The BMC Brief
July 1, 2013 Volume 2, Issue 12
In 2011 BMC rolled out its Be Exceptional strategic plan, a roadmap to guide the work of the hospital throughout the course of the next decade. Two years into the plan, BMC is on track to meet many of its goals, and at town hall meetings held June 26 BMC President and CEO Kate Walsh reviewed recent plan accomplishments.
Walsh opened by reviewing the financial progress BMC has made in the past few years. In 2010, a dramatic decrease in Medicaid and supplemental funding revenue took BMC to the brink of defaulting on its debt. After a series of significant cost-cutting measures, BMC stabilized its finances and closed 2012 with a small surplus. The hospital is positioned to achieve similar financial results in 2013.
“I’m pleased to report that we have seen an increase in revenue every month of this year,” said Walsh. “This puts us on track to again achieve a small surplus at the end of the year.”
Looking forward to 2014, Walsh said that BMC will continue to face significant financial challenges.
“We are looking at $40 million in potential funding cuts, so we need to keep working to control our costs,” she said
Walsh then reviewed the five themes of work under the Be Exceptional strategic plan.
Under the theme “Provide the Right Care to Every Patient,” which aims to ensure that BMC provides the highest quality care to all patients, BMC has made outstanding progress on its mortality scores, moving from a rank of 91 out of 119 comparison academic medical centers in 2010 to 28 out of 119 today.
“There is nothing we do that is more important than taking the best possible care of our patients,” said Walsh. “The progress we have made, against 119 of the best academic medical centers in the nation, is nothing short of exceptional. Thank you for your hard work.”
Under the theme “Be the Lowest Cost, Highest Performance Health Care Provider,” which aims to make administrative functions highly efficient and effective, BMC has made substantial improvements to its revenue cycle capability and opened a state-of-the-art retail pharmacy in Shapiro.
One proposal under this theme is a campus redesign that would add additional space to the Menino and Moakley Buildings, allowing for the move of clinical services from the Newton Pavilion and Doctors Office Building (DOB), and the closure and sale of the two buildings. The proposal, explained Walsh, is one that would consolidate clinical operations on one side of the campus, increasing efficiency and improving the patient experience.
“We believe consolidating services is important both for financial reasons – for example, we spend $2 million dollars a year transporting patients by ambulance from one side of the campus to the other – but equally for clinical reasons, as we believe operating on one campus will provide a better care experience for our patients and a better work experience for our providers.”
Walsh acknowledged that the proposal could invoke anxiety among staff working on the Newton campus, but emphasized that patient care service levels would not be cut under the current plan. She also noted that BMC is in the early stages of the proposal and that a consolidation would not occur until 2017.
“This plan is still a proposal that needs to be approved by our Board of Trustees and the city before we could move forward,” she said.
“We do not have the details of this worked out yet,” she continued, “but as the plan evolves, we will continue to communicate what we know to the BMC community.”
Under the themes of “Mission and Performance Based Funding” and “Preferred Provider in Target Commercial Markets,” BMC continues to meet its metric targets on the $103 million supplemental funding it receives from the state and federal government. Walsh noted that the waiver funding expires in a year and that BMC is hard at work determining what the next round of waiver funding will look like.
Walsh then focused on BMC’s volume, noting that after recent declines, an upward surge is encouraging for BMC’s future.
“The great news is we’ve reversed the trend,” she said. “The number of inpatients choosing to get their care at BMC has increased by six percent, and the rate of decline of people coming to us through our emergency room has slowed.”
Under the theme of “Lead in Integrated Care,” BMC has revamped its board structure to manage a health system across the hospital and BMC’s health plan.
“This revised governance structure will allow us to better respond to what health care reform requires of us,” said Walsh.
In closing, Walsh said work on the key areas of the strategic plan will continue in 2014, with an ongoing emphasis on the patient experience and employee engagement, as well as on continuing to position the organization for future health care delivery models.
Thousands of Bostonians chose to beat the heat on the weekend of June 22-23 by flocking to the Hynes Convention Center for the Health & Fitness Expo, a free community event co-hosted by BMC, NBC affiliate WHDH Ch. 7 and CW56.
BMC health services and providers were featured prominently at the event that attracted approximately 60,000 people from the Greater Boston area. More than 500 BMC staff were there to answer health questions, provide health screenings and assessments, and exhibit clinical services, such as primary care, pediatrics and women’s health. More than 100 volunteers greeted attendees with BMC bags and helped people navigate their way around the busy convention center. Over the course of the two-day event, BMC performed more than 5,000 health screenings and assessments, which included blood pressure, pulmonary function, skin, thyroid, hearing and glaucoma. Many visitors booked follow-up appointments right on the spot.
“This event was a tremendous success, with thousands of people getting health screenings, booking appointments and learning more about the great services BMC has to offer,” said BMC President and CEO Kate Walsh.
Walsh, Boston Mayor Thomas M. Menino and 7 News anchors Kim Khazei and Adam Williams kicked off the event Saturday with a ceremonial ribbon cutting. Visitors then poured into the Hynes, trying out the texting and driving simulator, talking with doctors and clinical staff and learning more about health and fitness.
Children enjoyed running, balancing and hopping through the obstacle course set up in the pediatrics section. Some tried their hand at surgery in a life-sized Operation game. Thanks to the Department of Neurosurgery, visitors could try their hand at being a brain surgeon as they carefully worked to extract specific items from a dollhouse using only an endoscope and video feed.
Other highlights included the Strollin’ Colon, an inflatable intestine visitors could walk through to learn more about digestive health. BMC Demonstration Kitchen Chef Tracey Burg revealed just how much sugar is in those daily sodas when she took to the stage to demonstrate healthy eating habits.
Special guests offered tips on staying fit and eating healthy throughout the weekend. On Saturday, Patriots Defensive Lineman Vince Wilfork signed autographs and spoke about his family’s personal struggle with diabetes, championing the importance of research and care. The following day, Patriots Linebacker Jerod Mayo, quizzed attendees about health while tossing footballs out to the audience. Mario Lopez, the charismatic host of Extra!, even made an appearance to discuss his fitness routine, telling the audience his goal was to “break a sweat each and every day.”
Though a thick shroud of mist obstructed the view of the city from high atop the State Room in downtown Boston, the gloomy weather didn’t stop fashion models from strutting their stuff on June 27 to benefit BMC Cancer Care.
In partnership with Open HeARTS Inc., a nonprofit event planning and arts organization, the event attracted 300 guests and featured six designers and one stylist who created unique looks for the models, who included modeling professionals, local celebrities and BMC staff and patient cancer survivors.
“As a cancer survivor myself, I know that celebration of life and strength is a very important part of healing,” BMC President and CEO Kate Walsh said in her opening remarks. “Delivery of exceptional cancer care to the residents of Boston who are most at-risk and require extra support is possible thanks to donors like you.”
“BMC’s cancer services are a testament to our hospital’s motto, ‘exceptional care without exception,’” echoed Chris Andry, Executive Director, Cancer Care Services, as he addressed the crowd. “By providing outstanding clinical expertise, state-of-the-art facilities and a dedicated support staff, we can ensure that we provide the best cancer care for all of our patients.”
Before the show began guests mingled, enjoyed hors d’oeuvres and bid on silent auction items ranging from clothing to restaurant and beauty treatment gift certificates.
Emceed by WHDH Ch. 7 morning news anchor Adam Williams, the models took to the catwalk to model their custom-made fashions. Marching to the beat of catchy pop songs that got the crowd cheering, fashions ranged from pastel summer dresses to shimmery evening couture. The crowd jumped to their feet, cheering as survivors and staff models walked by.
Models included Mix 104.1’s Kennedy Elsey, WHDH Ch.7's Janet Wu and Miss Massachusetts 2013 Taylor Kinzler. Twelve cancer survivors walked in the show, including three who are BMC staff members.
“BMC has been an anchor in my life. I am a two time cancer survivor and BMC has been a rock for me,” said Gloria Johnson, one of the models. “The moment you walk into the hospital you can feel the special care here. I am happy to be here, and I tell you, I rocked it tonight!”
In March, BMC kicked off its transition to eMERGE, the hospital’s new electronic health record system. eMERGE stands for Electronic Medical Records Generating Excellence. The system will replace existing systems in ambulatory, inpatient, emergency, pharmacy, perioperative and labor and delivery, providing a single, up-to-date medical record for every BMC patient. eMERGE is expected to go live for inpatient services in May 2014 and for ambulatory services in February 2015.
Since the March kickoff, groups across BMC have been busy working with Information Technology Services (ITS) and the Epic team to design a system that will work for the hospital. Based on workflows and feedback from units and clinics, the team has begun an eMERGE design and held validation sessions with physicians, nurses, ancillary representatives, and other employees to ensure eMERGE functionality is on track.
The transition to eMERGE has generated a lot of enthusiasm around campus as users look forward to how the system will impact their patients.
“eMERGE is a system that will truly benefit our patients,” says Mary Jo Pedulla, RNC, BSN, MS, Director, Nursing, Maternal Child Health. “In Labor and Delivery, our patients are fully integrated – meaning mother and baby are one in the same -- and having a complete electronic health record in front of us will determine the best plan of care for both patients.”
“Having one chart with complete patient information at our fingertips will enhance our ability to provide high-quality care,” says Ron Iverson, MD, Director, Obstetrics and Labor and Delivery. “eMERGE also brings many other benefits, including a more streamlined process for note writing and medication reconciliation, making it much easier to provide care that’s safe and integrated – leading to better outcomes for our patients.”
eMERGE also will provide a complete medication administration record and support the use of bar-coding for medication administration to ensure that each patient receives the correct medication and dosage at the right time.
“We’re excited to be on a unified platform,” says David Twitchell, PharmD, Director, Pharmacy Services. “There often are many phases of care for one patient, and having all departments on the same system with a central and complete medication record enhances the level of transparency and improves patient safety. This is the one source of truth for what happened to the patient.”
eMERGE also enables clinical staff to view the status of a patient’s prescription in real-time, including when the pharmacist has opened the order, current status and the reason for any delay.
This mechanism will enhance communication between clinicians and lead to greater efficiency.
Showing off the system
In July, ITS and Epic staff will host a live demonstration of eMERGE from noon-1 p.m. on Tuesday, July 16, in Keefer Auditorium.
Epic representatives will present a variety of clinical scenarios to demonstrate the features and capabilities of eMERGE, including one fictitious patient’s journey thought an inpatient setting with a diagnosis of acute appendicitis. The patient’s complete medical record will electronically transfer with the patient as they travel from the emergency department to surgery and then to post-op recovery on a medical/surgical floor. All staff are invited to attend.
For more information about eMERGE, visit the eMERGE section of the intranet.
Recently members of the Boston Combined Residency Program at BMC and Children’s Hospital Boston took part in a poverty simulation designed to shed light on the struggles for survival patients, sometimes living just a few streets away, face when they live below the poverty line.
According to the U.S. Census Bureau, 43.6 million people were living in poverty in 2009. One in eight Americans has income below the poverty level and one in five American children lives in poverty. Children living in Mattapan, Dorchester and Roxbury, three communities in the closest proximity to BMC, have a combined poverty rate of 42 percent, a sobering fact for the Pediatric residents.
“The simulation places our residents in the real-life living conditions of many of our families and gives them the insight to understand the challenges our families face,” says Robert Vinci, MD, Chief of Pediatrics, who took part in the simulation as the owner of a pawn shop where someone could trade belongings for cash. “This experience is designed to sensitize our residents to the complex burdens our families face on a day-to-day basis and to give them some insight into the tough choices they make that impact their health.”
Sponsored by the Community Action Poverty Simulation (CAPS), the poverty simulation is an interactive activity where participants feel the effects of having little to no money to pay bills and other expenses, and the stress of trying to stay above water.
“The simulation shows that zip code matters as much as genetic code when treating patients,” says Megan Sandel, MD, Pediatrics, as she addressed the group of participants before the start of the activity. “People have described poverty as choosing the lesser of two evils. You’re faced with having bad choices and really bad choices, such as choosing to spend your money either on a prescription medication or food.”
The group of 35 residents played the roles of father, mother, grandparent or child and all faced challenges typical of those living below the poverty line. Strapped for time and money, participants were immediately forced to make tough decisions. Do I leave this long employment line I've been waiting in to collect my paycheck and abandon my child at daycare or do I rush to pick up my child before it closes and forgo money for food? Or, with this small paycheck, do I pay for rent, utilities or groceries? While resources were available such as welfare and other community benefits, waiting in the lines for public assistance to register for welfare meant wasting precious time filling out forms.
As the simulation progressed, the scene became chaotic. Adults had to juggle dropping their children off at daycare, working a full-time job or collecting unemployment, haggling with the pawn broker, utilities collector and mortgage and bank lenders while fending off the temptation of get-rich-quick schemes. As participants rushed from resource to resource, often getting caught up waiting for inadequately staffed services, chairs were overturned symbolizing foreclosure, court summons were handed out and utilities were turned off. Families pleaded with the police to release their impounded children forgotten at daycare. As solutions to one problem gave rise to a new slew of issues, the point of the exercise was made clear: No matter how hard you tried, there was not enough time to stay afloat. Between time, money and bureaucracy, the limitations were endless.
At the end of the program , the residents gathered, flushed with effort from the stress of survival, to reflect on their experiences.
“You learned quickly that you couldn’t outsmart your way out of a problem; you just didn’t have enough resources,” said one participant.
“I quickly came to the realization that staying afloat wasn’t even possible and that I had to focus on minimizing losses as opposed to even attempting to stay above water,,” summed up another participant.
Summer is officially here, and the Fourth of July is just around the corner! Check out this this delicious recipe from BMC Demonstration Kitchen Chef Tracey Burg and then fire up the grill!
With the zesty zing of lime combined with the refreshing taste of ginger, this marinade will transport you to the tropics at your next barbeque. Serve it up on chicken breast, kebabs with grilled veggies or over a bed of rice.
Grilled Chicken Thighs with Ginger-Lime Marinade
Note: To bake instead of grilling chicken, place in a 8x8 inch baking pan and bake, uncovered, at 400° for 20-25 minutes.
Nutritional Information (per serving):
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BMC Receives Award for Creating Culture of Vigilance
BMC was one of five hospitals in the U.S. selected to receive an award from IntelliCentrics Inc., a leader in operational security and compliance management services. BMC received the $5,000 award as part of the company’s inaugural 5 Rings Award Program. The hospitals selected for the award were chosen from the more than 4,500 hospitals that use IntelliCentrics’ Reptrax™ vendor credentialing service as part of their ongoing security and compliance efforts. Hospitals were ranked based on: volume of visitors, percentage of visitors who complied with hospital credentialing requirements; ongoing improvement to compliance scores; steps taken to educate staff about policy enforcement; and regular communications with vendors about expectations. In addition to BMC, the other hospital recipients were: