Reflections on Joseph on Christmas Day

Each year I search for the perfect Christmas card. It’s a tough choice because I want to pick something that is going to stand out and actually be read -- not just quickly opened and tossed into the red basket with a Christmas tree painted on the side. Of course, each year it seems this becomes a little bit easier because fewer people send Christmas cards, making the competition less intense. This year, my wife Cheryl and I were looking over the selection in Barnes and Noble and the perfect card hit my eye! The picture on the front of the card was not the usual Madonna and Child, or Nativity scene, but rather a depiction of Joseph leading a donkey carrying an expecting Mary on the way to Bethlehem. Joseph is my favorite saint. Maybe it is because he is my namesake, but I hope it is more because I see in him the perfect role model for a Christian man. He was a quiet, hard working man with strong family values. As I reflected on my card selection which I chose only because it featured my favorite saint in a key role at Christmas, I realized that there was actually a deeper significance. Joseph, after all, was helping to bring Jesus to us. He protected Mary and provided for her, and for the new Baby. His was a low key, but extremely important role that helped make possible Jesus’ salvation mission. We too are challenged to be Joseph. By this, I mean we need to be present to Jesus and help bring him into the world today -- to our families, our friends, and those we encounter each day.

Every once in a while we get some sort of sign or affirmation that a personal revelation has occurred. This happened for me this year. I spent a Saturday morning writing out my Christmas cards, and it was while I was thinking of messages to write in individual cards that my reflection about the significance of St. Joseph on the card image took place. Then, I sealed the envelopes and headed for the Northport post office to send them off. I stood in line to buy stamps, patiently waiting as the clerk took passport photos of a family heading somewhere warm sometime soon, and for her to explain the fastest delivery for a package to the Midwest. It was my turn at the window and I asked for a couple of books of Christmas stamps -- “religious, please.” The clerk handed me the stamps and I paused as I looked at the image -- a picture of Joseph leading Mary on a donkey!

I feel fortunate to work in Catholic health care where my work very directly supports the role of the Church continuing to represent the healing presence of Jesus in our world today, just as he showed us over 2,000 years ago. Regardless of where we work, or what type of work we do, St. Joseph offers a true example of humbly serving so that a greater mission can succeed. That mission is one of Peace, Love, Forgiveness, and Healing. These gifts are needed today, as much as they were when Joseph led Mary on that donkey.

Do the Yankees play better when they play the Red Sox?

As I sat in my living room watching the Yankees and the Red Sox grind another great game out, the thought entered my mind, “why do both the Yankees and the Red Sox play better when they play each other?” It seems to not matter what record or problems either team is having with the rest of the league-- when they play each other it's as if the rest of the league doesn't even exist. They each manage to play to their highest level and play incredibly competitive (and long) games. Just like this relationship between the Yankees and the Red Sox, I can think of times in my experience in healthcare where having a high quality competitor improved our healthcare facility’s performance. Do you have a competitor who challenges you to greatness? In almost every organization I have been involved with in healthcare, when we had a strong competitor it made us perform better. There seems to be something about competition that brings out the best in our performance. Who is your great competitor, and in what ways do they challenge you to better performance?

Patient Safety Across the Continuum of Care

Multi-drug reistant organisms are a major challenge for healthcare organizations today. Whether we are dealing with MRSA, or drug resistant strains of C-diff, the care of these patients is expensive and time consuming, and can have a significant impact on morbitity and mortality. Controlling these organisms when patients move between different levels of care in the continuum is complicated by the lack of understanding and communication that often exists. While providers in a hospital setting would never dream of transferring a patient between one unit and another without giving the receiving unit a full report, the same is not true when patients are transferred to a nursing home from a hospital or vice-versa.

On Friday, November 13, 2009, I will be presenting about efforts to control the spread of multi-drup resistant organisms between hospitals and nursing facilities at the Patient Safety Across the Continuum of Care 2009 Conference sponsored by the Southeastern Pennslyvania Association for Healthcare Quality in Plymouth Meeting, PA. For more information about the conference, or to register, go to http://www.spahq.org. The focus of my presentation will be on building bridges of understanding and cooperation between care settings in the infection control arena, and several best practice examples will be presented.

If you are not able to attend this presentation and would like more information, or if your organization needs assistance with performance improvement in this area, you can contact me at joseph.tomaino@rsmi.com.

Continuing Care InSite is the blog of Joseph Tomaino, who assists his clients with smart approaches to improving continuing care organizations. He can be reached at jtomaino@continuingcareinsite.info

This is a second test of MacJournal

Continuing Care InSite is the blog of Joseph Tomaino, who assists his clients with smart approaches to improving continuing care organizations. He can be reached at jtomaino@continuingcareinsite.info

Health Care Reform Brings Heightened Provider Scrutiny

The proposed House and Senate plans for health care reform vary considerably, but the one common element of both, give or take a few billion, is that they are very expensive. The Office of Management and Budget discusses on their website the various sources of revenue that will be used to finance this expenditure. One category they point to is the billions of dollars that are lost each year to Medicare fraud and abuse. This means that the already active revenue recovery efforts by federal and state agencies will intensify over the coming years.

Despite their best intentions, providers can find themselves facing an Office of Inspector General or State Office of Medicaid Inspector General audit, and be surprised to find out that they have been submitting claims for reimbursement that are not supported properly. It may be that the wrong procedure or E&M code was selected; or the right code was selected for what was done, but the documentation doesn't support it; or the visit was not justified medically. Nursing home providers may find that MDS completion was not based on the true condition of a resident,or that the resident experienced quality of care issues while being covered by Medicare. A home care agency may find that the ICD-9 codes they selected for prospective payment were not appropriate for the client's medical diagnoses, or a hospice provider may find that they inadvertently billed for days after a patient died because of a breakdown in communication.

While these types of events are most often not intentional, they can happen very easily from a variety of factors:

1. Staff can become so absorbed in meeting the tremendous needs of patients that they don't pay enough attention to the "paperwork".

2. Interfaces between clinical and financial information systems can have glitches that remain unknown for months.

3. Providers become accustomed to doing things a certain way for years without being told it is not a proper procedure that they assume it is proper.

4. Staff can identify an issue as not being correct, but because of workplace politics, power structures, etc., nothing happens about it, so they stop bringing it up.

So what is a provider to do to prepare for the increased scrutiny of their claim submissions? Every provider organization should have a compliance plan where the principles of revenue integrity are spelled out for all staff to see, and the expectations for how that integrity will be monitored and what a staff member should do if he or she sees something they don't think is right, is laid out. This compliance plan should include ongoing monitoring of revenue cycle processes to make certain that claims submitted are based on proper coding and are supported with the appropriate clinical documentation. Staff who show a pattern of non-compliance should be given feedback and if they do not improve, should be subject to disciplinary action. It also is valuable to have both the compliance plan, as well as a sample of claims submissions for a period of time, reviewed by an outside consultant who will be objective and provide the perspective of external scrutiny.

For more information on this topic, or to discuss how a diagnostic assessment of how effective your organization's compliance and revenue integrity processes are, contact Joseph Tomaino at 212-372-1640, or joseph.tomaino@rsmi.com .

Continuing Care InSite is the blog of Joseph Tomaino, who assists his clients with smart approaches to improving continuing care organizations. He can be reached at jtomaino@continuingcareinsite.info

Earthquake Victims Have Long Term Needs

My career in health care has bridged both acute care and long term care. As I watch the rescue and emergency care efforts on TV in Haiti, my perspective on care across the continuum causes me to anticipate what the long term care needs of the survivors will be. With the crushing injuries that are evident with survivors, and the resulting amputations, there will be need for prosethetics and for rehabilitation.

The health care needs of the earthquake victims will be tremendous and ongoing. When we see a person pulled from the rubble on the cable news, that's just the beginning of the rescue mission. Next comes the need to address their injuries with IV fluids, surgery, medication, and lots of nursing care. Then comes rehabilitation. If they are debilitated or have suffered the loss of a limb, they need to strengthened and taught to adapt to their new reality.

A search of the web reveals a center for rehabiliation in Deyang City specifically for earthquake victims in the Sichuan region of China. This may serve as a model for what will be needed in future months and years. Read more about the Hong Kong Red Cross Centre for Rehab and Prosthetics and Orthotics.

Added to the physical needs of these victims are the enormous emotional consequences of living through such a disaster. The social fabric of many family units and neighborhoods have been torn apart, and will need to be replaced by new support systems. The work is just beginning. Unfortunately, the road to recovery will be long-- for the victims, and for the country. It is important that once the news cycle of the urgent needs passes, that attention continue to be paid to the continued needs of those we began to help. We need to see it through...

Continuing Care InSite is the blog of Joseph Tomaino, who assists his clients with smart approaches to improving continuing care organizations. He can be reached at jtomaino@continuingcareinsite.info