January 2016 Update

In an effort to inform the medical staff, as a whole, about the decisions and discussions at the Medical Executive Committee, Dr. Anderson and I will try to release a monthly communique.

Email notifications, an especially secure email communications, will necessitate a tenethealth.com email address. Please contact Kaye Everett at KAYE.EVERETT@Tenethealth.com for a request to set up that email address if you do not have one and Robbie Hecker at Robby.Hecker@Tenethealth.com  to assist you to receive these on your cell phone or tablet.

Current contracts with physician groups are:

  • CEP – existing group with the same medical director
  • DTS – existing group with the same medical director
  • Radiology –  existing group with the same medical director
  • EmCare – Hospitalists and Critical Care. New group. Requested change by MEC, and interview conducted by the MEC, BOT, and the Administration.  Dr. Gerry Martin is Medical Director for Hospitalists. Dr. Ken Wys and Dr. Learned Gonzales are Co-Directors in the Med-Surg. ICU and available for consults.
  • Anesthesia – existing group, Somnia, with new Medical Director assigned by Somnia. Dr. Arun Thunga in the new Director.
  • Pathology – Currently in discussion with Ameripath/Quest (Ameripath will meet with both Pathologists to determine if they are a good fit for their organization)
  • All contracting decisions are based upon operational needs of the hospital to deliver quality patient care.

Questions have arisen with regards to perceptions of Foundation physicians getting special treatment. The cogent factoids are:

  • FCPP currently employs 10 physicians
  • FCPP physicians are independent contractors and are not employed by the hospital.
  • FCPP physicians are treated just as any other physician on the medical staff and are held to the same standards.

There have also been some questions about Telemetry Technicians, ICU nurses and the newer EmCare Intensivists. Also some facts and activities occurring to address concerns are:

  • All physicians employed by EmCare for ICU are Board Certified Critical Care physicians.
  • Oversight and review of physicians for their eligibility for employment with EmCare to work in the ICU is now with the Medical Directors for their final interview and assessment.
  • ICU training protocols are being assessed as well as Telemetry Technician performance expectations.

Hospital wide communications have been intensely discussed for the past couple of years. This is a complicated issue with multiple laws and regulations associated with the appropriate solution. Being HIPPA compliant is at the top of the list with federal penalties in place for violations in compliance for communicating Protected Healthcare Information (PHI) via unprotected or unencrypted methods. It is illegal to transmit PHI via texting or emails from unencrypted means. Do not ask Tenet employees to do this. There is a strict prohibition against them participating in this type of communication. An interim solution is to have staff scan and email any documents to your tenethealth.com email address via the Ricoh Scan/Fax/Printers located throughout the hospital.

DRMC medical staff leadership is exploring solutions. We have had a presentation from PerfectServe and will have a presentation from Voalte in February. Both of these companies provide for HIPAA compliant text and voice and either should provide a secure, effective method of doctor to doctor communication and beyond. It is the intent of the MEC to provide some sort of secure communication system amongst medical staff with the hopes that the administration sees it’s value and provides for hospital-wide use.

The Spectralink system is going to be augmented to enhance reception throughout the hospital. Pagers will be utilized to assist contacting both Hospitalists as well as Intensivists. This is being implemented currently but won’t be completed for at least a month.

There was concern expressed a the recent Special Meeting that medical staff leaders who receive more than 50% (a suggested percentage) of their income from payments from the hospital should not be allowed to serve in leadership roles. Caution should be exercised when designing a requirement such as this as a significant percent of physician receive substantial payments from the hospital either through PSAs (Physician Service Agreements) or EA Health agreements. Perhaps a solution would be to simply have all intended medical staff leaders file a Conflict of Interest statement.

Why can’t nurses take verbal orders?

Our verbal order policy dictates when they are not appropriate to ensure compliance with applicable regulatory and/or legal requirements. Generally speaking, verbal orders are only acceptable during an emergency.

Why does it take until 1 or 2 pm to get to get routine labs back? How can we get patients discharged by 11am without labs?  

These barriers are being addressed through our lab director. Follow up to be determined.

For a list of policies that have recently gone through Medical Care Policy and MEC, please inquire at the Medical Staff Office.

Special Meeting

At the Special Meeting held on December 21, 2015 many issues were discussed. Fundamentally they can be distilled into the following areas: communication, trust, and leadership.

We elect our medical staff leaders and hopefully trust them to act in our best interests in their dealing with administration and with the medical staff as a whole. Not all information is shared with all members of the medical staff. Much of the information is confidential and therefore restricted. All members may feel entitled to certain information, but they are not. We have a representative leadership. They are elected by our departments and by the medical staff as a whole. It is their responsibility to disseminate information to their respective departments.

The raison d’être for our membership and privileging is to ensure safe, high quality care for our patients. Every member of our medical staff ( active, courtesy, provisional, temporary, or locums ) undergoes an application process and proctoring as appropriate. We seek to credential properly trained, competent, safe physicians.

Patient safety also the raison d’être for the hospital administration.

We are not entitled to tell physician groups how they should care for their patients. We are responsible for ensuring that all physicians practice safe, quality care. The care of the hospitalized patient is entering a new paradigm. We may not all be comfortable with this new paradigm; but we do have to respect the fact that it is the new face of hospital care.

I can tell you that every major decision made by administration has had the knowledge and input of the MEC and Governing Board. We don’t always agree, but we do have a seat at the table. I will endeavor to communicate better with the medical staff and I hope to use this medium to accomplish that.

Leadership is about showing up and providing constructive solutions to problems. Complaining does lead to the identification of problems but it’s not just about complaining. Those of us sitting on the MEC spend a significant amount of time trying to make DRMC live up to it’s motto. Trust that we really do have medical staff’s and our patient’s best interest in mind. If you think otherwise, ask your department chair. If you don’t like how they are doing, run for office. Leadership is done by those willing to show up and solve complex problems.