Regulations

Changes in MD Connect Delivery

Kenneth Keer, M.D.Chief of Pediatrics

Kamyar Kamjoo, M.D.Vice Chief of Medicine

Kamran Torbati, D.O.Vice Chief of OB/GYN

Wayne Kleinman, M.D.Immediate Past Chief of Staff

Richard Gritz, M.D.Chief of Radiology

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Mehran Okhovat, M.D. Family Practice Marc Cohen, M.D. Otolaryngology

Mohsen Rofoogaran, D.O. Internal Medicine (Hospitalist) Robin Zakariai, M.D. Internal Medicine (Hospitalist) Katrin Lalezardeh, D.O. Pediatrics

H. Dafna Bababeygy, M.D. Pediatrics Mona Sanghani, M.D. Radiation Oncology

Nazanin Firooz, M.D. Internal Medicine/Rheumatology

Shervin Aminpour, M.D. Otolaryngology

Seema Bhansali, M.D. Internal Medicine (Hospitalist)

John Conrad, M.D. Vascular Surgery Safi Satmah, M.D. Internal Medicine (Hospitalist) Elham Ghadishah, M.D. Family Medicine/Geriatrics (Hospitalist)

AppointmentsThe following physicians were appointed to the Medical Staff:

Leave Of Absence Alan Silver, M.D.Internal Medicine/Geriatrics

Resignations

Emeritus Status Paul Milberg, M.D. Plastic Surgery

Reid Brackin, M.D.Emergency MedicineNina Lightdale, M.D. Pediatric Orthopedic SurgeryVincent Gualtieri, M.D.UrologyMichael Levey, M.D. CardiologyCyrus Lavian, M.D.Internal MedicineArmen Kassabian, M.D. Urology

Andrew Lai, M.D. Internal Medicine/Infectious DiseaseCarmen Slavov, M.D. Internal Medicine/NephrologyJeffrey Weitz, M.D. TeleradiologyArash Matian, D.O.Family PracticeLancelot Alexander, M.D.NeurologyRaz Khavari, M.D. Internal Medicine/Rheumatology

Scott Calig, M.D.PediatricsOlga Popel, M.D. Internal Medicine/RheumatologyChristopher Rose, M.D. Radiation OncologyHoutan Sabahi, M.D. Emergency MedicineJohn Anastasatos, M.D.Plastic SurgeryAllen Selner, DPMPodiatry

Real Estate for Rent or LeaseAddress Size Asking Rooms Features Available Status

1 18411 Clark St. #205 1,278 Vacant

2 18411 Clark St. #108 2,043 Vacant

3 18411 Clark St. #304 1,063 Vacant

4 18411 Clark St. #203 1,527 2 consult, 3 exam Vacant

18321 Clark StreetTarzana, CA 91356

Today’s health care landscape is characterized by demands for lower costs, higher quality and accountability amid an overall trend of decreasing reimbursements. In the past year you have received materials about Providence Partners for Health, Providence Medical Institute, and Providence Care Network. I thought it would be useful to delineate the differences for clarity:Providence Care Network (PCN) – This physician network was established in 2010 to enable direct access to managed-care contracts for Providence-affiliated physicians. PCN was launched in the San Fernando Valley and will eventually expand to the South Bay. Providence Care Network will be the preferred physician network for the thousands of Providence Health & Services employees and their families.Providence Partners for Health (PPH) – This is a new physician-led and governed organization for clinical integration. It is a 50%/50% joint venture owned by physicians and PH&S Southern California. This enables independent physicians (nearly 700 physicians joined PPH during the initial offering) to collaborate with Providence to achieve improved quality, efficiency and coordination of care across the continuum. Physicians in PPH are eligible for Providence’s EMR Subsidy Program. This allows physicians to partner with a leading, quality-focused, financially-stable healthcare system that is the largest in our service area and the second largest in Los Angeles County.Providence Medical Institute (PMI) – PMI is a medical foundation model which provides administrative and support services to physicians. This entity was formed 14 years ago in the South Bay and was recently expanded into the San Fernando Valley. This model offers group collaboration and employment opportunities including:

• Compensation, benefits and retirement plans • Full administrative support • Call coverage• Scheduled vacation time • Peer supportive environment • Electronic medical records

These initiatives are mutually exclusive and are presented now as information for interested physicians to review. If you have any further questions, feel free to call me at (818) 708-5161.

The Difference Between all the “P’s” Out There