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Sombrero

Pima

County

Medical

Society

Home Medical Society of the 17th United States Surgeon General

JUNE/JULY

2013

of the 17th United States Surgeon General JUNE/JULY 2013 SPECIAL TUCSON MEDICAL CENTER ISSUE TMC’s new

SPECIAL TUCSON MEDICAL CENTER ISSUE TMC’s new look, top-notch technology, same compassion

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aliated with Pima County Medical Society.
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SOMBRERO – June/July 2013

Sombrero

Official Publication of the Pima County Medical Society

Vol. 46

No. 6

Pima County Medical Society Officers

President Charles Katzenberg, MD President-Elect Timothy Marshall, MD Vice President Melissa Levine, MD Secretary-Treasurer Steve Cohen, MD Past-President Alan K. Rogers, MD

Michael Connolly, DO Bruce Coull, MD (UA College of Medicine) Stewart Dandorf, MS, MPH (student) Howard Eisenberg, MD Afshin Emami, MD Randall Fehr, MD Jamie M. Fleming (student) Alton “Hank” Hallum, MD Evan Kligman, MD Melissa D. Levine, MD Clifford Martin, MD Kevin Moynahan, MD Soheila Nouri, MD Jane M. Orient, MD Guruprasad Raju, MD Scott Weiss, MD Victor Sanders, MD (resident)

Members at Large

Richard Dale, MD Anant Pathak, MD

Thomas Rothe, MD, president-elect Michael F. Hamant, MD, secretary

Board of Mediation

At Large ArMA Board

Bennet E. Davis, MD Thomas F. Griffin, MD Charles L. Krone, MD Edward J. Schwager, MD Eric B. Whitacre, MD

Ana Maria Lopez, MD,

Pima Directors to ArMA

Timothy C. Fagan, MD R. Screven Farmer, MD

Arizona Medical

Delegates to AMA

PCMS Board of Directors

Association Officers

William J. Mangold, MD Thomas H. Hicks, MD Gary Figge, MD (alternate)

Diana V. Benenati, MD R. Mark Blew, MD Neil Clements, MD

Gary Figge, MD, immediate past-president

Executive Director

Bill Fearneyhough

Phone:

795-7985

Fax:

323-9559

E-mail:

billf 5199@gmail.com

Advertising

Phone:

795-7985

Fax:

323-9559

E-mail:

billf 5199@gmail.com

Editor Stuart Faxon Phone: 883-0408 E-mail: tjjackal@comcast.net Please do not submit PDFs as editorial copy.

Art Director Alene Randklev, Commercial Printers, Inc. Phone: 623-4775 Fax: 622-8321 E-mail: alene@cptucson.com

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Publisher Pima County Medical Society 5199 E. Farness Dr., Tucson, AZ 85712 Phone: (520) 795-7985 Fax: (520) 323-9559 Website: pimamedicalsociety.org

SOMBRERO (ISSN 0279-909X) is published monthly except bimonthly June/July and August/September by the Pima County Medical Society, 5199 E. Farness, Tucson, Ariz. 85712. Annual subscription price is $30. Periodicals paid at Tucson, AZ. POSTMASTER: Send address changes to Pima County Medical Society, 5199 E. Farness Drive, Tucson, Arizona 85712-2134. Opinions expressed are those of the individuals and do not necessarily repre- sent the opinions or policies of the publisher or the PCMS Board of Directors, Executive Officers or the members at large, nor does any product or service advertised carry the endorsement of the society unless expressly stated. Paid advertisements are accepted subject to the approval of the Board of Directors, which retains the right to reject any advertising submitted. Copyright © 2013, Pima County Medical Society. All rights reserved. Reproduction in whole or in part without permission is prohibited.

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Inside

5

About this issue.

6

Orthopaedic and Surgical Tower: New facility opened May 6.

8

Perioperative Governance Council: Physicians given stronger role in policy.

10

TMC’s certifications and accreditations.

13

Arizona Coordinated Care: What it is, and is not.

19

‘Lean’ streamlines TMC’s procedures.

21

Chief Medical Information Officer: What Dr. Brian Cammarata does.

22

THMEP: Many area physicians have come from the Tucson Hospitals Medical Education Program.

24

TAVR: An alternative to open-chest surgery.

25

Ventana Medical Systems: TMC collaborates to strengthen diagnostics.

26

Healthy Living Connections: In this TMC program for seniors, peers support each other in making positive life changes.

27

Canyon Ranch Institute: TMC partners with Tucson’s famous spa in a 12-week program for wellness.

29

Dr. Charles Katzenberg: The PCMS president details how our organization is key to physicians being heard.

how our organization is key to physicians being heard. On the Cover The Tucson Medical Center

On the Cover

The Tucson Medical Center Orthopaedic and Surgical Tower is a state-of-the-art orthopaedic center and surgical facility.

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About this issue

By Bill Fearneyhough

PCMS Executive Director

L ast year PCMS officers began meeting with CEOs of local health organizations with the goals of learning which

strategies they are using to cope with change, and learning how PCMS can help the organizations succeed because we want all our hospital systems to thrive.

We found that no two organizations are using the same tactics, and that each had valid data and ideas for innovation.

In our February issue we re-introduced the remodeled Carondelet St. Mary’s Hospital and introduced the new Carondelet Heart & Vascular Institute to the medical community, working with Carondelet Health Network External Communications to portray some of the dedication, innovation, commitment and investment at the facility.

In this issue TMC Communications profiles Tucson Medical Center’s recent changes including its efforts as an Accountable Care Organization.

This Sombrero will have a wider circulation than a regular monthly issue. If you are an M.D. or D.O. who is not a PCMS member, you can download a membership application at pimemedicalsociety.org, or call 795.7985 for an application. First-year dues are only $100.

As a 108-year-old organization, we continually strive to increase our influence and outreach. We believe that today more than ever, physicians need to unite and speak up for their profession. Today is good day to commit and become part of our family of physicians.

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It’s open! A massive project costing more than $100 million with wide economic impact on
It’s open! A massive project costing more than $100 million with wide economic impact on

It’s open!

A massive project costing more than $100 million with wide economic

impact on the surrounding community, the TMC Orthopaedic and Surgical Tower officially opened on May 6.

“As a community hospital it was important to us to use as many Arizona contractors and local workers as possible,” said Richard Prevallet, TMC vice-president of facilities. “To that end, more than 78 percent of the project was awarded to Tucson companies, with the rest being awarded to Arizona companies. At any one time, there have been anywhere from 100 to 375 workers on site.”

The first floor includes a general lobby, support services, and the medical offices and clinics of Tucson Orthopaedic Institute, an independent physician group that leases the space.

The second floor houses TMC’s Surgical Service, with 14 state-of-the-art ORs that provide integrated technology for all specialties, plus interventional suites, cystoscopy, and dedicated pediatric surgery waiting, pre-op, and recovery areas.

Two of the surgical suites on this floor are hybrid rooms that will be used in both cardiac and vascular surgeries. The two rooms include the most innovative equipment on the market. Such top-of- the-line equipment will enable surgeons to treat a wider range of people, including the sickest of patients. As PCMS member, Dr. Matthew Namanny of Saguaro Surgical explains, “I can operate on people who are in their 80s or 90s, whereas before, these people were not candidates for the surgery because the mortality risk was too high.”

“With this new system, the sky is the limit,” said Dr. Luis Leon, vascular surgeon with Agave Surgical Associates. He explained that the extraordinary imaging the new equipment offers allows surgeons to be

incredibly precise. “In a minimally invasive procedure, everything is done through a needle stick which gives us access to put in catheters. Most of the time, surgeons are operating while looking at a screen. You absolutely need good imaging in order to do this.”

You absolutely need good imaging in order to do this.” A nurse helps a patient in

A nurse helps a patient in one of 40 private procedure recovery rooms in the new TMC Orthopaedic and Surgical Tower overlooking the Santa Catalina Mountains.

and Surgical Tower overlooking the Santa Catalina Mountains. Playing with children in the pediatric waiting area

Playing with children in the pediatric waiting area in the tower helps parents entertain and distract children while waiting to be brought to surgery.

In addition to vascular surgery, a hybrid OR makes it possible to interweave specialties, giving a patient the most comprehensive care and best outcome in one setting.

The new surgical suites are nearly double the size of previous OR space. High-tech surgical

The new surgical suites are nearly double the size of previous OR space. High-tech surgical equipment is attached to ceiling ‘booms,’ eliminating cords on the floor, providing for safer movement of surgeons and assistants.

New ‘hybrid’ operating rooms on the tower’s second floor allow for both non-invasive and more complex surgical procedures in the same OR, eliminating need to move patients, or in most cases equipment, in order to operate.

patients, or in most cases equipment, in order to operate. The third floor is devoted to

The third floor is devoted to orthopedic surgery, with 10 operating rooms and a new education conference center. The building’s top floor features 40 all-private patient rooms designed for orthopaedic post-surgical care and acute therapies. Two of those rooms are designed for bariatric surgery patients.

The flow of the design focuses on how patients arrive, how they are received, how they go to pre-op, surgery and post-op, and how they leave the area. Patient rooms have received comparable collaborative attention. Similar to TMC’s new pediatric rooms, the orthopedic patient rooms are broken into three distinct zones (serving the patient, the family, and the caregivers) to ensure quality of care and a positive patient experience.

While the construction project was daunting, work done behind

the scenes in preparation for the move and operation of the tower have perhaps been even greater accomplishments.

TMC leadership understood early on that this project represented a unique opportunity to examine existing processes and find ways to be more effective and more efficient. Work groups encompassing staff in areas throughout the hospital were formed to address these challenges and come up with working solutions. Everything from OR supplies to surgery scheduling to elevator etiquette was diagrammed, dissected, and worked through.

“Staff in key areas around the hospital have worked hard to question how we could do things better operationally,” said Linda Wojtowicz, TMC senior VP and chief operations officer. “We were able to zero in on our processes to assess what was not working,

what could work better, and how best to fix it.”

n

Physicians given stronger role in improvement, policy determination The TMC Perioperative Services team consists of
Physicians given stronger role in improvement, policy determination The TMC Perioperative Services team consists of

Physicians given stronger role in improvement, policy determination

given stronger role in improvement, policy determination The TMC Perioperative Services team consists of experts in

The TMC Perioperative Services team consists of experts in a range of pre-op and surgical procedures, from routine to complex.

T he new TMC surgical tower is poised to offer 24 state-of- the-art operating rooms and new opportunities for

extraordinary patient care.

In addition, it is propelling a fundamental shift toward a shared governance model, empowering physicians as they partner with hospital administration in a new way to achieve superior patient outcomes.

The move to the new building provided a strong incentive to take a critical look at day-to-day processes. Any practices that weren’t working efficiently would need to be adjusted to make sure they were as up to date as the new tower.

“Top-driven directives have not always proven to be the best way to generate buy-in from the folks who are directly involved with

patient care,” TMC President and CEO Judy Rich said, “so it became increasingly clear to us that physicians were going to have to have a stronger voice in crafting rules and policies to meet the changing demands of healthcare.”

Fourteen physicians and 10 hospital staff members took their seats on the new Perioperative Services Governance Council in June 2012, setting in motion a structure for professional collaboration that never existed before.

With 22 years of experience at TMC, including stints as anesthesiology department chairman, surgery department medical director, and chief of staff, PCMS member Matthew Atlas, M.D. knew that there were some long-standing practices that could work better. So when he agreed to serve as a consultant in

creating the governance structure and the charter for the new governance council, he immediately grasped the opportunity for significant change.

“This is an opportunity to have all the players work together to create the rules and find the solutions,” Dr. Atlas said. “It works way better than anything else.”

Among the top orders of business: Streamlining block scheduling for elective case surgeons in the operating rooms.

It’s a complex puzzle. Too much blocked time means other

physicians in the community can’t book cases for surgery because of a shortage of open time slots. Such reduced flexibility also could mean that when emergency cases come in, or if cases run longer than expected, it could push back

other cases and trigger delays, causing stress to staff and patients.

With efficient block scheduling as key to full use of the new ORs, the team combed through reams of data to see whether the blocked time matched actual patterns of usage, from whether surgeons had too much time allotted to them or too little, and whether mechanisms existed to release blocks of time that weren’t needed. Dr. Atlas and many others met with every surgeon who had block time—more than 50—to gauge their needs and share findings.

Ultimately the system was recalibrated to meet the industry standard of having no more than 80 percent of the OR schedule electively blocked, providing more flexibility for scheduling as well as more open time to handle overruns and urgent surgeries.

The current economic climate has left little choice but to carve out efficiencies, even when the solutions may initially be labor- intensive and sensitive, Dr. Atlas said. “People are often afraid of change and there can be a culture of resistance in any large system. But if any hospital wants to survive in this environment, with the economics that are going on, they have to look at fundamentally changing how they do things.

“In the old days when there was a lot of fluff, it was a different story. But with hospitals seeing margins of 1 to 2 percent, you need to use the resources you have more efficiently. If you sit still, you’re going to get run over.”

Dr. Atlas has been around long enough to see initiatives come and go, but predicts that success will cement this new way of doing business.

“If you look at where we started, and where we are today, it’s monumental the things we have accomplished,” he said. “The things we were fixing were long-standing things that had cultural components, and as we’ve all heard, culture eats process for lunch every day.

“To change minds and hearts so that people see there is a better

way might be a long process, but it’s also an exciting one.”

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TMC recognized for cardiovascular excellence T ucson Medical Center is proud to be the first
TMC recognized for cardiovascular excellence T ucson Medical Center is proud to be the first

TMC recognized for cardiovascular excellence

T ucson Medical Center is proud to be the first hospital in Arizona to

be awarded Atrial Fibrillation certification, and the first hospital in Tucson to receive Congestive Heart Failure (CHF) accreditation.

TMC has also been re-accredited in Chest Pain, after earning its original endorsement in 2010.

The three designations come from the Society of Cardiovascular Patient Care (SCPC), an independent, nationally recognized accreditation non-profit organization focused on transforming cardiovascular care by assisting facilities in their efforts to bring together quality, cost, and patient satisfaction.

TMC earned these distinctions by meeting or exceeding a wide set of stringent criteria, demonstrating

its expertise and commitment to quality patient care. The SCPC conducted extensive and objective reviews of TMC’s A-Fib, CHF and Chest Pain programs.

Atrial Fibrillation Certification

TMC’s protocol-driven and systematic approach to evaluating and managing A-Fib patients allows physicians to reduce time to treatment. It also allows them to stratify patients by risk to decrease their length of stay in the ED and the hospital.

By improving TMC’s processes and outcomes for A-Fib patients, SCPC is fulfilling its mission to reduce cardiac-related deaths. Patients can be confident they are receiving critically appraised evaluation, treatment, and management of A-Fib. According to SCPC, there are currently nearly 3 million A-Fib cases in the U.S. By 2050, it is projected that this number will jump to more than 7.5 million.

“This certification means that TMC is providing a recognized standard of care,” said TMC cardiac electrophysiologist and PCMS member Darren Peress, M.D., of Pima Heart Associates. “All of the physicians here are providing the same level of care. We’re all practicing in a way that’s evidence-based, and that’s been recognized as good medicine. Patients should know that if they

as good medicine. Patients should know that if they Dr. Darren Peress, electrophysiology lab director, works

Dr. Darren Peress, electrophysiology lab director, works with one of only 175 stereotactic ablation systems worldwide, and the only one in Southern Arizona.

come here, they’re going to get a full range of good care. TMC has processes in place to care for these patients in a very efficient way—we’re providing the right care to the right patient at the right time.”

Congestive Heart Failure Accreditation

TMC’s dedication to higher standards in enhancing care quality is also recognized through CHF accreditation. The hospital has adopted an operational model for CHF patients to organize care delivery in a systematic manner using evidence-based guidelines and quality initiatives. With this accreditation, TMC has expressed a deep interest in these patients’ well being by not only maintaining the standard of care, but also constantly improving it. Heart failure is a leading cause of morbidity and mortality in the U.S., affecting an estimated five million Americans. This accreditation demonstrates TMC’s ability to effectively manage the increasing number of these patients.

“TMC realized several years ago that a true collaborative effort among cardiologists, cardiothoracic surgeons, and hospital administrators was necessary to ultimately improve quality metrics and patient care,” said TMC cardiologist and PCMS member Gregory Pennock, M.D., of the Heart Center of Southern

Arizona. “Thus, in a fairly revolutionary idea at the time, the cardiology/CT surgery SLA (service line agreement) was formed—a joint management venture between hospital administrators and physicians.

“Results have been impressive, and the hospital accreditations reflect those efforts. Patient satisfaction and quality metrics have improved, and physician satisfaction has improved. Physicians have more ownership in the management of hospital processes and resources, and relationships between physicians and administrators have improved.

“Perhaps the most interesting and important aspect of the SLA is that multiple physician groups that were once fiercely competitive with each other are now much more collaborative. I would like to think that TMC has tried to figure out a model to preserve private practice in the region. This model is vastly different than an employed physician model used by other hospitals and networks. In general, I think physicians didn’t go into this profession to be shift workers, dictated to by administrators, accountants or the government.”

Chest Pain Re-accreditation

TMC’s Chest Pain re-accreditation ensures that patients who come to the hospital complaining of chest pain or discomfort are given the immediate treatment necessary to avoid as much heart damage as possible.

Protocol-based procedures developed by leading experts are part of TMC’s cardiac care, to reduce time to treatment in the early stages of a heart attack. With TMC’s accredited status, patients can be confident that they will be treated according to best- practice guidelines from the American College of Cardiology and the American Heart Association, and get education about treatment and prevention of heart disease.

In addition, staff members receive education about signs and symptoms of heart disease, and the resources TMC has to treat chest pain patients. SCPC’s goal is to use evidence-based medicine to eliminate heart disease as the No. 1 killer worldwide.

“Accrediting TMC as a chest pain center brought together multiple disciplines working toward the goal of rapid response to heart attack and efficient responses to less urgent presentations,” said TMC cardiologist Dr. Mark Goldberg of Camp Lowell Cardiology. “The re-accreditation process brought even closer scrutiny to our methods of providing care. Again, EMTs, ED nurses and physicians, cath lab personnel, and cardiologists worked together to fine-tune a system in which time is critical.

“We are very pleased with the quality measures that we’ve been able to report and the progress we’ve made in making the system more efficient,” Dr. Goldberg said. “This progress definitely

translates to better patient outcomes.”

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Goldberg said. “This progress definitely translates to better patient outcomes.” n SOMBRERO – June/July 2013 11

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T ucson Medical Center announced in March that it had joined an innovative new alliance that would not only focus on

keeping people healthier over the long term, but also help put healthcare on a more sustainable trajectory.

With such Accountable Care Organizations promoted in the Patient Protection and Affordable Care Act of 2010, the success of Arizona Connected Care will hinge largely on making sure chronically ill patients are better equipped to manage their conditions so they can avoid repeat hospitalizations and costly interventions.

We asked IM physician Jeffrey Selwyn, M.D., who took part in the planning for the new organization over the past three years, and Family Practitioner John Wadleigh, D.O., a relative newcomer to the new path, to explain what drew them to the approach and how it’s already helping them better serve patients. Both are PCMS members.

Dr. Wadleigh, what made you consider signing on with the ACO?

We’re in an unusual time in medicine. In the past it’s always been about quality of care. Now, it’s about quality and cost-effective care, and that is a much bigger challenge.

The original term Accountable Care Organization meant holding an organization accountable to patients and their families. I really like that concept and I like that we have control here locally. By being local, you are more accountable, because you live among your patients. They’re your neighbors. They’re the people you see in the store and who take care of you in restaurants, so the local management of medical dollars is very important.

Dr. Selwyn, you’ve been engaged in the ACO now for several years, from its inception to a fully operational entity. How is your practice different?

I have to say that New Pueblo Medicine has been at the forefront of really understanding and perpetuating this vision of coordinated care through improving the health of the population, engaging patients in wellness,

promoting health awareness, and managing chronic disease. So for me, the way of practicing hasn’t changed.

But I’m seeing more of the things I’ve desired come true: Better outcomes, better chronic disease management, more patient education, and more patient engagement.

That’s been largely fulfilled because of what we’ve been able to do with the electronic medical record. That was a difficult transition for me as an older physician. I thought I could do charts better than anyone and I didn’t see the value. Admittedly, it was a painful transition. But as I look back on that, and being on the other side of the fence right now, it’s night and day in terms of how you can manage your patients.

Do you have an example of that?

Well, as an example, very easily with the click of a button you are now able to pop up different screens and templates about what health maintenance and disease management steps each patient

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A patient consults with Dr. Jeffrey Selwyn, medical director of Arizona Connected Care. Dr. Wadleigh,

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Dr. Wadleigh, you’ve come to this more recently. How do you anticipate your practice changing?

Ask any office-based primary care provider and they’ll tell you they’ve had this exact experience. A patient will come in and they’ll tell you that since you saw them six months ago, they’ve had a heart attack, went to the hospital, had a bypass, spent time doing rehabilitation and then had some home healthcare—and we had no idea that ever occurred. With the robust information technology systems we have in place now, we’ll know these things so we can be better advocates for our patients.

needs. You could do that before with a paper chart, but if you couldn’t read your partner’s writing or if things were left out or the chart was disorganized, the ability to retrieve information from a written chart was much more difficult.

The ability to keep meticulous, organized, concise records has just exploded with EMRs. That allows me, as a physician managing 1,600 patients, the ability with a click of button to make sure that my diabetic patient has received appropriate labs within a reasonable time framework, and has had an eye exam, and a foot check or anything else that might be appropriate for that patient. It has allowed me to work smarter, not harder, and has allowed things to be much more transparent.

But you also see ACOs as having the potential to fundamentally change medicine?

We are getting fewer and fewer primary care providers than at any time in history, and that’s because the people who make the decisions at the HMOs and Medicare have made decisions that push new students into anything else but primary care. The hassle factor is higher, between having to do primary care verifications and referrals and prior authorizations. And since payments have been cut back, doctors are trying to see more patients, since the more you see, the more your income is.

But running through so many patients is really not what we want to do. Rather than seeing 30 or 40 patients a day, we’d rather see half that and give the care that we really want to give.

That’s going to change medicine. Now, there’s an option for those young providers who really want to do the kind of primary care where you knew your patients as children and then as young adults and then you get to know their children and it’s a 30-year relationship. We have to have a system that promotes office-based primary care providers and the ACO is really the only thing going that may do that.

Dr. Selwyn, you’re about to join Dr. Richard Johnson in the shared role of medical director for Arizona Connected Care. As you continue to build the network, what are the opportunities you’re seeing now for physicians in the community?

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The network and membership is open to any and all who are really interested in adopting a collegial mentality to promote better healthcare. We have roughly 200 primary care doctors participating now.

Change for anyone, including physicians, is not easy, since we’d prefer to stay in a comfort zone.

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But by moving forward in small steps with the help of a transformation team, physicians will find it’s a much less painful process than if they try to do it on their own.

How do you think it’s helping patients, Dr. Wadleigh?

There’s a wonderful saying that doctors take terrific care of the diabetic patients who come to the office. It’s the ones who don’t come to the office who go back and forth to the hospital and the emergency room and are spending the majority of money because they’re not getting preventive care.

We need the time and the personnel to do outreach to those individuals to make sure they’re taking meds and they’re doing visits and getting labs done to prevent problems.

But ultimately, I think everyone wants to have a provider who they feel is their advocate, and I think we’ve lost that in medicine. We go to our primary care doctor if we have a cold or sore throat. We go to CVS pharmacy for an earache. We go to an urgent care for that laceration and we go to a specialist for this or that. What we’ve lost is someone who will pick up the phone and say, “Yes, I’ve known Mr. Martinez for 20 years. What’s happening?” The vast majority of Americans need to have that kind of relationship with their doctors if they are to get the care they all want. Hopefully, this can help promote that.

Dr. Selwyn, you’ve been affiliated with TMC for four decades now. How important is it that TMC is participating in this effort?

I believe in TMC. I believe in what they’re trying to do in the community. I am totally invested in their commitment to making such an organization be successful and a model for other places in the country.

With clinics also part of the ACO, it means we’re no longer working in silos. I really like that collegiality. I like the fact we’re all on the same team and working together for a common goal and a common vision.

Everybody wins because we’re doing a better job and saving money by doing the right thing.

AzCC myths vs. facts

Because many in our community are still not sure what Arizona Connected Care is and is not, here are a few myths we have heard, and facts we can report about what Tucson’s first Accountable Care Organization (under PPACA) is actually doing.

Myth: Arizona Connected Care (AzCC) isn’t really a physician- governed organization.

Fact: A physician chairs AzCC’s board of directors, and eight of its 13 governing board members are doctors. Two other members are community representatives, and three board members hold TMC affiliations. Although TMC is a major supporter of AzCC, it holds only a minority governance position in this physician-driven organization.

Myth: The goal is to generate business for participating partners.

Fact: The goal is to provide quality healthcare to the patients we serve, when and where they need it. The only way participating clinicians can benefit from AzCC is by providing excellent and efficient healthcare with strong patient satisfaction results.

AzCC clinicians work to keep people healthy enough so they don’t need tertiary care, so the focus is on prevention and wellness. If an AzCC patient does require hospitalization, AzCC works closely with primary care physicians and hospital staff to provide appropriate transitions to make sure patients’ needs are met after discharge, but the goal is to minimize unnecessary admissions.

Myth: AzCC thinks the quality of care provided by area physicians needs improvement.

Fact: This is absolutely not true! Physicians work extraordinarily hard on behalf of their patients, including uncompensated time helping their patients stay well. AzCC believes it is the system we all work with that needs to be modified, including offering incentives for physicians for wellness checks, preventive

be modified, including offering incentives for physicians for wellness checks, preventive 16 SOMBRERO – June/July 2013

outreach, and many other aspects of quality care that focus on keeping people well.

Myth: AzCC will limit care in order to improve the bottom line.

Fact: Center for Medicare Services rules would prohibit any such effort, and such an approach is diametrically opposite AzCC’s mission. Patients in Arizona Connected Care could actually receive more care. AzCC providers offer preventive care focused on keeping patients healthy as the best way to “bend” the cost curve. Our formula is: More consistent care = healthier patients = lowering total healthcare cost.

Myth: AzCC will tell physicians how to practice medicine.

Fact: Arizona Connected Care is not different from its physicians; it is its physicians. They set the policies. They define quality and best practices. They hold each other to an agreed-upon high standard.

Because patients also serve on the board, they, too, have a say in establishing those standards. This collaborative approach gives clinicians the information they need to practice evidence-based medicine, and office efficiencies so they can spend more time with their patients and less time on the business of medicine. Arizona Connected Care helps physicians envision their ideal practice, and then helps them achieve it.

Myth: Patients won’t really see any difference.

Fact: Patients of AzCC-participating clinicians enjoy clear communication with their providers and become more engaged in their own healthcare. They receive greater support where they need it, including at home. They experience smoother transitions when leaving a hospital or other care facility.

AzCC’s success is predicated on positive outcomes and patient satisfaction, something patients can and will notice.

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The watchword is ‘Lean’ N o one likes to wait. And for those sick enough
The watchword is ‘Lean’ N o one likes to wait. And for those sick enough

The watchword is ‘Lean’

N o one likes to wait.

And for those sick enough to go to the emergency room, a long wait combined with anxiety makes for unhappy patients.

To take the wait out of the waiting room, Tucson Medical Center has embraced efficiency methods developed at Toyota half a century ago. Known as the Lean management process, it has spread across many sectors around the world. TMC uses this system in order to build a culture of learning designed ultimately to increase patient satisfaction, streamline processes, and strengthen the hospital’s financial position.

Although the Toyota Production System was developed to eliminate waste and streamline processes in manufacturing, the principles are being used at TMC to take a hard look at productivity measurements across the hospital, from the cafeteria to the OR.

When the new director of patient care services in the emergency services area heard about the effort, she literally begged to be the first project, even though it meant inviting significant scrutiny. “I was really excited about the idea because I knew I needed help to address important areas, from retention rates to employee morale,” Melissa Moreno said.

Under the Lean process, teams followed patients through the length of their emergency department stay, logging how long patients waited at every step in the process to ferret out the logjams and bottlenecks.

The teams drilled down deep, even looking at how rooms were situated to see if medical staff had key equipment at their fingertips or had to search for it. Every practice was weighed based on whether it added value for the patient.

For Moreno, it was an intimidating process. “It takes a lot of courage to sit back and let someone else tell you what’s going wrong in your department, but it’s been worth it,” she said.

Even though the work only began in January, changes have already been implemented:

Too many patients were sitting in the emergency department

Too many patients were sitting in the emergency department Emergency Department nurses show ‘Lean’ management

Emergency Department nurses show ‘Lean’ management changes across the organization, aiming to streamline processes by improving work flow and reducing waste.

waiting for discharge, so a discharge lounge was constructed where they can comfortably wait for prescriptions and other instructions to be finalized, while freeing up beds for other patients. And because it is staffed with a nurse assigned just to discharge duties, patients report they’ve had more one-on-one time and better understand the steps to take when they leave the hospital.

When data indicated some of the backup was attributed to patients waiting too long for diagnostic tests to come back, the staff not only shaved some time off of CT scan returns, but also placed a mid-level provider up front to see patients. That way, pain is addressed faster, and X-rays and other diagnostics can be ordered so that when the patient is seen, the information is there.

Let’s say a nurse had a patient with nausea and wanted to order a medication. Previously, the nurse had to leave the area to find the physician, who worked in another area. Now, the space is organized into “pods,” where the nurse can literally turn around in a chair to talk with the doctor. No more searching—and it provides a stronger team approach.

Make no mistake. It is an investment. Key staff members have been pulled from departments throughout the hospital to work on the project full time. Teams then had extensive training, and

traveled to hospitals where it is working, such as Seattle’s Virginia Mason Medical Center.

In a Lean model, process improvement is driven by frontline staff—those who are closest to the work and know best how to improve processes. It hasn’t always been easy.

Even Moreno, who was so welcoming initially, had to overcome a tendency to push back, particularly when she was asked to standardize a day’s work for her charge nurses. It seemed preposterous, in an environment as hectic as an emergency room, to dictate when lunch and rounds will take place. But after the nurses created their standards, they were proud.

“At the end of the day, they have a clean slate to hand off to the next charge nurse and they’re no longer driving home thinking, ‘Oh. Did I get that done?’ Now they know, because they checked it off their list,” Moreno said.

Dr. Richard Rosenthal, medical director of the emergency department, agreed that it’s been worth carving out the time for analysis and evaluation. And he hopes in the next few years to get to a place where there’s very little wait at all for patients.

“You don’t want patients to be in a waiting room. Even if someone has seen them briefly, you don’t know how serious they are, so you want them back in the treatment area where you can observe them and take care of them,” Dr. Rosenthal said.

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With Medicare reimbursement increasingly taking into account whether patient expectations were met, he predicts more hospitals will look more closely at measures of patient satisfaction.

Lean’s goal is to root out waste, and that encompasses more than waiting. Using the acronym DOWNTIME, here’s a look at the eight types of waste that staff is trained to find and address:

• Defects

• Overproduction

• Waiting

• Not being clear

• Transportation

• Inventory

• Motion

• Excess processing

Another prediction: Lean work will never be done. Not even when the Lean teams disband after combing through procurement, food services, and other areas of the hospital.

“I’d hate to be at a point where we assume we’ve reached ‘nirvana’ and can’t do any better,” Dr. Rosenthal said. “I hope we’re always on the cutting edge of

improving patient care and satisfaction. It’s an exciting time for us. It’s challenging, but we really enjoy this focus on making

things better.”

n

Dr. Brian Cammarata: CMIO The unique skill sets of Dr. Brian Cammarata, TMC’s first chief
Dr. Brian Cammarata: CMIO The unique skill sets of Dr. Brian Cammarata, TMC’s first chief

Dr. Brian Cammarata: CMIO

Dr. Brian Cammarata: CMIO The unique skill sets of Dr. Brian Cammarata, TMC’s first chief medical

The unique skill sets of Dr. Brian Cammarata, TMC’s first chief medical information officer.

T he role of chief medical information officer, dealing with healthcare information technology, is still fairly new to

medicine, but is rising in significance as industry leaders nationwide realize how technology is shaping healthcare’s future.

Brian Cammarata, M.D., took the new position in January because he found it a great match with his original interests.

“I started my undergraduate career in management information systems and had intended to work with computers,” Dr. Cammarata said. “Through a series of events, I became interested in medicine. After I graduated from medical school, I never anticipated using my computer background. The two fields, however, are now merging in interesting ways. The evolution of healthcare informatics will provide substantive improvements to medical care delivery. We are able to improve care for both individual patients and entire populations through improved information technologies.”

Like technology itself, the job is evolving, Dr. Cammarata said. The job “seeks to improve patient care through enhanced information access and availability. This job is new to TMC and undergoing evolution. When we first developed the position, it was difficult even to place specific objectives and criteria on paper. We continue to learn about and develop the role every day.”

The biggest challenge goes back to when TMC went live with its electronic medical record in 2010, Dr. Cammarata said. “As an institution, we were an early adopter of the technology. At that time, a fully electronic medical record was a significant practice change for most of our medical staff. While the idea of a full implementation of EMR was somewhat new, TMC leadership believed that the concept would mature to substantively improve patient care.

“Our biggest challenge on the horizon is data management. We have become effective at collecting data, but we need to continually develop better methods of using this data in meaningful ways. These include evaluating outcomes, improving patient safety, and meeting the hospital’s growing list of compliance measures.”

The ultimate goal is improving patient care.

“We use this information in a number of ways,” Dr. Cammarata said. “For hospitalized patients, we are working to improve care in multiple areas, such as minimizing the number of patients who develop blood clots and improving sepsis care. Another aspect is using information to help keep patients with chronic diseases out of the hospital. For example, for a patient with diabetes, using information to improve blood sugar control, minimize complications, and keep the patient out of the hospital is a win- win for everyone. The approach improves patients’ lives and saves healthcare system dollars.”

Healthcare IT’s ultimate goal, Dr. Cammarata said, is to “assist our physicians and nurses in providing the safest and most effective

care for every patient at Tucson Medical Center.”

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THMEP: Improving with age Medical education program still shines at TMC Tucson Medical Center this
THMEP: Improving with age Medical education program still shines at TMC Tucson Medical Center this

THMEP: Improving with age

Medical education program still shines at TMC

Tucson Medical Center this year is celebrating half a century of helping to educate current and future physicians.

The Tucson Hospitals Medical Education Program (THMEP), the education arm of TMC, was established in 1963 as the original medical education program for the community, since the University of Arizona had not yet opened its M.D.-producing college or begun its postgraduate residency training programs.

Tucson Medical Center remains one of the state’s major teaching hospitals for both residents and medical students alike. TMC sponsors a one-year transitional program for those individuals

moving on to specialty residencies elsewhere. TMC also independently sponsors a pharmacy residency and is in the process of getting approval for a podiatry residency, which will be co-sponsored by Midwestern University.

THMEP partners with a number of universities to meets its educational mission. Through THMEP, TMC is a major teaching institution for medical students and residents from several University of Arizona programs, including Internal Medicine, Surgery, Pediatrics, Neurology, Emergency Medicine and others. In all, more than 200 residents a year come through TMC.

“One thing that residents really value about coming to TMC is they get a different perspective than they otherwise would in a purely university-based setting,” said PCMS member Robert Aaronson, M.D., THMEP executive director, who is board-certified in IM, pulmonary, critical care, sleep, and neuro-critical care medicine.

“Residents take important knowledge and lessons away from every setting in which they practice, but here at TMC people get to see a wide variety of patients from very different cultural and socio-economic backgrounds. They also have the opportunity to work with skilled clinicians in a medically and technically sophisticated but real-world setting to learn cost-effective and medically effective approaches to patient care.”

and medically effective approaches to patient care.” Dr. Robert Aaronson works with a patient while mentoring

Dr. Robert Aaronson works with a patient while mentoring residents and doctors in the graduate and continuing medical education programs at TMC.

Starting in July, the program will add another important residency, which will be a novel concept offered in conjunction with A.T. Still University, El Rio Community Health Center, and the Wright Center in Pennsylvania. The collaboration will pilot a national family practice residency built on a model that focuses on community health centers in order to train primary care physicians to better meet the needs of medically under-served populations.

Designed to address a troubling shortage of primary care physicians, funding provided through the Affordable Care Act will encourage innovative training and will showcase a model that could be replicated elsewhere.

“We are really excited about this opportunity,” Dr. Aaronson said. “Residents accepted into this program are individuals who have stated a desire to deliver primary care and to focus that care on a needy population. That absolutely fits with TMC’s mission, which is to provide service to those across the entire economic spectrum.”

Dr. Aaronson said that the opportunity gives students and residents the chance to tap into the resources of TMC, including a strong focus on data collection, which has been driven through

establishment of the electronic medical record and, more recently, through partnership with the ACO, Arizona Connected Care.

With THMEP accredited by the Arizona Medical Association to provide CME programs that will meet the needs of physicians in the community, TMC also recently made a substantial investment in providing a subscription for all physicians on staff to UpToDate, a resource that provides the latest information on new clinical developments and recommendations.

One of the advantages to this resource is that physicians can earn CME credits when they research a clinical question.

“At THMEP our mission is to improve community health through the education of physicians at TMC and within our community, as well as at the

at TMC and within our community, as well as at the Dr. Charles Daniel reviews a

Dr. Charles Daniel reviews a patient case with a resident participating in THMEP.

undergraduate and graduate levels,” Dr. Aaronson said. “It’s been very rewarding to grow our own, with a focus on high quality,

effective, and efficient care.”

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to grow our own, with a focus on high quality, effective, and efficient care.” n SOMBRERO
to grow our own, with a focus on high quality, effective, and efficient care.” n SOMBRERO
to grow our own, with a focus on high quality, effective, and efficient care.” n SOMBRERO
to grow our own, with a focus on high quality, effective, and efficient care.” n SOMBRERO
Alternative to open-chest surgery gives hope to patients previously thought untreatable Patients once deemed too
Alternative to open-chest surgery gives hope to patients previously thought untreatable Patients once deemed too

Alternative to open-chest surgery gives hope to patients previously thought untreatable

Patients once deemed too high-risk for open chest surgery may soon get a new chance at a higher quality of life.

Tucson Medical Center is poised to offer surgeons the ability to perform Transcatheter Aortic Valve Replacement (TAVR), which was approved for wider use by the U.S. Food and Drug Administration last fall.

Candidates for the surgery suffer from a narrowing of the aortic valve, weakening the heart over time as it works harder to push blood through the tighter valve.

In the new procedure, instead of opening the chest,

an artificial aortic valve is fed through a tube inserted through the groin and up into the heart. It’s far less invasive and offers much faster recovery time.

Cardiologist and PCMS member William Thomas, M.D., one of the lead physicians helping to develop the program, said that without the procedure patients too sick for traditional surgery have a 50 percent chance of dying over the subsequent 12 months, facing limited lifestyle along with the high mortality risk.

For doctors in the community who currently have only one local option for the procedure, the new capability at TMC provides additional flexibility, Dr. Thomas said. He added that it will also provide a more open program to allow cardiologists to present cases and participate in a comprehensive valve clinic that will provide evaluation and treatment options for complex valve disease.

evaluation and treatment options for complex valve disease. Dr. William Thomas, structural heart medical director,

Dr. William Thomas, structural heart medical director, sponsors TAVR.

Implementing the program is a rigorous process that demands extensive training, adherence to strict criteria, and specialized equipment. The new TMC surgical tower will house two “hybrid” ORs large enough not only for the equipment, but for the large, collaborative surgical team, which consists of a surgeon, a vascular surgeon, two cardiologists, a cardiac anesthesiologist, imaging specialists, and other clinicians.

Anita Bach, TMC director of cardiac services, said she hopes to offer the procedure sometime within the next calendar year. “We

have a great group of cardiologists and surgeons who work well together, and now that we have the room and the equipment and the trained staff, we’re really in a perfect place to offer this alternative,” Bach said. “Physicians are always looking to technology for the newest, most innovative ways to improve healthcare. This is the kind of advancement that will allow them to give their patients a better alternative.”

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Unique collaboration with Ventana strengthens diagnostics T ucson Medical Center now offers a fully automated
Unique collaboration with Ventana strengthens diagnostics T ucson Medical Center now offers a fully automated

Unique collaboration with Ventana strengthens diagnostics

T ucson Medical Center now offers a fully automated

couldn’t. Without manual dipping, every slide has a fresh stain of very high consistency that makes it easier to read, reducing the possibility of misdiagnosis.

The automation also allowed for stronger management of patient identification throughout the process. The use of a barcode eliminates mislabeling. And because one pathologist works with one patient at a time through the entire process, there is greater continuity of care.

The laboratory also now features two machines that use immuno- histochemistry to help differentiate one tumor type from another and one tissue type from another.

A BenchMark stainer with 24 special stains also allows laboratory staffers to process more slides and improve their turnaround time compared to the older manual process the lab previously featured.

laboratory that optimizes staff efficiency, improves turn-

around time and reduces the potential for human error.

The hospital upgraded the laboratory under an innovative collaboration with Ventana Medical Systems, a member of the Roche Group, a leader in tissue diagnostics.

Ventana, the #1 provider of anatomic pathology and histology staining equipment in the world, had been looking for an affiliation that would allow the

company to showcase important technological advancements while strengthening the health of the community through increased educational outreach.

“In today’s healthcare environment, it’s more critical than ever to provide patients with information about the value of diagnostic testing, along with

accurate, comprehensive diagnostic results to ensure quality, cost-effective treatment,” said Megan Bailey, senior marketing manager for Ventana Medical Systems.

The discussions began in July, shortly after John Allen came on as the director of lab services at Tucson Medical Center.

From Ventana’s perspective, the alliance furthered its mission to improve the lives of all patients with cancer. “With TMC, this takes on special meaning, as the patients affected are members of our own community,” Bailey said. “In discussions with TMC’s leadership, it was clear they share a similar vision and are intent on delivering the best diagnostic result for every patient they serve. We’re proud to provide solutions to help them achieve that goal.”

Allen said the relationship came at a perfect time. “It fit a vision of where I thought we could take this lab and it fits the vision for TMC to be truly a premier provider,” he said.

The new systems will allow the hospital to perform more in- house tests, reducing the need for outside laboratories.

The new automated hematoxylin and eosin-staining equipment advances patient safety in ways the previous dip style stainer

In today’s healthcare environment, it’s more critical than ever to provide patients with information about the value of diagnostic testing, along with accurate, comprehensive

diagnostic results to ensure quality,

cost-effective treatment.

“We are as fully automated as any histology lab. We are state-of-the-art for staining techniques and workflow management,” Allen said.

The laboratory also added an iScan Coreo digital pathology slide scanner, which will allow the hospital to do more analyses in house, particularly with breast cancer, instead of sending those out to other labs.

Although the laboratory was completed at the end of February, TMC and Ventana are continuing to work on building a long-term relationship that will not only provide premiere cancer diagnostics, but also a forum for educational collaboration. From Ventana’s perspective, it also is helpful to have local lab staff provide ongoing feedback as they refine and develop solutions for customers.

From TMC’s perspective, the new equipment helps the hospital position for growth while providing exceptional quality and reliability.

Allen noted: “Getting state-of-the-art techniques allows us to be

capable of top quality, state-of-the-art results.”

n

Bridging the gap Peers support each other in making positive life changes T here may
Bridging the gap Peers support each other in making positive life changes T here may

Bridging the gap

Peers support each other in making positive life changes

T here may well be a recipe for reducing a patient’s risk of

re-admission to the hospital—and the mix includes a phone call, a volunteer care coach, and several home visits.

Tucson Medical Center launched a pilot program in March that harnesses the power of peers in helping patients with one or more ailments meet personalized health goals, whether it’s implementing a heart-healthy diet, increasing physical activity, losing a few pounds, or simply engaging more with life. The goal is to gauge whether lay people can make a difference in helping patients who need additional support beyond what they can get from their health professional alone.

A volunteer, trained in motivational

interview techniques, accompanies a nurse or social worker on a 30-minute introductory home visit. Patients who choose to proceed sign a “contract” agreeing to work on their health goals with their coach over a seven- week cycle.

The coaching is not designed to replace, but rather augment, regular physician care.

Some patients may be more honest with a peer about their adherence to a treatment regimen or challenges they might experience in making behavioral changes, said L’Don Sawyer, director of Senior Services at Tucson Medical Center. “These discussions might be a little less threatening with a peer who is there just to support them,” she said. “Plus, they are not under the same kind of time constraints in the hustle and bustle of a doctor’s office.”

Since Tucson Medical Center is a founding participant in an Accountable Care Organization called Arizona Connected Care, Sawyer noted the program fits with the vision of reducing hospital readmissions and more costly health interventions through a more robust focus on managing chronic disease.

The job description for the coaches doesn’t include counseling or help with financial management, grocery shopping, or finance management. Rather, they serve as a motivational support

system to make sure their partners take responsibility for making

a positive change.

partners take responsibility for making a positive change. Administrators of Healthy Living Connections, the

Administrators of Healthy Living Connections, the programming umbrella for TMC Senior Services, recorded more than 150 educational classes and community outreach events in 2012. The program continues to offer adults access to key community health and wellness resources.

“What we want to do is get people thinking of their strengths,” Sawyer said. “We will acknowledge weakness, but we don’t play to it, because everyone can do something, and it is the job of our volunteers to find out what their partners can do—what small steps they can take for success—and help them build confidence and self-efficacy.”

That personal connection is what makes the assignment so rewarding, said Mary Ellen Beaurain, a retired social worker who said she was drawn to volunteer with the coaching program because of the one-on-one interaction.

“To have someone tell you that they had some scary things happen and now they want to make the changes they need to make to have a second chance, I just find it so gratifying,” Beaurain said. “This kind of soul-searching and this kind of change can be very hard work, and no one should have to do it alone.”

An added benefit: The program has prompted Beaurain to revisit her own health priorities.

Sawyer said she hopes another round of volunteers can be trained by the end of the year, once care teams have a chance to

analyze the effectiveness of the pilot-program.

n

Leveling the healthcare playing field TMC and Canyon Ranch Institute partner to bring wellness to
Leveling the healthcare playing field TMC and Canyon Ranch Institute partner to bring wellness to

Leveling the healthcare playing field

TMC and Canyon Ranch Institute partner to bring wellness to the community

P atients in under-served communities are not likely to use

P atients in under-served communities are not likely to use Julie Ward, TMC chest pain coordinator,

Julie Ward, TMC chest pain coordinator, gives a presentation about the Life Enhancement Program, a new community offering that highlights an integrative approach to health and health literacy.

you should do with your diet. Now go forth and get better.’ That’s not working.”

Small things may be big barriers, she suggested. For example, many people don’t know how to cook without using oil, while others are confused about how to shop healthfully at the grocery store.

The program helps patients through interactive sessions, individual consultations, and hands-on activities. A presentation about portion sizes, therefore, might be followed by a cooking demonstration. A presentation about the importance of movement might be followed with a hands-on session about how to use fitness equipment.

Atkinson said the CRI Life Enhancement Program dovetails with the mission of TMC and Arizona Connected Care, which aims to keep people healthy while controlling healthcare costs. Beyond that, she said, the partnership with CRI was appealing because of data showing that the CRI Life Enhancement Program works.

CRI partners have been offering the program around the nation since 2007, and TMC will be Tucson’s second local site. CRI started partnering with El Rio Community Health Center in 2010.

The changes are statistically and clinically significant. Nationally and locally, CRI Life Enhancement Program participants have lost

certain phrases with their physicians:

“Would you mind repeating that diagnosis? I didn’t understand.”

“Would you review the instructions with me?”

“Are there any lifestyle changes I should make to ease my symptoms?”

The physician’s office can be intimidating to anyone, but for patients who lack access to care because of age, geography, or socio- economic barriers, a doctor’s office can be especially difficult to navigate.

Patients facing the greatest economic challenges are also most likely to have low health literacy, which is strongly linked to shorter lifespan, poorer total health, and the need for more costly interventions.

A program offered through a new partnership between Tucson Medical Center and Canyon Ranch Institute (CRI) aims to level this playing field. CRI, a non-profit charity established in 2002 by Canyon Ranch’s founders to bring wellness into community settings, is teaming up with TMC to offer the 12-week CRI Life Enhancement Program designed to help participants take better control of their health.

The participants, mostly adults 50 and older in the first group that started in April, receive intensive training with an integrative team of TMC health professionals. Based on the Life Enhancement Program pioneered at Canyon Ranch, participants first have a health assessment, including blood work, a behavioral health review, and a range of tests to measure strength, flexibility, and cardio fitness.

The TMC team includes nurses with a passion for prevention, physical therapists, dietitians, a pharmacist, a spirituality professional, and behavioral health specialists. The team takes an evidence-based approach to help participants form an individually effective health improvement plan.

“We want to empower them so they can take ownership of their health and start to reduce at least the symptoms of their chronic conditions,” said TMC Director of Wellness Mary Atkinson.

“In healthcare,” Atkinson said, “a lot of times you’ll hear us say, ‘Your glucose is too high. Here’s your prescription. Here’s what

weight, adopted exercise behaviors, reduced depression, lowered their blood pressure, increased their ability to manage stress, and been empowered to make healthier food choices, among other changes.

Jennifer Cabe, CRI executive director and a board member, said that although CRI is approached on a daily basis by organizations seeking to partner in its successful programming, TMC met a stringent selection process for new partners. It’s a natural fit, she said.

“TMC is really walking the talk of community benefit,” Cabe said. “That commitment is illustrated not only in their systemic and culturally sensitive approach to wellness, prevention, and health literacy, but through their strong desire to move to evidence- based wellness approaches. The goal is not just to help people have a greater depth of understanding, but to inspire them to move beyond understanding to action that will improve their lives for generations to come.”

TMC will also work with CRI to pilot a new CRI Life Enhancement Program for families, teaming at least one adult and one child from a family. “If we can get to them earlier with good information that can drive good habits,” Atkinson said, “we may be able to prevent disease instead of just reducing the symptoms.”

Atkinson said she hopes physicians, by calling 324-5227, will refer patients who could benefit from improvements in nutrition, exercise, stress management, and mindfulness. Beyond that, she said she hopes physicians may have more conversations with patients about what’s preventing them from following their medication regimen or maintaining an appropriate weight.

“If there are gaps that they’re seeing, perhaps we as a community hospital can help them fill those gaps, whether it turns out we have to give grocery store tours or host talks about exercise,” she said. “The bottom line is that we hope to empower people to

stay well, not just to keep them out of the hospital and using services appropriately, but

out of a genuine concern for making their lives the best they can be.”

n

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Pima County Medical Society EOB (Explanation of Benefits) By Charles Katzenberg, M.D. PCMS President “O

Pima County Medical Society EOB

(Explanation of Benefits)

By Charles Katzenberg, M.D. PCMS President

“O rganized medicine” is something of an oxymoron. We

physicians have abdicated many of our leadership roles

in our healthcare system.

Whether employed or independent, we have been, and will be assaulted with multiple challenges to our autonomy and our freedom to practice in an environment increasingly controlled by hospitals, insurance companies, administrators, lawyers, and regulators.

Pima County Medical Society and the Arizona Medical Association exist to support and give voice to physicians, whether they are employees or in private practice. PCMS is your local physicians’ lobbyist, and functions with ArMA statewide, working for appropriate legislation.

Of what benefit is this to you? Why continue to be a PCMS supporter? Why join? Some even ask, “What have they done for me lately?”—without realizing that “they” are you.

PCMS activities, accomplishments, and initiatives fall into several categories:

Tort reform advocacy

No entities have pushed harder for tort reform than PCMS and ArMA. Results include:

1. To qualify as an expert witness, the “expert” must have been in practice in the same field as the defendant within the past year.

2.

All malpractice cases require an Affidavit of Merit from an expert with the above qualifications.

3.

“I am sorry.” When things go south we often tell patients that we are sorry. This was previously used in court as admission of guilt—but no longer.

4.

Burden of proof has been raised from preponderance of proof (50 percent) to clear and convincing (75 percent).

5.

Results of the above efforts include 27 percent fewer malpractice claims during the past 10 years, an average 18 percent decrease in malpractice insurance premiums, and most of us have received premium rebates or dividends: real money in the bank.

Advocacy also includes supporting referenda in 1996 and 2000 to provide AHCCCS coverage up to 100 percent of the Federal Poverty Level, including childless adults. We are currently supporting Gov. Jan Brewer’s plan to expand AHCCCS.

Advocacy means supporting efforts to get funding to support The University of Arizona Medical Center’s Level 1 Trauma program, improving funding for childhood vaccinations, and increasing graduate medical education funding that helped establish the UofA medical school in Phoenix.

PCMS supports local physicians

1.

PCMS fields at least one call daily from a physician with a question related to his/her practice or regulatory issues.

2.

PCMS handles about 2,000 requests annually from the public for physician referrals.

3.

PCMS maintains a speakers’ bureau for community events.

4.

PCMS is here to counsel physicians regarding Arizona Medical Board complaints.

5.

PCMS in the coming months will launch a member “physician search” website available to physicians and the public.

6.

“Sunrise Process”: PCMS and ArMA lobbied the Arizona Legislature to require submission of applications to the Joint Legislative Audit Committee for anyone who wants to expand their scope of practice. This process has resulted in denials to chiropractors who want to inject medications, and psychologists who want to prescribe medication.

Politics, regulation, and policy

PCMS maintains relationships with local, state, and federal legislators representing Pima County.

PCMS is often a behind-the-scenes resource for the legislature and the Arizona Medical Board where new ideas and proposals are floated out for review before they are written into laws or statutes.

PCMS initiatives have resulted in physician-supportive changes at AMB.

Community

1.

PCMS, along with local hospitals and UPH, started the Pima Community Access Program (PCAP), to offer insurance to those in the “notch group” with incomes above the FPL, but too low to be able to afford private health insurance.

2.

In 2000, PCMS worked with ArMA to pass the Managed Care Accountability Act. This comprehensive set of reforms deals with pre-authorization, denials, billing, advertising, payments, and contracting. This act made insurers more accountable and responsive to both patients and physicians.

3.

PCMS recently started a Walk With a Doc/Just Walk program in which volunteer physicians lead a Saturday morning exercise walk along the Rillito with any interested and able Tucsonans.

4.

PCMS has a yearly social event and fund-raiser, which in 2013 raised money for Mobile Meals.

5.

PCMS monitors media and is ready to respond when needed and/or asked.

6.

PCMS networks with many local groups including Pima Council on Aging, Health Information Exchange of Arizona, and the Arizona Business Coalition on Healthcare.

The PCMS Board of Directors meets monthly and we have standing committees on Public Health, Bioethics, and History. PCMS formed Pima County Medical Foundation in 1990. The Foundation offers CME-related physician education programs.

All physicians in Pima County should belong to PCMS. If you have read this far, you, as a member, must know several physicians who would join if asked. When you identify a potential member, please call our interim executive director, Bill Fearneyhough, at 795.7985 and give him the physician’s name, cell phone number, and a time and day most convenient to talk about membership. Bill will do the rest.

At the bottom line your dues are equivalent to just a couple of nights out in support of the only game in town committed to 1) supporting physicians, 2) supporting patient-focused practice of medicine, and 3) supporting the general health of the Tucson community.

To learn more or to become more involved, please call or e-mail Bill or me. Bill’s phone is 795.7985; his e-mail is billf5199@gmail. com. You may reach me at 390.4750 or e-mail ckatzenberg123@ gmail.com.

Pima County Medical Society Mission Statement

The purpose of the Society shall be to secure unity and harmony in the medical profession in Pima County; to bring together in one organization all reputable, ethical and competent physicians of Pima County for the purpose of maintaining high standards in the medical profession in Pima County, and for the purpose of promoting the respected high reputation to which the medical profession’s history and achievement entitle it, and to promote the science and art of medicine; to develop a high type of ethical practice among its members; and to conserve and promote the public health.

Question: When was the Pima County Medical Society founded?

1894

1904

1914

1924

concerns.addresstophysiciansforplace

nswer:A

gatheringabeenhasSocietyMedicalCountyPima1904Since

Historical highlights include:

1909 - Calling for a state lab so disease outbreaks could

positively identified

1919 - Working for better quarantine laws as they battled

the influenza outbreak

1929 - Helping to establish the nation’s first city/county

health department

Agreeing to staff and run - at no charge - Pima County Hospital from 1939-1961

1963 - Buying vaccine and giving it to kids, making Tucson

the first polio-free metro area in the United States

1975 - Creating the first HMO and attempting to end the

notch group

1983 - Treating striking miners and their families for free

n

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MICA’s Board of Trustees Congratulates James F. Carland III, M.D., Recipient of the Physician Insurers Association of America 2013 Peter Sweetland Award of Excellence

At the 2013 Physician Insurers Association of America (PIAA) Annual Meeting, Dr. Carland received the Peter Sweetland Award of Excellence, recognizing his significant contributions and dedication to the medical professional liability (MPL) insurance industry and the PIAA.

Brian K. Atchinson, president and CEO of the PIAA, stated, “The Peter Sweetland Award of Excellence was created to recognize an individual from our ranks who has provided great leadership and has served as an inspiration to others in the industry. Jim truly embodies the spirit of this award, and we thank him for his hard work and years of service.”

(602) 956-5276 (800) 352-0402 www.mica-insurance.com

award, and we thank him for his hard work and years of service.” (602) 956-5276 (800)