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Currents To Medical Center employees: At the Nov. 6 communications meeting Sue Pletcher, director, Patient Access Services and Health Information Services, gave an interesting presentation concerning the various “patient access” services provided by the managers and employees within her department. The department of Patient Access Services was organized a few years ago to combine important service delivery functions into a department.  A summary of services provided is outlined below. The managers and employees within Patient Access Services and Health Information Services have done a wonderful job with their performance improvement initiatives and in demonstrating a high level of customer service.  The management team and staff are to be applauded for a job well done.  In the months ahead we will ask other Medical Center departments to give presentations on the services they provide. Thank you very much. W. Stuart Smith Vice President for Clinical Operations and Executive Director, MUSC Medical Center   Patient access services show 21 percent increase in registrations During the past three years, the Medical Center has shown a 21 percent increase in patients registered in the Emergency Department as inpatient admissions and in ambulatory surgery and hospital-based clinics, according to Sue Pletcher, director, Patient Access Services and Health Information Services. Currently, 65 percent of admissions to the Medical Center are unscheduled, which means the patients are considered either urgent or emergent admissions. Pletcher presented the information to the management team at the Nov. 6 communications meeting as part of an overall presentation of her department, a division of Financial Services. Cindy Williams is the manager of Admissions for the Medical Center.  Under the direction of Williams and her financial counselors, uninsured or indigents patients admitted to the Medical Center dropped from 13 percent in 1998-99 to 11 percent in 2000-01. This also required the efforts of utilization review, social services and the continuum of care managers. This collaborative team identified other funding sources or had the patients approved for Medicaid. Currently, the Medical Center has a Medicare/Medicaid case mix of 52 percent of all patient admissions. In addition to patient registration and financial counseling, patient access services also handles bed management. Maureen McDaniel, manager, Bed Management, assigns beds for new admissions and also handles in-house transfers and provides triage assistance for inter-facility transfers. During a 12-month period, bed management made 27,980 bed assignments and averaged approximately 12,000 telephone calls per month. Hannah Waites, manager, utilization review, and her staff communicate patient information to insurance carriers, review medical records for continued hospital care and troubleshoot insurance denials. This area of the department reviews 28,843 clinical charts annually and makes an average of 111 calls or faxes daily to insurance companies, and reviews some 161 insurance denials annually. Christine Lewis, manager, coding and record processing, and Kelly Shaw, manager, patient registration and health information services for CMH and McClennan Banks were complimented by Pletcher.  Lewis, Shaw and their staffs contributed to the “perfect review” rating received from OIG auditors on record coding. Some 321,102 inpatient, ambulatory care, observation ED and clinic records are coded per year. More than 4,000,000 lines of transcription are also integrated into the medical record. The Health Information Services management staff also mails an average of 400 letters and discharge summaries monthly to referring physicians on their patients. Record maintenance, managed by Brenda Bailey, handles all patient records, including responses to court subpoenas, court appearances, file maintenance, maintenance of the master patient index and release of information. This department currently has jurisdiction over more than 1,338,531 medical records. The recently established Health Information Security Program is responsible for ensuring compliance with the new Health Insurance Portability and Accountability Act.  This area investigates breeches of privacy of personal health information and is responsible for establishing policies to ensure compliance with regulations. Quality improvement and education, managed by Allen Coulter, shows an accuracy rate of 96 percent in the registrations completed by staff on a monthly basis. There are 196 fields of information required for each inpatient admission. This area maintains a database on employees to assure completion of required training and testing information, technical support for staff presentations, and in-service assessments on matters such as customer service, compliance and leadership skills.  Antibiotic resistant organism intervention effort under way In an effort to lower the rate of patients transmitting or acquiring antibiotic resistant organisms, an inter-ventional epidemiology project has been mounted that has significant cost-savings potential, according to Jodell Johnson, R.N.  The estimated cost of methacillin resistant Staphylococcus aureus (MRSA) to the hospital in 2000 was $1.5 million. The estimated cost of Vancomycin Resistant Enterococcus (VRE) to the hospital for the same period was $58,000. Members of the taskforce are Robert Cantey, M.D., epidemiologist; Betty Harley, R.N.; Pamela Fogle, R.N.; Beth Rhoton, R.N., and Johnson. The following measures are being taken to reduce the transmission rates: alcohol hand antiseptic availability; hand washing campaign; surveillance cultures; adequate isolation supplies; communication; identification; education; prohibition of artificial fingernails; and community involvement. Johnson said that during the next few weeks of the campaign, signs would be installed in patient rooms regarding hand washing. Information regarding the campaign will be posted throughout the medical center. Measures will include: Rectal swab for VRE on every admission to the teaching hospital and every seven days (excluding women’s and infants service) Nasal swab for MRSA on admission as above and every seven days on adult intensive care unit and dialysis patients  Known carriers will be excluded In addition, infection control alert warnings will be placed on the front of charts to identify patients with an antibiotic resistant organism. Identification will also occur through the electronic medical record (OACIS) and on all rosters on which the patient appears. Such identification may only be added or deleted by an infection control professional. Currently, surveillance cultures are being done on MICU, 6E, 4STN, and 8W.  The plan will expand the surveillance to 6W and 10W soon.  Other areas might be included as well, Johnson said.  Third quarter results (Aug. 20 - Sept. 30) indicate that of the 306 MRSA cultures, 33 (10.8 percent) were positive. Results for 306 VRE cultures show eight (2.6 percent) positive. MUSC is networking with local infection control practitioners and hospital epidemiologists in the tri-county in order to work toward a community approach. For example, MUSC, Roper and St. Francis have begun screening cultures. Pay increase reminders issued Susan Carullo, manager, employment, compensation and employee relations for medical center human resources reminded the management team of the upcoming performance pay increase for Medical Center employees.  Performance pay increases based on the most recent performance evaluation will be implemented on Dec. 30, for nonexempt hourly employees and Jan. 1, 2002, for salaried employees. Eligible employees are to be given performance pay increases based on their performance evaluation ratings as follows: “Meets expectations” will result in a 2.5 percent base salary increase “Exceeds expectations” will result in a 3.5 percent base salary increase “Substantially exceeds” will result in a 4.5 percent base salary increase Performance evaluations must be completed prior to the implementation of these increases. Additional details regarding the 2001-02 performance pay plan can be found with the human resources compensation policy #15 on the Intranet. December PTO cash-in or PTO conversion  The second PTO cash-in and PTO conversion will occur Dec. 17. An employee may only participate in one cash-in or conversion during fiscal year 2001-2002. The PTO cash-in incentive is subject to appropriate taxes and deductions for lump-sum payments. Employees who wish to cash-in up to 40 hours of PTO or convert up to 40 hours of PTO to ESL should complete the PTO cash-in and conversion form and return it to the Payroll Office, room 108 Clinical Science Building, no later than Monday, Dec. 3. The Payroll Department has also distributed information regarding the cash-in/conversion. The form can be found in the forms toolbox on the Intranet. For information regarding the PTO cash-in, contact Patty Burn at 792-7544.  The PTO cash-in may also be rolled into an active 401K account. For more information, contact Janet Browning at 792-1208. Calendar year paid time off cutback In accordance with PTO policy #18, the PTO balance will be automatically reduced to the maximum allowable carryover amount of 45 days or 360 hours effective Jan. 1, 2002.  Carullo encouraged managers to share the information with employees who might be affected by the loss of excess paid time off. For more information regarding PTO or ESL balances, contact the Human Resources office.