July 29, 2016
Stemming the Tide of Violence
"Do your little bit of good where you are; it's those little bits of good put together that overwhelm the world." - Archbishop Desmond Tutu

The names of the cities evoke the images: Dallas, five killed, nine wounded; Baton Rouge, three dead, three wounded; Orlando, 50 dead, 53 wounded; San Bernardino, 14 dead, 22 wounded; Newtown, 27 dead; Charleston, nine dead, one wounded; Aurora, 12 dead, 70 wounded.

The numbers are almost too staggering to fathom.

Since 2006, there have been more than 200 mass killings in the United States, according to a comprehensive database from USA Today. This means that, on average, they happen about every two weeks. The death toll for the past 10 years from such attacks is approaching 1,600.

The courageous police response to these tragedies rightfully grabs the headlines, but there are less-heralded heroes who are thrust into this too-frequent maelstrom: the women and men whose job isn't to protect the public from violence, but rather to save the lives of its victims. The nurses, doctors and other front-line caregivers whose calling is the everyday hospital battle to save lives are the warriors of last resort. It is only after the carnage that their work begins - jumpstarting hearts, extracting bullets, repositioning bones, sewing flesh. 

Regular exposure to such trauma can take an emotional and physical toll on hospital workers. Consider the words of Joshua Corsa, a senior surgical resident at the Orlando Regional Medical Center who treated victims of that city's nightclub shooting and vowed to wear his bloodstained shoes until the final patient from that night is released from the hospital: "This blood, which poured out of those patients and soaked through my scrubs and shoes, will stain me forever. In these Rorschach patterns of red I will forever see their faces and the faces of those that gave everything they had in those dark hours."

Hospital workers talk about developing a sort of psychological shield - a barrier that helps them stay focused, but can create an unintentional detachment from their patients as well.

That's why programs and resources are available to health care workers that recognize the impact of the stress of work-related traumatic events, and offer ways to mitigate it. One example: the Maryland Patient Safety Center's Caring for the Caregiver. This effort and others like it help ensure that we take care of our hospital workers, so they can take care of others.

But these are ways to help after the fact. The larger problem, one that seems to be growing in intensity and frequency, is the ease by which an individual, with whatever motivation, can take lives and inflict grave wounds on others. Whether the tool is a bomb, a firearm (77 percent of mass killings in the past 10 years involve a gun), or even a rented truck, the ability to inflict mass violence seems ever more possible. Is it becoming easier? Or is previously unthinkable harm no longer so unthinkable for those who have become so isolated, angry and lost in our society? What is driving the isolation and hatred?

Corsa, the surgical resident, said later that his shoes remind him "not of the terrible things that happened, but of the good that came from them ... how the city came together, how the hospital came together." The women and men whose life's work is to undo the damage caused by violence have been left asking if there isn't more that could be done to prevent such horrors in the first place; our skilled trauma teams are asked to respond to senseless violence on some scale day in and day out.

Their question begs our serious attention. 

ACMA Offers Observation, Opioid Training
The American Case Management Association (ACMA) Maryland Chapter is hosting a training session August 15 on:
  • Use of CMS' mandatory Medicare Outpatient Observation Notification form
  • Opioid use and how it relates to the patient experience and patient safety
Speakers include Dr. Ronald Hirsch, MD, FACP, FHCQM, an expert on regulatory issues, and Dr. Mishka Terplan, who is board certified in both obstetrics and addiction medicine.
The session will be held from 4 p.m. to 8 p.m. at Carroll Hospital Center (registration begins at 3:30 p.m.), 200 Memorial Ave. in Westminster. The training provides three continuing education units for nursing, social work and case management and is free for ACMA members and $45 for non-members. Register here. If you have questions, call Theresa Mannix, Director, Case Management at Carroll Hospital Center, at 410-871-7920. 
Maryland Campaign for Appropriate Antibiotic Use Seeks Participants
Hospitals were formally asked this week to enroll in the Maryland Campaign for Appropriate Antibiotic Use (CAAUSE). CAAUSE is a statewide collaborative designed to support hospitals' efforts to improve quality and patient care by encouraging proper antibiotic use and decreasing the rates of drug resistance in Maryland. The effort aligns with soon-to-be implemented standards by the Joint Commission and forthcoming regulations by the Centers for Medicare & Medicaid Services. CAUSSE is led by the Department of Health and Mental Hygiene (DHMH) and was designed with input from MHA, the Maryland Patient Safety Center, Maryland Health Care Commission, Maryland Society of Health-System Pharmacists, VHQC (Maryland's quality improvement organization) and others. Hospitals are encouraged to join this campaign, which will launch on October 1. Contact Dr. Lucy Wilson at DHMH with any questions, lucy.wilson@maryland.gov.
Maryland Star Rating Data Suppressed
As MHA requested, the Centers for Medicare & Medicaid Services (CMS) has suppressed Maryland hospital data from the five-star quality ratings released this week. Details, including CMS's note that Maryland's data would be suppressed for one or more quarters, and MHA's messages, can be found in a Member Alert sent Wednesday. MHA is continuing to urge Maryland's congressional delegation to support the Hospital Quality Rating Transparency Act of 2016 (HR 5927), which would require CMS to allow a 60-day period for comments on the methodology used and a third party validation of the methodology and data. The bill also would require removal of the ratings if they are posted to the Hospital Compare website before the bill is enacted. The American Hospital Association has noted many concerns with the star rating system, which are compounded for Maryland due to the unique all-payer model's data reporting requirements. In April, 225 members of the House of Representatives and 60 senators signed a letter urging CMS to delay the release of these ratings, citing concern with how accurately these ratings accounted for hospitals treating low income patients and patients with complex chronic conditions. 
Holy Cross Health Names New CEO
Dr. Norvell V. Coots was named this week as CEO of Holy Cross Health, succeeding Kevin J. Sexton, who is retiring after 18 years with the organization. Dr. Coots is a retired U.S. Army brigadier general and former commanding general and CEO of Regional Health Command Europe. He was the command surgeon, U.S. Army Europe and Seventh Army and has more than 20 years of executive experience in all aspects of health care management and medical administration. 
MD Exempt from CMS' Cardiac Bundled Payments
Maryland's hospitals are exempted from a mandatory bundled payment program revealed by the Centers for Medicare & Medicaid (CMS) Services Monday. The program makes hospitals in 98 markets financially accountable for the cost and quality of all care associated with bypass surgery and heart attacks, but because it affects only Inpatient Prospective Payment System hospitals our state is exempted. Similar to the recently enacted Comprehensive Joint Replacement bundle, however, CMS is seeking comments on potential approaches to include Maryland's acute-care hospitals. 
CDC Releases Updated Zika Guidance
The Centers for Disease Control & Prevention this week issued updated guidance and information to prevent Zika virus transmission. The guidance includes the following:
  • Updated interim guidance for health care providers caring for pregnant women with possible exposure to Zika virus
  • Updated interim guidance for the prevention of sexually transmitted Zika virus
CDC updates its interim guidance related to Zika virus transmission and related health effects based on the accumulating evidence, expert opinion, and knowledge about the risk associated with other viral infections. CDC will continue to update this guidance as new information becomes available. A media statement is also available.
Why Motivation Matters

It is easy to allow ourselves to believe that we are all motivated by the same sorts of things: success, accomplishment, money, power, etc. Perhaps we still ascribe to the notion of a hierarchy of needs or "satisfiers and dissatisfiers."

PRIME Offers Capital and Construction Solutions

Prime, through its affiliation with MedAssets, would like to introduce you to MedAssets Capital and Construction Solutions, which deliver end-to-end capabilities to help you complete successful, on-time and on-budget construction or renovation projects.

Center for Healthcare Governance Explores Innovation
The AHA's Center for Healthcare Governance has released a free webinar describing practical approaches for leaders to use in developing a sustainable capability for innovation.

THE WEEK AHEAD
Wednesday, August 3
- Total Cost of Care Work Group meeting

TOP NEWS FROM THE WEEK
The Washington Post, By Arelis R. Hernandez, July 22
 
The Washington Post, By Associated Press, July 25
 
Modern Healthcare, By Elizabeth Whitman, July 25
 
Modern Healthcare, By Dave Barkholz, July 26
 
The Washington Post, By Katie Zezima, July 26

Baltimore Business Journal, By Morgan Eichensehr, July 27