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NOVEMBER 2006
RGH MDS ELECTED
REPRESENTATIVES
Cynthia Christy, MD
President, 922-4028
Richard Constantino, MD
President-Elect, 922-3496
Linda Rice, MD
Past-President, 266-0730
Robert Mayo, MD
Secretary, 922-4707
Stephen Ettinghausen, MD
Treasurer, 922-4715
T. Jeffrey Dmochowski, MD
266-8401
Robert George, MD
342-0140
Joseph Kurnath, MD
641-0400
Ronald Sham, MD
922-4020
Pamela Sullivan, MD
922-3846
Maurice Vaughan, MD
338-2700
Peter H. Van Brunt, MD
Editor of Forum
24/7 PHYSICIAN
HOTLINE NUMBER:
922-4414
DIRECT ADMISSION
NUMBER:
922-7333
MARK YOUR CALENDARS
RGH MDS Dinner Dance
January 27, 2007
Riverside Convention Center
forum
A NEWSLETTER FOR THE MEDICAL AND DENTAL
S TA F F O F R O C H E S T E R G E N E R A L H O S P I TA L
Why Should I Care About the RGPO?
By John Genier, MD, President, RGPO
"If fees were truly too low, he said, physicians would quit the region for more lucrative
climes and thus force the insurers to raise rates."
- Jim Redmond, Excellus vice president of communications. Rochester Business Journal March 24, 2006
"Wanted: Area Rx for M.D. Exodus"
- Rochester Democrat and Chronicle, October 15, 2006
We are reaching a crisis in health care in Rochester, and now more than ever we need a strong
physicians organization to represent both ourselves and our patients. I recently became the president
of the RGPO, and before taking on the position I had to answer the question at the beginning of this
article. Why should I get involved? I am in a two man private practice group who has struggled to
recruit a new doctor for over a year, and every day I waste more time trying to squeeze my patients
into overwhelmed specialists for consults or battle for prior authorization for medications the patient
has been on for years. With the advent of direct contracting, will this ever improve? Will the major
insurers really listen to the concerns of a two man group? After considering the options, I felt it was
in my best interest to commit to help maintain a strong RGPO.
Clincal Integration is the project that the RGPO has committed to as a way of improving patient
care in an electronically connected environment. Successful clinical integration will allow us to negotiate as a group and have a voice in the care of our patients- a voice that would not be possible as a
small group practice. The RGPO Board has recognized there are several questions regarding the
Clinical Integration contract,and are working with the GRIPA management to address those concerns so that all PO members will be comfortable with the project and want to participate. Clinical
Integration can only be successful if the majority of our doctors participate. We represent you, and
want your feedback to assist in making Clinical Integration what you want.
At our October Board meeting, we addressed the contract concerns we have heard in terms of
charge data. GRIPA has agreed to strip and discard the charge data when it arrives at GRIPA, and
will provide an independent auditor who reports only to the RGPO to ensure it is done correctly.
The Board still had many concerns about the billing data required, and so we formed a committee
led by Ted Tanner who will provide a list specific restrictions in regards to the billing data that we
will present to GRIPA. The RGPO Board wants to protect physician interests while maintaining the
momentum of Clinical Integration. We also voiced our concerns over privacy and HIPAA issues.
GRIPA provided an educational piece on the privacy issues to the Board. The electronic environment has provided new questions about privacy that no one has answers for, but the state and Federal
government are planning on releasing new guidelines in 2007 to deal with portal and RHIO issues .
GRIPA will be involved on those task forces, and many physicians at RGH will be asked to provide
their expertise in terms of developing safeguards for sensitive patient information to be excluded
from our own portal.
I have committed to the RGPO Board that we will be a more transparent organization. This article is the first of many steps we have planned to keep our doctors informed and involved with the
PO. Many physicians do not understand the role that the RGPO plays in relation to GRIPA, RGH
and the insurers. It is up to us to educate our colleagues about the major issues and seek their opinions. I have asked the RGPO Board members to report at their practice and departmental meetings
the results of our Board meetings. Each month I will submit an article to the Forum outlining
Continued on page 2.
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Why Should I Care About the RGPO, continued
actions taken at our Board meeting. We will also be inviting at large RGPO
members to our meeting for their input and welcome anyone who has an
interest to attend.
I am excited at the challenge of serving as president of the RGPO at
such a dynamic time. We have an experienced group of Board members
who represent the many different constituiencies of the medical staff at
RGH. I want to be clear that the role of the RGPO Board is not to "sell"
Clinical Integration , but rather represent all of our physicians and use their
input to make Clinical Intergration the model for health care that our community deserves. The RGPO really is "physicians working for physicians".
Please feel free to contact me with comments /questions at
[email protected].
REPORT ON
Founders Society Gala 2006
Saturday evening, October 14, 2006 was another splendid event
celebrating Philanthropy at Rochester General Hospital. The party
at the Rochester Riverside Convention Center was attended by over
750 people – community leaders, board members, employees as well
as medical and dental staff. This year, we were pleased that 96 individuals from the RGH medical and dental staff attended. Once
again, Jeanne Grove, M.D., chaired the physician committee – that
encouraged support from MDS. Leaders like Steve Ettinghausen
and Ralph Doerr arranged tables of physicians.
The event is held to honor those who support the Foundation.
The Agnes Bartlett Curtis Philanthropy Award was presented to
Tom and Heather Golisano for their $9 million gift that will name
the B. Thomas Golisano Pavilion and Emergency Center. Drs.
Gwen and Richard Sterns were co-recipients of the John Whitbeck,
M.D. Philanthropy Award, given to honor those who are philanthropists as well as advocates for philanthropy. Congratulations, Gwen
and Rick!
In addition, Florence Belknap and her daughter Nancy Belknap
were awarded the Mary L. Keith Award for Nursing Philanthropy, in
memoriam. The Honorary Award was given to Stewart D. Davis,
Esq., an attorney with Harris Beach, for his loyal work on behalf of
the Foundation, most recently as Chairman of the School to Work
Program.
Additional News from the Foundation
Partners for Progress Campaign work continues. The goal for
the project to support facility master plan upgrades is $46 million.
To date, almost $42 million has been committed from a number of
most generous contributors. Stewart Cramer, M.D. and Rob
George, M.D. have been working with several medical and dental
staff on their personal gifts. Thank you to all who have already
made their gifts!
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RGPO Officers:
John Genier, MD President, Pat Riggs, MD Vice President, Robert
Thomson, MD- Secretary/Treasurer
RGPO Board Members:
Joe DiPoala, MD, Mark Davenport, MD, Ronald Kirshner, MD, Eric
Ingerowski, MD, Michael Jacobs, MD, Michael Kukfa, MD,
Paul Mikus, MD, Lyle Prairie, MD,Edward Tanner, MD, David Schlageter,
MD, Andrew Swinburne, MD, Gordon Whitbeck, MD
Flu vaccine coverage for seniors
From Ghinwa Dumyati, MD, Infectious Disease
There has been much conversation and confusion both nationally and locally about the possible impact of Medicare changes on reimbursement for flu shots given in community-based clinics. Below is a
summary from T. Cleveland, coordinator of the Immunization
Program and Disease Control Unit at Monroe County Health
Department.
During the Medicare Part D implementation process that took
place in 2005, insurance companies restructured many of their Part B
insurance plans and then offered these restructured Part B plans
(which cover flu shots) to consumers for purchase. Many of the new
plans are Medicare Managed Care products that cover flu shots only in
providers' offices unless the plan has a contract with a "mass" immunizer that covers flu shots given in community clinics. There is national speculation that many people chose less expensive Medicare managed care products that only pay for flu shots received in a provider's
office and that these people will arrive in community clinics unprepared to pay out-of-pocket. However, insurance plans can (and do)
enter into contracts with organizations that conduct community clinics, thus enabling the organization to bill the insurance company for a
shot given in a mall, a drug store, a senior center, etc. In our community, Preferred Care covers 16,000 of the 18,000 seniors in managed
care plans who usually obtain flu shots in public clinics, and Preferred
Care has contracts with Maxim, Independent Nursing Care, and the
Center for Nursing Entrepreneurship (UofR), the big three local mass
immunizers. Consequently, in our community, most seniors will be
unaffected by the Part B changes. However, we are advising consumers
who changed their Part B plans to confirm their flu vaccination coverage with their plan administrators before they head out to community
clinics.
forum
IT UPDATE
In the coming months, as space allows, I will try to include in this column, definitions of many of the terms used in IT. As the wireless network is almost completed in the hospital and many of the staff may
use a wireless router at home, I will focus on some "wireless" terms
this month.
Wi-Fi (also WiFi, Wi-fi or wifi) is a brand originally licensed by the
Wi-Fi Alliance to describe the underlying technology of wireless local
area networks (WLAN) based on the IEEE 802.11 specifications.
IEEE is the Institute of Electrical and Electronic Engineers.
Wi-Fi was developed to be used for mobile computing devices such as
laptops in LANs but is now increasingly used for more applications
including Internet and VoIP phone access, gaming and basic connectivity of consumer electronics. A person with a Wi-Fi device, such as
a computer, telephone or PDA can connect to the Internet when in
proximity of an access point. The region covered by one or several
access points is called a hotspot. Hotspots can range from a single
room to many square miles of overlapping hotspots. A wireless access
point (WAP) connects a group of wireless stations to an adjacent
wired local area network (LAN). An access point can relay wireless
data to all other compatible wireless devices as well as to a single connected LAN device allowing wireless devices to communicate with
any other device on the LAN.
Wi-Fi can be interrupted by other devices, notably 2.4 GHz cordless
phones. Power consumption is fairly high in wireless devices making
battery life and heat a concern. The most common wireless encryption (see below) standard, Wired Equivalent Privacy (WEP), has been
shown to be breakable even when correctly configured.
ENCRYPTION- In cryptography, encryption is the process of
obscuring information to make it unreadable without special
knowledge. A cipher is an algorithm for performing encryption
(and the reverse-decryption) a series of well defined steps that can
be followed as a procedure. The original information is known as
plaintext and the encrypted form as ciphertext. The ciphertext
message contains all the information of the plaintext message but
not in a format readable by a human or computer without the
proper mechanism to decrypt it.
Access points and computers using no encryption or the older
WEP encryption, are vulnerable to eavesdropping. WEP encryption can protect against casual snooping but may also give one a
false sense of security since freely available tools can determine the
encryption password in under a second. The newer Wi-Fi
Protected Access (WPA) and IEEE 802.11i (WPA2) encryption
standards do not have the serious weaknesses of WEP encryption.
IEEE 802.11, the Wi-Fi standard, denotes a set of Wireless LAN
(WLAN) standards developed by working group 11 of the IEEE
LAN/MAN Standards Committee (IEEE 802). The 802.11 family currently includes six over-the-air modulation techniques that all
use the same protocol. The most
popular are those defined by b, a
and g. The n standard will soon
be available. 802.11b and
802.11g standards use the 2.4
gigahertz (GHz) band in the
United States. Because of this
choice of frequency band, b and
g equipment may incur interference from microwave ovens,
cordless phones, Bluetooth
devices and other appliances
using the same band. The
802.11a standard uses the 5 GHz
band and is therefore not affected by the above products on the
2.4 GHz band.
Michael J. Feinstein, M.D.
Medical Director, Informatics
ViaHealth-Rochester General Hospital
Voice: 585.922.1642 (Humboldt);
585.922.2932 (RGH)
Fax: 585.922.1655
Email: [email protected]
Just as the 802.11g protocol had
a higher data rate (25 Mbit/sec)
than the 802.11b (6.5 Mbit/sec), but with the same range (100 feet
indoors), the new 802.11n protocol will have a much higher data
rate (200 Mbit/sec) and an extended range of 160 feet indoors.
BLUETOOTH is an industrial specification for wireless personal area networks (PANs) also known as 802.15.1. Bluetooth provides a way to connect and exchange information between devices
such as PDAs, mobile phones, laptops, PCs, printers, digital cameras and video game consoles via a secure, globally unlicensed
short-range radio frequency.
The name Bluetooth is derived from a 10th century Danish king,
Harald Bluetooth, who engaged in diplomacy which allowed warring parties to negotiate with each other. Bluetooth is a radio standard and communication protocol designed for low power consumption with a short range (generally 10 meters) based on a low
cost transceiver microchip in each device. Devices may communicate with each other when they are in range. As radio communication is utilized, the devices do not have to be in line of sight and
can be in other rooms so long as the transmission is powerful
enough.
Some common uses of Bluetooth are:
• Wireless control of and communication between a cell phone
and a hands free headset or car kit.
• Wireless networking between PCs in a confined space where little bandwidth is required.
• Wireless communication with PC input and output devices with
the most common being the mouse, keyboard and printer.
• Wireless control of a game console.
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forum
National Medical Staff Services Awareness Week
November 5-11
By Mary Lou McKeown, Manager Medical Staff Office
In 1992, The United States
Congress and George Bush, President
of the United States, issued a proclamation designating the first week of
November as “National Medical Staff
Services Awareness Week”.
The proclamation read:
The professionals who direct or manage
medical staff services, from hospital communications to the accreditation of physicians and
nurses play an important role in our Nation’s
health care system. In addition to serving hospitals and other primary care facilities, these
professionals also work in HMO’s, medical
societies, State Licensing Board and consulting
firms. By administering rules and regulations,
by ensuring accreditation compliance and by
providing a wide range of support to physicians, medical staff coordinators help to promote the quality and efficiency of health care.
Today many medical staff services professionals are striving to promote efficiency and
professionalism in health care by working
through the legal, financial and regulatory
requirements that have increased along with
new challenges and opportunities in health care
industry. This week we acknowledge such
efforts.
GEORGE BUSH, President of
the United States of America
When you go to the hospital seeking
medical care, how do you know that the
Medical & Dental Staff Members are
properly trained, licensed and qualified
to take care of your patients? The professionals working in the Medical Staff
Office investigate every practitioner
who applies for privileges to practice
medicine at Rochester General
Hospital. While the department may
not be involved in the “hands on” care
of patients, we are responsible for the
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physicians’ hands that care for our
patients on an ongoing basis.
which health care professionals have
been approved to treat RGH patients.
We are dedicated professionals who are
on the frontline of physician advocacy.
We work with the Medical & Dental
Staff
leadership
and
Clinical
Department leadership to assure that
only applicants whose history can be
accounted for, are presented for membership consideration. Through both
the application process and the reappointment process the Medical Staff
Office professionals secure information
to assist the clinical leadership while
making decisions on continued membership. Our actions assist the hospital
by assuring protection from incompetent, troubled and impaired health care
professionals. We are trained to identify problematic applications and reappointment documentation.
In addition, we are responsible for communicating services to the 1302 members of the RGH MDS, through meetings, mailings, newsletters, directories
etc. – all while maintaining the highest
level of customer service that regulations allow.
Within this profession, each person may
become nationally certified as a
Certified Medical Staff Coordinator
(CMSC) and a Certified Provider
Credentialing Specialist (CPCS). The
RGH office currently has two
nationally certified specialists.
The Medical Staff Office, which is
accountable to the Medical & Dental
Staff Leadership, as well as the Hospital
Board of Directors, frequently interacts
with many departments throughout the
hospital, including notification to the
Operating Room that a physician is
approved to perform a specific procedure, or notifying the Emergency
Room, when there is a change in privileges. It is imperative that each employee of the hospital be aware of this available information when determining
The “behind the scenes of caring staff
or “THOSE PEOPLE” as we have
been called, have never been seen caring
for patients directly, but our attempts to
provide comprehensive services, and
our dedication to quality excellence,
along with our loyalty to the RGH
MDS, ultimately affect the quality care
our patients receive.
The dedicated members of your RGH
Medical Staff Office have over 71 years
dedicated to this profession and are very
grateful to be working with the wonderful Medical & Dental Staff Members of
RGH. They are:
• Mary Lou McKeown – Manager - 20
years, Orthopaedic Surgery, Family
Practice
• Karen Curtis – 8 years, Cardiac
Services, Dentistry, Psychiatry,
Surgery
• Barbara Kahle, CPCS – Secretary,
NYS Association of Medical Staff
Services – 24 years
Medicine,
Ophthalmology, Pediatrics
• Bernadette Thomas, CPCS – 19 years,
Anesthesia, ED, Radiology, Radiation
Oncology, PM&R, Lab, Obstetrics &
Gynecology
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Message from the
President of the
Medical & Dental StaffCynthia Christy, MD
My first comment would be to thank our
new CEO Mr. Mark Clement and his administration for agreeing to split the cost of food and
drinks at our Medical & Dental Staff
Committees. Currently those expenses are
approximately $15,000 per year. They include
coffee, breakfast and lunch for MDS Members
and the Hospital employees who participate in
these extremely important meetings. As most of
the attendees are not MDS Members, the
Hospital was in absolute agreement that these
expenses should be shared.
As President of the RGH MDS I am grateful for this acknowledgement which shows the
hospitals partnership with its Medical & Dental
Staff.
We also appreciate the fresh coat of paint
that has been applied to the walls of the
Physician Lounge area.
I need your input and feedback. All Active
Members of the RGH MDS are expected to
attend 50% of the Quarterly Staff Meetings each
year. This data is maintained as part of the credentials file and considered at time of reappointment.
For our September Meeting we had almost
200 people sign-in, but within 20 minutes of the
meeting many of you had left. These meetings
are your opportunity to hear about what is going
on in the hospital and ways to assure that your
opinions are heard by your elected officers and
Hospital Administration. Please let myself, or any
of your Elected Members know what we can do
to make this meeting better for you.
Ideas that we have currently heard include:
- Shortening the meeting time to 60 minutes
- Allow for questions at the beginning
As your Elected President I am here to service your needs and make sure your issues are
heard. Please give me that opportunity and communicate with me on any suggestions you may
have.
Important Notice: Parking Lot Closures
By Kate Pisarek, Parking Manager
On November 10th, 2006, Rochester General Hospital will be celebrating
the ground breaking of the B. Thomas Golisano Pavilion and Emergency
Department. The celebration will take place in physician parking lot 2 which is
located next the Emergency Department. A large tent and other props will be
erected in this parking lot for this special event.
Please note the following:
• As of 11:30 PM on
November 8th, 2006,
parking lot 2 will be closed
to physicians and the few
employees
that
are
assigned to this lot. The
lot will re-open on
Saturday November 11th.
Those employees and
physicians who are parking in this lot should park
in the Portland Avenue
ramp garage during these
times. Physicians may use
their “hands free” parking
passes to exit. Employees
should sign the back of
their spitter tickets and
will exit via the cashier’s
booths at no charge.
• Employee parking lot 3 which is located next to the Carter Street ramp
garage will also be closed on November 10th for this event. Employees who
park in this lot will be able to park in employee lots 1 and 8. Please see
attached map which outlines the locations of these lots.
• Please post this notice for your staff and thank you in advance.
A Sincere Thank you to our
Nurse Practitioners
Every year, the first week of November, has been designated by the American
Academy of Nurse Practitioners as National Nurse Practitioner Week in celebration
of the knowledge, skills and professionalism of this group of advanced practice nurses.
In 1965, Denver Colorado graduated the first class of Nurse Practitioners. The designated role of these specially trained nurses was to take care of the health care needs of
a pediatric population that was not being served
by the current health care
providers of the times.
Forty years later the profession has grown beyond hopes. There are currently over
115,000 nurse practitioners in the United States. They now come in many specialties and
practice in many different settings.
If you see a Nurse Practitioner during their honorary week, please thank them for all
they do.
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forum
ED Medhost Update
MARK YOUR CALENDAR
RGH MDS Dinner Dance
January 27, 2007
Have fun with your peers.
Invitations to be mailed soon.
Important Coding Information
ICD-9-CM coding updates are effective for
discharges/visits as of October 1, 2006!
For a listing of the New, Revised, and Invalid codes go to the Vianet:
Departments - HIM
Coding Information/ICD-9-CM updates effective October 1, 2006
Remember to:
• Check your encounter forms for new, revised or obsolete codes
• Check your reference sheets for new, revised or obsolete codes
• Check your series billing for carryover of new, revised or obsolete codes
Inaccurate codes may result in insurance company denials or reduced payment.
Make sure you are using the most current ICD 9 CM version.
In response to questions from the RGH
Medical Dental Staff
regarding Medhost and
patient care issues, this is the next in a series of
statements meant to address those issues.
Now that the large, hand written locator
boards used to locate patients are no longer in
use, the tool used to find patients in the ED has
shifted to a computer generated screen. Although
there are such screens all throughout the ED,
they exist only at work stations and in various
states of display and require password entrance.
As part of our efforts to serve the RGH MDS,
we have determined that there are four locations
in the Adult ED where the medical staff usually
transit to attend their patients. We are in the
process of procuring large screen displays to be
placed at those areas and will display a map of
beds (similar to that which you may have
observed as restaurants locate a table for you)
located in specific ED areas with the patients
name. They should be in place soon.
As always, asking any staff in the
Department should result in assistance in locating your patient, but we plan to implement this as
one more tool. Thanks in being patient with us
as we implement our new Emergency
Department Information System.
Contacts for coding questions regarding the ICD 9 CM updates:
• Lorri Lauzze, Manager, Health Information Management, Coding Review
and Compliance
[email protected]
• Carole Woods, Manager, Health Information Management, Data Quality
[email protected]
Medical and Dental staff Alumni Dinner on
Wednesday November 15 from 6:00 pm –
10:00 pm at the Rochester Hyatt Regency.
MARK YOUR CALENDAR
Quarterly Staff Meeting Dates
December 15, 2006
March 16, 2007
June 15, 2007
September 21, 2007
December 14, 2007
Twig Auditorium
7:30 a.m.
50% Attendance requested
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Changes to Your RGH Directory
For those of you who access to the ViaNet, don’t forget the on-line directory in Departments and Medical &
Dental Staff. For those of you who do not have access to the ViaNet, there is a monthly excel directory available for
you upon request. Contact Mary Lou McKeown at 922-4259 or [email protected].
Meri Atanas, MD
Attending, Department of Radiation Oncology
1425 Portland Ave Box 233
Rochester
14621
585-922-4031
Margot Searls, RPA
Adjunct – Department of Medicine/Internal Medicine
1425 Portland Ave Box 287
Rochester
14621
585-922-9067
Olivia Chiang, PsyD.
Attending, Department of Psychiatry & Pediatrics
1425 Portland Ave Box 228
Rochester
14621
585-922-2575
Christopher Vereecke, NP
Adjunct – Department of Emergency Medicine
1425 Portland Ave Box 304
Rochester
14621
585-922-3846
Amy Fix, MD
Attending, Department of Pediatrics
913 Culver Rd
Rochester
14609
585-654-5432
Emily Wolfe, RPA
Adjunct – Department of Medicine/Internal Medicine
1425 Portland Ave Box 258
Rochester
14621
585-922-2300
Jeanette Guzman, MD
Attending, Department of Emergency Medicine
1425 Portland Ave Box 304
Rochester
14621
585-922-3846
Ann Marie Lagonegro, NP
Adjunct – Department of Psychiatry
490 East Ridge Rd
Rochester
14621
585-922-2500
Tiffany Maynard, NP
Adjunct – Department of Emergency Medicine &
Pediatrics
1425 Portland Ave Box 238
Rochester
14621
585-922-4097
Susan Newburge, PhD
Adjunct – Department of Psychiatry
224 Alexander St East Wing
Rochester
14607
585-922-7791
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CHANGE IN MEMBERSHIP
CHANGE TO INACTIVE
Jeremy Bowen, RPA-C ......................Inactive/Resigned
William B. Casey, MD..........................................Inactive
Heather Cook-Smith, NP.............Inactive/Terminated
Jack Dorkhom, DMD .......................Inactive/Resigned
Ronald Hainen, MD .........................Inactive/Resigned.
Susan Hartfield, RPA-C ...................Inactive/Resigned.
Amy Heimburg, RPA-C ....................Inactive/Resigned
Marc Lampell, MD ...........................Inactive/Resigned.
Stanley Novak, MD ...........................Inactive/Resigned
Brenda Perez, MD.........................Inactive/Terminated
Sushil Saha, MD ....................................Inactive/Retired
Michelle Siena, NP.............................Inactive/Resigned
Roderick Spears, MD.........................Inactive/Resigned
CHANGE TO ACTIVE
Nail Nagovskiy, MD - Attending. Medicine/Internal
Medicine Hospitalist