Moving Forward Update: ATRIUS 2.0

Issue 5 - January 9, 2015

Happy New Year!

Moving Forward Newsletter

Starting this week, this newsletter will typically be published weekly and will include both integration activities and other news about Atrius Health. This should minimize the number of separate global emails and give you one document to look for weekly.

Expanded Relationship with Beth Israel Deaconess Medical Center

I am pleased to share with you that, as of January 1, 2015, our Beth Israel Deaconess Medical Center (BIDMC) relationship has been expanded to include BIDH Needham, BIDH Milton and BIDH Plymouth. This means that our contract terms, including financial, clinical, IT and other collaboration initiatives, will now be extended to these community hospitals. As well, our new multi-year agreement with BIDMC will continue to include collaboration with our Harvard Medical Faculty Practice (HMFP) colleagues.

As part of this expansion effort we will be working to ensure that we have effective Clinical Collaboration Committees in place at each of the community hospitals, to extend the current BIDMC interoperability to the community hospitals, as well as continuing to work towards an even higher degree of interoperability with the BIDMC. At the system level, we will be investigating ways to structure the financial relationship such that both organizations will be fully aligned.

In addition to expanding the relationship across the entire BIDMC system, we have targeted two new areas to focus on that we think will add tremendous value. The first is a new Joint Performance and Metrics Committee and the second is a Strategic Business Committee. In the Performance area we will be working with the leadership teams from all the organizations to design and develop a Performance Dashboard that will identify key performance metrics and targets that will be uniformly collected, organized and available across Atrius Health, BIDMC, the BID community hospitals and HFMP. This information will help us understand in a systematic way where our relationship is working well across quality/safety/care management/ patient experience/financial dimensions and where there are opportunities for continued improvement. In the Strategy area, we will be working to identify key strategic initiatives that will promote more effective delivery of care for our patients and providers, with a keen focus on population health and innovation as well as primary and specialty care collaboration.

We will continue to keep you updated on our progress on all of the above and welcome your feedback on how we can continue to improve our relationship with our BIDMC and HMFP colleagues.

Richard Lopez, MD, Chief Medical Officer

Addressing Integration Myths and Misperceptions

Q. Do we still have the medical groups?

A. Yes, the medical groups still exist and will continue to be their own legal organizations until later in the spring/early summer when we have finished the necessary financial, IT and HR work to allow us to complete the merger. Until the merger is completed, we are working as if we were one organization, and, as of January 1, 2015, the trustees on the Atrius Health Board also serve as the trustees of the medical groups' boards.

Q. When the merger is complete, will we still use the medical group names?

A. After the merger is complete, we will still use the medical group names with our patients, and will continue to use the signage, stationery, etc. currently at the sites. Work is in progress that will inform a decision later in the year about whether or not we will continue to use the medical group names indefinitely or for a defined time period.

On the other hand, as we consolidate various systems, we will move to using the Atrius Health name and logo on many documents that are just for internal use and occasionally on some for external use. Specific questions on this may be referred to Marci Sindell or Donna Tolley in Marketing.

Q. Are there a lot of decisions that have been made already about how we will integrate, reporting structures, etc.?

A. We are committed to transparency. The decisions that have been finalized have been and will be reported here. Some decisions were made as part of the merger agreement. For the most part, the subcommittees and workgroups have just recently formed or are forming or are still evaluating their current state, so few decisions have been finalized. Lots of planning about really important issues are still in progress using A3 methodology, that is, develop reason for action, report on current state, develop target state, identify the gap, develop and evaluate different options for filling the gap, develop a plan, measure progress and consider insights.

Q. Am I now an employee of Atrius Health?

A. Until the merger is completed, you continue to be employed by one of the medical groups or VNA Care Network Foundation companies. Before the merger occurs, you will receive information about anything that will change. As previously reported, the current benefit and compensation systems stay in place through the end of 2015.

Q. How will consolidation and/or new jobs be handled?

A. We recognize that this is a big concern for everyone and is a priority for HR. An HR team has been working quickly to develop policies and procedures to ensure an employment process that is transparent, fair and performance-oriented. We will keep you informed as this work progresses.

Q. Are we working now in "groups" or "regions"?

A. We are working both in groups and regions for now. While it would be great if this change could happen all at once, the reality of combining and building infrastructure to support a single organization makes this complex. Budgets, for example, are being built at the group level now while we put the systems in place to roll up from detailed department budgets to regional budgets. On the other hand, we want to be a single organization and plan for the future as soon as possible, so we are starting to work as regions for some tasks. As a result, the transition from groups to regions will occur over coming months while we work simultaneously under both structures. We appreciate that this creates ambiguity and uncertainty, and will let you know what is happening as changes are finalized.

Questions may be sent to Integration@AtriusHealth.org

Dan Burnes, MD, Transition CEO

Insurance Verification Hotline

The first of the year always brings changes to health insurance, whether a company decides to switch its coverage or a family switching to a more affordable health plan. Whatever the reason may be it is important that we are asking our patients if they have any insurance changes.

If you do come across a patient who has an insurance change please contact the Insurance Verification department at 508-658-7711 or internally from a VNA Care Network phone at extension 5511 and an Insurance Verification representative will assist you and will make the necessary corrections.

Changes in INR Testing throughout the Enterprise

By Adele Pike, Director of Education

Starting on Monday January 12^th, we will begin the process of changing over from the Alere INRatio meter to the Roche COAGUCHEK meter for point of care testing of patients' INRs.

All non-Hospice clinical nurses need to attend a competency training before being able to use this new meter. The schedule for these trainings is below. Nurses need to sign up for a 45 minute session in their office by contacting their manager. If you currently have an INRatio meter, you need to bring it and all supplies to this training session as all INRatio and strips meters MUST be turned in.

We thank you in advance for coming in for competency training; we recognize that it is not always convenient to fit these sessions into busy schedules. The good news is that the problems with having access to strips should begin to go away! 

Our goals is for all nurses to complete competency training by the end of February.

COAGUCHEK Training Schedule---Please sign up through your manager.

"Hand-off Communications": Using the Plan for Next Visit (PNV)

By Annemarie Martin, Director of Patient Services

 Definition:  A "Hand-off" is when we deliver or give current information to another healthcare provider.

The objective is to provide concise and accurate information about:

• patient's care
• treatment or services
• current condition
• any recent or anticipated changes

Examples of communication hand-off from clinician to clinician are:

• RN to LPN
• PT to PTA
• Weekend admission nurse to the day-case manager

As noted in a recent Connector article, the Plan for Next Visit (PNV) is where case managers or any clinician document specific information and interventions that are needed for the next visit. 

Brief yet clear, concise direction as to what and why a visit is needed benefits both the care giver and the care receiver. 

A tip as to how to think about your PNV documentation might be:

• Ask yourself as the giver of the hand-off - what do you want the receiver to do, that is, if you were seeing the patient tomorrow, what would you do?

Next week's Connector will feature examples of PNV documentation.

Reducing "Lost" Documentation on iPads

By Kathy Schuft and Chris Day, Clinical Application Specialists

The Clinical Applications Department has been tracking reports of lost documentation from clinicians and reporting specific scenarios to the McKesson Support Team to find out possible causes. When McKesson looked behind the scenes on 2 of these specific incidences, they reported the following had happened. We hope by passing along this information that we can prevent similar incidences.

In one case the clinician left an admission visit after documenting to view something in Profile. When they returned their entire admission visit was gone. When McKesson check in the background they told us that the clinician had received a pop-up that asked if they wanted to save changes and they had checked NO. This removed the visit. Some contributing factors for this can include a lag in the iPad response and the clinician tapping multiple times accidentally hitting the wrong response. Another possibility is that the clinician in haste did not read the pop-up question properly and answered incorrectly.

The second instance that we asked McKesson to check involved a clinician who accidentally clicked "Remove Visit" rather than "Complete Visit Information". We know this is very easy to do on an iPad as we have had several instances regarding this problem.  Remove Visit will be disabled on January 19^th to end this particular problem. Until then if you accidentally click Remove Visit be careful in answering the pop-up questions asking you if you are sure you would like to remove the visit. Please answer NO.

It is important to take the time to read all pop up's carefully and wait after tapping your selection.

Here is one other suggestion that may help stabilize documentation. Clinicians have been asked to close McKesson and log out of Receiver between patients to stabilize their connection. There is a possibility that if you close McKesson too soon the documentation may drop before it makes it's way to the server. Therefore we are suggesting that when you have finished documenting you return to Cases and wait a minute or two before closing McKesson.

All of these suggestions may be hard to do on a busy day (most days). However in the end you may save yourself the time it would take to re-document.

The Clinical Applications Department takes lost documentation very seriously. Our department, the IS Department and McKesson have been working together to try to resolve this problem. It is important that you report all lost documentation to Liz Bourne (ebourne@vnab.org). This allows us to identify, track and attempt to resolve the reasons why documentation may be lost. If you have any questions please contact Kathy Schuft 617-886-6968 (x6968) kschuft@vnab.org or Chris Day 781-535-5321 (x5321) cday2@vnab.org.

Reminder: 2015 Therapy Reassessment Requirements

By Jennifer Bilodeau, Patient Care Manager

This is a quick reminder for all rehab staff regarding the recent therapy reassessment requirement changes for Medicare patients.

For episodes beginning on or after January 1, 2015, each active therapy discipline is required to perform a reassessment at least every 30 calendar days through the home health episode of care.

For episodes that began before January 1, 2015, therapy needs to comply with the existing 2014 therapy requirements to meet the 13/19th visit and at least every 30 day visit requirements through the end of that 60 day certification. At recertification, the 2015 30-day requirements are in effect for the new 60-day recertification episode of care.

There have been no changes to the intent of the reassessments or the content requirements. A 'qualified therapist' must perform the needed therapy services, assess the patient, measure progress, and document objectives and goals during the reassessment visit. Reminder, each discipline follows their own 30 calendar day count with the date of their discipline evaluation counting as Day 0. The discipline specific 30 day count is reset with each reassessment.

Question: Mr. Bean was admitted to the home health agency on 12/31/14 for SN, PT, OT and SLP services s/p a L CVA. PT, OT and SLP performed their respective evaluations on 1/2/15. Can therapy transition to the new reassessment requirement, now requiring a reassessment at least every 30 calendar days for each active discipline?

Answer: No, the new requirements are effective for episodes of care beginning on January 1, 2015 or after. In the above example, the episode of care began before January 1, therefore, therapy needs to comply with the existing 2014 therapy requirements to meet the 13/19th visit and at least every 30 day visit requirements through the end of that episode of care. Although the therapy evaluations did not occur until after January 1, 2015, the episode of care began before the new rules went into effect.

Please call Jenn Bilodeau 617.886.6802 or internally at the VNAB at X6802 or your respective Rehab Manager if you have any questions.

Immunization Changes with OASIS C-1

By Jennifer Bilodeau, Patient Care Manager

In the 2014 4^th Quarter OASIS Education session, we reviewed the immunization changes that went into effect for episodes beginning on or after January 1, 2015. These changes effect the influenza and pneumococcal vaccine questions on the OASIS tool. Below are the 2015 OASIS C-1 immunization questions.

Reminder: It is a requirement to document the immunization status of all patients once every certification period. This documentation is captured in the Interventions section of all SN, PT, OT and SLP visits (see screen shots below for an example). You will notice an updated [IM macro that reflects the current OASIS C-1 immunization questions.

If you have any questions, please contact a Patient Care Manager; Jenn Bilodeau x6809, Carol Morris x5380 or Elaine Gardner x6464. Thank you very much for all of your hard work!