Marie Beatrice "Bea" Grause
President and Chief Executive OfficerDecember 2001
OUR nation and health care communi-ties have undergone dramatic changes this year. Just one year ago, we were in the midst of a seemingly endless presidential election. We added to our vocabulary: "hanging chads." We waited for a constitutional crisis that never happened, but the ordeal shook our long-held notions of how democracy – in the form of elections – actually works.After the elections, we began 2001 enjoying the giddy but short-lived era of surplus politics. For the first time in decades, Republicans controlled both ends of Pennsylvania Avenue – the White House and the Congress. The first post-election tremor occurred in the spring when our own Vermont leader, Senator Jim Jeffords left the Republican party and thus handed control of the Senate to the Democrats.
The unbelievable and unthinkable happened on September 11th when terrorists attacked our country. We lost our innocence as a nation, went immediately into a global war against terrorism and, shortly thereafter, back into deficits.The national debate on health care has switched dramatically as well. We as health care leaders went from talking about Medicare reform and prescription drug benefits to determining whether we had an adequate supply of Anthrax vaccines and whether or not our facilities and communities were prepared to treat patients exposed to smallpox, toxic chemicals or even a nuclear attack.
In addition to this year’s tumultuous events, hospitals will continue to face dramatic – even seismic – changes of the regulatory and legislative variety. On the federal front, the cultural and structural changes mandated by the Health Insurance Portability and Accountability Act (HIPAA) regulations will absorb a great deal of hospital talent and energy in 2002. In less than one month, hospitals will also have to begin preparing for the highly controversial Center for Medicare and Medicaid Services (CMS) final regulations on the Outpatient Prospective Payment System (OPPS). In the upcoming congressional session (which precedes the November 2002 congressional elections), our facilities will also face a variety of proposed changes that will range from broad-based Medicare reforms to targeted provider payment reductions.
In Vermont, the potential for change is equally challenging. The recently finished Hogan Commission Report contains a hodge-podge of proposals designed to enhance health care availability and affordability. While the Report has many good ideas, some proposals would not achieve the Commission’s primary objectives. For example, the proposed Incentive Plan For Medicaid, which would provide rebates for avoiding health care services, would actually increase overall state expenditures. State legislators and the Administration will also debate Medicaid payments, professional licensure issues, the cigarette tax, privacy issues, the Certificate of Need Process and of course, the State Budget Process. A negative outcome on any one of these issues would have a dramatic and a direct impact on our health care facilities.
In facing this year’s expected and unexpected challenges, it’s important to keep in mind that as a statewide health care community, we are only as strong as our weakest link. We could fight indefinitely about who is responsible for one or more of the problems facing our health care system. Just as leaders in the police, fire and health care communities quickly came together to creatively and effectively prepare our communities for terrorist attacks, we should begin this year’s health care debates remembering that as a community of physicians, registered nurses, administrators, trustees, patient advocates and health workers, we all care deeply about providing quality affordable health care for those who need it. Working together towards creative health care solutions is a goal to strive for in 2002. Best wishes for a joyful and peaceful holiday season.
Bea Grause
CareLearning Coming Soon to Vermont Hospitals
Web-based educational programs are now available to Vermont hospitals through the Vermont Association of Hospitals and Health Systems, which is a member of a national educational consortium of 38 state hospital associations and the American Hospital Association. Hospitals that choose to enroll in the service will be able to make programs accessible to all employees at times convenient for both the employee and the organization. The course catalog includes programs on Health and Safety Compliance, nursing, business skills development, user desktop computing, Medicare compliance, medication administration, management, leadership and ethics. Individual hospital associations and educational organizations will continue to develop additional courses to meet the educational needs of members and their employees. This service provides a cost effective opportunity for health care providers to stay abreast of regulatory compliance and to continually develop the skills and competencies necessary to deliver care in an increasingly hi-tech environment.
For more information or to arrange for a demonstration at your hospital contact Julie Tonks.
Vermont Recognized Nationally as One of Six Exemplary Grant Sites
Early in 2001 the Vermont Association of Hospitals and Health Systems signed an agreement with the Vermont Department of Employment and Training (DET) to offer Specialty Nurse Training in Critical Care Nursing and Operating Room Nursing. The training is paid for with $1.5 million received as part of a federal grant (H1B) submitted by DET on behalf of the Human Resource Investment Council of Vermont and approximately $2 million in matching funds from Vermont hospitals.
The H1B grant funds are available for training US citizens and legal residents in industries which have been using foreign workers. To date, 150 grants have been awarded nationally. Vermont is one of six sites being recognized as exemplary.
The courses involve classroom and distance learning instruction and an extensive clinical experience. Faculty from Fletcher Allen Health Care (FAHC) provides the instructional portion of the two courses on the UVM and FAHC campuses. The clinical experience takes place at each nurse intern’s sponsoring hospital. The programs are available to nurses employed at all Vermont community hospitals and the Veteran’s Administration Hospital.
The unique characteristic of the Vermont Specialty Nurse Training programs that sets the VAHHS project apart from other H1B federal grant participants is its preceptor training. In addition to the curriculum, which is based on national standards, this is a formalized program that trains the preceptors who mentor interns during their clinical experience.
While the concept of a nursing preceptor may not be a new one, the formal training is. The Vermont Nursing Internship Project designed the preceptor training. It is a statewide program resulting from collaboration among Vermont nursing educators, practitioners and regulators. The program trains nurses in the skills necessary to educate adult learners and assist them in applying the classroom knowledge to the clinical setting. The preceptor supports the intern during the 600-720 hour clinical experience at the local hospital. The outcome of this process is a competent specialty nurse who can comfortably take on full responsibility for patients in a much shorter time. Anecdotal evidence indicates that nurses who have experienced this nurturing learning environment are retained longer by the hospitals employing them.
Vermont nurses interested in this training should contact their local hospital nursing department.
For more information contact Julie Tonks.
The Important Role of our Trustees
The recent Burlington Free Press articles criticizing the "code of silence" surrounding a patient’s medical records raised many issues about how Vermont’s health care system ensures quality to the patients they serve. Unfortunately, the article’s overwhelming focus on how the Vermont Medical Practice Board polices Vermont physicians gave readers an impression that the Vermont Medical Practice Board was the main avenue for consumers to learn more about the quality of care delivered by their providers. Fortunately, peer review, consumer advocacy and quality improvement efforts have all changed for the better since Lois Tarczewski’s tragic and frustrating experiences. Consumers today have a variety of helpful avenues to gain more information on their providers and as importantly, many enhanced checks and balances exist to prevent errors before they happen.
Hospital trustees play a vital role in both peer review and improvement of quality in their respective institutions. Under Vermont law1 , hospitals trustees operate under a duty of care. This duty of care2 requires trustees to act in good faith with the care of an ordinarily prudent person in a like position under similar circumstances. Translated, trustees must act honestly and without conflicts of interest. For example, while they can rely on information and reports presented by the hospitals’ officers and employees, they would be obligated to question the report if they knew or believed that the information or report was inaccurate or misleading. Acting as an ordinary or prudent person also doesn’t mean they must be experts on every aspect of the peer review process or of overall hospital operations. Trustees must however, use common sense and their informed judgment when making decisions affecting hospital operations.Trustees take an active part in credentialing and granting privileges to each physician who practices at their hospital. They are not required to make medical judgments on the standards of care (or deviations from the relevant standard of care), but they must oversee and determine that the hospital’s processes for identifying, addressing and reporting both system and practitioner errors is thorough and adequate. In addition, trustees must ensure that hospitals comply with the network of state and federal quality reporting requirements (such as the Joint Commission on Accreditation of Hospital Organizations’ sentinel event policy), in the event a serious error does occur. Hospital trustees help prevent errors by ensuring that hospitals continuously strive to improve the safety and efficacy of their health care delivery systems.
Quality improvement is an area where providers, hospitals and their trustees can never rest. While to err is human, even a miniscule error rate still means that someone’s husband, daughter or parent suffered from an untoward medical consequence. In the hospital community, quality improvement has long been – and will continue to be – a top concern. Trustees can and should continue to play an active role on their hospital boards to ensure that hospital quality assurance and prevention systems function at top capacity.
1 Vt. Stat.Ann. tit. 11B§ 8.30
2 Trustees operate under other statutory duties, such as the duty of loyalty. Discussion of these duties, however, exceeds the scope of this article.
MEDICAID TIMELY FILING COMPROMISE
The Vermont Health Access Advisory dated September 2001 indicated that as of January 1, 2002, Vermont Medicaid would place a six-month filing limit from date of service on all Medicaid claims, regardless of whether Medicaid is the Primary or Secondary payer. In response to this troubling Advisory announcement, VAHHS facilitated a meeting with the Office of Vermont Health Access (OVHA) and hospital representatives. VAHHS addressed hospital and health systems concerns with the proposed change, OVHA’s position, and potential areas for compromise.
Ultimately, VAHHS helped reach a favorable compromise. It consists of a twenty-four month filing limit on claims billed to Medicare with Medicaid noted as the secondary payer and a twelve-month filing limit for claims other than those specifically detailed in the rule as well as insurance types that Medicaid will require to be filed within six months of date of service. Hospital billing departments need to update systems and educate staff on the changes.
Hospitals should use official OVHA notices such as the Vermont Health Access Advisory or call EDS Provider Services at 878-7871 or 1-800-925-1706 for the specific details on these necessary changes.
For more information contact Erica McNamara.
Statewide ADULT Tobacco Cessation InitiativeTwo and a half years ago Vermont hospitals made a commitment to Jan Carney, the Commissioner of the Department of Health, to help address adult tobacco use in Vermont. With this commitment in mind and the assistance of tobacco grant funds, fourteen community hospitals are establishing mechanisms to identify adult tobacco users, offer brief counseling, direct those interested in quitting to appropriate community resources and assist them through the quitting process. All fourteen hospitals have established at least a six-month schedule for cessation classes. They share information on these classes and other cessation resources with the statewide telephone Quit Line provided by the Vermont Cancer Society. Hospitals coordinate with their local Area Health Education Center on the education of community health care providers. They distribute pharmaceutical coupons, called Quit Bucks, to eligible community recipients. Last but not least, they collect data on their program to share with the Vermont Department of Health.
Data collected since September 1, 2001 indicate that more than 600 individuals statewide have been counseled about tobacco cessation. Sixty-eight percent of these individuals have been counseled by their primary care provider and 392 are now clients receiving community cessation services. Since September 1, 128 pharmaceutical coupons have been distributed. This number represents approximately one-third of the clients receiving services and is consistent with the expected percentage of eligible Vermonters. Over time the electronic data collection process used by all fourteen hospitals will enable VAHHS to report on successful quit rates and movement toward the community health improvement goal of reducing adult tobacco use by 50% by 2010.
For more information contact Julie Tonks.
HIPAA EXPO A SUCCESS
The New Hampshire-Vermont Strategic HIPAA Implementation Plan (NHVSHIP) held its first annual HIPAA Vendor Expo on November 20th.More than 30 vendors and 120 health care providers took part in the event. The full-day Expo included information sessions and vendor booths. Special thanks to John Jessop, Dawne Smith, Linda Blaisdell, Marge Kemp and Deb Yeager for all of their hard work!
For more information contact Greg Farnum.