Friday, September 24, 2010

Kaizen Report-Out Today in the CCRMC Lobby at 10 AM

Behavioral Health and Safety System Kaizen teams will report back to the organization today at 10 AM in the CCRMC Lobby.

At the report-outs, teams made up of staff and community members will share with you the progress they continue to make to streamline operations and improve the patient experience at Contra Costa Regional Medical Center. I believe that the effects of these improvement efforts will have a lasting impact on the health of our community.

Please support the work of your colleagues and our patient and family partners as they draw on science and the energy and creativity of each other to continuously improve our health system.

Anna

Thursday, September 23, 2010

A new day in American Health Care

“We will go through the gate. If the gate is closed, we will go over the fence. If the fence is too high, we will pole vault in. If that doesn’t work, we will parachute in. But we are going to get health care reform passed.”
-House Speaker Nancy Pelosi, March 23, 2010
Many of the provisions of The Patient Protection and Affordable Care Act take effect today. The provisions contain protections for consumers and for many of the nation's most vulnerable and in need of health care. I realize there are mixed feelings about the reform legislation. Many may feel this is too little, while others may disagree with health reform altogether.

I'm grateful we've moved from recognition of the problem and talking, to acceptance of responsibility and action to improve our nation's health system. Like most change, I believe we will test and iterate our way forward. I'm relieved the work lies before us and that the time for action is now.

More very soon,
Anna

In case you missed it from my earlier post this week:

For Plan Years Beginning On Or After September 23, 2010, Privately-Insured Consumers Will Have The Following New Protections:

1. Your health coverage cannot be arbitrarily cancelled if you become sick
Up until now, insurance companies had been able to retroactively cancel your policy when you became sick, or if you or your employer had made an unintentional mistake on your paperwork. Under the new law, health plans are prohibited from rescinding coverage except in cases involving fraud or an intentional misrepresentation of facts.

2. Your child cannot be denied coverage due to a so-called pre-existing condition
Each year, thousands of children who were either born with or develop a costly medical condition are denied coverage by insurers. Research has shown that, compared to those with insurance, children who are uninsured are less likely to get critical preventive care, including immunizations and well-baby checkups. That leaves them twice as likely to miss school and at much greater risk of hospitalization for avoidable conditions.

The new law prohibits insurance plans both from denying coverage and limiting benefits for children based on a pre-existing condition. This protection applies to all health plans, except “grandfathered” plans in the individual market. These protections will be extended to Americans of all ages starting in 2014.

3. Your child up to age 26 can stay on your health plan
Young people are the most likely to be uninsured – with currently one in three young people having no health coverage. One reason is that young people are less likely to be offered coverage through their jobs. Under the new law, insurance companies are required to allow young people up to their 26th birthday to remain on their parents’ insurance plan, at the parent’s choice. This provision applies to all health plans. (For employer plans, only those young people not eligible for their own employer coverage receive the benefit, until 2014, at which time all young people up to age 26 are eligible.)

4. Your health plan cannot put a lifetime limit on your health coverage
Millions of Americans who suffer from costly medical conditions are in danger of having their health insurance coverage vanish when the costs of their treatment hit lifetime limits. These limits can cause the loss of coverage at the very moment when patients need it most. Over 100 million Americans have coverage that imposes such lifetime limits. The new law prohibits the use of lifetime limits in all health plans.

5. Your health plan’s annual limits are phased out over three years
Even more aggressive than lifetime limits are annual dollar limits on what an insurance company will pay for health care. Annual limits are less common than lifetime limits – but 19% of individual market plans and 14% of small employer plans currently use them. The new law phases out the use of annual limits over the next three years. For plan years beginning on September 23, 2010, the minimum level for the annual limit will be set at $750,000. This minimum is raised to $1.25 million in a year and $2 million in two years. In 2014, all annual limits are prohibited. The protection applies to all plans, except “grandfathered” plans in the individual market.


Beginning September 23, 2010, Consumers Purchasing NEW Plans Will Have The Following Additional Protections:

6. You have the right to key preventive services without deductible or co-payments
Today, too many Americans do not get the high-quality preventive care they need to stay healthy, avoid or delay the onset of disease, and lead productive lives. Nationally, Americans use preventive services at about half the recommended rate.
Under the new law, insurance companies must cover recommended preventive services, including mammograms, colonoscopies, immunizations, and pre-natal and new baby care, without charging deductibles, co-payments or co-insurance.

7. You have the right to both an internal and external appeal
Today, if your health plan tells you it won’t cover a treatment your doctor recommends, or it refuses to pay the bill for your child’s last trip to the emergency room, you may not know where to turn. Most plans have a process that lets you appeal the decision within the plan through an “internal appeal” – but there’s no guarantee that the process will be swift and objective. Moreover, if you lose your internal appeal, you may not be able to ask for an “external appeal” to an independent reviewer. The new law guarantees the right to an “internal appeal.” Also, insurance companies will be prohibited from denying coverage for needed care without a chance to appeal to an independent third party.

8. You have the right to choose your own doctor
Being able to choose and keep your doctor is highly valued by Americans. Yet, insurance companies don’t always make it easy to see the provider you choose. One survey found that three-fourths of the OB-GYNs reported that patients needed to return to their primary care physicians for permission to get follow-up care. The new law: 1) guarantees you get to choose your primary care doctor; 2) allows you to choose a pediatrician as your child’s primary care doctor; and 3) gives women the right to see an OB-GYN without having to obtain a referral first.

9. You have the right to access out-of-network emergency room care at in-network cost-sharing rates
Many insurers charge unreasonably high cost-sharing for emergency care by an out-of-network provider. This can mean financial hardship if you get sick or injured when you are away from home. The new law makes emergency services more accessible to consumers. Health plans will not be able to charge higher cost-sharing for emergency services that are obtained out of a plan’s network.

Wednesday, September 22, 2010

Kaizen Report-Outs are Friday September 24th at at 10 AM in the CCRMC Lobby


Behavioral Health and Safety System Kaizen teams will report back to the organization this Friday at 10 AM in the CCRMC Lobby.

At the report-outs, teams made up of staff and community members will share with you the progress they continue to make to streamline operations and improve the patient experience at Contra Costa Regional Medical Center. I believe that the effects of these improvement efforts will have a lasting impact on the health of our community.

Please support the work of your colleagues and our patient and family partners as they draw on science and the energy and creativity of each other to continuously improve our health system.

Anna

Tuesday, September 21, 2010

Consumer Protections take effect Thursday, September 23- United States Representatives Miller and Giramendi at CCRMC


U.S. Representative George Miller (D-Martinez) and John Garamendi (D-Walnut Creek) joined Bay Area residents today at Contra Costa Regional Medical Center to announce major new health care consumer protections that take effect this week under the historic health care law enacted this spring.

For example, no longer will insurance companies be able to cut off your insurance just because you are sick, or set annual or lifetime caps on your coverage, or deny coverage to children with so-called pre-existing conditions.

The nine new protections in a Patient’s Bill of Rights were designed to put patients and their doctors in charge of medical decisions – not insurance companies. They will take effect for plan years that start on or after this Thursday, Sept 23rd.

This means that these consumer benefits will be in effect during the next insurance ‘open season’ for consumers who receive coverage through an employer or the next time a consumer re-enrolls in or purchases a policy from an insurer.

“These are real protections against insurance company abuses,” said Miller, who co-wrote the Affordable Health Care Act. “Just six months after our historic health insurance reforms were signed into law, important consumer protections are going into effect. These protections mean that never again will your insurance run out or be taken away from you when you need it the most. And never again will a sick child be denied insurance because of a so-called pre-existing condition.

“Not only do consumers need to be aware that these new protections will take effect starting later this week – they need to know that these new protections and all the other provisions of our new law are at risk being taken away. Republican leaders in Congress and the Tea Party movement have made it clear that repeal of the health insurance law is one of their top priorities. They would put insurance companies back in charge of health care decisions for average Americans. They are once again standing on the side of the special interests, not on the side of consumers and patients.”

Rep. John Garamendi, who voted in favor for the health care and served as California Insurance Commissioner, said the new provisions taking effect later this week are critical for patients and their families.

For Plan Years Beginning On Or After September 23, 2010, Privately-Insured Consumers Will Have The Following New Protections:

1. Your health coverage cannot be arbitrarily cancelled if you become sick
Up until now, insurance companies had been able to retroactively cancel your policy when you became sick, or if you or your employer had made an unintentional mistake on your paperwork. Under the new law, health plans are prohibited from rescinding coverage except in cases involving fraud or an intentional misrepresentation of facts.


2. Your child cannot be denied coverage due to a so-called pre-existing condition
Each year, thousands of children who were either born with or develop a costly medical condition are denied coverage by insurers. Research has shown that, compared to those with insurance, children who are uninsured are less likely to get critical preventive care, including immunizations and well-baby checkups. That leaves them twice as likely to miss school and at much greater risk of hospitalization for avoidable conditions.

The new law prohibits insurance plans both from denying coverage and limiting benefits for children based on a pre-existing condition. This protection applies to all health plans, except “grandfathered” plans in the individual market. These protections will be extended to Americans of all ages starting in 2014.

3. Your child up to age 26 can stay on your health plan
Young people are the most likely to be uninsured – with currently one in three young people having no health coverage. One reason is that young people are less likely to be offered coverage through their jobs. Under the new law, insurance companies are required to allow young people up to their 26th birthday to remain on their parents’ insurance plan, at the parent’s choice. This provision applies to all health plans. (For employer plans, only those young people not eligible for their own employer coverage receive the benefit, until 2014, at which time all young people up to age 26 are eligible.)

4. Your health plan cannot put a lifetime limit on your health coverage
Millions of Americans who suffer from costly medical conditions are in danger of having their health insurance coverage vanish when the costs of their treatment hit lifetime limits. These limits can cause the loss of coverage at the very moment when patients need it most. Over 100 million Americans have coverage that imposes such lifetime limits. The new law prohibits the use of lifetime limits in all health plans.

5. Your health plan’s annual limits are phased out over three years
Even more aggressive than lifetime limits are annual dollar limits on what an insurance company will pay for health care. Annual limits are less common than lifetime limits – but 19% of individual market plans and 14% of small employer plans currently use them. The new law phases out the use of annual limits over the next three years. For plan years beginning on September 23, 2010, the minimum level for the annual limit will be set at $750,000. This minimum is raised to $1.25 million in a year and $2 million in two years. In 2014, all annual limits are prohibited. The protection applies to all plans, except “grandfathered” plans in the individual market.

Beginning September 23, 2010, Consumers Purchasing NEW Plans Will Have The Following Additional Protections:

6. You have the right to key preventive services without deductible or co-payments
Today, too many Americans do not get the high-quality preventive care they need to stay healthy, avoid or delay the onset of disease, and lead productive lives. Nationally, Americans use preventive services at about half the recommended rate.
Under the new law, insurance companies must cover recommended preventive services, including mammograms, colonoscopies, immunizations, and pre-natal and new baby care, without charging deductibles, co-payments or co-insurance.

7. You have the right to both an internal and external appeal
Today, if your health plan tells you it won’t cover a treatment your doctor recommends, or it refuses to pay the bill for your child’s last trip to the emergency room, you may not know where to turn. Most plans have a process that lets you appeal the decision within the plan through an “internal appeal” – but there’s no guarantee that the process will be swift and objective. Moreover, if you lose your internal appeal, you may not be able to ask for an “external appeal” to an independent reviewer. The new law guarantees the right to an “internal appeal.” Also, insurance companies will be prohibited from denying coverage for needed care without a chance to appeal to an independent third party.

8. You have the right to choose your own doctor
Being able to choose and keep your doctor is highly valued by Americans. Yet, insurance companies don’t always make it easy to see the provider you choose. One survey found that three-fourths of the OB-GYNs reported that patients needed to return to their primary care physicians for permission to get follow-up care. The new law: 1) guarantees you get to choose your primary care doctor; 2) allows you to choose a pediatrician as your child’s primary care doctor; and 3) gives women the right to see an OB-GYN without having to obtain a referral first.

9. You have the right to access out-of-network emergency room care at in-network cost-sharing rates
Many insurers charge unreasonably high cost-sharing for emergency care by an out-of-network provider. This can mean financial hardship if you get sick or injured when you are away from home. The new law makes emergency services more accessible to consumers. Health plans will not be able to charge higher cost-sharing for emergency services that are obtained out of a plan’s network.

For more details, consumers are urged to contact their individual provider or human resources department. Consumers can also visit www.healthcare.gov

Tuesday, September 14, 2010

Contra Costa Regional Medical Center and Health Centers Chief Operations Officer Appointment

Greetings,

On September 1, 2010, I assumed the role as Chief Executive Officer of Contra Costa Regional Medical Center and Health Centers. This integration of the medical center and ambulatory care system provides the opportunity for improved integration and redesign across the continuum of care and service in our delivery system.

To further our ability to improve operations across our system, I have been engaged in a search for a Chief Operations Officer of Contra Costa Regional Medical Center and Health Centers and am pleased to announce the appointment of Michael Anaya as the Chief Operations Officer of Contra Costa Regional Medical Center and Health Centers.

A 30-year veteran of health care management, Mr. Anaya has directed healthcare operations worldwide and held senior leadership roles in for-profit and not-for-profit hospitals where he has improved quality and safety, operating performance, as well as patient, physician, and employee satisfaction. Most recently, Michael served as the Chief Operating Officer/Vice President, Healthcare Operations for Mystikal Solutions, an information technology services company based in San Antonio, Texas. Previously, he served as Chief Executive Officer of Colorado Plains Medical Center, a diversified rural health system; CEO of the 297-bed dual campus Doctors Hospital of Laredo; and COO of 203-bed SouthPointe Hospital, a St. Louis specialty hospital. A 22 year military veteran serving in the Medical Service Corps, Mr. Anaya held management positions at Naval Hospitals in the U.S., Japan, Italy, and Middle East as well as U.S. Naval Ship Mercy, Bureau of Naval Personnel, and TRICARE Management Activity.

Active on national, state, and community levels, Mr. Anaya served as President & Chairman of the National Forum for Latino Healthcare Executives, Commissioner on Colorado’s Minority Health Advisory Commission, and Trustee of the Colorado Hospital Association. He has been a Fellow of the American College of Healthcare Executives since 1989.

I’m excited to bring someone with Michael’s tremendous experience to our health system. Most important, he is committed to our mission and will provide leadership to continue our path toward a model for the new American system of health care.

As Michael transitions to his new role this coming week, please join me in welcoming him to our health system.

Sincerely,
Anna


Anna M. Roth RN, MS, MPH
Chief Executive Officer
Contra Costa Regional Medical Center
and Health Centers

Wednesday, September 8, 2010

Pround Knowledge: Appreciation for a System


“A [man-made] system is a network of interdependent components that work together to try to accomplish the aim of the system. A system must have an aim. Without an aim, there is no system. The aim of the system must be clear to everyone in the system. The aim must include plans for the future. The aim is a value judgment.”
-- W. Edwards Deming, New Economics for
Industry, Government, and Education

Please join us tomorrow, on Thursday September 9 at the CCRMC Improvement Academy in Building One, Conference Room One at 9:00 AM for our next session of Deming's System of Profound Knowledge:

Session II: Appreciation for a System

Presented by Marc Miyashiro, Information Architect / Documentation Manager Health Services - Information Technology

I'm excited to see what the teams begins this series. Thanks to all of the teams who have stepped forward to teach us. All teach, all learn (IHI.org)...

Hope to see you there.

Tuesday, September 7, 2010

Exploring Ethics at "Food For Thought"

I'm really looking forward to the upcoming "Food For Thought," a monthly ethics discussion facilitated by Dr Jon Stanger. This is a thought provoking evening and provides a wonderful environment to begin to think through many ethical dilemmas we face daily in our work and in our lives.

Here is the detail:
Food For Thought
Wednesday, September 15
5:30 - 7:30 PM
CCRMC, Building 1 Conference Room (i.e. the "noon conference room")

For this session, our topic will be "WORK". What do we want from our work? What is the meaning of work in the lives of individuals? Rewards? Disappointments? What, if anything, is special - or should be - about work in the field of health care? How does our work experience affect the care we provide? .....

We will review selections from Studs Terkel's classic book, Working: People Talk about What They Do All Day and How They Feel about What They Do. Terkel interviewed >100 people, asking about their work lives, and transcribed their stories. I think you'll find that they make fascinating reading. As always, no pressure – particularly this time, since all told it's fairly long. Read whatever parts you have time and inclination for. If you can't get to the reading - come to our session anyway. We all have our own work stories. You can find NPR's revisit of Terkel's 'Working' here.

As decided by the group, someone kindly volunteers to bring the food for this gathering (this rotates and is not required and by attending you will not be expected to do this). Please send Jon Stanger or Peter Delfiorentino an RSVP if you haven't already, so that we have a rough idea of how much food will be needed. Please try and remember to bring $5-10 to the session to cover the food costs as decided by the group. There is no charge for residents, students, and anyone with student loans.

So, mark your calendar, send in your RSVP, and enjoy as much of the reading as feasible.
Hope to see you there.

Friday, September 3, 2010

Remembering Sergeant Paul Starzyk

Remembrance Event for Sergeant Paul A. Starzyk on Monday, September 6, 2010

Martinez Police Department will host a public remembrance to honor Sgt. Paul A. Starzyk, who was killed in the line of duty, September 6, 2008

Tentative Schedule for September 6, 2010
7:00 AM- Uniformed personnel form up in front of the fountain near the flag pole.

7:10 AM - Honor Guard to present flag and memorial flag at half staff in front of City Hall

8:00-11:00 AM - Council Chambers open to public for public memorial; small guided tours of the memorial wall inside the police department

11:35 AM - Police Chief's comments

1139:17 AM - Moment of silence
"The wicked flee when no man pursueth: but the righteous are as bold as a lion."- Proverbs 28:1

Thursday, September 2, 2010

"You are not alone"

The dream team from the Behavioral Health Kaizen is checking back in at today's CCRMC Improvement Academy. They've formed a rapid response (for lack of a better term) called the "You Are Not Alone" (YANA)Team. The team's aim is to ease the collateral suffering experienced by those close to major medical and psychological crisis. Team members are be trained in peer to peer crisis management, community resources, and organizational fluency to allow facilitation of visiting and to offer immediate support to the family and friends of our patients. Codes are predicted to last approximately 15 - 20 minutes for the purpose of assisting families in activating their own support systems for longer term support, orient them to the medical center and/or unit, and the provision of resources (local food, hotels, and support groups/crisis lines). The YANA design team plans to also work w/ medical center volunteers to create "comfort packs" for both children and adults (consisting off nonperishable food & water, and entertainment such as newspapers and activities for children).

Please join your colleagues and hear of the work they've been doing to ensure that when facing a crisis "you are not alone' at CCRMC.


Additionally: Jon Stanger continues his noon conference ethics discussions. Today Jon will present "Taking Suffering Seriously."

I hope you're seeing a theme here. and I hope you join today's discussions.

My best,
Anna