Access Blue
In April, the arbitration panel evaluating the Access Blue opt out ruled in favor of Brigham and Women’s and Massachusetts General Hospitals. Blue Cross created Access Blue, an open access product, about ten months ago and claimed it was a new benefit design, not a new product, so that all HMO Blue participating providers were automatically included in the Access Blue network. Partners believed that Access Blue was a new product, and was concerned about its structure, payment rates, and the possible use of specialty care carve-out companies. As a result, Partners hospitals and their employed and financially integrated physicians decided to defer participation in Access Blue. In order to settle this dispute, Brigham and Women’s Hospital and Massachusetts General Hospital went to binding arbitration with Blue Cross. The panel ruled that Access Blue was a distinct product and that BWH and MGH acted within their rights under the Unified Hospital Contract when they terminated their participation in Access Blue without terminating participation in HMO Blue.
Patient enrollment into Access Blue has been extremely limited thus far. Please contact Sharon Greenstein at ext. 5559, Meg Costello at (781) 433-3704 or Andrew Sussman, MD, at ext. 6240 if you have any questions about Access Blue.
Improving the Urgent Patient Admissions Process
In an effort to improve the admissions process, BWH is working to streamline admissions through the Emergency Department (ED). This means that attending physicians must take an active role when their patients are being evaluated in the ED. It is essential that the physicians and nurses in the ED receive up-to-date, complete, and timely information about the current problem, the past medical history, and social history. This should be done by the computerized expect note when available and appropriate, or the telephone. The ED staff is committed to communicating with the referring physicians and providing information and input to make the admission decision. Once the evaluation has started, the referring physician should call in or see the patient depending on the problem. The referring physician and the ED staff should make the decision to admit, discharge, or transfer. A decision about admission should be made early in the course of the evaluation so the admission process can be begun early, rather
than after several hours. The ED physicians and the referring physician should work together to determine which consultations and tests are necessary and decide whether these are needed in the ED, as an inpatient, or on an outpatient basis. Once the decision to admit is made the referring physician should be certain the attending who will care for the patient knows about the patient, the prior history, and the care plan. Physician-to-physician telephone communication is the best way to communicate this information.
Our patients are telling us we must improve our admitting process. They should have confidence that from the time they are told to go to our ED that their referring physician is involved in their care. All members of the care team need to communicate efficiently, have a specific care plan, and be sure the patient and their family are informed.
JCAHO Preparation--Health Information Services Reminder
1. Please date/sign/time all entries into the paper medical record, i.e., History and Physical, Progress Notes, and Consults. Please indicate your clinical ID when signing due to varying legibility of signatures. These are JCAHO, HCFA, and BWH requirements. Operative Notes and Discharge Summaries may be signed electronically through BICS.
2. Timely dictation of Operative Notes and Discharge Summaries is crucial for the upcoming JCAHO survey as well as patient care. Dictations play a key role in accurate coding and timely reimbursement. Please dictate prior to leaving for vacation so that the reimbursement process is not delayed.
3. Medical Records made available to you within the Health Information Services dictation/completion area may not be taken out of the department.
4. Please include the following information in documenting the “Brief Written Operative Note”:
JCAHO requires that every surgical record must contain 90 percent of the above items. A recent review of 163 surgical records indicated BWH did not meet that requirement on most of the above items. The most common source of problems came when specimens were removed but not indicated in the brief written operative note. JCAHO will be reviewing BWH’s compliance in the brief written operative note when they survey the hospital in January 2001.
Please contact Jackie Raymond at ext. 6068 or Georgette Wilson at ext. 5599 for more information.
Nursing Recruitment Efforts
Recognizing the challenge of attracting top tier nurses at a time when the
national nursing vacancy rates hover at 12 to 15 percent, BWH has taken an
aggressive approach to recruiting qualified nurses to the hospital. Over the
last year, Nursing and Human Resources have been developing and implementing a plan to recruit both experienced nurses and recent graduates of nursing programs. A series of nursing job fairs and open houses held and combined with
recruiting efforts at nursing conferences around the country have successfully attracted many new nurses. In the months ahead, the HR/Nursing team plans to increase its recruitment efforts.
In addition to direct recruitment efforts, several creative programs to provide nurses with the support they need have been launched, according to Cheryl Locke, vice president, Human Resources. These initiatives include a summer per diem program to bring unit coordinators on board and a joint endeavor with Bunker Hill Community College to train and hire new patient care assistants (PCAs). To attract more people to the ICUs, Nursing has developed an ICU training program for both internal and external nurses.
Women's Health Research Day Conference
On Thursday, May 25, 2000, from 2:00pm - 6:00pm, the Harvard Medical School’s Center of Excellence in Women's Health presents the First Annual Women's Health Research Day Conference. This conference, held at the Longwood Galleria, 342 Longwood Avenue, will enhance the visibility of women's health research and encourage developing dialogues at Harvard Medical School and affiliated hospitals, including Brigham and Women's Hospital. Welome address by Dean Joseph B. Martin. Topics include “Opportunities in Women's Health Research,” “Women's Health Research at HMS,” “Women's Health Research in the Future.” Keynote Speaker is JoAnn E. Manson M.D., Dr.P.H, Professor of Medicine, Harvard Medical School; chief of Preventive Medicine.
Speakers from Harvard Medical School, Brigham and Women's Hospital, Beth Israel Deaconess Medical Center, Massachusetts General Hospital, and Dana Farber Cancer Institute will be presenting. Speakers from BWH include:
• Robert Barbieri, M.D., Kate Macy Ladd Professor of Obstetrics, Gynecology and
Reproductive Biology, HMS; Chief, Obstetrics and Gynecology
• JudyAnn Bigby, M.D., Associate Professor of Medicine, HMS; Clinical Director and Co-Chair, Committee to Advance the Health of Minority Women, Harvard Medical School’s Center of Excellence in Women’s Health; Medical Director,
Office for Women, Family, and Community Programs
• Andrea Dunaif, M.D., Associate Professor of Medicine, HMS; Director, Harvard Medical School’s Center of Excellence in Women’s Health; Chief, Division of Women’s Health
• JoAnn E. Manson M.D., Dr.P.H, Professor of Medicine, HMS; Chief of Preventive Medicine
Reception and poster presentations of the 1999 HMS Fund for Women's Health grant recipients to follow the conference. To register or for more information, contact Stephanie Mandell: phone 432-4372 or e-mail smandell@hms.harvard.edu
Connors Seed Grants for Gender Biology Research
The Mary Horrigan Connors Center for Women’s Health and the BWH Research Council announce the availability of funding for pilot programs in interdisciplinary research in gender biology. The purpose of these seed grants is to stimulate new research initiatives and collaborations in areas related to the impact of gender on basic biologic processes in health and disease. Any research proposal related to these areas will be considered; investigators with peer-reviewed grant support who have not previously worked in this area and who can extend their research programs to examining the impact of gender on physiology and disease are particularly encouraged to apply. The interdisciplinary research grant will provide up to $40,000 per year for two years.
A letter of intent is required by 5 p.m. on Thursday, June 15, 2000. Applications are due by 5 p.m. on Tuesday, August 1, 2000. Further information on the stipulations of the application process can be obtained by contacting Caren Solomon at ext. 8866.
Summary of BWH’s Credit Collection/Free Care Policy
No person will be denied medically necessary hospital services due solely to a documented inability to pay for such services. The hospital will always provide emergent and urgent medical services without regard to the patient’s ability to pay. When a patient’s staff physician determines that non-emergency, non-urgent services are medically necessary but the patient has no identified means of payment, the physician must submit a request to the Clinical Approval Committee. The committee, through the Clinical Approval Process, will determine the extent to which prompt provision of the proposed services is medically necessary.
The hospital provides information on the financial assistance programs to which patients may apply, including MassHealth, Free Care, and other public assistance programs. Qualified hospital staff are authorized to screen patients for eligibility for MassHealth and Free Care, assist patients in making application for public assistance, and make eligibility determinations. Patients may appeal decisions to the hospital and to the state.
The hospital strongly encourages patients seeking Free Care to have a primary care physician oversee that care. Consistent with state regulations, the hospital will provide medically necessary services and medications to Free Care patients. BWH will not provide Free Care for non-medically necessary services such as non-medical services, experimental procedures, cosmetic services and surgery, personal convenience items, routine dentistry (except when performed in a community health center setting), artificial reproductive technology, private hospital room costs, and over-the-counter drugs.
Insulin Resistance Symposium
An MGH-MIT sponsored multidisciplinary symposium, “Insulin Resistance in Human Disease,” will be held on May 16, 1-6 p.m., at the Massachusetts Institute of Technology, 20 Ames Street (E15-070). Topics will include the cardiovascular implications of insulin resistance, use of NMR spectroscopy, and novel insulin resistance syndromes, including HIV lipodystrophy. For more information call 253-3091.
Bright Horizons Daycare
Slots are still available in the brand new Bright Horizons Daycare center, which will open in June 2000. The center doubles the routine child care BWH offers to its staff and employees. Apply now to ensure a place for your infant, toddler, or preschool-aged child. E-mail Patricia Salamone at psalamone@partners.org or call her at ext. 5067 for more information.
Obituary: Arthur Mu-En Lee
Arthur Mu-En Lee, MD, PhD, director of the Program of Developmental Cardiovascular Biology, passed away April 10 at the age of 46.
Born in Taiwan, Dr. Lee received his medical degree from Kaohsiung Medical College in Taiwan and his PhD in Physiology from UCSF. He joined the Brigham and Women's Hospital Cardiovascular Division in 1992. In addition to his roles at BWH, he served as associate professor of Medicine at Harvard Medical School, and associate professor of Molecular Biology at Harvard School of Public Health.
Dr. Lee's work produced fundamental new concepts in cardiovascular biology, including discoveries on the growth and differentiation of cells of the vascular wall in normal and disease states. His research garnered him several prestigious awards, such as the Caroline tum Suden Professional Award of the American Physiology Society, presentation of the Thomas W. Smith memorial lecture of the American Heart Association, and lectureship of the Tokyo Society of Medical Sciences.
A memorial service will be held for Dr. Lee in a few weeks.
Inpatient DFCI Psychiatry Referrals
Please route all inpatient DFCI psychiatry referrals through the Adult Psychosocial Oncology Program at DFCI (632-6181).
Protect Patient Confidentiality
When discarding copies of patient information, shred or tear documents to remove patient identifiers.