Five-part series helps inform transformation agenda for health care, business

TransformationReportHealth care industry leaders face incredible challenges in shifting from traditional, volume-driven fee-for-service to value-based care.

As a member of the national Health Care Transformation Task Force, an industry consortium, and as the hospital member of two accountable care organizations, Tucson Medical Center is at the forefront of innovative work to provide higher quality, more efficient health care.

“The Transformation to Value: A Leadership Guide” from the Health Care Transformation Task Force shares the collective experience and wisdom from organizations at the vanguard of value-based payment and care delivery.

The Health Care Transformation Task Force created the “The Transformation to Value: A Leadership Guide” to assist health care leaders as they design and implement their transition to value based delivery and payment. This series of captures the transformation journeys of individual organizations, including both successes and lessons learned, and allow decision makers to benchmark themselves against similar organizations that are actively moving toward value-based care.

“The Transformation to Value: A Leadership Guide” is one more reason we’re proud to be part of the Health Care Transformation Task Force,” said Julia Strange, vice president of community benefit for TMC. “This new series offers proven advice to health care leaders as they design and implement their own transition to value based delivery and payment. This initiative reflects our and other task force members’ common commitment to facilitate transformation, both for members and others.

The Transformation to Value: A Leadership Guide” from the Health Care Transformation Task Force is practical freeware that can save organizations at any stage of the transformation journey countless hours, while avoiding the pitfalls uncovered by early adopters. Others are encouraged to use and share this work. http://bit.ly/2ylIwEK

Community hospital works to reduce opioid use after surgery

PillsInHand_444966868 (002)Even as Gov. Ducey declared a public health state of emergency regarding the misuse and abuse of opioids, physicians practicing at Tucson Medical Center were already working to minimize the use of opioids for patients recovering from surgery.

Physicians have several opportunities to manage the use of narcotics, particularly important as patients leave the hospital with a plan for pain management during recovery.

Anesthesiologists from Old Pueblo Anesthesia, who practice at TMC, have been working to enhance their regional anesthesia program to provide additional options for patients.  If patients can keep opioid use to a minimum in those crucial first days after surgery, while reducing their pain and inflammation, the hope is that they can use fewer narcotics through their recovery period.

Shoulder surgery, for example, is notoriously uncomfortable for some patients because the shoulder is engaged when a patient is standing or when laying down. Traditional anesthesia only lasts about 24 hours.

Now, in addition to direct injections to numb the area and block pain during surgery, physicians can place tiny catheters near the nerves that supply the shoulder with a local anesthetic to provide greater comfort for up to 3 days. The patient can care for the pump at home and throw it away when the anesthesia is depleted.

Dr. Robin Kloth said that Old Pueblo performed a comparison of patients with total shoulder replacement who used traditional pain relief and those who used interscalene catheter placement. “Over the course of the full 3 days, the catheter patients took less than half the narcotics that our compared group took in just a single day,” she said, adding patients also reported far less nausea.

Dr. Neesann Marietta concurred. “These techniques can really extend a patient’s pain relief, which greatly increases patient satisfaction. They can go home and sleep comfortably, which is so important for the healing process.”

And that’s just one example. For abdominal surgery, patients relied previously on epidurals that could only be used during their hospital stay. Now, anesthesiologists can do a block that provides local relief in the abdominal wall that will last up to 24 hours, and patients may be sent home the same day.

Colorectal and gyn-oncology surgeons are increasingly using a slow release local anesthetic that lasts up to 72 hours.

The colorectal program reports that between greater patient education, early ambulation and regional anesthesia, patients are seeing a decrease in patient length of stay by 1.3 days and an 88 percent decrease in morphine equivalent, given in the first 24 hours post-surgery.

“Both doctors and patients are becoming increasingly aware of the potential for the misuse of highly addictive pain medications and it’s important that we be part of this national discussion,” said surgical oncologist Michele Boyce Ley, who uses regional anesthesia as well as nonsteroidal medications such as Celebrex and gabapentin to help control pain for her patients having breast surgery.

Ley said her patients are doing so well, many are managing post-surgical pain with little more than Tylenol or ibuprofen.

“We have been working on this in earnest and getting training on these techniques because of concerns about opioid usage,” Kloth said. “Opioids have been the go-to solution for many years, in part because patients had high expectations of pain relief and because a bottle of Percocet is really cheap. These techniques are more labor intensive, but we’ve demonstrated value to the patient – and it’s the right thing to do,” she said.

Many patients also feel less lucid and less awake when using narcotics, which could delay physical therapy and rehabilitation.

Marietta said the techniques are not right for every patient and every case, but patients who are concerned about the potential for opioid misuse should have a conversation with their physician about pain control – and see if a nerve block would be appropriate.

 

 

Lovell Foundation, Community Foundation for Southern Arizona partner to award nearly $3 million for end-of-life care and planning services

Conversation

The year leading up to death for those with chronic conditions can be emotionally difficult and stressful for patients and families. It’s also costly, with patients in that final year accounting for 25 percent of total Medicare spending on beneficiaries over the age of 65.

There has to be a better way.

The David and Lura Lovell Foundation and the Community Foundation for Southern Arizona in late July announced their alliance to award almost $3 million to Arizona nonprofits to cooperatively address issues related to the awareness, understanding, and availability of end-of-life care, particularly for underserved and vulnerable communities.

Tucson Medical Center Foundation is pleased to be part of that coalition, which represents one of the largest end-of-life care initiatives across the country.

It also builds on four years of focused effort at TMC on improving care for those with life-limiting illness.

“Breaking down taboos about mortality is the first step in empowering patients and their families to have conversations that provide an opportunity to share their values, priorities and beliefs about death,” said Michael Duran, TMC’s chief development officer. “Having a clear road map about what you want from health care providers to how you want to be memorialized is a gift to yourself and to your family because it reduces the guessing and power struggles that can arise in the absence of that certainty.”

TMC has engaged case management, Hospice and Senior Services teams, and two accountable care organizations, Arizona Connected Care and Abacus Health, in the effort to improve advance care planning for adults and their caregivers throughout the community. The grant will provide resources to primary care practices and hospital case management to assist patients in making more informed decisions.

Karen Popp, the director of care coordination for Arizona Connected Care, said the coalition may ultimately serve as a national model for those assisting patients with their choices at the end of life. “What is particularly profound about this collaboration is that we have an opportunity across an entire region to create positive change around the ability of patients to honor the quality of life they expect as they face the end of their lives.”

The Lovell Foundation awarded a total of $2,507,619 for end-of-life care and planning projects. CFSA grants total $390,000. Grants range from $20,000 to $1 million to support end-of-life care programs that engage the community, educate professionals and patients, institute organizational and community standards of practice, develop the healthcare workforce and impact public policy.

“Our collective goal is to fundamentally change the narrative on how we plan for, care for and experience death and dying in Southern Arizona and beyond,” said John Amoroso, executive director of the Lovell Foundation. “Ultimately we all – individuals, families, caregivers, health systems and communities – bear the responsibility for changing the status quo by helping each other to engage in compassionate, honest conversations about our mortality, the type of healthcare we wish to receive and how it is given across the spectrum of life choices.”

This year’s grants were awarded to the following organizations:

The Lovell Foundation shared this interest in end-of-life care and previously funded “Passing On,” an award-winning documentary produced by Arizona Public Media and broadcast nationally by PBS, and other projects.

“We did a community-wide scan on end-of-life issues. We discovered this group of dedicated organizations and individuals that had been working together with support from CFSA funding. That kind of energy and potential emboldened the Lovell Foundation to expand our commitment to end-of-life care and make an even bigger investment,” said Ann Lovell, president of the family foundation and daughter of its founders.

 

TMCOne opens specialty clinic on NW side, providing quality care and convenience

TMC One Med Group your health your team OLProviding high-quality care means recognizing all aspects that benefit patients and their families. Convenience matters, and TMCOne’s  new clinic will make quality medical care and treatment more convenient for northwest residents by including commonly needed follow-up services at one location.

TMCOne is opening a specialized clinic on 7510 N. Oracle just south of Magee road in northwest Tucson. The office will provide comprehensive and specialized care, as well as imaging, IV infusion and health management services.

Susan Vance 1“This unique clinic has been thoughtfully designed to meet varied medical needs in one place,” said TMCOne Executive Director Susan Vance. “From sports medicine and health counseling to imaging and same-day appointments, we’re taking the next step in care.”

Specialties that often converge such as wound care, chronic disease counseling and complex medication regimens can now be managed in one office rather than several clinics. On-site lab and x-ray services will also reduce multiple trips and appointments.

Borrás Carlos
Dr. Carlos A. Borrás has joined the provider team at the Oracle office. He specializes in both internal medicine and sports medicine, providing a needed perspective for injuries related to golf, swimming, tennis, and other sports.

Dr. Dawn Lemcke also joins the northwest office, brining more than 30 years of internal medicine experience – and a strong focus on communication with patients and families.

The office is conveniently located for Oro Valley, Marana and northwest Tucson residents. Same-day appointments and expanded hours further enhance accessibility.

Patients can visit www.TMCOne.com or call (520) 324-4910 to schedule an appointment or for further information.

 

 

 

 

Babies experiencing withdrawal receive specialized care

As they are weaned off drugs, these babies have very different needs from those not experiencing withdrawal symptoms. Those symptoms may include high-pitched cries, trouble sleeping, shaking, jitters, poor weight gain, irritation and stiff arms and legs. Thanks to a TMC nursing task force, TMC in April opened an annex just outside the intensive care unit, to provide these babies with a calming, quiet room featuring cycled lighting and fewer visitors to reduce overstimulation. Importantly, it also assigns specialized staff members who care just for these infants, who can be hard to console and who need significant time being swaddled and rocked to feel more secure.As hospitals nationwide see more babies born dependent on substances such as opioids, Tucson Medical Center has been rethinking how best to serve those littlest patients.

Tucson Medical Center’s newborn intensive care unit treated 27 babies in April. Of those, 11 were born addicted to drugs and diagnosed as having neonatal abstinence syndrome. The syndrome can also affect babies who were exposed in utero to alcohol and tobacco.

As they are weaned off drugs, these babies have very different needs from those not experiencing withdrawal symptoms. Those symptoms may include high-pitched cries, trouble sleeping, shaking, jitters, poor weight gain, irritation and stiff arms and legs.

Thanks to a TMC nursing task force, TMC in April opened an annex just outside the intensive care unit, to provide these babies with a calming, quiet room featuring cycled lighting and fewer visitors to reduce overstimulation. Importantly, it also assigns specialized staff members who care just for these infants, who can be hard to console and who need significant time being swaddled and rocked to feel more secure.

To expand care for these babies, volunteer coverage has doubled on shifts. “Nursing staff and volunteers alike are thrilled,” said Hope Thomas, director of volunteer services and community programs.

Because treatment can last for many weeks, and even months, the staff members also work to build a relationship with the parents to not only educate them about how best to help their baby through what may be a challenging first year, but to help connect them with counseling and treatment programs, as well as plan follow-up care meetings.

“This is really a new phenomenon that we’re seeing across the country, and we’re learning a lot about how to give these babies a stronger start in life,” said Pat Brown, manager of the newborn intensive care unit. “We are committed to caring for all children, and these are some of the most vulnerable as we work with our community to confront this growing problem.”

For volunteer opportunities in the NICU, visit www.tmcaz.com/volunteering

TMC for Children Supports Research Study to Gauge Success of More Frequent Pediatric Therapy

TMC for Children is supporting a study to help determine whether children diagnosed with cerebral palsy show more progress with a more intense and frequent burst of therapy delivered at young ages when the brain is rapidly developing.

Cerebral palsy, which is a disorder in which damage to the central nervous system results in motor dysfunction, is one of the most common pediatric developmental disorders in the U.S.

Under the study, funded by the TMC Foundation, 20 children with mild to moderately severe levels of spastic cerebral palsy between the ages of 18 to 36 months are being seen by TMC for Children’s pediatric occupational and physical therapists for five days a week for 12 weeks. The children would typically receive just one therapeutic session a week under most insurance plans.

Dr. Burris Duncan, a professor of public health and pediatrics who is leading the study, became intrigued by the question of intensity and frequency when he went to China more than a decade ago to participate in some maternal-child health clinics in rural China. While there, he found that the hospital in which he worked advised parents of very young children with cerebral palsy to put their child in the hospital for three months. The children received daily physical and occupational therapies, as well as acupuncture, deep massage and herb baths.

That isn’t practical to replicate here, he said, since parents and insurance companies would likely balk at three months of inpatient treatment. Read more at TMC for Children.


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